Trauma and Learning

Bruce Perry MD PhD Chris Dunning Ph D

Childhood trauma has profound impact on the emotional behavioral cognitive social and physical functioning of children

2

What does trauma experience do to children

1048729 Each year 5 million children in USexperience an extreme traumatic

event1048729 40 will develop some form of chronic

neuro-psychiatric problem1048729 Most problems classified as anxiety

disorders with post-traumatic stressdisorder being most common

1048729 Trauma event will impair emotionalacademic andor social functioning

3

Primary Trauma and Children

Child Trauma History Most Frequent Exposure Types

CEALo

ss

Impa

ired C

aregiv

er DVCSA

Neglec

tCPA

WarTe

rrorsm

(US)

0

15

30

45

60

593556

471 458408

338

281

184

4

EmotionalAbuse

Loss ImpairedCaregiver

DomesticViolence

SexualAbuse

Neglect PhysicalAbuse

WarTerrorism

Child Trauma History Less Frequent Exposure Types

5

InjuryAccident

IllnessMedical Disaster International

WarterrorismForcedDisplacement

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Childhood trauma has profound impact on the emotional behavioral cognitive social and physical functioning of children

2

What does trauma experience do to children

1048729 Each year 5 million children in USexperience an extreme traumatic

event1048729 40 will develop some form of chronic

neuro-psychiatric problem1048729 Most problems classified as anxiety

disorders with post-traumatic stressdisorder being most common

1048729 Trauma event will impair emotionalacademic andor social functioning

3

Primary Trauma and Children

Child Trauma History Most Frequent Exposure Types

CEALo

ss

Impa

ired C

aregiv

er DVCSA

Neglec

tCPA

WarTe

rrorsm

(US)

0

15

30

45

60

593556

471 458408

338

281

184

4

EmotionalAbuse

Loss ImpairedCaregiver

DomesticViolence

SexualAbuse

Neglect PhysicalAbuse

WarTerrorism

Child Trauma History Less Frequent Exposure Types

5

InjuryAccident

IllnessMedical Disaster International

WarterrorismForcedDisplacement

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

1048729 Each year 5 million children in USexperience an extreme traumatic

event1048729 40 will develop some form of chronic

neuro-psychiatric problem1048729 Most problems classified as anxiety

disorders with post-traumatic stressdisorder being most common

1048729 Trauma event will impair emotionalacademic andor social functioning

3

Primary Trauma and Children

Child Trauma History Most Frequent Exposure Types

CEALo

ss

Impa

ired C

aregiv

er DVCSA

Neglec

tCPA

WarTe

rrorsm

(US)

0

15

30

45

60

593556

471 458408

338

281

184

4

EmotionalAbuse

Loss ImpairedCaregiver

DomesticViolence

SexualAbuse

Neglect PhysicalAbuse

WarTerrorism

Child Trauma History Less Frequent Exposure Types

5

InjuryAccident

IllnessMedical Disaster International

WarterrorismForcedDisplacement

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Child Trauma History Most Frequent Exposure Types

CEALo

ss

Impa

ired C

aregiv

er DVCSA

Neglec

tCPA

WarTe

rrorsm

(US)

0

15

30

45

60

593556

471 458408

338

281

184

4

EmotionalAbuse

Loss ImpairedCaregiver

DomesticViolence

SexualAbuse

Neglect PhysicalAbuse

WarTerrorism

Child Trauma History Less Frequent Exposure Types

5

InjuryAccident

IllnessMedical Disaster International

WarterrorismForcedDisplacement

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Child Trauma History Less Frequent Exposure Types

5

InjuryAccident

IllnessMedical Disaster International

WarterrorismForcedDisplacement

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

The National Survey of Adolescents foundNearly one-half of American teenagers have experienced at least one of the four types of violent victimization

measured sexual assault physical assault severe physical abuse witnessing community violence

The prevalence is even higher among clinical or social

service samples

Of those victimized well over half have histories of multiple types of victimization

