From ‘attachment disorder’ to ‘developmental trauma’

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Dr Jennifer Nock outlines how schools should work towards trauma-lnformed practice.

Introduction
Until quite recently, the narrative around children who have experienced Developmental Trauma, sometimes referred to as Early Life Trauma (ELT), has focused almost wholly on attachment ‘disorder’, with a focus on attachment and relationship building. This of course, is vitally important and children who have not experienced consistent, nurturing care in their early lives frequently have difficulties making secure relationships later on because they find it hard or even impossible to trust others. This makes stable, caring, intimate relationships hard to tolerate. 

Early Life Trauma and the Brain
In the first years of life, babies and toddlers need safe, consistent, available and loving caregivers. When this is offered, the brain develops in a healthy, normal sequence of growth. The brain develops like a ladder, from the bottom upwards. Lower parts of the brain are responsible for functions which ensure survival, such as respiration and heart rate, and responding to stress and threat, through the manifestation of survival behaviours: fight, flight, freeze and flop. Upper parts of the brain are responsible for executive functions, including memory, concentration, planning, problem-solving, assessing risk, decision-making, social interaction and exercising moral judgement. Development of the upper parts is dependent upon prior development of lower parts. When stress reactions, due to neglect or abuse are repeatedly triggered over a prolonged period in an infant or toddler, the sequential development of the brain is disrupted. The ‘ladder’ develops, but underpinning steps are missing and many things that follow are out of balance because the child has not received the tender, loving care that enables them to thrive. A wide body of research indicates that patterns of stress activation early in life can change significant neural networks in, and functioning of, the developing brain. Children with ELS experiences often exhibit impairment over the lifespan, even when they receive intervention.  There is no cookie-cutter or one-size-fits-all approach that has been shown to work reliably for these children and young people because they present with a varied range of problems stemming from their own unique experiences and the multitude of factors that influence how they feel and behave. But by looking at some typical difficulties for those who have experienced ELT, we can begin to gain some insight into the ways in which we can offer support. 

The seven areas of difficulty experienced by children and young people who have experienced ELT

  • Sensory/somatic difficulties: severe sensory sensitivities, including difficulties processing sensory experiences and regulating the body, often with poor interoception (the sense that tells us what is happening inside our bodies, feeling hot, cold, tired etc). Also, body complaints which are often medically unexplained: the body is a loudspeaker for what is going on inside, and often communicates what has been suppressed or not available to conscious memory because the child was very young when the traumatic events occurred.
  • A tendency to dissociate, that is, a ‘separation’ between the mind and body in response to perceived threatening situations. The child may dissociate even when they are no longer in danger because their brain cannot turn off this extreme survival mechanism. 
  • Trusting others feels terrifying and this makes close relationships hard to tolerate, leading to isolation, loneliness and a lack of ability to turn to adults for help. 
  • Problems in regulating feelings because they have not had an available adult to co-regulate. This leads to extreme emotional highs and lows and rapid mood swings.
  • Difficulties with behavioural regulation and impulse control and exhibiting self-destructive, sabotaging behaviours to cope with daily life.
  • Experiencing an enduring negative self-image which often includes feelings of guilt, shame, wickedness and being unloved and unlovable. Having low self-efficacy and a sense of being responsible for or deserving of the abuse/neglect or other trauma that has taken place.
  • Cognitive difficulties including difficulties in memory and making sense of themselves, a poor or fragmented sense of identity, memory gaps and a confused ‘life story’.

Bearing this broad impact in mind, it is clear that parents, educators and other professionals need to recognise that attachment is but one of the seven areas of difficulty, and the sequence in which we respond to the child does not begin with the building of attachment relationships. If we take such a narrow focus, problems with the sensory and bodily systems, and even with dissociation, will prevent the child from accessing or benefitting from co-regulation and attachment building. Therefore, sensory and bodily functioning and dissociation must be addressed, together with focusing on attachment and relationships. Consider an infant: the attachment relationships that develop are based upon feeding; soothing; cleaning; medical care; in short, offering love through tender care of the body. “There is nothing in the intellect that was not first in the senses,” wrote Aristotle. What the body experiences from the start, forms the foundations of all later physical, emotional and cognitive development. Thus, if a child has not had the experience of his or her body being honoured, treasured, respected, valued, tenderly touched, kept clean and fed, he or she will not learn to love and honour self. So, regardless of the age of the child, our support should begin with positive physical experiences, which will support their mental as well as their physical wellbeing. We can communicate love through playful, nurturing activities, fun games, developmentally appropriate activities, and tender, nurturing activities. The very act of engaging with a child in this way helps the adult regulate the child’s behaviour and communicate love, joy, and safety to the child. It helps the child feel secure, cared for, connected and worthy, which is, of course, the basis of attachment. Once we have begun to fill in those missed developmental experiences, we can begin to address the other areas of difficulty, but we must work in a ‘bottom-up’ direction, regulating the lower brain through physical and relational experiences, before addressing the cognitive systems through reasoning and reflection.

In conclusion
If we are to succeed in really making a difference for children and young people who have experienced ELT, we need to be prepared to take a long journey with them. Attachment relationships take time to develop, so schools must plan for long-term support from a key adult.  All staff should have the opportunity to access high-quality training on attachment and the impact of trauma. Working towards trauma-informed practice is crucial. Trauma-informed practice allows practitioners to take into account the additional complexities involved when working with children who have experienced trauma and adversity. It orients us away from the question, ‘What is wrong with this child?’ and towards a much more useful question, ‘What has happened to this child?’ As Carl Jung said, ‘To ask the right question is already half of the solution to a problem.’

Dr Jennifer A Nock
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Dr Jennifer A Nock, CPsychol, AFBPsS, PhD, BSc (Hons) runs the Jennifer Nock Training and Consultancy. A specialist service for educators, families and those in the caring professions, who work or live with children with disabilities, special educational needs or who have experienced trauma.

Website:jennifernocktrainingandconsultancy.com
Twitter: @jennifer_nock
Facebook: Jennifer Nock Training and Consultancy

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