Multidisciplinary Approach for Healthy
Brain Development
Prevention & Intervention Division
Health Care Agency
Behavioral Health Services
HOPE
An internal
representation of a better
world
All rights reserved 2004 Bruce D. Perry
http://www.ChildTrauma.org/
Violence is the threatened or actual use of
physical force or power against another
person, against oneself, or against a group or
community that either results in, or has a
high likelihood of resulting in deprivation,
injury, or death.
Violence is…
Neglect
Elder abuse
Child abuse
Bullying/ cyber bullying
Domestic violence
Media violence
Sexual abuse
Physiological impact
Long-term consequences
“Exposure” is defined as being
within sight or sound of the
violence.

By Age 12, children exposed to violence are
two times more likely to be diagnosed with:
 Attachment disorder
 Depression
 Anxiety disorder
 Oppositional defiant disorder
(Dr. Linda Chamberlain, Alaska Family Violence Project)

Children exposed to violence (as victims or
witnesses), are more likely to become
juvenile and adult offenders.
(The ChildTrauma Academy 2004)
The Mismatch Between Opportunity and Investment
Spending on Programs Designed to
“Change the Brain”
Brain “Malleability”
0
3
Public Education
Early Childhood Programs
All rights reserved 2004 Bruce D. Perry
10
Juvenile Justice
Age
Criminal Justice
50
Mental Health/Substance Abuse
www.ChildTrauma.org

37,977 child abuse reports were filed in
Orange County during 2009 – 2010. The
age range of 0-5 represented 35% of the
total reports.
(Report on the Conditions of Children
in Orange County, 2011)
Creating this Local Orange
County Initiative
 Three Organizations:
 Westminster Police Department
 Orange County District Attorney’s Office
 Orange County Department of
Education
 July 2002 first meeting of OC Safe
from the Start Steering Committee
Safe from the Start is a public health
campaign to assist communities in
reducing the impact of violence on
children.
“Every Orange County Child Is My
Concern.”
1. To build an improved system of local and
county collaboration.
2.
To assist local communities and families to
reduce the number of young children exposed
to violence.
3.
To provide resources to educate parents,
guardians, and community members about
basic brain development and its effect on child
and adolescent behavior.
4.
To develop a parent workbook in multiple
languages (including English, Spanish,
Vietnamese, Farsi, and Korean).
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Anti-Defamation League of Orange
County
Children’s Hospital of Orange County
(CHOC)
County of Orange, Health Care Agency –
Prevention and Early Intervention
County of Orange, Social Services Agency
DoctorS Nonprofit Consulting
Early Intervention for School Success
(EISS)
Health Options
Human Options
McKinney-Vento Homeless Act
Orange County Department of Education
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Orange County District Attorney
Orange County Sheriff
Orange County Superior Court
Orange County United Way
Pacific Life Foundation
PHFE Management Solutions
The Family Violence Project
The Raise Foundation
Violence Prevention Coalition of Orange
County (VPCOC)
Wal-Mart (Westminster Store #2495)
Western Youth Services
Westminster Police Department
Reducing Children’s Exposure to Violence Initiative educates parents, guardians, and the
community regarding early childhood brain development, child development and behavior; and
adolescent brain development.
Agency Involvement
Law
Enforcement
Social Services
Mental Health
Sheriff/Police
departments
trained
Social Services
Agency Staff
trained
OC Health Care
Agency Staff
trained
Family
Courts/Family
Violence Council
Orangewood
Children’s Home
Public Health
Nurses
Education
Teachers trained to
recognize signs of
domestic violence
or child abuse
School
Counselors/School
Resource Officers
Broader Community
Parents/Families/
Children
PTA/Parent
Advocates
Family Resource
Centers
Shelters
Faith
Community
Multiples of Weight at Birth
20
15
Body
10
Brain
5
0
5
10
Age in Years
15
20
All rights reserved © 2004 Dr. Bruce Perry
1.
2.
3.
4.
5.
True or False: By age 6, a child’s brain is nearly
the size of an adult brain.
The human brain weighs about the same as an
average grapefruit or cabbage.
The human brain is the consistency of a banana
or jelly.
The cortex is one of the first or last areas of the
brain to develop.
True or False: Development of the child’s brain
is complete by 6 years of age.

