Neuropsychology of Trauma The Hidden Disability By Dr

Neuropsychology of Trauma – ‘The Hidden Disability’ By Dr George Harris Clinical Psychologist

TCTC Core Values Attachment Healthy attachment is a developmental requirement for all human beings, and should be seen as a basic human right. Containment A safe and supportive environment is required for an individual to develop, to grow, or to change. Respect People need to feel respected and valued by others to be healthy. Everybody is unique and nobody should be defined or described by their problems alone. Communication All behaviour has meaning and represents communication which deserves understanding. Interdependence Personal well-being arises from one’s ability to develop relationships which recognise mutual need. Relationships Understanding how you relate to others and how others relate to you leads to better intimate, family, social and working relationships. Participation Ability to influence one’s environment and relationships is necessary for personal well-being. Being involved in decisionmaking is required for shared participation, responsibility, and ownership. Process There is not always a right answer and it is often useful for individuals, groups and larger organisations to reflect rather than act immediately. Balance Positive and negative experiences are necessary for healthy development of individuals, groups and the community. Responsibility Each individual has responsibility to the group, and the group in turn has collective responsibility to all individuals in it.

Ways of viewing the Brain

How the Brain develops • Genetics and Environment • Both are essential for optimum development ‘Mother Nature meets Mother Nurture’

Two Brains

Early Brain Development • Brain and spinal cord begin to develop three weeks after conception • Neurons created and migrate • Development is sequential – ‘bottom up’ Brainstem Midbrain Limbic system Cerebral Cortex

Right and Left Hemisphere Lateralisation

The Growing Child’s Brain • Neuron – brain call (building block of the brain)

The Growing Child’s Brain • At birth – 100 billon neurons • Brain development – creating, strengthening and discarding connections between neurons • Synapses organise the brain by forming neural pathways • At peak – 2 million synapses per second • Aged 2 – 100 trillion synapses • Aged 3 – 90% of its adult size

‘Neurons that fire together wire together and survive together • Neural pruning - ‘use it or lose it’ The Growing Child’s Brain • Sensitive Periods - Critical windows • Myelination • Plasticity

‘Sensitive periods’ in early brain development Binocular vision Central auditory system Habitual ways of responding Language learning Emotional control Peer social skills High Low 0 1 2 3 4 5 6 7 20

Video 1

Adolescent Brain • Pruning • Myelination • Growth spurt – frontal lobe • Increases in white matter • Impulsivity, poor decision making, and increased risk taking

Adolescent Brain • Not a time of just raging hormones and immaturity • Vital period of human development • Move towards the unfamiliar, unknown, uncertain, uncomfortable, and unsafe • Dopamine change and Hyperrational thinking

Adolescent Brain • ESSENCE of ADOLESCENCE – Daniel Siegal • ES – Emotional Spark • SE – Social Engagement • N – Novelty • CE – Creative Exploration

Children prenatally exposed to alcohol • Most children with FASD: • Attachment issues • Display inappropriate sexual behaviors • Show poor judgment • Have difficulty controlling their impulses • Are emotionally immature • Need frequent reminders of rules

Traumatised Brain • Trauma undermines the development of brain regions that would normally help children: • Manage fears, anxieties, and aggression • Sustain attention for learning and problem solving • Control impulses and manage physical responses to danger, enabling the child to consider and take protective actions • Trauma can interfere with development of the prefrontal cortex, the region responsible for consideration of the consequences of behaviour, realistic appraisal of danger and safety and ability to govern behavior and meet longerterm goals

Brain Structures How does trauma affect the child's brain? • The child’s stress response is exaggerated and prolonged resulting in changes in the child's brain organs • Larger, more active Amygdala • Smaller Hippocampus • Smaller less active Frontal Lobes • Smaller Corpus Callossum

Amygdala Functions Problems w/emotional control Delays in cause and effect thinking Difficulty w/empathy Inability to describe own emotions Hyper-arousal, anxiety Frontal Lobe Functions Impulse Control Organization Time Orientation Reading Social Cues Corpus Callossum Not well integrated having problems using words to solve problems

Hippocampus Functions • Impaired learning • Less ability to make memories learning • Less ability to retrieve memories – recall • More impulsiveness Abused children often struggle with complex, goals directed behaviors, and have trouble adapting to transitions, changes and demand

• Traumatized children spend most of their lives in a state of low- fear – even though outwardly they may look calm and relaxed. • While in this state, it takes very little to move them up the arousal continuum. • They will respond by using either a dissociative or hyperarousal adaptation. Their functioning on every level (emotional, behavioral, cognitive) will reflect this state. • With a prolonged alarm reaction, the child will experience an altered neural state. • The longer the child remains in a persistent state of fear, the more likely it is that the child’s brain will change to reflect these experiences.

