Holidays and Memories

I was driving across the state two weeks ago and enjoying the fall colors as I headed over Vail Pass. My radio playing, the road ahead, and the beautiful scenery put me into a very nice, calm state of mind. Then the radio station announced that the next hour would be commercial-free and they were going to play music from “The British Invasion.” Songs from the Beatles, Stones, Animals and many more famous groups from that time began to play. I found myself singing songs I didn’t even realize I remembered the words to. Memories from my younger years came back along with many emotions. Memories of friends, girlfriends, parties, school teachers, and family rose into conscious awareness. All the time I was rocking out and reminiscing, I was flying down the highway at 80 miles an hour. What an amazing organ the brain is to allow me to engage in such a complex skill as driving, while I enjoyed my surroundings and revisited my past!

Brain Processing

Our brains are made up of 100 billion neurons, each forming connections with thousands of other neurons. This complex network of cells allows for the flow of information and energy through the organ. The nervous system converts sensory stimuli from the external environment into patterned electro-chemical signals. These signals have the capacity to modify the efficiency of communication between neurons and to change the actual architecture of the neurons themselves. The ability of neurons to change in response to stimuli is called plasticity. Plasticity is the mechanism that allows for learning, memory and development.

Our brains process environmental signals by modifying the connections between neurons and generating an internal representation of the external world. This is the foundation of memory. Our memories are not stored in just one place, but in various pieces throughout the brain. Visual information is stored in one area, auditory information in another, and emotions have a separate area. However, they are all connected through neural networks.
The way the brain categorizes information is by creating associations between stimuli. So when you hear barking you automatically envision a dog. This capacity to associate allows us to experience the present, compare it to the past and then anticipate the future, which increased our chances of survival. Imagine if we heard the roar of a lion, but had to wait until the lion appeared before reacting. Being so slow and weak as a species, anticipation became a real asset.

Multiple memory systems

Nature has a way of sticking with old designs and then building new functions on top of them. Memory is not a single system, but is composed of different systems that work together—when the system is functioning well. The memory system most of us recognize easily is the verbal system or declarative memory. These are memories that we are conscious of and can declare to ourselves and others.

A second memory system records experiences in sensations, images, emotions and behaviors. These memories function outside our conscious awareness but influence our actions on a daily basis. Information stored in this memory system is not expressed in words, but through internal or external actions. It is in this lower memory system that the procedures for driving are activated and occur without conscious attention.

The Drive

So you see that my driving activated my non-verbal, procedural memory system allowing me to operate the car while the music served as a cue to my declarative memory system to activate the neural pathways connecting the music to lyrics, past experiences and the many emotions connected to those experiences. However, when all of those memories came back to awareness they were changed because now in the future those songs and memories will be associated with that drive through the mountains on a sunny autumn day. Each time we retrieve our memories, they are modified by the current context in which they are recalled. Memories are not like photographs, but are evolving estimates of what actually occurred in the past.

Adverse Experiences

Memory systems function best when we experience a balance between stimulation and recovery. Under these conditions the brain works in an integrated manner allowing information and energy to flow both horizontally and vertically. Physical sensations, emotions, and cognitions are combined with information from the past and anticipated future to direct an adaptive behavioral response. Under adverse conditions, such as neglect or abuse, memory does not function so well.

From a biological perspective, neglect is the lack of developmentally required stimulation and abuse is exposure to prolonged, severe levels of arousal. For many of our clients who have had adverse childhood experiences, the traumatizing event may have taken place prior to the verbal system maturing.  This means that their memories cannot be consciously recalled or communicated verbally. For older children, the adverse event may have interfered with the integration of these systems so memories not only cannot be shared with others but cannot even be verbally declared to the self. These systems are dissociated from each other. The only way to express memories is through body sensations, images or behavior.  For these children, past events are not understood as memories from the past but rather experiences in the present. Our clients tell their stories by the relational situations they recreate.

Holiday Celebrations

This holiday season we should all be aware that for traumatized children and their families, association to the rituals connected to this season (songs, lights, foods, gifts) may trigger feelings of distress, frustration, abandonment and pain. Many of their memories cannot be expressed in words but only re-experienced in relational interactions. The greatest gift that caregivers, teachers, caseworkers, and other professionals involved with this population can give to a child is to be present, attentive, attuned and responsive to their developmental need for both stimulation and soothing. By having a different relational experience this holiday, where others truly hear, validate and respond, will allow vulnerable children to use their past memories in a way that begins to incorporate new meaning for the future.

Keys to a Safe Holiday Season

• Awareness: “What are my associations to the holidays and how might they be different than those of the children in my care?”
• Stay connected to your children so that you can monitor their arousal levels
• Know your children’s stress tolerance levels and structure recovery times before they get overwhelmed. Just because it is a special time of year our stress tolerance levels don’t change. 
• Try and structure quiet relational times to verbally process the day’s events.
• As much as possible try and communicate any upcoming change in structure so your children can anticipate transitions.
• Develop a safety plan so your children can signal you if they are getting overwhelmed, or you can signal them if you see them getting overwhelmed and what steps can take place to find space to recover.
  

All of these steps can be worked on collaboratively and put in place before the holidays begin. Your goal is to create a safe, positive experience for yourself and the children in your care.

Happy Holidays!

Is It Ten Years Already? Seems Like Yesterday.

November 22, 1963—I am nine years old, home sick from school, watching television when the news flashes across the screen that John F. Kennedy has been shot.

April 19, 1995—I am sitting in my office reading reports, when a co-worker tells me to turn on the radio because of the Oklahoma City bombing. Who can forget the sight of that fireman holding the infant outside the federal building? 

