The Effects of Early Loss and Trauma on Development
One of the most enduring myths about infants is that they are resilient. The notion persists that infants are more or less blank slates, incapable of absorbing or retaining experience before the acquisition of language. Current research from neuroscientists informs us that infants are actually the most impressionable and vulnerable to their early experiences, when their daily interactions exert the most influence on their development. Neurological development is experience dependent; experience determines how the developing brain and central nervous system organize, which directly impacts emotional, social, cognitive and physical growth.
Resilience is the ability to bounce back after adverse experience. Resilience is a learned trait, dependent upon the establishment of an effective internal stress regulation system and consistent emotional support. A well attached and emotionally healthy child will likely bounce back after trauma if she is supported, precisely because she has learned how to moderate stress through her interpersonal experiences in the process of becoming securely attached.
An unattached and unsupported infant, on the other hand, will have her brain molded by adverse experience. The brain is malleable and it will adapt itself to the experience of maltreatment in order to survive. Adaptive neurobiological responses will help to tolerate chronic stress at the expense of more typical development, and over time will become established neural pathways in the developing brain. The child likely will carry these adaptive responses forward with her into an adoptive family, at which point they are maladaptive for family life and healthy development.
This malleable and adaptive quality of the brain is called neuroplasticity, and is what drives the experiential process of brain and central nervous system development. The stage of optimum neuroplasticity is the first three years of life, a period of critical and rapid brain growth. The brain grows and organizes in response to experience in a predictable developmental sequence, starting with the brainstem and moving on up the midbrain and the cerebral cortex. There are certain developmental windows of opportunity when specific areas of the infant brain and central nervous system organize. Once a window has closed, the developmental sequence continues to unfold regardless of how optimum previous development has been.
Brain development builds upon itself and higher function is dependent on the organization of lower structures. Disorganization in a foundational stage of brain development will impact subsequent developmental stages in a cascading series of dysfunction. If early brain function is underdeveloped, the brain will not intuitively fill in the gaps but will continue to build on whatever foundation has been laid down. If the foundation is shaky, the structure it supports can never be solid.
As delicate as the timing of this sequence may seem, in typical development the brain and central nervous system self-organize easily and optimally through daily, ordinary experience. As a social species we have evolved to develop and thrive via daily interpersonal relationships and interactions with our environment. Typically, the infant gets everything she needs for healthy emotional, physical, cognitive and social development through ordinary interaction within a family.
Unless there is a placement shortly after birth, for most adopted kids this process will have been compromised. Neurobiological development will end up being shaped by loss, neglect, trauma, and poor attachment, resulting in a reduced capacity to integrate sensory, emotional and cognitive information into a cohesive whole.
Understanding how experience dependent neurological development is makes it easier to understand why some adopted kids struggle years after adoption, even if they have been adopted into emotionally healthy family situations.
Many of us entered into adoption believing that the positive influence of love and family would be enough to overcome early adverse experience. It doesn't help that this belief is echoed at large by society, professionals and institutions. Many pediatricians, therapists, social workers and adoption agencies are behind the curve on neuroscientific research, and reinforce the outdated idea that adopted children are little different than children born to us. Perhaps this is a notion held over from a generation ago, when the majority of adoptions were private domestic relinquishments of newborns. Now that the profile of adoption has totally transformed and the majority of adoptions are of older infants and children (via international programs and domestic foster care) we need a new paradigm.
Experts now believe that any time a child joins a family through adoption that attachment will be an issue. At a minimum, unless adopted at birth, adopted children have suffered two major losses: the primary maternal loss and the loss of the subsequent, intermediate caregivers. Pre-, peri- and postnatal research demonstrates that infants have bonds to their mothers in utero, and recognize their mothers at birth. A newborn knows her mother's smell, voice and touch and will experience acute distress if separated from her. A days old infant abandoned on a street for even a short time experiences extreme trauma. Separation from her mother is literally a life or death threat, and she will react neurobiologically with a massive internal stress response.
