This is the final installment of my series on trauma gleaned from CALO’s 5th Annual Conference on Trauma, with information presented by Joseph Spinazzola, Ph.D. from JRI in Massachusetts, Steve Sawyer from NVW, and folks from CALO including Rob Gent and Landon Kirk, as well as some general information from the field (towards the end).  In Part 1, I described how trauma creates a “fight or flight” reaction to the world that is based on survival instincts centered in the brain.  In Part 2, I talked about how that overly alert perception guides behaviors, and began the discussion about how those responses should guide treatment.  In Part 3, I will discuss attachment, trauma, treatment, and the path to a healthier emotional life.

A traumatized individual can appear difficult.  Symptoms may range from oppositional behaviors, cognitive disorders, mood instability, aggression, passivity, and/or obsession.  The child may make statements that “don’t make sense” to others (What’s he talking about–that’s not what really happened!)  The child craves “unconditional love” from others, yet ironically that is on the unhealthy end of the continuum of emotional regulation!  That is, the thing they crave the most, love, is also the thing most feared in a traumatized brain.  It is vital to understand that trauma affects relationships in many ways and makes it difficult for healthy attachments to occur.  Even well-intentioned individuals may inadvertantly re-traumatize an individual (a classic example, using a rape kit to test a rape victim).  Treatment modalities for many different types of emotional, psychological, or behavioral conditions often rely on talk therapy or even phase or level systems–yet not one of these is effective with victims of developmental trauma, as the triggers can be subtle or overt, and the response inconsistent and volatile.  Trauma creates a very “in-the-moment” response–fight, flight, or freeze–and as such must be addressed in the moment, and not in a behavioral manner but in a relational (attachment centered) way.

So what does treatment look like?  When does it begin?  How long does it last?  Well, treatment for trauma looks very different from other treatments.  It should begin immediately and in the moment.  And the trauma never “goes away” magically, so effective treatment must guide the individual to build a toolkit that will likely need adjustment from time to time throughout that person’s life–but hopefully, they will be doing many of the adjustments themselves.  This is why good treatment must start immediately, and must be appropriate to trauma, not to behavior alone.

Caregivers for children with trauma need to truly be present–not just physically, but mentally as well.  They need to be ready to attune to the child and follow or lead as needed by the child.  Some might think this sounds like coddling or allowing the child to manipulate the situation, but that cannot be further from the truth–we are talking about substantive changes in brain chemistry and processing that need careful guidance to realign and re-regulate an entire system!  Change is short-lived in trauma, so behavioral interventions might last a day, a week, even a month–but a trigger can undo all that work in a heartbeat!  Thus, therapeutic trauma work is fluid, ongoing, and relational.

Because our emotions are guided by the brain (see Parts 1 and 2), we interact with the world where our brains perceive ourselves to be.  So a good therapist/caregiver must be aware of that child’s perceptions and actions in that moment.  The therapist/caregiver wants to help the child find safe places–unfortunately, the situations they are used to are actually unsafe!  So when they are in a heightened state emotionally, and their feelings are ramped up, the therapist/caregiver needs to help the child by attuning to their needs and their state right now.  Only then can the therapist/caregiver help the child ramp down.  This is not the same as simply “supporting” (Oh, I’m so sorry you feel that way.  Here’s a cookie.), it’s about hearing them and realigning their entire nervous system in the moment.

Oh, really, you may ask, so how do we do that?  We do that by building a relationship of trust and reciprocity, by getting to know them truly and deeply and helping the child get to know themselves, and by helping the child learn how to repair their responses and their relationships in a structured, safe way.  Face to face interactions help us build communication in all aspects of our lives.  It is therefore imperative that we implement communication in treating children with trauma.  Time outs, locked rooms, and isolation have the exact opposite effect and only reinforce that child’s trauma (and the same is true for excessive physical and chemical restraints).  Empathy is the antidote for shame.  A traumatized brain does not process sarcasm, competition, or even praise appropriately or well.  Praise, for example, has to be equal to that child’s self-concept or it becomes confusing and the child thinks you’re lying.

