TRAUMA AND STRESS:
CULTIVATING WELL-BEING
FOR ZERO TO THREE
Holly Hatton-Bowers, PhD and
LaDonna Werth, MS
[email protected]
April 19th, 2017
Recharge for Resilience Conference
Welcome!
What we hope you will take away
Understanding of:
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Stress (positive, tolerable, toxic)
Impact of stress on the developing brain
Trauma and early brain development
Important strategies for helping families with infants and
toddlers impacted by trauma
What do you hope to learn in this
session?
Important Needs of Infants and Toddlers
• Young children are vulnerable
• Co-regulation of emotions is
critical, with attachment being
particularly important
• Developing communication, selfawareness, self-control and selfregulation, sense of self,
relationships
Lawson & Quinn, 2013
Attachment: A Social Need
• How the primary caregiver responds to cooing,
crying, bids for attention, etc. determines the quality
of the attachment
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Secure attachment relationships are:
Serve and return
Nurturant
Stable
Committed
• Attunement: the act or dance of creating attachment
through a series of actions and responses between
child and the attachment figure
Early Childhood Stress Influences Developing Brain Architecture
Research on the biology of stress shows that
chronic, severe, and/or uncontrollable
stressful experiences disrupt developing
brain architecture and can lead to stress
management systems that respond at lower
thresholds.
Attachment relationships are central
in this process
But what is stress?
Types of Stress
• Positive
• Tolerable
• Toxic
Normative Danger Responses
Autonomic Nervous Response System
• Fight
• Flight
• Freeze
Positive Stress
Brief increase in heart rate, mild elevations in cortisol
An important and necessary aspect of healthy development, especially when it
occurs in the context of stable and supportive relationships.
Tolerable Stress
• Can disrupt brain architecture, but generally occur within
a time-limited period
• Serious, temporary stress response to events, buffered
by supportive relationships
Source: National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the Developing
Brain. (2005). Working Paper No. 3., Summer 2005.
Prolonged Exposure to
Stress and Cortisol
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Kills brain cells
Reduces number of cell
connections
Shrinks hippocampus
Impairs selective
attention
Impairs thinking
Creates anxious behavior
https://www.youtube.com/watch?v=rVwFkcOZHJw
Toxic Stress
• Refers to strong and prolonged activation of the body’s stress
management systems in the absence of the buffering protection
of adult support
• Examples
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Extreme poverty
Physical or emotional abuse
Chronic and serious neglect
Enduring maternal depression
Family violence
Source: National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the Developing
Brain. (2005). Working Paper No. 3., Summer 2005.
Let’s Shake a Bottle
Baby’s and Stress
• Newborns and infants rely on their
caregivers to soothe and calm them.
• Two physiological systems control
heart rate:
• parasympathetic nervous system: rest
and digest
• sympathetic nervous system: fight or
flight
• These systems are in a constant
fluctuating balance to meet your
needs
Stress and Infants and Toddlers
• Because infants are not capable of meeting their own needs, they rely on
caregivers to become their “external stress regulator”
• When the caregiver is consistent, predictable, and nurturing, providing
patterned, repetitive stimulation, the infant develops an adaptive,
flexible stress response system and builds in healthy attachment
capabilities.
Understanding the Impact of Trauma on the
Developing Child
The first three years are when the brain is making the majority of
its “primary” associations and the core neural networks
organize as a reflection of early experience. Early
developmental trauma and neglect have a disproportionate
influence on brain organization and later brain functioning.
Perry & Hambrick, 2008
Encourage Abstract
Thought
Facilitate Socioemotional Growth
Introduce SomatoSensory Integration
Establish State
Regulation
Cortex
Limbic
Diencephalon
Brainstem
Perry, B. 2006
WHAT ABOUT THE DEVELOPING
BRAIN AND TRAUMA?
Abstract Thought
Concrete Thought
Affiliation/Reward
Attachment
Sexual Behavior
Emotional Reactivity
Motor Regulation
Arousal
Appetite /Satiety
Sleep
Blood Pressure
Heart Rate
Body Temperature
“An experience, or pattern of
experiences, that impair the
proper functioning of the
person’s stress-response system,
making it more reactive or
sensitive.” – Bruce Perry, 2016
WHAT IS TRAUMA?
“Trauma does not just ‘affect’ children, it literally changes
the wiring of the brain.”
– Jack Shonkoff, MD, Director, Harvard Center for the Developing Child
Types of Trauma
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Complex trauma
Family violence
Medical trauma
Natural disasters
Community and school violence
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Neglect
Physical abuse
Sexual abuse
Traumatic grief
Refugee and war
zone trauma
Source: Adapted from The National Child Traumatic Stress
Network, www.nctsn.org
Adverse Childhood Experiences
TOP 10 Areas of Trauma
• Psychological Abuse
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Physical Abuse
Sexual Abuse
Loss of a Parent (for any reason)
Mother treated violently
Substance Abuse
Mental Illness
Criminal behaviors in the household
www.acesstudy.org
Experience
creates
Expectation
which alters
Perception
Developmental Effects of Trauma
Ages 0-2
Physiological
Have a poor appetite, low weight, and/or digestive problems
Have poor sleep habits
Experience nightmares or sleep difficulties
Hibel et al 2009.
