Working With Maltreated Children

Perspective


Children who are having trouble adjusting to their worlds have specific problems and issues. These arenít the same from child to child. Even so, children do let adults know that things arenít going well. Their troubles show in their behavior and in how they deal with various people and situations. Observing the signs and understanding their causes are the keys to providing the children the support and help they need to move past their problems and get on with their lives.

The signs of maladjustment included in the next few sections are 'culturally neutral.' This means that they are important regardless of the child's racial, ethnic, religious, economic, or geographic background or heritage. Having made that point, though, the appropriateness of specific behavior and acceptable emotional expression do vary from place to place and from culture to culture. For this reason, you need to be particularly sensitive when interpreting the behavior and emotional expressions of any child with whom you are working.

Although seeing any of the signs is reason for concern, you need to combine your concern with your judgment about its significance, given the child's life experiences and cultural heritage. Just be sure that you aren't making too much, or too little, of what you are observing. It will help here to talk with others who know the child personally or professionally so you can incorporate their thinking into your perspective.

Both maltreated children and children who haven't been maltreated have problems and personal issues that 'come out' through signs of maladjustment. Seeing a sign of maladjustment in a child doesn't tell you what specifically caused the problem or what is bothering the child right now. What's more, the signs of maladjustment in maltreated children arenít significantly different than those seen in children who haven't been maltreated, although the signs seen may be more frequent and more severe.

Your challenge is to understand what is causing or contributing to the difficulties of the child today. Just keep in mind that children can have problems and issues that aren't related to the maltreatment they have experienced. They certainly may have those types of difficulties but also can have the same troubles other children have.

Signs of extreme behavior disorders such as intense defiance, intentionally injuring other people, drug or alcohol abuse, criminal activities, or willful destruction of property havenít been included. These obviously require professional intervention. Also, they require individually designed behavior management plans. If a child exhibits these types of extreme behavior problems, a qualified expert needs to work with the child and with his caretakers to develop the behavior management plan. Also, the child should be assessed by a child psychologist. The child very likely has learning and developmental disorders that are causing the behavior problems or making them worse.

Signs of severe emotional disturbance haven't been included either. These include signs such as hearing voices, extreme mood swings, suicide attempts, obsession with fire, extreme fears, intentional starvation or very excessive eating, serious withdrawal from people and activities, and very strange thoughts and ideas that are outside of what is real or probable. If a child is having these types of problems, he should be seen by a psychiatrist and a highly qualified therapist. Also, the psychiatrist and therapist should work with caretakers to help them help the child.

A child who has none of the signs in the next three sections likely doesnít have any serious adjustment problems. Children who have very serious adjustment difficulties also have the more typical problems that are included. In fact, they likely exhibited some of these signs prior to developing more serious problems.

The progressive nature of behavior and adjustment problems is, in part, why these signs must be taken very seriously. If they aren't taken seriously today, they will get worse. More serious signs will develop as the child gets older. For this reason, The best help a child can get is the help he is getting today.

From your point of view:



In each of the next three sections, fourteen signs of maladjustment are listed (forty-two signs in all). Think about the child with whom you are working. Look at the forty-two signs and simply put a check mark beside any sign that has recently been observed.

Signs of stress and depression



Stress and depression in children are caused by a combination of external and internal factors. Outside the child, there is perceived turmoil and tension either at home, at school, or with peers. Inside the child, there is intensely felt frustration, fear, and uncertainty. For maltreated children, there are the added elements of horrible past experiences and possibly the lack of permanence in their lives today.

As the child's fear and frustration increase, the perceived turmoil and tension increase. This in turn increases the child's fear and frustration. The vicious circle builds and the child becomes less able to cope. The result is mounting stress and deepening depression. To help, you need to first slow and then stop the vicious circle.

To help a child, the first order of business is to never add fear or frustration to the equation. To some extent, the child feels out of control. You must provide the personal and emotional control the child is seeking, keeping in mind that it will take time and patience. You certainly can't do that in an hour or a day and it may take weeks and months.

Advise the childís caretakers to use the following techniques.

Patience, patience, patience.

Staying calm and open to the child.

Being available to sit with and listen to the child. (Note that this doesn't call for their talking much or offering advice and suggestions.)

Being gentle but firm with the child in terms of their rules and expectations. ('I know that you are having a rough time of it; but you still need to. . . .')

Trying to understand the external problems and issues from the child's point of view. (When they can quietly explain things in a way that fits how the child perceives them and see why the child is so upset, they have reached empathy: they and the child are on the same page.)

Offering other ways of thinking about or looking at the situation, without judging or contradicting. (If the child tells them that they don't understand or that their ideas are stupid, they can say, 'I guess I don't get it yet. Help me understand why what I said was stupid. It isn't much fun being stupid. Will you help me get smart about this?')

If any of the following signs has been noticed within the past couple of weeks, stress and depression are likely a problem. Be sure to talk with the child about your observations and share your concerns. Listen carefully and start developing your plan to help.