April 20, 1999—I am working with teenagers at the Denver Children’s Home when another child tells me that two students attacked other defenseless students at Columbine High School right here in Colorado.

September 11, 2001—driving into work, my car radio informs me that a plane has hit the World Trade Center. I arrived at work shortly after the radio announcement and turned on the television to watch in disbelief as the towers collapsed.

Images of all of these events have been seared into my memory. I viewed the events multiple times on those historic days, the same way I find myself drawn to look at a car accident on the highway. They scared and angered me and yet I couldn’t turn away. When something in our environment is perceived as threatening it is difficult to disengage. Each of these events altered my perception of the world and my personal sense of safety and security. Memory researchers call these “flashbulb” memories. Memories of events that are highly emotionally significant that the brain records them more vividly and we believe we recall them more accurately then other less significant events.

That day—September 11, 2001—normal activities were not an option and I wanted to make contact with people I cared about. Everyone I interacted with shared what they were thinking and how they were personally impacted. Our cognitive templates didn’t account for such catastrophes. When threatened, our biological directives cause us to seek proximity to each other and begin circling the wagons.  It is amazing how tragic events seem to draw people closer together. We all shared something painful and we all felt soothed by our relational connections. However, when we huddle together that means everyone outside the circle is a danger.  Nobody wants to say anything that might get them kicked out of the circle. In times of danger, we must present a united front to our perceived enemies.

Although these events have many things in common, our response to them is what creates the difference. The message we received in those earlier events—before 9/11—was that the actions of disturbed individuals resulted in a terrible disaster.  However, the world was still good. The rituals, the funerals, the grieving and healing helped put meaning to the overwhelming, unimaginable experiences.

Something of a different magnitude occurred on 9/11 and changed forever the way we think, feel and behave when it comes to safety and protection. The world on that day was divided into good and evil. Our only hope of survival was to defend ourselves. As a nation we had to seek out and destroy the threat before it destroyed us. Survival was, and still is, at stake. Laws were quickly enacted and policies implemented that were designed to protect us but in reality generated increased anxiety.  Every time we travel we are reminded that the world is an unsafe place and that danger is ever present.  It is as if the very strategies that were initially put into place to keep us safe became the obstacles to healing and moving forward.

In some ways Kennedy’s assassination, the Oklahoma City bombing, and Columbine created an acute stress response, but 9/11 resulted in an entire nation suffering from Post Traumatic Stress Disorder. The diagnostic criteria for PTSD:

Exposure to traumatic event in which both the following were present

• Experienced, witnessed, or was confronted with an event or events that involved actual or threatening death or serious injury, or a threat to the physical integrity of self or other
• Response involves intense fear, helplessness or horror

The traumatic event is persistently re-experienced in one (or more) of the following ways

• Acting or feeling as if the traumatic event were recurring
• Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• Physiological reactivity to exposure to internal or external cues that symbolize or resemble the traumatic event

Persistent avoidance of stimuli associated with the trauma

• Efforts to avoid activities, places, or people that arouse recollection of the trauma
• Efforts to avoid thoughts, feelings or conversations associated with the trauma
• Diminished interest or participation in significant activities
• Restricted range of affect
• Sense of foreshortened future

Persistent symptoms of increased arousal (not present before the trauma)

• Hyper-vigilance
• Exaggerated startle response
• Irritability or outburst of anger

Duration of disturbance more than one month

The ongoing anxiety generated by 9/11 changed the world and shattered our assumptions. The speed in which we enacted new laws and shifted power to one branch of government and eliminated certain liberties, without understanding and debating the long term impact of those decisions, suggested the level of threat we felt we were under.  The openness to go to war with a country that was not even connected to 9/11, because it presented a potential threat, suggested how reactive we were. New homeland defense measures were funded and continue to function ten years later. Our profiling of a group of people that triggered memories of the traumatic incident suggested our efforts to avoid these individuals at all costs. I don’t think we monitored the whereabouts of all white middle class teenagers after the Columbine incident. No exaggerated startle response was necessary because we portrayed those two teenagers as troubled youths, unlike other teens.

Sandra Bloom, Past-President of the International Society for Traumatic Stress Studies and author of Creating Sanctuary: Toward the Evolution of Sane Societies and co-author of Bearing Witness: Violence and Collective Responsibility, states that under severe stress, a leader rapidly emerges within a group. The process is a combination of the needs of the group, individual characteristics of the individual leader and the demands of the moment. Under these conditions humans become more suggestible to the influence of a persuasive leader who represents the best defense for the clan and has the function of binding the group’s anxiety. Decisions are made quickly with input that is colored by a pressure to conform to standards of group cohesion (Neither Liberty Nor Safety, pg. 9). 

This tenth anniversary of 9/11 is an opportunity for our nation to heal from our wounds rather than just defend ourselves from possible future threats. Research over the past decade has shed light on how exposure to life threatening adverse events changes how an individual, an organization or even an entire nation  perceives, processes, stores, retrieves and acts upon environmental stimuli that has become associated with a traumatic event.

Trauma-sensitive approaches to helping victims heal suggest that our country must find a way to redefine our definitions of “safety” and integrate our past traumatic experience into a coherent narrative that can be used to navigate a healthier vision of the future. As a psychologist who works on a daily basis with victims of trauma, I am looking to leaders who are:

• Committed to creating an environment of physical, emotional, social and moral safety, so that we can engage our higher brain regions in advancing innovative and creative solutions to the complex problems confronting our world.
  
