The Impact of Toxic Stress, Adverse Experiences on the Brain

1. Kellie Turner Prevent Child Abuse Delaware 302-425-7490 The Impact of Toxic Stress, Adverse Experiences on the Brain

2. What is Trauma A traumatic event is one in which a person experiences (witnesses or is confronted with): • Actual or threatened death • Serious injury • Threat to the physical integrity of self or another • Responses to a traumatic event may include • Intense fear • Helplessness • Horror • Attachment

3. Perception of trauma varies vastly among individuals. • Trauma is something that overwhelms our coping capacity • Affects the whole self

4. Prevalence of Trauma • A report of child abuse is made every ten seconds in the United States. (Childhelp, 2013) • Children who experience child abuse and neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult, and 30% more likely to commit violent crime. (Child Welfare Information Gateway, 2006) • More than 1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner. (CDC,2013)

5. Prevalence of Trauma • Nearly 80% of female offenders with a mental illness report having been physically and/or sexually abused. (Marcenich, 2009) • Seventy-five percent (75%) of women and men in treatment for substance abuse report trauma histories. (SAMSHA/CSAT, 2000)

6. Impact of Trauma

7. The ACE Study

8. The ACE Study • Dr. Robert Anda and Dr. Vincent Felitti surveyed 17,421 adults who were having medical difficulties about their childhood experiences. • Created 9 categories of adverse childhood experiences which generated a person’s ACE score (number of categories a person experienced) • Recurrent physical abuse • Recurrent emotional abuse • Sexual abuse 4. Neglect

9. 9 categories of adverse childhood experiences 5. Growing up in a household where there was domestic violence 6. Growing up in a household with an alcoholic or drug abuser 7. Growing up in a household where someone was chronically depressed, mentally ill or suicidal 8. Growing up in a household where at least one biological parent was lost to the patient during childhood – regardless of cause 9. Growing up in a household where someone was in prison

10. ACE Study Demographics

11. The ACE Study - Results • Shows a relationship between a person’s adverse childhood experience and their physical and mental health as adults as well as are associated with major causes of adult mortality

12. The ACE Study - Results • The higher the ACE score the greater the likelihood that person would suffer significant health problems in adulthood

13. One Example

14. Heart Disease

15. ACEs Have A Strong Influence on • Adolescent Health • Teen pregnancy • Smoking • Alcohol abuse • Illicit drug use • Sexual abuse • Mental Health • Risk of revictimization • Stability of relationships • Performance in the workforce

16. ACEs Increase the Risk Of: • Heart Disease • Chronic Lung Disease • Liver Disease • Suicide • Injuries • HIV and STDs

17. The ACE Pyramid

18. The ACE Study • The ACE Study

19. The Brain

20. Brain Basics • At birth about 100 billion neurons have been produced • Genes (genetic code) and the environment both influence how a baby’s brain develops • Genes are responsible for the basic wiring of the brain • Environment and experience are responsible for the fine-tuning of those connections

21. Brain development Begins.. • Within a week of conception • During the prenatal period brain cells are sending and receiving sensory messages of touch, hearing, and movement.

22. Building Our Brain • Built from the bottom up • Brainstem • Midbrain • Cerebellum • Limbic • Cortex

23. Brainstem and Midbrain • Midbrain is the top of the brainstem • Governs the bodily functions necessary for life • Warns us of important incoming information • Midbrain controls: • motor activity, • appetite • Heart rate • sleep

24. Cerebellum • Behind brainstem • Coordinates movement and balance

25. Limbic System • Responsible for: • Emotions • Attachment • Memory • Consists of • Hypothalamus • Amygdala • Hippocampus

26. Limbic System • Regulates: • Appetite • Sexual urges • Sleeping • Hormones • Immune system

27. Cerebrum/Cortex • Upper brain • Makes up two-thirds of our brain • Crumpled up space – if unfolded it would be about half a square yard • Divided into two hemispheres

28. Cortex • Top layer/outside of the cerebrum • Our “thinking cap” • Regulates decision-making and controls thinking, reasoning and language • Understands time – sense of past, present, future • Allows us to reflect, plan make decisions and move • Responsible for abstract thinking • Contains 80% of the neurons • Divided into 4 lobes

