Trauma and Learning

1. Trauma and Learning Bruce Perry M.D., Ph.D. Chris Dunning, Ph. D.

2. What does trauma experience do to children? • Childhood trauma has profound impact on the • emotional • behavioral • cognitive • social • and physical functioning of children.

3. Primary Trauma and Children 􀂙 Each year 5 million children in U.S. experience an extreme traumatic event 􀂙 40% will develop some form of chronic neuro-psychiatric problem 􀂙 Most problems classified as anxiety disorders with post-traumatic stress disorder being most common 􀂙 Trauma event will impair emotional, academic and/or social functioning

4. Child Trauma History: Most Frequent Exposure Types Emotional Abuse Loss Impaired Caregiver Domestic Violence Physical Abuse Sexual Abuse Neglect War Terrorism

5. Child Trauma History: Less Frequent Exposure Types Injury Accident Illness Medical International War/terrorism Forced Displacement Disaster

6. Traumatic experiences in childhood are highly prevalent The National Survey of Adolescents found: Nearly one-half of American teenagers have experienced at least one of the four types of violent victimization measured: sexual assault, physical assault, severe physical abuse, witnessing community violence. The prevalence is even higher among clinical or social service samples. Of those victimized, well over half have histories of multiple types of victimization.

7. Children Experience Traumatic Events • Children are victimized in multiple ways: physical abuse and assault, sexual assault and exploitation, neglect, kidnapping and homicide • Children are victimized by family members, caretakers, friends, acquaintances, and strangers • Children experience trauma from being eyewitnesses to crime, violence, and homicide

8. Psychobiological Syndrome • Nearly all psychological symptoms of trauma are associated with neurological impairments • Problems of regulating emotion and arousal • Alterations in consciousness and memory • Damage to self-concept and identity • Disruption in cognitive capacities • Hyperactivity and attention problems • Relationship problems • Alterations in systems of self

9. Why Understand Psychobiology? • Physical and Emotional trauma can physically injure the brain • Severity of brain injury depends on child and environmental factors • Hurt children develop various emotional defense mechanisms • Many traumatized children develop disorders such as depression, PTSD, Somatoform,…

10. Why Does This Happen? • Trauma activates stress-response systems in the brain • Severe or chronic stress prevents the brain from returning to relaxed state • Traumatized children are in constant fight, flight, or freeze mode • Children are “taught” how to behave by trauma

11. Factors Influencing Response To Trauma And Recovery They include: • Characteristics of the stressor and exposure to it • Individual factors such as gender, age and developmental level, and psychiatric history • Family characteristics • Cultural factors-norms and beliefs

12. Prevalence of Posttraumatic Stress Reactions • Fewer than 20% of children with a history of exposure to a traumatic event have had a psychiatric disorder, mainly anxiety disorders, including posttraumatic stress disorder (PTSD). • Anxiety disorders, including PTSD, were three times as likely in children who had suffered the violent death of a parent or loved one, but only one in five of this group showed this level of distress . • Most children exposed to extreme events are remarkably resilient, which can explain the success of the human species despite the violence of our history (Costello, Erkanli, Fairbank, & Angold).

13. What Does Happen to Children?

14. Traumatic events impact children and adults differently Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event. The central nervous systems (brains) of children are not yet fully developed. They are unable to put their experiences into context or to make sense of them.

15. Traumatic events impact children and adults differently The two most fundamental responses to trauma are the “fight or flight response” where the instinct for survival takes control; or disassociation, which is a protective mechanism that creates a barrier to the actual experience. Repeated exposure to trauma prevents normal brain development in children.

16. Why Does This Happen? • Trauma activates stress-response systems in the brain • Severe or chronic stress prevents the brain from returning to relaxed state • Traumatized children are in constant fight, flight, or freeze mode biologically • ‘Fight or flight’ responses or actions are usually not available to children – therefore ‘freeze’ and other dissociative responses are common

17. Trauma and Children • Children are “taught” how to behave by trauma The ‘freeze’ response has been linked with the ‘learned helplessness’ models in animal studies – it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the ‘gas and the brake’ at the same time

18. Impact of Trauma on Brain Development and Protective Factors • If a child’s early environment is abusive or neglectful, the brain creates memories of these experiences, coloring the child’s view of the world. • Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

19. Neuro-Processing • Brain development in abused/neglected and traumatized children is adaptive for abusive/neglectful or dangerous environments • The focus is on survival and the child does not know how to deal with nurturing and kindness • Child’s brain has adapted to an unpredictable and dangerous world.

20. How we recognize and deal with danger Our minds, our brains, and our bodies are set up to make sure we make danger a priority. Things that are dangerous change over the course of childhood, adolescence, and adulthood.

21. Danger • First, we try to figure out what the danger is and how serious it is. • Second, we have strong emotional and physical reactions. These reactions help us to take action, yet they can be very distressing to feel and difficult to handle.

22. Danger Third, we try to come up with what to do that can help us with the danger. We try to prevent it from happening, try to protect ourselves or other people against harm, or try to do something to keep it from getting worse. How we feel about a danger depends on both how serious we think it is and what we think can be done about it. Dangers can become "traumatic" when they threaten serious injury or death.

23. Young Children • Can feel totally helpless and passive. • They can cry for help or desperately wish for someone to intervene. • They can feel deeply threatened by separation from parents or caretakers. • Young children rely on a "protective shield" provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare.