Signs:



__ Frequent restlessness and trouble calming down.

__ Frequent sleeping problems or bad dreams. (Also might have nightmares.)

__ Frequent crying or getting upset very easily. (Also might have crying spells.)

__ Frequently losing his temper very easily and quickly, with little to no provocation. (This can be easily misinterpreted as a behavior problem.)

__ Frequently worrying and fretting about not doing things well enough and about failing.

__ Frequently not starting things because he assumes that they will turn out badly anyway. (Also, past life experiences may cause the child to be afraid of adult reactions if the child displeases them.)

__ Frequently giving up on tasks and activities too quickly.

__ Frequently not liking himself. (Also might put himself down.)

__ Frequently not feeling like he fits in or belongs anywhere.

__ Frequently not feeling loved by anyone.

__ Becoming extremely embarrassed over something and not being able to deal with it or get over it.

__ Not getting over a serious loss or disappointment.

__ Feeling unable to do anything about what happens to him.

__ Talking about or threatening suicide. (This isnít normal behavior and must never be disregarded as something the child is just doing for attention.)

Discussion point:



how might differences such as racial, economic, religious, language, developmental, or disabilities contribute to stress and depression for children in care?

Signs of school and learning problems



For children with whom you are working, school attendance may be a problem. Since missing only a couple of weeks of school can lead to behavior and performance problems for children, the difficulties of a specific child may be a direct result of missing school. If so, extra help, patience, and a few weeks to get into the rhythm of regular school attendance will usually get the child back on track.

When a child with whom you are working is having performance or behavior difficulties at school, it's appropriate to start by assuming that the child can improve, with a little firmness and assistance from teachers and caretakers. Focus first on the behavior problems.

Have caretakers talk with teachers to work out a way to get some feedback about the child's behavior, daily if possible. They should calmly but firmly tell the child that the behavior isnít acceptable and that there will be consequences such as the following whenever there are behavior problems at school.

The caretaker can take away a privilege or two for one day or perhaps two whenever they receive negative feedback from school. This might be something like watching TV or being allowed to spend time with friends.

Be sure they don't punish the child or become frustrated or angry. There just needs to be a relatively mild, predictable consequence that is consistently repeated whenever the child misbehaves.

Don't increase the consequences over time. This never helps and will tend to make things worse.

With performance problems, talk with the childís teachers to be sure that you understand exactly what the child isn't doing and then consider these techniques.

Be sure that the child works on homework every evening but not for more than forty__five minutes each evening. Any more wonít help and will likely cause more frustration and performance problems. (For first and second grade children, thirty minutes is enough.) For high school students, a little more time may be necessary. Help the child learn where to study and how to pace himself.

Before the child starts homework, have him explain to the caretaker exactly what the assignment is and how he will go about getting it done.

They should check the child's work two or three times during the study time, offering help and suggestions.

If it's clear that the child doesn't know how to do part of the assignment, they should calmly explain how but don't push or get frustrated. The child is already frustrated enough for both of them.

If the child's performance doesn't improve noticeably within a month or so, talk with the school's psychologist or other mental health professionals about the problem. The child's trying harder or caretakersí trying harder won't help until everyone understands why the child isn't doing better. This likely isn't related to real ability. It's more likely related to a minor learning problem or to other issues neither the caretaker nor the child can directly control. Just be clear about the fact that it isn't the child's fault and that pushing, punishing, or blaming the child will make things much worse, very quickly.

Signs:



__ Often can't express his thoughts and ideas.

__ Often doesn't understand assignments and what people expect.

__ Often doesn't understand what he reads.

__ Trying harder usually doesn't lead to his work and skills getting better.

__ Does some assignments very well and others very badly.

__ Often forgets what to do or what people expected.

__ Often doesn't follow instructions and directions.

__ Gets bad grades.

__ Doesnít ask for help or let others help.

__ Regularly has excuses for not doing well.

__ Thinks his not doing well is someone else's fault.

__ Has to have an adult standing over him to be sure his work gets done.

__ Disrupts the class or the activities of others.

__ Doesn't make much effort to cooperate and get along.

Discussion point:



how might differences such as racial, economic, religious, language, developmental, or disabilities contribute to school and learning problems for children?

Signs of interpersonal (relationship) problems



Before dealing directly with the signs in this section, consider the possibility of school and learning problems. Interpersonal difficulties in children are very often accompanied by learning and performance problems at school. Helping the child with those problems usually leads to improvement in interpersonal areas, without specific attention to the interpersonal issues.

The social dimension of development normally comes into focus after the emotional and moral dimensions are more fully developed. The child has learned to manage his feelings fairly appropriately, without tantrums or pouting, uncontrolled excitement or unwarranted fear. Children do certainly get excited, unhappy, frustrated, upset, bored, and are clearly emotional people. Still, they manage all of these feelings and intense emotions reasonably well.

