Psychomotor Agitation with the Anti-Social Content in Internationally Adopted Children and Adolescents
Psychomotor Agitation (PMA) is a series of unintentional and purposeless motions that stem from mental excitation and anxiety of an individual.
A child afflicted with complex childhood trauma (having Developmental Trauma Disorder - DTD) has a distorted Central Nervous System (CNS) processing with major deficit in self-regulation of emotions and overt behavior. This child is easily frustrated and tends to accumulate tension related to this frustration. In certain situations, usually in familiar, structured, and monitored circumstances with an authority figure in sight and capable of managing the child's behavior, these children can for some time preserve control of their behavior. However, when tension is mounting, the ability to sustain the outburst diminishes, and the child releases tension through physical agitation that may take form of the a-social actions: physical or verbal aggression and damage of property/things. This psychomotor agitation is mostly unintentional and purposeless and stems from the traumatized child's anxiety. Inner tension is a feeling of nervousness, and an overwhelming mood discomfort. This drive makes purposeless actions practically unavoidable, almost compulsory for a child. For a by-standee it is impossible to empathise with or even understand the tension that is so extreme that it forces movement, but this is what happens.
By releasing tension through motor restlessness, the child experiences relief in spite of making his or her life miserable by often hurting other people and destroying property. They sometime laugh and smile in the midst of their destructive actions or when they are reprimanded or punished. This famous "orphanage smile" is reported by many parents and clinicians and is extremely frustrating for adults who live and work with traumatized children.
It's important for parents and school personnel to realize that this behaviour does not have purpose and does not have "triggers". It has inner dynamic dictated by the child's nervous system and is relatively free from the environmental influences. It may start "out of the blue", it may disappear for several hours to several days, and re-appear again without visible causes. That is why the traditional behaviour modification techniques and programs are often not successful with this type of conduct: nothing serves the purpose of "attracting attention" or "avoiding an assignment": it's just a tension release.
The question remains why this psychomotor agitation is released in such an anti-social manner; with physical aggression against peers, siblings and parents, with destruction of property, with violation of societal norms and school regulations? Young post-institutionalized children just do not know any other ways of releasing this tension, and one of the methods of preventing PMA anti-social nature is to teach them socially acceptable ways to discharge it.
Treating psychomotor agitation with anti-social content when it starts is hardly possible until the child is exhausted and the excitation of their CNS subsides (similar to tantrums that are a specific case of psychomotor agitation). However, it is possible to prevent PMA through relaxation techniques, attention redirection, and verbal interactions before the cycle starts. What can be done in the school to address this issue?
Behavior Improvement Plan (BIP)
Traditional behavior modification strategies (a system of rewards and punishment) that rely on self-control, presume willfulness and require an age-appropriate level of maturity and responsibility are likely to be ineffective or even impossible in preventing or controlling PMA. On the other hand, the strategies that do not presume self-control and do not put undue weight on behavioral slip-ups, which are suited to the child's level of emotional maturity and decrease their level of stress, will be more effective.
Traditional behavior modification programming often used in the school system, may not be effective for children with developmental trauma disorder, because constant "evaluation" of a person with emotional trauma perpetually puts this person in defensive state or in the state of anxiety, which leaves them feeling unsafe and thus unable to learn and socialize in the age-appropriate manner. Based on my experience working with internationally adopted children, I advocate for a trauma-informed approach, which is different from traditional behavioral methods. Social connectedness instead of reward-punishment methodology should be applied to aim at creating an environment that is proactive in preventing escalation of the emotional distress.
In practical terms, this should be a system of classroom and school-wide accommodations, including special crisis prevention and de-escalation techniques. Behavior Improvement Plan (BIP) should include teaching of alternative positive behavior, such as means of calming down. When dealing with a traumatized child, the focus should be on connection, not control. When reprimanded, a traumatized child may become further frustrated and stressed, which will escalate defiant behavior. Instead, when feeling frustrated, the child should be allowed to talk about his/her feelings of frustration and injustice and the listener should be able to look at the situation from the child's perspective.
The Behavior Improvement Plan (BIP) should include at least three sections:
Implement proactive interventions - for example, using a "frustration card": the child will be taught to show a card that he/she can use to signal feelings of frustration. After showing the card, he/she will be removed from the frustrating situation. The child will use a "Finish Later" folder or box to be used when he/she is not done with an assignment or project on time. Still other means of proactive interventions could be used if these are not in violation of school rules and regulations.
Teach alternative and adaptive behavior - strategies for calming down, such as breathing, counting, walking/stretching, etc. A child should be trained in self-regulatory scripts such as: "big deal/little deal," "choice/no choice," "plan A/plan B." Visual reminders are provided so that ultimately the child will be able to become more flexible rather than getting stuck in negative thoughts, getting frustrated and having a meltdown.
Use reactive Interventions - for any situation in which a child may present danger to her/himself and others: e.g. distracting the child from the frustrating situation, using calming techniques, removing them from the place of an incident.
Implementing Behavior Improvement Plan (BIP) we should always have in mind that our goal is to develop self-regulation in the child in order to effectively address PMA. A substantial part of BIP should be the Zones of Regulation methodology. This technique was initially developed by the occupational therapist Leah Kuypers and now is wildly used by school counselors and therapists who work with children lacking self-regulation skills (also called "executive functions").
The Zones of Regulation methodology classifies states of arousal into four easily identified color-coded zones: the Red Zone, where emotions are so intense and overwhelming, that the person feels out of control; the Yellow Zone, where emotions are not as extreme and a person has some control; the Green Zone, a calm state where the person feels focused, alert, in control of the emotions; and the Blue Zone, a state of relaxation, reduced alertness (this state is counter-productive for learning).
The zones can be explained much as we would explain traffic signs. Red means stop. Yellow is a warning to slow down and be cautious. Blue is like a rest area off the freeway, a place where we can stop, take a break, and get re-energized. Green means we're good to go. Within the course of 15 to 18 sessions, children learn ways to identify their different states of arousal and capacity for emotional control. Children who previously struggled when asked to explain how they feel now have a vocabulary for doing so. Children also learn about different tools for moving from one zone to another, including tools for staying in the green zone, a zone we need to be in to function well in class.
The Zones curriculum also provides practice in other emotion self-regulation strategies as well, including situation modification and cognitive change. For example, lessons teach children to recognize personal triggers that typically send them into yellow and red zones. Then they practice ways of identifying and preparing for triggers beforehand. This way they can prevent themselves from losing control in situations where losing control has occurred in the past. In order to encourage children to take more ownership of their self-regulation skills, Kuypers also incorporates a number of cognitive behavioral strategies designed to increase positive self-talk, self-monitoring, and self-management.
One big advantage of Zones of Regulation methodology is that it focuses particular attention on teaching the self-regulation skills necessary for making and keeping friends. Children learn how their reactions in different zones affect others, including other children at school. They also practice recognizing other people's facial expressions and how these different facial expressions relate to different zones people are in. Children become more skilled at appreciating other people's moods and emotions. In teaching social skills, The Zones of Regulation methodology is intended for anyone who works with students K-12 struggling in area of self-regulation.
You can learn more about Zones of Regulation by logging on to the website www.zonesofregulation.com or reading Leah Kuypers' book (which contains a CD ROM that includes reproducible visuals and handouts related to lessons): "The Zones of Regulation: A Curriculum Designed to Foster Self-Regulation and Emotional Control" (2011, Social Thinking Publishing,
Boris Gindis, Ph.D. Licensed Psychologist Center for Cognitive-Developmental Assessment and Remediation (BGCenter) 845-533-4300