The impact of trauma on brain development John Coleman The impact of trauma on brain development

Trauma - a complex concept Many different approaches to trauma in young people; This morning I will cover four aspects of trauma: Post traumatic stress disorder (PTSD) Adverse childhood experiences (ACEs) The impact of trauma on brain development Developmental traumatic disorder (DTD).

PTSD The notion originated with the sinking of the Herald of Free Enterprise in 1987; Many survivors came to Kings College Hospital in South London; The mental health team recognised common symptoms; They identified a syndrome which came to be known as post-traumatic stress disorder.

Common symptoms Flashbacks; Nightmares or night terrors; Depression; Anxiety; Trigger events; Survivor guilt.

ACEs This term applies to a range of experiences in childhood which may be seen to be damaging in some way; What I am going to tell you is based on a study in Hertfordshire – 5,500 people aged 18 – 65. ACEs refer to two types of event: One has to do with actual abuse; The second has to do with experiences in the family; These two are usually combined into an ACE score.

Abuse Three types of abuse: Verbal abuse (23% of sample) Physical abuse ( 14% of sample) Sexual abuse ( 6% of sample).

Household events Domestic violence ( 16%) Mental illness ( 11%) Parental separation ( 18%) Alcohol abuse ( 11%) Drug abuse ( 3%) Incarceration ( 3%)

Impact of ACEs Those with four or more ACEs are: Likely to have poor diet Likely to be regular smokers Likely to have had an unintended pregnancy Likely to be victims of violence Likely to be perpetrators of violence.

Trauma and the brain Most of the work on the brain is based on studies of “child maltreatment” Threat processing – both heightened and depressed responses in the amygdala (hyper-vigilance and avoidance) Reward processing – blunted responses (depression) Emotion regulation – increased ACC activation – to do with effortful processing Executive control – greater problems with error processing and inhibition.

Implications for practice Child maltreatment can affect brain function; Some of the results make sense in terms of behaviour – e.g. Emotion regulation being a problem; However this research takes place in a laboratory setting; Huge diversity of experiences, so careful how to interpret these findings; The brain is very adaptable, so good interventions can make a difference.

DTD This stands for Developmental Traumatic Disorder; Work by Sean Cameron and others looking at those in care who have been neglected, rejected and abused; They argue that this is quite different from PTSD and ACEs; Rejection has different implications.

“Rejection is not simply one misfortune among many, nor just a bit of sad drama. It strikes at the very heart of what the psyche is designed for.”

Theory of DTD They have a theory which is called the Parental Acceptance – Rejection theory; They see rejection as being at the centre of the child’s vulnerability; They believe that good parenting is not enough; They propose “enhanced parenting skills” to combat the rejection.

Progress and development Child is unable to understand or control his/her emotions. Has inexplicable changes of emotion. Child too often misinterprets his/her emotions or those of others. Child begins to have knowledge of emotions and matches emotion with context. Child is able to understand and manage emotions.

Match with brain development These ideas illustrate a different approach to that of PTSD; Rejection undermines, limits or restricts healthy brain development; It can lead to developmental problems in the brain – the amygdala and other areas to do with emotion are dominant; Could it be that warmth and acceptance facilitates all aspects of higher brain functioning? “Why love matters” !

Summary The four different approaches illustrate 4 different ways of thinking about trauma; It is clear that the symptoms that follow from PTSD are different from those that follow DTD; This approach helps us to link brain development with behavioural problems of vulnerable children and young people; The concept of trauma is complex – not all trauma is the same.

References Frances Jensen (2015) “The teenage brain” Harper Collins. David Eagleman (2015) “The brain: the story of you”. Canongate Publishers. Sue Gerhardt (2014) “Why love matters: 2nd Edn.” Routledge. McRory, E and others (2017) “Childhood maltreatment”. Journal of Child Psychology and Psychiatry. 58. 338-357. R. Sean Cameron (2017) “Child psychology beyond the school gates: empowering foster and adoptive parents.” Educational and Child Psychology. 34. r.cameron@ucl.ac.uk