By Richard Devine, Social Worker for Bath and North East Somerset Council
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These are five books that have profoundly influenced my social work practice. These books have been selected for their practical usefulness in our endeavor to be better, more effective social workers. I have not listed them in rank order. I am going to share one every day this week. So far I have Working with Denied Child Abuse by Turnell and Essex and Effective Child Protection by Munro.
One line review: An accessible overview of neuroscience, early childhood experience, and developmental trauma presented through illustrative case studies.
What I learned reading this book: One of the first core assessments I wrote was an assessment of two young parents and their two young children, a toddler and an infant. In this assessment, I wrote that the infant was protected from domestic abuse because of her young age. I assumed that the 18-month-old wouldn’t remember and would have no language facilities to recall what had happened. After my manager read the report, we sat side-by-side as we went through her tracked changes (there were plenty!), and she asked what I had meant by this point. I looked confused, ‘wasn’t it obvious what I meant’ I thought to myself and reflected to her that the child was probably too young to understand or be affected. It was her turn now to look confused. Like most good managers, she didn’t tell me what was wrong with my thinking but instead suggested I look at the research on the effects of domestic abuse on infants and consider revising my opinion.
In undertaking further research, I stumbled across a book called ‘The boy who was raised as a dog’. The title is journalistic and salacious, but don’t let that turn you off. This book turned out to be hugely influential on my thinking and understanding. In the book, I learned that the brain undergoes extensive development in infancy. In addition, the brain regions develop sequentially. The brainstem, responsible for essential regulatory functions, develops in utero and early infancy. The midbrain and limbic systems develop next, rapidly developing in the first few years. The cortex, the most evolutionary recent and sophisticated part of the brain responsible for abstract thought, emotional regulation, and planning, develops in adolescence.
This has important implications. Firstly, the effects of adversity or a traumatic incident will impact a child differently, depending on their age. For example, the impact of a mum and dad shouting, screaming, and being violent towards one another will impact an infant differently from a 7-year-old. In addition, exposure to trauma in infancy can disrupt or undermine the healthy development of essential regulatory functions (eating, sleeping, toileting, etc.). This means that developmental capabilities that unfold as the child becomes older, such as socialization, turn-taking, reading, maybe harder to achieve. However, if a child has stable, loving infancy and then is exposed to difficulties in middle childhood, this would have a different impact. I realised therefore that an infant could be affected by exposure to domestic abuse, and the effects could be even worse than for an older child.
Drawing upon his understanding of brain development, Perry developed the neuro-sequential model of therapeutics. He identified that children should be treated based on their developmental age and not their chronological age. This approach involves understanding the child’s developmental history and recognizing that some children might not have had the patterned, repetitive stimulation and comfort required for healthy brain development at specific points in their childhood.
For example, when I would later work with children in care, I would work with a 6-year-old, who should theoretically be learning to integrate with their peer group, engage in learning and develop some self-care and independence skills. However, this would be difficult to achieve if they still had difficulties with emotional regulation, sleeping, and toileting. The problems with the essential regulatory functions indicated that they missed vital care during their infancy. The challenges they faced with social skills and learning could not be remedied by more structure, limits, and discouragement from regressive behaviours. Instead, for some children, leaning into their regressive and ‘childish’ behaviour was exactly what was needed. Perry beautifully describes the idea in his description of Mama. P, a motherly foster parent who instinctively understood a child’s need for nurture, even though their age indicated otherwise;
‘When Mama P. had rocked and held the traumatized children she cared for, she’d intuitively discovered what would become the foundation of our neuro-sequential approach: these children need patterned, repetitive experiences appropriate to their developmental needs that reflect the age which they’d missed important stimuli or had been traumatized, not their chronological age’ (p.152).
‘…the research on the most effective treatments to help child trauma victims might be accurately summed up in this way: what works best is anything that increases the quality and number of relationships in the child’s life’ (p.80).
‘…pleasure and human interactions become inextricably woven together. This interconnection, the association of pleasure with human interaction, is the important neurobiological glue that bonds and creates healthy relationships. Consequently, the most powerful rewards we can receive are the attention, approval and affection of people we love and respect. Similarly, the most powerful pain we experience is the loss of that attention, approval and affection’ (p.85).
‘The fact that the brain develops – and also so rapidly in the first years of life – explains why extremely young children are at such great risk of suffering lasting effects of trauma: their brains are still developing. The same miraculous plasticity that allows young brains to quickly learn love and language, unfortunately, also makes them highly susceptible to negative experiences as well’ (p.65)
A question: What has been the most influential book, in terms of practical usefulness you have read? Please get in touch or leave a comment below.
An invitation: If you read any book I recommend and you are interested in sharing your learning, I would love for you write a blog post. Just get in touch.
By Richard Devine (19.01.22)