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14. National Child Adolescent Psychiatry
Congress 21-14 April 2004
• Each year many children lived traumatic
experiences.
• These destructive experiences impact the
developing child, increa...
OUTLINE
• The purpose of this
presentation is to
outline how these
experiences may result
in increased risk by
influencing...
• At birth, the human brain is undeveloped.
• It is during childhood that the brain matures and the
whole set of brain-rel...
Brain-Enviroment Model
• Brain develops in a predictable fashion.
It’s genetically programmed.
• Normal development of the...
Critical Periods
• These sensitive periods are windows of
vulnerability during which the organizing systems
are most sensi...
• The development of the
brain during infancy and
childhood follows the
bottom-up structure.
• The most regulatory,
bottom...
• Optimal development of
more complex systems
(cortex) requires healthy
development of less
complex systems
(brainstem and...
Complexity-Plasticity
• The brain remains
sensitive (plastic) to
experience throughout
life—but different parts of
the bra...
Plastisity
• The brain is most plastic (receptive to
environmental input) in early childhood.
• Different regions require ...
Memory
• Different parts of the brain,
which mediate different
functions, store information
that is specific to the functi...
Memory
• The brain stores information in
a use dependent fashion.
• The more a neurobiological
system is ‘activated’ the m...
Arousal-Memory
• In different states of arousal (e.g. calm, fear, sleep)
different neural systems are activated.
• Because...
• The infant’s early developing right hemisphere has deep
connections into the limbic and autonomic nervous
systems.
• The...
“Experience can change the mature
brain—but experience during the
critical periods of
early childhood organizes brain
syst...
Experience can either positively or negatively
influence the maturation of brain structure. This
developmental psychoneuro...
Brain-Enviroment Model
(Geenenogh and Black 1992)
Experience-expectant
Synaptogenesis
“Use it or loose it”
Experience-depe...
Brain-brain interactions between infant and mother:
eye-to-eye contact, vocalizations, gestures,
movements.
All acting to ...
Secure attachment and efficient right brain
function is a resilience factor for optimal
development over the later stages ...
Social-emotional development and
lymbic system
• Lymbic system:
– Amygdala
– Cingulate gyrus
– Septal nucleus
– Hyppocampus
Infant Relational Traumas
• Neglect
• Abuse (physical,
emotional, sexual)
• Cronical and severe
stresfull contitions
(Long...
Trauma and Developing Brain
• Deprived or abnormal
rearing conditions induce
severe disturbance in all
aspects of social a...
Trauma and Brain Neurochemistry
• Severe traumas effect not
just nerve cells, but their
neurochemistry, including
the secr...
Neurotransmitters
• Norepinephrine (NE) exerts
a stimulating effect on
neural growth, significantly
influences neuronal
ma...
• NE serves a neuronal protective function,
• When depleted, such as in response to chronic
stress,
– neurons are exposed ...
• Secure attachment
protects the child from
any stressfull or
traumatic events in
lifetime. (Glaser 2000).
• Changes in heart rate during strange situation
episodes for different attachment groups.
• Disorganized group shows the ...
• Under cronical stress lymbic nuclei may:
– Atrophy
– Kindling (Seizure-like activity)
– Form abnormal synaptic interconn...
Effects of trauma on lymbic nuclei
• ATROPHY: Results in functional loss .
• KINDLING= Seizure-like activity: Has a
hypera...
Amygdala
• Amygdala rapidly develops and completes its
myelogenetic cycle of maturational development by
the end of the fi...
• Hence, until six to months the child will smile (or at
least stare) at the approach of anyone, even
complete strangers.
Amigdala
• During the amygdaloid maturational phase
there is indiscriminate orality and social
contact seeking.
• The cont...
They even attached to the other species !
Amygdala
• As fear and wariness are
hallmarks of amygdala
activity it is the continued
maturation of this nucleus
which is...
Amygdala
• The amygdala contains facial
recognition neurons which
discern the emotional
significance of different facial
e...
