STAT+: What the Trump administration wants in its next FDA leader

WASHINGTON — The Trump administration is moving quickly to identify the next commissioner of the Food and Drug Administration after the resignation of Marty Makary on Tuesday, with an eye for someone who can rebuild trust with agency staff, focus on the agency’s food policy, and continue to drive drug-approval reforms.

Administration leaders hope to conduct the search over “the next several weeks,” according to an official with knowledge of the process, granted anonymity to speak candidly. Despite chatter among lobbyists about who is in contention, there’s currently no short list of candidates, the official said.

Despite the urgency, the process will take a while. The Senate is in session for only so many days, and the administration also needs to confirm Erica Schwartz, the Centers for Disease Control and Prevention nominee, and Nicole Saphier, the surgeon general nominee. It’s possible Kyle Diamantas, formerly in charge of the FDA’s food center, will still be acting commissioner when the midterms arrive in November. 

Continue to STAT+ to read the full story…

Assessing directional connections between symptoms, cognition, insight, and real-life functioning in schizophrenia: a partial ancestor graphs analysis

IntroductionSchizophrenia is a severe chronic mental disorder causing significant global disability. Understanding the intricate relationships between symptoms, cognitive functions, and real-life outcomes is essential for developing effective interventions. Prior research, while informative, could not often determine the direction of the association between these illness-related factors. This study aimed to investigate the possible causal connections within the interrelationships of these variables. MethodsThis cross-sectional study included 215 clinically stable patients diagnosed with schizophrenia. Comprehensive assessments covered psychopathology, neurocognition, social cognition, metacognition, clinical insight, and real-life functioning. Causal relationships were explored using Partial Ancestral Graphs, a causal discovery framework that accounts for mediators and confounders. The Greedy Fast Causal Inference algorithm was employed with 1,000 bootstrap replications to assign edge orientations.ResultsA central neurocognitive–metacognitive–functional system of directed connection emerged: visual learning was linked to attention/vigilance and working memory. Working memory showed a direct relationship with metacognition, which, in turn, was connected to real-life functioning. Two partly independent contributions to real-life functioning were also identified: conceptual disorganization and experiential negative symptoms, which were directly related to expressive deficits. Positive symptoms, depressive symptoms, and social cognition occupied peripheral positions, showing no significant connection with other variables. Unawareness and misattribution of symptoms showed an indeterminate association disconnected from the main network.DiscussionThe findings show a set of directed associations that start with neurocognitive abilities, pass through working memory and metacognition, and terminate in real-life functioning. Independently, conceptual disorganization and expressive negative symptoms also exert direct influences. These directed systems of connections provide operational guidance for clinical practice, highlighting critical targets for interventions such as cognitive remediation focused on working memory, metacognitive therapies, and strategies addressing disorganization and avolition, all aimed at improving real-life outcomes in schizophrenia.

Adopting a user-centred design approach for the development of on-device technology to prevent the viewing of child sexual abuse material: app design insights and principles from the development of ‘Salus’

