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The Impact of Toxic Stress, Adverse Experiences on the Brain

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1 The Impact of Toxic Stress, Adverse Experiences on the Brain
Kellie Turner Prevent Child Abuse Delaware

2 What is Trauma A traumatic event is one in which a person experiences (witnesses or is confronted with): Actual or threatened death Serious injury Threat to the physical integrity of self or another Responses to a traumatic event may include Intense fear Helplessness Horror Attachment

3 Perception of trauma varies vastly among individuals.
Trauma is something that overwhelms our coping capacity Affects the whole self

4 Prevalence of Trauma A report of child abuse is made every ten seconds in the United States. (Childhelp, 2013) Children who experience child abuse and neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult, and 30% more likely to commit violent crime. (Child Welfare Information Gateway, 2006) More than 1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner. (CDC,2013)

5 Prevalence of Trauma Nearly 80% of female offenders with a mental illness report having been physically and/or sexually abused. (Marcenich, 2009) Seventy-five percent (75%) of women and men in treatment for substance abuse report trauma histories. (SAMSHA/CSAT, 2000)

6 Impact of Trauma

7 The ACE Study

8 The ACE Study Dr. Robert Anda and Dr. Vincent Felitti surveyed 17,421 adults who were having medical difficulties about their childhood experiences. Created 9 categories of adverse childhood experiences which generated a person’s ACE score (number of categories a person experienced) Recurrent physical abuse Recurrent emotional abuse Sexual abuse 4. Neglect

9 9 categories of adverse childhood experiences
5. Growing up in a household where there was domestic violence 6. Growing up in a household with an alcoholic or drug abuser 7. Growing up in a household where someone was chronically depressed, mentally ill or suicidal 8. Growing up in a household where at least one biological parent was lost to the patient during childhood – regardless of cause 9. Growing up in a household where someone was in prison

10 ACE Study Demographics

11 The ACE Study - Results Shows a relationship between a person’s adverse childhood experience and their physical and mental health as adults as well as are associated with major causes of adult mortality

12 The ACE Study - Results The higher the ACE score the greater the likelihood that person would suffer significant health problems in adulthood

13 One Example

14 Heart Disease

15 ACEs Have A Strong Influence on
Adolescent Health Teen pregnancy Smoking Alcohol abuse Illicit drug use Sexual abuse Mental Health Risk of revictimization Stability of relationships Performance in the workforce

16 ACEs Increase the Risk Of:
Heart Disease Chronic Lung Disease Liver Disease Suicide Injuries HIV and STDs

17 The ACE Pyramid

18 The ACE Study The ACE Study

19 The Brain EVERYTHING Walking Talking Touching Laughing Crying Loving
Hating Creating destroying

20 Brain Basics At birth about 100 billion neurons have been produced
Genes (genetic code) and the environment both influence how a baby’s brain develops Genes are responsible for the basic wiring of the brain Environment and experience are responsible for the fine-tuning of those connections

21 Brain development Begins..
Within a week of conception During the prenatal period brain cells are sending and receiving sensory messages of touch, hearing, and movement.

22 Building Our Brain Built from the bottom up Brainstem Midbrain
Cerebellum Limbic Cortex

23 Brainstem and Midbrain
Midbrain is the top of the brainstem Governs the bodily functions necessary for life Warns us of important incoming information Midbrain controls: motor activity, appetite Heart rate sleep the oldest and deepest part of the brain, often referred to as the reptilian brain since it resembles the entire brain of a reptile. of the 12 body nerves that go to the brain, 11 end in the brain stem (the olfactory nerve goes directly to the cerebrum,). Centre of sensory reception monitors vital body functions such as heartbeat and body temperature.

24 Cerebellum Behind brainstem Coordinates movement and balance
is located just below the rear part of the cerebrum. coordinates every movement. monitors impulses from nerve endings in the muscles. modifies and coordinates commands to swing a golf club, smooth a dancer's footsteps, and allow a hand to bring a cup to the lips without spilling its contents. may also store the memory of rote movements, such as touch typing and tying a shoelace.