• Communicating clearly about actual probability of a threat and not scaring people with the possibility of an attack.
  
• Determined to look inward for the solutions rather than blaming others. In some respect we are a developmentally very young nation that needs healthy, attentive, attuned, responsive caretakers to both sooth us and challenge us to express our optimal potential.
  
• Capable of reflecting upon the decisions that were made under imminent danger and evaluating the need for elimination or modification of those decisions.
  
• Willing to shift our resources away from protection toward policies of optimal growth.
  
• Open to engaging in honest dialogue about what lead up to the attack and how we reacted. This dialogue is designed not to point fingers and blame, but as a way of beginning to integrate our experience, learn from the past, and begin to create a brighter future.
  
• Ready to invest in educating our citizens about the benefits of developing healthier relationships within families and communities. Work on supporting the development of adaptive coping strategies to deal with potential threats and challenges rather than short term solutions.
  
• Motivating individuals to not only remember the tragic events but to encourage them to perform some positive, caring action in their community.

Terrorism comes in many forms and in all walks of society.  The symbols of the collapsing towers and the loss of 3000 valuable lives can serve to awaken all of us to the terrible fear and pain children in our country face every day. Millions of children are abused neglected and exposed to violence in their homes and in their communities each year. In a 2004 longitudinal study of 768 New York City teens, reported in Applied Development Science (Vol.8, No.3) and sited in an article by Tori DeAngelis (Monitor on Psychology, September, 2011), the authors compared the rate of mental health problems among those exposed to the 9/11 attack with those teens who had experienced or witnessed community violence but were not directly exposed to the attack on 9/11. These youth are exposed to assaults, domestic violence, bullying, and murders were far more likely to experience a mental health issue than those exposed to the isolated event of September 11, 2001. True Homeland defense must not exclude those most at risk.  Take this tenth year anniversary to find a way to get involved in  your community to improve the quality of life for someone more vulnerable than yourself and making the world a safer place.

“The role of elders in any society is to determine what experiences we want our children to be exposed to with enough repetition that it gets passed onto the next generation.” Dr. Bruce Perry, ChildTrauma Academy 

Stress Changes The Way We Think - Part Two

Individuals who are exposed to isolated traumatic events, such as crime, car accidents, serious injuries, or medical procedures, may have a similar reaction to mine, but more intense.  These individuals experienced a biological reaction—stress, pain, fear—and the body replays these reactions whenever something reminds them of the stressful event.  They may find themselves avoiding situations that remind them of their scary experience. They might sense a physiological stress reaction to cues that have become associated with their painful memories.

Therapeutic interventions for people exposed to single traumatic events are designed to expose them to the cues associated with their painful memories of the event, but in a predictable, moderate manner. This allows them to master the situation and integrate it into narrative story that can be used to build resilience for the future. Cognitive focused treatments, EMDR (eye movement desensitization and reprocessing) and other trauma-sensitive treatments are very effective in helping these clients recover from their exposure to an overwhelming event.

Sadly, the children referred for treatment at the Denver Children’s Advocacy Center (DCAC) are rarely the victims of a single crime.  While parents live in fear of “stranger danger,” the little girl from a happy home who experiences one vicious sexual assault on her way home from school is actually much more likely to heal from the trauma than is a child who has been repeatedly abused from infancy.

The majority of children in treatment at DCAC have a chronic history of maltreatment that has affected their development and disrupted the functioning of their regulatory systems. Current stressful events are interpreted through a lens filtered with past traumatic experiences. Their brains lose the capacity to use internal sensations and feelings as a guide to interpret current events. Everything is associated with threats from the past and perceived as dangerous.  They are in a state of perpetual stress. 

Fight or flight works well in the jungle, or in response to a single isolated emergency—the need to run for a plane, for example.  The children we see are in a state of constant high alert, with elevated heart rates and no ability to rationally evaluate threats.  If your abuser could strike at any moment, and your home—which should be a place of safety—was instead a scary place where danger lurked around every corner, you would be hypersensitive too.

Staying hyper alert and constantly scanning the environment for possible threats takes up a great deal of these children’s energy, and interferes with their healthy development.  Many of them have learning problems, sleep problems, relationship problems, mood regulation problems and behavioral control problems. All of these problems are symptoms of a poorly organized, poorly functioning regulation system.  All of these symptoms are the result of unremitting trauma over a long period of time.  The body never has the opportunity to self-regulate. For these individuals an event similar to my airport experience could have been devastating.

Even when the children know that their abuser can no longer harm them, it can take many months (sometimes years) to “de-program” the accumulation of years of adverse experiences.  In the assessment and treatment program at DCAC, our therapists use trauma-informed assessments and provide developmentally sensitive interventions. Many of the initial therapeutic interventions are patterned repetitive regulatory sensory stimulation within a relationally safe environment. Teaching children and adolescents how to tolerate, identify, express and integrate emotional experiences into an adaptive behavior response becomes an important treatment goal. As the children and adolescents experience a sense of safety both in their bodies and within the therapeutic relationship, work on traumatic memories becomes possible. The therapists stay attuned to their clients’ verbal and nonverbal communication, shifting back and forth between focusing on traumatic memories and regulatory exercises.  This dosing of the trauma work allows the client to re-experience past painful memories in a more predictable, safe, moderate manner.

When we are scared we move into a protective stance and survival becomes the primary objective.  Our thinking becomes more concrete, our focus is on the immediate situation and our actions are impulsive.  As a species, when we feel safe and secure, we become motivated to take risks and to explore both our internal and external environments. We become open to growth, capable of abstract thinking and effective problem solving. We develop innovative, alternative solutions and respond in a flexible adaptive manner. It is under these conditions that healing becomes a reality.

