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Submission to the National Inquiry into Children in Immigration Detention from

Anita Chauvin

The immediate and long-term impact of trauma on children and young people: The implications of placement in detention centres for recovery from trauma and development of resilience

The Developing Brains of Children and Young People and the Immediate and Long-Term Effects of Trauma

Intergenerational Effects

Why Some People Survive Trauma Better Than Others: Programs Which Support Recovery and Build Resilience

Stabilising Children and Young People Who Are Traumatised

Conclusion

The immediate and long-term impact of trauma on children and young people: The implications of placement in detention centres for recovery from trauma and development of resilience

It is important that the impact of the trauma of exposure to violence, abuse, armed conflict, displacement and the absence of any support systems or social networks on children and young people are understood. The immediate impact of such trauma, the possible long term consequences, and the strategies to support recovery and build resilience need to be considered when Governments make decisions about placement of children who are asylum seekers. At the international conference, The Refugee Convention, Where to From Here? (Sydney, 2001), reports by lawyers, health professionals and others involved with asylum seekers in Detention Centres, described an environment which is, at best, sterile and devoid of opportunities for constructive daily activity and, at worst, unpredictably hostile, with frequent distressing incidents a part of daily life. These issues have also been raised by some 150 submissions to the Human Rights and Equal Opportunity Commission (HREOC) Children in Detention Enquiry by academics, non-government organisations and medical professionals (www.humanarights.gov.au).

Reports included descriptions of daily procedures reminiscent of a prisoner of war camp, with random military-style raids by guards in full riot gear; regular daily musters in a dusty, treeless compound; unaccompanied children/minors sitting outside their huts each day for six months, waiting for someone to come and interview them, no-one having explained the Immigration Department’s procedures to them. Children have watched attempted suicides and listen to the screaming and wailing of traumatised adults. Their parents, if they have any friends or relations in the Detention Centre, are often frightened and psychologically distressed and provide no reassuring reference point. There is a reported absence of health and support services, with detainees who have serious illnesses reported being given Panadol instead of the anti-biotics or other medication they may need. New detainees quickly become aware that there are residents in the Centres who have been there for years, not accepted as refugees yet not sent home, presumably because their homeland is dangerous. There are children in Detention who were born there and are now up to four years old. In what research tells us are their most critical years, this lifestyle is all they have known. Detention Centres may well exacerbate the repercussions of trauma, or even retraumatise children and young people.

Studies examining the impact of trauma demonstrate a significant effect on the developing brain of children and young people, which can lead to a range of health and behavioural problems later in life (Beall, 1997; Bremner et al., 1998; Nurcombe, 1999; Perry, 1997; Pynoos, Steinberg & Goenjian, 1996; van der Kolk, McFarlane & Weisaeth, 1996). There are a number of factors which interact to determine the extent of the damage a child or young person may experience in the face of violence, abuse and/or neglect. These include


The brain develops in response to its environment. Clinical trials show anatomical, neurophysiological and neurochemical changes are a common result of exposure to prolonged violence, abuse and/or neglect in childhood (Bremner et al., 1998; Perry, Pollard, Blakley, Baker & Vigilante, 1995; Perry, 1997; van der Kolk & Fisler, 1995). When a child adopts hypervigilant or avoidant coping mechanisms to deal with an unsafe environment, this chronic reactivity exacerbates neurochemical changes, which can lead to anxiety, depression, problems with anger management, impulsive sexuality, self-harming, and excessive risk taking later in life. This places children and adolescents who have been exposed to acute or longstanding stress, overwhelming anxiety, or trauma at increased risk of mental health problems and self-harming behaviours, including suicide, substance use, and unsafe sexual behaviours later in life (CGNACS, 1999; Perry et al., 1995; Perry, 1997; van der Kolk, 1994; Yehuda et al., 1997). The chronic mental health problems which can occur include symptoms that cross diagnoses such as post-traumatic stress disorder (PTSD), dissociation, somatic disorders and suicidality (van der Kolk, B. A., Pelcovitz, D., Roth, S., Mandel, F. S., McFarlane, A. & Herman, J. L., 1996).

