Toxic Stress: The Impact on Young Children and What YOU Can Do!

Transcription

1 Toxic Stress: The Impact on Young Children and What YOU Can Do! Betty Rintoul, Ph.D Growth of Brain Whole Brain Weight in Grams Conception to Birth Birth to Age 20 Birth Conception Source: A.N. Schore, Affect Regulation and the Origin of the Self,

2 CEREBRAL CORTEX LIMBIC SYSTEM BRAINSTEM Experiences Build the Brain developingchild.harvard.edu 2

3 Experiences Build Brain Architecture.wmv Role of Experience Repeated use strengthens brain connections If connections are not used, they are more likely to be pruned away The brain grows itself for the environment it experiences Emotion and relationships appear to play particularly important roles in shaping the brain s development 3

4 What is Stress? Stress Stress results when there is a threat to our well-being AND We attempt to defend ourselves from that threat Stress Reaction Begins with Perception of Threat in Limbic Brain 4

5 Stress Response Brain and body coordinate to release a series of biochemicals that prepare us to: Fight Flee Freeze Response developed for physical threat Usually intense, but short-lived Allows us to return to a baseline comfort level Body s Response to Stress Increase in heart rate Increase in blood pressure Increase in breathing rate Increase in muscle tone Release of stored sugar into the blood Hypervigilance (alert to threat) Tuning out of all non critical information 5

6 Chronic Stress Psychological/emotional threat Persistent uncertainty about well-being (lack of safety signals) Might not be as dramatic a reaction But may never fully recover to comfort state When we are unable to return to a comfort zone, stress becomes toxic to our health and well-being Normal and Chronic Stress Normal Stress Chronic Stress 6

7 Positive Stress Moderate, short-lived stress responses Examples include meeting new people, dealing with frustration, getting an immunization, or adult limit-setting An important and necessary aspect of healthy development that occurs in the context of stable and supportive relationships. Tolerable Stress Stress responses that could be disruptive, but are buffered by supportive relationships Examples include death or serious illness of a loved one, a frightening injury, parent divorce, a natural disaster, terrorism, or homelessness Generally occurs within a time-limited period, which gives the brain an opportunity to recover from potentially damaging effects. 7

8 Toxic Stress Prolonged stress in the absence of the buffering protection of adult support Examples include extreme poverty, abuse, chronic neglect, severe maternal depression, substance abuse, or family violence Disrupts brain architecture and leads to highly reactive stress response systems, increasing the risk of physical and mental illness. Pediatrics, 2012 Toxic Stress Derails Development developingchild.harvard.edu 8

9 Long Term Health Impact of Adverse Childhood Events ACE Study CDC Asked about 10 stressful childhood experiences Looked at long-term health outcomes ACE predicted 10 major causes of adult illness and death Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, & Marks (1998) 9

10 Compared to persons with an ACE score of 0, those with an ACE score of 4 or more were: 2 times as likely to be smokers 4 times more likely to be depressed 7 times more likely to be alcoholic 10 times more likely to have injected street drugs 12 times more likely to have attempted suicide ACE predicted higher rates of: Chronic obstructive pulmonary disease (COPD) Fetal death Heart attack and stroke Obesity Liver disease Risk for intimate partner violence Sexually transmitted diseases (STDs) Unintended pregnancies 10

11 Model of Causality Body s Response to Stress Increase in heart rate Increase in blood pressure Increase in breathing rate Increase in muscle tone Release of stored sugar into the blood Hypervigilance (alert to threat) 11

12 Stress Hormone - Cortisol Affect areas of the brain involved in learning and memory Affect areas of the brain involved in emotions and self-control Children who are stress reactive are at risk for behavior problems, school failure, and health problems Risk of Child Maltreatment In a study of 188 children under age 3 with newly opened child protection cases, 66% had developmental delays which met the eligibility criteria for early intervention In a sample of 125 foster children under age 6, over 80% had developmental or emotional problems (and 50% had both) Massachusetts Early Childhood Linkage Initiative, 2005 Klee, Kronstadt, & Zlotnick,

13 Impact of Poverty on Parenting Poor preschool children more likely to have abnormal cortisol (stress hormone) patterns These patterns were linked to impaired problem-solving, attention, and emotional regulation (and later school achievement) These links are correlated with a harsh and demanding parenting style Blair, 2012 And the circle continues Family stressors such as low maternal education, low income, and unsafe neighborhoods are strong predictors of adverse outcomes (especially when they occur in combination) Family stress is linked to negative child outcomes primarily through a harsh and controlling parenting style Vernon-Feagans, Family Life Project,

