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Thursday, December 1, 2011

PTSD: Jackie Meyer

The drawing that you see is from an eight year old boy who has
been in a SAFE foster home since he was three. We will call him
Dan. I had asked him to draw a picture of his family. I assumed he
was going to draw his foster family with whom he loves and feels
safe. He drew his biological family with mom out of the picture, his
siblings crying from pain and he is shaking because he is about to
be hit.
Dan is suffering from complex post traumatic stress. It is different
from other types of traumatic stress in that it is early, chronic
maltreatment within a care giving relationship.
Dan’s abuse was so early; it started before he was born. He had a
mom who was being severely beaten while she was pregnant. His
life was in danger and he knew it at an implicit level while he was
still in the womb.
Chronic maltreatment was ever present for the first three years of
Dan's life. He did not know if he would have food while parents ate
steak. He was often severely beaten for what normal kids do, like
lose a shoe. The people, who were supposed to protect him, hurt
CPTSD affects brain development. Dan, like the other children we
get into foster care, has a physically damaged brain. These children
have learning lags that are not always the result of a lack of
intelligence. They have no cause and effect thinking. Dan stood in
the school lunch room and loudly yelled at the lunch lady because
his class did not wait for him to put his colors away before going to
lunch. He used every vulgar word his bio dad taught him in front of
everyone. It did not occur to him that it was his slowness that
caused the problem.
These kids appear to be on hyper alert all of the time. They are
primed for the next bad thing to happen. It is the same feeling that
we get when we see the police car lights in our rear view mirror.
Only their feeling never ends. Dan has difficulty laughing because
the neurons for fun have been hijacked by rage and fear.
CPTSD affects the children’s ability to attach. Since it was the care
giver who hurt them, why would they want to connect to someone
else who they think will want to hurt them. As a result they behave
in ways that push the adults in their life away even it means getting
Kids who suffered from this kind of trauma get sick a lot more or at
least claim to be sick. Their sympathetic nervous system is out of
control. Being on hyper alert takes its toll on the body. Dan has to
have allergy shots on a regular basis
Because of the brain damage these kids often can not control their
emotions. The child may not be oppositional when he throws the
tantrum in Wal-mart. He may be just out of control. “It may be a
matter of can’t verses won’t.” They may use negative behavior to
make themselves feel better. The pain from cutting is a whole lot
easier to handle then remembering my father taking a gun to my
mom’s head. Getting in trouble for lying is a whole lot better than
taking the chance of getting beaten if I tell the truth.
Kids do not know for sure that foster parents or other caregivers
are not going to beat them. Dan was kicked out of school several
times in Kindergarten. One time he was so angry over some minor
thing that he hit the teacher. Dan was afraid and had no skills to
handle his big feeling. The school did not like this so much. They
were afraid that he would hurt the other kids. It was difficult for the
school to understand that he was not just being defiant. But they
did agree to a safety plan for Dan and the other children.
Bad memories may surface at any time. The child’s feelings of
terror are so overwhelming they may dissociate. This could
happen in school. He may just sit and stare and not cause any
problems. However, he has just missed class time. Dan was always
being accused of not getting his work done on time. The teacher
would often encourage Dan to do his work, but because his body
was feeling the emotions from abuse that happened years before he
could not do it.
Behavior control is a big issue with these severely traumatized kids.
One usually thinks about aggressive impulsive behavior. However,
excessive compliance is also a behavior issue. This is the kid that
every teacher and foster parent loves. He is doing helpful things
way beyond normal expectation. People have always abused him
before so he is going to do everything he can to prevent it. What
caregivers do not understand is that this child is extremely afraid.
He can be living in terror.
Foster parents often tell me that they can not get their child
interested in anything. CPTSD often does not allow the brain to
process new information. Everything is funneled through old
patterns. If he was always put down for trying he is not going to try
Kids with CPTSD suffer huge amounts of shame. These kids feel like
pond scum. Telling a child how valuable he is will do no good. All
preschool children believe they cause everything that happens to
them. Therefore these children believe that they caused the
maltreatment that happened to them. They made mom go to jail.
They made dad beat them. They are often stuck at this early
developmental age and continue to believe this.
The good news is that kids can be helped. We must work with them
at their level.
Think of Maslow’s hierarchy.

Kids need to feel safe first:
Treatment is phased based. They must feel safe first. Remember
Dan had been in foster care for five years and never felt safe.
Treatment must always be done with in the family setting because
only the caregiver can help him feel safe.
The foster parents literally redo the child’s early life. They put a
new narrative into his brain so that this time he feels safe. Like with
small children, the foster parent must set clear boundaries and give
lots of nurturing. As the child feels safe his brain will heal. He will
be able to do the things that other kids his age do. Until then a 16
year old that is functioning like a 10 year old should not drive.
The foster parent needs to help the child control his feelings. Two
year olds throw tantrums and often can not control them. Because
of CPTSD, a 16 year old may not be able to control his tantrums
either. The parent must calm the teen until his brain heals and he
can calm himself.
As the parent helps the child eliminate his shame, the child begins
to use his thinking part of his brain and not just react with
emotions. The child can now make clear and wise choices. He no
longer suffers from Complex Post Traumatic Stress.
To some this may seem impossible. Mary Dozier has done much
research on this and her conclusions show that it is the foster
parents that make the difference. This is true of Dan. Dan’s
teachers report he is doing above average work. There have been
NO violent out burst. Dan is on his way to becoming a productive
young man.
Never forget how much influence you have as a foster parent.

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