IntroductionThe volume of Child Sexual Abuse Material (CSAM) available online and the global demand for it has reached unprecedented levels. Increasing numbers of individuals concerned about their online behaviour are contacting therapeutic providers for help and support outside of the criminal justice system. Previous research asking individuals what would help them to stop viewing CSAM suggests that the availability of a technological solution to voluntarily self-manage access to CSAM could be an effective tool.AimTo explore the findings from the user-centered design (UCD) of the ‘Salus’ prototype – a technological prevention tool to support effective self-management of individuals at risk of committing a first or further CSAM offence(s).Materials and methodsIn this two-year, European Commission funded project we conducted research in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom (UK). For the UCD phase of the project we conducted semi-structured interviews with 31 at-risk individuals in Belgium (n=10), Germany (n=10) and the UK (n=11), to explore the specific needs, design features, deployment methods, and concerns and barriers for the design, functionality and deployment of Salus. Additionally, four focus group discussions (FGDs) were held in Belgium, the Netherlands, and the UK with service providers (primarily therapists and managers) with extensive experience of supporting individuals at risk of committing CSAM offences to explore the same questions at the service level.ResultsIn terms of privacy and security, the potential discovery of apps such as Salus, data security and legal consequences of app usage are the main concerns of potential app users. There was consensus on the value of blocking CSAM, but opinions on the inclusion of an optional adult sexual content (pornography) filter in Salus design were not unanimous. Users should be able to switch a pornography filter on and off at their convenience. Blocking notifications should be quiet and subtle. Interactivity features are welcomed by potential users – these may include a diary function; a personal CSAM statistics page; a resources section; and a function to allow users to provide feedback to the app developers. Such features should be optional for users in order to prevent any unintended consequences of app usage. Finally, app deployment must be safe and secure.ConclusionBased on these findings, we propose seven evidence-based design principles for user-centered harm-reduction technology: privacy-by-default architecture; discretion through design ambiguity; adaptive notification systems; optional interactivity with user control; trusted-channel deployment; progressive trust building; and fail-safe harm prevention. These principles provide a framework for app developers and researchers working on similar technologies to develop interventions that reduce harmful behaviours.

Fostering breakthrough AI innovation through customer-back engineering

Despite years of digitization, organizations capture less than one-third of the value expected from digital investments, according to McKinsey research. That’s because most big companies begin with technological capabilities and bolt applications onto them, rather than starting with customer needs and working backward to technology solutions. Not prioritizing the customer can create fragmented solutions; disjointed customer experiences; and ultimately, failed transformations.

Organizations that achieve outsized results from AI flip the script. They adopt a “customer-back engineering” mindset, putting customers at the heart of technology transformation.

It’s a strategy in which products and services are developed with the customer experience first in mind, including the customers’ challenges, needs, and expectations. Product development teams then work backward in a nimble and agile way to find the steps necessary to design and build solutions that achieve the desired experience.

“When you get your engineers closer to customers, you get a lot more sideways innovation,” says Ashish Agrawal, managing vice president of business cards and payments tech at Capital One. “That leads to a multiplier effect, because engineers can approach a problem from a different dimension that can be unique to the sales or product perspective.”

The case for customer-centricity in engineering

Engineers are problem-solvers by nature, says Agrawal. When they hear about challenges customers are experiencing, or how they are using products and services in the real world, they can devise ways to efficiently address customer needs, since they are naturally closer to systems and data than many other teams across the company.

“Fostering a customer-centric culture has a motivational effect on engineers when they actually start seeing how the core changes they’re making, or the features they’re adding, are having a direct impact on the lives of customers,” says Agrawal.

It also takes discipline. Agrawal explains that Capital One has set a goal for every engineer in his organization to establish several touchpoints with customers throughout the year in different forms, including:

  • Digital empathy sessions to observe user journeys and identify where users hit friction
  • Embedded customer support for periods of time to deepen understanding of servicing needs
  • Engineering ride-alongs, in which engineers join customer success, sales, and support staff on calls or on-site visits
  • Hackathon competitions to build solutions around real customer problems

The AI opportunities with customer-centricity

“The biggest challenge engineers within large companies face is a lack of direct access to customers,” says Agrawal. “This can make it harder for technologists to work with customers to identify problems and innovate solutions.”

AI has accelerated the challenges as well as the opportunities. The lifecycle of launching products has become significantly faster. But the good news is that engineers are closer to the data that feeds into AI, so they can more rapidly apply AI-informed data techniques to solve customer problems.

Agrawal outlines a recent scenario: In the customer servicing space, conversations can instantly be summarized and give a customer agent context on the member’s original request and remaining action points. Agentic AI can also be enabled to ask pointed follow-up questions about the interaction that would otherwise take human agents time to read through the entire thread.

