Adoption is not easy.

It is painfully difficult some days to parent children who have had traumatic loss and come to you broken. Day after day can be filled with challenges.  Most people have no idea and cannot understand what you are going through.   Your life, as you knew it, is totally gone.  Some days you are held hostage by disruptive behavior that comes from a child, that has experienced a horrific loss.  Who never had a chance to attach and bond with a parent when their little brains desperately needed it....and thus their little brains could not grow and thrive.  

Why do it?  Why give up your life? Why give up your peaceful home?  Why give up me time?  Why give up your freedom?   

Because I refuse to be indifferent to the heartbreak and cry of the orphan.  God loved me enough to rescue me from my hopeless life.  God came for me.   I am suppose to be the hands and feet of God, and I must reach out to love the unloved on behalf of Him.   It is an honor to serve the Lord and be His ambassador.  

I want my life to mean something.   I want my life to a life that is CONSUMED by following Christ and doing His Work.  Adopting orphans and all that comes with that, definitely does consume you.....and thus I am consumed by doing HIS WORK each day.  Loving, forgiving, nurturing HIS CHILDREN.   

Is there anything more important I can do with my life, other than to serve my Lord and work for Him every day?   

There are so many Christian self help books on how to be a better, more godly person.  I have found by just pouring out my life to others, I learn how to be less selfish, how to forgive, how to give unconditional love, how to impact others, how to be content, how to count my blessings, how to experience God in a tangible way.

You can just read.......or you can do.

I choose to be a doer.   Am I going to be perfect t it?   No, but the more difficult the task, the more we need the Lord and His wisdom to get through each day.   And the more He increases in our lives and the more we decrease.  

(By the way, I am not saying don't read books.  We read lots of books, as we try to glean & learn how new ways to care for our children, but it is important to not just read & learn, but to DO, to put it into action.  Otherwise there is no point in reading.)


So  why adopt?  
1.  Because we are commanded in the Bible to care for widows and orphans. (James 1)
2.  Because we love God and want to share His LOVE with others.
3.  Because we want to be molded by Christ into the person He wants us to be.
4.   Because we truly want to be more like Christ and want to die to our sinful natures.

---Corrie

http://www.reactiveattachmentdisordertreatment.com/ssi/article2.html


In this article, I want to give you an understanding of the characteristics of RAD in infants and in children. Parents are in the best position to see the true nature of their child. If they are educated about RAD, they can help detect the condition early. With this information, parents can seek help from a professional who can confirm the diagnosis and provide treatment.

The degree of Reactive Attachment Disorder (RAD) can range from mild to severe and is directly related to the extent and duration of the child’s early trauma. Abandonment is usually part of the history of RAD. If neglect and abuse are added the resulting condition is generally worse. Usually, the earlier the trauma begins and the longer it lasts, the more severe the RAD condition will be. Diagnosis is best made by assessing the current symptoms of the child and is confirmed by the child’s history. Information taken from the parents is usually more valid than a clinician’s perception of the child because the child with RAD has the capacity to manipulate and fake “looking good” especially in a short term relationship.

CHILDREN

When I worked at Evergreen Consultants from 1990-1995, it was standard practice to use information from the parents in making a RAD diagnosis. Click here for the CHILD Checklist.

When more symptoms are present, your child has a greater chance of having RAD. Similarly, when more items are listed as severe versus mild, the condition is more serious. Children with RAD usually display their symptoms more intensely with their mother than their father. Consequently, the parents are asked to describe their child as he relates to them individually and their answers are scored separately. The following are general comments about RAD and its diagnosis and symptoms.

• All RAD children display difficulty in giving and receiving love. Many parents struggle with the question, “Does your child love you?” Even though a child may have lived in a family for several years, parents often are uncertain of their child’s genuine loving feelings for them. Children with milder forms of RAD usually can express genuine love for their parents. Parents of children with severe RAD will often describe their child as lacking genuine loving feelings for them.
• At all levels of severity, RAD children will have difficulty accepting or seeking out physical affection and touch. If you touch a child with RAD, often he will recoil or flinch and say, “Ouch,” even though your touch is gentle and should produce no pain. “What would life be like if all touch either tickled or hurt?” I believe this is how many unattached children experience physical closeness or touch.
  
  
• All children with RAD have control issues. The key question is, “How extreme or intense is their need to be in control?” These control issues are captured in a number of the 28 symptoms listed in the checklist. The child with RAD is oppositional, argumentative, disobedient or often defiant. They are exceedingly strong-willed and will go to great extremes to be in charge. Their need to control comes from their intense fear that further harm will occur if they are once again as helpless as they were as babies.
  
