Trauma and Brain Development
The brain develops from the inside out. A newborn’s brain has about 100 billion cells. At birth, the primitive brain, called the brainstem, is sufficiently developed to insure that vital functions can be maintained independently for a short period. Baby can breathe, the heart beats, the body temperature self-regulates, reflexes are operating. This is nature’s way of insuring that survival has a chance.
The baby is born with “hard wiring” for these vital functions. This hard wiring, however, doesn’t require all 100 billion cells, so what are the rest of the cells used for? At birth, the baby can perceive through his senses, but only dimly. For example, newborns can see, but can’t focus both eyes on a single object, see fine-grained detail or see with depth perception. The senses are developed fully through repeated experiences of sight, sound, touch, taste and smell.
A diagram of the human brain is like a topographical map with folds, grooves and mounds. There is a specific location on the brain’s surface, called the cerebral cortex, for each of the higher functions like emotions, memory, concentration, muscle movement, speech and language and the five senses. The “hard wiring” for these functions is built over time, through repeated experiences which stimulate nerve cell connections and circuits to the relevant parts of the brain. So, each time baby hears a sing-songy voice, or experiences a pleasant touch, is fed, or locks gazes with another, an electrical impulse fires along a series of neuronal cells, eventually zapping the corresponding area of the cortex. The more a brain function is appropriately stimulated, the more refined and dense will the circuitry for that function be over time.
Consider, then, that the developing brain is traumatized when there is an absence of stimulation, such as hearing language, being held or touched, seeing colours, or hearing music. The developing brain is deprived of the opportunity to fire those electrical impulses and develop dense networks of hard wiring for the specific functions that enable the growing infant to reach her full potential. Through high tech human brain imaging, researchers have found that neglect in the first three years results in a cortex that is 20-30 per cent smaller than those of children raised in enriched and nurturing environments because the stimulation for developing higher level brain functions isn’t there. Infants who are traumatized early in life develop brains that are highly attuned to danger. Stress hormones are repeatedly released, firing electrical impulses which “hard wire” the developing brain for fight or flight. The genetic coding for human development is toward growth, increasing complexity and an ascending order of function. The absence of stimulation to enable this development is more than a void; it is brain trauma.
During the first three years of life, the human brain develops to 90 per cent of adult size and establishes most of the systems and structures responsible for emotional, behavioural, social and physiological functioning throughout life. Infants who come into their families through adoption have sustained a myriad of traumas, and adoptive parents are uniquely challenged to support their little ones to achieve their emotional developmental tasks.
The Attachment Cycle
The newborn lets us know that she is uncomfortable by crying. Typically, a loving person (mom, dad, primary caregiver) quickly attends to baby’s need, cooing, stroking, comforting, speaking softly, making eye contact, rocking baby. Baby settles when her need is met, and the loving person is, in turn, rewarded by virtue of having successfully comforted baby. This reciprocal cycle is repeated over and over again. Each time baby receives a pleasurable, nurturing contact, specific neurochemical activities occur in her brain, leading to normal organization of brain functions. Baby experiences being calm, safe and a reason to trust that over and over again, her discomforts and needs will be soothed and remedied, usually by the same loving, familiar face.
The repetition of this cycle produces a strong attachment between infant and caregiver, necessary for survival and the ability, later on, to form healthy relationships with others. If the infant’s need is expressed and not met, discomfort escalates. Baby becomes angrier and cries louder.
A state of rage ensues, with baby kicking, arms flailing and a type of crying that comes from deep within with increasing intensity. Baby becomes afraid, triggering the fight or flight response and its carousel of stress hormones.
Repetitions of this scenario result in the development of mistrust, continual fear and disturbances in the ability to relate to, empathize with or be intimate with others later in life. Hard wiring for disturbances in regulation of emotions and learning difficulties occurs.
When the infant doesn’t receive appropriate sensory stimulation, he either begins to stimulate himself by rocking, head banging or other self-harming behaviours or he withdraws. The critical time to establish a healthy attachment with a child is in the first three years of life. Neglect, malnourishment, substance abuse, post-partum depression, inadequate or multiple caregivers, neonatal illness or a chaotic environment can all contribute to interference with the establishment of a secure attachment between infant and caregiver.