6

Traumatic experiences in childhood are highly prevalent

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

bull Children are victimized in multiple ways physical abuse and assault sexual assault and exploitation neglect kidnapping and homicide

bull Children are victimized by family members caretakers friends acquaintances and strangers

bull Children experience trauma from being eyewitnesses to crime violence and homicide

7

Children Experience Traumatic Events

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Nearly all psychological symptoms of trauma are associated with neurological impairments Problems of regulating emotion and arousal Alterations in consciousness and memory Damage to self-concept and identity Disruption in cognitive capacities Hyperactivity and attention problems Relationship problems Alterations in systems of self

8

Psychobiological Syndrome

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

9

Why Understand Psychobiology

Physical and Emotional trauma can physically injure the brain

Severity of brain injury depends on child and environmental factors

Hurt children develop various emotional defense mechanisms

Many traumatized children develop disorders such as depression PTSD Somatoformhellip

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

10

Why Does This Happen Trauma activates stress-response

systems in the brain Severe or chronic stress prevents the

brain from returning to relaxed state Traumatized children are in constant

fight flight or freeze mode Children are ldquotaughtrdquo how to behave by

trauma

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

They includebull Characteristics of the stressor and

exposure to itbull Individual factors such as gender age and

developmental level and psychiatric history

bull Family characteristicsbull Cultural factors-norms and beliefs

11

Factors Influencing Response To Trauma And Recovery

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Fewer than 20 of children with a history of exposure to a traumatic event have had a psychiatric disorder mainly anxiety disorders including posttraumatic stress disorder (PTSD)

Anxiety disorders including PTSD were three times as likely in children who had suffered the violent death of a parent or loved one but only one in five of this group showed this level of distress

Most children exposed to extreme events are remarkably resilient which can explain the success of the human species despite the violence of our history (Costello Erkanli Fairbank amp Angold)

12

Prevalence of Posttraumatic Stress Reactions

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Lifetime Current (1 Yr)Psychiatric Disorder of Group of GroupMajor Depression

PTSD 417 292Trauma Only 92 71No Trauma 59 46

Simple PhobiaPTSD 292 292Trauma Only 121 106No Trauma 87 78

Social PhobiaPTSD 333 292Trauma Only 113 106No Trauma 146 123

Alcohol DependencePTSD 458 375Trauma Only 314 279No Trauma 166 157

Drug DependencePTSD 250 208Trauma Only 149 128

13

What Does Happen to Children

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Adults have more fully developed internal and external resources to make sense of and to cope with a traumatic event

The central nervous systems (brains) of children are not yet fully developed

They are unable to put their experiences into context or to make sense of them

14

Traumatic events impact children and adults differently

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

The two most fundamental responses to trauma are the ldquofight or flight responserdquo where the instinct for survival takes control or disassociation which is a protective mechanism that creates a barrier to the actual experience

Repeated exposure to trauma prevents normal brain development in children

15

Traumatic events impact children and adults differently

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

16

Why Does This Happen Trauma activates stress-response systems in the

brain Severe or chronic stress prevents the brain from

returning to relaxed state

Traumatized children are in constant fight flight or freeze mode biologically

lsquoFight or flightrsquo responses or actions are usually not available to children ndash therefore lsquofreezersquo and other dissociative responses are common

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Children are ldquotaughtrdquo how to behave by trauma

The lsquofreezersquo response has been linked with the lsquolearned helplessnessrsquo models in animal studies ndash it appears to involve both sympathetic arousal and parasympathetic counter-effects or stepping on the lsquogas and the brakersquo at the same time

17

Trauma and Children

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

bull If a childrsquos early environment is abusive or neglectful the brain creates memories of these experiences coloring the childrsquos view of the world

bull Neuronal pathways developed under negative conditions prepare children to cope in a negative environment

18

Impact of Trauma on Brain Development and Protective Factors

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Brain development in abusedneglectedand traumatized children is adaptive for abusiveneglectful or dangerous environments

The focus is on survival and the childdoes not know how to deal with nurturing and kindness

Childrsquos brain has adapted to anunpredictable and dangerous world

19

Neuro-Processing

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Our minds our brains and our bodies are set up to make sure we make danger a priority

