Holidays and Stress

For most of us, our memories of the holidays are warm and positive. The holidays are a time to share gifts and good will with friends and family. For many children in the Child Welfare system, however, the holidays mean something different, and they trigger painful memories of trauma, chaos, lost relationships, and unfulfilled wishes. For them, the sights and sounds of the holidays elicit unconscious physical responses of fear, anxiety, and grief. How can we help these children cope with these painful responses? How do we give these children a positive holiday experience and help them overcome their negative bias?

Adoptive parents, teachers, and child care workers will often try to indulge their children with parties, activities, and gifts to make up for the negative holidays of the past. But this might hurt the children rather than help them; the problem is that the changes in environment and schedule activate a child’s stress response system. As the body responds to these new stimuli and attempts to restore equilibrium, it remembers the sensations, feelings, and behaviors associated with traumatic holidays of the past. This can lead to overwhelming emotions and a general sense of helplessness and hopelessness, and results in an increased risk for either aggressive, impulsive behavior, or for the desire to disconnect and withdraw from the external world and escape into an internal one (this behavior is called “dissociation”). Both of these behaviors are an attempt to cope with feelings of distress (triggered by holiday-related stimuli), and both behaviors interfere with the child’s and adult’s ability to enjoy the holidays.

Children who associate the holidays with traumatic memories are also likely to avoid anything that might trigger these painful responses. By avoiding these triggers, children reduce their feelings of anxiety; however, such behavior also interferes with the child’s ability to heal. Research has consistently demonstrated that, in order to recover from past trauma, the individual must be gradually exposed to the anxiety-producing stimuli. Gradual exposure allows the victim to increase their tolerance level and to develop healthy coping strategies.

Therefore, the best way to help children who have traumatic holiday memories is to gradually expose them to anxiety-producing stimuli, but do so in the context of physical and psychological safety and with positive relational support. For caregivers to accomplish this, they must remain attentive and attuned to the child’s arousal levels, and they must provide co-regulatory support to help the child remain with their window of tolerance. The biggest challenge for caregivers is to be aware of their own holiday associations; an adult who associates the holidays with positive memories can be blind to the needs of the child with negative memories.

To foster a safe holiday season for you and the children in your care, please remember the following guidelines:

• Be aware:  What do you associate with the holidays? How might that differ from the children in your care? Be aware that what is a positive experience for you might be a negative experience for your child.
  
• Plan ahead: Know what to expect. Unpredictability generate anxiety.
  
• Stay connected: Be aware of, monitor, and influence your child’s arousal levels. Help them stay within their window of tolerance.
  
• Know your children’s stress tolerance: Structure recovery times before they become overwhelmed. It may be a special time of year, but our stress tolerance levels remains the same.
  
• Structure quiet relational times: Verbally process the day’s events.
  
• Communicate changes in structure: If your children can anticipate transitions, they will be better able to cope with anxiety.
  
• Be prepared: Now is the time to make sure you know your child’s triggers and have a number of coping skills available for you and your child. (Remember: behavior is an attempt to master anxiety.)
  
• Sleep well, Eat properly, and Exercise: The more energy you have, the better you are able to cope with stress. Be sure that you and your child remain physically healthy.
  
• Change what the holidays mean: Begin new positive rituals, but be sure to respect your child’s ability to tolerate closeness and be aware of their fear of abandonment.
  
• Create narratives: Clarify distortions and misconceptions and create new memories.

And finally, remember: “Simple and successful is better than overwhelming and painful. Always build upon success!”

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Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry@denvercac.org

The Changing Needs of the Developing Child

During early development many of the children and adolescents seen in the mental health system have been exposed to chaotic, unstable and threatening environments without the soothing presence of attentive, attuned, nurturing and responsive caregivers. These overwhelming experiences occur during the period of time when the brain’s massive neural networks are being formed. Unlike neuron births (neurogenesis) and migrations that occur while the fetus is still in the womb, the creation of neural connections continues at an explosive pace into the second year of postnatal life. At its peak 15,000 synapses are produced on almost every cortical neuron. This production is taking place at a rate of 1.8 million synapses per second. In order to accommodate this growth new connecting branches are grown. The neural signals transmitted during this period of time and later in life not only influence the functioning of the brain, but actually direct and orchestrate the structure and organization of the brain’s architecture. The most powerful signals impinging on the immature brain of an infant are the sensory signals being communicated by its caregivers. Facial expressions, voices, smells and touch all get converted to patterned neural signals that serve to facilitate this incredible developmental process.

