2012年2月27日 星期一

Trauma in Children - A Guide For School Nurses


Educators are faced with new challenges in the 21st century as students are exposed to growing numbers of images and stories related to violence, turmoil, and trauma. They live not only within a stressful global environmental context, but also have personal histories and living conditions that, in too many cases, are problematic. We would be dangerously ignorant to believe, simply, that "children are resilient," and that these global and personal conditions are not impacting our students' abilities to learn and behave in the classroom as expected.

Research conducted over the past two decades has explicitly revealed how stress and trauma change the brain and, ultimately, affect learning and behavior. I have witnessed the demonstrative effect of these changes in the many years I have worked as a school and clinical psychologist. When I receive referrals from teachers, nurses, administrators, and others, I always begin examining the problem by taking a detailed developmental history starting at the very beginning of the story: conception, gestation, birth, and the very first months and years of life. I thoroughly ask specific questions about accidents, falls, injuries, hospitalizations, and medical or dental procedures. When I do, I am reminded that an ever growing number of students' academic and behavioral challenges began with a crisis or with one or more traumatic events. Without considering these early sources of the problem when developing interventions, I have seen firsthand that, regardless of excellent intentions, we needlessly exacerbate problematic conditions for our students.

No matter how ill informed or unprepared we may feel at times when trying to help students who experience the residual effects of trauma, we need not despair. There are many simple yet powerful ways we can make a difference. Science is now showing us that even our facial expressions, body language, and willingness to maintain supportive physical proximity to our students make a measurable positive impact on brain and nervous system functioning. When we smile at a student, for example, and thereby show compassion for their struggle or suffering, even if little can be done, their heart rate and blood pressure decrease, settling their nervous system into a more effective state.

Anything we can do to help students function within this "more effective state," or what some researchers call the "Zone of Optimal Arousal," is more than worthwhile. Learning and adaptive behavior are only possible within this "zone" because it is there that the most important capacity for learning and adaptive behavior is possible: self-regulation. No one can sit still, concentrate, assimilate information, and remember what they just heard when arousal levels are "stuck on high," as they are for traumatized students, but that doesn't mean they have ADHD, Bipolar Disorder or learning disabilities. It simply means they lack the necessary capacity to modulate their arousal.

When students experience trauma, especially when repeated or prolonged, their brain's amygdala continues to fire messages of fear to the rest of the brain whether they are in actual danger or not. The amygdala "turns on" our students' fight or flight response for survival, and "turns off" the neocortex, the part of the brain critically necessary for school functioning. This is why too many of our students have poor attention, poor impulse control, and a hairline trigger for anger. They live in a constant state of fear when their brain's first and only priority is survival.

Without the healthy operation of the neocortex, the part of the brain responsible for foresight and planning, impulse control and mastery of language, it is nearly impossible for students to learn and behave as expected. Reduction of their anxiety and arousal through simple soothing techniques that keep them in the optimum zone is necessary. For instance, recent findings in the field of neuroscience highlight the biological importance of resources to the brain's optimal functioning. Some of the most important resources to our students, especially those who have experienced one or more traumatic events, include safety, competence, and sensory awareness.

Educators can provide a sense of relative safety for their students through explicit rules and regulations, limits, and boundaries that are consistently enforced. Traumatized students have experienced an event(s) that was unpredictable and beyond their control, contributing to their sense that the world is not only dangerous, but deadly. We can offset this experience by making their world at school more predictable and less scary with our consistency and compassion. Posted "If-Then" charts, for example, can make it clear: "When you do 'that,' 'this' WILL happen" 100 % of the time. Though they will challenge these limits and test the boundaries, they will eventually come to see that their world is more predictable than they thought. This is calming to students and aids in their ability to settle into the optimum zone.

Creating opportunities for success, mastery and competence is an important part of what we can do to counteract our traumatized students' sense of hopelessness, failure, and despair. Finding out what students are good at and providing them with chances to engage in those things has biological necessity, according to the latest neuroscientific research. Success and mastery change the brain, in all the ways that promote achievement and prosocial behavior.

Many educators already know the importance of incorporating sensory awareness into what they do, whether they teach reading through the Lindamood-Bell reading program or promote the critical capacity of self-regulation through the occupational therapy program called, "How Does Your Engine Run?" Teaching sensory awareness engages the part of the brain hijacked by trauma, and re-integrates it with the rest of the brain, making learning and adaptive behavior possible.

One tool I have found especially helpful and effective in developing and expanding upon our students' resources in order to promote self-regulation is what I call a "Resource Inventory."

I keep a record of what resources are available to students, as well as those that are missing and need to be created or restored. I never develop an intervention plan for a student without this information because of how imperative resources are to the optimal functioning of the brain. In addition to taking a detailed developmental history and resource inventory, as well as enhancing safety, competence, and sensory awareness, we can also provide important psychoeducation to colleagues and parents. Our psychoeducation about the effects of trauma on the brain and the importance of resources to ameliorate these effects is invaluable. I do this through conversations that emphasize strengths, what is working, and what we would never want to change. Neuroscience has proven the metaphysical hypothesis that what we focus on expands.

Finally, we cannot do any good work without taking care of ourselves. Let us first ask of ourselves, "Am I operating in this moment from my own zone of optimal arousal? What do I need to do to resource myself right now so that I am self-regulating my internal state and having a positive impact on my students?" We cannot give what we do not possess. To prevent my own burn-out, I ask myself every hour of the day, "What do I need right now? Do I need to go to the restroom? Do I need something healthy to eat or drink? Do I need to sit down quietly for a moment and take a few long, deep breaths?" Incorporating this simple self-care ritual has completely changed the way I experience my day and the people in it, including the traumatized students I serve who are, let's face it, some of our greatest challenges.

© Regalena Melrose, Ph.D. 2009




Please read Dr. Reggie Melrose's book, "Why Students Underachieve: What Educators and Parents Can Do about It," and visit her website, http://www.DrMelrose.com, for more information and resources.





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