The Impact Trauma and Stress Can Have on Healthy Brain

DevelopmentGene Griffin, J.D., Ph.D.

School Mental Health ConferenceJune 27, 2012

Brain Development

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);

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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)

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Normal Brain Development

Newborn 6 Year Old Newborn 6 Year Old

Disrupted Brain DevelopmentFrom Childhood Neglect

Bruce D. Perry, M.D., Ph.D. ©2002

www.childtrauma.org

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 Symptoms Trauma

1. Bipolar Disorder hyperarousal 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 Disorder a predominance of angry outbursts and irritability

Child Trauma

4. Panic Disorder striking 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 Symptoms Trauma

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 Disorder self-injurious behaviors as avoidant coping with trauma reminders, social withdrawal, affective numbing, and/or sleep difficulties

Child Trauma

7. Substance Abuse Disorder drugs and/or alcohol used to numb or avoid trauma reminders

Child Trauma

8. Psychotic Disorder severely 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.

www.childtrauma.org - Dr. Perry and The ChildTrauma Academy

www.nctsn.org - National Child Traumatic Stress Network

www.acestudy.org - ACES Study Jack P. Shonkoff, Center on the Developing

Child, Harvard University, www.developingchild.harvard.edu

Websites