How
different problems can manifest
themselves in daily life
Approaches to helping maltreated
children
Ways to
help!
Parents and caregivers
make all the difference in the lives of
maltreated children. This section suggests
some different ways to help.
Nurture these children:
These children need to be held and rocked
and cuddled. Be
appropriately physical, caring, and
loving to children with attachment
problems. Be aware that for many of these
children, touch in the past has been
associated with pain, torture, or sexual
abuse. In these cases, make sure you
carefully monitor how they react--be
“attuned” to their responses to your
nurturing and act accordingly. In many
ways, you are providing replacement
experiences that should have taken place
during their infancy--but you are doing this
when their brains are harder to modify and
change. Therefore, they will need even more
bonding experiences to help develop
attachments.
Try
to understand behavior before dispensing
punishment or consequences:
The more you can learn about attachment
problems, bonding, normal development, and
abnormal development, the better you will be
able to develop useful behavioral and social
interventions. Information about these
problems can prevent you from
misunderstanding a child’s behaviors. When
these children hoard food, for example, it
should not be viewed as "stealing" but as a
common and predictable result of being
deprived during early childhood. A punitive
approach to this problem (and many others)
will not help the child mature. Indeed,
punishment may actually increase the child's
sense of insecurity, distress, and need to
hoard food. Many of these children's
behaviors are confusing and disturbing to
caregivers. You can get help from
professionals if you find yourself confused
by a child’s behavior or struggling to
create and implement a practical and useful
approach to these problems.
Parent these children based on emotional
age: Abused and
neglected children will often be emotionally
and socially delayed.
When they are frustrated or fearful, they
will regress further. For example,
this means that, at any given moment, a
ten-year-old child may, emotionally, be a
two-year-old. Despite our wishes that they
would “act their age” and our insistence to
do so, they are not capable of that. These
are the times that we must interact with
them at their emotionallevel.
If they are tearful, frustrated, overwhelmed
(emotionally age two), parent them as if
they were that age. Use soothing non-verbal
interactions. Hold them. Rock them. Sing
quietly. Breathe deeply. This is not the
time to use complex verbal explanations
about the consequences of inappropriate
behavior.
It is also important to note that, while a
child may show a delay in one area, they may
be “on target” in others.
As stated above, stay “in tune” with the
child—meet her where she is.
Be
consistent, predictable and repetitive:
Maltreated children with attachment problems
are very sensitive to transitions,
surprises, chaotic social situations,
changes in schedule, and, in general, any
new situation. Busy and unique social
situations will overwhelm them, even when
they are pleasant! Birthday parties,
sleepovers, holidays, family trips, the
start and end of the school year--all can be
disorganizing for these children. Because
of this, any efforts that can be made to be
consistent, predictable, and repetitive will
be very important in making these children
feel "safe" and secure. When they feel safe
and secure, they can benefit from the
nurturing, enriching emotional and social
experiences you provide them. If they are
anxious and fearful, they cannot benefit
from your nurturing in the same ways.
Model
and teach appropriate social behaviors:
Many abused and neglected children do not
know how to interact with other people. One
of the best ways to teach them is to model
this in your own behaviors and then narrate
for the child what you are doing and why.
Become a play-by-play announcer: "I am going
to the sink to wash my hands before dinner
because…” or “I take the soap and get soapy
here and…" Children see, hear, and imitate.
In addition
to modeling, you can "coach" maltreated
children as they play with other children.
Use a similar play-by-play approach: "Well,
when you take that from someone they
probably feel pretty upset. If you want
them to have fun when you play this game…"
Positive play with other children can help
increase self-esteem and confidence. Over
time, success with other children will make
the child less socially awkward and
aggressive. Maltreated children are often
"a mess" because of their delayed
socialization. If a child is teased because
of her clothes or grooming, it can help to
have “cool” clothes and improved hygiene.
One area
that these children have problems in is
modulating appropriate physical contact.
Some of these behaviors are noticeable,
while some are almost imperceptible. They
don't know when to hug, when to pick their
nose or touch their genitals, how close to
stand, or when to establish or break eye
contact.
In these cases, it is important to gently
guide without shaming or embarrassing the
child.
