I’ve been working in the child trauma field all my career as a Clinical Psychologist and while my university training provided me a good foundation for assessing and understanding children it’s only in the last 5 – 7 years that I really feel like it’s all coming together and I have a much better understanding of how to more effectively treat children who have experienced trauma.
Developments in neuroscience have shed so much light on how our brains really work and more importantly for child trauma how they organise and develop. As a result of these discoveries we can now better plan treatment for infants, children and adolescents that is more respectful of neural development and in turn be much more efficient and effective in change.
What do I mean by all of this? Well to really help you understand this lets take a quick and VERY simplified science lesson in relation to brain organisation according to Dr Perry of the ChildTrauma Academy.
- To simplify things, lets think of the brain as having four main parts: the brainstem, the diencephalon, the limbic and cortex. Each part of the brain is responsible for different functions. The brainstem at the bottom of our brain takes care of things like heart rate, temperature regulation and blood pressure. Neuroscientists often refer to this as the survival part of our brain – its the bit that really concentrates on keeping us alive. The diencephalon manages things like our sleep/wake cycles, appetite/hunger, motor skills. Our limbic system can be thought of as the emotional and relational centre of the brain. Uniquely human and at the top of our brain is our cortex – the home of our things like abstract thinking, problem solving and language skills. While each part of the brain is responsible for its own set of functions – they all work together and can influence each other.
- The brain organises from the bottom up (brainstem to the cortex) and healthy organisation of one part is largely dependent on the lower part being organised well. Like making a wedding cake – you need a good foundation layer on which to place the upper layers, otherwise there will be an unhappy bride!
- Our brain develops as a function of our experience, or organises in a use dependent way. The more we experience particular events, the stronger the neural connection made will be as a result. So if you grow up experiencing lots of stress and fear, you will grow up more wired for stress and fear.
- A large component of the neural organisation happens in the first 4-6 years of life. This doesn’t mean that your brain is developed by 6 – not at all, our brains continue to develop throughout our lifespan it just means that the experiences we have in those first 4 – 6 years are much more powerful in organising the way our neural connections are formed.
- And while we now know that our brains are ‘plastic’ and changeable, we also know that the different parts of the brain aren’t equally changeable. For very good reasons the bottom more simple parts of our brain are harder to change than our cortex which is much more plastic.
So what does all this mean for child trauma?
Infants and children who experience trauma and/or neglect in consistent or chaotic ways while their brains are organising during those first 4-6 years, will have lasting neurodevelopmental insults as a result. While they will display the behavioural challenges that we so readily see, many of these children will also have difficulties in functions mediated by lower parts of the brain, things like faster resting heart rates, motor and/or sensory difficulties, attention problems, and sleep difficulties. So back to the wedding cake – if the bottom parts of the brain are disorganised and dysregulated as a result, then the foundation for the upper parts of the brain is compromised and there will be associated difficulties throughout the brain. Other elements complicate and further contribute to disruption in brain organisation as a result of trauma – but they are another blog!
So to be more neurodevelopmentally informed in trauma treatment and effective in healing, it makes sense that we need to reorganise and regulate the lower parts of the brain before we tackle the higher and more cognitive parts of the brain. We need to sequentially reorganise and regulate the brains of these children so to assist them to be ready to benefit from traditional cognitive and insight oriented treatments.
Perry, B.D. The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children In: Working with Traumatized Youth in Child Welfare (Ed. Nancy Boyd Webb), The Guilford Press, New York, NY, pp. 27-52, 2006