Recovery from trauma is possible, given reduction of risk factors, interventions to establish protective factors and linkage with appropriate therapies (Chauvin, 1998; CGNACS, 1999; Commonwealth Department of Health and Aged Care (CDHAC)b, 2000). A person’s ability to recover from difficulties, or even to become stronger as a result of adversity, is known as resilience. There is now a significant body of literature which demonstrates that there are identifiable risk factors which can be minimised, and protective factors which can be built to support the development of resilience (CGNACS, 1999; CDHACb, 2000). The key factors which support resilience, and which enable children and young people to build positive life experiences in the future, need to be developed across a number of domains and include:

The Commonwealth and State Governments of Australia have recognised and responded to this research through the policies and strategies encompassed by the National Anti-Crime Strategy (CGNACS, 1999), the National Suicide Prevention Strategy (CDHACc, 2000), the National Mental Health Strategy (CDHACb, 2000), and the Youth Pathways Strategy (CGYPAPT, 2001), which are largely mirrored in State and Territory policies and strategies. Yet children and young people who are asylum seekers continue to be placed in Detention Centres, which demonstrably increase risk factors and reduce protective factors. Further, when they act out in response to their distress, they are described as behaving provocatively. People working with asylum seeker populations need to be able to identify when health or behavioural problems are sequelae to trauma, and respond appropriately, if unnecessary lifelong distress and dysfunction are to be prevented. It is likely that current policies and practices around placement of children and young people who are asylum seekers in Detention Centres removes the protective factors necessary to recover from trauma and to build resilience and can place them at significant risk of lifelong distress and dysfunction.

Detention centres strip children and young people of most protective factors that could ameliorate the impact of exposure to trauma, such as strong family relationships, supportive adult relationships, attachment to community networks and opportunities for success and achievement. There is evidence that adolescence is a critical time since brain development lays down neural pathways which support constructive or destructive responses to heightened flight, freeze, submit reactions programmed in the early years of trauma (The Refugee Convention, Where to From Here Report, p. 18).

This chapter examines the effect of trauma on the developing brains of children and young people, including the possible long term psychological, behavioural and social consequences later in life and the ways in which intergenerational trauma occurs. The risk factors which exacerbate distress, and the protective factors which support recovery and build resilience, are identified. This research is then applied specifically to children and young people who are asylum seekers to consider what impact their placement in Detention Centres may have on them. The chapter considers these findings, given the Government’s current practice of placing children and young people in high risk settings. Also outlined are alternative approaches which would be more congruent with contemporary Government policies on the protection of children and young people and the strengthening of families and communities.


The Developing Brains of Children and Young People and the Immediate and Long-Term Effects of Trauma

Children’s brains develop in response to their environment and so they are particularly affected by violence, abuse and neglect (Perry et al., 1995; van der Kolk, 1994). The impact may occur because they themselves are being tortured, caught in war, or experiencing violence, abuse or neglect, or because they are experiencing threat through the chaotic behaviour of their traumatised parents (Yehuda et al., 1997; Bremner et al., 1997).
An environment of unpredictable danger leads to:


Early identification of children, young people and/or their families who have these chronic sequelae to the trauma of violence, abuse and neglect is important as these conditions are treatable and a lifetime of distress and other more serious sequelae in adulthood can be prevented (CGNACS, 1999; CDHAC, 2000b).

If untreated, the sequelae of trauma, including depression, anxiety, affect dysregulation, dissociation and post-traumatic stress symptoms, can generate self-destructive or impulsive behaviour, which does not change simply in response to information or education programs. Often children or young people who are seen as recalcitrant may simply be struggling with such neurophysiological problems, learned coping mechanisms and an increasing sense of hopelessness and fear. Programs and services need to address their complex and interacting issues (Chauvin, 1998; Chauvin, 2001).