What our children endured as infants was likely horrific for them. As adults with well developed coping mechanisms it's difficult for us to imagine the utter helplessness, annihilating terror, overwhelming dread, and staggering loss that these infants faced, well before the establishment of any sort of internal system for dealing with stress. Many of them then went on to experience varying degrees of stress in subsequent caregiving situations that failed to comfort, nurture, or provide the kind of consistent, attuned attention necessary to mitigate the effects of early stress and trauma.
Because this kind of relational trauma happens before the acquisition of language, it becomes stored as sensory and motor memories in implicit memory systems that are operational in the first months of life. These infants absorb their implicit emotional experiences and form mental models of themselves, their caregivers, and the world.
A nurturing caregiver who responds appropriately and consistently to the infant's distress helps the infant to internalize a mental model of herself as worthy of love, care and protection, and the belief in a benevolent and nurturing caregiver and, by extension, a benevolent and nurturing world. In the absence of consistent and nurturing care, infants internalize very different implicit mental models of themselves and the world.
In this way, adopted children can bring preverbal feelings of loss, shame, anger, helplessness or worthlessness with them into their adoptive families. Logically, these feelings may make no sense to adoptive parents, especially if there is little weight given to early experience. But to an infant or child, the feelings can be deeply imbedded beyond logic or words.
Manifestations of these imbedded feelings and mental models are expressed in a variety of ways in adopted children. There is a large range of possible outcomes and not every child will be affected equally. Each child is uniquely wired, and each child has a unique experience, so it's difficult to generalize about how children will fare. For some, adverse effects from early experience will be subtle and difficult to detect. However many will carry the effects of early loss and trauma forward with them in salient ways.
Some common areas of difficulty that emerge and persist in adopted children include:
Emotional Regulation: Adopted children frequently have a low tolerance for frustration and may have difficulty coping with normal daily stress or negative emotions. These children are often hyper-reactive, quick to anger or burst into tears over what others might consider insignificant or nonexistent slights. It can be difficult to calm these children with logic, consequences or discipline and many have out of control tantrums long past toddlerhood.
Social Interaction: Many adopted children have difficulty with social skills and navigating relationships. They often can't read social cues. They might have trouble sharing toys, food, friends, or family members, long past what is age appropriate. They might feel threatened by other children or in competition with them, or engage in sneaky, manipulative, or aggressive behaviors with peers. They might have trouble keeping friends, and in general mistrust others.
Control: Many adopted children have an intense need to be in control. They might seek to control the actions of others as well as their environment. This inevitably will affect their social realm, as they have trouble tolerating relationships on any terms other than their own. They are often bossy and manipulative. They may try to manipulate people, timetables, rules, or activities. Often they have trouble participating in competitive games and are sore losers. Sometimes control is expressed in unusual relationships with objects, possessions, or food.
Cognition: Children with early histories of loss, trauma and attachment difficulties frequently have trouble with higher brain cortical functions. They often have poor cause and effect reasoning and problem solving skills. Many adopted children struggle with poor visual or auditory processing. Learning and language disorders are common, as are behaviors that resemble ADD or ADHD.
Transitions: Adopted children often have greater than average difficulties with transitions. They are not "go with the flow" kids, but do best in environments of structure, predictability, and regularity. Often the transition from the school year to summer, vacations, holidays or other changes in routine are times of great stress, dysregulation, regression, and acting out.
Some other common manifestations: Dislike of physical closeness in relationships, superficial charm or indiscriminate affection, inappropriately demanding or clingy, lack of impulse control, self-destructive, blaming others inappropriately, aggression or violence towards others, lying or stealing, opposition, sleep disturbances, disorganized play or thoughts, distorted self-concept. (This is not a comprehensive list. For more information and list of symptoms go to
Attachment Disorder information and support at ATTACh.org.)
