Changing courses — Part 2

Science suggests that having a secure relationship with a caregiver can help protect a child’s brain and body from the effects of adversity. A Connecticut program for very young children who have experienced trauma or other challenges has gotten results by focusing on that relationship – and the things that can interfere, including depression, family violence and a parent’s own history of trauma. Arielle Levin Becker wrote this story while participating in the National Health Journalism Fellowship, a program of USC’s Annenberg School for Communication and Journalism.

This the second article in a four-part series. (Her entire project is archived here.) Read the first part here:

The long reach of childhood trauma — Part 1

Molly bounced around the therapist’s office. She clutched a blanket and ran into her father’s arms. She babbled and smiled. At 16 months, her development was close to being on track, her therapist said.

A few months earlier, things were different.

She was underweight. She didn't smile much. Sometimes she just stared.

“Life wasn’t going all that great for her to begin with,” her father, Joe, said.

Holly’s parents fought often. Her mother, Jenna, was depressed, Joe said, making it hard for her to take care of a young child. She was trying to take classes and manage a household on little money, she said. Joe was working two jobs, coming home tired.

“Neither of us really want fighting around [Holly]. It kind of just happened,” Joe said. “We had a lot of stress on each other.”

One night, a fight escalated and became violent. Jenna wanted to leave with Holly. Joe wouldn’t let her take the baby. Holly was in Joe’s arms when Jenna threatened him with a knife, according to their accounts and a police report.

Joe eventually left Jenna. After a few months, she and Holly ended up homeless, in a shelter.

In short, there were a lot of red flags, both for Holly’s immediate well-being and, perhaps more significantly, the years to come.

Experts say early exposure to trauma and severe stress can have profound effects on children’s developing brains, potentially leaving them vulnerable to a host of behavioral, mental and physical health problems.

But studies also suggest that the presence of a nurturing caregiver can make a significant difference in how that adversity affects them.

In other words: There’s an opportunity, experts believe, to prevent problems from occurring by making sure a child has a secure bond with at least one responsive parent or caregiver. And when young children don’t have that or experience trauma, early interventions can help stave off deeper mental health or behavioral problems.

“A lot of the kids who have these kinds of behaviors and are acting out and are aggressive have...experienced trauma and no one has ever helped them with it,” said Darcy Lowell, a developmental and behavioral pediatrician and professor at the Yale Child Study Center.

Lowell founded and runs Child First, a program that works with children under 6 who have a history of trauma or emotional or developmental problems. It focuses on the relationships between the child and his or her caregivers, and things that can get in the way of them – like depression, substance abuse or a parent’s own history of trauma. The program serves Holly and her family.

Nationally, more than one in four victims of child maltreatment is younger than 3, according to federal data. But many people still wrongly believe that children too young to speak can’t be harmed by what they see or experience, said Mickey Kramer, Connecticut’s associate child advocate.

“Do you remember when you were six months old? Of course you don’t,” she said. “Does your brain remember when you were six months old? You bet it does.”

Experts say a young child’s relationship with a responsive parent or other caregiver is key to development, forming the model for the child’s future relationships and giving them confidence to explore the world. But many things can interfere with that bond, and researchers now say that can have not just psychological but physiological consequences for a child.

“If you were going to do one thing that would make the most difference, it would be that secure attachment from the beginning,” said Judith Meyers, president and CEO of the Child Health and Development Institute of Connecticut. “That could take care of so many other ills that follow in its absence.”

Typically, babies learn that they’ll get fed or cleaned when needed, said Patricia Wilcox, who leads the Traumatic Stress Institute at Klingberg Family Centers in New Britain.

“But if that doesn’t happen, if the people just don’t come, or if they’re tense and angry, or if they’re harmful, the baby develops another template, which is people hurt you or people don’t care,” she said.

There are physiological consequences too. Key parts of an infant’s stress response system are still maturing at birth, and research indicates that babies rely on a caregiver to help them cope with stress.

The absence of that can have profound implications. Researchers say chronic or prolonged exposure to significant stress can influence the development of parts of the brain involved in learning, memory and perceiving threats. And chronically elevated stress hormones during development appear to shape the way children’s brains interpret and respond to stress in the future.

A lot of what’s known about this is rooted in animal studies.

