Patterns of Abuse and Their Consequences

In our recent Newsletters we are building a picture of how early childhood abuse and trauma influences the behaviour of the victims, in our work focussing on the classroom.  Children who experience abuse can be subjected to a range of different types and patterns of abuse. Two patterns that can have distinct impacts on a child's development, behaviour, and mental health are consistent abuse and unpredictable abuse.  The difference will determine how the child deals with future stressful interactions.

Although it's important to understand that each individual responds to trauma differently, depending on a person's personality, experiences, and support system.  When a child is raised in an environment where the abuse is predictable that is, there is a repetitive pattern, the child can develop a strong protective response that minimises the impact of that abuse.  These children will bring that response into the classroom.

One example that stays with me was during my time coaching junior teams.  I remember a small, immature child who I could see was afraid of the physical contact expected in the sport.  Every time he hesitated to make a tackle or missed his opponent his father would consistently berate him or show his displeasure.  To avoid this rejection the child threw himself into collisions that would physically hurt but the resulting pain was not as worrisome as that rejection.  That child presents to the class as a tough kid a behaviour that hides his true temperament. As an aside, we understand that to build behaviours we need repetition and these children have learned behaviours that are ‘functioning’ in their abusive environment.

On the other hand, unpredictable abuse occurs when a child is subjected to a range of assaults or when it occurs randomly or intermittently.  The uncertainty and unpredictability in the child's life doesn’t allow them to develop protective behaviour.  Each episode is different and so the child does not have the repetition to create the behaviours.

The resulting inability to predict what will happen develops a sense of hopelessness in these children, that they have no control over their life and so their behaviour becomes erratic with no apparent purpose especially in times of stress.

Examining the responses to the predictability, or lack of helps us understand what drives the student’s behaviour in class.  The difference between these two extremes of response to abuse can be illustrated by examining how they relate to the following five particular characteristics.  On the left side we examine those children raised in unpredictive families and the right predictive.        

 The children from unpredictable environments feel:

• Less Than – These kids, through their sense of worthlessness and shame never feel they are really entitled to have their fair share of life.  When they are rejected, or by-passed, their response is not to stand up for their rights but say what they think ‘it doesn’t matter’ because they think they don’t matter.
• Vulnerable – They are unprotected from future abuse and they lack the assertive capacity to get their own needs met.
• Bad/Rebellious – Remember it is their sense of self that shapes their reality and because they have felt their abuse was deserved, they believe they are basically were ‘bad’.  Then, in some act of defiance they confirm this opinion by their actions; it’s like a self-fulfilling prophecy – ‘so you think I’m bad well I’ll just show you how bad I am’!
• Dependent – Because they have no sense of competency, no belief they can do anything properly, kids with no protective behaviours they depend on others to make decisions for them. 
• Out of Control – These kids have no concept of being in control of their life. How could they when they have never experienced consistent consequences for their attempts to protect them self.  When they make decisions, they have no prior knowledge about what will happen and so they make their ‘best guess’. 

These ‘out of control’ kids are easy to recognise, in fact they demand our attention.  They will act impulsively and with dysfunctional behaviours that were functional in their childhood homes.

At the other end of the spectrum are the children who have been abused in a more consistent manner.  They display the following characteristics:

• Better Than – Because they had to be just what their parent wanted they learned that they could have a deal of power over the situation in which they found themselves.   Getting the decision on how to act was important, it had to be ‘just right’ to survive. 
• Invulnerable – These kids become very self-reliant, they don’t let anyone get close enough to find out how they really feel. This being locked in makes them appear and feel invulnerable but the cost is isolation.  Regrettably, this emphasis on preventing authentic contact with others limits opportunities to get their own needs met. 
• Good/Perfect – Much the same as ‘Better Than’ this characteristic is also a result of the earlier need to make no ‘mistakes’ when dealing with their abuser.  This reliance on perfection is their defence from being punished and they are well aware of how to avoid this. 
• Independent – Because they have been raised in an atmosphere of having things done to them and because there was no one to support them when they were being abused these kids don’t really feel they can trust others and so they never risked depending on another person.
• Total Control – It is no surprise that these kids don’t take risks, it is too dangerous if you make a mistake.  The tragedy is that the behaviours they use to ‘control’ their environment are the ones they learned in a dysfunctional environment; to try new behaviours is too dangerous and so they control what they can and ignore anything else!  

