Transcript for
Responding to complex developmental trauma

Narrator (00:02): Welcome to the Emerging Minds Podcast.

Chris Dolman (00:07): Hi everyone. Welcome to the Emerging Minds Podcast. My name is Chris Dolman, and today, it’s my pleasure to talk with Kathryn Lenton. Kathryn is the Program Manager for the Australian Childhood Foundation in Tasmania. She holds a Bachelor of Social Work and a Master of Counselling, and has been working in the mental health sector for 20 years or so. Kathryn’s experience has included both clinical interventions and leadership in trauma therapy for children, adolescents and adults, disaster recovery, child protection, older person’s care, community development, mental health and education, suicide postvention, and child and adolescent mental health.

(00:43): And I first met Kathryn via a webinar we were doing together presented by Emerging Minds and Child Family Community Australia on the theme of recognising complex trauma in infants and children. And I was really interested in having a further conversation with Kathryn about her work. So welcome to our podcast series, Kathryn. Thanks very much for joining us.

Kathryn Lenton (01:00): Thank you so much for having me. It’s a pleasure to be here.

Chris Dolman (01:03): Thank you. Kathryn, I know you have a particular interest in complex developmental trauma. So could we just begin even in everyday terms, what is complex developmental trauma? And what is it about this area of practice that interests you?

Kathryn Lenton (01:18): Thanks so much, Chris. It is such a complex area and it really is a pleasure to be able to speak to you about it. And before I talk to it, I would like to acknowledge that the ideas and themes and topics that I have are based on Western science and don’t fully encapsulate the cultural knowledge of our first nations people and the impact of the trauma. But complex developmental trauma, in terms of how I understand it, it’s where children have had exposure to multiple traumatic events over a prolonged period of time. And that might be experiences of neglect, abuse, or exposure to domestic violence.

(01:56): And these traumas often occur in the context of a relationship with a child or infant’s important caregiver, for example, a parent or a foster carer. And when we think about children’s experience of trauma in the context of a relationship, it impacts on the child’s sense of attachment, their stability and their sense of self and their safety. And I’m particularly interested in this area because there’s so much scope for creating change, and there’s so much hope for children that their lives can and will feel better for them. There’s so much that we can do to support them and their important people.

Chris Dolman (02:38): So in terms of the children that you work with, how does this complex developmental trauma show itself in their lives?

Kathryn Lenton (02:46): The children that we are working with at the moment at the Australian Childhood Foundation had exposure to family violence or may live in out of home care. So they might live in a kinship care placement or live in foster care or in residential care. So their experiences have been quite profound in terms of their experience with trauma.

Kathryn Lenton (03:06): What we are really noticing is the impact on children’s brain development as a result of exposure to trauma, that’s both being in utero, in infancy, early childhood and childhood. And what we’re really interested in is how chronic stress can impact on children’s brain development. And that means that when children are in environments that they feel threatened, then they will continue to wire their brain in a way that predicts threat. And then we see children’s behaviour really impacted by their expectation of threat.

Chris Dolman (03:42): Yeah. And so, what would we notice about children’s behaviour that would have us perhaps beginning to think that complex developmental trauma is kind of implicated in that behaviour?

Kathryn Lenton (03:54): And that’s a great question. We can see the impact of complex developmental trauma in a multitude of ways, both in brain development and in behaviour, if I start with what behaviour might look like, there’s a huge scope of how a child might show their experience of trauma. It might be by using really big behaviours like physical aggression, kicking, punching, biting, yelling. It might be through behaviours that show more of an internal collapse, like an inability to concentrate in class, zoning out, disassociating, having troubles with toileting, having toileting accidents and so on. And it might show behaviours that show us that children don’t feel safe unless they’re very, very aligned to adults in terms of this, what we call fawning behaviour, and really wanting to please the adult that is looking after them in an attempt to stay safe.

(04:49): In terms of the brain development, depending at what stage the developmental trauma occurred, whether it be in utero, in infancy, early childhood or childhood, we can see real impacts on the child’s brain stem, their limbic system and their cognition. And we know through the work of Bruce Perry that children who have chronic stress experience high levels of cortisol, which is the stress hormone, and that can impact on the child’s neuronal pathways and the way that the brain wires itself to predict threat and increase threat. So we can see that a child’s brain structure is impacted by chronic stress through trauma. And that means that as they develop, they’ll take through those pathways into their behaviour in later childhood and respond in the same ways as if were still in threat.

Chris Dolman (05:43): So these bring about challenging circumstances for children and families, and I guess for the practitioners too that are engaging with these families and seeking to respond and support them. Broadly speaking then, Kathryn, what do you think makes it possible for children to heal from complex trauma, or to be lessening its impacts in their life?