  
• Most children with RAD have problems with anger. Many will express their anger overtly, having frequent temper tantrums and a short frustration tolerance. A smaller percentage of children will be passive-aggressive and engage in annoying, frustrating, and aggravating behavior. Often this is disguised by a facade of innocence or hidden in socially acceptable behavior. For example, a child with RAD can hug a parent so hard it physically hurts. To a casual observer, it would seem the child’s hug was a loving act. In reality, the child inflicted pain, a hurtful act, within a hug, which is a loving act. This is the hallmark of passive-aggressive behavior or indirect anger.
  
  
• Children with RAD have problems developing a conscience. In the most severe children, their conscience is entirely absent. They have no remorse, regret, or guilt when they violate their parents’ or other people’s rights. In the milder condition of RAD, the conscience is underdeveloped. A number of the items on the checklist are related to the child having little or no conscience.
  
  
• All unattached children have trust issues. They do not trust their parents and the parents cannot trust their children. The severity of trust issues is directly related to the severity of the RAD condition. A number of the 28 symptoms assess the child’s desire and willingness to live outside their parent’s circle of control by being deceptive and disobedient. This failure to develop a bond of love, trust, and cooperation must be present in order for a child to be accurately diagnosed with RAD.
  
  
  
  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112822/

By Dora Black

Infants do not come into the world as “empty slates” but bring with them complex behavioural systems. One system that has been well studied protects the child from danger during the long period of extra-uterine immaturity. It involves the development of mutual attachment behaviour (box), which ensures that the child does not stray far from a caretaker. Infants are active partners in the development of this behaviour, using instinctive behaviours to engage caretakers in protecting them. These include smiling, vocalising, crying, and, later, returning frequently to the secure base of the adult after exploratory forays.1 Infant attachment is at its height at about 3 years of age and then becomes increasingly diffused by the development of other relationships, but it remains important throughout life, with later relationships qualitatively echoing the earlier ones. 

For optimal emotional, social, and psychosexual development to occur, children need a warm, secure, affectionate, individualised, and continuous experience of care from a few caretakers who interact with them in a sensitive way and who can live in harmony with each other. 

Summary points 

• The pattern of attachment between infant and parent is rooted in instinct but modified by experience. It is an important source of security throughout life 
• Separation from a parent in early childhood is followed, in succession, by protest, despair, and detachment; feeding difficulties, bedwetting, constipation, and sleeping difficulties may arise 
• In later childhood the loss of a parent commonly gives rise to emotional and behaviour problems 
• Children bereaved in childhood may be vulnerable to psychiatric disorder later in life 
• Forewarning can help children to prepare for bereavement, and they usually benefit from viewing a dead parent and attending funerals and other rituals 
• Family support meetings can reduce morbidity after bereavement 

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Separation and loss in childhoodInfants and toddlers react to separation from an attachment figure by protesting vigorously. If their cries are not successful in restoring the adult, protest eventually gives way to despair, and eventually, if they are not restored to their attachment figure, pathological states of detachment and indifference may ensue. They probably have little concept of death, and the disappearance of a parent, whatever the cause, will evoke similar reactions. Thus a parent away for a few hours and one absent for longer both evoke the same separation anxiety in infants and toddlers older than a few weeks or months.2 Even very young children can mourn for a lost parent, although the form of their grief differs from that of adults and older children.2,3 Their reactions tend to be bodily ones such as feeding difficulties, bedwetting, constipation, and sleeping difficulties. 

By 5 years of age, most children can understand the difference between a temporary separation and death. They know that death is irreversible and universal, has a cause, and involves permanent separation and that dead people differ from live people in several respects: they are immobile, unfeeling, and cannot hear, see, smell, or speak. It is more difficult for children to understand that dead people change in their appearance, and this concept does not develop until nearer puberty.4



Children from 5 to 11 years are more likely to understand the physical changes that death brings and are helped by seeing these changes for themselves. They should be told what to expect, and they should be allowed to view the body if they wish. Exceptions may arise if the body is severely mutilated or if the child or parents have a strong aversion to the idea of viewing. In such cases additional support may be needed. 

Children’s characteristic response to the death of a parent is an increase in activity, and behavioural problems may result. Hallucinations of the dead person are a common feature of grief in adult life.5 They can also be experienced by young children, who may interpret them as evidence of the parent’s return, or as evidence of persecution by the ghost of the dead parent because of imagined shortcomings on the part of the child, in which case they can give rise to severe anxiety. Because of their need for parenting, children who lose one parent often become anxious about the survival of the other, and they may protect that parent from knowing of their distress. That, and the difficulty of sustaining mood states in childhood, may lead the parent or teacher to believe the child has recovered from, or has not been affected by, a bereavement. 

