Doctor's Notes: At this Preschool for Traumatized Kids, Emotional Care Comes First, Then Academics

This article was originally published on California Health Report on 7/10/2018.

Reggie, now 5, was exposed to methamphetamines in utero and, after he was born, his biological mother wasn’t able to care for him. When he was 4-weeks-old, I was his doctor in the foster-care clinic at Harbor-UCLA Medical Center. He was adopted by one of my pediatric colleagues, Amy Huang, and her husband, Daniel. Because Reggie is a minor, his and his parents’ names have been changed.

“He was the best baby, no withdrawals, no terrible twos,” Amy Huang said. “We thought he had escaped the meth-effects.”

But, unfortunately, that wasn’t the case.

In January, when Reggie returned to preschool after winter vacation, he started having extreme behaviors. He became defiant and aggressive. He was biting, hitting strangers and at times getting on all fours and acting like an animal. His parents were frustrated and worried that the problems were related to his drug exposure.

The effects of methamphetamines on infants in the womb run a wide spectrum, from mild learning problems to significant impairment of brain function. These infants may be born premature, have low birth weight or suffer withdrawals causing jitteriness, irritability and poor feeding. In addition, meth-addicted mothers often have poor health and may use other substances such as marijuana, tobacco, alcohol and cocaine. All of these can have negative effects on the infant’s development, as well as the mother’s ability to parent.

Researchers have shown that children who were meth-exposed in utero have difficulties with their brain’s executive function, which is the central command for organizing thoughts, planning and learning. These children also have an increased risk of disruptive behaviors and attention deficit/hyperactivity disorder (ADHD), as well as depression, anxiety and other mental illnesses, when compared to non-exposed peers. Some of these problems don’t become obvious until the cognitive and behavioral demands of a classroom.

By spring, Reggie’s behavior was spiraling out of control and his preschool teachers couldn’t cope with him. The Huangs took him out of that school but didn’t know where to turn.

I recommended Children’s Institute Inc, as did some other friends with an adopted child who had also been exposed to drugs. I was familiar with the Institute’s therapeutic preschool called Day Treatment Intensive, DTI. Over the past 12 years, I have referred many children with behavioral difficulties due to drug exposure, abuse, neglect and other psychological traumas.

DTI “looks like a regular preschool,” said Nicole Fauscette, a licensed family therapist and supervisor of the program, but it offers real-time, individual therapy. First, DTI focuses on mental health, in a supportive and developmentally appropriate preschool setting. The school adds in academics as the children are ready.

The Children’s Institute building on Harbor-UCLA’s campus is surrounded by playgrounds. The inside is decorated in lively colors, and it’s neatly cluttered with toys and children. It looks like Crayola designed a home inviting visitors to come play.

Children ages 2½ to 5 are eligible. Many have been expelled from regular preschool. DTI has space for 12 children and classrooms have, on average, one staff member for every two kids. Referrals come from child protective services, pediatricians, Head Start, internal mental health programs and community mental health agencies.

DTI is one of less than a dozen such specialized programs in Los Angeles County, which is home to nearly 330,000 children younger than five. About 20 percent of those kids live in poverty and most have experienced adversity. The need far exceeds the slots available.

“Therapeutic preschool uses the neuro-sequential model,” said Jesus Parra, the regional director for clinical services for Children’s Institute. This approach provides a framework for helping a child, keeping in mind his or her trauma history, developmental stage and current ability to function.

“We help the kids get to a place where they can regulate their behaviors, increase their attention (and) their tolerance of frustration, and better navigate peer and adult relationships,” said Fauscette. The goal is to help the children achieve emotional stability, so they’ll be ready for a traditional learning environment.

The staff and volunteers at DTI are chosen in part because of their temperament and ability to regulate their own emotions. These qualities are as valued as their education, though most have backgrounds in child development, psychology or mental health.

“An adult in control of their emotions helps children who are not in control of theirs,” said Parra, who leads some of the staff trainings.

The program aims, Parra said, for “the parents to fall in love with their child again.”

Reggie started at DTI in early May. The teachers observed that when he behaves like a dinosaur or other animal, it is because he is feeling anxious and frightened. In this way, they reason, he is attempting to defend himself against the danger he perceives. So, instead of punishing him for disobeying, Reggie’s teachers approach him calmly and help him address his anxiety.

In the last few months, Reggie has made progress learning to use words—and not aggression—to express his emotions.

The Huangs have already noticed a change. The teachers “were able to describe to us how Reggie interprets his world,” Daniel Huang said. “It’s helping—him and me.”

Pediatrician ChrisAnna Mink writes the bimonthly Doctor’s Notes column on Cal Health Report’s children’s health.