Developmental Effects of Trauma
Ages 3-6
Cognitive
Physiological
Experience stomachaches and
headaches
Wet the bed or self after being toilet
trained
Have difficulties focusing or learning in
school
Develop learning disabilities
Trauma specific
Show poor skill development
Imitate the abuse
Emotional
Believe they are to blame for the
Act out in social situations
abuse
Are verbally abusive
Are unable to trust others or make
friends
Are anxious, fearful and avoidant
Lack self-confidence
False Associations
• The brain makes associations
between sensory signals that
co-occur in any given moment
in time. This capacity allows us
to survive but it also makes us
vulnerable to false associations.
Important points to remember
• All behavior has meaning
• Symptoms are adaptations
• Build on success not deficits
HOW TO CULTIVATE WELL-BEING
FOR INFANTS AND TODDLERS
Safety
“Because trauma – including that caused by neglect,
whether deliberate or inadvertent – causes an overload of
the stress response systems, which is marked by a loss of
control, treatment for traumatized children must start by
creating an atmosphere of safety.”
~ (Perry & Szalavitz, 2006, p. 154)
Predictability, Consistency, Supportive,
Stable, and Regulated = Safety
(Hodgdon et. al, 2013)
Affect Management
• When caregivers modulate their own affect and emotional
responses, they can create an emotionally safe environment in
which children a can learn
Remember the “bottom up approach”
Reason
Relate
Regulate
Bruce Perry, 2007-2015
Breathing Techniques for the Caregiver
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Controlled breathing, help calm emotional
control centers of the brain (app
MyCalmBeat)
• 5 breaths in and out
• With toddler teach controlled breathing
(“belly breadth)
Consistent Response
• Caregivers respond in a consistent way to both
positive (desired) and negative/unsafe behaviors.
Predictability reduces the child’s need for control.
Routines and Rituals
• Routines increases predictability and the child’s ability to anticipate
next steps. Establishing routines helps reduce trouble spots
(transitions, unstructured activities/days).
Consider beginning the day with predictable, structured, patterned, rhythmic music and movement
activities. Studies have indicated that children have increased self-regulation throughout the day when
sensory integration occurs early.
How do you promote these concepts in
a home visiting environment?
• Affect management
• Consistent Response
• Routines and Rituals
Use Reflection
• Provider Reflection Processes
“the mindful considerations of one’s actions.”
(Gilkerson & Shahmoon-Shanok, 2000)
Provider Reflective Process Assessment Scales (PRPAS) – Heller
& Ash, 2016
• Mindfulness
“ Mindfulness is “an open-hearted, moment to moment,
non- judgmental awareness” (Kabat-Zinn, 2005, p. 24).
PRPAS Examines…
Self-Knowledge
(Self-awareness, seeks
growth)
Process
(Relationships influence
change, Attends to
Process
Self-Regulation
(emotional breathing space,
hold uncomfortable
emotions, awareness of
emotional climate)
Authentic Attitude
(Openness, Acceptance,
Curiosity)
Collaboration
(Exploration, Resists
Pressure to Fix, Impact of
Words and Actions)
Multiple Perspectives
(consider personal history,
experiences, culture)
Heller & Ash, (2016)
Reflection Activity
Coping Tools: Supportive Trauma
Interventions for Educators (STRIVE)
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SIGHT: Calming an focusing: Green color
SOUND: Calming and comforting: low pitched white noise
SOUND: Calming and focusing: noise cancelling headphones
TOUCH: Calming and distracting: kinetic sand
TOUCH: Tension release: “stress eggs”
TOUCH: Tension release: Theraputty
Identify Feelings: Emotion cards
Reflection: mindfulness exercise, depth breathing
McConnico, Boynton-Jarret, Bailey, & Nandi, 2016
Take Aways
• Trauma is a unique individual experience
• For infants and toddlers, exposure to trauma and overwhelming
stress can impact the developing brain
• Take the time to “listen” and understand children and this can
mitigate trauma and toxic stress
• Relationships are key to healing
• Reflection and mindfulness can build relationships, understanding
and lead to children’s healing
Let’s Reflect!
What are your key take aways?
What questions do you have about the material we discussed?
What additional strengths are you able to recognize in your work
and practices? In the children you care for? Families you help
support?
What strategies did you see or hear that might be useful in your role
and work?
Thank you!
Resources
• Leiberman, A.F., Van-Horn., & Ghosh Ippen, C. (2005). Toward evidence-based
treatment: Child-parent psychotherapy with preschoolers exposed to marital
violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44,
1231-1248. doi:10.1097/01.chi.0000181047.59702.58.
• Lieberman AF, Knorr K. (2007). The impact of trauma: A developmental framework
for infancy and early childhood. Pediatr Ann., 36 (4):209-215.
• Osofsky JD, Lieberman AF. (2011). A call for integrating a mental health perspective
into systems of care for abused and neglected infants and young children. Am
Psychol.,66(2):120-128.
• Zero to Three