Dr. Jerry Yager

For more on our work at DCAC, including upcoming training opportunities, please visit us on the web at www.DenverCAC.org.

Stress Changes The Way We Think - Part One

Even Dr. Jerry can get overwhelmed by stressful situations and fail to make sensible decisions in the face of real and perceived threats. It’s a bit embarrassing, but I want to use two recent personal experiences to illustrate how stress works on our thinking.

I recently took a trip to Pennsylvania to give a lecture.  I was running late, I had difficulty finding a parking space, and my cell phone kept ringing.  I was in a pretty agitated state when I encountered airport security, which my mind interpreted as a threat to my survival (missing my plane).  As I passed through inspection, my anxiety must have been evident and agents identified me as a candidate for a more extensive search.  Already stressed, now I was being asked to empty everything out of my pockets and to hold my arms away from my body, while this stranger moved his hand down the inside of my pants leg and across my buttocks. This was not what I would label safe touch! 

Immediately following the completion of this uncomfortable search I picked up my items and left hastily. I tried to distance myself from this disquieting situation by running as fast as I could to my gate. Arriving with a few minutes to spare I started to calm down. After boarding the plane I relaxed and regained my sense of safety.

When I arrived in Philadelphia and attempted to rent a car, I realized I had not received my license back from security in Denver. Being without proper identification far from home is not an ideal situation, and I was annoyed with myself for having been so upset by the invasive airport security search that I’d left critical identification behind. However, in this second stressful situation I did not panic. I was able to solve my transportation needs with a train and a taxi, conduct a full-day training and get back to Denver.

In reflecting on my experiences, I was curious about how worry over missing my plane and enduring an embarrassing search had taxed my ability to think clearly, while another situation that also created great difficulty didn’t seem to interfere with my mental functioning.  The two situations, taken together, illustrate the fact that stress is not so much about what happens to you, but how you react to the situation. In one situation I felt totally out of control, while in another I felt stressed but in control.

Stress, when experienced in moderate, predictable ways, and we perceive that we can take action to effectively cope with the situation, can build resilience and improve performance.  When stress is unpredictable and we feel powerless, it interferes with our ability to function, and increases our vulnerability.

Over millions of years of evolution animals have developed a system to respond to real or perceived threats in the environment. This “fight or flight” alarm system functions automatically, with predictable neuronal and hormonal activation patterns, which results in fixed behavioral responses. 

The body’s threat response system is designed to be short-term and to mobilize the body’s resources for action.  In the event of a threat, the body:

• Shifts attention to the perceived threat
• Rapidly mobilizes energy—glucose, proteins and fats are processed and relocated away from non-essential organs
• Increases heart rate, blood pressure and respiration in order to move emergency resources throughout the system
• Halts growth, sex drive, and digestion (the body cannot focus on long-term threats to health when immediate survival is at stake
• Has a diminished perception of pain due to release of powerful endogenous opioids

The body also memorizes and documents threats, so that it will know how to respond in a similar event.  Next time I fly I will probably work hard to get to the airport early and better prepare myself for the inspection. However, I can be sure that memories of this past trip will be present and influencing my behavior. I might find myself getting anxious from the time I book my ticket until I get through security. You can be sure I will check to make sure I have my identification and ticket with me after passing through that check point. As time passes the anxiety about plane travel will probably diminish, but hopefully the lessons learned will stay with me.

(to be continued)

IMPOSSIBLE ADOLESCENCE

This past month many parents had an opportunity to celebrate high school graduation. Sitting in a local coffee shop I was listening to parents describe their trial and tribulations related to raising their child through adolescence. These parents shared stories which highlighted their challenges to establish the appropriate balance between adolescent autonomy and monitoring school work, peer relationships and activities. Many parents verbalized that at times over the past four years they didn’t know if their child would successfully complete high school. There were other parents who spoke with amazement about how things were not really as bad as they feared. One woman stated that she had this notion that all adolescents were angry, disrespectful and rebellious and she feared losing her daughter when she turned thirteen.

A significant part of parents’ anxiety about raising adolescents comes from cultural stereotypes portrayed in the media: these difficult, oppositional and irritable creatures that possess our children during the teenage years and totally disrupt the home and threaten our communities.Although some of these perceptions are built upon misinformation, like all myth some parts of the story are true.

With the exception of infancy and toddlerhood, where functional capabilities are just emerging, no developmental time period presents such dramatic changes in physical, emotional, cognitive and social capabilities as adolescence. Adolescents are going through a major neurological remodeling in the number of connections and new insulation in the wiring of their brain. By the end of adolescence their brain will be more efficient and effective in integrating and processing a wider variety of information simultaneously (like all remodeling projects, sometimes things get disorganized before they get reorganized). However, it is also important to be aware that research indicates only about 25% of parents and teenagers report having major problems during this period. In addition, 80% of these families reported that their teenager had problems that first presented during childhood. Only about 5% of adolescents who had positive relationships during childhood will exhibit serious problems during adolescence (Rutter, Grahm, Chadwick and Yule, 1976).

New conceptual models are emerging that suggest that, yes, adolescents will struggle with issues of autonomy but that their healthy transformation occurs within the context of a warm, ongoing  emotional relationship with involved parents. The adolescent requires the same commitment from a caregiver that the healthy two year old needs: a balance of support and encouragement to explore and discover their environment and a present, attentive, attuned, nurturing, responsive parent to ensure a safe environment, an age-appropriate level of structure and limits when necessary.