“A solution would have been a lot harder in an ecosystem without a lot of high-quality data,” says Agrawal. “But when you combine a rich data ecosystem with agentic tools, you move from incremental fixes to high-velocity transformation.”

By investing in AI data and tools and focusing on rapid experimentation, Agrawal says the cycle of deploying solutions can be accelerated. Teams learn that if they meet customer needs and iterate on a wider range of solutions much faster, then the entire innovation cycle speeds up.

For example, Capital One used customer insights to build a state-of-the-art, multi-agent AI framework called Chat Concierge to enhance the customer experience for car buyers and dealers. In a single conversation, Chat Concierge can perform tasks like comparing vehicles to help car buyers decide on the best choice and scheduling test drives or appointments with salespeople.

Agrawal explains that car buyers can engage with Chat Concierge directly through participating dealer websites. Dealers can access and can take over the chat through Navigator Platform. The AI assistant consists of multiple logical agents that work together to mimic human reasoning, allowing it to provide information and take action based on the customer’s requests.


The elements of an AI-first mindset

According to a recent MIT Technology Review Insights survey, 70% of leaders say their firm uses agentic AI to some degree. Roughly half of executives say agentic AI systems are highly capable of improving fraud detection (56%) and security (51%), reducing cost and increasing efficiency (41%), and improving the customer experience (41%).

Looking into the future, achieving these outcomes looks even more likely. More than half of the banking executives surveyed say they expect to continue to improve fraud detection (75%), security (64%), and the customer experience (51%). Agentic AI use cases that show strong potential to transform the customer experience in financial services include responding to customer services requests, adjusting bill payments to align with regular paychecks, or extracting key terms and conditions from financial agreements.

Placing the customer at the center of a transformation requires an AI-first mindset. Companies must shift from simply augmenting an existing product to fundamentally reimagining the problem and the user’s needs through the lens of AI’s capabilities.

A few best practices that Agrawal recommends include:

Reimagine the core function of AI to solve a user’s problem: “The true value isn’t in chasing the AI hype; it’s in solving meaningful customer problems. By focusing on impact, we ensure that our innovation isn’t just fast; it’s transformative,” says Agrawal.

Start with high-quality, well-governed data as the foundation: “Data readiness and unified information across systems are the non-negotiable foundations of AI. A clean data layer is what orchestrates the agentic loop— enabling the perception, reasoning, and execution required to solve a customer’s problem before they even have to ask,” explains Agrawal.

Rebuild workflows with AI embedded from the start: “People treat models as black boxes, but agentic systems require tremendous rigor and oversight. Having a data ecosystem that is well-governed and responsible AI standards are essential pillars for building trust in these systems,” says Agrawal.

Build a cross-functional team involving data science, engineering, product, design, and other partners: Agrawal advises, “It’s important to be open and nimble to transforming how we work and create impact as AI becomes more integrated into workflows. It’s also important to take a ‘crawl, walk, run approach’ if you are new to AI, as opposed to simply jumping into it.”

In the end, achieving end-to-end transformation depends on empowering engineers and partner teams to start with customer needs and work backward to technology solutions, rather than starting with technological capabilities first and finding applications for them. When organizations make a customer-back approach second nature, they are able to not only reimagine the customer experience from the inside out, but to also place the customer front and center from the very start.

This content was produced by Insights, the custom content arm of MIT Technology Review. It was not written by MIT Technology Review’s editorial staff. It was researched, designed, and written by human writers, editors, analysts, and illustrators. This includes the writing of surveys and collection of data for surveys. AI tools that may have been used were limited to secondary production processes that passed thorough human review.

Musk v. Altman week 2: OpenAI fires back, and Shivon Zilis reveals that Musk tried to poach Sam Altman

In the second week of the landmark trial between Elon Musk and OpenAI, Musk’s motivations for bringing the suit were under scrutiny.

