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). 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 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 Overproduction of cortical grey matter. Synaptic Pruning. 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 Responsible for reason, logic, and rational thinking All Rights Reserved 2009 Dr. Linda Chamberlain Boys Girls More white matter – enhanced spatial skills such as aiming at targets, navigation, and mathematical problem solving 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 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 The teen brain is vulnerable to stress. Teens tend to overreact and escalate their emotions. Under stress, they may become more reactive and impulsive because it is harder for them to use their upper brain – neocortex. Major transformation of the amygdala and hippocampus. Adults rely on their neocortex to regulate their emotions, teens rely on their primitive limbic system. Teens often misinterpret other people’s emotions. Teens confuse anger with sadness or concern. Boys: Amygdala & hypothalamus grow larger: Girls: 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 Processing and storing information Evaluates threats by putting them into context of previous experiences Shape - Sea Horse Frontal Cortex 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. The reaction to the threat is “fight or flight.” The initial response is the alarm reaction. The threat triggers a total body response. The brain directs and controls this response. Arousal moves from vigilance to terror. 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 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. 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.) 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) 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. 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