Apart from the problem-focused ‘Scourge’ paragraph (mine), this is a guest post from friend and book study group member, Dr. Geoff James – ‘The Solutions Focused coach’.
The case-studies – Justin and Connor
This chapter carries the title of the book and tells us we’re entering a world of extreme trauma, maybe new to the reader and in language that goes beyond what we might expect from a measured medical professional. Dr. Perry explains in the introductory notes to the book, “… when we started, I didn’t really know what I was doing, at least as a writer. Unlike Maria, I had never written a book.” The two authors agreed to use the stories from Dr. Perry’s clinical practice to carry the narrative. They had to draw a fine balance. Dr. Perry ends his briefing with a warning that some readers could find the details distressing.
Bearing that in mind, this chapter tells the story of the upbringing of the Boy in the title, left at two months old by his fifteen year old mother, in the hands of her mother. Nine months later his loving grandmother died and he passed into the care of her boyfriend, a dog breeder. He was totally unprepared to cope with a baby and called social services who asked him to look after the Boy, Justin, until they found a permanent placement for him. The boyfriend, out of his depth, began keeping the baby as he did his dogs, in a cage, fed and watered, taken out for exercise but with little emotional care or social contact. This continued for five years.
At two years old Justin was taken to a clinic with pneumonia. There was no investigation so nothing known about his home life. He couldn’t walk or talk, and was diagnosed with severe, permanent brain damage. Subsequent clinical assessments and diagnoses confirmed the unlikelihood of any change. But what followed when Dr.Perry clinic became involved was a remarkable recovery.
The Boy received the concentrated support of physical, occupational and speech and language therapists and daily visits by Dr. Perry and a staff psychiatrist. The team started thinking in a novel way about the Boy’s limited but positive experiences, such as the “social stimulation and affection from the dogs he’d lived with; dogs are incredibly social animals and have a sophisticated social hierarchy ….. At times he responded to unfamiliar people like a scared dog….”
Given steady, multi-faceted support, within weeks Justin was out of hospital. Even with his history of trauma, the inherent plasticity of his brain together with his resources and strengths enabled him to capitalise on the stimuli offered through the recovery programme. In Dr. Perry’s words,
This was the most rapid recovery from severe neglect we had yet seen. It changed my perspective on the potential for change given early neglect. I became much more hopeful about the prognosis for neglected children.
In this chapter we also met Connor. From two weeks until eighteen months of age he was abandoned during the day by his childminder. She took a second job, leaving him alone in a crib and only returning briefly in her lunch-break to check him. When his mother discovered the neglect she left work and took over his full-time care, but the early trauma had long-lasting effects. As a teenager, Connor was barely able to function socially and emotionally.
Again, Dr. Perry’s clinic was able to offer a wide range of medical and therapeutic interventions, to aid Connor’s recovery from this profound trauma. Connor’s progress was, however, much slower and the contrasting case-studies underline the significance of the timing of childhood trauma:
The earlier it starts, the more difficult it is to treat and the greater the damage is likely to be. Justin had nearly a year of loving and nurturing care before he was put in the cage. That affection built the basis of so many important functions into his brain and, I believe, greatly aided his later recovery.
A foundational principle of Dr. Perry’s work is that neural systems organise and become functional in a sequential manner. If one system doesn’t get the stimulus is needs when it needs it, those that rely upon it may not function so well either, even if the stimuli for the later developing systems are provided appropriately. “The key to healthy development is getting the right experiences in the right amounts at the right time.” Connor’s painstaking therapy needed to focus on repair from the bottom of the brain up – the neurosequential approach – and moved from affectionate touch (massage) to music and movement to a carefully graduated socialization processes.
The Scourge of Child Illiteracy
In reflecting on how these two children were failed for so long, Dr. Perry points out that public (state) education in the US includes no content on child development, caregiving, or the basics of brain development. Neither does this knowledge qualify as the ‘cultural capital’ that is important enough to be taught in English schools. “The result is a kind of child illiteracy.” This problem across both our cultures is aggravated by the fact that family units are smaller than they once were, more fragmented – reducing the infant’s opportunities for interaction with loving and responsive carers, beyond the primary. In addition, strong anecdotal evidence suggests that the modern-day scourge of the screen reduces the number and quality of even this restricted range of relational experiences.
Not only did Connor’s mother fail to recognise that the root of his difficulties lay in his year of near-daily neglect, but no-one in the school system, in special education, in occupational therapy, medicine, counselling or in any other field recognised the importance of exploring his history. Instead, presenting symptoms were matched with an alphabet soup of labels and disorders, such as psychotic disorder, ADHD and the strikingly descriptive ‘intermittent explosive disorder’…. a label that conveys a strong sense of Connor’s frustration and distress.
Implications for practice
A best hope for our reading group is to discover what insights the book could give us into our work with children who come to school with experiences ranging from the mildly distressful to the highly traumatic.
We had three main areas of discussion; the place for a focus on trauma awareness and practice in teacher standards; the relatively limited resources we have in schools in comparison with Dr. Perry’s clinic; in Initial Teacher Training (ITT), the need to raise awareness of the effects of trauma on children’s behaviour and engagement and to provide practical means to address and support children’s recovery and progress. All of these represent important opportunities to mitigate the problem of child illiteracy and to ensure that teachers are equipped with the knowledge and skills not simply to ‘manage’ behaviour, but to understand it.
The chapter gives a valuable insight into how to approach these issues from our educational, non-medical perspective. The antidote to relational trauma is not difficult to find:
Many of the truamatized children I’ve worked with who have made progress report having contact with at least one supportive adult: a teacher who took a special interest in them, a neighbour, an aunt, even a bus driver.
This means not leaving recovery to chance, but moving ahead of the most serious effects of trauma with predictable, respectful relationships:
From this nurturing ‘home-base’, maltreated children can begin to create a sense of competence and mastery. To recover they must feel safe and in control.
For myself I would sum this up as giving good grounds for the introduction of solutions focused coaching in ITT and in schools, promoting self-motivated learning through a child’s realisation of mastery, autonomy and purpose; Early Help for children’s mental and wellbeing as a whole-school solutions focused approach.