It is obvious from the descriptions above those kids who have been raised in unpredictive, abusive environments are easy to identify and our classic response of structured, predictable and consistent approach helps deal with them.  The kids who are damaged but in a predictable way will be at home in that environment and this is where the relationship component is decisive.  Only through getting to understand all the kids, not just the ones that demand your attention will you be able to help them become integrated members of the classroom. 

Remember none of us are:

• Less Than or Better Than – we are unique and there is no point in comparing our worth!
• We all live through times when we are vulnerable and there are times we have to risk being vulnerable.  All we can do is the best we can knowing that life will do things to all of us!
• Bad/Rebellious or Good/Perfect – Of course, no one is perfect, this is an impossible ambition and there might be some reward in being a bit cheeky and rebellious, it means you are human.
• We live in communities and so it is really impossible to be totally independent however, it would be a mistake to be totally dependent.  There are times when you will need to behave in ways that are near these extremes to either protect yourself or get your needs met but you need to be informed about the possible consequences before you make those decisions
• Just like dependence, you are never in control of the environment and so you can never be totally in control.  The purpose of behaviour is to provide you with defence against assaults or the ability to acquire something from the environment that will nourish you.  Education is learning this level of control!

Regardless of the type of abuse experienced, the strategies outlined above are applicable.  

Abuse - Consequences

The last Newsletters have described the impact of abuse imposed on children.  In summary these include damage such as:

• Broad scale reduction in the neural density caused by the lack of appropriate stimulation at the pertinent times and the corresponding, excess pruning.
• A deficit when it comes to forming memories because the very part of the brain that creates memories the hippocampus is reduced in size by up to 10%.  It is the hippocampus that decides what to remember and distributes this across the cerebrum.  
• The lack of neural density in the frontal lobes estimate at being as much a 20%. 
• The scarcity of neurons means the material to build memories is less than children who have had secure childhoods.
• The increased sensitivity of the amygdala creates a hypersensitive individual.

There are plenty of resources that describe the various types of abuse none better than that found on the Department’s Student Wellbeing policy under indicators of abuse and neglect.  The following is a very short description of the types of abuse that are recognised:

• Physical - This is the use of intentional force against a child’s body or an unwanted invasion of their physical space.  This is generally:
  •  Hitting
  • Holding down
  • Exaggerated tickling
  • Pulling hair
  • Twisting ear
  • Etc.
• Psychological/Emotional Abuse

Forms of emotional abuse are:

• Attacking the worth of the child by rejecting them, terrorizing or isolating them.
• Telling the child that they are stupid, un-loveable or unwanted.
• Being overly harsh in criticizing the child.
• Punishing the child when they become emotional – don’t be a baby, etc. or when they show no emotion when it would be appropriate to do so.
• When the love of a parent is conditional on their behaviour (I will love you if …)

• Sexual Abuse

This abuse is when an adult or older adolescent uses the child for their sexual gratification or for financial profit of the person committing the act.  This can include:

• Unwanted touching or penetration of the sexual organs.
• Adults exposing their own genitals to a child.
• Exposure to inappropriate sexual experiences or information (i.e. Pornography).

Other forms of Abuse that are not recognized by the Department include:

• Intellectual abuse which occurs when a child is placed in a situation where they are asked to perform a task they are developmentally incapable of successfully achieving.  Consider this abuse in regards to academic testing to identify rankings!  It also occurs when children’s performances are compared in any discipline
• Spiritual abuse occurs is when the parents put themselves above the child.  The child must ‘worship’ the parent.  A contrary form of spiritual abuse occurs when the parents put the child above themselves.  The child becomes the focus of their devotion, they can do no wrong.  These children never learn to take responsibility.  In the first instance the parent knows best and you just do as you’re told.  In the latter form the parent will not see any faults in the child’s behaviour and so they never get the natural consequences when they make a wrong choice.

The point is that children who have been subjected to neglect and abuse live with a real, imposed disability which causes them to exhibit a range of dysfunctional behaviours that can impact their academic success and social-emotional well-being.  As their teacher, you play a critical role in their lives.  It is important to recognize these behaviours and take steps to address them in a sensitive and effective manner.  Previously I have talked about children who have adopted behaviours that were functional in a dysfunctional home but whose behaviours become dysfunctional when they find themselves in a functional classroom.  

