Pay Attention to Trauma

Yesterday the June 29, 2008 Sunday Boston Globe featured an article written by Maggie Jackson titled Attention Class. According to Jackson, it turns out that the skills of being able to focus and pay attention are more complex than previously thought and tied in with other important capacities, including forming attachments. This article derives from a book on the same subject due out soon.

Poor focus, inattention and distractibility are front burner issues for our Penikese boys. Perhaps 8 or 9 of every 10 either currently are or at some time have been diagnosed with ADD/ADHD and prescribed medication for this condition, but that is only part of their diagnostic story that variously includes learning disability, mood disorders, and psychological trauma. Some have proven so uncontrollable in previous settings that they have come to us in what is essentially a chemical restrain, making one of our initial tasks tapering their medications down and, in the process, beginning to rule out extrinsic from intrinsic factors. 

Complicating the Penikese diagnostic picture is psychological trauma. ADD/ADHD tends to get over diagnosed, because it shares similar sets of symptoms with other disorders, and some symptoms are difficult to tell apart. For instance, is it fear-driven agitation that we are observing in the classroom, is it restlessness and distractibility that comes with ADD/ADHD, or is it a bit of both? The interplay between trauma and other disorders, including ADD/ADHD adds a degree of difficulty to the work, to say the least. Jackson's article does not mention psychological trauma, so it will be interesting to see how or if this topic is addressed in her book.

The effects of trauma on the brain is well documented, especially on its mid-regions and structures within that negotiate transactions between the excitatory and regulatory nervous systems, and the interaction between the rational and the emotional brain. It is because of trauma's effects on the brain that its sufferers often make little progress in talking therapies. Their underlying states of arousal are so high that the rational, learning brain is, for all intents and purposes, off line. This is why, at least at Penikese we put affective regulation at the top of the priority list to dampen the fear response so that attachments can form and learning can take place. 

We have for some time been committed to helping our students improve their self-regulation and executive functioning in as many ways as we can lay our hands on, including instilling the practice of mindfulness, yoga and other meditative, stress-reducing practices into their daily lives. More recently we have begun using neurofeedback which helps to improve focus and attention (the ADD/ADHD part of the picture) while simultaneously providing affective regulation and lowering anxiety (the trauma part of the picture). In the brief time we have been doing neurofeedback on Penikese we have seen some positive initial results with lower general anxiety and better focus in the classroom.

Whatever the single or combined reason for our student's improvement (including good old fashioned structured expectation) we have found that helping our students improve their functioning in one area often potentiates improvement in other areas as well, similar to how a rising tide lifts all boats in the harbor. Jackson’s article seems to affirm this last point by saying that “…children must be taught attention holistically, as a life skill. No brief training regime is likely to be a magic bullet, they say.”

The Last Word on Power Struggles

“Check Your Expectations at the Door” was the first in a series of posts touching upon various strategies for building authentic connections with those who tend to avoid connection, and using that connection to gain influence on behavior and effect therapeutic change. We characterize this approach as doing treatment ‘with’ rather than ‘to’.

As its title implies, folks engaging in a process of change with adolescents must first examine their expectations and assumptions, and make every attempt to ‘try on’ the perspective of the child in question as a way to avoid judgment and gain compassionate understanding.

Unless we are able to honestly recognize and be accountable for our own junk - our vulnerabilities, tendencies and patterns, the things that really get to us - our best judgment will get clouded by this junk rather than what is best for the child. Worse, we also become easy meat for endless exhausting and usually pointless power struggles.

Ah, the power struggle. On the island we call it the dance, as in “I see you two (staff and student) are really getting into it. Are you sure you want to dance?” The trick, of course, is knowing which battles to choose and then letting go of the rest, much easier to say than do. One way Penikese staffers choose their battles and avoid relationship-fatal power struggles is by letting the boys have the last word. Imagine the following scenario, as described by Penikese sage Dave Masch:

A boy is sitting at a piano plinking the keys, especially those annoying ones at the top of the register. You, the staff or parent, says in a level tone, “Please stop that.” Plink, plink, doink, doink. “Hey! I said please cut it out!” Plink, plink, doink. “Dammit, you do that one more time and there’s gonna be Hell to pay!” PLINK!

That last plink is the invitation to get it on, and we can handle it in two basic ways: Lose our temper and blast the kid with consequences, or say nothing and let him walk. Admit it, the first option is easiest and most common, and admit it, sometimes it even feels good in a retributive sort of way. But like all deals with the devil it comes with the dear price of scorched earth and disconnection. Don’t go there!

Responding by doing nothing is much more difficult, but think of it this way: he did stop, and isn’t that what you wanted? Meanwhile, allowing that parting shot gives the child in question a small measure of power and control at nominal cost to us, and most importantly, it keeps the therapeutic connection intact for another day. Piano plinks and last words, verbal and behavioral, come in all shapes and sizes, so try getting better at recognizing and letting them go. It just might save your sanity and your relationships.

Fishin' Impossible

Another tale - improbable but true - from the annals of long-time Penikeser David "Pops" Masch:

Vinnie had many accomplishments of dubious value: having brought urban graffiti to many places of the south shore of Massachusetts, gotten high in more ways than your normal astronaut, and attempted to fry his brain with uppers, downers, and glue in anyway he could. He was a wreck when we got him and much less of a wreck when we lost him.

Vinnie was also an accomplished smuggler and he could catch fish! Vinnie’s angling success angered the other boys, who, unlike Vinnie, were not willing to put the time and effort into fishing that Vinnie did. Vinnie was snorkeling with one of these envious lads, Abdullah, when he made his remarkable catch. I had shown the boys how to spot the signs of lobsters lain under rocks and how to catch them by distracting them with one hand while you reached in behind them to grab them with relative safety. Vinnie could not bring himself to reach into the lobsters’ den, so he made his “fish pick” form a piece of lath and a nail, to use to winkle them out of their dens. The boys were swimming over some rocks, searching the bottom three feet below them — Vinnie, armed with his pick, and Abdullah, just along for the fun. 

Then, as Vinnie put it, “Pops, the silversides (small bait fish) started acting nuts, flying around like crazy — even crashing into my mask — when I saw a flash out of the corner of my eye. I didn’t know what the (expletive) it was! Then I saw something coming fast, almost right at me. I lifted up my stick to protect myself and the nail stuck right in the eye of the bluefish. It went nuts! It yanked the stick out of my hand and swam straight down, sticking its nose in the sand, still beating its tail like it wanted to bury itself. The nail must have gone into its brain or some (expletive) thing. So I stood up, reached down and grabbed the stick and twisted it so that the fish was hung on the nail. I waded to shore with it still fighting. Holy (expletive)!! Wow! I’ll probably never do that again!”

Abdullah complained loudly “This (expletive) catches fish bigger than I have ever caught or seen caught with a stick and a nail! I spend hours with a rod and all and catch nothing!!” “What can I say?” says Vinnie.

I would wager that Vinnie’s catch is unique in fishing history and that he will never forget it. I have other Vinnie stories for another time. In regard to Vinnie’s smuggling prowess, he seemed to always have cigarettes on the island despite seemingly thorough searches. The source of these cigarettes was a mystery until one day a cigarette fell out of the forward section of one of his fishing rods when it was taken apart. You can stow a lot of cigarettes in a couple of surf rods. Vinnie calls almost every year and suggests that he and I get together for some more fishing. We will someday. We are both part of the Penikese family, and always will be.