What can professionals do to help?

First and foremost professionals must work to understand the profound and pervasive impact of abuse and neglect on the children they are placing in new families. They need to be honest with prospective parents and carers about the potential impact on families, to be pro-active and consistent in the support and understanding they offer both during the difficult times and when children present as being more stable. Traumatised children are likely to have long-term needs above those of their non-traumatised counterparts; their carers therefore will need long-term, consistent and empathetic support and understanding if they are to meet their children’s needs in the long-term.

Professionals need to help parents retain feelings of self-worth and self-esteem by valuing them and the contribution they have made, and continue to make, to their children’s lives. Noticing the positives while not dismissing parents’ concerns is crucial. Parents do not need to hear that ‘all children do that’ when they have been brave enough to share some of the difficulties; their worries and concerns need to be validated and supported. This needs to be balanced with an acceptance that parents are doing the best they can in very difficult circumstances.

Professionals need to be alive to the possibility that parents are being subject to aggression and violence and give them the opportunity to express this in a non-judgemental way. Awareness that a child has been abusive in the past should signal the need to ask questions about whether any acts of hitting or violence has occurred since the previous visit. Recognising the possibility that parents might minimise this and demonstrating understand and empathy will allow parents to talk about the extent of continuing violence and aggression. This is essential so that parents do not feel isolated and alone.

While not condoning aggressiveness towards children it is important that professionals understand the context in which parents might respond to violence with anger. This will help professionals demonstrate the understanding and empathy that is a precursor to helping parents deal in a more appropriate way with their children’s behaviours.

Trying to put yourself in a parent’s place and wondering how you might respond, for example, to a child swearing, lying, hitting you, rejecting you, or damaging things you hold precious might help to develop a spirit of understanding and of working together to make things better. This needs to reflect the fact that parents may well be managing these behaviours on a daily if not hourly basis.

We need to treat parents with respect and to validate and value the crucial role they play in the lives of some of the most vulnerable children in our society. This understanding provides the context for working with parents to help them develop different emotional and behavioural responses to violence and aggression. In doing so we can help both parents and children; both have a right to be listened to and both have a right to feel safe and free from fear. Both need strategies for managing their feelings in a more helpful way and practising different ways of behaving; neither will do this if they feel blamed and misunderstood.

Having an understanding ‘listener’ who can ‘hear’ the parents’ pain is also likely to reduce the potential that they act out their feelings by shouting at or smacking their children; being able to share feelings in a caring and supportive environment helps dissipate parents’ anger and frustration, even when the child’s behaviour remains challenging.

Parents can find that their current life reflects the chaos that was endemic to the early lives of their traumatised children. Helping parents to explore, in a non-judgemental manner, ways to make family life less chaotic is vital. Offering pro-active support and comfort forms the basis for the development of a trusting relationship between parents and professionals and allows for the reduction in the sense of isolation that many parents of aggressive children feel.

Since their outbursts are difficult to contain, parents might find themselves giving in to unreasonable demands to reduce angry outbursts in their aggressive children. As a result, aggressive children often control the emotional tenor of family life. This is not helpful for children, since it reflects the chaos of their early experiences and their inner world. Neither is it helpful for their families. Instead we need to support parents to provide the structure that will help change the balance of control within the family and, in doing so, create the atmosphere that is more likely to reduce their children’s aggression.

Positive parent/child interaction is dependent on relational reciprocity.  This is hard to achieve when parenting an aggressive child who challenges parental authority and who rejects every attempt for positive engagement. In this situation parents may feel that parenting is a chore and a joyless experience.

This, in turn, results in a lack of the hormone oxytocin which depletes the brain’s capacity to parent and can increase parents’ feelings of trauma and lead to blocked care (Hughes and Baylin 2012). Offering aggressive children safe and fun ways to engage in family life is crucial.

We therefore need to help parents and children experience joy and acceptance in their relationship, while recognising how difficult this might be for both parents and children. Alongside encouraging parents to reinforce the message that aggression is not an acceptable way to express feelings, we must support joyful family experiences. Love and the expression of it needs to be unconditional.

