Overcoming the Neurobiology of Early Neglect and AbuseCreated and presented by Brenda McCreight PhD

Children are removed from their genetic parents because they have been neglected and/or abused.

Children who are neglected and/or abused in early childhood have a measurably different brain structure than other kids.

This is one of the facts of adoption that is often difficult for prospective adoptive parents to understand because it’s hard to believe that a child who looks so adorable does not have the same brain as other children.

The early experiences won’t change the child’s appearance, but it will alter how he thinks, how he behaves, how he learns, how he interacts in relationships – his brain will not function like yours! You and your child will neither think nor learn in the same ways.

Significant maternal stress during pregnancy and poor maternal care during infancy both affect the developing stress system in the brain and alters genes that are involved in brain development.

The babies of women who experience high stress during pregnancy are more fearful and more reactive to stress themselves at birth

In the long term, there is evidence this results in long term impaired memory and learning disorders and even more aging-related memory and cognitive deficits in adulthood.

It begins before birth…

After the baby is born, the infant brain develops in the context of genetics & relationships

The interaction between the baby and the caregiver is as important as food and warmth.

Relationships that promote brain growth are based on the child’s partnered dance with the caregiver

The dance is specific to the child’s personality, to her interests, to her abilities.

The dance forms her sense of self and stimulates her brain

When the dance is one sided – the brain of baby experiences severe stress

Responding to stress… The ability to cope with stress is essential to

human survival A baby experiences stress when she is hungry,

or cold, or too hot, or too tired, or has a gassy tummy, or is afraid, or is uncomfortable, or needs touch or….

The potential to survive stress is built into brain circuits which are influenced by the interactive dance with the caregiver

Stimuli that activates these circuits are played out in the body’s chemical and neural responses

Children who end up in foster care have usually experienced both pre and post natal *toxic stress* (chronic & uncontrollable & ongoing)

Toxic stress negatively affects the developing brain circuits and hormonal systems

This results in a poorly controlled stress-response systems that will be overly reactive & slow to shut down

The overreaction of the neural circuits is the basis for the behavioral disorders that develop and the lack of emotional self regulation that will exist throughout the life

The neural circuits for dealing with stress are particularly “plastic” during the fetal and early childhood stages

When babies experience toxic stress, their cortisol levels remain elevated for long periods of time.

Long-term elevations in cortisol levels can alter the function of a number of neural systems, and even change the wiring and structure of regions in the brain that are essential for learning and memory (the hippocampus)

More factors… Increases in the level of cortisol in the brain

actually can turn specific genes “on” or “off” Most children who enter foster care come from

economically deprived families >>children who live in poverty generally have elevated cortisol levels.

Children whose mothers have depression also have toxic stress

Studies have shown that hat a mother’s depression during her child’s early years increases the child’s cortisol reactions to adverse family conditions later in childhood

Thinking processes that are damaged by neglect/abuse… The brain damage from early toxic stress

hits the most important parts of our thinking brain>> the Executive Function and the Working Memory and the Emotional Regulation system.

These are the parts of the brain that are supposed to help a child learn, behave, remember, plan, organize, and manage feelings in a way that allows for healthy relationships and healthy expression of feelings.

Executive function Executive function is a combination of

mental processes that connects past experience with present action.

EF allows us to perform activities such as planning, organizing, strategizing, paying attention& remembering the details, and managing time and space.

Location of EF…

Executive function allows us to:   Keep track of more than one thing at once Keep track of time and finish tasks on time Use past knowledge in current setting Evaluate our ideas and reflect on the possible

outcomes Make plans Change our minds while thinking, reading, and writing Participate appropriately Use reasoning judgement Problem solve Focus attention on anything

What does lack of EF look like? Can’t plan ahead for any task Can’t consider how long anything will take to complete Can’t give an organized narrative of anything, either verbally or in writing Can’t memorize or access information from memory Has a great deal of trouble initiating activities or tasks, or generating ideas Can’t retain information while doing something with it, ie remembering phone number while dialing Can’t organizing anything

Working memory…Working memory underlies the performance of almost all complex cognitive activities. The functioning of the working memory system

is highly predictive of academic success Is crucial for the general ability to acquire

knowledge and learn new skills. The basis of the brain's executive function. It allows you to plan, organize and focus The thinking part of EF

Let’s not forget emotional regulation! In From Neurons to Neighborhoods: The

Science of Early Childhood Development, Shonkoff and Phillips (2000) define self-regulation as…” a child’s ability to gain control of bodily functions, manage powerful emotions, and maintain focus and attention. The growth of self-regulation is a cornerstone of early childhood development and is visible in all areas of behavior.”

