Hiding in Plain Sight: Exploring Scotland’s Wellness Health Book Review

Carol Craig believes her ‘miserable’ childhood affected her adult health Photo Credit: TINA NORRIS

Can Scotland’s overall poor health record be explained by Adverse Childhood Experiences (ACEs)? This is the simple but undeniably challenging question that forms the basis of Carol Craig’s book, the third in the series of short books — Postcards from Scotland — that are written to spark new thinking about why us Scots are the way that we are.

The book gives a semi-autobiographical account of the author’s own challenges in her childhood and adds into the mix the experiences of ‘ordinary folk’ with well-known faces in Scottish culture — including the comedian Billy Connolly and Scottish actor and filmmaker, Peter Mullen. It also points to the latest evidence and academic research.

As a communications professional, I am always curious about the source and credibility of any written piece. At the start of the book, I must admit, I was initially a little skeptical as the emphasis seemed very much on the author’s own experiences, rather than any concrete research. She reflects on her upbringing in a council estate in Milngavie, a suburb to the north of Glasgow, in the 1950s and 1960s comparing this to the experiences of another child from the same estate, Scott. A few pages in, I did wonder should this not be an autobiography? Indeed, near the end of the book, the author herself admits that a friend asked her if she would not be better off writing a novel.

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Any doubts I had about the emphasis of the book being more anecdotal, rather than balanced with research, were soon laid to rest. In chapter two, ‘Childhood adversities, trauma, and health’, the author highlights early studies into the role of ACEs in ill health.

In particular, she talks about the work of Dr. Vincent Felitti, currently Director of the California Institute of Preventive Medicine, in surveying 17,000 patients to see if there was a link between childhood experience and ill health later in life.

The methodology for this research included a simple survey with questions focussing on two types of adversity: physical, emotional and sexual abuse; and second, what the wider family context was (e.g. did your parents separate?Was there abuse within the relationship?).

Phase two of this study, from the early 1980s, was to research the medical history of respondents and reveal any connections between such early adversities and health outcomes. According to the researchers, the links were startling. This initial study has arguably paved the way for current thinking and research on Adverse Childhood Experiences globally.

The real strength of this book is the accessibility of its tone, language and subject matter. Carol Craig definitely does not write from a narrow lens and the book should appeal to a wide range of readers — children’s sector frontline workers, social historians, policy-makers and think-tank workers, to name a few, and anyone really with an interest in the health of our small nation and the issues that surround it.

At the centre of the book, the author argues that adverse childhood experiences in Scotland are common and that ‘nurturing children has never been one of Scotland’s strengths’. This, combined with detailed accounts of childhood abuse, make for difficult reading, which the author does not shy away from. What she does really well, however, is make a series of serious points in relation to adversities in childhood that is mainstream and accessible without belittling the subject matter. No easy task. For example, she talks about the depiction of Scots in film, TV and in fiction, making the point that depiction of difficult subject matter is indicative of real life. Art imitating life.

I was drawn, in particular, to her accounts of the relationship between the character Chris Guthrie and her father in Lewis Grassic Gibbon’s classic Sunset Song. Not only did this passage take me back to my 16-year-old former self (I read this classic book for the first time as part of my Scottish Standard Grade in English), but it illustrates a key point that Craig’s book is trying to make: the poor fate of Gibbon’s main character can, at least in part, be explained by the abuse that she suffered in her formative years. It was, to name the title of the book: ‘hiding in plain sight’.

It would be a crass and unfortunate use of language to say that Adverse Childhood Experiences are in vogue just now, but in reality, there is increasing narrative in professional and public circles and research surrounding them as a way of explaining outcomes later in life. My work at CELCIS (the Centre for Excellence Looked After Children in Scotland) has taught me to always question labeling — unconsciously or otherwise — when it comes to children and young people as often this can lead to negative stereotyping and pigeonholing that separates children who may have experienced adversity with the rest of society.

While I uphold this belief, any phrasing or terminology that is used in a positive way to deepen society’s understanding of something that can have a detrimental impact of Scotland’s children and families can be justified when used appropriately. Hence, I would recommend Craig’s book for anyone with an interest in the subject matter.