When caring adults are present and attuned to the changing needs of the developing child the balance between stimulation and soothing is maintained within a developmentally appropriate level. This creates the relational arena for the child to grow and express his or her genetic potential. However, when the relational environment is chaotic, unresponsive, violent, or dangerous the immature brain of the infant begins to adapt to these painful circumstances.

There is both good and bad news concerning our development as a species. The good news is that we are born with the capacity to respond to danger in a patterned, automatic, behavioral, and hormonal manner that increases the likelihood that we can survive. Newborn infants have the capacity to sense internal distress and then communicate that distress to a caretaker to engage their protection. Their cries are designed to initiate an emotional response in the caretaker that serves to motivate that person’s attention and response. When a caregiver can sense, tolerate, and modulate their own internal distress, they are able to process this information and make a decision about how best to respond. When a caregiver effectively and accurately reads and responds to an infant’s needs both the child and the caregiver are rewarded with an internal sense of pleasure. Through these relational interactions the developing child learns that it is capable of impacting its world and the caregiver develops a sense of competency as a provider and protector.

Now for the bad news: this stress response system works in a reciprocally related manner with the consciously thinking parts of the brain. When we are reacting out of fear and anxiety the thinking parts of our brains shut down and the automatic, emotionally reactive part takes the lead. If a caregiver is already overwhelmed and coping resources are taxed or a baby’s cries activate unresolved past painful memories, the infant’s communication is ineffective in eliciting the response it needs. The caregiver is motivated to protect him or herself and is at risk of unintentionally neglecting the needs of the young, vulnerable child. For the child the relational experience gets encoded in the neural circuits as a potential sign of danger and the child’s fragile sense of self gets embedded in shame. Young children have limited ability to separate how they feel from who they are. Their core sense of identity gets associated with a painful internal state. It wasn’t just that they had bad experiences in the past; they come to feel that they are those bad experiences.  Compounding this, their behavior and other’s responses to their behavior often tend to reinforce those perceptions.

I don’t want to end this with bad news so here is some more good news. Science has discovered that the brain is capable of changing throughout a person’s life. In particular, neurons are specially designed to change in response to experiences. However, not all regions of our brains are equally capable of making these changes. The lower regions, which mediate the unconscious automatic functions of regulating the physiological milieu and the body’s arousal levels, are harder to change than the higher regions that mediate conscious thinking and memory functions. Therefore, interventions designed to influence functions mediated by the lower regions of the brain have to occur in a patterned, repetitive fashion with enough frequency to effectively facilitate growth.

Protection and safety always trump new learning experiences, so physical and psychological safety must always be a priority. In addition, we cannot hope to make significant progress in facilitating growth in our children, students, or clients by simply sharing cognitive information without also activating and regulating lower brain regions with sensory somatic stimulation and developmentally sensitive relational interactions.  In the protective presence of an attentive, attuned, nurturing and responsive care provider a child will naturally begin to explore its external and internal world. This will facilitate the child developing a range of capabilities, such as regulation of its body and emotions, modulation of fears and anxieties, empathy for others, response flexibility, and insight. The acquisition of these new competencies will result in the child having a more positive sense of self, others, and the world at large.

As a species we are endowed with the potential to develop the capacity to sense our own and other’s emotional states, to compare our current experience with similar experiences from our past, and to envision our anticipated future so as to make choices about how to effectively respond. These capacities can either be expressed or inhibited by the experiences and opportunities to which we are exposed along our developmental pathway. Prevention is about increasing opportunities for growth while decreasing risk factors that inhibit growth so that all children have a chance to express their potential.