Emotional self regulation…The central characteristics of emotional self regulation include the ability to: identify and understand his own feelings accurately comprehend emotional

expression in others, manage strong emotions in a healthy way regulate her own behavior, to develop

empathy establish and sustain healthy relationships

What are emotions?o Emotional feelings are biologically based traits of human functioning that are “wired” into the central nervous system through interconnecting brain circuits

The dance teaches us how to manage and express the emotions... Each time the baby signals his distress by crying or

fretting, the emotionally healthy parent will de-stress the baby by responding with care, nurturing, play, and attention Each time the baby experiences joy and happiness from this parental response, it learns how to experience stimulation as a positive and it begins learning how to lower the heart rate and experience calm. As these interactive and interpersonal, experiences

repeat, and repeat, and repeat, the baby’s brain develops the capacity to begin undertaking this process on it’s own.

The infant learns to self regulate her physical states, such as going from full to hungry, and from asleep to awake, in the same way = by repeated helpful and stress relieving behaviors that provided by the parent that are designed to calm the central nervous system of the baby.

The parent develops her own rituals for each of these transitions and the baby learns to recognize these as symbols that mean help and de-stress are on the way.

Feeding is a good transition example – The baby is hungry, she cries to let mommy knows she is distressed. Mommy quickly gets the food ready. She puts the baby in her high chair and puts on the bib, and then gets the bowl and feeding spoon ready. The baby is observing all of this, over and over at every meal so she learns to calm as soon as mommy gets the high chair because she knows she can rely on mommy – her brain begins to de-stress as soon as mommy begins to respond. While mommy feeds her, she talks nicely using fun or soothing words. The repeated experiences of being hungry, signaling distress by

crying, and being de-stressed by having her needs met by a caring mommy all teach the baby how to go from one state ie physically hungry and emotionally upset to>> another state of physically full and emotionally calm.

Not only is she learning to transition and to self-regulate , she’s also learning to trust.

However, if no one shows up to aid in the de-stress, or if the responses are chaotic, unpredictable, and inappropriate, the baby is left with the stress hormones surging and settling in her brain and body but she has no capacity to discharge these hormones

Typically, the baby will respond to this by either developing rage or withdrawal as a response to stress

Neither one is effective and both will cause the parent figures to pull away emotionally from the baby!

More problems… The brain is a problem solving mechanism that’s

designed to solve the problems that threaten or enhance us.  

The Right hemisphere of the brain runs the show in the first three years

of life and has many of the necessary problem solving tools – such as non-verbal communication, facial expressions, subtleties in tone and voice, emotional attunement – when neglect and/or abuse dominant caregiving patterns then these are all underdeveloped

The right hemisphere is also the part of the brain that are attacked by the mother’s stress hormones.

This part becomes vulnerable to damage from stress before the baby is even born! 

As the neurons develop, they form associations so that neurons that fire together one time will begin to fire together every time one of them is stimulated - Hebbs Axiom – “Neurons that fire together wire together

The neurons that develop and wire together in an neglected child will be:

Fear + parents Abandonment + parents Pain + parents Self + worthless Neglect trains the brain to associate parents with fear,

distrust & abandonment Neglect trains the brain to perceive the person as

worthless

Neglect/abuse prevents normal development of the parts of the brain that give a child the ability to:

Learn Plan Organize Trust Participate in healthy relationships Regulate emotions Differentiate between what is safe and

what is risky Learn to calm himself Feel that he has a right to be alive and to

be loved

What this looks like… The long term impact of neglect/abuse

is acted out through various negative behaviors that ultimately receive some kind of diagnosis.