Amygdala
If the amygdala is
destroyed, emotional
functioning is virtually
extinguished and the
desire for social contact
i...
Amygdala
• Among humans, non-human primates, and
mammals, bilateral destruction of the amygdala
significantly disturbs the...
Amygdaloid Destruction
• Animals or humans with bilateral
amygdaloid destruction respond in an
emotionally blunted fashion...
Cingulate Gyrus
• Cingulate gyrus also reaches
an advanced stage of
maturity during the first year,
but continues to devel...
• The cingulate is capable of
considerable emotional
flexibility, engages in role
playing, and can mimic and
express emoti...
Septal Nuclei
• Undergoes a more protracted
rate of development and does not
begin to reach adult levels until
three years...
Septal Nukleus
• As the inhibiting septal nuclei, cingulate gyrus and
the orbital frontal lobes mature, the desire for
soc...
Septal Nuclei
• Whereas the immature amygdala
is associated with the oral stage,
the development of the so called
phallic ...
Septal Nuclei
• SEPTAL ATROPHY:
Tissues such as the
amygdala or hippocampus
are no longer subject to
septal counterbalanci...
• Depending on a number of factors including
– Age,
– Genetic predispositions,
– Length of deprivation,
– Inadequate mothe...
Age and course of the trauma
• Deprivation in humans and non-human primates
that begins soon after birth and which continu...
Age of the trauma
• By contrast, if deprivation or abnormal
experience is provided later in development,
limbic structures...
• Children placed in foundling
homes soon after birth become
the most bizarre, autistic, self-
abusive, and self-stimulati...
Results and Suggestions
• Despite the well-documented
critical nature of early life
experiences, we dedicate few
resources...
• In order to prevent the development of impaired children, we need to
dedicate resources of time, energy and money to the...
• Money, energy and resources for prevention would
be less than for treatment of severe mental health
problems.
Thanks for your attention...
References
• Carter AS (2004) Assessment of young children’s social-emotional
development and psychopathology: recent adva...
Early relational traumas and Infant Mental Health
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Early relational traumas and Infant Mental Health

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Each year many children lived traumatic experiences.
These destructive experiences impact the developing child, increasing risk for emotional, behavioral, academic, social and physical problems throughout life. The purpose of this presentation is to outline how these experiences may result in increased risk by influencing the development and functioning of the child's brain.

Published in: Health & Medicine
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Early relational traumas and Infant Mental Health

  1. 1. 14. National Child Adolescent Psychiatry Congress 21-14 April 2004
  2. 2. • Each year many children lived traumatic experiences. • These destructive experiences impact the developing child, increasing risk for emotional, behavioral, academic, social and physical problems throughout life.
  3. 3. OUTLINE • The purpose of this presentation is to outline how these experiences may result in increased risk by influencing the development and functioning of the child's brain.
  4. 4. • At birth, the human brain is undeveloped. • It is during childhood that the brain matures and the whole set of brain-related capabilities develop in a sequential fashion. • The process of sequential development of the brain is guided by experience.
  5. 5. Brain-Enviroment Model • Brain develops in a predictable fashion. It’s genetically programmed. • Normal development of the neuronal systems and the functions they mediate requires specific patterns of activity — specific signals — at specific times during development.
  6. 6. Critical Periods • These sensitive periods are windows of vulnerability during which the organizing systems are most sensitive to environmental input— including traumatic experience. • There are different sensitive periods for different functions (e.g., regulation of anxiety, mood, abstract thought) because the different systems in the brain develop (or mature) at differenttimes in the life of a child.
  7. 7. • The development of the brain during infancy and childhood follows the bottom-up structure. • The most regulatory, bottom regions of the brain develop first; followed, in sequence, by adjacent but higher, more complex regions Sequential Development
  8. 8. • Optimal development of more complex systems (cortex) requires healthy development of less complex systems (brainstem and midbrain) because these brain systems develop in a sequential fashion, from brainstem to cortex. Sequential Development
  9. 9. Complexity-Plasticity • The brain remains sensitive (plastic) to experience throughout life—but different parts of the brain are more plastic (cortex) and others are relatively less plastic (brainstem).
