Nature or nurture?

[Hameggnchips]

Just read some Daily Mail articles about adoption, wish I hadn't. One about an adoption that completely broke down and the APs split up and gave the child back and another that talks about how adoption has changed over the years and how now most adopted children are all challenging and most have some sort of difficulty later in life - undiagnosed FAS, ADHD, ADD, attachment issues, violence and so on.

Just wondered what people's thoughts are on this subject? Is it true? With enough love and affection can you really turn an adopted child's life around for the better or are they all scarred for life?

Have you thought you could turn a child's life around but then struggled to cope or had any regrets?

@Yolande7 Thanks that is interesting. I am aware of differing from normal brain structure and function due to maltreatment. But also that brain structure and function then shows changes in scans in a positive way showing the brain normalising as children recover, if they get the right therapy, is that also covered in the course?

Does the course cover resilience as a topic?

@Yolande7 I just had a look at Psychology Today and similar and the consensus does seem to be that resilience (and the supporting and related skills to resilience) can be taught. I found this article from 2015 which is interesting:

www.psychologytoday.com/us/blog/good-thinking/201503/why-some-people-are-more-resilient-others

I think that @jellycatspyjamas hit the nail on the head when she said with some adopted children it makes it harder when you don't know what you are helping them recover from.

@notworthitwithoutsausages I don't think the comparison works (if that is what you are implying).

Roughly speaking, Adverse Childhood Experiences (ACEs) work accumatively. Most people experience one or two, from 4 upwards the risk for later MH problems, delinquency, suicide, homelessness, incarceration, drug addiction etc massively increases. Now, some of the care experienced children I know have scores of 9 out of 10 possible ACEs. They suffered many different types of trauma over a prolonged period of time ( = complex trauma) at a very young age.

Children who have experienced complex trauma, even if they recover, also have shorter life expectancies, because they have an increased risk for various illnesses.

According to the futurelearn course these children have changes in their brain structure which are visible in scans, even if they have no MH problems. However, they have "latent vulnerability". I can't remember if they said these structures normalise over time. From personal experience I can say that children seem to go back to unhelpful patterns when they are highly stressed, so my theory would be that the underlying pattern remains but is less often activated.

According to the course, little is known about the precise factors leading to resilience. The article suggests that an increased sense of control is helpful. However, children with an avoidant attachment style can be very controlling and need to learn trust an adult. So traumatised children can have very different needs from an adult recovering from a traumatic event. They also would not receive CBT, but play therapy or a creative therapy to help them make sense of what happened to them.

As a sociology and psychology graduate it's nature not nurture.

I studied sociology 30 years ago. They said there was no such thing as nature.

@paloooza I thought that studies currently say around 50 percent nature to start with but that nurture has a significant impact.

@yolande7 thank you for the post. My understanding is slightly different from yours. Yes, ACEs have a huge impact and will continue to do so without intervention. Where my understanding differs is that intervention, therapy etc will have a very significant affect and the brain structure will change to reflect this. The brain structure doesn't normalise over time without intervention. It normalises with intervention (ie the right therapeutic work for the child).

As you say, therapies for adults and children are different. I linked the article because my post had also referred to adults. Therapeutic work with children is more likely to be successful than with adults. There is a lot you can do to build resilience in children too.

Can you link your source which indicates that science doesn't know why some children have more resilience than others and that you cannot teach the skills and awareness that builds resilience to children?

Helping children understand and verbalise their own thoughts and feelings, which is easier said than done, will go a long way towards building resilience in my experience. Having an adult who understands them and cares for them deeply on a personal level over the course of their childhood will also be a factor. Even better if their adult has skills to help them develop. It is far more complicated than this obviously, I am just skimming the surface in a short post.

Sorry I asked you to link your source re resilience but I reread your post and see it was the course. If you have any other sources it would be interesting to see, though.

From personal experience I can say that children seem to go back to unhelpful patterns when they are highly stressed, so my theory would be that the underlying pattern remains but is less often activated I think that this is the same for most adults I know though! So we are talking about degrees, and the level of awareness and insight which enables the person to put the brakes on and return to helpful thought processes. The person has healed to the extent that the brain has normalised and the person is not affected day to day and in extreme situations will know themselves and know their vulnerabilities and can have regard to them, to stay on an even keel but it doesn't mean there won't be any vulnerabilities. But the vulnerabilities are brought to within average (ie most people have vulnerabilities to some extent) limits. If that makes sense.

There are skills to help with this which can be taught and practised and which strengthen over time.

However, children with an avoidant attachment style can be very controlling and need to learn trust an adult I agree that where there isn't a trusted adult at the outset, this is the first hurdle to overcome in therapy. Apparently sensory therapies are helpful at the outset in relation to this particular problem.

Children who have experienced complex trauma, even if they recover, also have shorter life expectancies, because they have an increased risk for various illnesses again, what I have seen is that even this changes too with the right intervention.