In utero brain development. A clip or a
graphic. Experiences Build Brain Architecture
You Tube clip (2min)

In utero and during the first four years of life, a
child’s developing brain organizes to reflect the
child’s environment.

Physical connections call synapses between nerve
cells increase and strengthen through repetition.

Use it or lose it

From birth to 8 months, there is an explosive
increase in the number of synapses.

At birth, the brain cells are not organized.

Each brain area has its own timetable for
development.
▪ The adult brain weighs about
three pounds.
▪ At birth, brain is rapidly growing
and 60% of calories are used by
the brain.
▪ As an adult, only 18% of calories
are used by the brain.
▪ Everything we do, everything we
think, everything we feel, every
wish, dream, regret and hope is
regulated by our brain.
Neocortex
The brain is hierarchical
from bottom to top and
from simple to complex
Limbic
Diencephalon
Brain Stem
All rights reserved 2004 Bruce D. Perry
www.ChildTrauma.org

Our brain wants to create a state of
homeostasis (equilibrium).

Physical and chemical information
from outside the body travels up into
the brain to be processed.

Our five senses filter our experiences:
 Sight
 Sound
 Taste
 Smell
 Touch

Information is sent to the brain stem
deep in our brain.

The brain matches the information
against previously stored patterns.

Then the brain chooses an action.
Neocortex
Limbic
Diencephalon
Brainstem
All rights reserved © 2004 Dr. Bruce Perry
Abstract thought
Concrete thought
Affiliation
"Attachment"
Sexual Behavior
Emotional Reactivity
Motor Regulation
"Arousal"
Appetite/Satiety
Sleep
Blood Pressure
Heart Rate
Body Temperature

The brainstem is the least complex part of the brain
and regulates automatic body functions such as
breathing, heart rate, and the fear response.

The cortex is the most complex part of the brain
with 50% of all neurons, or nerve cells.

The cortex regulates complex thinking.
Neurons: the Brain’s Building Blocks

At birth we have one billion neurons and one trillion glial
cells.

No two neurons are the same.

Glial cells help the electrochemical communication between
neurons.

They wrap around the neuron to insulate the cell with a
substance called myelin.
Some information taken from “The Amazing Teen Brain: What Every Child
Advocate needs to Know” by Dr. Linda Chamberlain and “Brain Fact” from the
Society of Neuroscience.

During puberty, the teen brain begins to
undergo many changes including:
 More efficient
 Advanced skills
 Use it or lose it
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Overproduction of cortical grey matter.
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Synaptic Pruning.
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Myelination of nerves – the final coating of
myelin develops in early to mid 20’s.

Prefrontal cortex begins to thicken.

Growth spurt around 9 or 10

Synaptic pruning begins
around age 12
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Responsible for reason, logic,
and rational thinking
All Rights Reserved 2009 Dr. Linda Chamberlain
Boys
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Girls
More white matter –
enhanced spatial skills such as
aiming at targets, navigation,
and mathematical problem
solving
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More grey matter –
more efficient in
processing information,
have stronger verbal
skills, and can often
multi-task
All Rights Reserved 2009 Dr. Linda Chamberlain

Teens have tremendous capacity for acquiring new
knowledge and skills

Lack of capacity for multi-tasking
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They have difficulty with organizational skills and
prioritizing

Teens may seem defiant, but are actually
overwhelmed

Vulnerability is the capability of being physically
wounded; open to attack or damage

Rapid development during the teen years, makes
teens more sensitive to stress and neurotoxins, such
as alcohol, tobacco, and drugs
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The teen brain is vulnerable to stress.
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Teens tend to overreact and escalate their emotions.
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Under stress, they may become more reactive and impulsive
because it is harder for them to use their upper brain –
neocortex.
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Major transformation of the amygdala and hippocampus.
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Adults rely on their neocortex to regulate their emotions,
teens rely on their primitive limbic system.
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Teens often misinterpret other people’s emotions.
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Teens confuse anger with sadness or concern.
Boys:
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Amygdala & hypothalamus
grow larger:
Girls:
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Hippocampus grows faster:
 Strong social skills
 Body’s response to fear
 Emotionally supportive
 Contact sports
 Coordinate complex
 Increased sexual desire
relationships
 Assertive behaviors
All Rights Reserved 2009 Dr. Linda Chamberlain

Lack of sleep can affect teens’ brain development and their
ability to manage their emotions

Teens need 9.5 hours of sleep per night; more than adults.