Kathryn Lenton (06:00): I think there’s always possibility that people can and will feel better. So holding hope that people will feel better is incredibly important. And healing occurs within relationships. And healing occurs within safe relationships. But for a child who’s experienced complex developmental trauma, it’s going to take many, many, many repetitions of an experience of a safe relationship before they start to allow themselves to believe that maybe this person is safe for me. So understanding the impact of developmental trauma is incredibly important. And many people that we support have very successfully used traditional methods of parenting with other children, or they may have had a very positive experience of a traditional parenting experience from their own parent or caregiver.

(06:54): However, for a child who’s experienced complex developmental trauma, they need a different way of being parented. And we call it therapeutic parenting. If the adult or the caregiver or the parent who’s supporting the child can be regulated themselves, notice the child’s cues that the child may not be coping or maybe needs some extra support, and they respond in a way that is playful, if that’s appropriate. Sometimes playful is not appropriate because it might escalate or shame or embarrass the child. But in a way that is accepting, which is not saying that the behaviour is okay, it’s saying that I accept you in the presentation that you are now. And I accept who you are and that you are feeling these feelings. Curiosity about what might be happening for the child. And empathy.

(07:49): If we can respond in these ways, that creates a situation where the child can start to feel safe and start to be co-regulated by the adult. So children with complex developmental trauma often haven’t had positive experiences of co-regulation. They may not have been rocked or soothed or cooed to or held when they were an infant. And they’re the things that the infant needs to feel safe. And so they may have missed out on those early experiences of safety. And they’re going to need those experience of co-regulation, of, I see you, I accept you, I hear you, you’re okay, I’m okay, as older children to create a new pathway in their relationship.

Chris Dolman (08:35): Are they some of the other key ideas that really support you or underpin your work besides what you’ve mentioned? What place do they play in your work?

Kathryn Lenton (08:44): We’re really interested in parents and caregivers own experiences of being parented, and what really worked well for them, and perhaps what they would not take along with them in their parenting journey. Because if we understand their own attachment framework, then we can help them make sense of their attachment with their child that they’re looking after. But we can see that therapeutic parenting does invoke a different response from children to traditional methods of parenting. So a child who’s experienced developmental trauma is unlikely to respond to punitive measures. They’re unlikely to respond to rewards and punishment. They are more likely to respond to connection than correction.

Chris Dolman (09:32): So when you are beginning to work with a child and family, what are your initial intentions? What are you initially wanting to bring forward in your work with them?

Kathryn Lenton (09:41): In any therapeutic intervention? Safety is paramount first. And that’s safety in relationships as well as physical safety. You cannot have a therapeutic intervention without a felt sense of safety between the clinician and the young person or the child and their caregiver. We are really wanting to create a space where we can have open, dynamic conversations. We want to be able to share wisdom and have the parents’ wisdom acknowledged as well as the child’s wisdom. We really want to set up a space where there is collaboration. And we want to offer deep listening to the child.

(10:28): The way that we work with children and young people is, we recognise that children’s language is through their behaviour, and they will not necessarily tell us, or maybe they can’t tell us what they’re thinking or feeling or what their experiences are because they often don’t have words to tell us. They’ll show us through their behaviour. So we are using play-based approaches to therapy. So we really need to help the parent or the caregiver understand why we are doing what we’re doing, and helping them engage in play with the child in session or after session, depending on what’s appropriate with the child.

(11:07): Because we recognise that we’re only with the child one hour a week or one hour a fortnight, the rest of the time, they’re with their important adult. And we really need to resource the parent or the caregiver to play with the child and to connect with that child. Because the deeper that connection and the felt sense of safety between the carer and the child is what’s going to create change. So we’re really wanting to support the parent and the child to connect.

Chris Dolman (11:35): So in speaking with parents, you need to sort of make your intentions for these things clear with them?

Kathryn Lenton (11:42): Absolutely. One of the things about safety is predictability. And when a child has experienced trauma, we want to create a very deep sense of predictability, of when we meet we’re going to be in this room and we’re going to meet together for this long. And these are the games that we might play together. And starting at 10-minute warnings, in 10 minutes, we’re going to say goodbye and finish up. And in five minutes, we’re going to finish up. And so on. So we really want to create safety through predictability and transparency, and really helping those important transitions, coming into session and exiting out of session as well.

Chris Dolman (12:21): In your work with the family, what are some of the understandings you’re hoping that parents walk away with?