Things that are dangerous change over the course of childhood adolescence and adulthood

20

How we recognize and deal with danger

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

First we try to figure out what the danger is and how serious it is

Second we have strong emotional and physical reactions These reactions help us to take action yet they can be very distressing to feel and difficult to handle

21

Danger

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Third we try to come up with what to do that can help us with the danger We try to prevent it from happening try to protect ourselves or other people against harm or try to do something to keep it from getting worse How we feel about a danger depends on both how serious we think it is and what we think can be done about it

Dangers can become traumatic when they threaten serious injury or death

22

Danger

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Can feel totally helpless and passive They can cry for help or desperately wish

for someone to intervene They can feel deeply threatened by

separation from parents or caretakers Young children rely on a protective shield

provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare

23

Young Children

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

School-age children start to face additional dangers with more ability to judge the seriousness of a threat and to think about protective actions

They usually do not see themselves as able to counter a serious danger directly but they imagine actions they wish they could take like those of their comic strip heroes and feel like failures if they donrsquot

24

School-age Children

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

With the help of their friends adolescents begin a shift toward more actively judging and addressing dangers on their own

This is a developing skill and lots of

things can go wrong

Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger

25

Adolescents

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Controlling impulses Initiating appropriate behavior Inhibiting inappropriate behavior Organizing things Setting priorities Making decisions Insight Working memory

26

Brain Functions to be Developed

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

27

THE RAW MATERIALS

A child is born with 100 billion neurons(brain cells)

Neurons form synapses(the brainrsquos wiring system)

Synapses support basic functions for survival

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

1 Neurogenesis- ldquoneuronsrdquo are born starting in the womb

2 Migration-Brain cells or ldquoneuronsrdquo have the ability to travel within the brain and link itself to other neurons through neural pathways

3 Differentiation-neurons develop into specialized cells to perform or serve a particular function

4 Apoptosis-literally deterioration and death of neuron through atrophy if no ldquohomerdquo is found a process called pruning

28

Core Processes of Neurodevelopment

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

5 Arborization-branching out of neurons using dendrites

6 Synaptogenesis-the vehicle at the end of the dendrite that closes the barrier or gap between two neurons The actual transfer is done by neurotransmitters

7 Synaptic Sculpting-synapses can get stronger or weaker As they weaken they disappear

8 Myelination-As neurons are fired they strengthen the myelin by using proteins hence the brain is stronger

29

Core Processes of Neurodevelopment 2

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

By age four the rate of glucose metabolism to develop synapses is twice that of an adult and continued to age 10

Myelination or development of brain pathways also need to occur

Brain structures do not mature all at the same time

The prefrontal cortex matures last Brain remodeling can be derailed if

trauma occurs during critical periods

30

Brain growth

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

31

Hierarchy of Brain Function

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

32

In the brain of someone who has experienced a variety of emotional behavioral and cognitive stimuli a ldquotop heavyrdquo ratio develops In this ratio the brain matures to moderate the more primitive instincts of the midbrainbrain stem

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

33

When key experiences (Which develop the corticallimbic part of the brain)are absent or minimal the ldquohigherrdquo to ldquolowerrdquo brain ratio is impaired In this case the ability of the brain to moderate impulsive reactive responses and to work through frustration is diminished significantly

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

34

Children raised in environments characterized by domestic violence physical abuse or other persistent trauma will develop an excessively active midbrainbrainstem This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

35

When the developing brain is both deprived of sensory stimuli and experiences traumatic stress the brainstem midbrain to corticallimbic ratio is profoundly altered

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Trauma impedes brain maturation and interferes in the normal hierarchical development and integration of brain systems

The physical organization of the brain directly reflects the childrsquos interpersonal experiences

In response to trauma a child can develop an overactive stress response and an underdeveloped cortex

36

As a general rule

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

It is highly adaptive for the traumatized child to be hyperaroused hypervigilant and ready to attack and defend

As part of the survival mechanism extreme stress interferes with the functioning of the cortex especially prefrontal cortex the thinking part of the brain that is crucial for inhibiting the stress response

37

Result

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

One traumatic event in life like an earthquake especially in the life of a child can change the structure and the chemistry of the brain

