We’re seeing consistent theme in the immigrant crisis in news reports now. A boy, age 4, has walked, hitched rides and ridden trains for about three months from Honduras with his mother. He is tired and scared at times but he could see his mom being hopeful about getting to the United States border. Life back home had become too unsafe for the family. They already had lost his father due the gang violence. As they arrived, instead of being welcomed in a humane way, he was suddenly taken from his mother and shuttled to where other children his age stood. He was not told anything about what was to happen. Neither was his mother. Both were in tears, filled with worry about what was happening to them. And they wouldn’t know anything for almost two months. 

Children taken from their parents abruptly at any age suffer fear, a sense of abandonment and mistrust of those around them. Before the age of five, one is so much more susceptible to trauma and scarring that impacts the ability to grow and adjust with the challenges of day-to-day life. And one’s ability to relate and connect with others can be severely hampered.

This kind of trauma need only happen once for a period of time for the scarring to be deep and lifelong. The tender trust that has been growing for the child is now gone. It is ever so hard to regain. 

This has been studied in depth since the 1950s. John Bowlby, M.D., proposed the first levels of attachment theory in children. Erik Erikson, M.D., observed that without a strong attachment to the parent, trusting other adults later in life is more difficult as is achieving autonomy or emotional intimacy. The data about the lack of a parent or guardian in the lives of New Mexico children is shared in an op-ed by a colleague, S. Siddhu M.D. (https://www.abqjournal.com/1195030/when-mom-dad-are-gone.html)

Siddhu notes the Bucharest Early Intervention Project study done at an orphanage on Romanian orphans after the collapse of the Soviet Union.  Lack of a primary parent led to a host of both cognitive and behavioral issues including difficulties in learning and poor emotional regulation as well as physical health issues. 

Separation is an Adverse Childhood Event

Parental separation is now considered an Adverse Childhood Event(ACE)  by the Center for Disease Control due to the compelling science behind the impact of this event in a child’s life. The number of ACEs in one’s life impacts the quality of life as well as physical and mental health. Overall resilience to handle life’s stressors is diminished. 

Mary Main, Ph.D., has helped us understand the impact of disrupted attachment at a young age in adults. We now have increased awareness of those people in our culture who create levels of mayhem. They are the ones with the deepest childhood wounds. Many of these people have character flaws. We know them as persons with personality disorders (antisocial, borderline, histrionic). Treatment is possible in adults with an intervention known as DBT (dialectical behavioral therapy). This includes mindfulness training and active learning to explore emotions a person experiences daily along with a level of being responsible for these feelings internally. Without the treatment, the tendency is to blame the whole world for the feelings of abandonment and anger. 

Working with adopted children over the last twenty years in a residential setting has taught me much of the maladaptive strategies these children from here in the U.S. and around the world. Adults are seen as objects, not people, to meet their needs and wants. Manipulation to get what they want often is ruthless with little regard of the impact on the person. Pushing away those seeking to connect at the heart level, these children align themselves increasingly with others who seek to create chaos and disruption. Fear is a driving force, with primitive behaviors showing up.

Dyadic Developmental Psychotherapy helps children build trust with adults

A form of therapy known as Dyadic Developmental Psychotherapy is incorporated in the individual, family and milieu. This is specific for the treatment of children and adolescents. 

The approach with children is similar but slightly different due to how young the children are when they are in treatment. Reparenting starts with the power of repetition in an intensive milieu with a staff ratio of 1:3 or 1:1 if need be. It is in this special  and safe setting that a shift is possible. 

 It is only when seeking to be with them and have them kept close to a person to meet all their needs, sorting out their wants will slow healing begin. The responsible adult starts by asking/anticipating what they need and assisting them with their basic needs. That person seeks co-regulation with the child. Most important is attuning to the child’s needs. Much like the mother anticipating the needs of her own child, so does the staff anticipate the needs of this child in the milieu.

There is no point system. Given the mental and psychological challenges of the children, there is a trend to poor cause and effect so a traditional behavioral system is lost upon these children. The child is given what is needed for them at that time. Natural consequences can  occur but always with the presence of the staff in the milieu. The child is not ever isolated from staff and often the interventions happen in the milieu. The child is never sent to his or her room away from the group. This is referred to as a “time in,” not a time out. The practitioner seeds a sense of security so that subtle internal emotional shifts take place. This appears to create more lasting change with a sense of being able to connect to others in a healthier, more socially appropriate way. 

Alliance, not compliance

The priority is the relationship with the caregiver and healthy interpersonal interactions. This is where the change ultimately happens—not on what level the child has achieved for the day or week. The main thing is to seek an alliance, rather than compliance, with the child. Again, it is in the power of the relationship that the magic happens. 

The interventions are shared with therapist, and often there is a repair session with the staff to sort out the feelings elicited in the moment. Repairing the child’s trust is most important. A sign of growth often is when there is an incident toward the staff and child shows remorse in the most healthy way possible. This is a start of the child seeing all adults in his life as a resource of support, rather than a “thing” to manipulate or to push away at all cost to avoid emotional intimacy. Trusting the adults will care for him allows then the heart of the child to start to heal and a more healthy relationship is possible with the staff, the therapist and ultimately, with the primary parent/guardians….over time. 

It is the power of the relationship in the milieu with the staff and integration of the individual and family therapy into the setting that facilitates the remarkable healing of many of these children’s hearts and minds. There are other modalities involved, including education, medication or nutrient/herbal remedies but many of these interventions had not been effective for them in other settings. 

Why traditional parenting won’t work

Traditional parenting does not work with many of these children. It leads to lots of conflict and defiance, which can be overt or covert. The children with the covert strategies are often the most difficult to reach emotionally. Only with time will we know if these immigrant children who have been separated from family will have similar challenges. They have other hardships that may have created other scars prior to this separation as they often were with parents fleeing due to safety issues in their home land. 

The immigrant children are not alone in this sense of abandonment but are the current poster child to draw attention to abandoned, abused and neglected children here in the U.S. and around the world. A child needs a caring, loving and attentive parent/guardian who is capable of adapting to the child’s developmental needs. Being genuine in their efforts as caretakers is so necessary as these kids are great lie detectors. 

Let us reunite the remaining innocent immigrant children as soon as possible with their guardians. Here is hoping that compassion for these  and all immigrant children becomes a priority amidst the chaos of this current US immigration policy. This could assist in reducing the level of psychological trauma they have already been subjected to. 

There are no easy answers about the immigrant/refugee process except this one: No child will be separated from their guardian unless the risk to stay with the parent/guardian is greater than the separation. 

References

Adverse Childhood Experiences (ACEs) – CDC; https://www.cdc.gov/violenceprevention/acestudy/index.html

About BEIP – Bucharest Early Intervention Project www.bucharestearlyinterventionproject.org/About-Us.html

Synopsis of Creating capacity for Attachment. Ed Arthur Beckman-Weidman Phd and Deborah Shell MA with specific reference to Villa Santa Maria RTC in Cedar Crest, New Mexico. Full disclosure: I am medical director there. 

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