Trauma and the Adolescent Brain Presented to: Tahal 2nd International Conference: Shedding Light on the Darkness of Abuse Wednesday, December 2, 2015 Sandi L. Isaacson, Ph.D. Midwest Neuroeducational Services Overland Park, KS

How Our Brains Develop Environment Parent – Child Interaction Genes Epigenetics: the study of external or environmental factors that turn genes on and off and affect how cells read genes. In Utero

How Our Brains Develop Brains develop from back to front, from sensorimotor and emotion areas to thinking areas “Feeling brain” subcortical late early prefronatal cortex sensorimotor “Thinking brain” “Acting brain”

Our “Thinking brains” are not fully developed until our 20’s! How Our Brains Develop Our “Thinking brains” are not fully developed until our 20’s! Prefrontal Cortex

Adolescent brains are in a period of tremendous reorganization!

Adolescent Brain Rapid developmental shifts in brain structures and networks Transition from “feeling” and “acting” brain to “thinking” brain Affect/Action Thinking/Planning Limbic activation vs. dorsal (control) network – executive fx. vs.

Trauma and the Brain Many factors affect how trauma influences brain development: Genetics Gender Age Social Support Trauma Characteristics Type Severity Length <5 worse than >5 Physical/sexual abuse > neglect/emotional abuse Multiple forms of maltreatment Severe sexual abuse Interactions of gender x age x type of trauma

Trauma and Cognitive Functioning Intelligence (IQ) Language Academic Achievement Reading Visual Attention Memory Learning Executive Functioning All adversely affected by trauma!

Multiple brain networks are affected by trauma: Trauma and the Brain Multiple brain networks are affected by trauma: LHPA LC-N/SNS-C Serotonin Oxytocin Networks are interrelated and affect each other Stress results in adverse brain development through aptosis (early neural death), delays in mylenation, abnormal pruning, inhibition of neurogenesis, decreased brain growth. Immune

Brain Networks and Trauma

LHPA (Limbic-Hypothalamic-Pituitary-Adrenal Axis) Controls release of cortisol Affects immune functioning, learning, memory Priming: hyper-response to later stress Too HIGH: INTERNALIZING behaviors - depression, anxiety Too LOW: EXTERNALIZING behaviors – antisocial, aggressive, disruptive Increased anxiety, aggression, hypervigilance, Decreased feeding and sexual behavior Premature aging, chronic mental/physical health problems

LC-N/SNS-C Locus Coeruleus-Norepinepherine/Sympathetic Nervous System/Catecholamine Norepinepherine (adrenaline) = “fight or flight” Inhibits thinking Increases survival/alertness Increased activity – PTSD Decreased activity – Antisocial behavior, DISSOCIATION

Serotonin Operates mainly in midbrain Affects mood, behavior, cognitive functioning, motor functioning and appetite Also affects body rhythms: Cardiovascular Circadian Neuroendocrine Respiratory Sleep Midbrain = prefrontal cortex, amygdala, hippocampus

Oxytocin Regulates interpersonal relationships: Sexual response Social cognition and memory Emotional recognition Empathy Attachment Particularly affected by emotional abuse Affects girls more than boys --- promiscuity

Immune/NEI Network NEI = Neuroendocrine Immune Network Stress a cytokines a inflammation a depression Long term effects seen in adulthood: Hypertension Atherosclerosis Metabolic Syndrome Increased Body Mass Index (BMI) Often manifests in adolescence and adulthood Also bipolar disorder, schizophrenia, substance abuse

Is There Hope? Only 22% of those abused as children determined to be “resilient” BUT… Enriched environment Social support network Are crucial in limiting damage. Address sleep issues through medication/therapy CBT effective in decreasing fear response Supportive, enriching environments are crucial Return to biological parents is NOT always the answer – maltreated kids in foster care showed less self-destructive behavior, substance abuse, total risk behavior and better academic grades at 6 yr follow up than kids reunited with bio parents