by Rebecca Potter, M.S., LMHC
BEHAVIORS ASSOCIATED WITH PTSD AND CHILDREN
The National Center for Post Traumatic Stress Disorder (PTSD) reports PTSD in children and adolescents at alarming rates:
- PTSD in 90% of sexually abused children
- PTSD in 77% of children exposed to a school shootings
- PTSD in 35% of urban youth exposed to community violence
- PTSD in 35% of youth exposed to domestic violence
Children with PTSD present with various problems:
- Sleep problems
- Attention problems
- Emotional numbing
- Social avoidance
- Aggressive play
- School failure
- And regressed and/ or delayed development
Professionals may be unaware of ongoing traumatic stressors (such as domestic or community violence or the presence of a pathological parent in the child’s life) and may frequently misdiagnose PTSD. Consequently, children with PTSD are often diagnosed with attention deficit disorder, oppositional-defiant disorder, conduct disorder, separation anxiety or specific phobias. (** Editor note: To know the difference between PTSD in children and Reactive Attachment Disorder in children also read Parental Challenges Column in the Parenting Section. Each disorder is slightly different.)
Due to the biological adrenal stress response, PTSD is a chronic disorder. Left untreated PTSD contributes to a host of neuro-psychiatric problems throughout life:
- Attachment problems (as an adult can become personality disorders)
- Eating disorders
- Suicidal behavior
- Substance abuse
- Violent behavior
- And Mood disorders
Various studies also indicate that adults who were victimized by sexual abuse in childhood are more likely to experience:
- Gastrointestinal disorders
- Gynecological disorders
- Chronic pain
- Heart disease
- Chronic lung disease
- And various risk behaviors
As an adult, the treatment approach to PTSD is medication, Eye Movement Desensitization Reprocessing (EMDR) and Cognitive Behavior Therapy. Until recently, the PTSD diagnosis was relegated to war veterans however research now indicates that many survivors of trauma also experience PTSD. Unfortunately, many adults are diagnosed years after the trauma, consequently the condition has been untreated for many years and the psychiatric and physical effects have taken their toll on the body and mind. Studies indicate that Cognitive Behavior Therapy is effective in treating early onset of PTSD in adults. What about treatment for children?
TREATMENT FOR CHILDREN
Unfortunately, most children are not being treated they are merely being medicated. Many agencies do not have trained staff to address PTSD so medication is used to decrease the physical, behavioral and emotional symptoms instead of therapy.
My work with traumatized children (and children exposed to pathological parenting) has consisted of behavior therapy, play therapy, family therapy, EMDR and if necessary, medication.
Why Behavior Therapy?
Adults have the cognitive ability to understand and develop insight about why bad things have happened while young children do not. Behavior therapy/behavior plan adds a motivational factor to achieve behavior change while decreasing anxiety and promoting safety, security, cooperation, self-esteem and attachment to the parent. If acting out behavior is not changed, these behaviors become coping skills used by the child to address stress throughout adolescent and into adulthood. In adulthood, these chronic coping attempts can lead to significant mental health issues.
Very young children exposed to trauma may present with behaviors that indicate stress:
- Generalized fear of strangers
- Separation anxiety
- Avoidance of situations or people
- Sleep disturbances
- Preoccupation with words, symbols or toys
- Loss of an acquired developmental skill such as toilet training
- Easily startled perhaps when they perceive that a parent is angry with them
- Need for increased attention
EFFECTS OF PATHOLOGICAL PARENTING
Working with young children is complex as verbal skills are not yet well developed. Additionally, if the caregiver is involved with leaving or litigating with a pathological, the caregiver is also under a great deal of stress and perhaps is numbing and denying the child’s behaviors. This is a stressful period for the entire family. Because of the stress the child is experiencing, structure is important for the child but unfortunately a pathological parent cannot and does not provide the structured or safe environment the child needs.
Pathological parents may allow the child to
- Stay up very late
- Eat enormous amounts of sweets
- Watch inappropriate movies
- Alienate the child from a protective parent
- Be inconsistent in parenting swinging from indulging to ignoring
- Use drugs/alcohol around the child
- Expose the child to the pathological’s risky behavior
- Expose them to their rapidly changing partners
- And the list goes on…
Additionally, if the child expresses a need, pain or concern they are no longer the object of the narcissistic supply and the pathological will typically rage at the child. To a pathological, it is all about them and everyone (including children) is required to meet their needs. The child is merely an object for their personal use. Although a pathological is good at “talking the talk” they are unable to demonstrate this talk consistently in their behavior, especially in parenting. They may talk the talk of concern and sensitivity, but they do not demonstrate this behavior unless they are being observed or are attempting to manipulate. This can be confusing for children. Behavior counts—even the pathologicals!
If a child has visitation with the pathological they may display an array of various disruptive behaviors when they return from visitation (or perhaps before the visit). With limited vocal skills, a young child must communicate by behaviors. Often when a healthy parent tries to inform the court system of the child’s effects from the pathological parenting they end up being accused of alienating the child from the pathological parent. Healthy parents often feel helpless, powerless, and guilty that they are not able to protect child from the system or the pathological.
Children exposed to pathological parents need extensive help to counter the pathological conditioning. Many healthy parents feel sorry for the child and inadvertently reinforce the dysfunctional behaviors the child is picking up while with the pathological parent. All behaviors of a child have a function. When the function of the inappropriate behavior is discovered, a reward system can be implemented to encourage the use of healthy coping skills and behaviors. Using positive parenting methods along with appropriate consequences increases the child’s healthy sense of themselves.
At The Institute I am offering behavior services for children and support for parents.