Components of attachment behaviour in infants Behaviour that maintains attachment: 

• Smiling 
• Vocalising (babbling) 
• Clinging 
• Following

Behaviour on separation: 

• Crying (protest) 
• Restless searching 
• High anxiety 
• Irritability 

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Reactions to bereavement in childhoodThe florid reactions tend not to last beyond a few weeks, with most children regaining their previous level of psychosocial functioning.6 However, as assessed by parental reports, children have higher levels of emotional disturbance and symptoms than non-bereaved children for up to two years, and up to 40% of bereaved children show disturbance one year after bereavement.7,8 In direct assessments of bereaved children, Weller and colleagues found that 37% of their sample of 38 bereaved prepubertal children had a major depressive disorder one year after bereavement.9

Longing for reunion is common and may lead to suicidal thoughts in bereaved children and adolescents, although they are rarely acted upon.9 Other difficulties include learning problems and failure to maintain school progress.10


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Long term effects of bereavement on childrenChildren who are bereaved early are more likely to develop psychiatric disorders in later childhood.11 Rutter found a fivefold increase in childhood psychiatric disorder in bereaved children compared with the general population.12

Adults bereaved of a parent in childhood seem to be more vulnerable than the general population to psychiatric disorder, particularly depression and anxiety, and this is often precipitated by further losses.13,14 Attempted suicide is more common in adults bereaved in childhood.15

Children who lose their mother suffer a reduction in the quantity as well as quality of care, and this may account for the finding of differential effect according to the sex of the deceased parent.9


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Effects of the death of a siblingChildren compete for parental attention and often feel resentful of the attention given to a sick sibling. This can be heightened if a parent has spent time in hospital with the sibling. Guilt may be the predominant emotion that follows triumph at having survived when a sibling dies. Young children may believe that their hostile or ambivalent feelings actually caused their sibling’s death, and this may lead to profound behavioural changes. If the sibling was older, and carried out some parental functions, the reaction may be similar to that after loss of a parent. 


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Helping bereaved childrenChildren are rarely prepared for the death of a parent or a sibling, and yet we know from studies of bereaved adults that mourning is aided by a foreknowledge of the imminence and inevitability of death.16 Children who are forewarned have lower levels of anxiety than those who are not, even within the same family.17

When death occurs, young children in particular may need the concrete experience of seeing the parent after death. Bereaved adults find it particularly difficult to help a child in this way, and the general practitioner could offer to accompany the child. Similarly, children benefit from attending the funeral but need some protection from the raw expressed grief that may be shown at that time. Attending in the company of someone less affected by the death than the immediate relatives is desirable. This could be the child’s teacher or someone from the family practice with whom he is familiar. 

The monitoring and help with practical matters (applying for a home help, mobilising family support, ensuring adequate income, etc) needs to be accompanied by specific bereavement counselling for both the child and the surviving parent. A controlled trial of family therapy with children bereaved of a parent showed that the postbereavement morbidity of 40% at one year could be reduced to 20% by six sessions of family meetings which focused on promoting shared mourning within the family and encouraging communication about the dead parent.8,9 Preventive counselling is properly the responsibility of the primary care team, utilising the resources of bereavement counselling services as necessary. Cruse (the national charity for bereavement care) publishes useful literature for bereaved children and their carers and provides training and bereavement counselling services. Dyregrov’s excellent handbook for adults deserves a place in a practice library,18 and workbooks for children of primary school age can aid those counselling them.19,20

Finally, the practitioner needs to be aware of the small number of children who may need more specialised help in recovering from depressive or other symptoms that may be associated with bereavement. These will include children who may have been partly instrumental in causing death (of a sibling perhaps), those who have gone through sudden and particularly traumatic bereavements, children who have suffered more than one bereavement, adolescents who express suicidal ideas, and children who do not respond to the initial preventive interventions. 


​
Figure
Asked to draw her mother as she imagined she might be after radiotherapy for carcinoma of the breast, 6 year old Eva at first drew mother with a scarf to hide her bald head and then attempted to hide the scarf in a similar coloured background (purple). ...
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Footnotes

Funding: No additional funding.





Conflict of interest: None. 





The articles in this series are adapted from Coping with Loss, edited by Colin Murray Parkes and Andrew Markus, which will be published in May.