Rather than describe specific behaviours I will focus on the broad issues that drive those dysfunctional actions.  One of the most common is the difficulty children who have experienced abuse have with their ability to regulate their emotions.  These children may be prone to outbursts, aggression, and other disruptive behaviours and when a crisis is over they will take much more time to regain an emotional state where they can participate in the lesson.  It is important to create a safe and supportive environment where students feel comfortable expressing their emotions.

Another common problem exhibited by children who have experienced abuse is the difficulty with the establishment of positive social relationships.  The most critical undertaking children of all ages is to acquire the social behaviours that allow them to participate in their community; rejection creates more damage than any other assault!    These kids are more likely to exhibit overt aggressiveness towards their classmates or withdraw from the class.  These kids will struggle to make or retain friendships. 

Critically these children are likely to struggle academically.  Because they are hypervigilant they may have difficulty focusing. If the abuse is ongoing they may miss school due to injuries or appointments with social workers, and may struggle to keep up with coursework.

Finally they can experience a range of physical symptoms, including chronic pain, headaches, and fatigue which will impact on their attendance or in the least their level of engagement.

It is important for teachers to be aware of the signs of child abuse and to take appropriate action if they suspect a student is being abused.  Teachers are mandated, through Child Protection laws to report suspected abuse or neglect.  All schools are familiar with these requirements but when in doubt it is important to make the report.

Our whole purpose is to support teachers when dealing with these kids.  Our model of structure, expectations built in an atmosphere of positive relationships is key.  In doing so you create a safe and supportive environment for all students.  You promote positive behaviour, creating a sense of belonging, and providing opportunities for students to feel valued and respected.

Neglect - Passive Abuse

In the last Newsletter we discussed the damage that occurs when a child is exposed to extreme levels of stress.  Of course, this stress is generated by conditions in the environment often, but not always the reaction to abuse.  Neglect could be considered to be the inverse of these conditions.  It is a condition where the environment fails to provide the stimulus that is needed to form the neural connections that build the cognitive structure that determines our sense of self!

Appropriate stimulus is essential in early childhood when the brain is primed to develop foundation networks and there is an abundance of neural material to create the behavioural schemas to navigate the environment.  It is a process of trialling behaviours that will address the needs we have to survive in homeostatic equilibrium.  Over this period of exploration one solution will take primacy.  With progressive use of the neural pathway that facilitates that behaviour will reinforce it creating a memory.  This process is referred to as long term potential (LTP) and is characterised by the popular declaration ‘neurons that fire together are wired together’!  These will eventually become the long-term memories that drive our behavioural choices.

The conditions that support this process are at their greatest in early childhood with the abundance of neurons available and the presence of myaline, critical to the strengthening of pathways.  It is also the time when the brain is particularly sensitive to the environment.  One feature of this process is what is described as ‘windows of opportunity’ when areas of the brain are particularly enriched to support specific undertakings.  A powerful example of this process is in establishing the ability to interpret visual stimulation, that is learning to see. 

If a child is born with cataracts they are unable to receive visual stimulation, there is nothing to evaluate.  It is in about the first eight months the conditions to learn to see are augmented that is, there is abundance of myaline present.  If the cataracts are removed in time the ability to see will be in place.  However if not, then that child will not be able to correctly interpret their visual environment.  This phenomena illustrates the dual types of impairment that are the consequence of neglect.

The first is the necessity of a stimulus to generate the need to create neural pathways, hence memory and resultant behaviours.  The example of the presence of cataracts illustrates just one of the significant processes that require stimulus in early childhood.  In broad sequential terms these periods start with sensory development as illustrated above and the same is required for the interpretation of other receptor inputs such as sound.  The next is the acquisition of language.  All parents rejoice at their child’s first word and it is miraculous how they quickly learn, not only put those words into language. 

The next is social and emotional development.  This starts with attachment where the stimulus provided by the primary caregiver, usually the mother will determine the child’s ability to attach with others.  Attachment theory provides a powerful illustration of how different stimulus results in different properties of the child’s ability to bond with others.  In general, there are four types of attachment very briefly described below:

• Secure – where the child feels comfortable and protected in the presence of their caregiver.  They grow to feel they have someone on whom to rely.
• Anxious-Ambivalent – this is the result of inconsistent parenting; the child is unable to depend on the support being there.  This results in fear of rejection of abandonment and these children will be described as ‘clinging’.
• Disorganise – This develops as a result of consistent failure of the caregiver to respond when the child is in distress.  This has an impact on their ability to regulate their emotions.
• Avoidant – this is a result of parenting by strict and emotionally distant parents who do not comfort their child when distressed.  These children become extremely independent and often are uncomfortable in intimate relationships.