  10. 10. Plastisity • The brain is most plastic (receptive to environmental input) in early childhood. • Different regions require specific kinds of experience targeting the region's specific function (e.g., visual input while the visual system is organizing) in order to develop normally. • These times during development are called critical or sensitive periods.
  11. 11. Memory • Different parts of the brain, which mediate different functions, store information that is specific to the function of that part. • This allows for different types of memory (cognitive—such as names, phone numbers, motor —such as typing or bike riding, or affective – such as nostalgia).
  12. 12. Memory • The brain stores information in a use dependent fashion. • The more a neurobiological system is ‘activated’ the more that state will be built in. • Eg. memorizing a poem, practicing a piano, or staying in a state of fear.
  13. 13. Arousal-Memory • In different states of arousal (e.g. calm, fear, sleep) different neural systems are activated. • Because the brain stores information in a use-dependent fashion, the information stored in any given situation depends upon the state of arousal—which neural systems are activated. • Learning is one example of ‘state dependent ‘learning. • Another is the hyperarousal symptoms seen in post traumatic stress disorder.
  14. 14. • The infant’s early developing right hemisphere has deep connections into the limbic and autonomic nervous systems. • These systems are dominant for the human stress response. • The attachment relationship facilitates the expansion of the child’s coping capacities. (Shore 2001a).
  15. 15. “Experience can change the mature brain—but experience during the critical periods of early childhood organizes brain systems!”
  16. 16. Experience can either positively or negatively influence the maturation of brain structure. This developmental psychoneurobiological model clearly suggests direct links between: Secure attachment Efficient right brain regulatory functions Adaptive infant mental health Traumatic attachment Inefficient right brain regulatory function Maladaptive infant mental health
  17. 17. Brain-Enviroment Model (Geenenogh and Black 1992) Experience-expectant Synaptogenesis “Use it or loose it” Experience-dependent Synaptoogenesis The more a certain neural system is activated, the more it will "build-in"
  18. 18. Brain-brain interactions between infant and mother: eye-to-eye contact, vocalizations, gestures, movements. All acting to express interpersonal awareness and emotions.
  19. 19. Secure attachment and efficient right brain function is a resilience factor for optimal development over the later stages of the life cycle.
  20. 20. Social-emotional development and lymbic system • Lymbic system: – Amygdala – Cingulate gyrus – Septal nucleus – Hyppocampus
  21. 21. Infant Relational Traumas • Neglect • Abuse (physical, emotional, sexual) • Cronical and severe stresfull contitions (Long term hospitalization, grow up in orphanage
  22. 22. Trauma and Developing Brain • Deprived or abnormal rearing conditions induce severe disturbance in all aspects of social and emotional functioning, and effect the growth and survival of dendrites, axons, synapses, interneurons, neurons, and glia.
  23. 23. Trauma and Brain Neurochemistry • Severe traumas effect not just nerve cells, but their neurochemistry, including the secretion of neurotransmitters which are important in regulating neural development and neural plasticity.
  24. 24. Neurotransmitters • Norepinephrine (NE) exerts a stimulating effect on neural growth, significantly influences neuronal maturation and promotes neural plasticity and synaptic development during the early stages of preand post-natal development.
  25. 25. • NE serves a neuronal protective function, • When depleted, such as in response to chronic stress, – neurons are exposed to the debilitating effects of enkephalins and corticosteroids —stress hormones released as part of the "fight or flight" stress response. • Unfortunately, NE may fluctuate wildly in response to even mildly adverse early experiences. • In consequence, – Aberrant neural growth – Atrophy – Formation of abnormal neural networks
  26. 26. • Secure attachment protects the child from any stressfull or traumatic events in lifetime. (Glaser 2000).