Autonomy, which can be defined as the extent of parental control on the adolescent, is a major area of change during the adolescent period. Steinberg and Silk, 2002, in a chapter on “Parenting Adolescents” distinguish psychological autonomy, the ability to express opinion, feelings and thoughts, from behavioral autonomy, the amount of supervision and monitoring of behavior. Often times the adolescent and the parent struggle separating these issues related to autonomy. The young adolescent expectations are that they should be totally autonomous and they push for increased independence. In reaction, the parent may provide too much or too little autonomy. Research suggests that adolescents benefit from decreased psychological control while maintaining and slowly adjusting behavioral control.

It is also important to remember that the adolescent is not the only one going through a developmental transition. For many parents who watch their adolescent develop physically, cognitively, and sexually, concerns about their own developmental competencies begin to emerge. For the adolescent, who seeks excitement, adventures, romance and whose future is wide open, the parent begins to reflect on their own physical decline and awareness that time is limited to achieve career goals or make changes. This, combined with the task many parents have of taking care of their own aging parents, creates an additional challenge and stress on themselves and their relationships. For some parents, they mange this developmental crisis by competing for control with their adolescent or they may attempt to become peers and try and fit in with the adolescents. Both of these strategies are an attempt to avoid issues the adolescent is perturbing in the psyche of the parent. These strategies may decrease internal distress in the short term but ultimately increase family tension and dysfunction.

The good news is adolescence does not have to be such a terrible experience for everyone. However, like all transitions you have to expect to experience disruption from the equilibrium the family developed during childhood so you can establish a new sense of balance in your relationship with your bigger, stronger, faster, and smarter adolescent. Never forget that even though the adolescent acts like they don’t need you, you are just as important to them as you have been throughout their lives.

DISCLOSURE: Why Won’t They Tell?

by Dr. Jerry Yager, PsyD

Director of Education & Training

Denver Children’s Advocacy Center

At six years old, Allyson was sexually abused by her cousin.  The perpetrator told her that she was being punished for being bad.  In seventh grade Allyson was caught having oral sex with her male friend. She was disciplined and made to come into treatment. While in therapy she disclosed that she had been abused as a little girl. The therapist had to inform the mother and the Department of Human Services. The first question the mother asked is, “Why didn’t you tell me?”

So many children who have been sexually abused don’t tell anyone and hold the “secret” in for many years.  As parents we would like to believe that if our child was being hurt they would tell someone immediately. Many children will not tell and even make up lies to hide the truth about their abuse for the following reasons:

• Communication:  They have not yet developed the language skills necessary to communicate the experience
• Trust:  They are afraid no one will believe them because that is what the perpetrator told them.
• Protection:  They are protecting someone they love, a parent or relative.
• Shame:  They feel ashamed and believe it was their fault
• Consequences:  They are afraid of the consequence for leaking the truth to themselves and their family.
• Fear:  The perpetrator threatened to hurt someone they love if they tell
• Avoidance:  They just want to forget and avoid any feelings or thoughts connected to the incident.
• Familiarity:  Sadly, they might not even identify what happen to them as abuse.

Unfortunately, the impact of holding this “secret” is as detrimental to the child’s developing sense of identity and social relationships as the actual traumatic event. The inability to share the experience fosters destructive cognitive distortions, creates distance in social relationships, damages the developing sense of self, creates anxiety about being exposed and changes the trajectory of a child’s overall development.

Giving children vaccinations doesn’t guarantee that children will not get sick, but it does decrease the risk and severity of the illness if they do get sick. As parents we can inoculate our children against the long term consequences of abuse. The belief that children know how to and are capable of protecting themselves is a recipe for disaster. The most important prevention is the presence of attentive, attuned, nurturing adults, along with the mindset that adults are responsible for providing protection to children.  As caring adults we must be attuned to a child’s verbal AND non-verbal communication when determining their sense of security and safety.

Here are some preventative suggestions on how to increase your child’s ability to effectively communicate their needs to adults:

• Educate your child about their own bodies, using the correct terminology, including the concept of “private parts”.
• Talk about the difference between “safe touch” and “unsafe touch” in language they understand.
• Explain to your child that the only persons who can touch him/her on their private parts are the parents and the doctors to keep them clean and healthy. No one else should be touching them on their private parts. This is an important safety rule.
• Teach your child to use their voice to say “no” when people are violating their boundaries, runaway and to tell an adult.
• If a child expresses their discomfort being hugged or kissed, even by relatives, respect them and validate that they have the right to say “no.”
• If your child does attempt to communicate that something has happened to make him or her feel uncomfortable, first manage your own reactions and then validate the child’s experience. Your goal is to create a safe relational connection that allows the child to share more of their experience.

 The message to our children must be:

“We are not afraid to talk about it and we want you to feel comfortable talking about it if you need to!”

The Denver Children's Advocacy Center (DCAC) has successfully implemented a bilingual, research-based prevention of child sexual abuse program since 2005 entitled Denver Safe from the Start.

DCAC’s “Denver Safe from the Start” program is based on the premise that sexual abuse is 100 % preventable if those responsible for the care of young children have the necessary knowledge and skills at their disposal.  This program works simultaneously on three levels to increase the safety of children:

• By teaching educators how to identify those children who appear to be at risk for sexual abuse and then how to take the appropriate action
• By teaching parents and adults involved in the child's life  to recognize the signs of the potential for abuse (or actual abuse) and how to take appropriate action
• By teaching young children (3, 4, 5, and 6 year olds) basic self-protective skills.