Go to:
References1. Bowlby J.  A secure base. London: Routledge Kegan Paul; 1988. 
2. Bowlby J. Attachment and loss. Vols 1-3. London: Hogarth Press, 1969-80. 
3. Furman E.  A child’s parent dies. New Haven: Yale Univeristy Press; 1974. 
4. Lansdown R, Benjamin G. The development of the concept of death in children aged 5-9 years. Child Care Health Dev. 1985;11:13–20.  [PubMed]
5. Parkes CM. Bereavement in adult life. BMJ. 1998;316:000–000. [PMC free article][PubMed]
6. Fristad MA, Jedel R, Weller RA, Weller EB. Psychosocial functioning in children after the death of a parent. Am J Psychiatry. 1993;150:511–513.  [PubMed]
7. Black D, Urbanowicz MA. Bereaved children-family intervention. In: Stevenson JE, ed. Recent research in developmental psychopathology. Oxford: Pergammon, 1985;179-87. 
8. Black D, Urbanowicz MA. Family intervention with bereaved children. J Child Psychol Psychiatry. 1987;28:467–476.  [PubMed]
9. Weller RA, Weller EB, Fristad MA, Bowes JM. Depression in recently bereaved prepubertal children. Am J Psychiatry. 1991;148:1536–1540.  [PubMed]
10. Van Eerdewegh MM, Bieri MD, Parrilla RH, Clayton PJ. The bereaved child. Br J Psychiatry. 1982;140:23–29.  [PubMed]
11. Black D. Annotation: the bereaved child. J Child Psychol Psychiatry. 1978;19:287–292.  [PubMed]
12. Rutter M.  Children of sick parents. Oxford: Oxford University Press; 1966. 
13. Birtchnell J. Early parent death and mental illness. Br J Psychiatry. 1970;116:281–288.[PubMed]
14. Brown GW, Harris T, Copeland JR. Depression and loss. Br J Psychiatry. 1971;130:1–18.  [PubMed]
15. Birtchnell J. The relationship between attempted suicide, depression and parent death. Br J Psychiatry 1970;116:307-13.  [PubMed]
16. Parkes CM.  Bereavement: studies of grief in adult life. Harmondsworth: Penguin; 1986. 
17. Rosenheim E, Reicher R. Informing children about a parent’s terminal illness. J Child Psychol Psychiatry. 1985;26:995–998.  [PubMed]
18. Dyregrov A.  Grief in childhood; a handbook for adults. London: Jessica Kingsley; 1991. 
19. Heegaard M.  When someone very special dies—children can learn to cope with grief.Minneapolis: Woodland; 1991. 
20. Heegaard M.  When something terrible happens—children can learn to cope with grief.Minneapolis: Woodland; 1991.

http://www.pcavt.org/assets/files/Articles/'s%20Development.pdf


Susan Hois, Child Development Specialist

It is only within the context of the adult-child relationship that children accomplish the various developmental tasks related to psychological maturation. Separation from or loss of parents due to death, divorce, incarceration or removal to foster care will have a major impact on the child’s psychological development and possibly on his/her cognitive and physical development as well.

Although the effects of parental separation/loss will vary from child to child and family to family, the negative impact this has can be minimized if the child can live in an environment that is supportive to the grieving process and able to offer an explanation and understanding of his life events. Unfortunately, many, many children who have suffered this trauma have not received sufficient help in resolving loss issues and are, to one degree or another, psychologically “stuck” at the age of the loss of their primary attachment objects.

Separation and Loss During the First Year of Life

Short term effects:

• Regression in terms of dependency needs.
  
  
• Undermining of the child’s sense of security and trust that adults will be
  
  available.
  
  
• With the changes in daily routine that accompany changes in caregivers, there will be interruption in the acquisition of sequencing and basic cause and effect.
  
  How to Minimize the Effects of the Loss:
  
  

• The parents/caregivers need to be available “on demand” for the infant, once again meeting the child’s earlier developmental needs.
  
  
• All interactions need to be gauged by asking the question, “What will help this infant learn to trust that adults will be available?”
  
  
• Following a consistent routine is particularly important for these infants. Possible Long Range Effects of the Loss:
  
  If the infant’s dependency needs are not met, the child will grow up to be one who continues to think life owes him. It is quite likely that he will have trouble ever meeting the dependency needs of others. Trust for others will be impaired. Learning problems, secondary to problems with cause and effect, may occur although they may not become evident until grades 4 – 6.
  