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Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry@denvercac.org

When Events Rock Our World

Over the past several weeks our community has been exposed to a number of very high profile cases of violence and abuse. A police officer was shot in the park at a concert, a man went on a shooting spree in a theater, and children who attended a preschool were being supervised by an adult involved with child pornography.

All of these situations occurred in environments that had been associated with safety and pleasure and now something scary and unsafe has altered that perception. These events have evoked many strong emotions - anger, sadness, fear, disgust, helplessness, anxiety - not only for those individuals directly impacted, but also for those who have been exposed through relational associations, or simply media exposure.

It is natural for children and teens to seek out adults to help then process these types of experiences. This presents a unique challenge to parents and teacher because just as the youth are attempting to organize their thoughts, cope with their feelings and make some meaning of these events, the adults are engaged in the same process. I have received many requests from parents and the media asking questions about how to talk with children about these terrible events without increasing the children’s anxiety and fears about the world.

The National Child Traumatic Stress Network offers some good guidelines to answer this difficult question http://www.nctsnet.org/

Suggestions for Adults

• Take care of yourself. Do your best to drink plenty of water, eat regularly, and get enough sleep and exercise.
• Help each other. Take time with other adult relatives, friends, or members of the community to talk or support each other.
• Put off major decisions. Avoid making any unnecessary life-altering decisions during this time.
• Give yourself a break. Take time to rest and do things that you like to do.

Things to Do for Children

• Spend time talking with your children. Let them know that it is OK to ask questions and express their concerns and feelings. You should remain open to answering new questions and providing information and support. You might not know all the answers and it is OK to say that. At the same time, don’t push teens to talk if they don’t want to. Let them know you are available when they are ready.
• Find time to have these conversations. Use time such as when you eat together or sit together in the evening to talk about what is happening in the family as well as in the community. Try not to have these conversations at bedtime, as this is the time for resting.
• What does your child already know? Start by asking what your children already know and think about what they have read, heard or experienced. Listen carefully in an accepting and non-judgmental manner. As children express their thoughts and beliefs listen for misperceptions and misinformation. Be attuned to how their perceptions are making them feel and validate those experiences before providing information to correct them. Say something like “This really scared you! I can see the way you are thinking about this made you feel that way.” Then respectfully correct their inaccurate information. Provide this new information in a simple, clear and age-appropriate manner.  
• Help your children feel safe. Talk with them about their concerns over safety and discuss changes that are occurring in the community to promote safety. Encourage them to voice their concerns to you or to teachers at school.
• Maintain expectations or “rules.” Stick with family rules, such as curfews, checking in with you while with friends, and keeping up with homework and chores. On a time-limited basis, keep a closer watch on where they are going and what they are planning to do to monitor how they are doing. Assure them that the extra check-in is temporary, just until things stabilize.
• Address acting out behaviors. Help them understand that acting out behaviors are a dangerous way to express strong feelings (like anger and grief) over what happened (e.g., cutting, driving recklessly, engaging in unprotected sex, abusing drugs or alcohol). You can say, “Many of us feel out of control and angry right now. Some people may think drinking or taking drugs will help somehow. It’s very normal to feel that way - but it’s not a good idea to act on it.” Talk about other ways of coping with these feelings (distraction, exercise, writing in a journal, spending time with others).
• Limit media exposure. Protect them from too much media coverage, including on the Internet, radio, television, or other technologies (e.g., texting, Facebook, Twitter). Explain that media coverage and social media technologies can spread rumors and trigger fears about the event happening again.
• Be patient. Children and teens may be more distracted and need added help with chores or homework once school is in session. It is normal for all humans to have a stress response to any potential threat in the environment. Reactions such as increased startle responses, increased emotional reactions, anxiety, decreased attention span, intrusive thoughts and disrupted sleep may be present for the first month after the exposure. For most people in the community these reactions lessen and we are able to re-establish our equilibrium after about one month. For individuals more directly impacted this time period can be extended due to continued exposure to reminders of the events and more complicated feeling of loss and grief.
• Ask for professional help. If the reactions continue or the family feels unable to manage the situation due to overwhelming emotions or lack of knowledge and support, contact a professional to assist you and the family through this experience.