At the end of the book, the author proclaims: ‘I will judge this book a success if three things happen’. While the list of three are fairly altruistic and focus on better outcomes for children and society’s need to better understand how we can bring up children, the use of the proclamation jarred with me a little. I cannot recall another author who would make a proclamation in such a grand and forthright way.

That said, if you want a stimulating read about an ever-evolving and important subject matter, this is a really good and accessible read. I look forward to her next book in the series.

Tracking the Impact of Early Abuse and Neglect

Children who experience abuse and neglect early in life are more likely to have problems in social relationships and underachieve academically as adults.

Maltreatment experienced before age 5 can have negative effects that continue to be seen nearly three decades later, according to a new study led by Lee Raby, an assistant professor of psychology at the University of Utah.

“It is not a controversial statement to say abuse and neglect can have harmful consequences,” Raby said. “This study adds to that by showing that these effects are long term and don’t weaken with time. They persist from childhood across adolescence and into adulthood.”

The journal Child Development published the study. Co-authors are: Glenn I. Roisman and Madelyn H. Labella, Institute of Child Development, University of Minnesota; Jodi Martin, Department of Psychology, York University; R. Chris Fraley, Department of Psychology, University of Illinois at Urbana-Champaign; and Jeffry A. Simpson, Department of Psychology, University of Minnesota.

Raby said his team wanted to know two things: Does maltreatment early in life have long-term associations that extend into adulthood and do those effects remain stable or weaken over time?

The researchers used data from the Minnesota Longitudinal Study of Risk and Adaptation, which has followed participants since their births in the mid-1970s. The U study looked at data on 267 individuals who had reached ages between 32 and 34.

Information about the participants’ exposure to physical abuse, sexual abuse and neglect was gathered from multiple sources during two age periods: 0-5 years and 6-17.5 years. Throughout childhood and adolescence, teachers reported on the children’s functioning with peers. The children also completed standardized tests on academic achievement. The participants were interviewed again during their 20s and 30s, during which they discussed romantic experiences and educational attainment.

Unlike studies based on adults’ retrospective accounts of their childhood experiences, the data used here were collected in real-time. In addition, because data on the participants has been collected throughout their lifetimes, the researchers were able to disentangle the effects of maltreatment that occurred in their early years from experiences of abuse and neglect during later childhood.

“The design allows us to ask our two questions in a way no other study has before,” Raby said.

Raby said the findings showed those who experienced abuse or neglect early in life consistently were less successful in their social relationships and academic performance during childhood, adolescence and even during adulthood. The effects of maltreatment did not weaken as the participants got older.

“The harmful effect of early abuse and neglect was just as important when we were looking at outcomes at age 32 years as when we looked at outcomes at age 5,” he said.

The researchers found abuse and neglect in later childhood also impacted these competencies in adulthood, but that later maltreatment did not fully account for persistent and long-term influences attributed to abuse and neglect experienced in early childhood. They also found long-term difficulties with social functioning — but not academic achievement — occurred independent of such factors as gender, ethnicity and early socioeconomic status.

“These findings add more evidence for the importance of identifying high-risk families and attempting to intervene before experiences of abuse and neglect occur,” Raby said.

Cultivating Resilience in Children

Cultivating Resilience in Children

I’ve always been fascinated by the concept of childhood resilience. In fact, this inquisitiveness led me to a career in child psychology and the non profit sector working with the world’s most disadvantaged children. I’ve made it my life’s work to understand how trauma affects children and help them to cope with it. The curiosity came out of an eagerness to understand my own profound resiliency after having a childhood of chaos.

Shortly after the death of my mother, when I was a six-month-old infant, I was diagnosed with ‘failure to thrive’. My body simply wouldn’t grow until I felt safe and loved. Understandably, my father couldn’t cope with looking after an infant at that time and I was given away to be raised by relatives in another country.

By the age of three, I was given back to my father. One doesn’t have to be a psychologist to imagine the kind of trauma the first three years of my life entailed. The rest of my childhood and adolescence was filled with more hardship and challenges. And yet even though I faced so much adversity, I managed to overcome it. I ‘made it’. As a young adult, I was always told things like: ‘You must have had a guardian angel looking after you’ or ‘You’re really lucky’.

