Understanding the Impact of Hurtful Words and Broken Things on the Brain

1. Ever had a argument with a loved one that lead to…*Hurtful Words?*Broken Things?And later reflected on“What just happened?”

2. The 2 BrainsHuman Brain&Primitive Brain

3. The Cerebral Cortex:Thinking/Personality Brain

4. The Cerebral Cortex:Thinking/Personality Brain • Evaluates emotions in a more sophisticated manner • Impulse control, planning, organization, personality • Making meaning & choices

5. The Cerebral Cortex:Thinking/Personality Brain Large in Humans Our Individuality How We Take Action “we rule the world because of our large brains”

6. The Brain Stem:Primitive/Survival Brain

7. The Brain Stem:Primitive/Survival Brain • Controls the rhythms of life: • heartbeat, waking, sleeping, breathing, cyclical release of hormones • Arousal systems • Reaction to threat: • fight, flight or freeze

8. The Brain Stem:Primitive/Survival Brain As Animals we… Eat, Breathe, Move Make waste prodcts Make babies

9. The Limbic System The Emotional Brain

10. Human Brain – in our controlWe think and control urgesPrimitive Brain – out of our controlFast response and urges

11. The Stress Response SystemVideo 1Video 2 • The alarm reaction • A quick, complex, total body response to a serious threat • The body is mobilized for “fight, flight or freeze”

13. Physiological Changes Involved in the Alarm Response (Fight or Flight) • Increased heart rate, blood pressure & breathing • Release of glucose + increased muscle tone • Nervous system changes increased focus on the threat and tuning out of everything else • Stress hormones (adrenaline, cortisol) are the messengers that initiate all of the above

14. The Story of a SoldierThe Basic Instinct to SurviveFight Flight Freeze

15. When the threat is so overwhelming there is no hope in fighting or fleeing • Freeze – Submission - Collapse • The body prepares to be injured • Heart rate slows, blood moves from extremities to inner organs • The mind detaches from current situation • Natural endorphins are released which decreases perception of anxiety and pain

16. The Story of a StudentOverwhelmed, can’t think and becomes detached from reality

17. Physiological Problems Constant High Levels of Stress Hormones • High Blood Pressure • High Glucose Levels (weight gain, diabetes) • Cortisol inhibits anti-inflammatory chemicals to inflammation lead to pain (fibromyalgia) • With high levels of stress hormones (adrenaline, cortisol) the body downgrades the receptors. • Memories are hard to make (hard to learn)

18. Early Brain Development • Nurturing, responsive, and individualized interactions from birth build healthy brain structure. • Healthy brain architecture is the necessary foundation required for optimal future learning, behavior and health. Regional Child Abuse Prevention Councils 2011

19. The brain develops in the context of human relationships

20. Review of Brain Development Most of Brain Development Occurs in the Early Years

21. Stress and the Brain • Excessive and repeated stress: • Neglect, violence • Chaos, unpredictability • Hostility, rejection • Causes disruption of brain architecture: • Impairs cell growth • Interferes with healthy neural circuits Regional Child Abuse Prevention Councils 2011

22. Regional Child Abuse Prevention Councils 2011

23. Flashbacks • Trauma memories that have not been verbally integrated and come back in the form of sensory memories that make it feel as if the trauma were occurring again in the here and now.

24. Trauma TriggersFlashbacks are most often triggered by a non-verbal memory • Sights • Sounds • Smells • Bodily sensations • Emotional reactions • Motor memories

25. Death The ACE pyramid Early Death Disease, Disability and Social Problems Scientific Gaps Adoption of Health risk Behaviours Whole Life Perspective Social, Emotional and Cognitive Impairment Adverse Childhood Experiences Conception

26. Some findings so far... Increased risk of: • lung cancer • auto immune disease • prescription drug use • chronic obstructive airways disease • poor health related quality of life.

27. Neurobiology Neglect and the brain Parietal lobe Frontal lobe Reading comprehension area Structures tend to be fixed by birth, but the connections and functions carry on being sorted until early adulthood. Occipital lobe Motor speech area of Broca Pons Sensory speech area of Wernicke Cerebellum

28. Healthy brain An abused brain Front Front Temporal lobes Temporal lobes Back Back Most activity Least activity Illustration based on actual PET scan images - Center for Disease Control and Prevention

30. Intense, prolonged, repeated, unaddressed Social-Emotional buffering, Parental Resilience, Early Detection, Effective Intervention

31. What are ACEs?Adverse Childhood Experiences ACEs are experiences in childhood that are unhappy, unpleasant, hurtful Sometimes referred to as toxic stress or childhood trauma