When researchers separated infant rats from their mothers for prolonged periods each day, for example, the pups became more anxious and vulnerable to stress. Even as adults, their stress hormones would rise dramatically more than those in other rats when faced with stressors. By contrast, baby rats separated from their mothers for a few minutes at a time became more resilient to stress.

Megan Gunnar began her career hoping to understand whether similar things occur in humans. A professor at the University of Minnesota, she’s spent years studying children and the system that produces and regulates the stress hormone cortisol. In the right doses, cortisol is necessary for survival. But having too much of it for prolonged periods can have harmful effects, including disrupting memory and damaging brain cells.

Gunnar and other researchers found that a toddler’s relationship with a caregiver makes a difference in whether he mounts a stress response to a mildly scary situation, like seeing a clown or getting vaccines. Cortisol levels rose in the toddlers who didn’t have a secure relationship with the caregiver who was with them, but not in the toddlers who did.

Another team of researchers found evidence suggesting that a responsive mother could buffer the physiological effects of stress in middle schoolers exposed to multiple risk factors, including substandard housing, violence and family turmoil.

In extreme situations, young children raised in orphanages – who had no opportunity to bond with a caregiver – were found to have significantly delayed growth and unusually low electrical activity in their brains. Gunnar found signs of abnormalities in the children’s cortisol regulation systems.

She and other researchers have also studied children who were adopted from orphanages. They found signs of some enduring problems. But many of the children experienced rapid growth and more normal cortisol patterns after becoming part of a family.

While Gunnar was doing cortisol studies, Lowell was in Bridgeport, developing the program that would become Child First. It was an attempt to better meet the needs of families who seemed to be falling through the cracks. Some had children who were getting kicked out of day care for behavior problems. Parents were overwhelmed.

Child First is one of more than a dozen home-visiting programs for families of young children in Connecticut. Many are aimed at promoting healthy development and preventing bad outcomes in families with certain risk factors. Child First, by contrast, is an intervention to address issues that already exist. The vast majority of parents in the program have experienced trauma. More than half are involved in the child welfare system, or were at one point. Some families have fewer risk factors but can use help with children with special needs.

The program is available in just under half the state’s municipalities, with funding from the state Department of Children and Families, the federal government and private foundations. It serves about 1,000 families a year. Last month, there were 255 waiting for spots.

“We serve people who live in housing projects with urine-soaked stairways to people in gated communities, and the problems in terms of the parent-child relationship could be the same,” said Kristina Foye, program director for Child First’s Bridgeport site.

But poverty can bring additional stresses that can interfere with a parent’s availability for a child, like worrying about staving off homelessness or paying for food, she said.

For the Child First teams that serve the New Britain area, the initial home visits often have a familiar sound: the beeping of smoke detectors that signal they need new batteries. It's a landlord's job to make sure smoke detectors have working batteries, but often, they don't.

The noise is a constant reminder that the home isn’t a safe environment, noted Melissa Mendez, clinical supervisor for that area’s Child First program, which is run by the Wheeler Clinic. It’s the sort of thing that can pile up to increase stress and, as she puts it, “clog the brain,” making it harder to do other things, such as helping children learn.

Nearly 80 percent of the children in Child First have experienced trauma, including sexual abuse, community violence, witnessing a parent being dragged away in handcuffs, or seeing one parent beat up the other. It can lead to nightmares, hypervigilance, fear or aggression – things that could appear to be bad behaviors.

Because young children tend to think the world revolves around them, they can easily distort the meaning of what they experience, said Judy Adel, clinical coordinator for the Child First program at the Child Guidance Clinic for Central Connecticut. A 3-year-old who sees his parents fight might conclude it’s his fault they don’t love each other.

“Sometimes what happens in the shuffle, when a child is removed and cops come and an ambulance comes, nobody talks about what happened,” Adel said. “And they’re left to their own devices.”

It’s important to figure out how children interpret what happened, and to correct any distortions, Adel said. Often, that occurs through play and explaining things in language they understand:

Daddy has a hard time sometimes, and he doesn’t know yet that he can’t use his hands. He’s going to go and learn how to be angry.

Mommy’s mind is sick, and she has to take medicine and work hard to get her brain to a good place.

Daddy died in an accident, and it wasn’t your fault, and he loved you very much.

Some mommies need help.

People often ask Adel, “How the heck do you do therapy with a 1-year-old?”