As
discussed earlier, children with attachment
problems will often initiate physical
contact (e.g., hugs, holding hands, crawling
into laps) with strangers. Adults often
misinterpret this as affectionate behavior.
It is not. It is best understood as
"supplication" behavior and it is socially
inappropriate. How adults handle this
inappropriate physical contact is very
important. We should not refuse to hug the
child and lecture them about "appropriate
behavior." We can gently guide the child
toward ways to interact differently with
grown-ups and other children (e.g., “Why
don’t you sit over here?”). It is important
to make these lessons clear, using as few
words as possible. They do not have to be
directive--rely on nonverbal cues. It is
equally important to guide in a way that
does not make the child feel bad or guilty.
Ironically enough, children with
attachment problems frequently are overly
affectionate and attentive to strangers.
This is often misinterpreted as a form of
healthy attachment bonding but in fact is
reflecting profound attachment problems and
makes them more vulnerable to exploitation.
Listen
to and
play
with
these
children:
One of
the most
enjoyable
ways to
help is
just
stop,
sit,
listen,
and play
with
these
children.
When you
are
quiet
and
interactive
with
them,
you find
that
they
will
begin to
show you
and tell
you
about
what is
really
inside
them.
Yet, as
simple
as this
sounds,
it is
one of
the most
difficult
things
for
adults
to
do--to
stop,
quit
worrying
about
the
time,
your
next
task,
the
“right
words,”
and
really
relax
into the
moment
with a
child.
Practice
this.
You will
be
amazed
at the
results.
These
children
will
sense
that you
are
there
just for
them--they
will
feel how
you
care.
It is
during
these
quiet
moments
that you
can best
reach
and
coach
these
children.
This is
a great
time to
begin
teaching
children
about
their
different
"feelings."
Regardless
of the
activity,
the
following
principles
are
important
to
include:
1.
All
feelings
are okay
to feel:
sad,
glad, or
mad
(more
emotions
for
older
children).
2.
Teach
the
child
healthy
ways to
act when
sad,
glad, or
mad.
3.
Begin to
explore
how
other
people
may feel
and how
they
show
their
feeling --
e.g..,
“How do
you
think
Bobby feels
when you
push
him?”
4.
When you
sense
that the
child is
clearly
happy,
sad, or
mad,
askhim
how he
is
feeling--
let him
tell
you.
Help
them
begin to
put
words
and
labels
to
feelings;
help
them
prepare
alternate,
healthy
ways to
respond
to these
feelings.
Have
realistic
expectations
of these
children:
Abused
and
neglected
children
have so
much to
overcome.
And, for
some,
they
will not
overcome
all of
their
problems.
For a
Romanian
orphan
adopted
at age
five,
after
spending
her
early
years
without
any
emotional
nurturing,
the
expectations
should
be
limited.
She was
robbed
of some,
but not
all, of
her
potential.
We do
not know
how to
predict
potential
in a
vacuum,
but we
do know
how to
measure
the
emotional,
behavioral,
social
and
physical
strengths
and
weaknesses
of a
child.
A
comprehensive
evaluation
by
skilled
clinicians
can be
very
helpful
in
beginning
to
define
the
skill
areas of
a child
and the
areas
where
progress
will be
slower.
Be
patient
with the
child's
progress
and with
yourself:
Progress
will be
slow.
The slow
progress
can be
frustrating.
Many
adoptive
parents
will
feel
inadequate
because
all of
the
love,
time,
and
effort
they
offer
their
child
may not
seem to
be
having
any
effect.
But it
does.
Don't be
hard on
yourself.
Many
loving,
skilled,
and
competent
parents
have
been
swamped
by the
needs of
a
neglected
and
abused
child
that
they
have
taken
in.
Take
care of
yourself:
Caring
for
maltreated
children
can be
exhausting
and
demoralizing.
You
cannot
provide
the
consistent,
predictable,
enriching,
and
nurturing
care
these
children
need if
you are
depleted.
Make
sure you
get rest
and
support.
Respite
care can
be
crucial.
Enlist
help
from
friends,
family
and
community
resources.
You will
not be
able to
help
your
child if
you are
exhausted,
depressed,
angry,
overwhelmed,
and
resentful.