Remember, a healthy brain is relational.  It likes commitment, acceptance, security, attachment, and empathy.  But these require higher order thinking skills, something missing and/or detached in a traumatized brain.  In order to heal, the traumatized brain needs caregivers who can help that brain, slowly, patiently, and in the moment, re-regulate, calm, and realign perception–about what is happening around it as well as to it.  To be effective, care must be trauma informed and therapy trauma focused.  A child needs to develop a feeling and thinking brain connection through understanding feelings (affect literacy), relationships (relational literacy), the body and the brain responses (somatic and nervous system literacy), and nervous system management and entrainment.  Yes, they need to be aware of how their body responds to feelings and learn how to self-soothe in a healthy manner (no more head banging, cutting, or sensation seeking).  Breathing regularly, for example, is actually the best defense to calm the brain (rather than the hyperventilation one often experiences when stressed).  Finally, treatment must include something tangible for the child to hold onto, with a regimen he or she can use daily (the famous toolkit!).

There are many paths to self-regulation.  Trauma system yoga, Heart Math, Neurofeedback, Equine (or other animal) therapy are examples of excellent approaches.  But if a child is truly traumatized and in need of care, intensive treatment that may include residential placement is essential.  In the best residential setting for trauma, trauma work continues 24/7, the same time frame in which trauma is lived by that child.  A close staff to resident ratio allows the child to build at least one trusted relationship, and the opportunity to practice new skills in the moment rather than at prescribed times of the day or the week.  A strong program of any kind must also include family therapy so that the parent or caregiver can develop their own toolkit that will help them rebuild a healthy relationship with their child.

In conclusion, a parent or primary caregiver should never feel ashamed or embarrassed by seeking outside help.  After all, caring for this child can create its own trauma in the parent or caregiver as well.  By seeking help, you acknowledge that you and your child need help overcoming something bigger than both of you.  And by seeking and receiving the right care, you are preparing your child for a healthier emotional life and better relationships, and that treatment, the development of that lifetime toolkit, is priceless.

For more information, I’ve attached some sites that may be of interest to the reader.  This is intended as a guide only, and there is even more information out there!  Nor is this a specific endorsement of specific programs, although there are only a few that specialize in trauma-informed care.


Trauma and The Brain Part 2

This is Part 2 of information gleaned at CALO’s 5th Annual Conference on Trauma, with the information herein distilled from a great deal of current research and presented by Joseph Spinazzola, Ph.D. from JRI in Massachusetts, Steve Sawyer from NVW, and folks from CALO including Rob Gent and Landon Kirk.  In Part 1, I described how trauma creates a “fight or flight” reaction to the world that is based on survival instincts centered in the brain.  In Part 2, I will talk about how that perception guides behaviors, and how that response should guide treatment.

According to research from the National Incidence Study (NIS-4), about 1 in 58 children are harmed in the United States–44% from abuse and 61% from neglect.  That means about 1.25 million children are harmed.  But there are two basic standards of maltreatment that include “harmed” or “endangered”.  Endangered children often don’t display manifestations of maltreatment, and that is how they are defined separately from those whose maltreatment is more evident (such as physical or sexual abuse).  The majority of “endangered” children exhibit a delay between the onset of problems from the mistreatment and the mistreatment itself.  The “danger” has passed, but now the behaviors become evident.  The scary part of this should be understanding the numbers–about 3 million children, or 1 in 25, falls into the endangered category.

In Part 1, I described how the brain encodes feelings, processes information, and activates the senses for survival.  If we experience moderate amounts of good and bad things, our brains can process information more effectively.  We learn to recognize that “this” is good or “this” is not or even that “this” is unknown, so I need to think about the potential “good” or “bad” about it.  An endangered child may have experienced trauma and encoded those negative responses or feelings over time. When things become overwhelming or trigger those feelings again, thinking goes out the window.  Things become confused, and the individual has no clear perception of what is happening.  Their responses break down.  And everyone around them becomes confused by their responses.

Let me clarify this a little more.  The brain is use dependent–our brain responds to input that we receive from activities and sensations around us, and it develops pathways to process or streamline the way we view future activities and sensations.  Our brains adapt our behaviors to stimuli based on what pathways are created.  During stress, our brain produces cortisol (the stress hormone) to help us respond appropriately–do I run?  Do I fight?  We need this during truly stressful situations, such as a hurricane (run!).  But if the brain gets stuck in flight or fight mode, the cortisol is not taken back to the attic for storage–and research now shows that excess cortisol is highly toxic to brain development.  In fact, fMRI studies have revealed that even the visual cortex, literally how we see things, is negatively affected by the excess of stress hormones over time in the brain.   These underdeveloped pathways affect how we respond to new stimuli–and unfortunately, the response is largely negative.