@notworthitwithoutsausages I did not mean to say that you cannot teach resilience, just that the exact factors that play into it have not been identified by science yet. I definitely think that nurture has an impact. I would have never adopted otherwise ;-)

Roughly speaking, Adverse Childhood Experiences (ACEs) work accumatively. Most people experience one or two, from 4 upwards the risk for later MH problems, delinquency, suicide, homelessness, incarceration, drug addiction etc massively increases. Now, some of the care experienced children I know have scores of 9 out of 10 possible ACEs. They suffered many different types of trauma over a prolonged period of time ( = complex trauma) at a very young age.

There are significant challenges around the ACEs agenda in research, and diversity in the understanding of the dataset. While I think it gives a basic understanding of adversity in childhood, it’s very simplistic and doesn’t wholly stand up to scrutiny. I certainly wouldn’t be relying on it as a predictor of outcomes into adulthood.

The concept of complex trauma is relatively new - I’d look at Judith Herman’s writing to gain an understanding of the issues and treatment for people who have experienced complex trauma. But yes, appropriate support, care, relationship can go a long way to supporting recovery in adopted children.

@Yolande7 I think that we all come at this from our backgrounds to some extent. I have experience of sibling groups being split up, after trauma, and their adult lives being hugely different because of differences in upbringing. One stark difference being to do with life skills, where life skills (practical, emotional intelligence, selfawareness, knowledge of social rules, social skills, educational, etc etc etc) had been effectively taught it had made a very positive difference. But yes I see your point, about why you adopted!

Incidentally, there is a film relevant to this subject, "Three Identical Strangers", though I haven't had a chance to watch it yet.

@jellycatspyjamas There are significant challenges around the ACEs agenda in research, and diversity in the understanding of the dataset. While I think it gives a basic understanding of adversity in childhood, it’s very simplistic and doesn’t wholly stand up to scrutiny. What agenda and diversity in understanding are you referring to and ? I have heard in lectures given by psychiatrists reference to their struggle to get funding for more research in the direction of full recovery and an inference that there is a pharma vested interest group which does not support it, are you referring to that?

Sorry - I meant "What agenda and diversity in understanding are you referring to?"

That’s ok. The original dataset for this research wasn’t intended to focus on adverse childhood experiences or childhood trauma at all - it was undertaken by health insurers in the US to look at how they minimise their risk to paying out for long term health conditions and highlighted common experiences in adults with poor health outcomes. The original dataset is over 20 years old and set culturally in the population in the States with access to healthcare, so a particular demographic. While further studies have been carried out, they’ve used the assumptions drawn from the original dataset as their base, so have tended to be confirmatory.

The dataset doesn’t allow for complex trauma as we understand it (the concept wasn’t understood at the time of the research) and doesn’t account for experiences of racism, discrimination or difference. You can see the impact of culture and setting if you look at the resulting ACEs score questionnaire which looks at the 10 most “impactful” ACEs when calculating an ACEs score. Many issues that we know are incredibly harmful aren’t on there and others which are included I’d argue aren’t necessarily harmful.

Other studies using the dataset suggest there’s a level of adversity needed to build resilience (sometimes referred to as grit) into adulthood.

I guess trauma is very complex and this research is very trendy just now, probably because it’s a simple concept that can be easily understood but it’s problematic.

Thank you for explaining.

I think that rather than trendy, it is more that the new thinking about trauma and ongoing research is giving people hope and a way out of the idea that they may be imprisoned by various disorders or MH unnecessarily, though.

I guess what I’m saying is the discourse around ACEs doesn’t represent new thinking and is quite determinative in approach eg x amount of ACEs predetermines poor outcomes in adulthood, which simply isn’t the case.

I say trendy because folk use it as a hook without having a deeper understanding of the complexities of trauma which can lead to people writing off children who have faced significant adversity.

I think being realistic, you can’t go into adoption expecting to get a neurotypical child that will just bounce back to “normal” behaviour and development after a few months of good parenting. Or ever. In the past with lots of healthy babies relinquished by healthy mothers at birth it was a different story, but I think these days when children are removed for a reason, the early neglect or abuse or substance abuse in utero has permanent effects. There will of course be exceptions to this rule where someone grows into a completely normally developed (behaviourally and emotionally) teenager and adult but they are few and far between. The one example I know is a little boy who was orphaned from a super loving family but with no other family at all to take him in, then adopted from a single long term foster carer. If you can’t handle that reality then adoption isn’t for you.

@jellycatspyjamas Ah I see, I agree with you then, about prognosis

@notalwaysalondoner the children who have suffered neglect/abuse won't just bounce back, but with the right specialist care and therapeutic work can recover.

OP have you posted questions about adoption before, just out of interest?

@Jellycatspyjamas I was aware of some controversy around ACEs and the assumption that very different kinds trauma have the same effect. I am not a psychologist, but to me the idea that more trauma causes more problems (on average of course) sounds believable. Don't you think so?

I understood it to mean that ACEs increase the risk for poor outcomes, but is not deterministic. I might have misunderstood though.