Cortisol • Cummulative exposure compromises the ability of neurons to withstand neuropathological insults. • Has a neurotoxic effect on the prefrontal cortex

Effects of Cortisol on the Amygdala • Involved in fear processing – sets in motion the stress response • Stimulated by cortisol (forcing our attention onto emotions we feel) • Overrides the prefrontal cortex when involved with the fight or flight system – commandeers the prefrontal cortex • Shows volume increase • The thinking brain gets side-lined for the duration • Reactivity rather than a more thoughtful and critical approach • ‘cognitive dysfunction’

Effects of Cortisol on the Hippocampus • Central for memory and learning • Converts content of ‘working memory’ into long-term for storage • Short-term memory loss • Especially vulnerable to stress because of the damaging effects of cortisol • Also increased rate of damage by other toxic challenges and normal attrition • Hippocampus loses neurons and is reduced in size • Depresses immune system -

Two types of Trauma • Developmental or Attachment Trauma • Chronic Trauma

Impact of Trauma on Brain Development

Attachment and Brain Development Parents with a mature psychological organisations serve as self-objects that perform critical regulatory functions for the infant who posses an immature, incomplete, psychological organisation. Relies on nonverbal, subconscious awareness.

So why focus so much on bonding and attachment in early development? • “Because healthy brain development and organization occur in the context of a safe, nurturing, attuned relationship, and because early patterns of attachment affect the quality of information processing throughout life. ” –(Crittenden, 1992) • The first three years are when the brain is making the majority of its “primary” associations and the core neural networks organize as a reflection of early experience. Early developmental trauma and neglect have a disproportionate influence on brain organization and later brain functioning. (Perry & Hambrick, 2008)

Attachment and Brain Development • Attachment is an essential ingredient for normal human development • ‘Brain development is exquisitely turned to environmental inputs that, in turn, shape its emerging architecture’ – Shonkoff and Phillips (2000) • “the infant’s transactions with the early socio-emotion environment influence the evolution of the brain structures responsible for the rest of the life span” Schore (1994) • The brain is at it’s most adaptable for the first two years after birth, during which time the primary caregiver acts as an external psychobiological regulator of the ‘experience-dependent’ growth of the infant’s nervous system. • The structure and functioning of the developing brain – is shaped by the parent’s more mature brain. This occurs within emotional communication – Siegal (1999)

Video 2

Modern Attachment Theory – Allan Schore • Shift away from behavioural model of attachment in 60 s-70 s and a cognitive model in 80 s-90 s • Emotional (Affect) model of attachment • Right brain development (3 rd trimester to second year of life) • Experience dependant growth • Process of emotional regulation (positive and negative emotions)

Modern Attachment Theory – Allan Schore • Co-regulating process • Right brain – to – right brain communication • Non-verbal (facial expression, tone of voice, gestures, posture, tactile) • Includes both up playing of positive emotions and down playing of negative emotions • Formation of the integrated self • Connection to the body • Formation of Empathy

Modern Attachment Theory – Allan Schore • Absence of secure early emotional relationship results in dysregulation • Thought to be the cause of many severe mental health problems • Linked to emotional ‘shut down’ dissociation and suicide • Can be shaped by later experience – requires relational experiences with an emotionally sensitive and empathy other

Video 3

Chronic Trauma • Survival Process • Operates before birth • Involves Sub-cortical process (fast but does not think) • Hyper-aroused state (anger/aggression) • Reacts even if do not want too • Not geographical • Triggered by non-verbal communication and implicit memories stored in subcortex

Chronic Trauma • Persistent Fear Response and Hyperarousal • Create permanent memories • Memories that automatically trigger fear response without conscious thought • Highly sensitive to nonverbal cues • Misinterpret neutral and positive cues • Can associate people who pose no threat with people who caused harm • Constantly on a state of alert (unable to achieve calm) • Hypoarousal – • Dissociation (shut down) • associated with suicide

Anything can remind children of past traumatic experiences (even years afterward) • Places • People • Sights • Sounds • Smells

Trauma Memory – Implicit Memories (Non-Declarative Memory) Non-Declarative Memory • Stored as early as 6 months In-Utero • Stored in Limbic System (Amygdala & Hippocampus) • Much more permanent • Unconscious • Similar to procedural memory • Smaller Hippocampus (long term memory) • Short term memory deficits • Dysfunctional Stress-Response System (Cortisol)

Talking to and calming the Right Hemisphere of the Brain 1 2 3 4 5 6 Eye contact Facial expression Tone Posture Gesture Intent of response

‘Being’ rather than ‘Doing’

Examples • Amygdala – Emotional brain, reacts to fear. Sends stress hormones to Hypothalamus. • Hypothalamus – Responsive Brain. Releases Oxytocin released to help calm the stress, making it overwhelming. Stress hormones sent to Hippocampus. • Hippocampus – either works properly or is overwhelmed and shuts down • Pre-frontal Cortex – thinking brain, Positive social and emotional responses

Thank you Dr George Harris georgeharris@gh-psychology. com