There can be a range of flow-on effects in the way people live their lives due to exposure to trauma in childhood or adolescence. These effects can be understood to result from neurophysiological changes in response to trauma and to be reinforced by learned behaviour and established cognitive-behavioural patterns developed over time as a result of the maladaptive brain/nervous system responses and altered neurochemistry. Studies have shown that women who have been sexually abused are at higher risk of sexual assault or further episodes of abuse later in life (van der Kolk, 1989; Webster & le Brocq, 1995; Hastings & Hamberger, 1997; Melzer-Lange, 1998; Johns Hopkins School of Public Health, 2000). It may be that this increased risk is a result of a dissociative response (van der Kolk et al., 1996; Steele, van der Hart & Nijenhuis, 2001). Studies showed that the earlier in life a person was traumatised, the more likely they were to dissociate as a coping mechanism, and that women are more inclined to dissociate under stress as a result of early trauma (van der Kolk & Fisler, 1995). Women may find themselves in compromising circumstances or feeling intimidated by a ‘date’ or partner and dissociate in response, appearing passive and perhaps therefore compliant with sexual overtures. When they are distressed and dissociating, they may respond to fight/flight triggers with a learned freeze or submit response (Herman, 1992; Van der Hart, 2000).

Studies (Webster & Le Brocq, 1995; Hastings & Hamberger, 1997; Melzer-Lange, 1998) have shown that people who engage in a whole range of risk-taking, self-harming and harmful behaviours have a higher proportion of family dysfunction in their background. Studies suggest that this risk taking, self-harming and harming behaviour may be driven by the neurophysiological changes which occur in childhood in relation to the trauma of violence and abuse, particularly the effect on impulse control. It may also be that the tendency to dissociate can make the threat of harm seem remote and theoretical, rather than real and imminent. There is also some speculation that the numbness associated with chronic dissociation is only broken through when extreme arousal occurs — for example, sexually, through self-harming and/or excessive risk taking (FYCCQ, 2000).

Self-harming is also not always obvious and a range of data sources would seem to suggest that numbers of young people who are self-harming may be quite high and that this behaviour seems to affect young women more than young men (Department of Families, Youth and Community Care (DFYCC), 2000). Self-harming can be caused by many things, including depression and/or a reaction to trauma in the past or present. Where there is a background of trauma, the person could be acting out to cope with internalised pain, trying to break through dissociation — to feel, rather than be numb; and/or they could be expressing a desire to feel in control of some part of their life.

Self-harming can include:

Risk-taking, self-harming and harming behaviours which can be associated with past trauma include:

These behaviours and their consequences can result in retraumatisation. If children and young people stay locked in these cycles, and their neurophysiology is predisposing them to depression, intrusive violent and fearful images and suicidal ideation, their risk of self-harming and suicide are also increased (Chauvin, 1998; CDHAC, 2000b; CDHAC, 2000c).



Intergenerational Effects

When a child is cared for by a parent who is suffering from symptoms such as PTSD and other sequelae, that child can be raised, developing significant anxiety, with a view of the world as a dangerous and distressing place. The parent may care about the child deeply, but have dysfunctional behaviours that put the child at risk. Yehuda et al. (1997) demonstrated that the offspring of parents suffering PTSD as a result of the Holocaust, engagement in war, or through becoming refugees, often develop the same neurochemical changes as their parents. The impact of a parent who has had a background of violence, abuse and neglect may be compounded if the parent has also adopted dysfunctional coping mechanisms. These may include emotional disconnectedness (for example, attachment problems at birth and through childhood) and/or by the parent’s self-destructive or destructive coping mechanisms, such as alcohol, tobacco and drug use, violence, changing sexual partners, or lifestyle instability (Chauvin, 1998). A parent in Detention, who has not had the opportunity to recover from their experience of trauma, is therefore at higher risk of having an unintended negative impact on their child.

Why Some People Survive Trauma Better Than Others: Programs Which Support Recovery and Build Resilience

We have all met individuals who have experienced prolonged distress and difficulties, or who have gone through traumatic events, and observed how some bounce back and survive well while others may remain fragile or distressed or even deteriorate and become depressed and anxious. A person’s ability to recover from difficulties or even become stronger as a result of adversity is known as resilience. There is now a significant body of literature which demonstrates that there are identifiable risk factors which can be minimised and protective factors which can be built upon to support the development of resilience (CGNACS, 1999; CDHAC, 2000b). Some of the key factors which support resilience and which enable children and young people to build positive life experiences in the future include:

Many of these elements are captured when children and young people are involved in well-facilitated community development programs, such as group/team-based projects to achieve some end, community art/theatre/music projects (Chauvin, 1998; 2001). Reintegration into normal community life, in a community which embraces them and experiences which generate a sense of optimism about the future are critical to recovery from trauma (CGNACS, 1999; CDHAC, 2000c).