From a moral perspective, young children have learned a lot about right and wrong, good and bad, appropriate and inappropriate. They also have learned to 'read' the emotions and feelings of other people and can decide about things based on how others feel about them. 'I won't do that because Mom will be upset.' 'I will do this since it will make Dad happy.' Getting Mom upset is 'bad' and making Dad happy is 'good.'

Children also learn to apply these simple notions of good and bad to their interactions with other people. The process is complex; but they take the other person's perspective. 'If this would make me unhappy, it will likely make others unhappy too.' 'If this would hurt me, it would hurt other people too.' 'If I would like being treated this way, it would be a good way to treat my friends.'

When emotional management and moral judgement are combined, the result is a child who has the developmental skills and attitudes needed to be interpersonally successful. This success plays out in the context of the child's personality which varies a lot from child to child. Some children are more outgoing while others are more reserved. Some are more bold while others are more timid. Some are talkative while others are more quiet. The point is that these characteristics have a wide normal range and only the extremes are anything to be concerned about.

As you look at the signs of interpersonal difficulties, then, you can see that they do reflect problems getting along with other people. More importantly, though, they reflect deficits in the children's emotional and moral development.

For the first eight signs of the fourteen in this section, the primary emotional management issue is how the child deals with anger and frustration. Things happen that can frustrate the child and he may not handle it appropriately. This emotional mismanagement can range from pouting and being hateful to more open aggression and uncontrolled anger.

Assuredly, maltreated children may have a lot of reasons to be angry and frustrated. Further, it's likely that they haven't had constructive, positive emotional and moral examples set for them. Even so, they must learn better interpersonal approaches to people and frustrating situations.

Never add anger to the equation. Caretakers and other adults certainly need to be firm and clear about what they expect; but getting angry models the very behavior they want to change.

To the extent they can, be sure they don't try to stop the inappropriate behavior while it's happening. They should do what is needed to be sure other people or the child don't get hurt; but try to let the episode run its course. Attempting to stop the behavior while it's happening usually only intensifies the child's reaction.

Once the episode has passed, they should calmly tell the child that the behavior was unacceptable and why it was inappropriate. Ask, 'Did you have better choices? How else could you deal with those situations?'

Be clear about what the consequences of such behavior will be in the future. Those consequences need to be fairly mild, not lasting for more than a day or two, consistently applied, and something that caretakers can control. Again, taking away a privilege for a specific amount of time is best.

Remember that these problems are developmental and that changing the behavior will take time. The goal is to gradually see fewer, less intense reactions from the child. It will help to keep in mind that not dealing successfully with these developmental issues is the single most common reason why children have adjustment problems in later life.

Although the first eight signs do reflect a lack of social skills, emphasis needs to start with work on the emotional and moral developmental deficits the children are likely experiencing. For the last six signs, emphasis needs to be on social skill development. When these signs are seen, children need help with relating to people in more assertive, self__determined ways. This starts with the child's relationships with caretakers and other people at home. These approaches will be useful.

Don't tell the child that what other children think and feel don't matter. They do matter, a lot, especially to the child.

Talk with the child about social behavior and approaches that may be 'putting off' other children. 'When you do or say this or that, children probably think. . . .'

Encourage the child to be more assertive. 'When you don't stick up for yourself or don't say anything when children treat you that way, they will keep trying to get a reaction from you. It's your job to let other people know what you will and won't put up with.'

Help the child set better personal boundaries. 'When you cry or get upset, other children will keep tormenting you. You might try either calmly telling them that they are being stupid or maybe you can just ignore them. If they can't get you upset, they will work on better ways of getting your attention.'

Help the child understand relationships better. 'Your friends don't want to just have you as their friend. They also want to spend time with other children. When you try to keep them to yourself, they don't like that and won't want to spend time with you.'

With all of the signs, 'teach' children the things they need to know about the give and take of relationships and about the skills they need to be interpersonally successful. Also, encourage their caretakers to play with them, do things with them, and help them develop related skills such as playing ball, just sitting and talking, and whatever else they need to be able to do to participate effectively in their social worlds. Just keep in mind that a very normal part of this learning process for children is trying most of the interpersonal strategies that don't work, discarding those approaches, and coming up with ones that do work. Doing it wrong and then finding a better way is one of the most effective learning strategies for children, and for adults too, for that matter.

Signs:



__ Frequently pouts and is hard to live with.

__ Is often hateful and in a bad mood.

__ Gets very angry when things donít go his way.

__ Frequently screams and yells at people. (This is a problem unless the adults are screaming and yelling as much as or more than the child.)

__ Frequently breaks or damages things.

__ Hits or hurts people.

__ Starts or gets into fights.

__ Bullies and picks on others.

__ Has a lot of trouble making and keeping friends.

__ Wants to keep his friends all to himself.

__ Frequently gets his feelings hurt.

__ Frequently is the brunt of teasing and put__downs.

__ Regularly tries to please everyone and keep everyone happy.

__ Most children his age donít like him.

Discussion point:



how might differences such as racial, economic, religious, language, developmental, or disabilities contribute to interpersonal problems for children?



By Gary A. Crow, Ph.D. March 23, 2017