  

____________________________________ 1 ____________________________________


_________________________________________________________________________

Effects of Separation and Loss on Children’s Development

_________________________________________________________________________

Separation and Loss During the Toddler Years (Ages 1 – 3) Short term effects:

• The balance between age appropriate dependency and independency will be disrupted.
  
  
• Interference with identity – with changes in family position, the child’s ego development may be disrupted.
  
  
• The child’s awareness of both internal and external stimuli may be dulled and there will likely be regression in terms of the most recently acquired skills.
  
  
• The normal acquisition of language may be temporarily interrupted with parental loss, especially if that parent was the child’s “interpreter.”
  
  How To Minimize the Effects of the Loss:
  
  

• Careful attention must be paid to meeting the child’s dependency needs while at the same time helping him feel more adequate and independent on his own terms.
  
  
• If regression to earlier levels of functioning is allowed, the toddler will usually acquire the skills within a few months time.
  
  
• If undue pressure is put on the child to continue to function at his highest levels, or to attain new skills without time for transition or reattachment, long range problems are more likely.
  
  Possible Long Range Effects of the Loss:
  
  There is the possibility the individual will permanently take on the “victim” or “victimizer” role. Long term control issues may be prominent. A serious effect may be the disruption in ego development, with an increased incidence of “borderline personality” problems. Lack of self-awareness may be ongoing. There may be long term subtle language problems. As adults, these individuals may be rigid, inflexible, and not able to deal appropriately with aggressive impulses.
  
  Separation and Loss During the Preschool Years (Ages 3 - 6) Short term effects:
  
  
  • The child’s egocentric magical thinking can cause him to misunderstand the causes of the separation and loss. It is important that adults work hard to identify the child’s personal magical thinking about the loss. Does he think he caused the loss? Does he think he can do something to reverse it?
    
    
  • The child may display indiscriminate attachment to adults and have conflicting feelings about the “good” and “bad” traits in himself and others.
    
    

____________________________________ 2 ____________________________________


_________________________________________________________________________

Effects of Separation and Loss on Children’s Development

_________________________________________________________________________

How To Minimize the Effects of the Loss:

• Identifying, clarifying, and remedying the magical thinking (that the child is to blame) is particularly important.
  
  
• Offering the child age-appropriate explanations for the separation and loss and continuing to urge parents/caretakers to repeatedly and consistently confirm the child’s place in the family.
  
  
• Adequate opportunities for play must be provided; at this age all psychological issues, including grieving, are resolved primarily through play.
  
  Possible Long Range Effects of the Loss:
  
  Because of the combination of magical thinking and the “good vs. bad” struggle, the preschooler may perceive himself as so “bad” that he caused the loss. Secondary to the combined effects of the magical thinking and the Oedipal conflict, the child may think the loss was related to his wanting the parent of the opposite sex all to himself. This may have long term ramifications in terms of sexual identify issues. This can be amplified in cases of sexual abuse. The magical thinking and the “big vs. little” struggle may lead the child to attribute the loss to his either being too “big” or too “little” in his family.
  
  Separation and Loss During the Grade School Years Short term effects:
  
  

• As the grade schooler goes through the grieving process, he will have less energy available for the usual tasks of this age.
  
  
• School-age children become acutely aware of differences between themselves and their peers and these may lead to problem behaviors with peers.
  
  How To Minimize the Effects of the Loss:
  
  

• Provide the child with opportunities to focus on grieving so that at other times he can focus on the tasks at hand, whether they are academic or peer related.
  
  
• Help the child expand his thinking and understanding about losses with factual information.
  
  
• Disengaging work is a priority at this age. The child needs to gain permission to let go of old attachments and form new ones.
  
  
• Help the child and the family develop a “cover story.” Possible Long Range Effects of the Loss:
  
  If the child has a series of disruptions in schooling and peer relationships during this stage of development, he may have long-term problems in either or both of these areas. There may be problems with the internalization of conscience.
  
  

____________________________________ 3 ____________________________________


_________________________________________________________________________

Effects of Separation and Loss on Children’s Development

_________________________________________________________________________

Separation and Loss During the Adolescence Short term effects:

• In order to successfully complete the tasks of psychological separation the adolescent needs to come up against and oppose parent figures who are nonetheless consistently available and caring. Parent separation and loss will disrupt these tasks.
  
  
• Control issues will continue to impact the adolescent’s behaviors, especially if he feels a large part of the decisions about his life are out of his control.
  
  How To Minimize the Effects of the Loss:
  
  

• Adolescents need to feel they have increasing control over their own lives. Especially at times of separation and loss, adults must provide them with as many opportunities as possible to be in control of other aspects of their lives.
  
