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.

Our Children Are Watching

Survival of any biological system requires the establishment of homeostatic equilibrium and the flexibility to change in response to environmental challenges. 

This tension between maintaining stability and adapting to change is the canvass on which development is painted.  Development is a process of perturbing a system enough so that a new homeostatic set point (or “comfort zone”) is established.  Development can be conceptualized as a system moving from a state of organization, to disorganization and then reorganization.  It is not a continuous  upward progression but of peaks and valleys.  In the weeks prior to a toddler beginning to walk they may have difficulty sleeping through the night.  These developmental transitions are pivotal points that present children and their family members with both     opportunities and challenges.

However, if the mother’s attachment templates are associated with inconsistency, unpredictability, abandonment and threat then the thoughts of the infant trigger anxiety and distress.  To cope with this stress, some mothers may recapitulate her early experience and distance herself from her infant.  These mothers may not experience the same level of pleasure and struggle to meet the anticipated demands of their new role.  The mother might interpret the movement within her body as irritating, demanding, already overwhelmed and anticipate the worst after birth.  She may begin to question her own capacity to care for the infant but not see others as a resource.  Some mothers think that the baby will provide them the love they never felt earlier in their lives.  In these situations the mother knows the fetus is a part of her but she struggles to hold on to their separateness. 

After birth the mother can experience a sense of loss, depression or an overall sense of being overwhelmed.   A mother with a history of unhealthy attachments may not exhibit the same biological drive to be present and attuned to her newborn.  She does not derive a sense of pleasure when interacting with the infant.  This lack of pleasure or stress is communicated nonverbally to the infant through facial expressions and tactile interactions.  The infant’s own pleasure centers are not activated and his/her stress responses are not soothed.  Associations to other humans are weak and unsatisfying.  In an attempt to survive, experiences their mother can tolerate are ruled in and actions that cause her to withdraw are ruled out.  These rules are the framework for relational templates that guide future social interactions.

If an infant has access to other caregivers (fathers, relatives, and community members), they can form more positive, rewarding associations that allow them to compensate for the unresponsive maternal figure.   In today’s society, however, many parents are separated from their families of origin and isolated from community resources.   It is only after a child has been abused or severely neglected that the larger community gets involved.  

 There is no greater investment a society can make than to invest in the well being of its children.  In order to protect children, we must first protect the women in our society.  By creating opportunities for women to express their genetic potential, protecting them from abuse, providing access to quality health care and creating a supportive community, we develop the foundation for growth facilitative environments for our children.  Dr Bruce Perry says “The best time to help a child is 100 years before they are born”.   We cannot afford to wait.  Our children are  watching. 

 

REAPING WHAT WE SOW

A vast majority of the young people treated in the Child Protection, Mental Health and Juvenile Justice Systems have experienced exposure to chaotic, abusive, neglectful or violent environments in their lives. Although the exact prevalence of abuse and neglect varies, there is agreement that a significant number of youth served in these populations have survived exposure to overwhelming adverse life experiences. The impact of their exposure to traumatic stress has resulted in long term biological, psychological and social changes (www. childtrauma.org).  Isolated traumatic events tend to produce a conditioned, biological response to cues associated with the memory of that event.

 In contrast, there is a distinctively more pervasive effect on the development of youth who grow up experiencing chronic maltreatment and then find themselves victims of an isolated traumatic experience, such as a sexual or physical assault. Developmental trauma and chronic exposure to maltreatment during early childhood interferes with the organization and functioning of the brain’s regulatory systems.  Logically, this results in an increased need for mental healthcare and correctional measures as well as medical and other social services.  Research confirms that exposure to early childhood maltreatment sets a negative developmental pathway that ultimately leads to serious problems for the victim that impact all relationships that the child encounters throughout his or her life.

The Adverse Childhood Experience Study provided a link between childhood exposure to violence and other traumatic events and later developing psychiatric and physical disorders as well as substance abuse. The study found a significant relationship between adverse childhood experiences and depression, suicide attempts, substance abuse, sexual promiscuity and other high risk behavior. Additionally, the study found that the higher the number of adverse experiences reported, the higher the risk for developing not only psychiatric symptoms, but medical problems as well including heart disease, cancer, diabetes and liver disease (http://www.acestudy.org/).  The advances in neuroscience over the past two decades have led to new insights on how traumatic experiences early in life can influence an individual's development and often result in changes in perceptions, feelings, cognitions and behavior. One's behavior is a reflection of the world in which they have lived. High-risk, abusive behaviors toward themselves, others, or property can be understood as a way the youth adapted to early life relational experiences, which ultimately became wired into their neurobiology.