Common diagnoses of children in the adoption community… Oppositional defiant disorder Conduct disorder Reactive attachment disorder Bi-polar disorder Depression Post traumatic stress disorder And others……

A mental health diagnosis is a way of describing the way in which the brain has been harmed by the early neglect/abuse

A mental health diagnosis can be the access to services and help

A diagnosis does not limit a person’s potential A diagnosis tells you about the condition of

the brain, it does not tell you about the person as a whole being

There are many different ways of treating these disorders

Recovery… Helping a child/youth who experienced

brain damage from early neglect/abuse to re-wire and re-organize his brain takes a multi-faceted approach.

Simple steps first… Stabilize the environment – the child

must be in a loving, stable, and permanent home

Long term healing requires fully committed, long term, parents

Learn to manage power struggles (see end of presentation)

Managing power struggles… Recognize that power struggles are about survival

and that the child’s brain is not allowing her to understand choices or to take in new information. 

Remember that you are the adult and must take the first steps out of this

  Realize that your teen has not experienced a healthy sense

of power  Realize that the power struggle may be your teen’s only way

of knowing and showing that he is important Use the conflict as a way of knowing your teen’s feelings and

thoughts and fears  Check to see if you and the teen really have time for this   Realize that the power struggle may be about previous bad

experiences  

Continued… Help your teen to save face during the power struggle  Sidestep – offer an alternative at the beginning of the power struggle

Keep your voice neutral and your tone low  Avoid known trigger topics during the ps  Let your teen win on occasion  Let your teen have the last word  Use conflict and negotiation skills – get training in these

Take “no” as a negotiating point, not a red flag  

Still continued… Ask your teen to make a snack with you while you

or make one and serve the teen  Move away from the audience  Sit down – make your body lower than his  Don’t get drawn into one if either of you is tired  Listen to the teen 

Still more… Ask what the experience means to the teen, rather

than why he won’t do it ie “What happens when you take a bath?”

  Don’t moralize, sermonize, or use put downs  Listen to yourself, monitor your own behaviour  Ask your teen for ideas on how to resolve the problem  As soon as the teen moves the slightest bit toward

compromise, you do the same

More home based strategies… Plan for some fun/success in each day –

both parent and child Allow for fidgeting, restlessness, boredom Give concrete instructions/use concrete

language in a loving/friendly manner Break down each task into smaller chunks Make the rules and consequences clear and

consistent – but don’t live for the rules, use kindness to know when to be flexible

Home based strategies continued… Reduce choices/teach choices Remind the child of the schedule each

day Prepare ahead for change in routine &

expect meltdowns when there is change Teach sequencing Teach generalization Be aware of peer problems – alienation,

isolation, depression

Still doing home based strategies… Repeat, re-teach, retrain Stop using anything that does not work Emotional age and chronological age

may be very different Notice when your child’s brain overloads

or *freezes* and have plans for support

The grey matter of the brain will not alter over time, but the white matter, which is the connective tissue, will improve with stability, care, and nutrition. However, it takes all of the growing up years for this to improve.

Therapy… Most therapists have a favorite modality

of treatment. Here are a few that I recommend:

EMDR Dialectical Behavior Therapy Dyadic Developmental Psychotherapy Theraplay

Choosing a therapist… The therapy is only as good as the

therapist Ask about his training, his experience,

his knowledge of your particular issues Do other people recommend her? If you are an adoptive family, be sure he

has training that is specific to adoptive family dynamics and is well trained in grief and loss issues as well as trauma

The good news… Believe that your child will recover and

will have a good life Get help, use therapy as well as home

based strategies Remember --love and effective

parenting skills are equally important Take care of yourself in this process –

you are important too!!

Thank you for sharing this time with me… You can check out other services and products at these sites: http://www.lifespancounselling.com http://www.theadoptioncounselor.com http://www.hazardousparenting.com The Hazardous Parenting facebook site Udemy.com (search under Brenda McCreight) Slideshare.com (search under Brenda McCreight) Amazon.com (search under Brenda McCreight) brendamccreight@gmail.com Brenda provides counselling and parent coaching worldwide via

skype, telephone, and email – please contact her by email if you would like to book an appointment.

Some of Brenda’s books