Why Keeping a Developmental Perspective is Critical when Working with Complex Trauma
by Dr. Chuck Geddes
As we continue working with children and youth who have extensive trauma histories and exhibit severe behavioural problems, it is becoming increasingly apparent to me that establishing and keeping a developmental perspective is a crucial goal. This perspective helps in numerous ways. First, it helps the team, and particularly the caregivers, to keep the child’s developmental age in mind and to reframe their view of behaviour to a more positive one. For example, we often initially hear comments like –“He gets so worked up and out of control when other kids are around”, or “She’s so clingy that I can’t turn around without literally bumping into her”. As we explain the developmental perspective we hear comments that are more positive –“Looks like she’s showing her 5 yr old needs today”, or “Okay, he’s showing us that in these situations he isn’t yet able to calm himself”. Our emphasis is on trying to meet the child or youth at their developmental age. The reason for this is that they’ve missed something necessary for them to grow and mature out of that stage and it is our job to provide that – whether it is safety, security, or nurturance.
Second, a developmental perspective helps us keep in mind that the child is learning and growing and that the challenges they show us tell us where they need help. Dr. Dan Hughes offers a helpful phrase for foster parents in explaining to the child that “you haven’t had a chance to learn this yet”. The adults’ job is to be a steady, nurturing presence and see themselves as teachers and coaches and cheer leaders – not at all easy when the child’s behaviour is challenging and problematic! Fitting with this perspective, Dr. Ross Greene has defined a list of “lagging skills” that he sees in “explosive children” and encourages adults to help children learn these skills.
Third, a developmental perspective gives us a clinical view of the child which explains the various challenges they present with. In our work, we emphasize a neuro-developmental and trauma-attachment perspective on the challenges faced by these children and their caregivers. As such, we focus on the current developmental level expressed by the children across a number of key areas related to their social-emotional-behavioural development, and actively seek ways to enhance their growth in these areas.
Research indicates that for children who have experienced a single trauma or multiple traumas, developmental progression is distorted and often arrested (Pynoos, Steinberg, & Wraith, 1995). Others, like Ford, Mahoney, and Russo (2004) and van der Kolk et al (2005), suggest that a traumatized child’s body redirects resources normally used for growth to survival. Thus, traumatized children are often seen as developmentally “stuck” and delayed in their maturity. Part of the trauma treatment process involves not only assessing the child’s developmental level, but also helping the child move forward to more age appropriate developmental stages (Summarized by Taylor et al, 2008).
Children who have been exposed to maltreatment and trauma often experience challenges in predictable areas which are described in the research literature. For this reason, it is essential that our Care Teams understand and assess for gaps in each of these areas and then design interventions to help development in each area. In our work, we have created a list of 7 Developmental Domains which we use as a framework for viewing the child’s developmental needs. These are:
Our approach parallels the content areas or symptom clusters described by the NCTSN Complex Trauma Task Force, (Cook, Blaustein, Spinazzola, & van der Kolk, 2003) in their proposal for a Developmental Trauma Disorder, although we use somewhat different names to reflect the additional influence of the Child Trauma Academy and other sources.
A final way in which our approach is informed by a developmental perspective relates to how we view dependence vs independence. We actively encourage caregivers to provide experiences which are deeply nurturing – in essence, providing care which provides the experiences which the child may have missed out on earlier in life. So, we encourage high degrees of touch and cuddling, reading out loud and family “rituals”. One way of thinking about this is that we provide the building blocks which help the children to move forward when they are ready. It may look to some like we create dependency rather than stressing too quick a move to independence. One 15 yr old recently told her caregivers –“ I need this touch and cuddling SO much – I didn’t have a mom you know”. We believe that the child will let us know when they have had enough and are ready to move on to another developmental challenge.
For more information, please see OUR APPROACH at: https://www.complextrauma.ca/about/our-approach/
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