Scientific knowledge continues to demonstrate that early childhood maltreatment causes permanent damage to the structures and functioning of the developing brain. These changes impact the child’s stress response systems, immune systems and neuroendocrine system. In 2002, the President’s New Freedom Commission on Mental Health report stated that mental illness ranks first among illnesses that cause disabilities in the United States, Canada and Western Europe. In 1997 the United States spent 71 billion dollars on treating mental illness. In addition, the indirect cost of mental illness to the economy was estimated to be 79 billion dollars in lost productivity.

This information suggests that  part of the our nation's strategy for fixing the healthcare system must include investment in abuse prevention, early interventions and mental health training . Protecting and caring for our children is not only the right thing to do, it is the most economically sound thing to do as well.

We must begin to change the way we look at, treat and educate the most vulnerable members of our society.

Brain Development in Toddlers: What Happens and Why

The brain—unlike other vital organs in the body, whose organization and processes are completely functional at birth and then grow in a linear manner along with the body—is unfinished and immature in its development at birth. Brain development is front-loaded, with the majority of neurological systems being developed within the first three years of life.

This explosion of the brain and nervous system is constructed through interactions of our genetic programming and environmental influences. Over 70% of the brain’s organization takes place after birth. By exposure to patterned, repetitive stimulation from the external sensory and the internal biochemical environment, neurons are modified and the connections between them are established, strengthened, or eliminated. Neurons that are activated simultaneously form connections that increase the probability that these same neural patterns will be activated together in the future. Those cells or neural networks that are not activated die and get reabsorbed. This neurological architectural sculpturing process of overgrowth of neuronal synaptic connections, followed by a pruning back of unused cells is a principal labeled “use- or experience-dependent development.” Cells that fire together are wired to get together.

A two-year-old has twice as many synaptic connections as an adult. The incredible capacity of the brain to change in response to sensory information, store that input, and then use the information to guide our behavior allows humans to adapt to a wide range of environments. This ability to adapt is a gift but it also leaves children extremely vulnerable to long term consequences from maltreatment. The most powerful stimuli during this critical developmental period are the interactions with caretakers. The sensory interactions between a caretaker and an infant actually wire the brain and create the internal relational representations that will guide our behavior throughout life.

The brain, which is going through such explosive development from conception to age four, is most sensitive to exposure to growth facilitative or growth inhibiting experiences. Experiences we have early in life have the greatest impact on our long term cognitive, emotional and social functioning.  The experiences we expose our children to with the greatest frequency will influence not only their behavior but alter the way their genes are expressed and the way their brains process information, Two children with equal genetic potential, one raised in a safe, predictable and nurturing environment and one raised in a threatening, chaotic environment will have very different developmental trajectories. The first will be capable of tolerating stress, engaging in and succeeding in the complex social environments of school, peers and later work. The second child will struggle to feel safe, have trouble engaging others and maintaining healthy relationships and be at greater risk for mental health, academic, medical and substance abuse problems throughout their lives.

The best way to help children is through preventive measures that raise the awareness of the potentials and vulnerabilities of our children in our communities. By educating parents, grandparents, physicians, teachers, coaches, and other adults that interact with children to be sensitive to their developmental needs, we can increase exposure to those experiences that allow the expression of our children's genetic potential and minimize exposure to those that increase risk factors. For those unfortunate children exposed to abuse, neglect and violence, early identification and interventions from mental health professionals that are trauma-informed will have the greatest impact and result in best outcomes.

Welcome Dr. Jerry!



Dr. Jerry Yager
DCAC's Director of Education & Training

 We would like to give a huge WELCOME to Dr. Jerry Yager as our Director of Education & Training.

Dr. Yager is a Clinical Psychologist with more than 25 years of experience in the assessment and treatment of traumatized children and adolescents. He specializes in working with adolescents who exhibit self-destructive behavior and have severe mental illness such as clinical depression, bipolar mood disorder, post-traumatic distress disorder and psychosis. Before joining DCAC, Jerry was the Executive Director of the Denver Children's Home, which shares a mission with DCAC to provide high quality mental health care for low-income children whose problems would otherwise go undiagnosed and untreated. Jerry received his Doctorate in Psychology from Nova University, and a Bachelor of Arts in Psychology from the University of Colorado.  He is a ChildTrauma fellow with the ChildTrauma Academy, and conducts professional training in Colorado and nationally.

In this newly created position, Jerry will lead the expansion of DCAC's training program for mental health professionals and community members, with a dual focus on child abuse prevention and the assessment and treatment for child trauma. The multi-level training program is designed to equip all those who work with children-therapists, foster parents, social service caseworkers, police, prosecutors, victim advocates, medical doctors, school personnel and family members-with the tools to meet the complex needs of children along the continuum of need from at-risk to severely traumatized. By providing high quality training, DCAC's goal is to create a seamless web of care for children in our state.

I know you will want to visit this blog weekly to see what Dr. Jerry has to share.  You may contact him directly by CLICKING HERE with your questions and responses.

Welcome, Dr. Jerry.  We're happy to have you aboard!