Last week, Musk took the stand, alleging that OpenAI CEO Sam Altman and president Greg Brockman had deceived him into donating $38 million to the company. He claimed that they’d promised to maintain it as a nonprofit dedicated to developing AI for the benefit of humanity, only to later accept billions of dollars of investment from Microsoft and restructure the company to operate a for-profit subsidiary.  

This week, Brockman fired back with his side of the story, arguing that Musk had actually pushed for OpenAI to create a for-profit arm and fought a bitter battle to have “absolute control” over it. OpenAI has argued that Musk is suing because he didn’t get his way and is now trying to undermine a competitor to his own AI company, xAI.

Shivon Zilis, a former OpenAI board member and the mother of four of Musk’s children, also testified, revealing that Musk tried to recruit OpenAI CEO Sam Altman to lead a new AI lab at his electric-car company, Tesla. 

Musk cofounded OpenAI in 2015 with Altman, Brockman, and others but left in 2018. Now, he’s asking the court to remove Altman and Brockman from their roles and to unwind the restructuring OpenAI undertook last year, which converted its for-profit subsidiary into a public benefit corporation. He is also seeking as much as $134 billion in damages from OpenAI and Microsoft, OpenAI’s investor. 

The outcome of the trial could upend OpenAI’s race toward an IPO at a valuation approaching $1 trillion. Meanwhile, xAI, which Musk founded in 2023, is now a division of his rocket company, SpaceX; the combined companies are also expected to go public as early as June, at a target valuation of $1.75 trillion.

On Monday, Brockman walked into the courtroom in a blue suit and tie, holding hands with his wife, Anna Brockman. On the stand, he was serene, even chipper, as he recalled OpenAI’s early days. But he grew agitated under impassioned questioning from Elon Musk’s lawyer, Steven Molo. Altman listened in silence, while Anna Brockman sat behind him, fidgeting. Outside the courthouse, protesters rallying against the AI race sang hymns over the voices of lawyers giving press conferences.

Two days before trial began, according to Brockman, Musk messaged him to ask if he would be interested in settling. When Brockman suggested that both sides drop their claims, Musk texted back: “By the end of this week, you and Sam will be the most hated men in America. If you insist, so it will be.”

Musk stormed out with a Tesla painting

Last week, Musk testified that he’s suing to save OpenAI’s nonprofit mission to develop AI safely, but he said he was open to seeing OpenAI become a capped-profit company with moderate investments from Microsoft

This week, Brockman told the jury that Musk was never truly committed to keeping OpenAI a nonprofit. In the summer of 2017, when an AI model that OpenAI built beat the world’s best players in a video game called Dota 2, Musk hosted a gathering at his “Haunted Mansion” near San Francisco. The house was splattered with confetti and cups, Brockman recalled, and the actress Amber Heard, who was Musk’s girlfriend at the time, served whiskey.

“Time to make the next step for OpenAI. This is the triggering event,” Musk wrote in an email—having said weeks earlier that if OpenAI made a major public achievement, it would be “time to create a for-profit,” Brockman told the jury.

Over the next six weeks, Brockman said, Musk and the other cofounders had intense discussions about creating a for-profit entity to raise enough capital to build artificial general intelligence—powerful AI that can compete with humans on most cognitive tasks. Musk wanted to have majority equity in the entity and the right to choose a majority of the board members. He also wanted to be its CEO, said Brockman. 

Brockman testified that in August 2017, he and other cofounders gathered to hash out the terms of the for-profit structure. Ilya Sutskever, OpenAI’s chief scientist at the time, arrived bearing a painting of a Tesla as a “token of goodwill” in return for the actual Teslas Musk had given them days earlier. “It felt a little bit like [Musk] was buttering us up, right,that he wanted us to feel indebted to him,” Brockman told the jury.

When Brockman and Sutskever proposed that they all have equal shares of equity, said Brockman, Musk fell silent and finally said, “I decline.” Musk then stood up and “stormed around the table,” he said. “I actually thought he was going to hit me.” Musk grabbed the painting and walked out. 