  27. 27. • Changes in heart rate during strange situation episodes for different attachment groups. • Disorganized group shows the highest heart rates. (Nachmias 1996, Spangler 1999)
  28. 28. • Under cronical stress lymbic nuclei may: – Atrophy – Kindling (Seizure-like activity) – Form abnormal synaptic interconnections, • Resulting in : – Social withdrawal, pathological shyness, explosive and inappropriate emotionality, and an inability to form normal emotional attachments.
  29. 29. Effects of trauma on lymbic nuclei • ATROPHY: Results in functional loss . • KINDLING= Seizure-like activity: Has a hyperactivating influence, such that tendencies normally associated with the afflicted part of the brain may be exaggerated. • Abnormal synaptic interconnections : Results in unexpected functions.
  30. 30. Amygdala • Amygdala rapidly develops and completes its myelogenetic cycle of maturational development by the end of the first postnatal year. • The immature amygdala (Contact-loving amygdala):It is which is responsible for the extreme orality and indiscriminate socializing of the infant; • Interaction which it requires in order to mature normally.
  31. 31. • Hence, until six to months the child will smile (or at least stare) at the approach of anyone, even complete strangers.
  32. 32. Amigdala • During the amygdaloid maturational phase there is indiscriminate orality and social contact seeking. • The contact-loving amygdala expresses its experience-expectant needs. • Stimulus seeking was so high that they can attached to the different .
  33. 33. They even attached to the other species !
  34. 34. Amygdala • As fear and wariness are hallmarks of amygdala activity it is the continued maturation of this nucleus which is also responsible for the experience of wariness and then a fear of strangers.
  35. 35. Amygdala • The amygdala contains facial recognition neurons which discern the emotional significance of different facial expressions. • It is the infant's amygdala which selectively attends to and responds to the human face and which prefers faces to other stimuli.
  36. 36. Amygdala If the amygdala is destroyed, emotional functioning is virtually extinguished and the desire for social contact is essentially abolished.
  37. 37. Amygdala • Among humans, non-human primates, and mammals, bilateral destruction of the amygdala significantly disturbs the ability to behave in a socially normal manner, or to determine, discern, or identify motivational and social-emotional nuances, including facial expressions or body language.
  38. 38. Amygdaloid Destruction • Animals or humans with bilateral amygdaloid destruction respond in an emotionally blunted fashion, and become pathologically shy and "blind" and "deaf‘ to the social, emotional or motivational characteristics of their environment. • This social-emotional agnosia includes even the ability to feel love or affection.
  39. 39. Cingulate Gyrus • Cingulate gyrus also reaches an advanced stage of maturity during the first year, but continues to develop over the course of the next several years. • Contributes to the establishment of infant- maternal attachment during the latter half of the first postnatal year, • Including the expression of maternal separation anxiety.
  40. 40. • The cingulate is capable of considerable emotional flexibility, engages in role playing, and can mimic and express emotional states which it does not feel. • Hence, as the cingulate gyrus (and frontal lobes) continues to mature, additional cingulate activities emerge: – Complex play activities, role playing, and creative fantasy around age three.
  41. 41. Septal Nuclei • Undergoes a more protracted rate of development and does not begin to reach adult levels until three years of age; a process of development which actually continues well into puberty. • The septal nuclei inhibits and counters the indiscriminate social desires of the amygdala and contributes to a narrowing of social contact seeking and the generation of wariness of strangers.
  42. 42. Septal Nukleus • As the inhibiting septal nuclei, cingulate gyrus and the orbital frontal lobes mature, the desire for social contact becomes increasingly narrow, focused, inhibited, selective, and discriminating. • Hence, between 7-11 months of age, infants no longer respond in a generalized and indiscriminately friendly fashion. • They increasingly bond to their mothers, show separation anxiety, and are more likely to restrict their smiling and socializing to familiar faces and specific members of their family.