Young children are dependent upon their caregivers to help them feel safe and create meaning of experiences in their world. How a child processes these types of experiences is greatly influenced by the nature, quantity and quality of the interactions they have with the significant adults in their lives. A well regulated, attentive, responsive parent can help the child re-establish a sense of safety and security and manage distressing emotions. The child, within this protective relational nest, can learn that at times bad things happen, to good people, in basically a good world.

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Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry@denvercac.org

Bridging the Gap

Several years ago I took up the game of golf as a hobby. Initially I would go out with minimal expectations and celebrate my successes on the course. As my game improved, I became aware of a growing gap between who I wanted to be as a golfer (my idealized golfer self) and what my skills allowed me to accomplish (my real golf self). This gap became actualized in the expectations I began to put on myself each time I played. If I hit a good shot that supported the internal image of my ideal self I enjoyed the game. When I hit a shot that exposed my real golf self I became frustrated and internally critical. If I was to continue playing this game I had to figure out what I could do to better manage this stress. I had to accept my real golf self’s limitations and then develop a strategy to reduce the gap between my current skill level and how I wanted to perform in the future.

I decided to take lessons from a golf professional. He spent some time looking at my clubs to get the past history of how I had been hitting the ball and then evaluated my current skills by observing my swing. By combining my past history with my current performance he was able to make some recommendations on how I could improve. My swing coach gave me several things to work on during the week and had me practice them while he watched. I could feel and see the difference immediately and felt I was on my way to being a much better player. However, when I played that week I actually performed worse, not better. I was thinking about everything he had taught me, but playing badly. My initial thought was that the lessons were not worth the time and energy. When I saw him the next week he asked how I did with the skills we worked on. I told him I had played poorly and that I was more frustrated because I’d believed I was getting better after our last session. He shared with me that golf is not only a game of making good shots, but also a game of managing bad shots. When you hit a good shot, you get an immediate reward that has a positive effect on you. However, when you make a bad shot, it creates a stressor that you have to be able to manage. You have to objectively assess where you are at, what happened to cause you to be in the situation you are in, and what shot you could hit next  to minimize the impact of the situation.

So golf is not only about swinging a club and hitting the ball, but also about learning how to regulate yourself and mange both the reward and stressors create by the experience on the course. It is a metaphor for life itself. Even though there is no real danger on the golf course, the symbolic meaning we apply to the game generates a physiological stress response that will either allow us to focus on our game or interfere with our capacity to perform. When faced with a challenging situation, the golfer has to tolerate and regulate his stress response, and engage in higher order analytic thought to evaluate the situation and find a creative solution. The golfer must be able to reflect on the past shot, envision the next shot, and then be able to be firmly in the present during the swing.

 

For many of the children who have been exposed to multiple adverse experiences early in life without the presence of an attentive, attuned, nurturing, responsive caregiver to assist them in managing their physiological arousal, stepping back and reflecting on their experience is not an option. Good caregivers assist their infants in learning to tolerate and modulate emotions by first matching the children’s affect state and then remaining regulated themselves. When parents are not available for these repetitive experiences of co-regulation the developing child is at risk for inadequate capacity for self-regulation.

Just as the capacity for self-regulation occurs within a reciprocal interpersonal relationship with a responsive caregiver, so, too, does the capacity for self-reflection. When the infant experiences internal arousal and the caregiver accurately reads the cues and is sensitive to the infant’s experience, it gives meaning to the communication and lays the foundation for the child to begin to experience the capacity to have an impact on his world. This reflective mirroring process facilitates the developing child’s awareness of inner experience and the capacity to express those inner experiences to the self and to others. When a child grows up without the experience of an attentive, attuned adult reading the nonverbal cues and then providing feedback, the child cannot organize his internal experience or make meaning of it. These children develop the feeling that they are unable to effectively make an impact on their world. As they grow, there becomes a widening gap between how they feel inside and what they believe the environment is demanding of them.  Their inability to tolerate and regulate their emotions and their lack of a capacity to self-reflect increases the likelihood that earlier relational experiences will be repeated in future interactions.