25 Limbic System Responsible for: Consists of Emotions Attachment Memory
Hypothalamus Amygdala Hippocampus Amygdala is responsible for mediation and control of affective activities – friendship, love, affection, expression of mood – center for identification of danger – fight or flight almond-shaped structure is part of the limbic system appears to play an important role in emotions. Stimulation can produce rage but can also cause fear or pleasure. encodes an emotional message, if one is present, when learning is transferred from working memory to longterm storage. The emotional message is recalled whenever the memory is recalled. Hippocampus – responsible for memory formation – compares present threat with past similar experiences located at the base of the cerebrum assists in consolidating learning and in converting information from working memory via electrical signals to long term storage, a process that may take weeks. constantly checks information relayed to working memory and compares it to stored experiences. Hypothalamus – responsible for regulating hunger, thirst, response to pain, levels of pleasure, sexual satisfaction, anger and aggressive behavior – regulates things like pulse, blood pressure, breathing and arousal in response to emotional circumstances

26 Limbic System Regulates: Appetite Sexual urges Sleeping Hormones
Immune system

27 Cerebrum/Cortex Upper brain Makes up two-thirds of our brain
Crumpled up space – if unfolded it would be about half a square yard Divided into two hemispheres A soft jellylike mass, the largest of the three areas, represents over 80 percent of the brain by weight. surface is pale gray, wrinkled, and marked by furrows called fissures. One large fissure runs from front to back dividing the cerebrum into two halves called the cerebral hemispheres. . Controls thinking, memory, speech, and muscular movement deep within the cerebrum limbic system, that is involved with emotional responses lies here and permits the interplay of emotion and reason.

28 Cortex Top layer/outside of the cerebrum Our “thinking cap”
Regulates decision-making and controls thinking, reasoning and language Understands time – sense of past, present, future Allows us to reflect, plan make decisions and move Responsible for abstract thinking Contains 80% of the neurons Divided into 4 lobes

29 Frontal Lobes Located in the forehead area Last area to develop
Biggest section Planning for the future Decision making Problem solving Empathy Feelings Stimulated by nurturing touch

30 Parietal Located at the top of the brain
Represent the body in the brain Receive incoming sensory information Allow us to judge things like weight, shape and texture Mathematical and visual reasoning

31 Temporal Lobes Located above the ear Language Auditory processing
Language comprehension Speaking

32 Occipital Located in the back of the brain Devoted to vision

33 Cortical Modulation Upper parts of the brain control or monitor lower parts of the brain Important because if this did not occur there would be no time between impulsivity and reaction Baby example Lower parts of the brain are more primitive, reactive and impulsive Babies – moment they feel hungry they want to be fed The more mature the brain becomes the more control the cortex has and the better we can control our reaction to being hungry

34 Mature cortex The ability to regulate reactivity is related to how well your cortex works Mature cortex controls aggressive and impulsive behaviors better Things that impair cortex functioning increases reactivity Alcohol/drugs Stress trauma

35 2 Hemispheres Connected to right side of the body. Connected to left side of the body Integrates many inputs at once Deals with inputs one at a time. Processes information in a linear Processes information more diffusely fashion and simultaneously. Deals with time. Deals with space. Responsible for verbal expression Responsible for gestures, facial movements and body language. Specializes in recognizing words Specializes in recognizing and numbers places, faces, objects, and music. Does logical and analytical thinking. Does intuitive and holistic thinking. The seat of reason. The seat of passion and dreams. Crucial side for wordsmiths Crucial side for artists, craftspeople, and engineers and musicians

36 Left Hemisphere Develops later Responsive to stability
Promotes inhibition Math Logic Language Cause and effect Content Social emotions – like guilt and remorse

37 Right Hemisphere Develops earlier Responsive to action
Promotes activation Nonverbal communication Context Primary emotions – like mad, scared and happy Receives and analyzes information from the outside world Spatial abilities Face recognition Visual imagery Music

38 Factors that influence early brain development
Genetics predispose us to develop in certain ways but our interactions with our environment have a significant impact on how our predispositions will be expressed – these interactions organize our brain’s development and shape the person we become. Responsiveness of parents Daily experiences Physical activity Love Food and nutrition

39 Baby’s relationship with her primary caregivers has the biggest effect on how the brain develops.

40 Responsive Interaction
Young children learn from the responses they receive from care giving adults When parents and caregivers respond in a positive, attentive way, babies begin to learn to care about others. .

