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We’re reviewing a paper in latest issue of Journal of Child and Adolescent Psychology and Psychiatry. The paper is by Eamon McCory and associates from the University College of London and the Anna Freud National Center for Children and Families. The paper is titled ‘Childhood Maltreatment, latent vulnerability and the shift to preventative psychiatry - the contribution of functional brain imaging. Check out the show notes for the reference to the paper. In this paper, McCory and colleagues clearly summarise the key findings about the impact of trauma on children’s brains. Childhood maltreatment, including physical, sexual, emotional abuse and neglect, have a traumatic effect on students, and arguably represent the most potent predictor of poor physical health mental health and educational outcomes across the lifespan.Much like dyslexia, autism or any other learning disability or disorder, childhood trauma has a pattern of impact on children that can be understood and accommodated within classrooms and schools.
So lets start by learning what functional magnetic resonance imaging is? In our brains, the activity of neurons, the basic cells that form the brain, fluctuates with signals as we engage in different activities. From simple tasks like controlling your hand to reach out to pick up a cup of coffee, to complex cognitive abilities like understanding a lesson of literacy or numeracy. Functional magnetic resonance imaging (or FMRI for short) is a technique for measuring and mapping brain activity that is noninvasive and safe. It's used in many studies to better understand how the healthy brain works, and in a growing number of studies, it is being applied to understanding how normal function is disrupted by disease and psychosocial circumstances, such as abuse and neglect.
The authors of this paper organise the findings of these FMRI studies looking at the impact of trauma on children’s brains into four key domains: threat processing, reward processing, emotion regulation and executive control. So let take a closer look at what they found in each of these four domains.
Threat processing refers how people identify and make sense of danger and threat in their environment. The experience of fear is very important to our survival. It alerts us and our brain to danger, and helps mobile the body to react and seek safety. Repeated experiences of danger also shapes how we learn to anticipate and look for danger in our environment, by influencing how our the neural circuits in our brains become wired. In FMRI studies on groups of maltreated children, its been found that there appears to be a certain pattern of activation in the part of the brain called the amygdala.
The amygdala is of the one of two almond-shaped structures in the brain, thought to be part of the limbic system. Research has shown that the amygdala plays a primary role in the processing of memory, making decision, and most importantly, how we react emotionally to the events around us. McCory and his colleagues found that several FMRI studies have found that the amygdala of maltreated children is easily activated and causes them to perceive danger and negativity, even in the objective absence of such dangers.
What they have also found that the sensitivity of the amygdala to responding in this way is directly linked to the amount of time a child has been lived in adverse circumstances of abuse and neglect.
Interestingly, some studies have also found that for some children, there is a pattern of marked de-activation of the amygdala. That is, that some children seem to properly identify or detect signs of danger in social environments, and tend to avoid attending to these cues in their environment. The authors of this paper describe this as a pattern of ‘hypoactivation’ or under-activation. These children often dissociate - bottling up their feelings, becoming emotionally numb and disconnected from their surroundings.
How traumatised children process threat is inherently linked to their escalated behaviours and feelings of what we describe as ‘felt safety’. Felt safety refers to the students perception of feeling safe socially in the school community - with administrators, teachers and other students. Several of their behaviours come from misinterpretations or misperceptions of threat in the classroom environment, and so interventions, accommodations and changes implemented must have processes linked to them to review and gauge the ‘felt safety; of these students. This could be anything from speaking directly with the student themselves, to liaising with trusted adults about the student’s perception of the school environment, to recruiting non-academic support staff to build a trusting relationship with the student.
Let’s go to the second key findings of these studies, which relates to reward processing. The reward system is a group of structures in the brain that are responsible for motivation and “wanting” - that desire for positive reinforcement or craving for a reward. Its also linked to positive emotions, such as joy, euphoria or ecstasy. For children exposed to abuse and neglect, FMRI studies have found a blunted neural response to anticipation and receipt of rewards. That is, that they do not seem to respond with as much pleasure or joy on receiving rewards, praise or other forms of positive reinforcement. Such patterns of brain activation have been associated with symptoms of low mood and major depression.
Implication: Reward charts don’t always work with traumatised children. I’ve often heard teachers complain about finding it difficult to find rewards that are meaningful or pleasurable for these children. What we know from this research finding is that such observations may be based neurological patterns that hinders traumatised children experiencing the full effect of such positive reinforcement. However, it doesn't mean that these children don’t find a meaningful reward pleasurable - it seems that they may not respond with as much happiness and pleasure as other student who haven’t been traumatised. You can observe a similar phenomenon with praise. When praise is provided to traumatised student, it is reasonable to expect that the student will have difficulty accepting it and in fact, because of their unfamilairity with the feeling of being proud of accomplishments, may be suspicious of the person providing the praise. In the end, it comes down to persistence and repetition. Accepting positive reinforcement and experiencing pleasure in a safe way is a learnt skill. With the brain being plastic, and constantly changing in response to its environment, the provision of praise, engagement in active and pleasurable events, are all key in reshaping a traumatised student’s brain for recovery and resilience.
