the impact of trauma and neglect on young children · 2/12/2014 · bruce d perry, md, phd ©...

Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org

The Impact of Trauma and

Neglect on Young Children Bruce Perry, M.D.,Ph.D.

Senior Fellow, The ChildTrauma Academy, Houston,TX Adjunct

Professor, Department of Psychiatry and Behavioral Sciences,

Feinberg School of Medicine, Northwestern University in Chicago

Senior Fellow, Berry Street Childhood Institute, Australia


RHYTHM AND RELATIONSHIP

Core Concepts in Developmental Trauma


The human

brain is not

designed for

the modern

world.

For thousands

of generations

we lived in

small, multi-

generational.


All rights reserved © 2010-2013 Bruce D. Perry

Cortex

Limbic

Diencephalon

Cerebellum

Brainstem

Abstract & Reflective Cognition

Concrete Cognition

Affiliation

Attachment/Reward

Sexual Behavior

Emotional Reactivity

Arousal

Appetite/Satiety

Blood Pressure

Heart Rate

Body Temperature

Sleep

Motor Regulation

NEDA

ANS - body

SER

Efferent Distribution of Primary Regulatory Networks


Developmental Trauma: The Great Imposter

Is this trauma-informed?


Sensitization and Tolerance

www.ChildTrauma.org


Sensitization


Tolerance

www.ChildTrauma.org


Differential “State” Reactivity

Extreme Stress Stress Baseline

Vulnerable

Normal

Resilient

Terror

Fear

Alarm

Alert

Calm


Terror

Fear

Alarm

Alert

Calm

The Learning Window: State Dependence

Challenge Distress Extreme stress


Cognition Abstract Concrete Emotional Reactive Reflexive

Mental

State CALM ALARM FEAR ALERT TERROR

Primary

secondary

Brain Areas

NEOCORTEX

Subcortex

SUBCORTEX

Limbic

LIMBIC

Midbrain

MIDBRAIN

Brainstem

BRAINSTEM

Autonomic

Sense of

Time

Days

Hours

Hours

Minutes

Extended

Future

Minutes

Seconds

Loss of

Sense of

Time


Adaptive

Response Rest

(Adult Male)

Vigilance Freeze Flight Fight

Hyperarousal

Continuum Rest

(Male Child)

Vigilance Resistance Defiance Aggression

Dissociative

Continuum Rest

(Female Child)

Avoidance Compliance Dissociation Fainting

Mental

State CALM ALARM FEAR ALERT TERROR


Dimensions of Neuroplasticity

Development (Time)

Anatomy/Structure

Specificity (Specific neural network)

Pattern (frequency, intensity, timing)

All related to the dynamic activity of complex systems.


“Self-regulation” (SR)

Somatosensory regulation/self-soothing (SS)

Bottom – Up: Primary

Starts in womb; suck/swallow

Tied to intrauterine and perinatal associations

Breathing, walking, running, rocking, swimming, rhythm

Doodle, hum, swing, jump, dance

Cortical Modulation (CM)

Top – Down: Secondary

Tied to cortical development & state-dependence

Slower process -

Dissociation (Diss)

In – Out: Pervasive

Adaptive continuum

Mind-wandering to threat-induced full dissociation

Used rhythmically (“in-out”)


Relational Regulation


“Self-regulation” (SR) Self-”soothing” – using SS

Cortical modulation

Dissociation

Somatosensory regulation (SS) Self vs Other

Relational regulation (Rel) Positive co-regulation

Co-dysregulation

Tied to primary relational templates

Pharmacological regulation (Rx)

Optimal regulatory interactions use “multiple” pathways

SS and Rel

Cort and SS

Diss and SS


Developmental Trauma: Poly-pharmacy



Terror

Fear

Alarm

Alert

Calm

Time

Child

Adult

Co-dysregulation

Reactive child and overwhelmed teacher

Present, overwhelmed, frustrated, angry = escalation =

increased incidents/ restraint


Terror

Fear

Alarm

Alert

Calm

Time

Child

Adult

Present, parallel, patient, persistent –

facilitate multisensory, multi-domain, repetitive activity

Rhythm & Relationship= Regulation

Co-regulation Reactive child and well-regulated teacher


Sequence of Engagement

Reason

Relate

Regulate


Core elements of positive developmental,

educational and therapeutic experiences

Relational (safe)

Relevant (developmentally-matched)

Repetitive (patterned)

Rewarding (pleasurable)

Rhythmic (resonant with neural patterns)

Respectful (child, family, culture)


Healthy Early Caregiving Weaving Together the Neurobiology of Relationship, Reward and

Regulation


24

6

12

18


18 6

12

24


Developmental Trauma: Relational Poverty



What is Trauma-informed?

Trauma-informed

appreciates the individual &

the need for individualized

treatment


Genetic

Epigenetic

Intrauterine

Attachment

Stressors

AE 1

AE 2

AE 3

Dysregulated Typically Regulated Hardy, Resilient

Birth

Child A Child B Child C

Post AE Life


www.ChildTrauma.org

(Main Website)

www.ChildTraumaAcademy.com

(Online mini-courses)

Also see:

Twitter: @ChildTraumAcad

@BDPerry

Facebook: ChildTrauma Academy

YouTube Channel: The ChildTrauma Academy Channel

http://www.ChildTrauma.org

http://www.ChildTraumaAcademy.com


February 12, 2014 from 12-1PM Working with Older Adults in Mental Health Services Presented by: Mari Umpierre, Ph.D., LCSW

Upcoming CTAC Events


Contact Kara Dean-Assael or Lydia Franco, the CTAC

Clinical Lunch & Learn Webinar Series Coordinators at

[email protected]

Additional information and resources available at:

www.ctacny.com

Materials owned

by ICL, Licensed

Contact Us….

mailto:[email protected]

http://www.ctacny.com/

the impact of trauma and neglect on young children · 2/12/2014 · bruce d perry, md, phd ©...

Documents