Brockman said that afterwards he struggled to decide whether to continue building OpenAI with Musk or break away. “There was a fork in the road,” he said. “Do we accept Elon’s terms? Or do we reject the terms, he quits to create his own, and then we create our own?”

“The one thing we could not accept was to hand him unilateral, absolute control, potentially, over the AGI,” Brockman told the jury.

What was Brockman thinking?

In his theatrical baritone, Molo argued that Brockman was motivated by greed rather than a commitment to OpenAI’s nonprofit mission to develop AI that benefits humanity. He noted that while Brockman never invested money in the company, he now owns a stake worth close to $30 billion. 

“Solving for the mission has always been my primary motivation,” Brockman said, pushing back on Molo’s characterization of him. “It remains so today.” 

Molo pulled up Brockman’s electronic journal on a screen in the courtroom, trying to show the jury what Brockman was really thinking behind the scenes. In 2017, while negotiating with Musk about the future of OpenAI, Brockman wrote about wanting to become a billionaire: “Financially what will take me to $1B?” 

“Why didn’t you take the $29 billion and donate it to the nonprofit that you had a fiduciary duty to, for the good of humanity?” Molo asked Brockman, raising his voice to dramatize moral indignation. 

Molo then pulled up a journal entry Brockman had written in November 2017, while he was torn over whether to turn OpenAI into a for-profit without Musk: “it’d be wrong to steal the nonprofit from him. to convert to a b-corp without him. that’d be pretty morally bankrupt.” Brockman and Musk had previously considered creating a b-corp, which is a for-profit company that pursues a social mission.

Brockman explained, “I meant it would actually serve the mission, but it’d be hard to look at yourself in the mirror.”

Molo also tried to undermine Brockman’s credibility by revealing that he holds a stake in multiple companies with business ties to OpenAI, including the AI company Cerebras, the cloud provider CoreWeave, and the nuclear fusion startup Helion Energy. Altman has tried to steer OpenAI into deals with companies that he invests in, including Helion and the rocket maker Stoke Space, drawing scrutiny over potential conflicts of interest.

Former OpenAI chief technology officer Mira Murati and former OpenAI board member Helen Toner both appeared in video depositions. They addressed the brief firing of Altman in 2023, saying that they could not trust him because of his alleged history of lying. Murati’s text messages with Altman from that time, which were introduced as evidence, revealed his desperate attempts to understand what was happening and regain control. 

Musk plotted a rival AI lab at Tesla

After Brockman’s two days of testimony, Shivon Zilis, who left OpenAI’s board in 2023, took the stand in a black jacket and black jeans, appearing composed but with a flicker of nerves. OpenAI’s lawyer Sarah Eddy asked her in a deceptively soothing voice whether she acted as a conduit for Musk as he tried to poach OpenAI’s cofounders to work at a new AI lab within Tesla. Eddy argued that Musk is suing OpenAI only to undermine a competitor in the AI race. 

Zilis said she met Musk while working at OpenAI as an informal advisor in 2016, and that they had a “one-off” romantic encounter. In 2017, she joined Tesla and Musk’s brain-implant company, Neuralink. In 2020, she joined OpenAI’s board of directors. She became pregnant with Musk’s children through IVF but did not disclose her ties with Musk to OpenAI until Business Insider reported them in 2022. 

By late 2017, Musk had concluded that OpenAI was unlikely to build AGI and pivoted to building an AI lab at Tesla, according to an email sent to Zilis. 

Eddy pulled up a draft of an FAQ document that Zilis emailed a colleague at Tesla in 2017 about an event the company was organizing at the NeurIPS AI conference: “The purpose of this event is to share that Tesla is building a world leading AI lab(?) which will rival the likes of Google/DeepMind and Facebook AI Research.” 

