Renee Friedman attended the 2003 NACAC workshop presented by Ronald Frederici and Lisa Locke on “The Neuro-developmental and Attachment Related Disorders.” Here’s what she learned.
Despite its lofty title this workshop proved informative. Dr Frederici, an adoptive parent and ex-worker at an international orphanage, made the assertion that if a child has been institutionalized for two years or more, it is probable that he or she will display neuro-cognitive deficits. In other words, the child’s brain will have developed differently than if trauma had not occurred.
Dr Frederici explained that parents who think that their child is merely experiencing a developmental delay, that will be amended over time, with the love of a family, could be witnessing a neurological impairment that might worsen as tasks become more complex and more difficult to master. The impairment occurs as a result of prolonged and elevated stress that triggers hormones like cortisol to be released and maintained, at high levels, during a time when the brain is developing.
Dr Frederici stressed that parents need to be strong advocates for their children and not to take a “wait and see if she or he catches up” approach. Regardless of what professionals recommend, early intervention is the best road map for recovery. It is essential that this process takes a multidisciplinary approach, including the school, family therapy, medical assessments, neurocognitive/psychological assessments and pharmocology, if needed.
Dr Frederici believes that too often parents and professionals treat the symptoms of a diagnosis, rather than the cause. What is crucial is that treatments address the beginning of a trauma, not the outcome. For example, attachment is a biologically-related function. When prolonged separation from a primary caregiver occurs, an infant will become goal-oriented. One of the behaviours that might emerge is a shift from disorganized to controlling behaviour. Relationships are perceived by the child, not as a source of comfort but, as objects needing control. Attempts to curb the controlling behaviour will not alleviate the problem. What are called for are efforts to secure attachment to the primary caregiver.
Symptoms a post-institutionalized child could display
- Disconnection from full awareness of self, time and/or extrernal circumstances
- Verbal, academic, visual and memory deficits
- Desire for control at all costs
- Easily trigged fright, flight, freeze or flail response
- Poor emotional monitoring (i.e., is angry when should be frustrated, or rather than feeling sad goes into a rage).
- Highly developed survival skills that are self-serving
- Cannot calm, self-sooth or manage stress
- Poor attention and information processing
What parents need to do for their child and themselves
- Not to expect the child to return your efforts. It’s not fair to put that expectation onto them.
- Remember that attachment takes time
- Respect the child’s past
- Care for the child’s physical needs
- Acknowledge the child’s level of functioning—not to coerce them into doing better but to encourage
- Provide loving moral values
- Focus on the child’s strengths, not weaknesses
- Provide a regular, consistent environment
- Build trust
- Be a strong wall for the child to lean on
- Don’t take it personally
- Train your child to self-sooth and relax
- Roleplay difficult situations (i.e., when a social situation like a party becomes too noisy, how they can deal with that).
- Don’t let up or give up on structure
- Speak the language of emotion
- Display love, empathy, caring and sensitivity
- Love yourself and take time for yourself
Tapes of this NACAC presentation are available at www.nacac.org or by calling 1-651-644-9848.