Sleep deprived teens are more likely to be:
 Depressed
 Lack of emotional control
 Act aggressively
 Human response to threat.
 Children respond or “experience”
trauma or maltreatment differently
than adults.
Amygdala

The brain’s rapid response
system to fear that sends the
body into high alert.

Helps determine what
behaviors and individual will
learn and remember.

Size of an almond.
Hippocampus
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Processing and storing
information
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Evaluates threats by putting
them into context of previous
experiences
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Shape - Sea Horse
Frontal Cortex
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Reins the amygdala and
calms the body if the threat
is determined to be
insignificant.

If they are children exposed
to violence, they don’t have
the hardware.

The human body and mind have a set of very important
and very predictable responses to threats.

A threat can be from inside or outside the body.
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The reaction to the threat is “fight or flight.”
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The initial response is the alarm reaction.
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The threat triggers a total body response.
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The brain directs and controls this response.
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Arousal moves from vigilance to terror.
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If a child can not flee or fight they may dissociate.

Dissociation is a mental mechanism
that allows the child to withdraw
inward, perhaps to a fantasy world.

When the traumatic event ends, the
child moves slowly back down the
continuum to calm.
Moving up and down arousal continuum is universal.
Sense of
Time
Extended
Future
Primary
secondary
Brain Areas
Loss of
Minutes
Sense of
Seconds
Time
Days
Hours
Hours
Minutes
NEOCORTEX
SUBCORTEX
LIMBIC
MIDBRAIN
BRAINSTEM
Subcortex
Limbic
Midbrain
Brainstem
Autonomic
Cognition
Abstract
Concrete
Emotional
Reactive
Reflex
Mental
State
CALM
AROUSAL
ALARM
FEAR
TERROR
•At a young age, domestic violence causes stress responses to develop in an abnormal way.
•The brain is stuck in a threat state and never has a moment to calm.
•Difference between a child of domestic violence and a healthy (organized) stress response. Once brain is
organized, it has specific cues to threat.
•However, you can develop in a normal, healthy way; and then be raped. This changes arousal state.
All rights reserved © 2004 Dr. Bruce Perry
Adaptive
Response
Rest
Vigilance
Freeze
Flight
Fight
Hyperarousal
Rest
Continuum (Male Child)
Vigilance
Resistance
Defiance
Aggression
Dissociative
Continuum
Avoidance
Compliance Dissociation
(Adult Male)
Rest
Fainting
(Female Child)
Primary
secondary
Brain Areas
NEOCORTEX
SUBCORTEX
LIMBIC
Subcortex
Limbic
Midbrain
Cognition
Abstract
Mental
State
CALM
MIDBRAIN
Brainstem Autonomic
Concrete Emotional Reactive
AROUSAL ALARM
BRAINSTEM
Reflex
FEAR TERROR
All rights reserved © 2004 Dr. Bruce Perry
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Traumatized children may have less capacity
to tolerate every day demands and stresses
of school, home, and their social life.
When faced with a challenge:
 Resilient children are likely to stay calm
 Normal children may become vigilant or slightly
anxious
 Vulnerable children react in fear and terror
(Dr. Bruce Perry, 2004)
Terror
Fear
Vulnerable
Alarm
Normal
Vigilance
Resilient
Calm
Baseline
Stress
Trauma
All rights reserved © 2004 Dr. Bruce Perry

If the event reoccurs often, the child
will remain hyper vigilant and hyperaroused.

Persisting physiological and
emotional distress is physically
exhausting and emotionally painful
to the child.

When this hyper vigilant state occurs,
the brain development stops.