Zilis told the jury that when Musk was still on OpenAI’s board, he tried to recruit Altman to lead that prospective AI lab. Musk had asked Andrej Karpathy, an OpenAI research scientist he’d recruited to work at Tesla, “to send a list of top OpenAI people to poach,” according to a text message by Zilis. 

“There is little chance of OpenAI being a serious force if I focus on TeslaAI,” Musk texted Zilis in 2018, just before he left OpenAI. Tesla’s AI lab never came to fruition.

Eddy pressed Zilis about whom she was loyal to when she was working for OpenAI and Musk at the same time. “I had an allegiance to the best outcome for AI for humanity,” Zilis told the jury.

What’s going on next week?

Next week, Ilya Sutskever will testify, as will Microsoft CEO Satya Nadella. The lawyers for both Musk and OpenAI will deliver their closing arguments. The jury will begin deliberating the week after and deliver an advisory verdict guiding the judge to decide the case.

This story is part of MIT Technology Review’s ongoing coverage of the Musk v. Altman trial. Follow @techreview or @michelletomkim on X for up-to-the-minute reporting.

What Is Traumatic Separation?

You may have a memory of being separated from a parent when you were a child, even just for a few minutes. Maybe you lost them in a crowd or wandered a little too far at the store and felt panicked and afraid.

A moment like this might be among your earliest memories because the feeling was so intense, says Caitlyn Downie, LCSW, the Director of Trauma and Resilience at the Child Mind Institute. That offers some insight into the fear of a child of any age who is separated from a parent or caregiver in a more serious way. The effects of this stress are so powerful they can actually change the way a child develops.

A toddler whose mother goes to prison. A kindergartener whose father is detained and deported. A teen who is placed in foster care. These are a few examples of what experts call traumatic separation, a clinical concept based on the importance of the parent-child bond and the profound effects that can result from breaking it.

What is traumatic separation?

Traumatic separation isn’t a clinical diagnosis, but research shows that it can be profoundly harmful to kids. What makes it traumatic (as opposed to routine partings, like when an adult regularly leaves their child to go to work) is the character of the separation: ones that are sudden, unexpected, or confusing, or those that come about through larger distressing events, like a natural disaster or war. It’s not defined by the time spent apart — both short and long-term separations can be harmful.

Some common examples of separation that can become traumatic include:

  • Parental deportation
  • Immigration (e.g., forced separation at the border)
  • Parental military deployment
  • Parental incarceration
  • Termination of parental rights

Separating from a parent or primary caregiver can be distressing to a child even when it’s deemed necessary for their safety, as in cases where the parent they have been separated from has abused them, says Kimberly Alexander, PsyD, a psychologist at the Child Mind Institute. “There’s still a natural attachment that occurs. And the separation disrupts that relationship, even if it’s for the support and care of the child.”

Why is traumatic separation harmful?

More than eight decades of research has shown the profound developmental importance of the parent-child bond. This is the guiding principle of attachment theory, which was pioneered by a British psychologist who studied children who were evacuated during the Blitz, the aerial bombardment of London in World War II.

Here’s what the research tells us about the harms of traumatic separation:

It can disrupt secure attachment

Think of secure attachment as a “fundamental sense of security and safety” that a child feels with a parent or caregiver, says Dylan Gee, PhD, a psychologist at Yale University who studies how early-life stress affects children’s development.

“Attachment is the lens through which children come to know what they can expect from the world around them,” she explains. “Is this going to be a safe place or a dangerous place? This is foundational to a child’s sense of their ability to navigate the world. Traumatic separation can shatter that sense of safety.”

It can affect neurobiological development

Children’s brains are especially plastic, says Dr. Gee, constantly learning to understand their environment and how to deal with stress. “Trauma that occurs in childhood can be even more consequential than trauma that occurs later in life,” she says, and experiencing these disruptions in childhood can affect the way your brain and body are primed to react to stress later on.