Denver Safe from the Start impacts a high number of children, families/caregivers and teachers in our community every year. In 2008, we served 351 children, 85 parents and 10 teachers. In 2009, we provided services to 338 children, 102 parents and 12 teachers. 2010 was a very successful year for our Denver Safe from the Start program as DCAC received funding from the Office of Justice and Juvenile Delinquency Prevention (OJJDP) which allowed us to reach 897 children, 164 parents and 53 children.

If you'd like to obtain more information about Denver Safe from the Start, please contact Angela Davidson, Director of Prevention and Education Program at Angela.Davidson @denvercac.org or call 303-825-3850

OBESITY: A Threat to our Children’s Brain

Picture a group of Teenagers sitting in front of a computer or a video game snacking on chips and drinking soda.  While their brains are engaged in this highly visually stimulating activity their bodies are not burning sufficient calories to maintain their weight.  Soon their waist lines are expanding and their health is deteriorating.  Now, think of the young girl who allows herself to gain a large amount of weight to protect herself from men, as a reaction to her abuse.   Today, obesity among our youth is a major health problem.  The National Center for Chronic Disease and Health Prevention reports that obesity has more than tripled over the past 30 years.  The prevalence of obesity among children age’s 6-11years old increased from 6.5% in 1980 to 19.6% in 2008.  The prevalence of obesity for adolescents during that same period increased from 5.0% to 18.1%.  Decreased activity levels has been associated with decreased long term memory, reasoning, abstract thought, problem solving, attention, visual spatial abilities and reaction speed.  The question of how decreased exercise correlates with decreased cognitive functioning has been of interest to researchers the past several years.

John J.  Ratey, M.D.  , in his book Spark: The Revolutionary New Science of Exercise and the Brain, highlights the connection between exercise and brain functioning related to learning.  Darwin described learning as a survival mechanism that allows us to adapt to a changing environment.   Our brains are made up of 100 billion neurons each with connections to hundreds of other neurons.  These neurons form networks that allow energy and information to flow.  It is this flow of energy and information that generates the functions of the human body.  The connections between neurons are called a synapse.   The neurons don’t actually touch but a narrow space or “gap” is established to allow chemicals to move from the end of one neuron to another.   To understand how the brain perceives, processes, encodes, stores, retrieves and acts upon environmental signals we have to understand how information is communicated within the brain. 

Sensory stimulation activates sensors in the body (eyes, ears, nose, and skin).   These sensors convert  stimuli into patterned electrical signals.  The electrical signals move down the cells outgoing structure called an axon.  The electrical signal reaches the end of this branch called the pre-synapse.  The pre-synapse is where neurotransmitters are stored.   The neurotransmitters will facilitate the transmission of the message across this gap to the receiving branches, dendrites, of the next neurons in the network.    The chemical messengers plug into receptors on the post-synapse and change the chemical balance and generates an electrical charge.  If the charge is large enough it triggers a signal in the next neuron and information is passed on. 

Learning requires a modification of the connection between neurons.  Eric Kandel, a Nobel prize winner for his work in neuroscience, discovered that repeated activation of a neural connection actually causes the synapses to swell and to become stronger.  This allows this network to fire more easily and results in long term memories.  The neurons ability to change in response to environmental stimuli is called “plasticity”.  This is how our life experiences actually get wired into our brain. 

In the 1990’s neuroscientist began to discover a group of proteins that didn’t transmit information but are used to build and maintain the health of the cells in a network.  This group of proteins (called “factors”) improves the efficiency of neurons, encourages their growth and protects them against deterioration.  Exercise increases the production of these chemical proteins and their ability to cross over a barrier into the brain to facilitate more efficient and effective information flow.  Exercise has been connected to improve functioning in the hippocampus, facilitating long term memory storage.  In addition, exercise influences the functioning of the prefrontal cortex, which mediates working memory, body and emotional regulation, response flexibility, empathy, fear regulation, and problem solving.   All of these functions are beneficial in helping individuals negotiate the complex social environment we currently must adapt to for our survival. 

A child or adolescent’s lack of physical exercise is not only results in weight gain but also deprives him or her of important biochemical processes necessary for social, academic and healthy functioning.  Parents and schools need to encourage aerobic exercise programs at least 30 minutes twice to three times per week.  Sensorimotor activities should be integrated into the classroom structures for those children that seem to require movement to improve attention and concentration.  These physical focused programs are even more important to children and adolescents who have suffered exposure to chronic stress related to abuse, neglect, and exposure to violence and are suffering from mental illness.  For some children, physical exercise is enrichment because they are involved in many extracurricular activities after school.  Many children are not willing or capable of participating in these activities.  The statistics are telling us all that our children are at greater risk and these programs are a necessity.  During these economically challenging times let us all think twice before we cut programs that will hurt our children and cost us much more in the long run. 

ADOLESCENCE: The Transition

Adolescence can be defined as a transitional period between childhood and adulthood. It is a stage of life that is bracketed on one end by puberty, a physiological process, and on the other end by the ability of an individual to assume social responsibilities assigned to adults in the society. It is during this period of time that a youth separates from the dependence on the family and begin to explore the world at large. In order to function independently the individual has to develop certain skills that allow them to reflect, conceptualize and strategize alternative solutions before engaging in action. The individual has to demonstrate the ability to work toward future goals, following a sequence of steps and delaying immediate rewards for longer term gains. All of these functions are mediated by the brain region that is under construction during adolescence known as the prefrontal cortex.

The second decade of life is a time of enormous change in brain architecture but these changes are just the product of processes that began in utero and early in life.  The brain is going through a major upgrade where processes are becoming more effective and efficient during adolescence. Early in life, these same functions are just emerging from genetically–driven and environmentally modified neuronal structures.