Stabilising Children and Young People Who Are Traumatised

The most important point to consider in designing interventions to support recovery is the need to stabilise symptoms, to identify and build on strengths and to build life skills (Steele, van der Hart & Nijenhuis, 2001; van der Kolk, van der Hart & Marmor, 1996). It is then possible to deal with the trauma (only if the person wants to and/or feels ready to) and then to integrate the learning or gains from these interventions into a constructive approach to life in the future (Steele, van der Hart, Nijenhuis, 2001; van der Hart, 2000). If it is decided by the person that it is inappropriate to address the trauma directly, at least for some time, then this must be respected. To deal with trauma directly before the person has developed their strengths and established protective factors around themselves could actually be harmful and result in retraumatising them.

As long as children and young people who have been traumatised have to reside in a Detention Centre, where factors that allow them to stabilise are absent, they are not able to recover, let alone develop life skills and resilience. The absence of support services, the lack of opportunity for their family to be strengthened, or for supportive networks and a sense of belonging in a community to be established — all these factors actively undermine their opportunity to stabilise, avoid retraumatisation and to recover mental health. Government programs are very clear on the range of protective factors which need to be in place at an individual, family, school, community and cultural level, in order for children and young people to recover from prolonged exposure to trauma and to build resilience (CGNACS, 1999; CDHAC, 2000b).

When the young person is ready to deal with the trauma through psychotherapeutic interventions they can be linked into appropriate services. There are a number of therapies that are appropriate at different phases of recovery and which might need to be linked/coordinated with other interventions. A range of individual and family therapies may be helpful at different times in the healing process, including those which provide insight, build self-awareness and strengthen problem-solving skills: cognitive behavioural therapy; behavioural and solution-focussed strategies; therapies such as EMDR (eye movement desensitisation and reprocessing); relaxation/stress management; and meditation exercises. Research suggests that all these therapies may also help with neurophysiologically-programmed fight, flight, freeze and submit responses and other sequelae resulting from prolonged trauma, including anxiety, depression and suicidal ideation. Detoxification and treatment programs are available for alcohol and drug-use; and pharmacological and other interventions are appropriate for depression and/or comorbidities (van der Kolk, McFarlane & Weisaeth, 1996; Nurcombe, 1999).

Building on strengths and establishing resilience

The guidelines for fostering and building on strengths and for the establishment of sustainable protective factors are very clearly laid out in contemporary Government programs for children and young people (CGNACS, 1999; CDHAC, 2000b; CDHAC, 2000c).

In the table of risk and protective factors, Table 1 below, it becomes clear that children and young people need to feel embraced by a community which values and protects them. They need to have a sense of belonging. Research supporting the programs cited above also cites the importance of a cohesive family or where a family is disrupted, for strong linkages with respectful, affirming adults and good role models. The importance of strong, supportive peer networks is also recognised, both as a vehicle for learning and to support the sustaining of positive behaviour changes. The school as a community and a potential health promoting environment is recognised and emphasised globally (CDHAC, 2000a) and the protective value of learning life skills and being exposed to positive life experiences and experiences of success has been demonstrated to build optimism and reduce recidivism (CGNACS, 1999).

Studies and reports from agencies working with traumatised young people suggest a fine balance is required between acknowledging and dealing with the impact of past trauma, and focussing on building on the positives, thinking forward. The growing literature on building strengths or protective factors suggests that it is important to first build strength, life skills and support to stabilise the person before attempting to deal with examining the issues around trauma (Steele, van der Hart & Nijenhuis, 2001). It is the person’s choice whether, in fact, they ever choose to examine the trauma — for some it may simply serve to retraumatise them. The key issue is to reduce the risk of further trauma in the future through isolation and self-destructiveness.