When we are facing a potential threatening situation, our body’s survival system is activated. Powerful neurochemicals and hormones are released which are responsible for increasing arousal - our heart rate increases as the body prepares for action. Resources are diverted away from non-essential functions, those not considered essential for managing the immediate threat. Higher order, complex thought is non-essential and only interferes with a person reflexively reacting to danger. These automatic, habitual behavioral and hormonal patterns of reacting are designed to increase our chances of survival. The reflexive action patterns are mediated by lower sub-cortical neural networks that drive us to focus on potential threats and avoid pain, but they inhibit our natural capacity for curiosity. Stressed individuals rely on past negative experiences to interpret their current situation and they have trouble learning, altering rigid beliefs, and envisioning a better future. Their stress response system becomes hyperreactive and they exhibit deficits in their ability to regulate their emotions, modulate their anxiety, and reflect and learn from their experiences. These individuals tend to see new experiences as a repetition of the past rather than an opportunity in the present.

Therapy does not attempt to erase past adversity, but rather strives to provide the client with sensory, relational and cognitive experiences that will facilitate the organization and integration of those past experiences within a safe, attentive, attuned and responsive relational environment. The goal of therapy is to assist clients in developing the capability to tolerate and modulate their internal experience, to learn to identify and express their internal experience, and to develop the skills to organize, strategize and implement effective response.

The therapist and the golf coach have much in common. They both have to understand the current problem within the context of past experience in order to make an effective plan that leads to the perception of a brighter future. In both cases, their clients have to understand that it is not only about having positive experiences, but also managing the negative ones, that allows us to develop a sense of efficacy.

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Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry.yager@denvercac.org

Healthy Children Start with Healthy Mothers

As we approach another Mother’s Day, it seemed like a good opportunity to reflect on research findings that suggest our understanding of infant development cannot be separated from the impact of the child’s interactions with the primary caretaker. This “transactional model” views development of our brains as initially driven by genetically programmed processes that are then modified by exposure to environmental experiences. These experiences can either facilitate or inhibit the expression of the developing child’s potential.

Because human beings are born almost completely dependent upon others, the infant’s emerging social, psychological and biological capacities must be understood within the context of the mother-child interactional relationship. The early sensory experiences of a mother looking into her infant’s eyes, touching skin to skin, her scent and voice are stimulating patterned neuronal activity in the infant’s rapidly developing brain. The quantity, quality and rhythms of these sensory experiences activate temporary mental states in the infant. When certain experiences occur with enough repetition the probability of that pattern of activation will be increased and the temporary state becomes a consistent trait. Those early associated sensory experiences become organized into our core sense of self, others and the world. They influence whether the child sees himself or herself as a competent, capable small person who is excited about exploring a benevolent world as opposed to an inadequate, damaged individual who struggles to feel safe in a dangerous world. Because our brains are in an incredible growth spurt starting from the third trimester of pregnancy and continuing into the third year of life, early experiences have a disproportionate impact throughout a child’s life.

  

Whether or not an expectant mother is well-supported, well-nourished and receiving good medical care can have a profound impact on the developing child. Pregnant women who are suffering from mental or physical illness, are in unsafe or unsupportive relationships, or are too young or developmentally immature to care for their child will be greatly challenged in their efforts to create a growth facilitative environment. Children start off with equal genetic capacities, but not all have the exposure to experiences that allow them to express that potential.

  

A culture’s commitment to child protection cannot be separated from the values, policies and practices created to protect and care for mothers. Dr. Bruce Perry repetitively reminds us that “the success of any society depends upon the health and well being of its children.”  We can never have healthy and well-developed children without healthy and well-cared for mothers.

Happy Mother’s Day!


Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry.yager@denvercac.org

The Adolescent Brain – A Major Remodeling Project

Yes, there is a biological reason for some of your adolescent’s actions! Adolescence has been described as a time in which the brain is going through a major remodeling project.  On the front end of puberty (approximately 11 years for females and 12 for males) there is a genetically driven growth of neural connections, increasing the number and density of synapse and dendrite in several areas of the brain. This period of growth is followed by a process of elimination of non-essential connections that is probably influenced by both genetics and experiences that adolescents are exposed to in their daily lives.  The sensory, emotional and cognitive experiences that adolescents are exposed to with frequency or intensity will become wired into their central nervous systems.  Therefore, the types of experiences, both intellectual and relational, that adolescents encounter can have a profound impact on their developmental trajectory. Exposure to community and relational violence, drugs and self-destructive behaviors during this developmental period can have significant long- term consequences for the developing brain.

