The Wounded Child

In the previous Newsletters we discussed the impact of stress on the formation of memory and consequently a child’s sense of self.  In this, and the next essays I will discuss the impact too much or too little stress has on brain development and consequent behaviour.  We begin with the situation where a child is exposed to extreme levels of stress!

 

In the last essay we described the stress response, the secretion of various hormones that facilitate the fight/flight/freeze response.  This process is described in broad terms as the hypothalamic-pituitary-adrenal (HPA) axis, that is the response flows through these systems.  One of the outcomes of this is the production of cortisol the hormone that increases glucose that facilitates energy and defence to deal with the situation.  It also curbs functions that are not essential to the immediate protection of the body.  Things like physical development, behaviour adaption in a social context.  The presence of cortisol denies these experiences.

 

When a child experiences re-occurring, extreme levels of stress this continuous exposure results in a reduction in the physical growth of that child.  They fail to reach their potential physical size, which in itself is a tragedy.  For our discussion the presence of cortisol alters the following physical capacity of our brain:

• Hippocampus – this is part of the limbic system and is primarily involved in the formation and the retrieval of memory.  For children who have experienced constant highly elevated stress the hippocampus can be reduced by 12%.  This is a significant disability!
• Prefrontal Lobes – this is the intellectual centre of our brain where we do our thinking and consider our behaviour and how it impacts our future.  It is also where our ability to resist impulsive behaviours, a property so vital in managing how we conduct ourselves.  There can be a 20% reduction in this critical part of the brain and that has huge implications.
• Cerebellum – this is a critical part of the brain, although it only occupies 10% of the brain’s volume it contains half the brain’s neurons. The function of the cerebellum is to evaluate the existing environmental conditions with the homeostatic status of our self, to evaluate the need for action and if required initiate that action.  The cerebellum is the key component in all our decision making and this is significantly reduced in the presence of cortisol.
• Corpus Collosum– this is that part of the brain that coordinates cognitive functions that exist on opposite sides of the brain.  The efficiency of the process is compromise by the lack of development.

A paradoxical alteration to our cognitive landscape that is a result of continuous elevated stress is the growth of the amygdala.  This structure is the part of the brain that controls our emotions and the behaviours that are initiated by those emotions especially fear.  The continual stimulation of the amygdala results in its over-development.  It is larger and more sensitive to potential threats resulting in a hyper-sensitivity that makes the child more anxious.

 

The child who has lived with this chronic continuous stress is left with a cognitive system that has been deprived of the availability of those functions that protect them from future stressful events and a hypersensitivity to potential threats.  The following diagram illustrates the stress response when you are confronted with a stressful situation.

 

As can be seen, the stimulus comes into the cerebellum and on to the thalamus, that part of the brain that distributes stimulus.  From there, depending on the intensity of the stimulus it will go either to the hippocampus where a considered response can be adopted or to the amygdala which will evoke a reflexive, unconsidered reaction.  For the damaged child, the propensity to suppose a real threat and the limitation in the ability to make a considered response means they at a real disadvantage in a busy classroom.  You have to remember they have no ability to ‘will away’ the heightened emotions despite your efforts to reassure them.

 

The long-term exposure to elevated stress and the presence of cortisol means the child is more likely to suffer the following health problems:

• Anxiety
• Depression
• Digestive problems
• Headaches
• Muscle tension and pain
• Heart disease, heart attack, high blood pressure and stroke
• Sleep problems
• Weight gain
• Memory and concentration impairment

 

In the classroom these damaged students will challenge your patience and endurance.  They will minimise or misrepresent any positive interaction you attempt to have with them just as they will be hypersensitive to any negative social skills, not only from you but also their class mates. 

 

Of course what I have been describing is early childhood post-traumatic stress disorder (PTSD) or the abnormal learning associated with fear.  PTSD is at the heart of the model of behaviour management I present and is an ever-present element in our approach.

 

The impact of extreme stress, as we have discussed above is at the heart of trauma however, in the literature that is focused just on trauma there are more specific descriptions for all cases.  These are:

• Traumatised people portray ‘snapshots’ of their unsuccessful attempts to defend themselves in the face of threat.  That is a given for a child, of course they can’t ‘defend’ themselves.. 
• The inability to discharge the energies associated with the preparation to defend themselves means they are fixed into patterns of readiness.  Adults can be given opportunities to discharge these energies, children cannot!
• We remain in a constant state of neuromuscular readiness - fixated in an aroused state.

 

All references to trauma imply that events challenge the very foundations of our expected survival.  Adults function with the expectation that they will endure and this gives them the confidence to plan and act within our community.  However, there will be times when these expectations are shattered through the experience of:

• Unexpected life-threatening events such as car accidents, earthquakes, severe illness, the death of a loved one, anything that threatens your stable view of the world.
• You come face to face with human vulnerability, you witness the injury to another person that demonstrates the fragility of life, in an instant the world changes through events that are out of your control.
• You come face to face with the capacity for others to preform what can only be called evil in the world. 

Children do not have these expectations.  They are unable to put meaning to the trauma!  This is an area that I have never been able to find any information but I believe it accounts for a difference between early childhood and adult episodes of PTSD!

 

One of the most significant things about early childhood PTSD is that it is most often perpetrated by their primary care-giver.  Because infants are totally egocentric they will blame themselves for the abuse.  This is at the heart of toxic shame, the belief that you are a mistake!

 

Whether you refer to the conditions outlined above as early childhood trauma or exposure to chronic stress the result is the same.  In the classroom you will be dealing with students who have a real physical disability that has been put on them by an adult.  Along with the physical deficit there will be a sense of worthlessness that is a powerful part of their sense of self.  It takes a special teacher to understand this and hang in with them long after they think you will give up!

 

The next Newsletter will deal with the impact of neglect, a feature that is so often co-exists with Trauma.