PEDIATRICS
Understanding Developmental Trauma Its lifelong impact on health BY NORM THIBAULT, PHD, LMFT
T
here is a very small window in the early life of humans to learn to trust the world around us. The process of bonding to caregivers – attachment - is our most important task during this time, and one that will have a resonating impact throughout our life. The sensitive period for attachment, when our brains are most malleable, begins in pregnancy and continues up to about 24 months post-birth. Prenatally, epigenetic research is helping us understand how the environment of the birth mother and experiences of the birth father can shape the way that genes are expressed later in life. During this time of development, significant events happen neurologically as sensory, language and higher cognitive function pathways are formed in the brain. At the outset of life, infants have one significant survival task: to determine if the world is safe or dangerous. When the world is safe, infants will strive towards social engagement. When the world is unsafe they will be defensive in nature and learn to not trust their environment, nor those around them. These two systems, social engagement and social defense, are impacted by the caregiving the infant receives. When caregiving is appropriate, responsive, and timely, the infant learns to trust and becomes
more willing to socially engage. Significant research posits that “early experiences with sensitive, nurturing caregivers promotes a pattern of brain development supportive of emotional resilience, empathy and cognitive flexibility.” When caregiving is lacking, misinterpreted or abusive, the infant’s social defensive system will engage in an effort to protect and survive, thus showing up as hypervigilance, being slow to trust and quick to become defensive. Ultimately, children develop neurologically in the context of relationships, yet most trauma begins at home – the vast majority of people responsible for child maltreatment are the children’s own parents. We know what happens when children are programmed to explore their world in a healthy environment. When a toddler strays away from a caregiver and then becomes frightened or hurt, it returns to the caregiver for safety, comfort and reassurance. But, what if the caregiver is the one who is frightening or harmful? Who or where does a toddler turn to for safety or comfort? When caregivers are not in tune with the needs of their child or when they are abusive to their children, it may create a situation wherein the children involved become distressed. This type of anxiety can reach a point that a child loses trust in the ability of others to care for them or to provide relief. These children cannot regulate their own emotional states, and consequently learn that they cannot depend on others to assist them when in emotional distress.
Developing emotional responses
Quality Transcription, Inc. Setting the standards for excellence
Quality Transcription (located in Minnesota) maintains a professional office environment, thus the confidentiality of your work is strictly maintained. We provide medical transcription services on a contract or overload basis. Our equipment is state of the art with 24 hour dictation lines and nationwide accessibility. We are experts in our field. We deliver on time. We have experienced staff. We monitor the quality of our work. We provide services tailored to your needs and will do whatever it takes to get the job done.
Quality Transcription, Inc. 8960 Springbrook Drive, Suite 110 Coon Rapids, MN 55433 Telephone 763-785-1115 Toll Free 800-785-1387 Fax 763-785-1179 e-mail info@qualitytranscription.com Website www.qualitytranscription.com
20
JULY 2021 MINNESOTA PHYSICIAN
Neurologically speaking, the amygdala seeks to protect us from harm. In children who have experienced caregiver abuse or neglect, it is typically overactive. The neural substrate between the amygdala and the lower prefrontal cortex is not engaged in a way that inhibits reactivity or impulsivity. Therefore, children respond to situations in ways that are interpreted as anti-social or inattentive; they demonstrate significant levels of anxiety or anger, which typically lead to unhealthy or socially inappropriate responses. There is no space to learn or apply experience because they transition so quickly from stimulus to response. Oftentimes these children are then given pejorative labels, such as “Oppositionaldefiant” or “Conduct-disordered.” Simultaneously, they are frequently diagnosed with Attention-Deficit Hyperactivity Disorder, when in fact, they are simply demonstrating hypervigilance in order to stay safe, as dictated by their amygdala. This dichotomy between caregivers as “guardians” and as “abusers” creates a confusing predicament for the child in regard to caregiver loyalty. This may ultimately manifest itself as behaviors designed to keep the child safe, and at the same time, keep the family intact. Ironically, a child cannot remove itself from a home in order to protect itself, and it typically does not want to see its family separated, either. When these children are then compared to normative standards of behavior, they fall short and their coping mechanisms are often misinterpreted by professionals in a deleterious way.