Current research even indicates that when a brain is given aversive stimuli over time and it is equated with something “rewarding”, the brain becomes addicted to seeking the aversive stimuli (Note: I am simplifying this information!  But from a practical application one can look at this as addictive behavior).  The underdeveloped brain begins to crave or seek those negative stimuli that it feels will result at the end with some positive reward–whether it is real or imagined.  Thus, research is exploring how people (more underdeveloped pathways) get caught up in dysfunctional relationships that a more “rational” or “thinking” person (better developed pathways) would abandon.

So returning to those endangered children: Psychological maltreatment is the more prevalent, and the most enduring, form of child maltreatment.  Psychological maltreatment can be broken into verbal abuse (commission–“You are worthless.  No one loves you.”) or neglect (omission–“It’s not my problem.  Go ask your Mother.”) by caregivers (and no, this does not refer only to parents!).  The child remains in a situation in which there may be no escape, and eventually may remain in the situation because this is how “normal” feels to that child.  But it is unhealthy–very unhealthy.  These children have significantly increased internalized and externalized behaviors when compared with kids who have suffered sexual or physical abuse.  And the majority of risky behaviors do not manifest until these children are teens–there is very little treatment for children.  In fact, there is very little treatment prescribed to any of these individuals, and none of the common treatment modalities for mental illness or emotional disturbance are designed to focus on this type of trauma.

The triggers for a traumatized brain can be extremely subtle.  These children are quick to notice things like changes in facial features.  Unfortunately, just as they are “quick noticers” they are also poor interpreters.  Just because someone screws up their face quickly does not mean they are about to attack–they may have allergies that caused their nose to get irritated and thus their “face” changed.  But the traumatized child has learned to respond quickly and in the moment.  They feel vulnerable, frightened, ashamed, and/or threatened.  Being in the dissociative state of extreme dysregulation, they fight, flight, or freeze.  They might punch the child about to sneeze, or run away screaming–and the other children look at them with equal amounts of fear, disgust, or judgment:  “He is crazy that boy!”  That child’s brain pathway has become in Dr. Spinazzola’s words, the “Highway to Hell”.

The pathway to trauma is very different than say behaviors caused by inattention.  Thus, treatment must be different than what is normally used with other presenting behaviors.  The approach with children must also be very different from the approach used with adults.  Well-intentioned caregivers often unintentionally re-victimize the child.  For example, level systems may seem appropriate to give a child something to reach for–but if the child “fails” and loses a level, they feel once again as if they have failed completely and their trauma is reinforced.  And because of the “in the moment” dysregulation that is the hallmark of the traumatized brain, effective treatment must follow in the moment.  All the talk therapy in the world will not help a traumatized brain during your session on Mondays at 11!  Anyone working with a traumatized child must be aware and present.  They need to be attuned to the child’s moods and reactions in the moment.  They must be willing to share power, challenging and testing limits in very small increments through a pace set by the child.  And they must be willing to adapt to the child.

In Part 3, I will talk more about attachment, trauma, and treatment, and the path to “repair”.

Trauma and The Brain Part 2

Trauma and The Brain, Part 1

Before I begin, I want to acknowledge that the following information was gleaned from researchers and practitioners in the field who presented at the 5th annual Developmental Trauma Conference at CALO — Change Academy at Lake of the Ozarks — on Tuesday June 23rd and Wednesday June 24th 2015. Speakers included Joseph Spinazzola, PhD from Justice Resource Institute in Massachusetts, Steve Sawyer from New Visions Wilderness, and Rob Gent, and Landon Kirk from CALO. The information is based on research that includes brain mapping and longitudinal studies to study the effects of trauma and stress on our neurological functions and emotional responses.  My goal is to make this information accessible to the parents and caregivers of individuals who suffer from trauma as well as to those individuals.  A special thank you to the team at CALO who do this good work every day and who put together this conference every year.

To simplify, the centers of the brain that regulate emotion developed first to protect human beings.  We learned early on in human evolution to tune into danger and remain hypervigilant so that we could protect our lives and the lives of our fellow beings.  When danger passes, however, we can take part in other things, particularly more complex problem solving and creative pursuits.  One often hears these days about the prefrontal cortex which is responsible for higher level thinking and learning.  The higher level skill set in the prefrontal cortex is as important as our hypervigilant skill set (our parasympathetic network), but it is hard to access the higher level thinking when one is frightened, hyper-alert to danger, or otherwise fighting for survival.  That is how our brains evolved.

