DEVELOPMENTAL TRAUMA

​In the first years of life, infants and toddlers need safe, predictable, accessible, and loving caregivers. In this environment the brain is able to develop in a healthy, normal sequence of growth.
 
The brain develops from the bottom upward. Lower parts of the brain are responsible for functions dedicated to ensuring survival and responding to stress. Upper parts are responsible for executive functions, like making sense of what you are experiencing or exercising moral judgement.
 
Development of the upper parts depends upon prior development of lower parts. In other words, the brain is meant to develop like a ladder, from the bottom up. When stress responses (typically due to consistent neglect or abuse) are repeatedly activated over an extended period in an infant or toddler, sequential development of the brain is disturbed. The ladder develops, but foundational steps are missing and many things that follow are out of kilter.
                       
Understanding that early/developmental trauma upsets the entire development of the person and limits the person's ability to use imagination and perception. Their lives become focused on survival where the need to learn and develop socially, emotionally, spiritually, and cognitively become overridden by the need to survive.
​Erin Diedling interviews Dr. Stephen Terrell, PsyD, about creating new healing paths in the field of psychology through specific, safe & therapeutic touch. He details early developmental trauma and how it's different from shock trauma. He uses therapeutic touch to regulate the subtle phases of the nervous system and repair early baby wounds, neglect and trauma. He also discusses how healing touch brings about resilience.
​“The most highly paced time of development in the human lifetime is the window between conception and three years of age.  When we spend too much time during this window in a state of survival physiology, we are not building the neurophysiological architecture that will fully support regulation and connectedness. Knowing the extent to which our very early lives shape our neurological hardwiring, it makes sense that early, sometime forgotten disruptions in our development can dramatically alter the way we experience the world, ourselves, and others.”  - Nurturing Resilience, p. 73 
Kathy Kain's Site | http://www.somaticpractice.net/about/ 
Stephen Terrell's Site | https://www.austinattach.com/ 

Brains: Journey to Resilience
​In a world where human brains inch across snowy landscapes, where perils lurk in every shadow, one community will rally behind a struggling brain—and just might change the world in the process. Learn about the resilience scale in this scientifically rigorous (and cinematically epic) video created by the Alberta Family Wellness Initiative in consultation with the FrameWorks Institute and the Harvard Center on the Developing Child.

​Consensus Proposed Criteria for Developmental Trauma Disorder 

by Bessel van der Kolk

​Exposure.  The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including:  
  • Direct experience or witnessing of repeated and severe episodes of interpersonal violence;  
  • Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse
 
Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following:  
  • Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization
  • Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions)
  • Diminished awareness/dissociation of sensations, emotions and bodily states
  • Impaired capacity to describe emotions or bodily states
​Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following:  
  • Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues  
  • Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking
  • Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation)
  • Habitual (intentional or automatic) or reactive self-harm
  • Inability to initiate or sustain goal-directed behavior
Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following:
  • Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation
  • Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness
  • Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers  
  • Reactive physical or verbal aggression toward peers, caregivers, or other adults
  • Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance
  • Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others
Functional Impairment. The disturbance causes clinically significant distress or impairment in at two of the following areas of functioning: Scholastic: under-performance, non-attendance, disciplinary problems, drop-out, failure to complete degree/credential(s), conflict with school personnel, learning disabilities or intellectual impairment that cannot be accounted for by neurological or other factors.
Familial: conflict, avoidance/passivity, running away, detachment and surrogate replacements, attempts to physically or emotionally hurt family members, non-fulfillment of responsibilities within the family.
Peer Group:  isolation, deviant affiliations, persistent physical or emotional conflict, avoidance/passivity, involvement in violence or unsafe acts, age-inappropriate affiliations or style of interaction.
Legal:  arrests/recidivism, detention, convictions, incarceration, violation of probation or other court orders, increasingly severe offenses, crimes against other persons, disregard or contempt for the law or for conventional moral standards.
Health:  physical illness or problems that cannot be fully accounted for physical injury or degeneration, involving the digestive, neurological (including conversion symptoms and analgesia), sexual, immune, cardiopulmonary, proprioceptive, or sensory systems, or severe headaches (including migraine) or chronic pain or fatigue.
Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training): disinterest in work/vocation, inability to get or keep jobs, persistent conflict with co-workers or supervisors, under-employment in relation to abilities, failure to achieve expectable advancements.

