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The Stress of Transitions

Stress is an inescapable part of life. This is true for children as well as adults. Yet stress is not necessarily always a negative thing. As one neuroscientist explains, “Through moderate, predictable challenges our [brain’s] stress response systems are activated moderately. This makes for a resilient, flexible stress response capacity.”1
If one’s stress response system is overloaded, however, the results can be traumatic. It is estimated that 40 percent of American children will have a potentially traumatizing experience by the age of eighteen, such as a serious accident or natural disaster, physical abuse, neglect, sexual abuse, domestic violence, or the death of a parent or sibling.2 These experiences usually involve some form of loss, and the pain of loss is intensified by an unwanted or unexpected transition.

Actually, the transition itself can be traumatic because the neural systems of the brain are especially sensitive to novelty. New experiences can be a signal of danger.3 “If the incoming information is initially unfamiliar, new, or strange, the brain instantly begins a stress response.”4 The stress response can range from alertness to terror, depending on how threatening the situation seems.5 For children, a loss and its associated transitions often cause not only emotional pain but also fear, which creates a significant stress response in one’s body.6

We all experience a number of transitions in our lives, from moving to a new neighborhood or getting married to starting school or beginning a new job. Remembering the feeling of not knowing what to expect or being with unfamiliar people can help us plan and structure more positive transitions for children.

Daily Transitions Can Help Heal Traumatic Transitions

Children who have had traumatic transitions often struggle with simple, daily transitions. By making the everyday transitions predictable, patterned, and repetitive, the child’s anxiety will be decreased and healing can occur.

All healthy transitions have three parts: “anticipate, do, and review.” Let’s examine each of these parts.

Anticipate. A child is often expected to go along with whatever parents or adults have in mind. The key is that the adult usually does have something in mind–we have thought about, planned, or anticipated what will happen next, and we have had time to adjust to the transition. Yet we then turn around and force our choices onto a child who has had less time and has fewer skills with which to adjust. This can be very stressful for children, and that stress might show up as a tantrum, aggression, refusal to cooperate, or whining.
Helping a child anticipate a transition is critical to making transitions less traumatic. It is logical that the larger the transition, the more time a child needs to plan.

Have you ever been working on something important and someone says to you, “I can’t find my shoe” or “Will you look at this”? Often what we say is “Let me finish up here” or “Just a minute.” In that moment you are anticipating the transition–you are ending what you are doing and thinking about what is next.

When we don’t allow children to similarly anticipate a transition, we are sending the message that “What you do is not important or valuable” or, even worse, “Your life will be full of surprising transitions that will catch you off guard” or “You never know when a bad thing will happen.”

Do. The middle of the transition is the actual “doing”–going to the store, moving to a new home, attending the first day of school. It is sometimes the only part of a transition that gets any thought. But by itself, the doing portion of a transition is like a peanut butter sandwich without bread–essential parts are missing and it doesn’t work very well. In fact, a transition is much more likely to be traumatic when it involves only the “doing.”
Review. Many parents and adults help a child anticipate a transition by discussing with the child what the plan is for the day. Rarely, however, do we think to review the transition with the child. However, adults who understand children always include reviewing. Remember Mr. Rogers, host of the children’s television show? He ended the program with a review or recap of what had happened.

Reviewing sends the child the message that the adults in her life are predictable, and it increases her sense of security. Helping a child to use memory is critical to helping her make sense of life. If a child is in a chaotic situation, she is fending for herself in the moment and her senses are on high alert, wondering what’s next.7

When you are able to use memory, a number of healthy psychological things occur:
1. You can enjoy a good experience again. Recalling positive experiences is one way to mitigate a current stress or anxiety.8
2. You can process an event more completely. This is especially important for children, who by nature are excellent observers but are prone to misinterpret events due to incomplete cognitive development.
3. You can understand consequences or the wholeness of something by seeing the entire arc of the time before the experience, the experience itself, and the results of the experience.

One of the best ways to decrease a child’s overall anxiety is through the daily use of “anticipate, do, review.” This sends the message “I usually know what is going to happen, and I will help you. You don’t need to worry about it.”