What we know about trauma is that one gets stuck in hypervigilant mode.  Thus, “thinking” kind of goes out the window.  We have all seen someone in distress, and people around them might say “calm down” or “think about what you’re doing” when in fact those are two things that person cannot do in the moment.  The person who is not suffering trauma will, after a moment or two, calm down because their body can and will respond quickly to self-regulation.  Maybe without thinking that person begins breathing steadily, which is the most effective method by which to bring down one’s internal danger barometer.  Some folks will start counting to ten.  Some will sit down and slowly, calmly, regain their composure.  A person in a trauma cycle, on the other hand, will not.

So what is trauma?  Most people think of a traumatic event, such as a tornado whipping through one’s town and destroying homes and/or lives, or a war, or an act of violence upon the self such as a robbery–these are legitimate situations that can impact an individual.  Some will find it harder than others to overcome the trauma.  What we do know now is that the longer the individual suffers the situation, the harder it is to self-regulate because one remains in hypervigilant mode.  Think of a soldier who repeatedly goes into battle, or a spouse who suffers emotional or physical abuse at the hands of another spouse.  This type of trauma is characterized by re-experiencing the event(s), there is avoidance or numbing, and there is increased arousal.  We often think of these individuals as “walking wounded”.  But that is not the only thing that defines trauma.

Research now indicates that there is something known as Developmental trauma.  This is complex, and often involves an amalgam of problems over a longer span of time and is also comorbid with other disorders.  The more enduring the trauma, the more intense it is over the span of a lifetime.  That is, it impacts both immediate and long term outcomes for the individual.  Even if a child works through complex childhood trauma for the most part, it can come back to haunt that individual if they suffer additional trauma as an adult.  It is our limbic system that encodes our emotions, processes information, and activates our senses for survival.  If one becomes overwhelmed, things fragment and get confused.  And the more deeply entrenched our traumatic “memory” the harder it is to return to a state of self-regulation–to “think” and respond appropriately.

For a child with complex trauma, the most common signs or problems include affect dysregulation (can’t maintain an even keel emotionally), poor impulse control (act without thinking), negative self-image (I am not worthy), poor concentration, and increased aggression.  This creates functional impairment and a view that the world is unsafe, others can’t be trusted, and also that they are unable to function as demanded (I can’t).  Problems are usually more noticeable at home, because school is often more structured, predictable, and relationships with teachers often less emotionally loaded.  There is often a feeling that “I can hide” at school.  Of course, not all children with complex trauma do well in school.

It is important to recognize that these children are not always “victims” of severe abuse at home.  In fact, research indicates that some children suffer from caregiver separation or absence rather than because of the presence of violence/abuse.  [Think of children who live their early lives in orphanages in which they receive little to no human touch or affection.]  At present, this research is ongoing, but there is a belief that relationships are paramount to the extent to which the trauma is increased or decreased over time.  What is certain, however, is that the child with complex trauma develops maladaptive self-soothing, such as head banging, and emotional regulation is increasingly disturbed over time.  Thus, appropriate treatment as early as possible is imperative.  And it must be grounded in trauma informed and trauma centered practices.  All the talk therapy in the world will not help such a child!

In Part 2, I will talk more about perception and the general approach to healing. Stay tuned!

Trauma and The Brain, Part 1

Why College? Why Now?

A former client dropped by the other day to say hello.  I had worked with both of her sons who are dyslexic and had received poor elementary level education in their public schools before she came to me.  They went on to a wonderful school for dyslexic students, then transferred to another wonderful private high school for students with learning disabilities.  They both made progress.  The last time I spoke with this mother, her oldest was thinking about college.  I offered to meet with him, but he decided to proceed with his guidance counselor, and I thought that would be fine, too.  Her younger son is now a junior at a similar crossroads.  I offered to meet with him, and she said she really wants to have him do that.

The older son (I’ll call him Joe) went to a well respected college that has extensive supports for students with learning disabilities.  At that, Joe was enrolled in an additional program that gave him even more support.  He actually got good grades.  But he still felt lost.  Joe became depressed, and eventually he told his parents he wanted to drop out.  He is working, but feels that somehow he will never “make it” and his self-esteem is poor.  Joe’s parents remind him he did well, so it’s ok, but somehow the magic button that is college did not pan out like he thought it would, so he thinks the fault is his somehow.