There are many people who exaggerate the changes taking place in the adolescent brain while others attempt to minimize the impact of these events. The facts are clear, however, that the adolescent brain is different from and eight year old and different from an adult’s brain.  During adolescence, there is an elimination of nearly 40% of the synaptic connections that were over produced earlier in life. The majority of these connections are excitatory in nature. The percentage of inhibitory neurons is greater in adults than children and adolescents. (A.L Spenssort, K.J. Plessen, and B.S. Peterson, 2004)

Although we are still researching the causes for this significant reduction, the best hypothesis is that it occurs from a combination of genetics and experience dependent processes; the concept of “use it or lose it” where neurons that are activated with enough frequency become stronger and those that are not used get reabsorbed.

The adolescent’s reward system is also being modified. An increase in receptors and the phaseal release of the neurotransmitter, dopamine, has been related to increase sensation seeking and a focus on short term rewards at the expense of longer term gains (Steinberg, 2009). For most teenagers this change in the reward system stabilizes in early adolescence while self regulation skills do not mature until late adolescence. This means that younger adolescents are being driven toward high risk situations with an immature internal control system. No wonder middle school presents such a challenge to teachers and parents.

One of the most significant changes taking place in the brain of the adolescent is the wiring being insulated within the prefrontal cortex, between the cortical regions and in sub-cortical regions. This allows information and energy to flow 1oo times faster. The supportive glial cells are forming a fatty sheath around the axons of the neurons in a process called myelination. The speed of information flow allows adults to integrate past associations, analyze current information, and make better decisions. It isn’t that adolescents cannot problem solve, it just that they have difficulty processing information on multiple levels simultaneously (Giedd, 2004).

In our society, one of the things that makes adolescence so unique is that this is a time when we begin to pay the price for not providing the appropriate level of social scaffolding to adequately support a child’s development. The best time to insulate adolescents from the threats present in their environment such as drugs, crime, unprotected sex and major accidents, is not at age twelve but at conception. The parts of the brain that regulate resource allocation are not in the cortex but in the brain stem. The brain stem is being organized in the last trimester of gestation. Relational templates are being organized during the first three years of life. When children learn that adults are both a source of protection and rewards they demonstrate the capacity to use these relational connections as scaffolding.

Scaffolding is the supports that are put in place to reinforce a structure that is not fully capable of supporting itself. The scaffold remains in place until the structural remodeling is complete. Adolescents need adults to stay connected, attentive and attuned to both their needs for engagement and for disengagement, just as the caregiver does for a newborn. Development always takes place within a relational context.

Tips for parents:

1)      Parents should talk with their teenager, even when they roll their eyes.  If your child is expressing perceptions of life that are not consistent with your own, remember to celebrate the fact they are talking with you. If you can keep them talking you have a better chance of helping them think through their decisions.

2)      Engage teachers, coaches and other interested adults as partners.  Believe it or not it does take a clan to raise a child.   

3)      Adolescents need structures that are consistent but not rigid.  Don’t maintain a rigid structure that eliminates opportunities for the adolescent to practice problem solving and negotiating skills.

4)      Place them in social and academic situations that challenge them but also create a high likelihood for success. You can adjust the structure to increase successful outcomes without lowering you expectations of their efforts. They are much more likely to be motivated to work hard if they believe they have a chance to be successful.     

5)      Set limits on the adolescent’s behavior but not on them as individuals. Remember, their identity is being formed and they are vulnerable to confusing negative feedback as a reflection of their identity rather than their decisions.

6)      Encourage and support engagement in structure activities (athletics, clubs, music, dance). Think carefully before using these activities as consequences for the adolescent’s actions.

7)      Above all make sure to tell them how much they are loved! 

Bibliography

A.L Spenssort, K.J. Plessen, and B.S. Peterson. (2004). Neuroimaging Of Developmental Psychopathology: The Importance of Self-Regulation and Neuroplastic Processes in Adolescence. In R. E. Dahl, & L. Patia-Spear, Adolescent Brain Development (pp. 86-87). New York: New York Academy of Science.

Giedd, J. N. (2004). Structural Magnetic Resonance Imaging of the Adolescent Brain. In R. E. Dalh, & L. Patia-Spear, Adolescent Brain Development:Vulnerabilities and Opportunities (pp. 77-104). New York: New York Academy of Science.

Steinberg, L. (2009). Should the Science of Adolescent Brain Development Inform Public Policy? Retrieved 10 2011, from psycnet.apa.org: http://psycnet.apa.org/journal/amp/64/8/739.html

Self-Control & Delayed Gratification Lead to Long-Term Success

While surfing the internet I came upon an article by Maia Szalavitz, “The Key To Health, Wealth and Success: Self-Control."  In the article she reports on the outcome of a study that follows 1,000 children from birth to age 32 years old. Children who exhibited early self regulatory skills were less likely to develop substance abuse problems or be involved with crime as adults. These children turned out to be healthier and more successful financially.

The findings were consistent with previous research conducted by Walter Mischel, a Stanford professor, which showed that children with low ability to delay gratification were more likely to exhibit behavioral problems at home and school.  Their lack of self control at age four resulted in consistent difficulty managing stressful situations and less effective problem solving abilities. There turned out to be a 210 point difference on High School S.A. T. scores between children with low delay and high delay ability.