ADVERSE CHILDHOOD EXPERIENCES (ACES)

What are ACEs?

Adverse Childhood Experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household.

Traumatic events in childhood can be emotionally painful or distressing and can have effects that persist for years. Factors such as the nature, frequency and seriousness of the traumatic event, prior history of trauma, and available family and community supports can shape a child’s response to trauma.
 
"ACEs" comes from the CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence, as well as financial and social problems. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.

​The ACEs the researchers measured:
  1. Physical, sexual and verbal abuse.
  2. Physical and emotional neglect.
  3. A family member who is:
    1.  Depressed or diagnosed with other mental illness;
    2.  Addicted to alcohol or another substance;
    3.  In prison.
  4. Witnessing a mother being abused.
  5. Losing a parent to separation, divorce or other reason.
 
Subsequent to the ACE Study, other ACE surveys have expanded the types of ACEs to include racism, gender discrimination, witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a peer or adult, involvement with the foster care system, living in a war zone, living in an unsafe neighborhood, losing a family member to deportation, etc.

What is ACEs science?

ACEs science refers to the research on the prevalence and consequences of adverse childhood experiences, and what to do to prevent them. It comprises:
 
The CDC-Kaiser Permanente ACE Study and subsequent surveys that show that most people in the U.S. have at least one ACE, and that people with four ACEs— including living with an alcoholic parent, racism, bullying, witnessing violence outside the home, physical abuse, and losing a parent to divorce — have a huge risk of adult onset of chronic health problems such as heart disease, cancer, diabetes, suicide, and alcoholism.
 
Brain science (neurobiology of toxic stress) — how toxic stress caused by ACEs damages the function and structure of kids’ developing brains.
 
Health consequences — how toxic stress caused by ACEs affects short- and long-term health, and can impact every part of the body, leading to autoimmune diseases, such as arthritis, as well as heart disease, breast cancer, lung cancer, etc.
 
Historical and generational trauma (epigenetic consequences of toxic stress) — how toxic stress caused by ACEs can alter how our DNA functions, and how that can be passed on from generation to generation.
 
Resilience research and practice — Building on the knowledge that the brain is plastic and the body wants to heal, this part of ACEs science includes evidence-based practice, as well as practice-based evidence by people, organizations and communities that are integrating trauma-informed and resilience-building practices. This ranges from looking at how the brain of a teen with a high ACE score can be healed with cognitive behavior therapy, to how schools can integrate trauma-informed and resilience-building practices that result in an increase in students’ scores, test grades and graduation rates.

​The ACE Study revealed six main discoveries:

  1. ACEs are common…nearly two-thirds (64%) of adults have at least one.
  2. They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence
  3.  ACEs don’t occur alone….if you have one, there’s an 87% chance that you have two or more.
  4.  The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. People have an ACE score of 0 to 10. Each type of trauma counts as one, no matter how many times it occurs. You can think of an ACE score as a cholesterol score for childhood trauma. For example, people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.
  5.  ACEs are responsible for a big chunk of workplace absenteeism, and for costs in health care, emergency response, mental health and criminal justice. So, the fifth finding from the ACE Study is that childhood adversity contributes to most of our major chronic health, mental health, economic health and social health issues.
  6. On a population level, it doesn’t matter which four ACEs a person has; the harmful consequences are the same. The brain cannot distinguish one type of toxic stress from another; it’s all toxic stress, with the same impact.
    https://www.cdc.gov/vitalsigns/aces/index.html 

Short Film | ReMoved

​Matanick, N., Matanick, C. 2014. ReMoved is a short film following the emotional journey of a nine-year old girl who is taken from her abusive birth home and placed in the tumultuous foster care system. After winning multiple awards at several film festivals within the United States and internationally, this 13 minute film proceeded to spread virally online. The ReMoved Film was created with the intent to bring light to the often unknown subjects of Foster Care and Child Abuse/Neglect. Two additional ReMoved films were made in the series.
Beacon House is passionate about developing freely available resources so that knowledge about the repair of trauma and adversity is in the hands of those who need it. Please feel free to use our resources in your home or work setting. 
 
RESOURCES ON: Development Trauma, Neurosequential Model, Occupational Therapy, Trauma and Attachment in the Classroom, Child and Family Mental Health, Animations, Inner World Work

Links and Resources