Thirdly, McCory and colleagues found FMRI studies as identifying differences in the emotion regulation of maltreated children. Emotion regulation describes a person’s ability to effectively manage and respond to an emotional experience. People unconsciously use emotion regulation strategies to cope with difficult situations many times throughout each day. Most of us use a variety of emotion regulation strategies and are able to apply them to different situations in order to adapt to the demands of our environment. Some of these are healthy, some are not. For children traumatised from physical, sexual or emotional abuse, FMRI studies have found an increased activation of the anterior cingulate cortex (or ACC) when trying to control strong emotions.
The ACC is a collar shaped structure that is in a unique position in the brain in that it connect to both the part of the brain responsible for our emotional responses ( the limbic system) and the cognitive, rational parts of our brain (the prefrontal cortex). Thus, the ACC plays a very important role our mental health by helping us keep our emotions and impulses in check, with rational thinking and restraint. For traumatised children, the prolonged and increased activation of this area indicates that it is harder for these children to control their emotions, requiring greater effortful processing by the brain to accomplish this task, compared to other children who have not been traumatised.
Implications: Emotion regulation is a learnt skill. The biology of traumatised children make it hard for them to learn this - requiring them to expend more effort in achieving this goal compared to other children. Much like a child with dyslexia expends more energy and effort in reading text without support. Persistent practice of such SEL skills, in a safe and containing school environment, are the keys to helping traumatised children.
Finally, the paper discusses the impact of adverse circumstances on executive control. Imagine yourself driving home, talking on the cell phone, planning dinner, and deciding to stop by the fish store to pick up some salmon. You alternate between steering and braking, watching traffic, following the conversation, thinking about wines, and looking out for the turn to the fish store. None of these activities is especially difficult, but the combination can be deadly. The difficulty you experience in multitasking transcends skills and habits. It reflects the strain on your executive-control processes in your brain— the processes that control and coordinate skills and habits, allowing you to choose among tasks, monitor and adjust your performance, and change tasks if you need to.
The findings from FMRI studies about the executive functioning and control of children seems mixed and less conclusive. For example, McCory and colleagues cite a study where the data collected demonstrated that although individuals with a history of childhood victimization were characterized by deficits in IQ or general intelligence and executive control (in line with the extant literature), such deficits were largely explained by cognitive deficits present prior to the experience of childhood victimization and by nonspecific effects of childhood socioeconomic disadvantage (Danese et al., 2016). Thus, the neuroimaging findings with respect to executive control reported here need to be viewed with a degree of caution, as they may not reflect alterations in cognitive processes associated with maltreatment per se, but rather reflect prior cognitive vulnerabilities.
What’s referred to as general intelligence or IQ has been repeatedly found to be a protective factor in coping with trauma and being resilient in the face of adversity. To learn more about this, check out episode 7 of our podcast where we interview Dr. Raul Silva about risks and resilience linked to trauma. Just as cognitive capacities are protective for children in unsafe environments, early vulnerabilities make children cope more poorly with traumatic experiences. This is why an investment in early childhood education, attachment and care practices are the key to building lifelong resilience in children. What this finding also highlight is that for some traumatised children, that dormant capacities for learning may be activated, once they are supported to learn the emotion regulation skills required to help participate and function in a school environment.
McCory and colleagues explain these findings using the concept of ‘latent vulnerability’/ They argue that alterations in brain structures and cognitive functioning may have adaptive value when the child is in adverse caregiving environments. That is, the brain may be geared to help the child survive these unsafe and unsupportive environments. However, they go on to explain that despite the adaptive value of such changes in the brain in the short-term, these changes constitute a risk for poor physical and mental health outcomes, and in turn, educational outcomes for children over time. That is, although brain functioning that support hypervigilance in an unsafe home environment might be useful, such adaptations may not be as helpful in a class, where you are required to attend to academics, and not be preoccupied by being embarrassed by peers or rejected or shamed by teachers.
Such findings establishing a compelling case for identifying those children at most risk and developing mechanistically informed models of preventative intervention. Such interventions should aim to offset the likelihood of any future psychiatric disorder, as well as educational disadvantage.
School is often a safe haven for several students, away from the chaos and adversity in their life at home. Teachers play a crucial role in building skills to combat the deficits linked to these four key domains, in an inclusive and safe classroom environment.
Thats it for today - We hope you’ve found this review useful and interesting. Please do check out the reference to this paper in our show notes on our blog at www.tipbs.com. Feel free to let us know what you think of this episode in the comments section below. Thank you for listening. See you next time.