  43. 43. Septal Nuclei • Whereas the immature amygdala is associated with the oral stage, the development of the so called phallic stage of psychosexual development could be viewed as representing an advanced stage of septal maturation, • Septal stimulation induces penile erection and clitoral engorgement.
  44. 44. Septal Nuclei • SEPTAL ATROPHY: Tissues such as the amygdala or hippocampus are no longer subject to septal counterbalancing influences and will therefore function abnormally. • Septal destruction triggers an extreme desire for social and physical contact coupled with aggressive, assaultive and bizarre behavior. • KINDLING: Heightened and abnormal septal activity may increase and exaggerate the inhibitory influences on various portions of the amygdala, hypothalamus, and hippocampus. • Extreme social withdrawal and indifference
  45. 45. • Depending on a number of factors including – Age, – Genetic predispositions, – Length of deprivation, – Inadequate mothering, as well as the quality of the mothering, when she is present, • Different aspects of social-emotional development and different limbic system nuclei may be affected. • This is because the amygdala, septal nuclei, cingulate and orbital frontal lobes mature at different rates and become more or less vulnerable at different time periods.
  46. 46. Age and course of the trauma • Deprivation in humans and non-human primates that begins soon after birth and which continues for six months or longer results in the most profound disturbances of social-emotional functioning, in part because the amygdala and other still maturing limbic nuclei are directly impacted. • However, if some social and emotional stimulation is provided for the first several months, those limbic and amygdala neurons whose experience- expectancies were briefly met tend to survive and function somewhat normally.
  47. 47. Age of the trauma • By contrast, if deprivation or abnormal experience is provided later in development, limbic structures such as the septal nuclei are more severely affected. • Like those with septal destruction, children deprived later in life may crave social contact, but behave in a shy, bullying, and socially inappropriate manner.
  48. 48. • Children placed in foundling homes soon after birth become the most bizarre, autistic, self- abusive, and self-stimulatingand are the most likely to respond with "blood curdling screams" if strangers approach. • Children placed in foundling homes after six months or one year of age, although socially bizarre, violent and aggressive, often respond to strangers with extreme stickiness and persistently express an intense desire for social cohesion.
  49. 49. Results and Suggestions • Despite the well-documented critical nature of early life experiences, we dedicate few resources to this time of life. • We do not educate our children about development, parenting or about the impact of neglect and trauma on children. • As a society we put more value on requiring hours of formal training to drive a car than we do on any formal training in childrearing .
  50. 50. • In order to prevent the development of impaired children, we need to dedicate resources of time, energy and money to the complex problems related to child maltreatment. • We need to understand the indelible relationship between early life experiences and cognitive, social, emotional, and physical health. • Providing enriching cognitive, emotional, social and physical experiences in childhood could transform our culture.
  51. 51. • Money, energy and resources for prevention would be less than for treatment of severe mental health problems.
  52. 52. Thanks for your attention...
  53. 53. References • Carter AS (2004) Assessment of young children’s social-emotional development and psychopathology: recent advances and recommendations for practice. J Child Psychol Psychiatry 45(1):109-134 • Joseph R (1999) Environmental Influences on Neural Plasticity, the Limbic System, Emotional Development and Attachment. Child Psychiatry and Human Development, Vol. 29(3):189-208 • Schore AN (2001a) The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 2001, 22, 7-66 • Schore AN (2001b) The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health. Infant Mental Health Journal, 2001, 22, 201-269 • Zeanah CH, Smyke AT, Dumitrescu A (2002) Attachment disturbances in young children. II: Indiscriminate behavior and institutional care. J Am Acad Child Adolesc Psychiatry 41(8):983-989 • (www.ChildTrauma.org). • Perry B . Bonding and attachment in maltreated children. Consequences of emotional neglect in childhood. Adapted in part from: “Maltreated Children: Experience, Brain Development and the Next Generation” (W.W. Norton & Company,New York, in preparation)

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