Take
advantage
of other
resources:
Many
communities
have
support
groups
for
adoptive
or
foster
families.
Professionals
with
experience
in
attachment
problems
or
maltreated
children
can be
very
helpful.
You will
need
help.
Remember,
the
earlier
and more
aggressive
the
interventions,
the
better.
Children
are most
malleable
early in
life and
as they
get
older
change
is more
difficult.
Remember
that
what you
are
doing is
enormously
important.
You may
not feel
as
though
you have
made a
difference.
However,
it is
critical
to
remember
that
every
positive
experience
a child
has with
a kind,
attentive,
respectful,
adult--even
when
brief--can
help
refute
what
they
have
known in
the
past.
Lesson 4
Section
Quiz
1. Consistency and
predictability are particularly important for maltreated children because:
a.
Children need an extremely full schedule to learn and
develop
b. They instill the
child with a sense of safety, allowing them to better learn and
develop
c. A caregiver needs to
know what a child is doing at every minute to help the child
learn and develop
d. None of
the above
2. True or False: Punishment typically
helps a maltreated child feel secure, because they know where they stand.
3. True
or False: Abused and neglected children always experience physical touch as
positive.
4. Maltreated children often have
difficulty coping with all the but following:
a.
Consistency and predictability
b.
Transitions
c.
Chaotic social situations
d.
Novel
circumstances
5. True or False:Offering
a running commentary on a child’s behavior during play can help teach a
child appropriate social skills.
6. If a child runs to hug
you when you first meet her:
a.
Turn and walk the other way
b.
Stop and give her an explanation about appropriate behavior
c.
Gently guide her toward a more appropriate greeting
d. None of the above
7. True or False: Listening
and playing with maltreated children can allow the child to open up and talk
freely.
8. When
working with or caring for maltreated children, it is important to:
a. Maintain fixed
expectations
b. Improvement should
happen fast if it is going to happen at all
c. Talking a lot helps
a child feel comfortable
d. The earlier and more
aggressive the intervention, the better.
9. True or False: A comprehensive,
professional evaluation can help identify a child’s strengths and
problematic areas.
10.
Which of the following is a self-care strategy?
a. Getting
adequate rest
b. Setting aside time
for yourself
c. Enlisting occasional
respite care
d. All of the above.
Lesson 4 Quiz Answers
1.
Consistency and predictability are particularly important for maltreated
children:
The correct answer:
b
Comment:
Consistency and predictability instill children
with a sense of safety, allowing them to better
learn and develop.
2. Punishment typically
helps a maltreated child feel secure, because they know where they stand.
The correct answer: False
Comment:
Maltreated children, as do all children, respond
best to encouragement, gentle redirection, clear
limits and expectations.
3. Abused
and neglected children always experience physical touch as positive.
The correct answer: False
Comment: Many
maltreated children find physical touch threatening
and must learn, over time, what both
appropriate touch and physical boundaries are.
4. Maltreated children often have
difficulty coping with all the but following:
The correct answer:
a
Comment: Consistency and predictability help
all children feel safe and secure.
5. True or False:Offering
a running commentary on a child’s behavior during play can help teach a
child appropriate social skills.
The correct answer: False
Comment: Your
insightful comments can help a child understand
cause and effect. When you say to your child
"I see you've offered Rachel your toy truck.
Sharing is a great way to make a friend," it helps
your child understand the value of his interaction.
6. If a child runs to hug
you when you first meet her:
The correct answer: c
Comment:
Many children with attachment problems are
indiscriminant with their physical affection.
Do not reject these children. Rather gently
guide their intended embrace into a more slightly
distant interaction - such as a warm pat on the arm
or rub on the back along with a big smile and warm
hello!
7. Listening and playing
with maltreated children can allow the child to open up and talk freely.
The correct answer: True
Comment: The
safer a child feels, the more he will reveal.
8. When
working with or caring for maltreated children, it is important to:
The correct answer: d
Comment:
Intervene as early and as aggressively as possible.
9. A comprehensive,
professional evaluation can help identify a child’s strengths and
problematic areas.
The correct answer:
a
Comment:
Focus your efforts.
8.