Each of these types are a result of the social, environmental stimulus that was present at the time the child was ready to develop attachment behaviours.  The same process of relating with others continues with the ability to connect with peers, affiliation is the next stage.  This occurs at playgroup, or preschool, anywhere they mix with children of their own age.

One stage that has been identified but, to my knowledge not examined for the same neural and myaline conditions of early childhood is the emergence of the teenage brain, the time when the frontal lobes, in particular are being developed.  In contemporary culture teenagers spend inordinate amounts of time on electronic devices immersed in social media or the various gaming platforms.  The focus on this particular environment may well develop very sophisticated accommodating networks.  I wonder what stimulus is not being catered for?  At a school level, while we develop an authoritarian focus on numeracy and literacy (the dreaded NAPLAN regime), what are we neglecting to provide the stimulus for a healthy development of self?

In summary, the first behavioural casualty from neglect is the absence of stimulus.  This is a different issue than the presence of inappropriate stimulus which is a separate cause of dysfunctional behaviour.  In this latter case the pathways will be developed and strengthened; the brain does not make ‘principled’ judgements it just provides for the presenting environment.

The second casualty is a result of the brain’s drive for efficiency.  We have discussed the development of dominant neural pathways which were formed through trial and error.  What we must understand that during these trials there are many efforts that did not provide a satisfactory behaviour and were discarded.  This residue of neglected neural connections create an inefficiency in the processing of behaviour and along with those neurons not used they are discarded; this is a process referred to as pruning.  The issue is, once this neural material is removed any attempts to re-address the issues arising from an environmental stimulus are much more difficult to construct.  This is why students who have built a powerful collection of behaviours that work in their early childhood environment struggle if the adult environment they now experience contrasts.  It is very difficult for these students to learn new ‘appropriate’ behaviours!

In summary, the behavioural outcomes from neglect is a child who is at risk of cognitive delay, high levels of aggression and anxiety and social isolation.  For students, and there are many who suffer neglect along with the damage that comes from direct abuse, attempts to help them alter their behaviour is an immense challenge.

The following is an extreme example of the damage done through acute neglect and abuse.

The MRI on the right is of a child rescued from the Romanian orphanage after the fall of the USSR.  These children suffered the permanent damage to their brains: 

• Amygdala is increased in size.
• Hippocampus reported to be reduced by 12%.
• Prefrontal lobes are 20% smaller and have lesions on the surface.
• Cerebellum is reduced in size

All of these are the result of the actions of adults on these children.  They are not at fault!

I hope these recent Newsletters help you understand the enormous challenge you face when dealing with these children and more importantly the real disability resulting from the absence of appropriate stimulus and the neural material lost through pruning. 

The Wounded Child

In the previous Newsletters we discussed the impact of stress on the formation of memory and consequently a child’s sense of self.  In this, and the next essays I will discuss the impact too much or too little stress has on brain development and consequent behaviour.  We begin with the situation where a child is exposed to extreme levels of stress!

In the last essay we described the stress response, the secretion of various hormones that facilitate the fight/flight/freeze response.  This process is described in broad terms as the hypothalamic-pituitary-adrenal (HPA) axis, that is the response flows through these systems.  One of the outcomes of this is the production of cortisol the hormone that increases glucose that facilitates energy and defence to deal with the situation.  It also curbs functions that are not essential to the immediate protection of the body.  Things like physical development, behaviour adaption in a social context.  The presence of cortisol denies these experiences.

