Hello everyone. In this post, I wanted to talk about childhood trauma. To heal childhood trauma, it’s important to understand how trauma affects a child’s development. So, that’s where we’ll begin. If you have not yet read my last post on adoption and preverbal trauma, you can check it out here. Today, I’ll present a very brief overview of brain neurosequential development and how trauma affects this process. I am a trainer and educator to fost/adoptive parents on complex developmental trauma, attachment, and TBRI®.
First, let’s talk about childhood trauma. You can go to this link to learn more about adverse childhood experiences, or ACES, and the impact of negative experiences on an individual’s lifelong health and wellness. We know that children in foster care and children in orphanages have suffered trauma, and their ACE scores are high. The very fact that they are in such institutions is a trauma. Children in foster care typically come into care due to neglect, physical/sexual/emotional abuse, domestic violence between parents. Kids in foster care and kids who have been adopted experience separation, loss, and grief, feelings of abandonment, instability, and have often not been provided with the kind of sensory diet that promotes healthy development. Additionally, many kids in foster care have experienced multiple placements. Prolonged exposure to one or more of these factors can lead to complex developmental trauma, which psychologist Bessel van der Kolk describes as “the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (italics and bold added).” Complex trauma impairs social, emotional, and cognitive development.
Dr. Karyn Purvis, Developmental Psychologist and Co-founder of Trust-Based Relational Intervention (TBRI®), described six early risk factors that influence the way children from difficult backgrounds think, trust, and connect with others: 1) Difficult pregnancy – the birth mother has experienced medical problems, drugs/alcohol, crisis, or other trauma. Persistent and high levels of stress throughout pregnancy affect the infant in-utero. Stress response chemicals in an infant’s brain can remain for up to a month after the mother gives birth. 2) Difficult birth – a difficult and traumatic birth is risky for lots of reasons, including perinatal hypoxia, which can lead to mild neurological insult. 3) Early hospitalization – children who experience early hospitalizations often experience painful touch rather than nurturing, comforting touch in the first days of life. 4) Abuse – the brains of children from abusive backgrounds have been trained to be hypervigilant, or always on guard, to the environment around them. 5) Neglect – children from neglectful backgrounds, e.g., orphanages, often suffer from the most severe behavioral problems and brain deficits. The message they have learned is you don’t exist. 6) Trauma – this may include witnessing an extreme event, like a natural disaster or 9/11, or any number of traumas in the child’s life. A child’s developmental trajectory will change as a result of trauma.
As you probably already know, different parts of the brain have different functions. Author and psychiatrist, Dr. Dan Siegel, says the brain is like a two-story house. Emotional reactivity, motivation, attachment, and the “fight, flight, or freeze” response are regulated in the downstairs brain. This is where the brain stem and limbic system are located. I’m not going to discuss all of the structures in the brain, but will highlight the areas that pertain to this discussion. The limbic system is involved in emotions and motivations related to survival, including emotions that are pleasurable, e.g., eating and sex. The upstairs brain regulates executive functioning, thinking, planning, control over emotion and body. It’s where the cerebral cortex or “grey matter” is located.
When you experience a strong emotion such as fear or stress, your downstairs brain sounds an alarm, and a stress response is activated. The sympathetic nervous system triggers the fight or flight response. This causes certain physiological responses to occur in your body. Think back on a time when you felt frightened or stressed. Your heart and respiration rates increased, your pupils likely dilated, and the blood flow to your muscles increased in preparation to fight or flee. This is a survival response. Other parts of your brain are off-line when your stress response is activated. In other words, thinking clearly or executing a well-defined plan become much more difficult when your stress response system is activated.