Clues that an infant may have some disturbance of attachment are continual resistance to being comforted and cuddled, an absence of “fold and mold,” that unique melting into the adult when held, avoidance of eye contact, resistance to feeding or other nurturing, inability to settle in the absence of a known explanation (e.g., gas pains), unexplained sleep disturbances, failure to distinguish primary caregiver from others. The late infant or toddler may show, in addition to the above behaviours, unexplained developmental delays, ambivalence toward one or both parents, raging, aggressive behaviour, indiscriminate seeking of comfort from strangers, extremely negative and controlling behaviour, premature inde- pendence, poor impulse control, absence of normal separation anxiety (none or extreme).
Spotlight on Building Attachment
Adoptive parents can do much to repair the damage their children sustained in their pre-placement lives. Attunement and patience is essential in building a healthy bond with the child. This requires extra sensitivity to the child’s cues, comfort zones and particular preferences in pleasurable contact. Activities which use primal soothing motions, such as rocking, bouncing, stroking, “raspberries” on the neck or belly will engage the child. If baby is resistant to certain touches, parents can interact in proximity, gradually getting closer as the infant develops more trust. For example, baby resists being held, but responds to being rocked in a table top baby carrier. Each interaction should include elements that promote eye contact. Hold an interesting article in front of baby and as she reaches for it, bring it closer to your face so she must catch your eye to get the treasured toy. Lots of language and encouragement along with these reciprocal activities will help baby associate these activities with mom or dad. When baby first comes home, avoid having him picked up and handled by people outside the immediate family until a primary connection with the parents is well established. Any appropriate activities that promote skin to skin contact, that baby will tolerate, will build an attachment connection. Parents should wear soft clothing with short sleeves so there are more opportunities for baby to experience pleasant touches. Activities can be combined with feeding, thus baby associates nourishment with nurturing. Feeding should be primarily done by one consistent person. Parents may need to require, when baby avoids eye contact, that she look at mamma before she gets the food or other desired object. This can be done in a fun way rather than a power struggle. Baby’s brain needs lots of stimulation so music, talking, laughing, looking at pictures, dancing, bouncy games, pat-a-cake and peek-a-boo or any other interactive activities that require baby to make eye contact and reciprocate will help build attachment. When opposition occurs in the older infant or young toddler, parents need to provide a safe, consistent environment, with lots of closeness between parent and child.
Discipline should build closeness. Use “time ins” rather than time outs, “house arrest” and more time with mom or dad, rather than being grounded. Doing chores together is a consequence that brings the child closer. For children who exhibit a high need to control, parents need to be “smarter” than the child, so the child is redirected to her appropriate role. The parents must be in control without engaging in power struggles with the child. This takes a lot of creative thinking, and a tool box full of techniques such as the “60 second scolding.” When the child misbehaves, the parent comes close to the child and gently holds her face so eye contact is made, which creates some arousal in the child. The parent speaks firmly and intensely (not shouting), telling, in age-appropriate language, how her behaviour affects mamma or daddy. Then, the voice is softened while hugging her, telling her how much she is loved and that mamma’s job is to take care of her, that together they’ll keep working the problem through.
Never use physical discipline or techniques that isolate or separate the child from the parent, as this reinforces the disturbed attachment. Parents should be prepared for two steps forward and one step back, especially when the child is highly stressed, is frightened or experiences a loss. During these times, progress in building attachment may recede while the child temporarily regresses to previous behaviours. Temper tantrums must be contained; thus, the parent should sit on the floor and gently hold the child, while he is in a rage, until it subsides. Gentle voices and expressions of love provide reassurance that the child can’t destroy the parent-child relationship. Help the child talk by using simple language: “Can you tell mommy if you’re feeling mad, sad or bad?” Never leave a child who is having a temper tantrum. This list of attachment building techniques is just a sample of the tools parents can put in their tool box.
P’nina Shames, RN, MSW, RSW, is a private practitioner in adoption serving the West Kootenays through Adoption Agencies throughout the Province. She can be reached at 250-352-9547 or by email at firstname.lastname@example.org