  
• They need to be an integral part of the decision making for their future.
  
  
• Adolescents need assistance in grieving the loss of early relationships in their lives. They need as much information as is available about their early history so that they can go on to identify formation and develop a sense of being worthwhile.
  
  
• Teens need help in deciding how much of their history to reveal to friends and intimates.
  
  Possible Long Range Effects of the Loss:
  
  If the adolescent believes he has lost all control over his life, he is likely to become either suicidal or to act out in a variety of antisocial ways.
  
  

•  
  
  

There are multiple charts that show the findings of the study.  Copy and Paste this web address to see them.   https://childtrauma.org/wp-content/uploads/2013/12/PerryPollard_SocNeuro.pdf


Altered brain development following global neglect in early childhood

Bruce D. Perry, M.D., Ph.D. Ronnie Pollard, M.D.

The ChildTrauma Academy

www.ChildTrauma.org

*This is an Academy version of a paper presented at Society for Neuroscience Annual Meeting, New Orleans, 1997

Official citation: Perry, BD and Pollard, D. Altered brain development following global neglect in early childhood. Society For Neuroscience: Proceedings from Annual Meeting,New Orleans, 1997

Introduction

Each year in the United States alone, over 500,000 children suffer from some version of "neglect." Neglected children brought to the attention of the Child Protective Services has a much higher probability of emotional, behavioral, cognitive, social and physical delays and dysfunction than "comparison" children. It is becoming increasingly clear that the nature, timing and extent of neglect in childhood are critical in determining the nature and extent of these deficits (Perry et al., 199 5; Courchesne et al., 1994).

This observation may seem somewhat obvious to individuals familiar with the principles of neurodevelopment and the animal studies documenting the critical role of sensory stimulation in organizing the developing central nervous system. Indeed, use (or activity) dependent development and modification of neural systems is one of the core principles of neurodevelopment (see Singer, 1995). In animals raised in sensory depriving situations, a host of abnormalities in neurochemical and neuroarchitectural organization have been documented (e.g., Darwin, 1868; Ebinger, 1974; Cragg, 1975). The functional consequences of sensory deprivation during neurodevelopment can be significant. Indeed , in some severe deprivation situations, sensory deprivation or sensory disorganization during critical or sensitive periods can result in permanent dysfunction (e.g., Spitz & Wolf, 1946; Perry, 1997). This has ominous implications for human development.

While many studies have described various functional consequences following neglect in childhood, few have examined aspects of neurodevelopment in



neglected children. The present study reports a preliminary examination of measures of brain growth in a large group of neglected children.

Method

Children (ages 0 to 17) were referred to our specialty clinic for evaluation by Child Protective Service or other agencies working with children following abuse or neglect. Comprehensive physical, developmental and neuropsychiatric evaluations were conducted to assist in placement and treatment planning. As part of this evaluation, comprehensive pre- and perinatal history were obtained, as were various measures of growth
(height, weight and frontal-occipital circumference: FOC).

Charts were reviewed for evidence of pre-natal drug exposure (PND) and neglect. Neglect was considered global neglect when a history of relative sensory deprivation in more than one domain was obtained (e.g., minimal exposure to language, touch and social interactions). Chaotic neglect is far more common and was considered present if history was obtained that was consistent with physical, emotional, social or cognitive neglect. When possible history was obtained from multiple sources (e.g., investigating CPS workers, family, police).

Based upon these reviews, the neglected children (n= 122) were divided into four groups: Global Neglect (GN; n=40); Global Neglect with Prenatal Drug Ex posure (GN+PND; n=18); Chaotic Neglect (CN; n=36); Chaotic Neglect with Prenatal Drug Exposure (CN+PND; n=28). Measures of growth were compared across group and compared to standard norms developed and used in all major pediatric settings.

In cases where neuroimaging studies had been conducted as part of a medical or neurological evaluation, these images were examined in a retrospective fashion. Neuroradiologists had read the scans in context of the original medical or neurological referral and, typically, were unaware of the neglect or psychosocial situation of the child.

Results

Growth

Dramatic differences from the norm were observed in FOC (suggesting de creased brain growth) for the globally neglected children (see Figures). This group



6;s mean FOC was only in the 10th percentile, while height and weight measures of growth demonstrated less difference (30-40th percentile). In contrast , the chaotically-neglected children did not demonstrate this marked group difference in FOC.