Understanding how the brain develops and functions allows caregivers to support adolescents from the perspective of what these youth need developmentally from adults in their lives, rather than reacting solely to how they behave or make us feel. We know that socially adolescents separate from their family and begin to explore a much larger social environment. Physical changes in size and strength allow them to feel that they can now compete in an adult world, but their knowledge and experience lag behind these physical changes. Connections with peers become much more influential during this time period.  Hormonal changes are stirring sexual attractions, increasing interest in intimate relationships, and destabilizing moods. All of these changes create both excitement and anxiety for parents, teachers and the other adults who interact with developing youth.

The most important thing adults can do is to provide healthy relational and developmentally sensitive experiences prior to adolescence to create the scaffolding that will support everyone through this transitional period. The balance between respecting adolescents’ drive toward independence, with their need for monitoring and guidance is a constant challenge for adults. Over the last few decades, science has uncovered some important findings related to changes occurring in the brains of adolescents that has added to our understanding of development. The hope is that with increased understanding of the strengths and vulnerabilities of adolescence, as a society we can begin to create age appropriate support to facilitate the successful transition from childhood into adulthood.

What Happens Inside the Adolescent Brain

Developmentally, emerging functions are built upon earlier more simple functions. Two significant regions undergoing change during this developmental period are the pre-frontal cortex (PFC) and the cerebellum. The PFC which mediates such functions as working memory, body regulation, emotional regulation, empathy, insight, fear modulation, abstract thinking, problem solving and morality, is being modified during this period. The number and strength of the connections both within this area and between the PFC and regions lower in the brain and the body allows for improved integration of information. There is also an increase in the insulation of the connections that allows for information to travel much faster. These changes will result in improvements in top down, cortically modulated control and a decrease in automatic, habitual behavioral and hormonal patterns of reacting to stressful environmental demands. However, just like any remodeling project, functioning temporarily gets less efficient before the benefits can be enjoyed.

The cerebellum is also being remodeled during this developmental time period. This region coordinates physical movement, but is also important in recognizing social cues. Important information flows from the body to the lower parts of the brain and then get integrated in the higher brain regions. The modifications occurring in these neural pathways may initially mean that the adolescent may focus on some important social cues and miss others. Lacking a more comprehensive understanding of a social interaction may cause the adolescent to react in an irrational, illogical manner. In addition to the changes in the wiring of this region there is a change in the rhythmic release of the neurotransmitter, dopamine. Dopamine is a chemical important to attention and motivation. These chemical changes, most influential in the early period of adolescence, cause youth to be motivated to a greater extent by short-term gains rather than concerns about long-term losses.  (The thrills outweigh the risk of injury and death.) As the release of dopamine stabilizes, around the age of 14 or 15, the ability to weigh the long term consequences of our actions begins to improve, but top-down regulation does not fully mature until the mid 20’s.  This research suggests that it might be helpful to involve younger teens in activities that give them short-term personal gratification and then work on self- regulation and delayed gratification goals later in adolescents.

It is important to understand that it is not that adolescents cannot think like adults, but more that their cognitive equipment is not working as efficiently during this developmental period. When they are thinking they may not be feeling, and when they are feeling they may not be thinking. Stress plays a significant role in how adolescents are affected by these neurological changes.