If this state is chronic, the higher
centers of the brain do not develop
normally.
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Traumatized children, when faced with
reminders of the original traumatic event,
may experience so much pain and anxiety
that they become overwhelmed.
This overwhelmed state is called
Post Traumatic Stress Disorder (PTSD).
These images illustrate the negative impact of neglect on the
developing brain. The CT scan on the left is from a healthy three
year old child with an average head size (50th percentile). The
image on the right is from a three year old child following severe
sensory deprivation neglect since birth. The brain is significantly
smaller than average and has abnormal development of cortical,
limbic, and midbrain structure. (Bruce D. Perry, M.D., Ph.D.)
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Children in a state of fear retrieve information
from the world differently than children that
feel calm.
Children that do not feel secure live in a state
of emergency.
The crisis consumes their energy and makes
it impossible for them to focus on learning.
(Jenny Horsman, 2000)
Infants exposed to violence
have eating and sleeping
problems, decreased
responsiveness to adults, and
increased crying.
(Source, Jaffe et al, 1990; Hughes & Brarad, 1983)

An 18 month old female infant, “Tina,” lives in a
home with ongoing domestic violence (threats,
intimidation, pushing, slapping, and one
incident of attempted strangulation). Tina is
underweight, has feeding problems, and seems
irritable when she is touched or picked up. She
was brought in for an evaluation because she
sleeps with her eyes open.
See this often in these cases…adaptive behavior to the violent home. (Dr. Linda Chamberlain, 2008)
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Violence and terrorizing environments affect
the child’s cognitive/academic, emotional and
social functioning.
Having an intact, supportive, and nurturing
family environment protects the brain’s
normal development.
Childhood exposure means more than
“seeing” the violence--children hear it, feel it,
and LIVE it.
The vortex of violence is a flow of
violence down a power differential.
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Men against men
Men against women
Women against women
Women against children
Child against younger child
Young child against animals

If one is smaller and weaker, it is likely that
the direction of the frustration and violence
will be from the more powerful to the least
powerful.

The child at the center of the vortex will
absorb and accumulate the violence and
wait until they are old enough, big enough,
strong enough to hurt humans, or they may
pass it on to animals.

Living in this vortex of violence creates
violent children.

The cycle of violence continues
throughout adulthood.
Children exposed to consistent, predictable, nurturing, and
enriched experiences will develop neurobiological capabilities
that will increase their chance for health, happiness,
productivity, and creativity.
 Experience refers to the interaction between the individual
and his/her environment (Scarr & McCartney, 1983).
 Somatosensory Bath: When the child’s development is
characterized by structure, predictability, nurturing, and
enriching emotional, social and cognitive experiences, a
vulnerable and powerless infant can grow to become a happy,
productive, insightful, and caring member of society.

In Caregiver – Infant interaction:
Touch
Taste
Sight
Smell
Sound
Movement
These primary sensations play a
major role in providing the
patterned, repetitive, sensory
stimulation and experiences
that help organize the child’s
developing brain.
All rights reserved © 2004 Dr. Bruce Perry
“What we are as adults is the
product of the world we
experienced as children.”
Dr. Bruce Perry

Websites:
 Center on the Developing Child at Harvard University
www.developingchild.harvard.edu/
 Dr. Linda Chamberlain, Ph.D., MPH
www.drlindachamberlain.com
 Laboratories of Cognitive Neuroscience at Children’s
Hospital Boston
www.childrenshospital.org/research/brainworks
 National Scientific Council on the Developing Child
www.developingchild.net/pubs/wp.html
 The ChildTrauma Academy www.Childtrauma.org
Jannell Jones, M.S.
Program Specialist, OC Safe from the Start
Orange County Department of Education
(714) 327-8195; jjones@ocde.us
Mary Marlin, M.S.N., R.N., P.H.N.
Consultant, OC Safe from the Start
President, Health Options
(949) 322-8520; healthoptns@hotmail.com
Debra Lynn Stout, Psy.D.
Consultant, OC Safe from the Start
DoctorS Nonprofit Consulting
(714) 356-2798; debbie@doctorsconsulting.org
http://ocsfts.ocde.us