Positive Relationships: Child Behaviour - Lost boys

Dear Don,

Thank you for sending me the background details on these two boys. It makes chilling reading. You asked me to pick out the serious risk factors found in their family life, and these seem to be frighteningly obvious, as does the life-path that such maltreated children may well follow.

In Utero

It appears inevitable that both these boys were influenced unfavourably when in utero. From the little you know, it seems that the mother came from a background of abuse and neglect, which might explain the substance abuse as a form of self-medication, and so she would be easily tipped into feeling extreme stress. Looking after any baby is normally stressful; but in the situation you describe I think we can assume that family dynamics were marked by every form of sudden, scary and unpredictable eruptions you can imagine.

Being subjected to repeated stressful experiences in infancy - the case for these two boys - often marks the beginning of a personality trait characterised by a hair-trigger stress response. You can see the generational continuity already here.

We know that the father is frequently violent, is also a substance abuser, and that domestic violence has long been a feature of this family. It is a safe bet that the mother felt attacked and under extreme strain throughout her pregnancy.

Mothers who are abused during pregnancy develop negative attitudes towards the unborn child, which continue after birth. They relate to their babies in a less sensitive and open way, and at the same time often import into the mix a conviction that they are incompetent mothers.

Maternal stress during pregnancy also affects the nervous system of the foetus - effects that continue throughout childhood and include emotional and cognitive problems, increased risk of attention deficit/hyperactivity disorders, anxiety and language delay. It also doubles the risk of behavioural problems in middle childhood.

As you can imagine, such children would be hard for anyone to look after, and so in a family already overburdened with risks, this 'foetal programming' exacerbates the likelihood of subsequent maltreatment.

If a stressful pregnancy is followed by untreated severe post-natal depression, then that is an additional influence on the child's development; and can lead to an increase in insecurity and behavioural disturbances, including less creative play, unsatisfying friendships, poor self-control and an increase in aggression.

Dependency Problems

The fact that both parents abuse drugs is significant. Caregivers who are chemically dependant are often unable to provide the comfort, security and consistency in care which babies and toddlers need to develop behavioural and emotional self-regulation.

Drinking alcohol during pregnancy is the single biggest cause of learning disability. The difficulties that these children develop again make them hard to parent, as they cry continually, find it hard to soothe themselves or be soothed, often have sleeping and eating disturbances and tend to withdraw from others.

The homes of parents with significant chemical dependency problems are often chaotic, neglectful and violent. As a result, children can have the horrific experience of being abandoned within their own home.

Witnessing Violence

Mindless violence seems to be a defining feature of this family. Children who witness violence show many serious adverse reactions, including nightmares, ill-health, great emotional distress and aggressive or switched-off behaviours.

They are suffering from post-traumatic stress disorder caused by witnessing the destruction of security in the home as their parents divide up the roles of terrorist and helpless victim.

Children who have witnessed violence or been victims of it are more likely to become perpetrators of violence in later life. If you have never experienced empathy, this is something that may remain beyond comprehension for ever.

Mothers who are traumatised by domestic violence are often left with a sense of helplessness and frustration with their inability to protect their children, causing a further hiatus in the relationship.

This leads on to the question of attachment. Children growing up in violent households often develop what is labelled in the research literature as 'disorganised attachment'. This is a marker for future conduct disorder and psychopathology, as the child will forever approach relationships with a mind scrambled by hostile or helpless caregivers unable to allay their child's distress by providing security.

Brain Development

Such family circumstances will have had a major effect on the way the boys' brains have developed.

The brain is, in a way, 'designed' to change itself physically in response to the emotional environment of significant relationships, especially during the first three years of life when the bulk of the brain is formed and its structure is at its most 'plastic'. (There is a second chance during adolescence, when the wiring of the pre-frontal cortex is completed, but this builds upon the foundations of infancy.)

Positive, predictable interactions with responsive, nurturing caregivers profoundly stimulate and organise young brains. However, a baby surrounded by trauma, fear, neglect and chaos will develop neural systems and functional capabilities that reflect disorganisation. As far as the child is concerned, this is just how the world works.

Everyone's brain structure is sculpted by the process of 'proliferate and prune', as the initial stupendous growth of connections between the brain's neurons is whittled down by experience to those circuits demanded by the world about us.

A world of trauma suppresses a child's brain development and also results in involuntary and rapid stress responses. Thus threats, real and imaginary, can tip some individuals into unbearable mental states to which they are only capable of responding to in very primitive terms of either 'fight and flight' or 'freeze and fade'.

Professional Help

It is a shame that you don't have an infant mental health service available that could have tried to offer help even before the older boy was born. Our service accept referrals on the basis of research-based risk, knowing that a certain accumulation of pressures on a vulnerable family will almost inevitably be titrated into the mother-baby relationship, and thus affect the quality of these early formative experiences.

Where assistance is deemed unfeasible (or even unsafe), then this may become part of the necessarily stringent assessment process; and when removal and finding an adoptive family is the best and safest option, then this can occur when the child is only a few months old.

As it is, these two boys sound as if their brains are being marinated in horror; so if you cannot change this, definitely get them out immediately.

I fear that the damage done to the older child may by now be so embedded in both his psyche and nervous system that it is too late to prevent him becoming prone to violence when he is older. The younger boy is still at an age when adoption, undoubtedly the best treatment, is likely to really help.

However, you need to move quickly, as research has shown that the probability of later emotional disturbance increases with every month after this age that a child is adopted.

Like all children maltreated in their early years, these boys will be far more prone to develop mental health problems such as depression, anxiety disorders, self-harm, substance abuse and personality disorders. They may go through life feeling physically and psychologically unsafe, abandoned and terrifyingly vulnerable.

Add to this poisonous mix the common psychological reactions (we call these ego-defences) of identifying with the aggressor and turning passive into active, and it gets worse! The danger is that deep-rooted and callous fantasies of revenge become a permanent, but unconscious, pressure in their minds.

So, without immediate specialised help, there is every chance these boys will grow up searching for a victim. They may find a home in, say, such institutions as the BNP, but their hunt for somewhere to put their fear - so it can then be destroyed - will turn them into dangerous adults, a threat to society.

They will be unlikely to contribute by paying taxes and will consume the taxes of others as they work their way through social services, child and adult mental health services, the police and prison. And, of course, there is the collateral damage they mete out to other people on their way.

If you want to follow up on brain development, then get hold of Sue Gerhardt's book Why Love Matters. Essential reading is the WAVE Report, as is Ghosts from the Nursery by Robin Karr-Morse and Meredith Wiley, which should be absorbed by every MP before they start pontificating about being tough on crime and the causes of crime.

I hope these observations are of help in making the difficult decisions that lie ahead of your department.

Best wishes,

John Kent (not his real name), Consultant child and adolescent psychotherapist

FURTHER INFORMATION

- The WAVE Report (www.wavetrust.org) explains how the adverse experiences of some children, from conception to age three, propel them towards violence as they get older

- Why Love Matters - How affection shapes a baby's brain by Sue Gerhardt (Routledge)

- Ghosts from the Nursery: Tracing the roots of violence by Robin Karr-Morse and Meredith Wiley (Grove Press)