Frozen – The impact of ACES on early brain development.

Thursday 6th April, 2017

Kinmel Manor Hotel, Abergele

Chris Dunne – Children’s Service Manager, Powys

12 April, 2017

Recognising the symptoms of trauma in early years’ development and behaviours.

Ensure support is focused to challenge the root causes.

‘Experience may alter the behaviour of an adult but it provides the organising framework of the infant and child’(Bruce Perry)

• Wales Structure

• Skills for Living

• Families First

• gofod 3

• Skype Scrums

• Clothes Banks

• Mobile Network Tethering

• Loop & Policies

• Annual Leave

• End of Year Stats & REACH

Wales ACES exposure

Trauma memory is saved in a state specific way, ‘frozen’ at the age and stage when trauma occurred

ACES – Critical Years

ACES – Early Brain Development

`Sensitive periods’ in early brain development

Vision

0 1 2 3 7654

High

Low

Years

Habitual ways of responding

Language

Emotional control

Symbol

Peer social skills`Numbers’

Hearing

Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

“Pre-school” years School years

What implications do ACEs have for

brain development?

• Sensitive periods of brain development mean that the brain has

certain tasks to carry out in the early years.

• Developing brain: neurons changing in response to external signals from the environment.

• Sensitisation of templates: states becoming traits.

• ‘Use it or lose it’. Conversely, the more frequently patterns are activated, the stronger the template.

• Some children are frequently in a state of threat and are somewhere along the arousal continuum (calm, to vigilance, to alarm, to fear, to terror). As are some adults.

Facts – Brain Development

• 85% of foundational neurobiological systems are organised in the first 5 years.

• The brain is a ‘historical organ’: stores experiences and these have an effect on the way the brain is organised.

• Within the 2 way attuned reciprocal relationship, the baby finds the sense of self.

• Attachment is the system which is moulding itself for survival.

Facts – Brain Development

• The brain develops ways of managing threat.

• With repeated experiences - super highways develop.

• Neurones ‘fire together, wire together’

• The brain is wired to react quickly.

• States become traits.

• After the threat is removed, the brain might react as if the threat is still present.

Neuroplasticity

Brain

• Full blown response pattern (hyper arousal/dissociation) at minor stresses.

• The amygdala is set off quicker, which means less processing of later trauma.

• The earlier this becomes a habitual way of dealing with stress, the harder it is to change things.

• Treatment is about the threat response not being activated or minimised, to create enough time to bring the other element of high order thinking into the equation so the person can begin to process the event.

Dissociation and hyperarousal

Trauma Response

Chemicals flood in

Chronic Stress from ACEs over-develop

‘life-preserving’ part of the brain.

• Children who have experienced a lot of trauma can find it harder to process positive experiences.

• They are using the right side of the brain more.

• The left side (language, sense of time) is turned off.

• Pure Survival.

Reality

Effect on child development

Effect on brain development

Effect on self regulation

Effect on ways of managing trauma in the future

Effect on positive experiences

Summary of Impact

Definition of PTSD :-

• History of exposure to traumatic event

• Re-experiencing event: e.g. Intrusions, dreams

• Avoidance of stimuli associated with trauma

• Negative alterations in cognitions and mood

• Alterations in arousal and reactivity

Prevalence of PTSD in a non referred sample of children and adolescents: 16% with rate highest amongst those that have experienced interpersonal trauma. (Perrin, 2014)

Recognising Trauma in Early Years

Recognising Trauma in Early Years

Developmental Trauma Disorder – current diagnostic

proposal:-• Witnessing or experiencing multiple adverse interpersonal

events involving caretaker(s) for at least one year;

• Affective and physiological dysregulation;

• Attentional and behavioural dysregulation;

• Self and relational dysregulation;

• Chronically altered perception and expectations;

• At least two posttraumatic symptoms.

• Functional impairment- at least two of the following areas:

academic, family, peers, legal, health.

• More behavioural examples either outward or inward

• More developmentally sensitive potential delay motor skills, speech and sensory.

• More emotionally sensitive.

• Unprocessed memories from trauma are activated by everyday triggers.

Recognising Trauma in Early Years

• a replay or play displaying themes of the traumatic event

• repetitive compulsive play

• themes of mastery of people & objects

• restricted range of toys in play

Play – What might you observe?

• Distress

• Looking withdrawn

• Fear

• Aggression

• Guilt or Shame

Emotion – What might you observe?

• Problems with concentration

• Hypervigilance

• Repetitive questioning

“Attention seeking behaviours”

“Attention needing behaviours”

Behaviour – What might you observe?

• show more generalized fears such as stranger or separation anxiety

• avoid situations that may or may not be related to the trauma

• have sleep disturbances

• be preoccupied with words or symbols that may or may not be related to the trauma

• These children may also display posttraumatic play in which they repeat themes of the trauma.

• In addition, children may lose an acquired developmental skill (such as toilet training) as a result of experiencing a traumatic event.

0-5 Years

Trauma intervention should target factors causing

on-going stress and on supporting natural

recovery rather than focus on symptoms.

Root causes – service design & delivery.

What factors inhibit recovery?

Continued exposure to ACEs

Intervention

If the child uses the caregiver as a mirror to understand the self, the disorganised child is looking into a mirror broken into a thousand pieces.

Trauma – Fright without Solution

Frozen – The impact of ACES on early brain development.

Thursday 6th April, 2017

Kinmel Manor Hotel, Abergele

Chris Dunne – Children’s Service Manager, Powys

12 April, 2017