This led me to want to understand why some children are more resilient than others. Is it luck? Is it genetics? Is it the quality of relationships in the child’s life? And is there something we can do to cultivate resiliency in children so that when faced with life’s challenges they are able to cope and manage these situations?

Of course my childhood is on the extreme side of the spectrum but the reality is that all children will face some challenges in life whether at school or home. As parents, we want to bubble wrap our children keeping them from risk and harm. However, children require learning how to try and fail. They need to understand that not all stress is bad. As Dr. Bruce Perry’s renowned research has proven, ‘resilient children are made, not born.’ Research has identified a common set of factors that predispose children to positive outcomes in the face of adversity. I recently spent two days in Vancouver, B.C. at the Heart-Mind 2016 Conference on Cultivating Resilience by the Dalai Lama Center for Peace and Education.

The Dalai Lama Center for Peace and Education is focused on children’s social and emotional development. They call it fostering Heart-Mind well-being. Providing children with the knowledge, attitudes and skills necessary to understand and manage their emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions which has been proven to not only improve their well-being but also improves their academic performance.

During the two day conference, parents, caregivers, and educators were informed of the latest research on how to promote resilience in children. Here’s everything you need to know and some free (and really cool!) resources:

5 Ways to Cultivate Resilience in Children

1. Relationships: The single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult such as a teacher. The quantity and quality of relationships in a child’s life is key.

2. Altruism: Children can be empowered by helping others. Engage your child in age-appropriate volunteer work which gives the child a sense of purpose and meaning. For ideas you can check out my previous post.

3. Self Efficacy: Teach your children that they have a sense of control in their life. Enable them to believe in their power to change their own life.

4. Self Regulation: Provide opportunities for your children to strengthen their adaptive skills and self-regulatory capacities through tools such as mindfulness. Mindfulness creates structural and functional changes in the brain that support a healthy response to stress.

5. Culture and Language: Mobilise sources of faith, hope, and cultural traditions in your children. In order to be resilient the child needs a strong sense of self and identity. The more solid and rooted the child, the more resilient they will be. Children need a sense of family, it can be biological or anyone else that makes the child feel loved the feeling is reciprocated. A sense of community is important for the child to feel that they belong.

https://socialworkhelper.tumblr.com/post/152675287454/free-resources-boost-resilience-and-sel-skills-in

Children Who Experience Early Childhood Trauma Do Not ‘Just Get Over It’

Humans are relatively adaptable beings which is why we are thriving and not dying out like other species. Horrendous disasters such as the Philippines typhoon, the Boxing Day Tsunami, the nuclear disaster in Japan, the major wars of our time, and horrific famines see great suffering, but these events also inspire survival through adaptation. It turns out we possess a strong survival mechanism in our brains directly linked to our bodies, fight, flight, freeze, flop and friend (fffff).

In fact, the survival part of our brain, which is primitive yet effective, is the first to develop in utero starting at around 7 weeks. It regulates our breathing, digestive system, heart rate and temperature, along with the ‘fffff’ system which operates to preserve our life.

If we have to dodge a falling object, jump out of the path of a speeding car, keep very still to avoid being seen, run for the hills from a predator, or get someone potentially threatening ‘onside’ we need this to happen fast. If a baby is scared, cold, hungry, lonely, or in any way overwhelmed, this triggers their survival system and they cry to bring an adult to them to help them survive.

If a baby is repeatedly scared and emotionally overwhelmed and they do not get their survival brain soothed, so they can cope, they begin to develop a brain and bodily system which is on hyper alert and the World seems to be a scary place. Sadly, this is not something they can ‘just grow out of’. Far from it as what neuroscience is showing us from all the recent findings. An early experience has a profound effect on the way in which a child’s brain forms and operates as the survival brain is on overdrive and senses threats everywhere so works too hard, too often, for too long.

Babies and young children systems are flooded with potent stress hormones which help in the event of needing the 5 fffff’s, but they are not good to have at high levels for too long. Imagine the feeling when you truly believe you have lost your wallet with all your cards and money in it. You feel a bit faint, your brain is whirring, your heart is racing, your breathing is shallow, and you may get the urge to empty your bowels or bladder. Hopefully, this may only last for the usual 45 minute cycle for those who are not traumatised.