The Behavior Report includes:
- 12 hours of consultation with parents to determine the function of their child’s behavior
- The development of methods to decrease destructive behaviors
- Background information of the current situation and resulting behaviors
- Written documentation for authorities which include reports, charts, and graphs
- Charts and graphs of the behaviors and time that the behavior occurs
This documentation can be used for any court proceeding and is a powerful tool in litigation utilizing documented facts and not merely one parent’s testimony over another parents.
SUPPORT AND TRAINING FOR PARENTS
The work with the healthy parent will:
- Document the behaviors and the function of the behavior
- Assist in the development of appropriate coping behaviors
- Implement a reward systemto encourage the use of healthy coping skills
- Teach positive parenting methods
- Establish appropriate consequences to increase the child’s self esteem and sense of power
- Emotional support for the parent
Since there are so many injuries to the family unit and a behavior plan cannot address all of the intense psychological issues of pathology, families are encouraged to continue their work with area therapists.
Some parents may not need the detailed report for court but would benefit by the use of these methods to help their children. Because a child who is being co-parented by a pathological needs specialized approaches to decrease the pathological conditioning, provide security and structure, and build a strong attachments with the healthy parent, these methods are highly effective and can provide the emotional protection children need. Individual sessions are available to discuss the reduction of behavior issues.
My hope is to bring awareness to professionals and parents involved in parenting and custody issues with a pathological parent. If you feel your child is experiencing PTSD it is extremely important to seek services of a professional because untreated PTSD can lead to further psychiatric and physical disorders.
At The Institute, we are dedicated to providing support to families exposed to pathology.
(** Editors note: To know the difference between PTSD in a child and Reactive Attachment Disorder in a child, also read the column in the Parenting Center section called Parental Challenges.)
Rebecca Potter, M.S., LMHC is a licensed mental health counselor with a bachelor’s degree in Psychology and Education, and a Master’s Degree in Psychology. She completed internships at a community mental health center, domestic violence treatment center, juvenile detention center, and an agency treating abused children. Rebecca is trained in Critical Incident Stress Debriefing and has worked with over 100 different companies lecturing on health topics and assisting employees who have been traumatized. Currently she is a trained Behavior Analyst who works with abused children reducing acting out behaviors and in private practice treating adults, children, and families. She is a trained EMDR provider and treats all mental health issues as well as survivors of pathological relationships. She has personally struggled with all the complex legal and emotional issues that are involved in divorcing a successful and charming pathological pilot.
Rebecca is a provider for United Health Care and Cigna Behavioral Health insurances.
I first began my counseling work in a treatment setting that few counselors dare to touch: abused children. Today, I now also work with children who have a pathological parent. If you are reading this, maybe your child is forced to endure visits with a pathological.
Children of a pathological parent often have acting out behaviors that need remediation in order to be successful at school, in the family, and most importantly, in order to heal. Although the children seem fine to others, the families who love them and live with them, see a chaotic nightmare of intrusive thoughts, flashbacks, nightmares, trouble sleeping, sexual acting out and intense anger. Is this your child’s behavior?
I am a Behavioral Analyst that develops personalized behavior plans for abused, special needs and children exposed to pathological persons. Behavioral approaches with children have lengthy documented success in reducing problematic and traumatic behavior. When traditional approaches take too long or are ineffective, behavioral approaches can quickly reduce severe behaviors and stabilize families.
David is a good example of a child I worked with. David was a small two year old. He had been abandoned by his mother and father. Both parents were abusive to each other in his presence and the parents had developed drug dependencies that David had witnessed.
The father became incarcerated and the mother was in and out of his life. The core family was in chaos and crisis. Luckily, he was eventually adopted by his loving grandparents but David was angry and defiant. He would punch holes in his bedroom wall, try to run away and the worst issue was that he picked at his nose repeatedly.
He had been given various psychiatric medications by his physician to reduce his acting out and self injuring behaviors. Despite the medication, this adorable child had trouble with eye contact, connecting with others, and sharing. When you saw his face the first thing you noticed were two raw red wounds on each side of his nose.
While David could not tell you about the violence and fights that he witnessed or the many crack houses he inhabited what was noticeable was his severe reactions and behaviors that indicated he had been exposed to significant trauma.
Maybe your child has not been exposed to domestic violence, been abandoned due to an addiction–but children in white collar yet pathological family dynamics can show the exact same types of behavior disruption. That’s because normal people are always affected by the behavior and worldview influences of someone who is pathological. Children are especially sensitive to pathological inconsistencies, behaviors, and emotional belittling. How does Behavioral Programs help children exposed to pathology or addictions?
How Behavioral Interventions Help
I helped his grandparents develop a simple behavior plan to reward his good behaviors and his cooperation. Although he was resistant to the changes and initially challenged his grandparents, his anger began to reduce as did his physical violence. Best of all, his wounds on his nose began to heal! The family turned a corner and began to have pleasurable times with this previously traumatized child.
Why children act out is because they have heard the word ‘no’ so often that they begin to internalize that they are bad not just their behaviors. Sometimes being told they are loved still does not help them feel accomplished and empowered. It’s through behavioral systems that children become empowered and traumatized children heal.
Behavior techniques are essential to reduce the acting out behaviors which is why The Institute offers this assistance to parents needing help with children exposed to pathologicals. Learning to reward the acceptable behaviors through effective techniques provides both appropriate consequences and appropriate rewards. Abused children begin to feel positive feelings and increased self-esteem.
Monthly, I will be discussing tips and techniques for the child exposed to pathological parenting. Also, if you need help developing a behavioral program for your child, here’s how to start your child on their own Path to Recovery….
Rebecca Potter, LMHC
Licensed Mental Health Counselor
The Institute’s Child Behavioral Analyst
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