1.
14. National Child Adolescent Psychiatry
Congress 21-14 April 2004

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.
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.
• 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.
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.
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.
• 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.
• 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.
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.
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.
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.
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.
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.
• 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.
“Experience can change the mature
brain—but experience during the
critical periods of
early childhood organizes brain
systems!”

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.
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.
Brain-brain interactions between infant and mother:
eye-to-eye contact, vocalizations, gestures,
movements.
All acting to express interpersonal awareness and
emotions.

19.
Secure attachment and efficient right brain
function is a resilience factor for optimal
development over the later stages of the life
cycle.

20.
Social-emotional development and
lymbic system
• Lymbic system:
– Amygdala
– Cingulate gyrus
– Septal nucleus
– Hyppocampus

21.
Infant Relational Traumas
• Neglect
• Abuse (physical,
emotional, sexual)
• Cronical and severe
stresfull contitions
(Long term
hospitalization, grow
up in orphanage

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.
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.
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.
• 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.
• Secure attachment
protects the child from
any stressfull or
traumatic events in
lifetime. (Glaser 2000).

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.
• 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.
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.
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.
• Hence, until six to months the child will smile (or at
least stare) at the approach of anyone, even
complete strangers.

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.
They even attached to the other species !

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.
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.
Amygdala
If the amygdala is
destroyed, emotional
functioning is virtually
extinguished and the
desire for social contact
is essentially abolished.

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.
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.
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.
• 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.
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.
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.
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.
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.
• 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.
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.
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.
• 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.
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.
• 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.
• Money, energy and resources for prevention would
be less than for treatment of severe mental health
problems.

52.
Thanks for your attention...

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)