Healthy lifestyle and relationship patterns are able to grow stronger when there is a focus on enhancing the strengths which clearly exist in someone who has survived violence, abuse, neglect, displacement, loss and/or other distress. The development of insight and skills supports constructive life experiences in the future and with each experience of success and of positive intimacy resilience is reinforced. Over time, with the absence of repeated cycles of trauma and distress, and consequent retraumatisation, the young person has the opportunity to make the best of their life. They are more able to fulfill their potential, enjoy happy relationships, and in time, if they wish, to become a constructive, caring parent themselves, not repeating the cycles of violence, abuse or neglect which may have harmed them in the first place.


Australia’s National and State Policies and Programs For Children and Young People

National and State Governments in Australia have responded to research on the impact of violence, abuse and neglect and the evidence of risk and protective factors, by establishing a range of prevention and early intervention programs, including parent skills development programs, young parent programs, home visitation, and expanded child health centres. The Commonwealth Government has adopted the findings on the impact of trauma on children and young people and declared a commitment to act to reduce risks to children and young people by establishing programs which identify and work to reduce risk and which build protective factors to generate resilience. This commitment to identifying and reducing risk factors and at the same time identifying and building protective factors, underpins the approach taken in a range of programs, including the National Anti-Crime Strategy, the National Mental Health Strategy, and the National Suicide Prevention Strategy.
For reasons which are not clear, and despite the Government’s overt acknowledgement of the impact of trauma on children and its acceptance of the research on risk and protective factors, the Government continues to place some of the most vulnerable children and young people in this country into high risk settings, stripped of all the factors which enable them or their families to recover and to build resilience. It is important to have early identification of children, young people and their families who have chronic sequelae to the trauma of armed conflict, oppression, violence, abuse and neglect, as these conditions are treatable and a lifetime of distress and other more serious roll-on effects in adulthood can be prevented.


Table 1: Risk factors and protective factors

R I S K F A C T O R S
CHILD FACTORS
FAMILY FACTORS
SCHOOL CONTENT
LIFE EVENTS
COMMUNITY AND CULTURAL FACTORS
  • Prematurity
  • low birth weight

    disability

  • prenatal brain damage
  • birth injury
  • low intelligence
  • difficult temperament
  • chronic illness
  • insecure attachment
  • poor problem solving
  • beliefs about aggression
  • attributions
  • poor social skills
  • low self-esteem
  • lack of empathy
  • alienation
  • hyperactivity/disruptive

    behaviour

  • impulsivity

Parental characteristics:

  • teenage mothers
  • single parents
  • psychiatric disorder, especially depression
  • substance abuse
  • criminality
  • antisocial models


family environment:

  • family violence and disharmony
  • marital discord
  • disorganised
  • negative interaction/social
  • isolation
  • large family size
  • father absent
  • long-term parental unemployment


parenting style:

  • poor supervision and monitoring of child
    discipline style (harsh or inconsistent)
  • rejection of child
  • abuse
  • lack of warmth and affection
  • low involvement in child’s activities
  • neglect
  • school failure
  • normative beliefs about aggression
    deviant peer group
  • bullying
  • peer rejection
  • poor attachment to school
  • inadequate behaviour management
  • divorce and family break up
  • war or natural disasters
  • death of a family member
  • socioeconomic disadvantage
  • population density and housing conditions
  • urban area
  • neighbourhood violence and crime
  • cultural norms concerning violence as acceptable responses to frustration
  • media portrayal of violence
  • lack of support services
  • social or cultural discrimination
P R O T E C T I V E F A C T O R S
  • social competence
  • social skills
  • above average intelligence
  • attachment to family
  • empathy
  • problem solving
  • optimism
  • school achievement
  • easy temperament
  • internal locus of control
  • moral beliefs
  • values
  • self-related cognitions
  • good coping style
  • supportive caring parents
  • family harmony
  • more than two years between siblings
  • responsibility for chores or required
  • helpfulness
  • secure and stable family
  • supportive relationship with other adult
  • small family size
  • strong family norms and morality
  • positive school climate
  • prosocial peer group
  • responsibility and required helpfulness
  • sense of belonging/ bonding
  • opportunity for some success at school and recognition of achievement
  • school norms concerning violence
  • meeting significant person
  • moving to new area
  • opportunities at critical turning points or major life transitions
  • access to support services
  • community networking
  • attachment to the community
  • participation in church or other community group
  • community/cultural norms against violence
  • a strong cultural identity and ethnic pride


Source: Pathways to Prevention, CGNACS, 1999, p. 136 & p. 138.