So what went wrong?  The family did everything that was advised to them, and their son did well in his college.  On the surface, there seems to be no reason for this evident “failure”.  Now their second son (“Bud”) is at the same crossroads.  His mother says he is different, and he really wants to go to college.  At the same time, she is concerned because his college counselor, as with Joe, told Bud he should “just go” as if somehow everyone should without question.  I asked, well, should I “just go” to Paris?  She laughed, but I think she got my point.  And then she said that Bud asked if he should study dentistry, if he should study business, he doesn’t know what he wants to do. . .from my perspective, I think I see what is wrong with this picture.

Why college?  If a young person is so uncertain about their future, the first thing they should be asking themselves is what they hope to gain from college.  It is not a magic button.  It is one of many possible stages or arenas in which to learn new skills and learn about one’s self.  It requires continued studying and homework–something that many students seem to forget in their quest for self-knowledge and the perfect job.  College is an opportunity, in short, to grow, to become, to explore.  It is not the final destination, it is part of the journey.

Why now?  Well, frankly it is easier to go to college before one is married or has other deeper obligations that take the focus away from those learning opportunities.  It can seem magical in the eye-opening and exploration, but the hard reality is that if you party hard you will suffer!  So again, no magic button.  It is as I said a part of life’s journey, and what better time to explore than when one is young and unencumbered.

Here is the exercise a young person and their parents need to undertake before moving to the future.  What does a young person such as Joe or Bud hope to accomplish over the long term?  Likely, they are thinking I hope to get a good job in something like XXXX, maybe get married and have a couple of kids, and eventually settle in a nice neighborhood near my parents/cousin/best friend.  That’s the long term goal.  So how do you get there?  The short term goal may include more learning, like college.  It might include working in a specific trade or field.  It might include travel.  But does more learning or college have to be now?  Should it be now?  Should a student work or travel for a year?  Should they take a PG year at another school?  There are alternatives.  A four year college degree opens doors, but guarantees nothing–especially not if the student does not have a focus.

I probably would have advised Joe to wait.  He can do the work, but he had no focus.  Now he feels like a failure, and he did not fail at his school work!  There was a clear disconnect between the college work and his goals (which I suspect were not clear to him at that point in his life), but he is interpreting that as a problem on his part.  As for Bud?  I’m not sure how I will advise him yet, but just from what his mother said, I think college could be a great choice for him.  He wants to explore opportunities in a way that is often best addressed in college (i.e., trying different courses).

And when all else fails, I remind students that I wanted desperately to go to college when I was 18.  I loved learning, and I wanted to continue learning.  I wanted to explore things.  During my sophomore year I learned that I would lose some of my funding in spite of my excellent grades.  I was devastated and had to leave school because no matter how we worked the numbers I could not afford to stay.  Eventually, I returned to college–after having married and having had children.  It was hard, but once in college again, my love of learning reignited, I realized that I now had more to offer.  I had gained new insights into myself and into my goals through life experiences and work.  And that realization was very rewarding.  It made me understand that there is a “neatness” to attending college on a traditional trajectory (straight out of high school) that is timed perfectly in many ways to the development of the young brain–but there is also a reality that not all students need to go to college right away.

So ask yourself–what do you hope for?  And can college get you there?  And do I need to do that now?  This the first step in the development of self-knowledge, and it is as important a part of the life journey as is filling out an application.

Why College? Why Now?

It’s That Time of the Year Again

I have had several families call recently concerning college options and if they are “too late” or “too early” in the search, what do they need to do, how do they get accommodations, etc., etc.  I hope to answer some of those questions for you here.

First, it is usually a good idea to think about the future when a student begins 8th or 9th grade in terms of selecting classes that will help set the student up for a college trajectory.  You can do this by working backwards.  For example, a student who excels at math should have completed AP Calculus by their senior year of high school, so working with his/her advisor, that usually means Algebra I is completed in 8th grade.  “Average” students should be placed in classes that allow flexibility, so that if they exhibit undiscovered talent in a particular area they will get the chance to shine at some point.  For example, a “College Prep” or mid-level curricula that allows a student to bump up into Honors levels when they do well in a particular course in a particular year will be well placed to challenge themselves in Honors the next year.