41 Attachment Overall brain development is profoundly influenced by attachment experiences Healthy balance between security and exploration – caregiver as secure base Sharing emotions Attachment is relationship specific “Is a blueprint of adult functioning” – Dr. Vicky Kelly

42 Attachment No Need Need Satisfaction Trust

43 Secure Attachment – What Does It Look Like?
Self esteem, Independency and autonomy Resilience Self-control –ability to manage impulses and feelings Ability to develop long-term friendships Positive relationships with parents, caregivers and other authority figures Uses pro-social coping skills Trust, intimacy and affection Positive and hopeful belief systems about self, family and society Empathy, compassion and conscience Academic success Better language skills Superior motor skills and cognitive ability

44 New York Attachment Center
Attachment is primarily established in the first three years of life as the caregiver fulfills a child' s basic needs and provides touch, eye contact, smiles and positive affective engagement. “Through an active and constant cycle of bonding, repeated thousands, if not millions of times in the first few years of life, a child develops a positive internal working model (I am loveable, worthwhile, my needs are met, I am safe), establishes a sense of trust and security and learns how to organize their reality.”

45 Attachment No Need Need Ignored Hurt No Trust

46 Trauma and Attachment Need goes unsatisfied or punished
Child learns world is uncaring, unsafe, dangerous and frightening Belief repeated – believed over time Focus becomes on taking care of self As child gets older looks for examples to reinforces our beliefs

47 Poor Attachment Dependent Learned helplessness Underdeveloped ego
Cognitive stunting Poor impulse control Poor coping strategies Low self-esteem Unable to develop and maintain friendships Are alienated from and oppositional with parents, caregivers and other authority

48 Poor Attachment Are aggressive and violent
Are incapable of trust, intimacy and affection Are negative, hopeless and have a pessimistic view of self, family and society Poor academic performance Lack empathy, compassion and remorse Perpetuate the cycle of maltreatment

49 The Effects of Trauma “As the brain is organizing, it is waiting for the world to tell it how to structure itself.” – Dr. Bruce Perry

50 Trauma, Brain and Relationship

51 Where does trauma “reside”?
Brain stem and limbic system Need therapy that works to change the brain stem activity By design Do not want brain stem to be easily altered Want cortex to be easily altered/learn – need for survival Need to quickly learn/identify that an on-coming train is dangerous

52 Our Wiring By the time a child enters kindergarten, much of their “wiring” is set. By age 4 the child’s brain is 90% adult size. (Dr. Bruce Perry) “Whether children are on a path leading to academic success and positive social behavior or to violence and school failure is determined largely by the manner in which this wiring has occurred”- (Joan Lessen-Firestone)

53 The experiences of infancy and early childhood literally provide the organizing framework for the expression of children’s intelligence, emotions and personality

54 Children who have experienced chronic abuse and neglect during their first few years may live in a persistent state of hyper-arousal or dissociation, anticipating threats around every corner and their ability to benefit from social, emotional and cognitive experiences may be impaired - Perry

55 Do Babies Remember??? They can identoyf therir primary caregivers
Do they remember being loved? Early emotionally meaningful experiences is stored in memory and has a lasting impact on the babies nervous system

56 Memories Amygdala is fully developed at birth
It processes highly charged emotions Babies can feel a range of emotions, even though they cannot understand what is going on Hippocampus – organizes memories Not fully developed until 2 to 4 years of age So can not organize or put words to these early memories

57 HOWEVER They do exist

58 Explicit and Implicit Memories
Explicit Memories Full maturity at 3 years of age Conscious memory Enables us to tell stories Understand what happens Implicit Memories Available at birth Unconscious Encoded in emotional, sensory, and visceral recall We don’t remember with our minds, we remember with our bodies, our hearts and guts

59 Memories If the early environment is abusive or neglectful, our brains create memories of these experiences that may adversely color our view of the world throughout our lives

60 Stress Brief periods of moderate, predictable stress are not problematic – they prepare the child to cope with the world Prolonged, severe, or unpredictable stress during a child’s early years is problematic

61 Positive Stress Learning how to cope with adversity is an important part of healthy development When we perceive a threat our body responds – increased heart rate, blood pressure and secretion of stress hormones When protected by caring adults, children learn how to cope and response system returns to baseline

62 Tolerable Stress Caused by more serious events – fire, hurricane, death of a loved one, serious injury Child is buffered by caring, supportive adults who helps that child deal with the challenging situation Brain is protected from potentially damaging hormones

63 Toxic Stress Caused by prolonged and serious events – extreme poverty, repeated abuse, violence, Child is NOT supported by caring, supportive adults who helps that child deal with the challenging situation Brain is NOT protected from the increased levels of cortisol and brain development is disrupted

64 Toxic Stress

65 Chronic Stress Sensitizes neural pathways and over-develops certain regions of the brain involved in anxiety and fear responses of the brain (Shore, 1997) Focus becomes on survival and responding to threats in their environment (physical, sexual, neglect) – “Me against the world”