Which of the following is a self-care strategy?
The correct answer:
d
Comment:
Don't underestimate the energy it requires to care
for at-risk children (and children in general)!
Get rest, time for yourself and help with the
children in your care so that you can return to them
refreshed and more able to meet their needs.
Resources
There are
many other places to learn more about attachment and bonding in
maltreated children. A few starting places are listed below.
ORGANIZATIONS
Zero to Three
is a national, nonprofit organization located in Washington,
D.C., dedicated solely to advancing the healthy development of
babies and young children. Founded in l977 by top developmental
experts, ZERO TO THREE disseminates key developmental
information, trains providers, promotes model approaches and
standards of practice and works to increase public awareness
about the significance of the first three years of life.
ZERO TO
THREE
734 15th Street, NW, Suite 1000
Washington, DC 20005
(202) 638-1144.
Homepage:
http://www.zerotothree.com
PACT:
A
nonprofit 501(c)(3) organization begun by two adoptive parents
in 1991, Pact has developed a national reputation for excellence
in serving all members of the adoption triad. Each year, Pact
offers educational events attended by more than 1500
individuals, provides - free of charge - over 1000 crisis
consultations to birth parents, and consults with hundreds of
potential adoptive parents. Top priority is given to programs
especially designed to support and inform adopted children and
adopted adults of color.
Pact, An
Adoption Alliance 3450
Sacramento Street Suite 239
San Francisco, CA 94118
(415) 221-6957
(510) 482-2089 FAX
e-mail:
info@pactadopt.org Homepage:
http://www.pactadopt.org
Attachment Parenting International
is a coalition of concerned individuals, professionals, and
grassroots organizations. They advocate special “attachment
parenting” methods to develop and fulfill a child's need for
trust, empathy, and affection in order to create secure and
enduring relationships. This organization feels that attachment
parenting, in conjunction with support groups can not only
strengthen families but provide a simple and cost-effective
model to aid in the prevention of
child abuse,
behavioral disorders,
criminal acts, and other serious
social problems.
AttachmentParentingInternational
1508 Clairmont Place
Nashville, Tennessee 37215
(615) 298 4334
Attachment:
A special form of emotional relationship. Attachment involves
mutuality, comfort, safety and pleasure for both individuals in
the relationship.
Attunement:
The ability to read and respond to the communicated needs of
another. This involves synchronous and responsive attention to
the verbal and non-verbal cues of another.
Bond:
A bond is a relationship. Bonds may be of special mutual
emotional nature such as an attachment or they may be based upon
other emotions (e.g., fear – such as seen in the bond between
captor and captive).
Bonding:
Any activity, action or behavior that helps establish or
maintain a relationship.
Strange-Situation procedure:
A specialized clinical-research procedure involving eight
separations and reunions with an infant and their caregiver
designed to determine the nature of the attachments.
Getting Involved
Our society has been ineffective in preventing,
identifying, and responding to the maltreatment of children.
The impotence of our social systems to help children does
not mean that you, as an individual, are powerless. Your
actions can have dramatic impact on children in your
community and, by supporting the efforts of effective
organizations, your actions can impact thousands of children
in this generation and in generations to follow.
There are many ways that you can choose to fight the
maltreatment and trauma of children. Whatever method you
choose, know that however small your effort seems, your
participation is critical. In the end, unless we all
participate in some fashion, we will always fall short of
our true potential as individuals and as a society. Choose
to help in a way that works for you. You may want to work
directly with maltreated children, or you may choose to
contribute in any variety of important ways. Please
remember, you don't need to work directly with the child to
be able to make a dramatic difference in their life.
Give Your Time
In your community, there are children that need the gift of
attention, respect, instruction, comfort, and hope. So many
children from abusive settings have lost hope. Even brief
interactions with respectful, honest, and nurturing adults
can be helpful to the abused or traumatized child, allowing
them to know that adults can be kind.
There are many ways to find children who need your time.
Volunteer to be a foster parent, to rock the crack-addicted
infant in the hospital, to teach a child to read, to be an
aide in the local public school, to answer phones at a
battered women's shelter. In all of these settings, you can
enrich the life of a child. You can give a child hope.