29. Frontal Lobes • Located in the forehead area • Last area to develop • Biggest section • Planning for the future • Decision making • Problem solving • Empathy • Feelings • Stimulated by nurturing touch

30. Parietal • Located at the top of the brain • Represent the body in the brain • Receive incoming sensory information • Allow us to judge things like weight, shape and texture • Mathematical and visual reasoning

31. Temporal Lobes • Located above the ear • Language • Auditory processing • Language comprehension • Speaking

32. Occipital • Located in the back of the brain • Devoted to vision

33. Cortical Modulation • Upper parts of the brain control or monitor lower parts of the brain • Important because if this did not occur there would be no time between impulsivity and reaction • Baby example

34. Mature cortex • The ability to regulate reactivity is related to how well your cortex works • Mature cortex controls aggressive and impulsive behaviors better • Things that impair cortex functioning increases reactivity • Alcohol/drugs • Stress • trauma

35. 2 Hemispheres

36. Left Hemisphere • Develops later • Responsive to stability • Promotes inhibition • Math • Logic • LanguageCause and effect • Content • Social emotions – like guilt and remorse

37. Right Hemisphere • Develops earlier • Responsive to action • Promotes activation • Nonverbal communication • Context • Primary emotions – like mad, scared and happy • Receives and analyzes information from the outside world • Spatial abilities • Face recognition • Visual imagery • Music

38. Factors that influence early brain development • Genetics predispose us to develop in certain ways but our interactions with our environment have a significant impact on how our predispositions will be expressed – these interactions organize our brain’s development and shape the person we become. • Responsiveness of parents • Daily experiences • Physical activity • Love • Food and nutrition

39. Baby’s relationship with her primary caregivers has the biggest effect on how the brain develops.

40. Responsive Interaction • Young children learn from the responses they receive from care giving adults • When parents and caregivers respond in a positive, attentive way, babies begin to learn to care about others. .

41. Attachment • Overall brain development is profoundly influenced by attachment experiences • Healthy balance between security and exploration – caregiver as secure base • Sharing emotions • Attachment is relationship specific • “Is a blueprint of adult functioning” – Dr. Vicky Kelly

42. Attachment

43. Secure Attachment – What Does It Look Like? • Self esteem, • Independency and autonomy • Resilience • Self-control –ability to manage impulses and feelings • Ability to develop long-term friendships • Positive relationships with parents, caregivers and other authority figures • Uses pro-social coping skills • Trust, intimacy and affection • Positive and hopeful belief systems about self, family and society • Empathy, compassion and conscience • Academic success • Better language skills • Superior motor skills and cognitive ability

44. New York Attachment Center • Attachment is primarily established in the first three years of life as the caregiver fulfills a child' s basic needs and provides touch, eye contact, smiles and positive affective engagement. • “Through an active and constant cycle of bonding, repeated thousands, if not millions of times in the first few years of life, a child develops a positive internal working model (I am loveable, worthwhile, my needs are met, I am safe), establishes a sense of trust and security and learns how to organize their reality.”

45. Attachment

46. Trauma and Attachment • Need goes unsatisfied or punished • Child learns world is uncaring, unsafe, dangerous and frightening • Belief repeated – believed over time • Focus becomes on taking care of self • As child gets older looks for examples to reinforces our beliefs

47. Poor Attachment • Dependent • Learned helplessness • Underdeveloped ego • Cognitive stunting • Poor impulse control • Poor coping strategies • Low self-esteem • Unable to develop and maintain friendships • Are alienated from and oppositional with parents, caregivers and other authority

48. Poor Attachment • Are aggressive and violent • Are incapable of trust, intimacy and affection • Are negative, hopeless and have a pessimistic view of self, family and society • Poor academic performance • Lack empathy, compassion and remorse • Perpetuate the cycle of maltreatment

49. “As the brain is organizing, it is waiting for the world to tell it how to structure itself.” – Dr. Bruce Perry The Effects of Trauma

50. Trauma, Brain and Relationship