2. How does trauma apply to ‘looked after’ children?

Whether ‘Looked After’ children were accommodated at birth or subsequently they share one thing in common; they have experienced separation from their birth parents an experience that is likely to have engendered feelings of abandonment. Many will also have suffered abuse and/or neglect; some will have experienced multiple transitions within the care system.  All of these can be recognised as ‘distressing or emotionally disturbing experiences’ that are ‘associated with terror and helplessness’ and ‘a feeling that the individual or someone important to them is at serious risk’.  Sadly the corollary that the emotional experience ‘results from events outside normal human experience’ may not be true for an abused or neglected child or for their parenting figures. Instead abuse and neglect may be experienced by children on a daily basis and become endemic to the way they view themselves and the world around them. It is the way they find a ‘usual coping mechanism’ to manage ongoing abuse and neglect that continues to impact them as they move to new families and which, in turn impacts on family life.

Babies can be born traumatised. Foetal exposure to drugs, alcohol and/or domestic abuse means that the foetus is at risk for developing in a toxic environment that can profoundly impact their psychological and physiological well-being. (Scottish Government 2013)  After birth, even if placed in the safety of foster care, these babies’ first experiences of life are likely to continue the trauma of their pre-birth experiences. Babies born drug dependent may need post-natal hospital care where they experience ‘multiple caregivers’ and therefore multiple abandonments; they may be more fractious and difficult to settle meaning that they cannot find comfort by being soothed and also meaning that they are unlikely to feel the sense of calm that promotes feelings of safety and security (Potts 2005). The result is that they are likely to experience a threat to their physical and/or psychological integrity which, in turn, engenders feelings of fear, horror and/or helplessness.  Essentially these babies have greater care needs than the ‘average’ baby and less ability to benefit from safe, loving care.

Birth parents who, perhaps due to having experienced unsafe care themselves as children, can struggle to provide adequate care for their baby. This means that a baby who needs better than average nurture and care, may, in remaining with a birth mother who is struggling, receive less than average nurture and care. This is likely to compound the traumatised baby’s pre-birth difficulties meaning that threats to their physical and/or psychological integrity are more intense.

Research has highlighted the intersubjective nature of the way in which babies develop their sense of themselves, their environment and their carers (Stern 1998, Siegel 2012). The meaning babies give to experiences is ‘state dependent’; i.e. dependent on the nature of their relationship with their primary carers and the sense that these carers input to their baby.  A mother struggling to parent her child as a result of having a childhood history of abuse and neglect, being reliant on drugs and/or alcohol, being subject to domestic violence and/or through post-natal depression may wish to provide a loving and stable environment for her baby but instead finds herself struggling to meet her baby’s needs in a sensitive, timely and loving way. Instead of conveying a message that her care is safe and that the world is a safe place, an angry, scared or dismissive mother might convey a message that the world is a scary place, that her parenting cannot be trusted and/or that her baby is creating stress and pressure. Babies living in this environment may develop an additional belief that they do not ‘deserve’ to have their needs met. Essentially the mother is downloading her view that the world is an unsafe, dangerous and scary place onto her baby at a time when the baby is just beginning to develop an understanding of the world and their place within it (Sunderland 2006).

The neuro-biology of trauma demonstrates that the impact of abuse, neglect and/or abandonment is most profound during a baby’s earliest months and years; and by the frequency and intensity of these experiences. This is significant for babies who are subject to abuse and neglect at time when they are totally dependent on their parents for survival. Babies have no means to protect themselves, they have no escape route; early trauma experienced from survival figures is therefore likely to feel more extreme; i.e. to engender even greater fear and terror than it would in older children or adults. Furthermore babies live ‘in the moment’ meaning that relatively minor traumas can feel overwhelming to them. This, along with the frequency of incidents, can mean that babies can experience abuse and neglect as life threatening and lifelong; i.e. as trauma (Lanius, Vermetten, Pain 2010).

Abused and/or neglected children who have been exposed to on-going trauma, over a prolonged period of time, and during a time when they had few opportunities to experience safety and security carry brain and body responses consistent with their traumatic experiences. A growing body of scientific research supports this by identifying the way in which the neuro-biological impact of early abuse impacts children in their brains and in their bodies meaning that traumatised children can develop different neurological patterns to their non-traumatised counterparts (Shonkoff & Levitt 2010).

Exposure to stress chemicals such as adrenaline and cortisol can also have a long-lasting impact on traumatised children’s ways of understanding themselves and the world around them. Furthermore the intersubjective nature of the way in which babies and children make sense of the world means that traumatised children develop ‘mirror neuron patterning’ that colours their understanding of the intentions of the adults who are caring for them; in effect they may interpret the positive intentions of safe and loving parenting figures as potentially abusive and threatening (Iacoboni et al 2005).

Furthermore the nature of abuse and neglect means that traumatised children are likely to have experienced repeated trauma. It is this accumulative impact of traumatic incidents that is a key factor in understanding the traumatisation of both children and their parenting figures.

Traumatised children often have difficulty making and maintaining healthy attachments and in trusting adults especially those in a caring role; they are likely to struggle to feel a sense of self-worth. Feeling helpless and hopeless, they may display anger, withdrawal, extreme controlling behaviours and a seeming refusal to accept the parameters of ‘ordinary’ family life. Some children respond by becoming the ‘good child’ acting out their distress by extreme compliance or by passive /aggressive responses. The beliefs that underlie these controlling, oppositional and withdrawn behaviours, embedded as they are within the neuro-biological structure of the traumatised child’s brain and body, means that the emotional, psychological and behavioural impact on the body and brain of early trauma is both profound and long-lasting; it may have become their ‘usual coping mechanism’ to manage stress. Trauma experienced in the womb and/or in a baby’s early months and years can therefore continue to impact through later childhood, into adolescence and adulthood. For example, fewer than 1% of all children in England are in care but looked after children make up 30% of boys and 44% of girls in custody. (Ministry of Justice 2012).

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