It’s really therapy with the parent and child. Sometimes it involves helping parents figure out how to read the signals of a preverbal toddler or understand what’s behind a child’s aggression.

One of the 1-year-olds Adel works with is Holly. In her case, therapy included working with Joe to think about ways to reassure her that she was safe in his arms, where she’d been when she witnessed the fight involving the knife. They talked about the importance of routines to give her a sense of predictability and safety.

(The Mirror has changed the names of Holly, Joe and Jenna to avoid identifying the family. Information about them comes from police and court records, and interviews with Joe, Jenna, and with Adel, who spoke about Holly and Joe with his permission.)

Joe didn’t want his daughter to grow up the way he did, with fighting and violence at home. His family moved frequently when he was young, and he never felt the security of being settled in one place. After his father left the family, Joe dropped out of high school and got a job to help pay the bills.

But he didn’t have much time to think about that when Holly was younger. He was preoccupied with supporting a family on low-wage jobs. He and Jenna, Holly’s mother, clashed often. They were both stressed and seemed to push each other’s buttons. Eventually, Joe left.

"The fighting was just getting so much, I couldn't handle it anymore," he said. He feels guilty for leaving Jenna "down and out,” with Holly and no job and nowhere to turn. The landlord began eviction proceedings. Jenna and Holly eventually moved into a shelter.

Multiple agencies had been working with the family, including Birth to Three, a home-visiting program for infants and toddlers with developmental delays, and Child First. The Department of Children and Families was involved. Eventually, Holly was placed with Joe. He had moved in with extended family, a stable environment.

Joe and Adel talked about what scary memories would be like at Holly’s age and what it was like to be away from her mother. They discussed ways to foster her development, like reading and talking to her as much as possible. At a recent visit, Joe asked for tips on building her fine motor skills.

Holly always had a strong connection with her dad, Adel said. Now she was with him regularly.

Within a couple months, Holly was babbling and saying words like “daddy” and “apple.” Her development was close to baseline for her age. She was gaining weight.

But there were still concerns. Joe noticed that whenever he left a room, Holly would cry inconsolably, as if she didn’t trust that he’d come back.

Adel suggested that Joe talk to her from the other room, to let her know he was still nearby and coming back.

It’s impossible to know what the future holds for Holly, or what would have happened without intervention.

But recently, she hit another milestone: Joe could leave to go to the bathroom, and she didn’t cry.

Jenna is frustrated that she doesn’t get to see her daughter more and hopes that will change. She’s made changes in the past few months. She has an apartment and has been working. She’s taken parenting and anger management classes, attended counseling and gotten help for depression and anxiety.

Joe said he and Jenna have talked about what they want for Holly.

“We want [her] to be happy and have loving, caring parents,” he said. “So we’re working on that.”

Child First operates with a premise that parents want to be good parents and want their children to have better lives than they did – and that the things that get in the way can be addressed. Often, those barriers are related to the parents' own histories of abuse, neglect or violence.

“They want to do the right thing, but they don’t know how,” Lowell said. “No one ever sat and played with them. No one ever talked to them about how they felt. No one ever asked them, ‘Were they hurting? Was there pain?’"

The ability to think about a child’s perspective – to wonder if a baby is crying because she’s hungry or needs a diaper change, rather than assuming it’s because she’s manipulating you – is a big factor in successful parenting, Adel said.

But to a parent who was severely abused as a child, hearing a 3-year-old yell, “I hate you!” might trigger feelings of worthlessness or fear related to her own abuse. A mother who was a victim of domestic violence might see her toddler’s aggression as a sign that he’s just like his father.

“If you start thinking, ‘The baby is only doing this to get to me,’ which is so close to the surface when you are so tired, those are cognitions that begin the pathway to maltreatment,” said Gunnar, the Minnesota professor.

“You can see how it’s a big deal to not have been parented well yourself, to then turn around and manage to do a good job parenting,” she said.

When working with parents who had brutal upbringings, Child First clinicians try to focus on how they survived. Who looked out for them? What inside them helped them get through it – and how can they build on those strengths?

“You’ll hear that, ‘Oh, my grandma was always good, she would come get me and make sure I ate,’” Adel said. “So those are the people who give us enough good to survive sometimes.” ♦

This story was originally published by The Connecticut Mirror.