The Impact of Maltreatment on the Brain’s Remodeling

Many of the templates we use to guide us in the relational world are established in the first two years of life and influence us outside of our awareness.  As the teenager separates from the home environment and faces complex social demands, the social neural networks - both conscious and unconscious - are activated.  If the foundation of these templates contains fragments of sensations, feelings, images and perceptual biases formed by maltreatment this makes the developmental journey for an adolescent more difficult to negotiate. Experiences of prolonged, chronic abuse, neglect or exposure to other forms of violence divert resources away from cortical regions and predispose an individual toward action rather than thought. Maltreatment affects brain development throughout childhood, but becomes a much larger issue during adolescence. It is one thing to manage an aggressive, impulsive, irrational five-year-old, but another thing entirely to manage those same behaviors in a 16-year-old who is bigger, more mobile, and has increased opportunity to engage in unsafe activities in the community. Adults who have to deal with these difficult-to-manage adolescents often misattribute their reactivity to their character, “bad seeds,” rather than an outcome of their adverse developmental experiences earlier in life.

Know Your Teenager Inside and Out

Everyone wants to feel understood and validated for who they are. Even though it may sometimes feel as if your teenager doesn’t care what you think, remember that your child is in fact greatly concerned about your love, respect and your opinions. Staying relationally connected to teenagers is very important to their development. Most children and families are able to successfully negotiate this period without major conflicts.  For those parents, foster parents, teachers or other caring adults who are dealing with troubled youth, remember that their behavior is an indication they are having difficulty coping with what they are experiencing internally and externally and it is not about you personally. Here are a few tips to think about to guide you through the remodeling of your adolescent’s brain.

• Try and focus on what they are thinking and feeling inside instead of always focusing on their behavior. Work on seeing the world through their eyes before expecting them to see the world through yours.
• Teenagers often want to control the social interaction. They seem to talk most when you are not trying to get them to talk. Create opportunities when you are just with your teenager and you will be surprised by how much they might share. Go out for a ride in the car, take walks, shot a basketball around, have dinner together or just sit in the same room reading. 
• Teenagers need clear expectations and structure plus validation and support - not one or the other. Teenager trust adults who can act like adults and respect them as teenagers, not someone who wants to be their friend or wants to control them.
• If you find that your teenager is creating a high level of internal distress for you - generating feelings of shame, helplessness or powerlessness - look first inside yourself for what unresolved issue might be reactivated from your past. The best way to stay connected to your teenager is to first stay connected to yourself.  Self-awareness is your greatest asset. 
• Help teenagers to use all of their brain in order to solve problems.  Ask them how they feel. What they think. Try to help them see issues from someone else’s perspective, in order to generate multiple solutions.  The goal is not just finding the solution, but teaching them to integrate sensations, feelings and thoughts into a more comprehensive, coherent picture of the world in which they live and the relationships they develop.

Remodeling can be messy and disruptive, but the end result is generally worth the effort!

I welcome your comments and questions. Please don't hesitate to post them here, or to contact me directly by email at jerry.yager@denvercac.org.

New Year's Resolutions: A Complex Challenge for the Brain

Setting goals for the New Year is a ritual that dates back at least as far as 2000 B.C. It began with the Babylonians and was later enthusiastically taken up by the Romans. The month of January is named after the Roman deity Janus, who had two faces, one looking toward the past and one toward the future.

The ability to set and implement goals is one of the brain’s most sophisticated capacities. Goal setting is mediated by the prefrontal cortex, the last region of the brain to fully mature.  In order to set and achieve a goal, a person has to hold onto what they have learned and experienced in the past, and then integrate that information with what they desire for the future. An individual has to resist reacting to current environmental stimuli and instead be guided by an internal representation of the future. The ability to achieve the desired outcome will depend upon accessing long-term memories, focusing attention on stimuli in the environment related to achieving the desired outcome, delaying short-term gratification, inhibiting old patterns of response, and planning the steps and sequences for new responses.

How do our brains accomplish these complex tasks? We use the cortical executive functions: Working memory, cortical modulation and cognitive flexibility.

• Working memory consists of a workspace in which information can be temporarily stored and mental work can be carried out. Neuroscientist Joseph LeDoux uses the computer to illustrate these cognitive capacities. The operating system of a computer is responsible for moving information from permanent storage (ROM) to a central processing unit with active memory (RAM). The executive function operates in a similar fashion by selecting appropriate environmental stimuli and then moving relevant information from storage throughout the brain into this workspace to process and direct behavioral responses. These executive functions allow for problem solving, decision making, and choosing a particular course of action.
  