Give Your Skills
You may not realize how your skills can benefit maltreated
children. Desperately underfunded child protection, child
welfare, and child mental health systems can always benefit
from the innovative use of your skills. A residential
treatment center may need help with accounting or computer
programming. A local children's shelter may not have a
library.
A dancer can teach some foster children how to dance. A
computer programmer can teach these children computer skills.
A writer can write editorials/articles/books about these
issues or help an agency create a newsletter. Your skills,
whatever they are, can be used to fight abuse.
Give Your Money
In the United States, we spend more money on studying and
treating abusers than we do on their child victims. Research,
clinical services, and specialized professional training in
child abuse are dramatically underfunded. You can help support
these critical activities by financially supporting effective
and innovative programs such as the ChildTrauma Academy.
Please direct donations to:
The ChildTrauma Academy 5161 San Felipe, Suite
320 Houston, Texas 77056
Checks should be made payable to "The ChildTrauma
Academy."
As you give time, skills, or money to help these broken
children, you may find that your life will be enriched and
that hope has a new meaning for you. You can make a difference
in the life of a child with your time, and in the lives of
many children with your financial support. Choose to act.
Give Your Voice
Play a role in helping change the policies and practices
that have allowed our society to ignore children. Remember,
children don't vote. And far too many traumatized children
have no effective adult advocacy. We allocate research and
service-delivery dollars in the United States in a way that
reflects political power. Maltreated children have no
political power in this country, nor any other country.
Whenever you can, talk to the media. Talk with your local,
state, and federal representatives to inform them and urge
them to think about the future of our children. Write letters
or send e-mails to make them aware of your concern. They all
say that children are our future. Make them walk the walk and
not just talk the talk.
Assignment #4
Identify 3 resources (i.e., professionals, agencies,
organizations) in your community that can assist
families and children. Examples of these types of
resources can include:
�
Social workers
�
“Child Find” programs
�
Doctors
�
Head Start/Early Head Start programs
�
Psychiatrists
�
Child advocacy attorneys/agencies
�
Psychologists
�
Parent education programs
�
Counselors
�
In-home family services
�
Early Childhood Intervention programs
�
Children’s enrichment programs
Congratulations! You have completed Lesson
4 and the Course.
A Final Word From Your
Instructor
I have really enjoyed the opportunity to teach all of you
about Bonding and Attachment. This course is intended as an
introduction. The subject is such an important one.
So much of healthy development is dependant upon the early
relationships we each experience in our lives. I encourage
you all to continue learning.
Read, question your colleagues, network in your community, and
find ways to help children.
It is my sincerest hope that you will be able to apply the
information you have
learned in your daily life. Each positive interaction you
have with a child will undoubtedly make the world a
better place for children and ultimately us all.
I wish you the best of luck in your endeavors and thank you
for your time and commitment to children.
Bruce D. Perry, MD, Ph.D.
If you have just completed this course for
CEU credit, please remember
that you need to complete the questionnaire and mail your
payment to us.
Return to
questionnaire & payment instructions.
QUESTIONNAIRE
Bonding and Attachment in
the Maltreated Child (3 credit hours)
Reminder -- To receive
CE credit for this course, you must 1) Purchase this
course and
2) send in the following questionnaire
Copy and paste the questions into a new
document (into an email or into a Microsoft Word document), type in your
answers and then email the completed document to us (if you've chosen
Microsoft Word, send your file as an attachment).
Or mail the questionnaire
Print this page, write in
your answers and then mail (along with your payment) to The ChildTrauma
Academy, 5161 San Felipe, Suite 320, Houston, TX, 77056
Today's Date:
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it should appear on your CEU
Certificate:
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where you will receive your CEU Certificate: (Street,
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if needed:
The purpose of the
following questions is to: verify that you have
read the required course material, demonstrate an
understanding of the practical application of the material and officially document
your participation and completion of this course.
*
Brief answers will suffice.
1.)Did you read
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actively consider the course assignments?
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concepts discussed on the course lessons do you believe can be of practical
value to professional practice (provide at least 1 specific example)?
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practical value to professional practice (provide at least 1 specific
example)?
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Now Rate this course (required for credit):
On a scale of 1 – 5
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