The Impact of Trauma and Neglect on Young Children · 2/12/2014 · Bruce D Perry, MD, PhD ©...
Transcript of The Impact of Trauma and Neglect on Young Children · 2/12/2014 · Bruce D Perry, MD, PhD ©...
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
The Impact of Trauma and
Neglect on Young Children Bruce Perry, M.D.,Ph.D.
Senior Fellow, The ChildTrauma Academy, Houston,TX Adjunct
Professor, Department of Psychiatry and Behavioral Sciences,
Feinberg School of Medicine, Northwestern University in Chicago
Senior Fellow, Berry Street Childhood Institute, Australia
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
RHYTHM AND RELATIONSHIP
Core Concepts in Developmental Trauma
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
The human
brain is not
designed for
the modern
world.
For thousands
of generations
we lived in
small, multi-
generational.
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
All rights reserved © 2010-2013 Bruce D. Perry
Cortex
Limbic
Diencephalon
Cerebellum
Brainstem
Abstract & Reflective Cognition
Concrete Cognition
Affiliation
Attachment/Reward
Sexual Behavior
Emotional Reactivity
Arousal
Appetite/Satiety
Blood Pressure
Heart Rate
Body Temperature
Sleep
Motor Regulation
NEDA
ANS - body
SER
Efferent Distribution of Primary Regulatory Networks
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Developmental Trauma: The Great Imposter
Is this trauma-informed?
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Sensitization and Tolerance
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Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Sensitization
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Tolerance
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Differential “State” Reactivity
Extreme Stress Stress Baseline
Vulnerable
Normal
Resilient
Terror
Fear
Alarm
Alert
Calm
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Terror
Fear
Alarm
Alert
Calm
The Learning Window: State Dependence
Challenge Distress Extreme stress
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Cognition Abstract Concrete Emotional Reactive Reflexive
Mental
State CALM ALARM FEAR ALERT TERROR
Primary
secondary
Brain Areas
NEOCORTEX
Subcortex
SUBCORTEX
Limbic
LIMBIC
Midbrain
MIDBRAIN
Brainstem
BRAINSTEM
Autonomic
Sense of
Time
Days
Hours
Hours
Minutes
Extended
Future
Minutes
Seconds
Loss of
Sense of
Time
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Adaptive
Response Rest
(Adult Male)
Vigilance Freeze Flight Fight
Hyperarousal
Continuum Rest
(Male Child)
Vigilance Resistance Defiance Aggression
Dissociative
Continuum Rest
(Female Child)
Avoidance Compliance Dissociation Fainting
Mental
State CALM ALARM FEAR ALERT TERROR
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Dimensions of Neuroplasticity
Development (Time)
Anatomy/Structure
Specificity (Specific neural network)
Pattern (frequency, intensity, timing)
All related to the dynamic activity of complex systems.
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
“Self-regulation” (SR)
Somatosensory regulation/self-soothing (SS)
Bottom – Up: Primary
Starts in womb; suck/swallow
Tied to intrauterine and perinatal associations
Breathing, walking, running, rocking, swimming, rhythm
Doodle, hum, swing, jump, dance
Cortical Modulation (CM)
Top – Down: Secondary
Tied to cortical development & state-dependence
Slower process -
Dissociation (Diss)
In – Out: Pervasive
Adaptive continuum
Mind-wandering to threat-induced full dissociation
Used rhythmically (“in-out”)
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Relational Regulation
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
“Self-regulation” (SR) Self-”soothing” – using SS
Cortical modulation
Dissociation
Somatosensory regulation (SS) Self vs Other
Relational regulation (Rel) Positive co-regulation
Co-dysregulation
Tied to primary relational templates
Pharmacological regulation (Rx)
Optimal regulatory interactions use “multiple” pathways
SS and Rel
Cort and SS
Diss and SS
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Developmental Trauma: Poly-pharmacy
Is this trauma-informed?
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Terror
Fear
Alarm
Alert
Calm
Time
Child
Adult
Co-dysregulation
Reactive child and overwhelmed teacher
Present, overwhelmed, frustrated, angry = escalation =
increased incidents/ restraint
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Terror
Fear
Alarm
Alert
Calm
Time
Child
Adult
Present, parallel, patient, persistent –
facilitate multisensory, multi-domain, repetitive activity
Rhythm & Relationship= Regulation
Co-regulation Reactive child and well-regulated teacher
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Sequence of Engagement
Reason
Relate
Regulate
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Core elements of positive developmental,
educational and therapeutic experiences
Relational (safe)
Relevant (developmentally-matched)
Repetitive (patterned)
Rewarding (pleasurable)
Rhythmic (resonant with neural patterns)
Respectful (child, family, culture)
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Healthy Early Caregiving Weaving Together the Neurobiology of Relationship, Reward and
Regulation
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Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Developmental Trauma: Relational Poverty
Is this trauma-informed?
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
What is Trauma-informed?
Trauma-informed
appreciates the individual &
the need for individualized
treatment
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
Genetic
Epigenetic
Intrauterine
Attachment
Stressors
AE 1
AE 2
AE 3
Dysregulated Typically Regulated Hardy, Resilient
Birth
Child A Child B Child C
Post AE Life
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
www.ChildTrauma.org
(Main Website)
www.ChildTraumaAcademy.com
(Online mini-courses)
Also see:
Twitter: @ChildTraumAcad
@BDPerry
Facebook: ChildTrauma Academy
YouTube Channel: The ChildTrauma Academy Channel
Bruce D Perry, MD, PhD © 2010-2014 www.ChildTrauma.org
February 12, 2014 from 12-1PM Working with Older Adults in Mental Health Services Presented by: Mari Umpierre, Ph.D., LCSW
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