Even for the sensitive parent, it can be difficult to determine whether a behavior is part of typical development or whether it is being driven by an underlying adoption issue. Often the answer lies in the degrees rather than the behavior itself. Out of context a behavior, in and of itself, can mean little. Evaluating it in context, a behavior can stand out for its intensity, its persistence, or for being developmentally age inappropriate.
For parents who wonder whether a behavior is normative or not, it's useful to ask some questions: is a behavior interfering with a child's success socially, emotionally or academically? Is it standing in the way of a child's happiness and ability to fit in, in groups, at school, with peers? Is it persisting long past age appropriateness? If so, it's probably worth investigating through the lens of early experience and attachment.
Why is it important to view behavior as attachment related? Isn't an impulse control problem just an impulse control problem? The distinction is important in informing the response. Approaching symptoms piecemeal rather than as manifestations of an underlying systemic disorganization is failing to see the whole picture and missing the opportunity for effective intervention.
For children impacted by attachment and trauma issues, certain parenting techniques can exacerbate existing problems. Placing a child in time out, or letting her cry it out at night, for instance, can reinforce internalized feelings of shame, worthlessness, or fears of abandonment. For the securely attached child there may be little risk of harm, but for children with early loss experiences these techniques can be counterproductive at best, and emotionally damaging at worst. Parents can unwittingly aggravate underlying issues by inadvertently re-traumatizing their children.
Children with histories of early loss and trauma can find it exceptionally difficult to reconcile their internal emotional landscapes with their current realities. Despite living in safe and loving families, they might be held hostage by their own hyper-reactive responses to the triggers in their environments. In brains shaped by early loss and trauma the corpus callosum, which facilitates left brain-right brain communication, is often underdeveloped, making it much more difficult to process and integrate traumatic implicit memories through explicit autobiographical memory systems. For such children, therapists experienced in adoption and attachment issues can help in processing and integrating early traumatic experience.
Attachment therapy is a dynamic and evolving field that incorporates findings across many disciplines including neuroscience, trauma studies, academic attachment theory and developmental psychopathology. A unifying theme in attachment therapy is the implementation of corrective emotional experiences that address non-integrated or dysregulated neural networks, promoting better psychological functioning. Central to this methodology is the notion of attunement. More than just sympathy, attunement is the experience of recognizing, connecting with, and sharing inner states with the child. In effect, it is providing the child with the profound, formative, verbal and nonverbal communication of mother and child that so many of our children missed in infancy. This powerful interaction helps to heal and facilitate developmental organization in the child.
Psychotherapist and author Daniel Siegel writes that “attachment relationships may serve to create the central foundation from which the mind develops. " While children with early experiences of loss, neglect and trauma may have missed the development of a solid foundation, neuroscience gives us enormous hope for rebuilding structures, growth and healing. With insight and care, a child's primary relationships can calm, soothe, help organize her experiences, and teach her that negative emotions can be tolerated and overcome.
Heidi Holman
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Sources/Suggested Reading:
"Nurturing Adoptions: Creating Resilience After Neglect and Trauma" by Deborah Gray, 2007.
"The Boy Who Was Raised as a Dog: What Traumatized Children Can Teach Us About Loss, Love and Healing" by Bruce Perry, 2006.
"Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder" by Allan Schore, 2002.
"The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are" by Daniel Siegel, 1999.
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Additional reading:
"The Connected Child" by Karyn Purvis, David Cross and Wendy Lyons Sunshine, 2007.
"Beyond Consequence, Logic and Control" by Heather Forbes and B. Bryan Post, 2006.
"Smart Moves: Why Learning Is Not All In Your Head" by Carla Hannaford, 2005.
"Parenting the Hurt Child: Helping Adoptive Families Heal and Grow" by Gregory Keck and Regina Kupecky, 2002.
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Heidi Holman is also the author of "Short Circuits; An Adoptive Mom's Exploration of the Neurological Impact of Trauma, Neglect and Sensory Deprivation"