24. School-age Children • School-age children start to face additional dangers, with more ability to judge the seriousness of a threat and to think about protective actions. • They usually do not see themselves as able to counter a serious danger directly, but they imagine actions they wish they could take, like those of their comic strip heroes, and feel like failures if they don’t.

25. Adolescents • With the help of their friends, adolescents begin a shift toward more actively judging and addressing dangers on their own. • This is a developing skill, and lots of things can go wrong. • Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger.

26. Brain Functions to be Developed • Controlling impulses • Initiating appropriate behavior • Inhibiting inappropriate behavior • Organizing things • Setting priorities • Making decisions • Insight • Working memory

27. THE RAW MATERIALS A child is born with 100 billion neurons (brain cells) Neurons form synapses (the brain’s wiring system) Synapses support basic functions for survival

28. Core Processes of Neurodevelopment • Neurogenesis- “neurons” are born starting in the womb • Migration-Brain cells or “neurons” have the ability to travel within the brain and link itself to other neurons through neural pathways. • Differentiation-neurons develop into specialized cells to perform or serve a particular function. • Apoptosis-literally deterioration and death of neuron through atrophy if no “home” is found, a process called pruning.

29. Core Processes of Neurodevelopment 2 • Arborization-branching out of neurons using dendrites. • Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons. The actual transfer is done by neurotransmitters • Synaptic Sculpting-synapses can get stronger or weaker. As they weaken, they disappear. • Myelination-As neurons are fired, they strengthen the myelin by using proteins, hence the brain is stronger,

30. Brain growth • By age four, the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10. • Myelination, or development of brain pathways, also need to occur. • Brain structures do not mature all at the same time. • The prefrontal cortex matures last. • Brain remodeling can be derailed if trauma occurs during critical periods.

31. Hierarchy of Brain Function

32. In the brain of someone who has experienced a variety of emotional, behavioral and cognitive stimuli, a “top heavy” ratio develops. In this ratio, the brain matures to moderate the more primitive instincts of the midbrain/brain stem.

33. When key experiences (Which develop the cortical/limbic part of the brain)are absent or minimal, the “higher” to “lower” brain ratio is impaired. In this case, the ability of the brain to moderate impulsive, reactive responses and to work through frustration is diminished significantly.

34. Children raised in environments characterized by domestic violence, physical abuse or other persistent trauma will develop an excessively active midbrain/brainstem. This results in an overly active and reactive stress responseand a predisposition to aggression and impulsiveness.

35. When the developing brain is both deprived of sensory stimuli and experiences traumatic stress, the brainstem/ midbrain to cortical/limbic ratio is profoundly altered.

36. As a general rule, • Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems. • The physical organization of the brain directly reflects the child’s interpersonal experiences. • In response to trauma, a child can develop an overactive stress response and an underdeveloped cortex.

37. Result • It is highly adaptive for the traumatized child to be hyperaroused, hypervigilant, and ready to attack and defend. • As part of the survival mechanism, extreme stress interferes with the functioning of the cortex, especially prefrontal cortex, the thinking part of the brain that is crucial for inhibiting the stress response.

38. Life- and Brain-altering experience • One traumatic event in life like an earthquake, especially in the life of a child, can change the structure and the chemistry of the brain. • The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses.

39. Conduct Disorders • Behavior is the language of trauma. • Most children lack the language skills needed to describe how they are suffering, so they use behavior to express themselves. • Most behaviors used by children to express themselves are considered “negative” behaviors.

40. Emotional Maturity • During a trauma, intense fear easily overwhelms young children's beginning efforts to manage emotions. • The normal sources of solace, protection, and help may be unavailable from an abusive or traumatized parent.

41. Emotional Maturity • For school-aged children, the intensity and speeding up of emotions during traumas blur the ability to identify differencesin emotional intensity and take them to the extreme. • They may have difficulty modulating emotions • They may “clamp down” on emotions and become numb. • Shame and guilt can lead them to be secretive about their feelings. • Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive, rule abiding way.

42. Cortical Modulation Is Age-Related • The capacity to moderate frustration, impulsivity, aggression, and violent behavior is age-related. • With sufficient motor, sensory, emotional, cognitive, and social experiences during infancy and childhood, the mature brain develops (in a use-dependent fashion) a mature, humane capacity to • tolerate frustration • contain impulsivity • channel aggressive urges.

43. Impact on Adolescent Development • Social stigmatization • Lose ability to trust • Retard social and interpersonal growth • Dilemma between evil and heroic action

44. Implications for Learning • Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs. verbal cues • May be very intelligent but can’t learn easily→must do verbal learning when calm • Learning needs to be more experience-based → when traumatized children are stressed they are reactive/reflexive vs. accessing cognitive solutions

45. Implications for Behavior • During early development, these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues. • Once out of such an environment, it is still difficult for the child's brain to interpret (relearn) these innocent looks and touches as benign.

46. These children are often labeled as learning disabled. • Difficulties with cognitive organization contribute to a more primitive, less mature style of problem solving -- with violence often being employed as a "tool.“ • A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn. • The brain of this child has different areas activated -- different parts of the brain controlling his functioning. • The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated, which in turn requires a state of attentive calm. • This is a state that the traumatized child rarely achieves.

47. Bruce Perry M.D., Ph.D. 1997 UWM School of Continuing Education