Intervention also reduces the likelihood of the cycle of violence being repeated in the next generation and supports development of more stable, peaceful societies. The placement of refugees, especially children and young people, in community settings where they can begin to reduce the risk factors in their lives and can establish protective factors, such as a sense of belonging, peer support, building strength and achievement, would not only be a constructive and compassionate response, but would save Governments significant expense in the long term when chronic health problems, crime and future conflict are prevented as a result.

It should also be borne in mind that young people from backgrounds of trauma will need a long term, staged developmental and multimodal approach to help them recover and to build resilient lives. The wealth of literature on harm prevention and harm minimisation programs confirms that access to community development programs is useful to lay important groundwork, including building trust with health professionals, beginning to generate constructive peer networks and developing life skills as a side effect of interaction and problem-solving in group settings (Chauvin, 2001). These interventions provide the first stage of the recovery process. Having built trust with their health workers, and gained a level of comfort attending the organisations that auspice these activities, young people are more likely to seek help and return for other developmental and therapeutic interventions.

Similarly, mental health services that provide sessions on site in youth agencies or youth-friendly community-based agencies also become familiar and trusted and are more readily accessed. This then provides the bridge into the mental health services themselves and opens up the possibility of more formal therapeutic interventions addressing trauma, should the person continue to have intrusive symptoms or other sequelae.

The Commonwealth Government’s plethora of programs, cited herein, for children and young people confirm the elements required for recovery from trauma and establishment of constructive life patterns. When all the interacting, complex issues affecting refugee and asylum seeker children, young people and their families are addressed — that is, reducing risk, building strengths and linking into therapeutic interventions when/if ready — then self-maintaining and positively reinforcing lifestyle patterns are established which contribute to resiliency and reduce self-harming and harmful behaviours.

Service providers need to remember that young people from a background of armed conflict, violence, abuse and neglect may go on to develop depression and/or impulsivity and self-harming life patterns. The nature of their neurophysiological state in itself undermines their ability to maintain positive behaviour change in response to health promotion and prevention programs, and treatment services.

Programs which address specific issues, such as alcohol, tobacco and other drug interventions, sexual health promotion, suicide prevention and other prevention and harm minimisation programs, need to take into account the possibility that a young person from a refugee background may be ‘acting out’ in response to the neurophysiological and cognitive-behavioural patterns laid down in response to early trauma. These sequelae, including depression, anxiety, affect dysregulation, dissociation and post traumatic stress symptoms, can generate self-destructive or impulsive behaviour, which does not change simply in response to information or education programs. Often children or young people who are seen as recalcitrant are in fact simply struggling with neurophysiology, learned coping mechanisms and an increasing sense of hopelessness and fear. Programs and services need to address their complex and interacting issues with compassion and a spirit of genuine enquiry (Chauvin, 2001).

Conclusion


For children and young people who are asylum seekers/refugees it is likely that placement in Detention Centres strips them of the protective factors necessary to recover from trauma and to build resilience. The distress of their parents further places them at risk. National and State Governments have recognised the need to ‘strengthen families’ in a range of policies, including Pathways to Prevention: Developmental and Early Intervention Approaches to Crime in Australia (CGNACS, 1999), the Suicide Prevention Strategy (CDHAC, 2000c) and the National Mental Health Strategy (CDHAC, 2000b).
Appropriate placement within the community and interventions to reduce the likelihood of the cycle of violence being repeated in the next generation are cost effective and in line with current Government policies for strengthening families and communities, and for nurturing the wellbeing of vulnerable children and young people. The placement of refugees, especially children and young people, in community settings where they can begin to reduce the risk factors in their lives and can establish protective factors, such as a sense of belonging, peer support, building strength and achievement, would not only be a constructive and compassionate response, but would save Governments significant expense in the long term when chronic health problems, crime and future conflict are prevented as a result. Sadly many of our health, welfare and justice systems do not recognise when destructive or self-harming behaviour is the consequence of unresolved trauma. Consequently, young people are punished, further retraumatising them, instead of providing them with appropriate interventions and support.

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Last Updated 14 July 2003.