Kathryn Lenton (12:27): We really understand that parents and caregivers are doing the best they can with the resources they have available to them at that moment. And we are really wanting to add to those resources. And we are really wanting to acknowledge the wisdom and experience and care for the child that the parent or caregiver has, as a starting place. We are really wanting to build on hope, on connection. We really need to focus on parents and carers own sense of self care.

(12:59): Parents and carers cannot offer co-regulation to children in the way that they need it if they’re not regulated themselves. So we really need to encourage parents and carers to resource themselves first, before they can focus on caring for their children. We really want to help parents and carers understand the trauma-based behaviours. These are pain responses. They are not the child being naughty or manipulative. They’re not the child being bad. They’re not intentionally pushing the parents or carers buttons, so to speak. The child is using pain-based behaviours because they’re in pain.

Chris Dolman (13:38): What difference are you hoping that understanding would make to how parents go about being with their child?

Kathryn Lenton (13:44): The response will be completely different. And if we know that the child is in pain, we will see their behaviour in a completely different context. We’re not going to see the child as being naughty or manipulative or trying to get us to have an anger-based response. We’re going to see this child as trying to get their needs met, and that’s going to resource us as adults to be able to respond differently.

(14:12): And we know that people can’t possibly respond from a place of empathy and curiosity and acceptance all the time. But if we can look after ourselves enough that we can respond most times, or more often than not, from a place of empathy and curiosity and acceptance and playfulness, if it’s appropriate, then that will become much more familiar and easy for us to do as adults. And that creates connection and relationships. And that’s where healing happens.

Chris Dolman (14:44): When parents have concerns about children’s behaviour, I guess some of the behaviours you mentioned, are they what parents bring to their consultations with you, these kind of concerns about behaviour? Is that correct?

Kathryn Lenton (14:56): Yes, very much so, because these are really big behaviours that we’re talking about and they’re incredibly hard for parents to support, and they’re incredibly hard for children to experience. So parents and carers will often come to us and say, “I want my child to stop doing X, Y, or Z. And can you please do therapy and then they’ll be different?” What we try to help people understand is that the behaviours that the child is using kept them safe when they were experiencing the trauma. And that those behaviours were very effective in helping them survive the trauma.

(15:38): The child might then be in an environment where that same risk to their safety doesn’t exist, but the brain cannot possibly shut off those really adaptive, clever behaviours. And any sense of threat or risk will invite those behaviours to come back. And they look like really big behaviours. And they’re incredibly hard for the parent or carer to manage. And the child is not going to respond to traditional parenting techniques like timeouts or punishment or reward because the child is responding to trauma. They’re trying to survive. Their brain can’t tell the difference between threat because they were told no to threat when they’re experiencing abuse. So helping a parent or a carer to understand that these behaviours are trauma behaviours, and then the parent or carer can respond in a different way to help the child feel safer.

Chris Dolman (16:38): In terms of the parent’s responses to the big behaviours, like these different ways of responding. Do you introduce parents to some other ways of responding?

Kathryn Lenton (16:46): We do. And it comes back to therapeutic parenting and the PACE model by Dan Hughes, we really encourage parents and carers and adults to respond with PACE, which is playful, acceptance, curiosity, and empathy. And that’s really, really hard when a child is offering an adult a very big behaviour. The adult is going to want to respond with anger or discipline. That’s very, very natural. However, the child is showing us a pain-based behaviour. And for them to feel safe, we, as adults, need to respond in a regulated, peaceful way. And it’s important to remember that PACE is a framework. And adults need to be kind to themselves as well with their expectations, because we can’t possibly always get it right. And if we don’t get it right, it’s being able to acknowledge, I wasn’t very kind to them. I’m going to take a deep breath and I’m going to try that again.

Chris Dolman (17:46): You mentioned how this is a complex area. And I guess one of the complexities relates to the extent to which it’s important to differentiate between the impacts of trauma on children’s lives, on their behaviour, as well as various labels or diagnoses that children might be given. I’m thinking of ADHD or ODD or autism, probably a whole raft of others as well. How important is it to differentiate between these things from a practitioner’s perspective?

Kathryn Lenton (18:15): Yeah, it’s a great question. I think diagnosis can be incredibly useful for helping obtain extra funding or resourcing or interventions. With a diagnosis, children may be eligible for support through the NDIS. They may benefit from medical intervention, which would be discussed with a paediatrician. We do see that for many of the children that we work with who have had an experience of complex developmental trauma, they might also bring with them diagnosis of autism or ODD or ADHD.