Internal Transitions

Internal transitions are a different type of transition–they occur when a child’s idea of what is real comes in contact with reality, and the child’s misconception is shattered. Internal transitions often involve grief and mourning. Some adults never see internal transitions in children and mistakenly think that a child just “gets over” difficult things. Adults who are tuned into the idea of an internal transition can be an invaluable emotional anchor to a child during this uncertain and frightening time.

A bright and capable student at Westminster College poignantly described a dramatic internal transition in her childhood:
My mom would sometimes leave our home for days at a time, and no one was aware the four of us (my three siblings and I) were home alone. We had been taught not to use the stove, never to touch knives, and not to climb on chairs. Consequently, when none of us were tall enough to reach the cereal on top of the refrigerator we ate raw oatmeal with cold milk or uncooked ramen noodles with the flavor packet sprinkled on top.

At this point in my life I believed that everyone’s life was like mine. I didn’t know that parents were home when their children awoke in the morning, and I didn’t know that children could sleep at night not worrying that in the morning they would find their mom near death in a pool of her own blood after attempting suicide….

I had over twenty sets of parents in the eleven years that I spent in foster care. During my stay at my second foster home, my school class was going on a field trip, and I needed to take a sack lunch from home. During every previous field trip, I pretended to be too busy to eat a lunch that I didn’t have. I remember waking up that morning and my foster mom at that time had packed a brown bag lunch for me with my name written in marker on the front.

That moment shattered my misconception that everyone truly had a life like mine. I realized, in that moment, that all the kids I had thought were lying hadn’t been. The world that I knew ended in that moment and completely obliterated my self-confidence. I felt unwanted and rejected by my parents for the first time–I was eleven.9

As this student powerfully describes, being aware of transitions is crucial because they have the potential to forever change a child’s idea of how the world functions. Thoughtful, well-planned transitions, with a caring adult present for support, may still be difficult for the child. Yet painful events such as a death, separation, or move will be easier if we allow the child time to think, review, anticipate, mourn, and prepare for the change ahead.

How to Use: Real Stuff for Real People

Transitions are tied to our senses. For example, the smell of an old place can be comforting and reassuring, especially to infants who get their sense of trust not only from familiar people but also from familiar places.

A child’s natural connection to pictures and images can be used to help with transitions. Building on this concept, parents and professionals can increase a child’s understanding of an upcoming transition or ease the stress of a transition using pictures in the “anticipate, do, review” process mentioned above.

Using a digital or disposable camera, make a visual representation of an upcoming transition. For example, if the upcoming transition is changing schools, the pictures could include the outside of the new school, the entrance door for the child, the hallways, classroom, restrooms, lunchroom, and playground of the new school. A picture of the teacher and some classmates would further reduce the child’s distress over the transition.

The pictures are also a great tool for the review portion of the transition. The child usually enjoys recounting what happened where during the first days in the new school. The visual “anticipate, do, review” can even be used to help children with the transitions of daily routines such as bedtime or getting ready for school.

References
1 Perry, B. D., Szalavitz, M. (2006) The Boy Who Was Raised as a Dog, p. 41
2 Franey, K., Geffner, R., & Falconer, R. (Eds.) (2001). The Cost of Maltreatment: Who Pays? We All Do (pp. 15-37).
3 Wolf, M.E. (Eds.), PTSD: Biological Mechanisms and Clinical Aspects (pp 158-170).
4 Perry, B. D., Szalavitz, M. (2006) Ibid. p. 47
5 E.L. Giller, (Ed.) Advances in Psychiatry: Biological Assessment and Treatment of PTSD (pp. 87-115).
6 Goodwin, J.M. & Attias, R. (Eds.) (2001) Splintered Reflections. (pp. 26-47).
7 Perry, B.D., Pollard, R, et. Al. (1995) Infant Mental Health Journal 16 (4), 271-291.
8 Nolen-Hoeksema, S., et al (1993) Journal of Abnormal Psychology, 102(1), 20-28.
9 Personal correspondence.

Cinda Morgan, LCSW, is Clinical Director of Wellspring Child & Family Counseling Center and Associate Instructor at Westminster College.