Pre-natal drug exposure appeared to have an interactive, but complex effect on growth. In the global neglect population, it appeared to exacerbate the observed growth differences. In the chaotic neglect group, however, no differences in growth were observed.

Neuroimaging

Neuroradiologists interpreted 3 of 26 scans abnormal from the children with chaotic neglect (11.5 %) and in 11 of 17 of the children with global neglect (64. 7 %). The majority of the readings were "enlarged ventricles" or
"cortical atrophy." Few focal abnormalities were noted.

Normal vs. Abnormal CT or MRI Scans in Neglected Children


Normal


Abnormal


Chaotic Neglect 18


1


Chaotic Neglect + 5 PND


2


Global Neglect 3


8


Global Neglect + 3 PND


3




Discussion

These findings strongly suggest that when early life neglect is characterized by decreased sensory input (e.g., relative poverty of words, touch and socia l interactions) it will have a similar effect on humans as it does in other mammalian species. Sensory deprivation has been demonstrated to alter the physical growth and organization of the brain in animals.

The present studies suggest that the same is true for children globally neglected in the first three years of life. It is important to emphasize the timing of the neglect. The brain is undergoing explosive growth in the first years of life, and, thereby, is relatively more vulnerable to lack of organizing experiences during these periods. These unfortunate globally neglected children (some literally were raised in cages in dark rooms for the first years of their lives) appear to have altered brain growth.

There are likely many factors contributing to this observation. Nutrition is one key aspect. Based upon the relative impact on the brain as opposed to other growth, a total nutritional explanation is inadequate. It is likely that the actual lack of experiences (sound, smell, touch) associated with global neglect in these children plays a major role.

While the actual size of the brain in chaotically neglected children did not appear to be different from norms, it is reasonable to hypothesize that organizational abnormalities exist.


Volumetric studies of key areas are indicated, as are MRI studies to examine the functional impact of neglect; global or chaotic.


All rights for reproduction of the above image are reserved, Bruce Perry, M.D., Ph.D. Baylor College of Medicine.

These images illustrate the negative impact of neglect on the developing brain. In the CT scan on the left is an image from a healthy three year old with an average head size. The image on the right is from a three year old child suffering from severe sensory-deprivation neglect. This child’s brain is significantly smaller than average and has abnormal development of cortex.

References

Courchesne, E., Chisum, H., & Townsend, J. (1994). Neural activity -dependent brain changes in development: Implications for psychopathology. Development and Psychopathology, 6, 697-722.

Cragg, B. G. (1975). The development of synapses in kitten visual cortex during visual deprivation. Experimental Neurology, 46, 445-451.



Darwin, C. (1868). The variations of animals and plants under domestication. London:

Ebinger, P. (1974). A cytoachitectonic volumetric comparison of brains in wild and domestic sheep. Z Anat Entwicklungsgesch, 144, 267-302.

Perry BD, Pollard RA, Blakley TL, Baker WL, Vigilante D: (1995) Childhood trauma, the neurobiology of adaptation and use-dependent development of the brain: How states become traits. Infant Mental Health
Journal 16:271-291

Perry, BD (1997) Incubated in Terror: Neurodevelopmental Factors in th e ‘Cycle of Violence’ In: Children in a Violent Society (J Osofsky , Ed.). Guilford Press, New York, pp 124-148, 1997

Singer, W. (1995). Development and plasticity of cortical processing architectures. Science, 270, 758-764.

Spitz, R. A., & Wolf, K. M. (1946). Anaclitic depression: an inquiry into the genesis of psychiatric conditions in early childhood. II. Psychoanalyt ic Study of the Child, (2), 313-342.

 

http://traumamamat.blogspot.com/2012/03/10-things-you-can-do-to-support-parents.html



Parenting hurt kids is rewarding, but it is hard.  It can be isolating and lonely.  Even people I thought would understand, haven’t always.  Even the parent of an older, internationally adopted child once told me, “You and your friends scare me.”  I don’t know about how you handle things emotionally, but that didn’t slide off my back without cutting my heart deeply along the way.

Still, I believe most people want to support families who are raising hurt kids.  They just don’t know what to do or say.  They don’t know when to step up, or when to step back.  Some think they know better, even though they’ve never walked in these shoes.  (They’re never helpful.)  Some walk in similar shoes but only want to draw close when they themselves are hurting.  