66 Chronic Stress When a child is stressed or frightened the limbic system secretes cortizal into the blood. The cortizal washes over the neural cortex and prevents neural connections from being formed and strengthened. This causes a child to revert back to basic survival and child uses fight or flight to respond. Studies have shown that many maltreated infants and children have abnormal secretions of cortisol, indicating that their bodies’ responses have been impaired

67 The Brain and Stress Repeated exposure to a great deal of cortisol programs the child’s brain to expect, like and seek out situations that will lead to the release of cortisol. Children who are accustomed to high levels of cortisol begin to live in the brain stem rather then in the thinking cortex. They view each interaction as one that may threaten their survival. Toxic stress brings the past to the present Joan Lessen-Firestone Emotional Center of the brain is being refined during this time. Repeated exposure to a great deal of cortisol programs the child’s brain to expect, like and seek out situations that will lead to the release of cortisol.

68 Impact of Early Stress Childhood Stress Chronic Flight or Fight
Increased cortisol Changes in the Brain architecture Hyper-responsive stress response Decreased coping

69 Hyper-arousal When a child is exposed to chronic, traumatic stress, his brain sensitizes the pathways for the fear response and creates memories such that his fear response becomes almost automatic Because of constant stress the part of the brain responsible for the hyper-arousal response is always working Child experiences hyperactivity, anxiety, impulsivity and sleep problems When child experiences something that reminds him of previous trauma he responds anxiously and/or aggressively

70 Prolonged Alarm Reaction Altered Neural Systems
Traumatic Event Prolonged Alarm Reaction Altered Neural Systems

71 Chronic State of Fear Brain develops in a way that is very adaptive to the child’s negative environment but is maladaptive in other environments The child may have difficulty functioning when presented with a world of kindness, nurturing and stimulation – it is an unfamiliar world to the child and his brain has not developed the pathways and the memories to adapt to his new world Children who spend a great deal of time in a chronic state of fear often exhibit behavioral impulsivity and cognitive distortions

72 Effects on Learning Areas of the brain may be underdeveloped due to abuse and/or neglect No part of the brain can change without being activated “To learn and incorporate new information, the child’s brain must be in a state of “attentive calm” which traumatized children rarely achieve.” Understanding the Effects of Maltreatment on Early Brain Development Can’t learn French if you are asleep

73 Hemispheres Right side address primary emotions, fear, stress, etc.
Right side “turns on” in distress In order for the left side to “turn on” -function and grow the brain must be in a state of calm Children under severe stress may have deficits on the left side – language, logic, social emotions etc. Left side can work up to 7x slower

74 In order to learn: Child needs to be in a calm state
Traumatized children are in an alarm state – sense of time is altered A threatened child is not thinking of the future Immediate reward is most reinforcing Delayed gratification is impossible Consequences become more inconceivable to the threatened child Reflection on the behavior is impossible Primitive parts of the brain are engaged –response is impulsive and reactive

75 Neglect Viewed by infants as intense anxiety
Capacities like language, kindness, empathy, positive interactions may not fully develop because the required neuronal pathways were not activated enough to form memories needed for future learning Studies show a decrease in brain growth

76 Neglect

77 Outcomes Don’t know how to give and take
Can’t trust – believes “ I don’t matter” Impaired interest – attention Difficulty managing emotions Difficulty focusing Don’t receive joy and reward the same way

78 Social Impairments Ability to feel remorse and empathy are built on experience Altered cortisol reactivity in maltreated children may also relate to impairments in social competence

79 Example A young child growing up in a home with pervasive threat will create a set of associations between a host of neutral cues and threats These associations become automatic – and will elicit fear response for the rest of the child’s life The cues can be scents, facial expressions, music of interpersonal styles of interaction In order to change these inaccurate and false associations, the child must have opportunities for new experiences that will allow the brain to decrease the overgeneralization of these trauma-related associations

80 Trauma Informed Care Aims to avoid re-victimization.
Appreciates many problem behaviors began as understandable attempts to cope. Strives to maximize choices for the survivor and control over the healing process. Seeks to be culturally competent Understands each survivor in the context of life experiences and cultural background. (Alvarez and Sloan, 2010)

81 Protective Factors There are behaviors, characteristics and qualities inherent in some personalities that that will assist in recovery after exposure to a traumatic event, these are called, protective factors.

82 Thank You!! Researchers who examined the life histories of children who succeeded despite many challenges in their lives have consistently found that these children had had at least one stable, supportive relationship with an adult beginning early in life

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