On the other hand (spoiler alert–this is for parents who worry about excessive stress and strain on their already stressed children!), pressing the student to excess at the outset may backfire.  If a student is doing well, and can handle some challenge, go for it!  Sometimes students need to be pushed or need incentives.  We all know people like that. For the college search, it is not about the grades per se, but the effort and the challenge that goes into the grade.  Colleges love seeing Honors and AP courses on a student’s transcript because it conveys that the student pushed him or herself, as both levels require a certain degree of ability and effort.  Thus, a C in an Honors class carries more weight than a B in a lower level class.   But I have seen many bright, talented students get pushed too hard and too soon and they do not do well in the higher level class.  This leads to them being dropped a level, which often leads to shame, embarrassment, and frustration.  It also looks questionable on a transcript if the student does not at some point improve their performance (and/or their class levels).  Another problem is created by grade inflation in lower level classes that have not prepared the student fully for college yet it “looks good” on paper.  Or the student has learning issues that causes them to be placed in lower level classes in all areas because the school does not offer differentiated levels of instruction, so the student becomes frustrated and their talents left untouched.  It is important to understand that grades are not everything, nor is performance on standardized exams.  If a student is engaged and learning, that is far more important.  Thus, even lower level classes should be preparing a student for college and/or the professional world.  Students in such classes do not have to write a book so to speak, but they should be writing five to ten page research papers by the time they graduate.

Thus, the true college search usually begins in the fall of the junior year.  Most students have had the chance to join a club, get a job babysitting, take driver’s ed, flirt with the student sitting next to them, learn how to use a library, run a five minute mile, or learn how to put together a halfway decent presentation.  They have begun thinking about the future as their older friends graduate and go off to college.  They are preparing for their senior year.  So at the beginning of the school year, college admissions representatives begin sending out mailings, set up booths at college fairs, and attend ball games to size up the “next big thing” for the college football team.  Students notice this and other events.  By mid-year they should develop a list of interests and compile a list of possible colleges based on their interests, their completed work, and their dreams.  By spring break they should begin visiting.  And during the summer, they should be diligently working on whatever skills they need to improve as well as completing their essays.  Come September, they need only fine tune applications, secure recommendations from trusted teachers or other professionals and narrow the field so they can concentrate on their class work.

Students who will need accommodations in college should be very busy during this time. They need to update any psychoeducational evaluations, doctors reports, etc. during the late spring/early summer.  They need to find out about the support services of different colleges and draw comparisons so they pick the one that is right for them.  They may need to take additional summer courses, work with a tutor on study skills, and/or take SAT prep classes.  College will provide them with accommodations, but will not provide remediation.  Check out what coursework is “required” vs. “recommended” both for admissions as well as for graduation from those institutions that most interest your student.  And parents need to stay on top of IEPs and 504s to ensure that their student will get what they need before they go off to college or a post-graduate program–and decide whether or not the student needs a post-graduate program!

Short answer?  You don’t need to start worrying about college when your child is in elementary school.  But please do not wait until the beginning of the senior year!  And if you are dissatisfied with your school’s guidance services, please do not be afraid to check out other resources.  Yes, you will have to pay for those resources–but college is an investment in your student’s future.

It’s That Time of the Year Again

When Do I Know That My Child Needs Help?

When do you know if your child needs help–in school, at home, on the playground. . .?  Let me begin by suggesting that if you are asking that question, the time might be now!  You might be especially concerned, with good reason, if you or someone in your family struggled when they were little, and/or if your child was born prematurely.  We hear that a child develops in stages, but what does that really mean?  After all, some children are quick to develop in one area, slow in another.  That is not unusual in and of itself.  But there are some tell tale signs at different ages of “typical” developmental milestones and basic skills.  If you question your child’s development in these or other similar areas, do not hesitate to seek support, or at least get answers to your questions.

An infant begins noticing the world around him or her fairly quickly by turning their head to sounds.  By about 6 weeks of age, most infants recognize human faces and smile back when someone smiles at them.  By 6 months, most infants grasp at objects, try to verbalize when spoken to by moving their mouth and tongue or making noises, giggle when you blow on their bellies, sleep a few hours at a time (or even overnight) without crying for food or a clean diaper, and recognize the faces of primary caregivers.  By 18 months, toddlers walk, talk in words and/or phrases, eat (messily) with a fork or a spoon, hold a cup or a bottle by themselves, and try to run away to explore the world when you don’t want them to.  Many know the word “No!” quite well and are not afraid to use it, even if they seem to forget what it means when you say it.