(18:54): And the way that we look at it is, we are responding to the child. We are responding to the child’s behaviour rather than responding to the diagnosis. With ADHD, the symptoms of inattention or not listening, or disassociation or not being able to follow instructions, or being impulsive, or looking disruptive are all symptoms of complex developmental trauma. With autism, having difficulties in relationships, or having difficulties in forming relationships or reciprocating relationships, or having a blunted affect, or being sensitive to environmental triggers, or having a strong need for a routine are all symptoms of developmental trauma.

(19:40): And across all of these diagnoses, there’s a difficulty in taking turns and sometimes some repetitive behaviours. And so, it’s incredibly complex because developmental trauma can look like all these other medical conditions. It’s not to say that a child with a diagnosis of ADHD doesn’t have ADHD because they’ve got developmental trauma. It means it’s complex. And all things need to be considered.

Chris Dolman (20:10): When you said responding to the child’s behaviour, not the diagnosis. So when you have a child in front of you, what you discern in terms of the child’s behaviour, whether it’s an account of ADHD or developmental trauma, or maybe intersection of those, to what extent does it go about influencing how you go about working with the child?

Kathryn Lenton (20:27): It helps us understand the context of the child’s life. We want to know what it’s like for the child. So we might help us understand the funding supports the child might need, or it might help us to understand the impact of medication. It might help us use language with the school or with the parent. However, we want to know, what does that mean for the child? What is the child’s experience of having so much energy that they need to move their body all the time? What’s that like? And how do we connect with that experience? Because, in the connection of the relationship is where the child feels safe.

(21:06): So it’s very important to understand the child’s history and work within a system where medication or diagnosis is incredibly important. And we do want to work with a child and their important adults because the child doesn’t live in isolation. So we do want to understand how the medical practitioner perceives what’s happening to the child. We want to know how the parent perceives what’s happening to the child. We want to know what the early childhood educator perceives. We want to know everything, because children don’t exist in isolation. And we need to be supporting their important system. But I want to know what it’s like for the child. That’s how I would make sense of it.

Chris Dolman (21:47): Thank you for that. That’s really important messages, I think, for us all. Kathryn, I’m thinking about children who may be experiencing a real sense of shame on account of what they’ve been through. What are some important considerations in working with children and responding to that shame?

Kathryn Lenton (22:01): That’s a really important question. Thank you. When we experience shame, we feel that we are bad. So blame is, I’ve done something bad. Shame is, I am bad. And children who have complex developmental trauma will often have experiences of shame that is internalised, that I am bad. And shame can be a response to many, many different experiences. It might be being told off at school, or it might be not performing well, or it might be being given a compliment. Some children who have had significant developmental trauma aren’t able to tolerate positive feedback and will invoke a shame response. And shame is internalised as I am bad. And then the child will show their distress through their big behaviours.

(22:55): And they will try to push away these really distressing, internalised feelings of shame through what we call the shield of shame. And what we’ll often see children doing is lying, blaming, minimising, or experiencing rage. And what they’re trying to do is push away these feelings of deep shame, that I am a bad child. So a child might push over another child in the playground. And the teacher says, “Why would you do that?” The child, if experiencing shame, and they say, “I didn’t.” Even though the teacher has just seen them. That is a shame response. And going back to using PACE, of being accepting, being curious, being empathetic, might be like, “Oh, I wonder what happened there? What do you think happened?” Or the child might minimise and say, “I didn’t push them. They fell over.” Or they’ll try to deflect. Or the child might experience a real rage response where they start kicking or punching the teacher. This is a shame response. The child is experiencing internal state, which is, I am bad. It’s incredibly painful for children.

(24:14): Going immediately to correcting the behaviour is not going to resolve the issue. Saying, “That’s it. You’re in time out. You are suspended. Or this is happening, or you’re not going to the party on the weekend.” That is going to increase the feelings of shame. The child needs to experience connection before correction. It doesn’t mean that the behaviour doesn’t have consequences. It means you slow down the process so you can connect with them using the PACE framework. And then when the child is regulated, then you can talk about natural consequences for the behaviour.

Chris Dolman (24:54): Well, Kathryn, I think that brings us to the end of our conversation today. Thanks so much for bringing your practise knowledge and skills and compassion, really, for children and families that you work with that have been through very difficult times. I’ve really valued hearing about your insights. So thanks so much for contributing to the understanding of these things. And we’ll be providing some links in the show notes to some of the resources that Kathryn’s mentioned as well as some other things too. Thanks so much, Kathryn, once again.

Kathryn Lenton (25:20): Thank you so much. It’s been my pleasure.

Narrator (25:23): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by The National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian government Department of Health, under the National Support for Child and Youth Mental Health Program.