Then, stress hormone levels drop and you can think more clearly and resume your day fairly unscathed. What if you are 4, 9 or 15 years old? How will you cope if your repetitive early childhood trauma of living with domestic violence, unavailable or rough carers, chaos and unpredictability has left you traumatised?

As I referred to at the start, humans are amazingly adaptable in order to survive, although not necessarily thrive. So a child’s system adapts to get whatever basic needs met it can and to live to the next moment, think the soldier in a war zone kind of survival. In an abusive environment, this will make sense but it is not something a child can just stop doing as their survival brain is in charge and has to do what it has learnt to keep them alive.

The kinds of survival behaviours they commonly develop are:

Regression

Presenting as helpless may have made carers frustrated, even angry and rough with them but will mean they sometimes had to touch a child who presented as unable to say get dressed or wipe their bottom or feed themselves – this can look like immaturity and ‘babyish’ behaviour in an 8 year old but it has previously served a purpose

Being held and touched kindly is a basic human need and tragically children in Romanian orphanages who were not, died. Almost ‘pathetically’ children often devise ways which can seem strange, given their age and previous capabilities, to get some physical contact, even if it’s unpleasant

Children often learn to survive by being ‘like a baby’ as they have either learnt how babies get more kindness and attention or have some in-built ‘memory’ of this. However, ‘acting like a baby’ can be negatively viewed as regression, yet it is often an expression of trust in carers as they feel safe enough post abuse to seek out kindness from them. These behaviours need to be handled gently until the child is ready to move on. Imagine you had never experienced physical closeness and gentle touch, but you were driven to seek it out which requires real courage.

Dramatic reactions

When a child is in the ‘I’ve lost my keys’ panic state most of the day, it’s like a pan boiling on the stove and the smallest extra heat causes it to boil over

The survival brain leaps into action at the slightest thing, an accidental shove from another child, a small scratch on the arm, a lost pencil, a ‘look’ from another child and the 5 fffff’s are triggered, for most children that’s flight but if cornered and unable to escape, or previously overused, it will be a fight.

Children may cry more readily and for much longer and louder as they do not have the ability to self soothe or to be soothed easily as their brain has not been exposed to this and is not wired that way so telling them to ‘calm down’ is of no use

They are feeling things as deeply as they seem to be at this point and are not just ‘attention seeking’

Disassociation

Disassociation or ‘zoning out’ is another way the brain and body cope with high levels of potentially toxic stress hormones for overly long periods. It can also be a learnt survival strategy, submit, switch off and wait for the frightening, painful, incomprehensible act to be over. This ability to switch off can look like defiance or non-compliance as a child may just stare ahead and not respond to requests from adults

Children cannot continuously cope with the muscle tension, nausea, thudding heart, racing thoughts so finding something to fixate on to soothe them can become a great coping strategy and again will look as if they are being non-compliant whereas they are escaping from their trauma the only way they know how.

How long until they do ‘get over it?’

It’s a fair question as to why it’s so hard for traumatised children to trust caring adults. If they were removed from the abuse and trauma as a baby or even directly after birth, surely they should not be having these dramatic reactions?

Going back to our survival part of our brain, this is not designed to be the dominant part of anyone’s brain as we also have an emotional memories part and a thinking, reasoning, socially able cognitive part which should mostly be ‘in charge’. All three areas are interlinked and share info back and forth all the time but mostly we need to think before we act and then we do better. However, if your start in life has made your survival brain ‘hyper alert’ then to manage this is like repeatedly trying to get a squirrel into a matchbox!

Children need us to be calm, kind, to use rhythm, patience and to try to step into their world and emotional state and show empathy. As practitioners, it can be helpful to research ways of supporting traumatised children, pushing for appropriate training and most importantly being very aware of the extra strain that comes with working with and caring for traumatised children. However, with the right long term acceptance, kindness and support children can get a better chance at eventually being able to manage their reactive survival brain which has, after all, got them this far. 

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