But heightened plasticity is a paradox, she adds. “It confers more vulnerability, but it also confers more potential for resilience — children have heightened potential for supportive intervention and for healing and recovery.”

What do the effects of traumatic separation look like?

There are acute and short-term effects that are common across kids of all ages:

Sleep problems: “It’s often one of the first things that we see: nightmares, trouble falling asleep, or a lot of crying as kids are trying to fall asleep,” Dr. Gee says.

Separation anxiety: This might look like distraction, withdrawal, or clinginess because of fear of being separated from their new caregivers, Dr. Alexander says.

But signs may take weeks or months to show up. Dr. Alexander advises caregivers to consider the child’s baseline — their typical patterns of eating, sleeping, or engaging with others. “If they’re having more trouble with sleep, they’re eating more, eating less, they’re withdrawing or expressing a lot of worried thoughts three or four months later — that’s something worth getting looked at by a clinician,” she says.

Signs of traumatic separation at different ages

“Sometimes people ask, ‘Well, when is separation the most harmful?’ It can be extremely harmful at any age,” Dr. Gee emphasizes. But there are specific signs at different developmental stages:

Infants

Babies may not be as consciously aware of being separated from a parent as older children, “but they’re fundamentally aware that their primary source of regulation and safety is missing,” Dr. Gee says. Because infants are so reliant on caregivers for nurturing and sustenance, the separation “can be experienced as a threat to their survival.” That might look like “crying a lot or becoming withdrawn,” she says. “And at any age we can see intense fear.”

Toddlers and young children (3–6)

Toddlers and young children might become extra clingy with new caregivers or show regressive behaviors like bedwetting or baby talk. Regressive behaviors happen when kids are overwhelmed by stress and can’t express themselves another way, Downie says. “It’s like your nervous system goes kind of haywire,” she explains, “so it uses the body to signal that something is wrong.”

Similarly, kids at this age might act out more, throwing more tantrums, or withdraw. They might develop selective mutism, a condition where kids are too anxious or distressed to speak, even when they want to, in certain situations or with certain people.

School-age children

School-age children might act out or experience separation anxiety. They may also struggle to understand the meaning of the separation, why it happened, or who is at fault for it. Thus, kids at this age are more prone to magical or distorted thinking and feelings of guilt, thinking or saying things like, “I’m the one that caused this” or “This is my fault.”

The weight of these distorted thoughts or other worries, Dr. Alexander says, might make it appear as though a child is struggling to concentrate or that they’re disengaged or distracted. They might withdraw in a group or be averse to stepping outside of their comfort zone.

Children who are school age or older can also experience emotional desensitization — a kind of emptiness of feeling — Downie says, which can look like spikes in irritability, a lack of empathy, not smiling or expressing positive emotions, or an inability to relate to others.

Preteens and teenagers

“I’ve seen teenagers have a lot of mistrust with systems and be very oppositional,” says Downie. “Like, ‘I don’t trust you. I don’t trust my teacher. I don’t trust this child services worker.’” It might make sense that, say, a teen in foster care would be wary of the foster care system. But Downie says it’s often a larger instinct for anger and mistrust, one that extends beyond any specific entity or person.

The teenage years are also when kids are forming their identity, and traumatic separation can fundamentally alter that process. For example, a teen with younger siblings may step into a parent role, taking on new worries and responsibilities. Conversely, teens may become more reckless in a caregiver’s absence, putting them at risk for substance abuse or incarceration.

How to help kids separated from a parent

Adults caring for a child who has been separated from a parent — family members, foster parents, teachers — “can play a profound role in supporting their mental health and resilience,” says Dr. Gee.

Validate feelings

One of the most important things caregivers can do is be present as a child reacts to their experiences, especially if and when scary feelings come up. But be careful not to lead kids or assume they feel a certain way. “You don’t want to make something more distressing to a child if it’s not presenting itself,” says Downie.