Children who are slower to develop these early skills at about these times, but who continue to develop nonetheless should be monitored closely.  While they may not yet need significant supports, they should not be neglected, for it is our timely development of basic milestones that seems to have the deepest impact on later development.  For example, our language skills develop exponentially in those early months, and we acquire several hundred to thousands of words in our first two years of life!  We may not speak all the words we know, but we know them when we hear them.  And our sense of grammar and syntax develops with equal speed in that time frame.  Children who seem to have a limited number of words, who do not speak even in “babble”, and/or who do not respond at all may have any number of developmental language issues.  Similarly, a child who does not walk, crawl, or grasp at objects may have any number of muscular or skeletal problems, many of which are easily addressed.  On the other hand, some toddlers have night terrors for no apparent reason, are particularly shy or particularly bold, or flit from one activity to the next.  These types of behaviors by themselves are not necessarily worthy of concern unless accompanied by other behaviors or limitations.  So a child who cannot grasp small objects, who does not respond when you speak to them, has a very limited ability to communicate, and has poor sleep patterns may have developmental disabilities that need to be explored and addressed.

By the time our children enter preschool and kindergarten (3 years and older), they should be talking, using the bathroom (with fading support by age), feeding themselves, playing with toys, and interacting with others.  If a child exhibits unexplained outbursts, experiences poor sleep on a consistent basis, does not respond to his/her name and/or seems “absent” most of the time, has difficulty walking, running, and/or throwing, does not speak or speaks unintelligibly, does not interact with caregivers or others without significant prompting, cannot manipulate small objects in their hands (such as buttons), tears at clothing or exhibits nearly obsessive behaviors with certain articles of clothing, eats things that are not food, and/or exhibits overly aggressive, overly passive, and/or inappropriate behaviors with others, then outside intervention is likely needed.  Any of these traits can be signs of something organic, such as a food allergy or headaches, or a neurobehavioral or developmental condition (such as ADHD or Autism Spectrum Disorder), or a musculoskeletal condition (such as low tone or dyspraxia).  By kindergarten and 1st grade, children should know basic two dimensional shapes, know primary and secondary colors, and be developing early reading, writing, and math skills.  A child who has been exposed to books from an early age should speak their alphabet by age 6 (with minor errors that are not always consistent), even if they make mistakes writing it (such as letters slightly out of sequence).  Mirror writing or letter or number reversals are not highly unusual at this age, but should be monitored especially if the errors are consistent (such as a child who mirror writes numbers all the time).

Do not be afraid to ask questions of the professionals who work with your child.  And if you are still concerned, keep asking!  Some issues are easily remediated, such as b and d reversals when writing.  But others require expert and professional support.  The best barometer to determine when to question whether or not your child needs help?  When you think he or she might need help.  Trust your instincts!

When Do I Know That My Child Needs Help?

What is Therapeutic Wilderness?

I have parents ask what is wilderness, and why does it work better than sending my child to therapy?  These are basic questions to answer on some level, although the underlying factors and facts are not so easily answered.  So bear with me as I lead you down a path to understanding.

Let me begin by saying that there are many talented and hard working therapists out there. Their job with adolescents is not easy.  They must compete with many other distractions on an infrequent basis to provide not only an outlet for the child to complain about their environment but to build an individual tool kit to help that child survive and thrive amidst those distractions.  For some individuals, let alone for some children, the therapist becomes the first and best line of defense.

Most of the families we see have tried this route.  They may have already seen a few therapists–one for the child, one for the family, one in school and one outside school, even one for each parent–and perhaps it worked for a while.  But another stumbling block might have emerged, and they found themselves back at the beginning.  Or perhaps they tried to find a good therapist but could not find one that worked for them.  After all, one must like working with one’s therapist and find the relationship rewarding on some level.  But that level is subjective.  That is the human nature of psychology.  While there are never guarantees, we do what we can to effect change.  And that may be why, for some people, outpatient therapy is not enough.

Wilderness programs have been around for many years now, with recent research bearing up that this is, for some students, a reasonable therapeutic alternative with positive outcomes  (  [As a note, I am not including boot camps in this discussion as I consider them to be highly punitive and therefore not therapeutic.]  Anasazi began as an experiment some 50 years ago through a university program to help turn around the lives of young people by removing them from their current difficulties and rerouting their thinking.  Formally launched as a nonprofit in Arizona in 1988 by Larry Olsen and Ezekiel Sanchez, Anasazi still runs a traditional wilderness model in which students live in the desert for 8 weeks.  Food and shelter are provided (and field staff carry satellite phones for emergencies), but cell phones, television sets, and iPods are not.  Since then, many other wilderness programs have come along (and some have gone).  There is a wide range of programs now, including high adventure models with intensive exercise, base camp models in which students sleep in dormitory style cabins and venture out on two or three days hikes, campuses with dormitory type accommodations in which students only go out during the day, to those with farm-like settings.  The basic premise that separates wilderness from other therapeutic settings (such as boarding schools) is the intense experiential work and the short length of stay (typically 6 to 10 weeks).

