The Impact Trauma and Stress Can Have on Healthy Brain Development Gene Griffin, J.D., Ph.D. School Mental Health Conference June 27, 2012

Brain Development

 Simple Cell  Message comes in  Information processed  Message goes out

Brain Development  A cell can connect with other cells  Over 100 billion brain cells  Each cell can develop over 50,000 connections  Result is trillions of paths

Brain Development  Those connections that are used frequently become stronger (networks, highways)  Those cells that never connect to others die off (pruning)

Brain Development  Critical Periods  Timing Matters  For some brain functions, there is a particular time when that function should develop  If the timing is off, that function may be delayed or never develop

Brain Development  Plasticity  Your brain changes based on what it is exposed to  Events cause changes in the brain  We strengthen connections through repetition  Powerful events can cause major changes  There is always hope for change

 The Brain controls many functions  Physical (Breathing, heart rate, body temperature)  Emotional (Love, Hate, Fear, Calm)  Cognitive (Language, Math, Planning, Impulse Control)  The functions are affected by the sequence of the brain development, with physical development ahead of emotional and cognitive development Brain Development

Brain Development- Children

Brain Development- Adolescents 

Teenage Development  Adolescence is like giving a teenager a car with  A new body with a lot of horsepower (physical);  A sensitive gas pedal that can go from 0 – 60 mph in a few seconds (emotional); and  A brake system and steering that won’t work effectively for several years (cognitive); 11

Trauma

 The experience of an event by a person that is emotionally painful or distressful which often results in lasting mental and physical effects. (NIMH)  Event  Experience  Effect Trauma- Definitions

 DSM IV Diagnostic Criteria for Post Traumatic Stress Disorder (PTSD)  After experiencing the event, the person must exhibit all three types of symptoms:  Re-experiencing  Avoidance  Hyperarousal Trauma- Definitions

Figure 2: Child Trauma Continuum Per 1000 Children

 Abuse- Physical, Emotional, Sexual  Neglect  Victimization  Domestic / Community Violence  Accident / Illness  Natural Disaster  War / Terrorism  Removal from Home Traumatic Events

 Life Threatening  Overwhelming  A Subjective, Internal State  Varies Between People  Varies Over Time with the Same Person- Developmental Level  Single Incident or Chronic Incidents Trauma- Experiences

 Symptoms can include:  Nightmares  Flashbacks  Fight or Flight  Dissociation  Cutting  Hyperarousal  Misinterpretation of Cues  Overreaction Trauma- Effects

 Most people can get through adverse experiences without developing trauma symptoms  Resilience and Protective Factors  Recovery Trauma- Effects

Adverse Childhood Experiences: Influence on Health and Well-being over the Lifespan Early Death Disease, Disability, Social Problems Adoption of Health Risk Behaviors Social, Emotional and Cognitive Impairment Disrupted Neurodevelopment Adverse Childhood Experiences Conception Death

Trauma’s Impact on the Brain  Disruption in Neural Development can include:  Failure to expose youth to appropriate experiences at the critical times (Neglect)  Overwhelming the brain’s alarm system (Abuse) 21

Normal Brain Development Newborn 6 Year Old Newborn6 Year Old

Disrupted Brain Development From Childhood Neglect Bruce D. Perry, M.D., Ph.D. ©2002

 Alarm System as a Survival Mechanism  Extreme or frequent threats can damage the alarm system  With trauma, the alarm system is too easily triggered and too slow to shut down Trauma and Alarm

 Fight  Flight  Dissociation  Nonresponsive  Self-Mutilation  Passing Out Traumatic Response Styles

 After Trauma  Youth is on Constant Alert  Youth may overinterpret signs of danger  Youth overreacts to normal situations Trauma and Triggers

Alternative Diagnoses for Clinical Symptoms (AACAP, 2010) Overlapping SymptomsTrauma 1. Bipolar Disorderhyperarousal and other anxiety symptoms mimicking hypomania; traumatic reenactment mimicking aggressive or hypersexual behavior; and maladaptive attempts at cognitive coping mimicking pseudo-manic statements Child Trauma 2. Attention Deficit / Hyperactivity Disorder restless, hyperactive, disorganized, and/or agitated activity; difficulty sleeping, poor concentration, and hypervigilant motor activity Child Trauma 3. Oppositional Defiant Disordera predominance of angry outbursts and irritability Child Trauma 4. Panic Disorderstriking anxiety and psychological and physiologic distress upon exposure to trauma reminders and avoidance of talking about the trauma Child Trauma

Alternative Diagnoses for Clinical Symptoms (AACAP, 2010) Overlapping SymptomsTrauma 5. Anxiety Disorder, including Social Anxiety, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, or Phobia avoidance of feared stimuli, physiologic and psychological hyperarousal upon exposure to feared stimuli, sleep problems, hypervigilance, and increased startle reaction Child Trauma 6. Major Depressive Disorderself-injurious behaviors as avoidant coping with trauma reminders, social withdrawal, affective numbing, and/or sleep difficulties Child Trauma 7. Substance Abuse Disorderdrugs and/or alcohol used to numb or avoid trauma reminders Child Trauma 8. Psychotic Disorderseverely agitated, hypervigilance, flashbacks, sleep disturbance, numbing, and/or social withdrawal, unusual perceptions, impairment of sensorium and fluctuating levels of consciousness Child Trauma

Jack P. Shonkoff, M.D.

 - Dr. Perry and The ChildTrauma Academy  - National Child Traumatic Stress Network  - ACES Study  Jack P. Shonkoff, Center on the Developing Child, Harvard University, Websites