When a child experiences re-occurring, extreme levels of stress this continuous exposure results in a reduction in the physical growth of that child.  They fail to reach their potential physical size, which in itself is a tragedy.  For our discussion the presence of cortisol alters the following physical capacity of our brain:

• Hippocampus – this is part of the limbic system and is primarily involved in the formation and the retrieval of memory.  For children who have experienced constant highly elevated stress the hippocampus can be reduced by 12%.  This is a significant disability!
• Prefrontal Lobes – this is the intellectual centre of our brain where we do our thinking and consider our behaviour and how it impacts our future.  It is also where our ability to resist impulsive behaviours, a property so vital in managing how we conduct ourselves.  There can be a 20% reduction in this critical part of the brain and that has huge implications.
• Cerebellum – this is a critical part of the brain, although it only occupies 10% of the brain’s volume it contains half the brain’s neurons. The function of the cerebellum is to evaluate the existing environmental conditions with the homeostatic status of our self, to evaluate the need for action and if required initiate that action.  The cerebellum is the key component in all our decision making and this is significantly reduced in the presence of cortisol.
• Corpus Collosum– this is that part of the brain that coordinates cognitive functions that exist on opposite sides of the brain.  The efficiency of the process is compromise by the lack of development.

A paradoxical alteration to our cognitive landscape that is a result of continuous elevated stress is the growth of the amygdala.  This structure is the part of the brain that controls our emotions and the behaviours that are initiated by those emotions especially fear.  The continual stimulation of the amygdala results in its over-development.  It is larger and more sensitive to potential threats resulting in a hyper-sensitivity that makes the child more anxious.

The child who has lived with this chronic continuous stress is left with a cognitive system that has been deprived of the availability of those functions that protect them from future stressful events and a hypersensitivity to potential threats.  The following diagram illustrates the stress response when you are confronted with a stressful situation.

As can be seen, the stimulus comes into the cerebellum and on to the thalamus, that part of the brain that distributes stimulus.  From there, depending on the intensity of the stimulus it will go either to the hippocampus where a considered response can be adopted or to the amygdala which will evoke a reflexive, unconsidered reaction.  For the damaged child, the propensity to suppose a real threat and the limitation in the ability to make a considered response means they at a real disadvantage in a busy classroom.  You have to remember they have no ability to ‘will away’ the heightened emotions despite your efforts to reassure them.

The long-term exposure to elevated stress and the presence of cortisol means the child is more likely to suffer the following health problems:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Muscle tension and pain
• Heart disease, heart attack, high blood pressure and stroke
• Sleep problems
• Weight gain
• Memory and concentration impairment

In the classroom these damaged students will challenge your patience and endurance.  They will minimise or misrepresent any positive interaction you attempt to have with them just as they will be hypersensitive to any negative social skills, not only from you but also their class mates. 

Of course what I have been describing is early childhood post-traumatic stress disorder (PTSD) or the abnormal learning associated with fear.  PTSD is at the heart of the model of behaviour management I present and is an ever-present element in our approach.

The impact of extreme stress, as we have discussed above is at the heart of trauma however, in the literature that is focused just on trauma there are more specific descriptions for all cases.  These are:

• Traumatised people portray ‘snapshots’ of their unsuccessful attempts to defend themselves in the face of threat.  That is a given for a child, of course they can’t ‘defend’ themselves.. 
• The inability to discharge the energies associated with the preparation to defend themselves means they are fixed into patterns of readiness.  Adults can be given opportunities to discharge these energies, children cannot!
• We remain in a constant state of neuromuscular readiness - fixated in an aroused state.

All references to trauma imply that events challenge the very foundations of our expected survival.  Adults function with the expectation that they will endure and this gives them the confidence to plan and act within our community.  However, there will be times when these expectations are shattered through the experience of:

• Unexpected life-threatening events such as car accidents, earthquakes, severe illness, the death of a loved one, anything that threatens your stable view of the world.
• You come face to face with human vulnerability, you witness the injury to another person that demonstrates the fragility of life, in an instant the world changes through events that are out of your control.
• You come face to face with the capacity for others to preform what can only be called evil in the world. 

Children do not have these expectations.  They are unable to put meaning to the trauma!  This is an area that I have never been able to find any information but I believe it accounts for a difference between early childhood and adult episodes of PTSD!

One of the most significant things about early childhood PTSD is that it is most often perpetrated by their primary care-giver.  Because infants are totally egocentric they will blame themselves for the abuse.  This is at the heart of toxic shame, the belief that you are a mistake!

Whether you refer to the conditions outlined above as early childhood trauma or exposure to chronic stress the result is the same.  In the classroom you will be dealing with students who have a real physical disability that has been put on them by an adult.  Along with the physical deficit there will be a sense of worthlessness that is a powerful part of their sense of self.  It takes a special teacher to understand this and hang in with them long after they think you will give up!

The next Newsletter will deal with the impact of neglect, a feature that is so often co-exists with Trauma.