Through the last five or six years, I’ve come to know a lot of trauma mamas who are raising hurt kids.  Sometimes they’re supporting me or others; sometimes they need support themselves.  I'm friends with a mama that is hurting SO much right now.  I've dealt with some things recently and am doing well, but when I'm not, I wish someone - SOME ONE - could hear my heart, too.  I’ve heard several things, from hurting mamas - over-and-over again - things that parents of hurt kids wish to God would happen, so they might not feel so alone.  My friend is voicing some of these things now.  This list is not meant as a personal groan session.  It is genuinely put "out there" to tell people who care what we wish we could say in those lowest of times.  Here are ten things I've heard (and sometimes felt) most often:


 1. When you ask how a trauma mama is doing, and she says, “Okay,” but she doesn’t sound all that enthusiastic about it, tell her to “quit joshing” and tell you the truth.  Then, be ready to hear it, without judgment, and without trying to “fix” it if you don’t know anything about it.  And PLEASE don’t say, “You need some time away.”  Most trauma mamas already know that, but trying to actually get away is nearly impossible.  When we do, we usually have hell to pay when we get back home, because we left our traumatized kid and they’re triggered beyond triggered by the “abandonment.”

 2. When we say we’re sleep deprived, please say something like, “I’m sorry.  I can see in your eyes that you’re tired.”  Don’t tell us you know "just what we're talking about" because you stayed up to watch a movie and have some fun, and then you couldn’t sleep because it was so exciting.  We can’t sleep because our minds won’t turn off thinking about the misery our children are in and the trouble they've gotten into, and because we're also listening to see if our kids are getting up and trying to sneak around to do something they're not supposed to do.

 3. When we ask you to pray for us, take the two minutes and do it, right then and there.  On the spot.  And give your trauma mama friend a hug.

 4. If she is less than kind to you, or if she should happen to snap at you one day, and you know that it’s not like her to do that, please don’t hold it against her.  Hold her accountable, but recognize she's hurting and without any reserve in that moment.  Try not to snap back.  Don't say hurtful things in return.  Whatever you do, please don’t push her away.  Reach out to her.  She needs you more then than ever.  Be there for her, especially if she's been there for you when you've hurt.  She knows you’re tired and beat down.  But, she's tired, too.  She's beat down, too.  She's prayed, but she couldn’t find her joy in that moment.  It might feel like you’re hugging a porcupine, but none of us is all that cuddly ALL the time, including you.    

 5. Parents of traumatized/attachment disordered (or still attaching) kids need friends who don’t hug their kids, don’t let them sit on their laps, don’t pick them up, don’t give them gifts, don’t say “I wish you could come live with me,” don’t invite them on outings or to their house without talking to us first, and don’t believe everything that comes out of our kids’ mouths without checking it out – especially if they’re saying something about us that seems “off” in any way.  Attachment disordered kids are masters at triangulating adults.  They may tell you we said something negative about you, when we never even thought it, let alone said it.  Attachment disordered kids often "shop" for new and improved versions of parents (usually those with more money who could give them more “stuff”).  Some of them can come up with pretty horrible stories about their parents that just are not true.  Again, please don't jump to conclusions.  Most of our kids still need time to learn what it means to be a family, what appropriate affection means, and that Mommy IS their mother and Daddy IS their father.  

 6. No matter what the situation, remember the parents are the ones who should be in charge of their children.  They know their children best.  Do not lump a traumatized/attachment disordered child into the “all kids” category.  Do not say, “But all kids do that.”  Not “all kids” have the same motivations as traumatized kids.  Allow experienced therapeutic parents to teach you some new skills and knowledge.  We don’t know it all, but neither do you (even if you are a teacher, or a parent, or a grandparent, or a therapist).

 7. Surprise us by bringing us a healthy, but kid-friendly meal.  Call a few hours in advance so your trauma mama friend doesn't drag herself to the grocery store, trying to figure out what she can throw together for dinner while dealing with a triggered child.  (See #1-4 above.)

 8. Love her.  Just be there.  Take her out for coffee while the kids are in school.  (She'll even pay her own way.)  Talk about the garden you’re planning and get her mind off things at home – or just listen if she needs that.  Again, listen without judgment -- without trying to fix anything.  And pray for her then and there, too.

 9. When you have a question, talk to her privately.  Do not ask her about a concern, or if her child can do something with you, go somewhere with your family, or have a gift from you (even a piece of candy) in front of the child.  This does not matter if they are 3, 6, 13, or 16.

10. Remind her when things are tough that her child CAME TO HER this way.  She did not do anything to hurt her child.  Remind her that God is near the brokenhearted and He does not bruise the tender reed.  Remind her, without judgment in your voice, that she loves her child and he loves her as best he can.  Tell her you love her, too.  Remind her God loves her especially.