@cherrypie111 I agree that we are all influenced in our views by our experiences. I also agree that different upbringings generate different outcomes. (I like to see that in my kids and their siblings, though there were other factors too.) With limits though. I don't think children's brains are like clay in our hands.

I am not a psychologist, but to me the idea that more trauma causes more problems (on average of course) sounds believable. Don't you think so?

Not necessarily so, much depends on the support to recover and secure attachment. For example, a child who experiences a bereavement and is supported to process that, who then is involved in a car accident, has a medical issue and is assaulted at school but is held in the context of a secure family with access to social supports will have a very different experience than a child who experiences physical, emotional, sexual abuse or domestic abuse throughout the course of their childhood and at the hands of parents or carers.

One off traumatic incidents, even multiple one off traumas don’t impact in the same way as interpersonal trauma which is repeated, ongoing and feels inescapable - which we now understand as complex trauma. The ACEs agenda doesn’t have anything really to say about complex trauma in the way we understand it because the original study wasn’t anything to do with childhood trauma - it’s been extrapolated to fit.

Complex trauma is known to have a much far reaching impact on individuals (if there are no mitigating measures) than singular traumatic incidents. Both impact but where single incidents might cause PTSD, with quite an array of symptoms complex trauma adds another layer which is why comparing recovery from a single incident to someone with a history of complex trauma is a bit apples and pears. Judith Herman has done some excellent work mapping out the difference in trauma response looking at the traumatic event in the context of childhood, parenting and attachment.

One off traumatic incidents, even multiple one off traumas don’t impact in the same way as interpersonal trauma which is repeated, ongoing and feels inescapable PTSD and PTSDc are two different diagnoses, I think? But I also think that it can be even more complicated than your quote here. A child can suffer from a one off trauma and their behaviour presents in a similar way to autism, and if trauma isn't recognised they are sent off into the wrong world of suspected autism, SEN, and do not get the help they need - or a child is given inappropriate therapies over a long period of time - this can then unwittingly turn the one off into the longer experience of inescapable trauma. This is why I think the fact that more people are talking about trauma is a good thing even without expertise as it at least means it is on the radar.

like clay I see it as the opposite, I think it is more to do with helping a child reach their own unique potential...!

Another thing I would say about someone who does recover from negative childhood events is to do with that the old adage what doesn't kill you can make you stronger. People I know who have dealt with multiple trauma and recovered can be better than average at handling life without being knocked off their feet.

A child can suffer from a one off trauma and their behaviour presents in a similar way to autism, and if trauma isn't recognised they are sent off into the wrong world of suspected autism, SEN, and do not get the help they need - or a child is given inappropriate therapies over a long period of time - this can then unwittingly turn the one off into the longer experience of inescapable trauma.

The issue there though is surely the misdiagnosis rather than the original trauma. Most children in warm, caring homes with appropriate social support will overcome an individual traumatic event in much the way the adult population will without needing access to specific therapies. Our systems are built to respond physiologically to trauma and to heal and recover, in the right environment most of us will do that. We talk about PTSD when that natural healing process fails, post traumatic stress is a natural response to trauma, and one which research shows facilitated post traumatic growth in that the stress process allows the individual to process their experience. That process can become blocked or distorted which is when we talk about the process being disordered.

The PTSD/CPTSD issue goes further than diagnosis, the majority of children removed from birth parents will experience complex trauma regardless of whether they receive a diagnosis of any kind, most of those children will most likely be assessed for some kind of learning difficulty and in a-lot of cases that will be appropriate. The presence of trauma doesn’t mean there are no SEN, they need to be assessed in parallel among with physical health needs, with trauma always in the mix.

I guess for me the bottom line is that adversity doesn’t always result in a damaged life, and the struggle to understand that trauma can lead to significant growth.

People I know who have dealt with multiple trauma and recovered can be better than average at handling life without being knocked off their feet.

That’s the process I referred to where research suggests that people need a degree of adversity to develop resilience, it’s also the premise behind the concept of post traumatic growth.

Yes and probably in reality the vast majority of people in the wider population affected by PTSDc will not have a formal diagnosis.

I think with some trauma the warm loving home on its own is not enough because the sort of measures a parent would put in place and how they would help their child with trauma is completely different from how they would proceed if their child had autism or other sen. Even without diagnosis, if parents are advised to think along lines of autism or sen by schools for example rather than trauma then that could cause harm, I think. But I wasn't thinking about adopted children here, trauma is usually in mind for adopted children. I think it is now being considered more that there are many children suffering from trauma in schools who are not adopted and that is a good thing.

Sorry, OP, I am drifting off topic.

I agree that there’s a significant overlap in presentation between autism, trauma and some personality disorders into adulthood, and both misdiagnosis and comorbity are issues that need consideration. I don’t think we’re disagreeing here 🤷‍♀️

I don’t think we’re disagreeing here
No, no, I was raising points as they came to mind (somewhat rambling) rather than disagreeing!