This is Part 2 of information gleaned at CALO’s 5th Annual Conference on Trauma, with the information herein distilled from a great deal of current research and presented by Joseph Spinazzola, Ph.D. from JRI in Massachusetts, Steve Sawyer from NVW, and folks from CALO including Rob Gent and Landon Kirk. In Part 1, I described how trauma creates a “fight or flight” reaction to the world that is based on survival instincts centered in the brain. In Part 2, I will talk about how that perception guides behaviors, and how that response should guide treatment.
According to research from the National Incidence Study (NIS-4), about 1 in 58 children are harmed in the United States–44% from abuse and 61% from neglect. That means about 1.25 million children are harmed. But there are two basic standards of maltreatment that include “harmed” or “endangered”. Endangered children often don’t display manifestations of maltreatment, and that is how they are defined separately from those whose maltreatment is more evident (such as physical or sexual abuse). The majority of “endangered” children exhibit a delay between the onset of problems from the mistreatment and the mistreatment itself. The “danger” has passed, but now the behaviors become evident. The scary part of this should be understanding the numbers–about 3 million children, or 1 in 25, falls into the endangered category.
In Part 1, I described how the brain encodes feelings, processes information, and activates the senses for survival. If we experience moderate amounts of good and bad things, our brains can process information more effectively. We learn to recognize that “this” is good or “this” is not or even that “this” is unknown, so I need to think about the potential “good” or “bad” about it. An endangered child may have experienced trauma and encoded those negative responses or feelings over time. When things become overwhelming or trigger those feelings again, thinking goes out the window. Things become confused, and the individual has no clear perception of what is happening. Their responses break down. And everyone around them becomes confused by their responses.
Let me clarify this a little more. The brain is use dependent–our brain responds to input that we receive from activities and sensations around us, and it develops pathways to process or streamline the way we view future activities and sensations. Our brains adapt our behaviors to stimuli based on what pathways are created. During stress, our brain produces cortisol (the stress hormone) to help us respond appropriately–do I run? Do I fight? We need this during truly stressful situations, such as a hurricane (run!). But if the brain gets stuck in flight or fight mode, the cortisol is not taken back to the attic for storage–and research now shows that excess cortisol is highly toxic to brain development. In fact, fMRI studies have revealed that even the visual cortex, literally how we see things, is negatively affected by the excess of stress hormones over time in the brain. These underdeveloped pathways affect how we respond to new stimuli–and unfortunately, the response is largely negative.
Current research even indicates that when a brain is given aversive stimuli over time and it is equated with something “rewarding”, the brain becomes addicted to seeking the aversive stimuli (Note: I am simplifying this information! But from a practical application one can look at this as addictive behavior). The underdeveloped brain begins to crave or seek those negative stimuli that it feels will result at the end with some positive reward–whether it is real or imagined. Thus, research is exploring how people (more underdeveloped pathways) get caught up in dysfunctional relationships that a more “rational” or “thinking” person (better developed pathways) would abandon.
So returning to those endangered children: Psychological maltreatment is the more prevalent, and the most enduring, form of child maltreatment. Psychological maltreatment can be broken into verbal abuse (commission–“You are worthless. No one loves you.”) or neglect (omission–“It’s not my problem. Go ask your Mother.”) by caregivers (and no, this does not refer only to parents!). The child remains in a situation in which there may be no escape, and eventually may remain in the situation because this is how “normal” feels to that child. But it is unhealthy–very unhealthy. These children have significantly increased internalized and externalized behaviors when compared with kids who have suffered sexual or physical abuse. And the majority of risky behaviors do not manifest until these children are teens–there is very little treatment for children. In fact, there is very little treatment prescribed to any of these individuals, and none of the common treatment modalities for mental illness or emotional disturbance are designed to focus on this type of trauma.
The triggers for a traumatized brain can be extremely subtle. These children are quick to notice things like changes in facial features. Unfortunately, just as they are “quick noticers” they are also poor interpreters. Just because someone screws up their face quickly does not mean they are about to attack–they may have allergies that caused their nose to get irritated and thus their “face” changed. But the traumatized child has learned to respond quickly and in the moment. They feel vulnerable, frightened, ashamed, and/or threatened. Being in the dissociative state of extreme dysregulation, they fight, flight, or freeze. They might punch the child about to sneeze, or run away screaming–and the other children look at them with equal amounts of fear, disgust, or judgment: “He is crazy that boy!” That child’s brain pathway has become in Dr. Spinazzola’s words, the “Highway to Hell”.
The pathway to trauma is very different than say behaviors caused by inattention. Thus, treatment must be different than what is normally used with other presenting behaviors. The approach with children must also be very different from the approach used with adults. Well-intentioned caregivers often unintentionally re-victimize the child. For example, level systems may seem appropriate to give a child something to reach for–but if the child “fails” and loses a level, they feel once again as if they have failed completely and their trauma is reinforced. And because of the “in the moment” dysregulation that is the hallmark of the traumatized brain, effective treatment must follow in the moment. All the talk therapy in the world will not help a traumatized brain during your session on Mondays at 11! Anyone working with a traumatized child must be aware and present. They need to be attuned to the child’s moods and reactions in the moment. They must be willing to share power, challenging and testing limits in very small increments through a pace set by the child. And they must be willing to adapt to the child.
In Part 3, I will talk more about attachment, trauma, and treatment, and the path to “repair”.