If a child expresses guilt, or says something like, “This is my fault,” there are still ways to validate the feeling without endorsing the statement, says Dr. Alexander. You might say something like: “I can understand why that thought comes to mind and how difficult it is to feel that way. When you’re ready, let’s think about other possibilities to this situation.”

Create consistency and stability

One of the hardest things about traumatic separation is the uncertainty — Where did they go? When will they come back? What is happening? Giving kids some sense of consistency and stability can help them feel safe despite the unknowns. So as much as possible, help them stick to any routines: going to school, seeing friends, doing activities they enjoy.

Dr. Alexander advises focusing on things you can control — for example, shielding kids from potentially worrying discussions in a family where a parent has been deported.

“There would likely be a lot of conversations in the home about the situation, maybe a lot of watching the news, maybe making a lot of phone calls to attorneys,” she explains. “So where are you having those conversations, and can you have them in an area or at a time of day where your kid isn’t overhearing the discussions out of context?”

For young kids, it might be as simple as asking them to play in their room. For teens, it might be better to have certain conversations when they are out of the house and invite them to participate directly in others.

Be honest but reassuring

Caregivers might not have all the answers — like knowing when a child’s parent is coming back — but they can create a sense of consistency and stability in how they respond to kids’ questions, too.

Avoid undue reassurance (“Everything is going to be fine”) or over-promising (“They’ll be back in two weeks”) by focusing on what kids can expect, says Dr. Gee. For example: “What I can tell you is that I’m here for you, and I’m going to be with you until he’s back,” or “You’re safe with me, and I’m going to stay with you through this really hard time.”

Model handling stress

Children are sensitive to tone, Dr. Alexander says. “So, if you’re having really big emotions that are out of context for a child, the child is looking at these emotions and trying to understand what’s happening. ‘Am I in danger in this specific moment?’”

She says it helps to have conversations about these moments, especially with younger kids. “Like, ‘I know you noticed mommy crying. We’re feeling really big feelings, and this is how we’re going to deal with those big feelings. I’m going to take a break. I’m going to get a sip of water. Whenever you’re having big feelings, I want you to let me know so that I can help you try doing the same things,’” Dr. Alexander says, explaining the importance of naming the emotion and then teaching kids that there are ways of dealing with it.

Long-term risks of traumatic separation

The effects of traumatic separation can persist even after a child and their caregiver are reunited. Traumatic separation, like other adverse childhood experiences, puts kids at risk for a host of long-term medical and mental health conditions, including depression, anxiety, attention issues, and post-traumatic stress disorder (PTSD).

But Downie notes that not everyone who experiences traumatic separation develops PTSD. “Just because someone’s experiencing trauma now doesn’t mean that it’s going to become a PTSD diagnosis,” she says. “A lot of the behaviors that we’re talking about are normal and expected. There’s an adjustment period when a separation happens.” But if symptoms persist or escalate over several months, a child may need more serious support.

Treatment for a trauma diagnosis

While not every child who experiences a separation may receive a trauma diagnosis or require treatment, cognitive behavioral therapy (CBT) — and the more specific trauma-focused cognitive behavioral therapy (TF-CBT) — is the “gold standard,” says Downie. TF-CBT is specifically for children experiencing trauma-related symptoms. An important component of TF-CBT is creating a trauma narrative, where kids create a story about what happened to help them process it. “But if you have a child who is not ready to process and integrate that trauma, you can’t force the pacing of the treatment,” she says.

In short, a good clinician will follow a child’s lead — even if that means just sitting in the same room with them to build trust. “People really need to feel like they’re being heard and that they can trust someone,” Downie says. Which is why a supportive caregiver or trusted adult can make a big difference.

“If people can take anything away from this, it’s that you want to make kids understand that that they’re not responsible for what’s happened and that people do care about them,” Downie says. “Kids are really resilient, and they can adapt in a good-enough environment. They don’t have to have everything to be successful.”

The post What Is Traumatic Separation? appeared first on Child Mind Institute.