The neurobiological consequences of repeated dissociative or hyperarousal responses on developing brain organization-- the more plastic developing brain may be more vulnerable to disruptions related to these responses

38

Life- and Brain-altering experience

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

39

Conduct Disorders

bull Behavior is the language of trauma bull Most children lack the language skills needed to describe how they are suffering so they use behavior to express themselves

bull Most behaviors used by children to express themselves are

considered ldquonegativerdquo behaviors

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

During a trauma intense fear easily overwhelms young childrens beginning efforts to manage emotions The normal sources of solace protection and help may

be unavailable from an abusive or traumatized parent

40

Emotional Maturity

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

For school-aged children the intensity and speeding up of emotions during traumas blur the ability to identify differences in emotional intensity and take them to the extreme They may have difficulty modulating emotions

They may ldquoclamp downrdquo on emotions and become numb

Shame and guilt can lead them to be secretive about their feelings

Feelings of revenge can interfere with their efforts to manage aggressive feelings in a more constructive rule abiding way

41

Emotional Maturity

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

The capacity to moderate frustration impulsivity aggression and violent behavior is age-related

With sufficient motor sensory emotional cognitive and social experiences during infancy and childhood the mature brain develops (in a use-dependent fashion) a mature humane capacity to tolerate frustration contain impulsivity channel aggressive urges

42

Cortical Modulation Is Age-Related

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

bull Social stigmatizationbull Lose ability to trustbull Retard social and interpersonal growthbull Dilemma between evil and heroic action

43

Impact on Adolescent Development

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Traumatized children often spend so much time in the lower level brain in a state of persisting fear that they consistently focus on non-verbal vs verbal cues

May be very intelligent but canrsquot learn easilyrarrmust do verbal learning when calm

Learning needs to be more experience-based rarr when traumatized children are stressed they are reactivereflexive vs accessing cognitive solutions

44

Implications for Learning

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

During early development these traumatized children spent so much time in a low-level state of fear that they were focused primarily on non-verbal cues

Once out of such an environment it is still difficult for the childs brain to interpret (relearn) these innocent looks and touches as benign

45

Implications for Behavior

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Difficulties with cognitive organization contribute to a more primitive less mature style of problem solving -- with violence often being employed as a toolldquo

A traumatized child -- in a persistent state of arousal -- can sit in a classroom and not learn

The brain of this child has different areas activated -- different parts of the brain controlling his functioning

The capacity to internalize new verbal cognitive information depends upon having portions of the frontal and related cortical areas activated which in turn requires a state of attentive calm

This is a state that the traumatized child rarely achieves

46

These children are often labeled as learning disabled

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47

Bruce Perry MD PhD 1997

UWM School of Continuing Education 47

• Trauma and Learning
• What does trauma experience do to children
• Primary Trauma and Children
• Child Trauma History Most Frequent Exposure Types
• Child Trauma History Less Frequent Exposure Types
• Traumatic experiences in childhood are highly prevalent
• Children Experience Traumatic Events
• Psychobiological Syndrome
• Why Understand Psychobiology
• Why Does This Happen
• Factors Influencing Response To Trauma And Recovery
• Prevalence of Posttraumatic Stress Reactions
• What Does Happen to Children
• Traumatic events impact children and adults differently
• Traumatic events impact children and adults differently (2)
• Why Does This Happen (2)
• Trauma and Children
• Impact of Trauma on Brain Development and Protective Factors
• Neuro-Processing
• How we recognize and deal with danger
• Danger
• Danger (2)
• Young Children
• School-age Children
• Adolescents
• Brain Functions to be Developed
• Slide 27
• Core Processes of Neurodevelopment
• Core Processes of Neurodevelopment 2
• Brain growth
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• As a general rule
• Result
• Life- and Brain-altering experience
• Conduct Disorders
• Emotional Maturity
• Emotional Maturity (2)
• Cortical Modulation Is Age-Related
• Impact on Adolescent Development
• Implications for Learning
• Implications for Behavior
• These children are often labeled as learning disabled
• Slide 47