Many children and adolescents who are placed in wilderness are angry, defiant, scared, depressed, anxious, oppositional, shut down, engaging in risky or harmful behavior, and/or in general are not doing well at home and/or at school.  They may or may not be using drugs, engaging in sex with multiple partners, hurting themselves, refusing to eat or to speak, sneaking out at night or disappearing for days on end.  They may or may not be failing in school.  They may or may not be hiding in the basement of their parents’ house.  In any event, many have been seeing one or more therapists, and things are either not improving or are getting worse.  Most do not want to go to wilderness, or anywhere else for that matter.  Not surprisingly, this is the point at which critics of the industry suggest that children should be able to drive their own therapy.  Unfortunately, many of them have been, and it has not been successful.  It is at this juncture that parents have to exert control and decide–is this step right for my child, and if so, which program do I choose?

Understand that the basic premise of wilderness is to remove a child from their current environment.  The idea is that by removing all distractions, the child will be forced to confront their issues and/or their concerns, and will do so in a structured way in an unstructured environment (we cannot control whether or not it rains, but we can control whether or not to put up a tarp to keep us dry).  They will have the opportunity throughout the day and the night, 24/7, to discuss or to explore their feelings and the factors that have led them to this place.  In a good program, they will work with carefully trained field staff and therapists to find their “genuine” self, to build self-esteem and self-efficacy through self-care, to understand how big the world really is and yet how much one person can have an impact on it, to appreciate the importance of relationships to survival and to joy, and to rebuild those relationships that were almost destroyed.  For families, it can serve as a break, but families also need to take part in their own therapeutic work if only to better understand the child who is now living in a tent.

I liken wilderness to a honeymoon.  The participants might be a bit nervous or anxious at first, but once they “figure things out” they don’t want to leave.  It never ceases to amaze me how often my clients leave wilderness stating that beyond wanting a shower they did not want to leave the field.  It can be and often is that powerful an experience.  And some do move on to become field staff or therapists themselves.  They loved it that much.  Still, it is only the beginning, and most students need additional therapeutic work when they return home.  After all, the honeymoon is only the beginning stage of a marriage.  Wilderness is the kick-start or beginning stage to an emotionally healthy life.

So here are some things to consider when making this very difficult and very personal decision:

  • If your child is regressing and/or you feel helpless to help them, you likely need outside support.  If outpatient therapy has not worked for your child and/or is not making a difference in their behaviors or attitude, you may need to think about alternatives, which could include wilderness.  Speak with someone who is familiar with such programs, though, and do not rely on the Internet or your friend’s cousin’s sister’s step child’s experience.  Your child is unique and may have very different needs from someone else.
  • What work are you willing to do or have you done?  A family system needs work when anyone in that system is struggling, regardless of the reason.  Perhaps you have been too distant, perhaps your child needs their own space, perhaps everyone in the family shuts down when there are strong feelings expressed, or perhaps everyone expresses their feelings so strongly that nothing is solved.  If a child is doing their therapeutic work, the family needs to do theirs as well.  Positive change can only continue if things change at home–even if the change is small it can be powerful.
  • If you are looking for a “quick fix” wilderness is not going to help.  Often students who attend a wilderness program take part in additional therapeutic work after they leave.  This might include returning to their home therapist or attending a therapeutic school.  Wilderness is the kick-starter, not the cure!
  • Some families might not want to spend the money for wilderness.  There are a variety of programs out there and the costs range widely as well.  I cannot tell a family how to spend their money.  What I can suggest is for a family to consider where they are now and where they think their current course of action will lead them.  If that action is leading to a good place, then keep your child home.  If things are not going well, wilderness should be seen as an investment towards change.
  • If a child is making progress in therapy, then there is no reason to send them away.  On the other hand, a short-term summer program might be a nice break for everyone, but it should be agreed upon with the child if they are in fact making progress (and therefore the right program will be essential to prevent “undoing” all that good work).

For more information on whether or not wilderness is right for your child, please find someone who is knowledgeable about such programs and what they can or cannot do for your family.  Independent Educational Consultants who specialize in working with therapeutic programs (, the National Association of Therapeutic Schools and Programs (, or the Outdoor Behavioral Healthcare Council ( are good places to begin.

What is Therapeutic Wilderness?