Delay of gratification requires the child to tolerate internal distress and use higher cortical functions to regulate and modulate impulsive responses. These capabilities are developed slowly, within the context of early interpersonal relations with an attentive, attuned and responsive caregiver. When a caregiver is able to accurately read the cues of the infant, form a hypothesis about the infants needs and then respond accurately, the infant’s arousal system is quieted.  After thousands of these attuned interactions, the infant’s neurobiology is modified to reflect these regulatory interactions. The child learns to read his or her own internal signals, tolerate the internal distress generated by his orher unmet needs, and then develops strategies that result in personal satisfaction. These children have developed an internal template of the world that it is a positive place where they are eventually capable of having their needs met.  With this positive internal representation of themselves, of others and  of the world,  they are able to identify their needs, establish long term plans and then work toward achieving their desired outcomes. These children are able to establish and maintain relationships and engage others' support when needed.

The capacity for self-control remains undeveloped for the child who grows up in a chaotic, unsafe, unresponsive relational environment.   As the infant's internal needs are stimulated, their arousal system is activated.  Without the assistance of a responsive caregiver, the infant's coping capacity is overwhelmed. These children are forced to rely on alternative self soothing strategies because they are unable to meet their needs independently.  Their template of the world is that it is  a scary, unsafe, and unpredictable place that cannot be trusted. If there is something they need they should take it because it might not be available later. Focused on short term survival strategies, they are unable to allocate resources toward longer term achievements. Later in life these children are at greater risk of turning to drugs, alcohol, food and sex to satisfy their early unmet needs. Their engagement in these high risk coping strategies exposes them to negative social experiences and the risk for involvement in crimes. Once you are on the wrong track, the destinations you pass are different and very dangerous.

Science is beginning to demonstrate that early childhood relational interactions creates genetic markers that increase or decrease the expression of our genetic codes. These epigenetic influences increase tolerance or sensitivity to stress and our ability to inhibit, organize and modulate reflexive behavioral responses. Even though both groups of children may possess equal genetic potential, some get exposed to the experiences that allow them to express their potential. The question is whether you can change the trajectory of these children's lives once they have been set on course. The answer to that question is YES.

If children are placed in healthy relational environments that provide them with the opportunity to associate with attentive, attuned adults who respond to the child in a developmentally appropriate manner, self-control can be improved. If we can educate new parents and caregivers about the need to actively attend to infants we can increase the probability for a healthy start. When we identify a child in a daycare or pre-school, we shouldn’t wait until they experience multiple failures before intervening. An intervention may include educating the providers about developmental activities and strategies that can be used to activate the brain regions necessary to develop self regulation. The longer we wait,  the intensity, frequency and duration of therapeutic interventions increase, along with the costs.

TEEN PREGNANCY: Truth and Consequence

Human development always takes place within the context of a relational environment.  These relationships serve to support us or hinder us as we transition from one developmental level to the next.   As I wrote in my last blog, development can be conceptualized as a system moving from a state of organization, to disorganization and then reorganization.  For women, pregnancy presents some incredible growth opportunities but also some very real challenges.  When the new mother is a teenager, the risks are significantly greater.  The United States ranks number one amongst western industrialized nations in the number of teenage births.   The statistic reports that for every 1000 girls between the ages of 15-20, 42.5 will become teenage mothers.   Children of the adolescent mothers often display developmental and behavioral problems and are more likely to go on to become teenage mothers themselves.

Adolescence is a time when it is developmentally expected that the individual will demonstrate increased self-centeredness, mood instability, risk-taking and a focus on short term rewards without weighing out of all the consequences of one’s actions.  These developmental changes are in contrast to the sacrifices and commitments required of parents.  Some lifestyle choices such as eating habits, smoking, drinking and sexual relations must change in order to protect the developing fetus.   

Babies born to mothers who smoke during pregnancy are at increased risk for premature births, low birth weights, pregnancy complications, and sudden infant death syndrome (SIDS).  Teenagers are less likely to get early and regular prenatal care.  A teen mother is at greater risk for high blood pressure, anemia and the presence of a sexually transmitted infection.  These delays in medical attention place both the mother and developing child at significantly greater risk for complications. 

A premature baby’s lack of developmental maturity can result in under-developed organs.  The brain of the infant is faced with more challenges than when the child is in utero.  In the womb, no food is ingested directly into the stomach but is processed through the mother’s digestive system.   The fetus does not have to breathe on their own because the mother’s body takes care of that function.  In the womb, the fetus can see and hear but cannot yet regulate sensory input in the same way a full term infant is capable of processing.  The premature infant is extremely dependent upon their caretaker to regulate their physiology.  Their immature, internal systems can be flooded and overwhelmed.  Because the brain of an infant is being organized by the patterned and repetitive sensory experiences, they are vulnerable to chronic stress.   This stress can alter the sensitivity of the infant’s alarm system, leading to long-term mental, medical and social issues.   

So we have a high risk situation where a developmentally immature mother is caring for a developmentally immature infant.  Further complicating this scenario is the high incidence of family and community poverty, single parenthood, high rate of limited education and disrupted extended family relations.  When the mother and infant need the most support, they are often left alone and vulnerable. 

Many teenage mothers, with the support of their family, are able to negotiate all of these obstacles and are incredible success stories.  Yet many the hurdles are way too high and their resources are way too low.   Seventy-five percent of all unmarried teen mothers will depend upon welfare within 5 years of the birth of their first child (marchofdimes.com/medical resources).

Early and regular prenatal care and supportive services can make an enormous difference in the lives of these teen mothers and children.  Education regarding proper nutrition, stress management, and the benefits of continuing their education within the context of a supportive relational environment can scaffold the developing teen mother and her new born through this important transitional period.   Supporting teen mothers can result in an early return on our relational investments.