In this way children will begin to internalise the message that it is their behaviour that is being challenged and not themselves as worthwhile individuals. For this reason it is important that some family activities are sacrosanct regardless of the child’s behaviour; for example a bedtime story, or song should not be dependent on whether a child ‘deserves’ it.  Parents may struggle to do this unless professionals also offer support unconditional support that recognises that parents are doing the best they can in very difficult circumstance.

There is a link between decreases in the level of the hormone serotonin and an increase in aggression (Damasio 2007). This suggests that helping children and parents to increase their serotonin levels will decrease violence. One way of doing this is to help parents feel more relaxed by increasing their feelings of efficacy.  Offering practical strategies for helping parents and children express their feelings in non-aggressive ways is therefore an essential component in working with families.

Adrenaline decreases and serotonin increases when engaging in physical activities such as walking and cycling. Introducing these activities within the structure of family life can be time well spent when compared with the more stressful, time consuming and less productive time spent managing a child’s aggressive outbursts.

Supporting parents and children to play together is likely to benefit family life in a way that insistence on completing homework tasks will not. We may have to work with school to help them recognise the priorities for children and their parents. If aggression is reduced parents’ feelings of efficacy and self-worth is likely to increase; and if change is more tenuous the exercise itself can make parents feel better.

Noticing the times of the day that are most difficult for a child can be helpful. Many of the parents we work with at Adapt (Scotland) report that their children are highly aroused and difficult to manage when they are collected from school. Understanding the reasons for this, for example recognising that a child, who has had five different families before placement in their adoptive family, is likely to have feelings on abandonment, allows parents to remember that their child’s serotonin levels may be depleted by the end of the school day. Offering their child a healthy snack such as a banana at the end of the school day and walking home from school, perhaps encouraging children to skip, run and/or sing during the journey may well give them the serotonin boost they need to reduce their propensity for acting out their feelings in aggression. If the snack has been agreed during the morning routine, this will convey a message that the parent will be there at the end of the day and potentially reduce feelings of abandonment during the school day.

So, too, is supporting parents to ‘name’ their children’s behaviour alongside a clear message that aggression, while understandable in light of the child’s history, is not acceptable. This must be accompanied by the message that parents are willing to help their children manage their anger in different, healthier, ways. Such discussions can only be effective during periods of calm when both parents and children are more likely to be in cortical, thinking mode. This means that naming feelings and behaviours should be done either in the ‘calm before’ or the ‘calm after’ the storm (of an aggressive outburst). As this can be difficult to manage parents may need help to think about when and how to reflect on their children’s behaviours and the potential underlying reasons.

Having a range of alternatives and having these, perhaps, printed on a family poster, with a pictorial representation of safe alternatives to anger, that can be referred to may help to provide this message. This is especially important for those occasions when anger is threatening to spill over into aggression. At these times both parents and children are likely to be operating from their fear based limbic systems meaning that their capacity for cortical processing, i.e. their thinking ability, is reduced. Having strategies to hand that have been agreed during periods of calm reflection and that can be ‘pulled out of the bag’ at moments of stress offers children the message that parents are there to help them manage their feelings in a healthier way.

Having a pre-prepared range of strategies also reduces the need for words. This is important. When children are operating from their limbic and/or brain stem – in flight, fight or freeze – their capacity to respond to verbal cues is reduced. This means they are not likely to be able to respond to verbal messages to calm or to questions about the how, why and what that caused their aggression to erupt. Such questions are likely to increase rather than decrease anger and therefore aggression. Instead, the sight of a parent skipping into the room holding their agreed ‘Calming Poster’ and singing or acting out the previously agreed alternatives is likely to be more effective. At the very least this strategy will help to keep parents on track by increasing their feelings of efficacy and, consequently, their serotonin levels.

Teaching parents about the neuroscience of aggressive behaviour and supporting them to remember that, however deliberate or controlling their child’s behaviour seems, the underlying reasons for aggression lies in their children’s early histories and in the neuro-biological impact of trauma can help parents maintain a positive attitude. Recognising that children ‘can’t do’ rather than ‘won’t do’ can support positive interactions and remove the feeling of ‘it’s my/her fault’, ‘I’m a bad parent/child’ for everyone,