Now let’s talk about brain neurosequential development. The brain develops sequentially from the bottom to the top and inside-out from the brain stem to the cortex. Our downstairs brain comes much more developed at birth than our upstairs brain. Each part of our brain develops at different times beginning in-utero and continuing to adulthood (the brain is fully developed around 25-years of age). An infant’s brain stem is the most developed region of her brain. When distressed, she needs a responsive caregiver to help her regulate. She has a need and expresses it through crying, fussing, or raging. The need is gratified when a caregiver changes her soiled diaper, feeds her, provides movement, skin-to-skin contact, speech, and warmth. The parasympathetic nervous system helps to put on the brakes and calm the body once the distress has passed. All of these actions serve a very important purpose – to teach the infant how to self-regulate. We refer to this dance as the arousal-relaxation cycle.
When abuse and neglect occur, it interrupts the arousal-relaxation cycle, and consequently, affects the attachment cycle. This leads to serious problems in the development of personality, which has long-lasting effects into adulthood. When the cycle is not completed and repeated, difficulties may occur in very critical areas, including social/behavioral development, cognitive development, emotional development, cause and effect thinking, conscience development, reciprocal relationships, parenting, and accepting responsibility. Furthermore, positive or negative experiences that occur during critical or sensitive periods of brain development alter the development in that particular area, which cascades and alters other areas of the brain. When children experience repetitive activation of the stress response system, their baseline of state of arousal is altered. The child lives in an aroused, hypervigilant state, ill-prepared to learn from social, emotional and other life experiences. She is living in the minute and may not fully appreciate the consequences of her actions. Her brain stem has “muscled up” in fight, fright or freeze mode, as any part of the brain that we use most often is the part most developed. Her ability to control her emotions and body and behave in ways we consider age appropriate may be severely compromised.
As a side note, two Yale pediatricians, Provence and Lipton, found that if caregivers did not meet the needs of infants quickly, they stopped crying within a period of 30-60 days. The infant learns that no one comes. She has lost her voice. Despite the absence of crying, the baby may still be hungry, scared, soiled, or in pain. Additionally, she is likely to have high levels of cortisol, or stress hormones, released in her brain, though outwardly she may appear to be calm and not at all distressed.
Infants and young children need to feel safe. They use attachments with their caregivers as models for future relationships. Caregivers are a secure base from which infants can explore their physical and social worlds. As you can well imagine, children who have histories of abuse or neglect very often have not experienced felt safety or secure attachment. This sets them up for attachment difficulties with foster and adoptive parents and difficulties in relationships with others.
There are numerous theories and therapy approaches directed at parenting and healing children who have experienced trauma, including abuse, neglect, grief and loss. I will delve into this in later posts, but a good resource is Attachment Theory in Practice: Building Connections Between Children and Parents edited by Karen Doyle Buckwalter and Debbie Reed. There is a chapter at the end of the book called The Voice of the Adoptee written by adoptees Faith Friedlander, Clinical VP and co-founder of Kids and Families Together, and Melanie Chung-Sherman, Licensed Clinical Social Worker and psychotherapist. Finally, an attachment-based professional/parenting resource that includes adoptee voices!
We know that traditional parenting does not work with kids who have experienced trauma. With deep fear comes a desperate need for deep control. It’s a survival strategy, as these kids do not know to do anything better. The way they think, feel, learn, process the senses, and interact with peers has been profoundly altered due to trauma. Their stress systems stay on, and the smallest thing or a transition can cause a meltdown. They fight or flee. They have lost their voice. Timeouts, spankings, and lectures are not effective and may further traumatize the child. There is hope. Parents must become healers and help repair their child’s brain by creating the proper environment for change. The brain can adapt and new behaviors can be taught and learned. In the next few posts, I’ll offer more resources. Stay tuned for an overview on attachment and attachment styles in my next post.
Keck, G.C., & Kupeckty, R.M. (2009). Parenting the hurt child. Colorado: Navpress.
Perry, B. (2005). Maltreatment and the developing child: How early childhood experiences shapes child and culture. Retreived from http://www.lfcc.on.ca/mccain/perry.pdf.
Provence, S., & Lupton, R. C. (1962). Infants in institutions. New York: International Universities Press.
Purvis, K. and Cross, D. (July 2013). The healing power of “giving voice.” Retrieved from http://www.adoptioncouncil.org/files/large/f7bb17e8fba418b.