  
• Cortical modulation is a higher brain function that allows individuals to inhibit impulses, resist temptations, and disrupt automatic habitual ways of behaving. This capacity allows us to make choices—to stop and think before we act.
  
  
• Cognitive flexibility allows individuals to shift their attention, adjust to changing environmental demands, and understand rules that govern behavior in different situations. For example, in the home a child is told to share his toys with other children, but on the soccer field he is instructed to steal the ball from a peer. In life there are exceptions to many rules that demand flexibility in our thinking and actions.
  
  

Developmental perspective

This ability to intentionally direct our behavior, and inhibit or modulate automatic, habitual patterns of reacting is not a skill we are born with, but one that must be developed over time. As people mature, they become less impulsive and reactive, allowing them to be more thoughtful and deliberate in their responses. These expanding behavioral capacities are a reflection of the underlying maturation and organization of the brain.

The developing child depends upon adults to provide structure and predictable routines to support the emergence of the brain’s executive functions. By matching the environmental demands to children’s developmental capacities, adults allow the child to experience the repetition of challenges, frustration and success as they work on tasks. This builds strong neural networks, allowing children to begin to integrate sensations, feelings and thoughts into a goal-directed action. These same abilities will foster the capacity for children to wait their turn, stay focused on tasks, and to remember and follow instructions when they enter the complex social environment of a school setting. These social/emotional capabilities are what make children “school ready,” not just the ability to understand numbers and letters.

The impact of trauma on executive functions

Early exposure to developmental insults affects the emergence of executive functions. Prenatal complications such as substance abuse, exposure to environmental toxins, illness, and high levels of maternal stress can disrupt the intrauterine environment and impact the fetus’s developing brain. Abuse, neglect and exposure to chaotic, unsafe environments can interfere with the regulation of important biochemicals resulting in modifications of brain architecture and functions. Exposure to adverse early experiences not only interferes with the child’s current functioning, but also alters the developmental pathway and can result in profound age expected deficits in working memory, cortical modulation and cognitive flexibility.

Hope

Don’t get discouraged because science tells us there is hope for children whose brains have been impacted by trauma. The developing brain’s capacity to be influenced by environmental stimulation presents us with the possibility of altering children’s developmental trajectory by exposing them to effective developmentally sensitive interventions. Research demonstrates that the brain remains plastic throughout life, meaning it is able to change in response to environmental input. However, the brain overproduces neurons early in life, and then chisels away those cells that are not used while strengthening the connections between pathways that are repetitively activated. Therefore, the earlier the intervention, the more adaptable the brain is to developmentally appropriate stimulation. It takes less energy and resources to create change in a system that is still being organized than it does to disrupt a system and then reorganize it. A system once organized will work to maintain itself.

A child who has missed out on certain academic knowledge will be much more capable of benefiting from academically focused remedial interventions than a child who has deficits in self-regulatory functions. Our child welfare and educational systems must radically rethink the way they treat children with learning and behavioral problems.  Interventions must be focused on stimulating the development of lower brain functions before attempting to address higher cortical mediated functions.  This can be accomplished by balancing exposure to somatosensory, emotionally meaningful and cognitive activities throughout the child’s day.  The timing, intensity and duration of each of these interventions should be sensitive to the child’s capacity to process the experience. To be effective, interventions must challenge children, but not overwhelm them. Children will naturally seek to explore their environment when they feel safe. The process of discovery and learning becomes pleasurable.  Pleasure will increase the likelihood of repetition, and repetition will create long-term changes in the brain that the intervention is designed to accomplish.

As a society, instead of labeling children who struggle to negotiate developmental demands, we must all become more developmentally sensitive, encouraging, and responsive. Our long-term goal is to help facilitate the development of citizens who can collaboratively function in a social group, delay gratification of immediate needs, and work toward the achievement of individual, family and community goals. Both for our children and for ourselves, we should strive to emulate the qualities of Janus—the ability to learn from the past and to develop strategies in the present, in order to achieve a desired outcome in the future.

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Dr. Jerry welcomes your questions! If you'd like additional information on any topic discussed or suggestions for future entries, please let us know!