32. What are the Adverse Childhood Experiences? • Child physical abuse • Child sexual abuse • Child emotional abuse • Physical Neglect • Emotional Neglect • Mentally ill, depressed or suicidal person in the home

33. What are the Adverse Childhood Experiences? 7. Drug addicted or alcoholic family member 8. Witnessing domestic violence against the mother 9. Loss of a parent to death or abandonment, including abandonment by divorce 10. Incarceration of any family member

34. ACEs often last a lifetime . . . but they don’t have to • Healing can occur • Cycle can be broken • Safe, stable, nurturing relationships heal parent and child

35. Family Centered Practice, June 8, 2007

36. Adverse Childhood Experiences vs. Adult Alcoholism

37. Childhood experiences underlie chronic depression

38. ACE score vs. serious job problems

39. ADVERSE CHILDHOOD EXPERIENCEs The Most Powerful Determinate of the Public’s Health Abuse and Neglect • Child physical abuse • Child sexual abuse • Child emotional abuse • Neglect Indicators of Family Dysfunction • Mentally ill, depressed or suicidal person in the home • Drug addicted or alcoholic family member • Witnessing domestic violence against the mother • Parental discord – indicated by divorce, separation, abandonment • Incarceration of any family member ACE Score: the number of categories of adverse childhood experience to which a person was exposed.

40. ACEs Influence Via Biologic Impact on Neurodevelopment INDIVIDUAL • Edgy • Hot temper • Impulsive • Hyper vigilant • “Brawn over brains” OUTCOME Individual & species survive the worst conditions. BRAIN Hormones, chemicals & cellular systems prepare for a tough life in an evil world TRAUMATIC STRESS NEUTRAL START INDIVIDUAL • Laid back • Relationship-oriented • Thinks things through • “Process over power” OUTCOME Individual & species live peacefully in good times; vulnerable in poor conditions BRAIN Hormones, chemicals & cellular systems prepare for life in a benevolent world

41. ACEs have many impacts throughout the lifespan PSYCHIATRIC DISORDERS Chronic Disease CRITICAL & SENSITIVE DEVELOPMENTAL PERIODS Early childhood, ages 7-9, Pre-puberty, Aging into adulthood IMPAIRED COGNITION Work/SchoolAttendance, Behavior, Performance ADVERSE CHILDHOOD EXPERIENCE MORE CATEGORIES – GREATER IMPACT Physical Abuse, Sexual Abuse Emotional Abuse, Neglect Witnessing Domestic Violence Depression/Mental Illness in Home Incarcerated Family Member Substance Abuse in Home Loss of a Parent BRAIN DEVELOPMENT Electrical, Chemical, Cellular Mass ADAPTATION Hard-Wired Into Biology OBESITY ALCOHOL, TOBACCO, DRUGS RISKY SEX GENETICS Including gender – Remember that experience triggers gene expression (Epigenetics) CRIME intergenerational transmission, disparity poverty

42. Behavioral health Chronic disease

43. Mental health disability

44. ACEs Influence Via Biologic Impact on Neurodevelopment INDIVIDUAL • Edgy • Hot temper • Impulsive • Hyper vigilant • “Brawn over brains” OUTCOME Individual & species survive the worst conditions. BRAIN Hormones, chemicals & cellular systems prepare for a tough life in an evil world TRAUMATIC STRESS NEUTRAL START Normal Biologic Response to Toxic Stress Can Make Parenting Harder INDIVIDUAL • Laid back • Relationship-oriented • Thinks things through • “Process over power” OUTCOME Individual & species live peacefully in good times; vulnerable in poor conditions BRAIN Hormones, chemicals & cellular systems prepare for life in a benevolent world

45. Impact of ACEs on Brain Development A PET scan of a normal brain (left) shows a high level of brain activity in the temporal lobes of the brain. The temporal lobes are responsible for regulating emotions and receive input from the senses. The temporal lobes on the right are from a severely traumatize child in which the lobes are inactive. Children with damage to this part of the brain suffer sever emotional and cognitive problems as well as have difficulty in making and/or sustaining positive relationships.

46. Top 10 risk factors for death in the USA smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, history of STD Regional Child Abuse Prevention Councils 2011

47. ACE Scoreand Teen Sexual Behaviors – National Data Intercourse by Age 15 Teen Pregnancy Teen Paternity

48. Relationship Between Number of Adverse Childhood Experiences and Adolescent Pregnancy Percent who had a teen pregnancy 0 1 2 3 4 5 6 7-8 ACE Score

49. ACE Score and HIV Risks Ever Injected Drugs Had 50 or More Intercourse Partners Ever Had an STD

50. The ACE Score and the Prevalence of Attempted Suicide Percent attempted (%) ACE Score