14 Even in Their Sleep, Babies are Learning. Even during sleep, infants show reactions to angry voices (based on fmri scans) Infants from high conflict homes showed the greatest reactivity in brain areas linked to stress and emotion regulation Graham, Fisher, & Pfeifer, 2013 Effects of Toxic Stress in Early Childhood Limbic irritability reactive stress response A low threshold for daily stressors Impaired brain structures responsible for memory formation, attention, and self-control Risk for school failure, behavior problems Compromise of immune system, perhaps permanently Teicher, 2000; Pollak, 2009; Essex,

15 So What Can We Do? Web-Resources BuncombeAces.Org 15

16 What is Needed to Buffer Toxic Stress? Presence of warm, nurturing and responsive adult caregivers in homes, in child care, and in school Encouraging Connections 16

17 Buffering Stress through Responsive Relationships Betty Rintoul, Ph.D. How Brains are Built 17

18 Effects of Toxic Stress in Early Childhood - REVIEW Limbic irritability reactive stress response Creates a low threshold for daily stressors Impairs brain structures responsible for memory formation, attention, and self-control Risk for school failure, behavior problems Compromise of immune system, perhaps permanently Teicher, 2000; Pollak, 2009; Essex

19 The child who has experienced toxic stress. Does not expect adults to be helpful or supportive Comes with a brain that expects negative experiences and is focused on defense and survival Has minimal experiences with empathy, comfort, planning ahead, or focused attention May have frequent illness and discomfort What is Needed to Buffer Toxic Stress? Presence of warm, nurturing and responsive adult caregivers in homes, in child care, and in school 19

20 Limbic System Developed and functioning at birth Emotional brain - actually the front line of processing basic survival emotions Coordinates automatic responses to threat or danger Relationships are the Active Ingredients" of Early Experience Nurturing and responsive relationships activate the basic connections necessary for building the foundation of healthy brain development When these relationships are not present, persistent stress results in elevated cortisol levels that impair cell growth and interfere with formation of healthy neural circuits h d d 20

21 Still Face Experiment Dr. Edward Tronick 21

22 Discussion What happens when the communication link is cut by the mother not responding? What kinds of chronic stress do our children face? So How Can We Help? 22

23 Think of Someone Who Influenced You Positively in Childhood What words describe your relationship with that person? How did they treat you? Talk to you? Children don t care how much you know until they know how much you care. Stress-Busting Caregivers Provide: Protection Structure Comfort Coaching 23

24 Safety First Feeling physically and emotionally safe calms the stress response system Young children depend on supportive relationships for feelings of safety Establish and provide safety signals (blanket, pacifier) Protect from Danger Cues Threat alerts the primitive brain; shuts down higher level thought processes Each of us has our own unique set of danger cues (find out about previous negative experiences) Young children mirror the emotions of their caregivers 24

25 Structuring the Biological Foundation Sleep Activity Nutrition Structure through Routines Routines calm and strengthen us by helping us predict what is going to happen Maintain old routines Establish new routines and rituals Daily schedules what comes next? Rituals, especially when separating (ending visits, child care, bedtime) 25

26 Structure through Limits Limits should emphasize keeping everyone safe Communicate and enforce limits by being: calm, consistent, respectful, firm, and kind No yelling, threats or sarcasm - threat alerts the primitive brain; shuts down higher level thought processes Comfort can be an effective part of discipline Negative Emotion Survival Fredrickson,

27 Positive Emotion Flexibility Creativity Receptiveness to others LEARNING! Fredrickson, 2003 Keeping in the Comfort Zone Overarousal (distress, agitation) Caregiver comforts Quiet Alert Underarousal (bored, drowsy) Encouraging Connections 27

28 Limbic Level Communication Touch Tone of voice Facial expression Music Smell Rocking, other rhythmic motion Special Guidelines for Children Affected by Toxic Stress Provide comfort even when child does not seek it act as if the child needs you Offer comfort and support early don t wait until the child has a meltdown Be careful with expressions of annoyance and anger they can trigger dysregulation 28

29 Coaching Emotional and Behavioral Regulation Strengthen inhibition and coping skills FRONTAL CORTEX Frontal Cortex Cortex registers conscious awareness of emotions and plans how to respond Inhibits impulsive action on messages sent by the limbic system (effortful control) Grows most rapidly between 8 months and 5 years of age Growth is influenced by interactions with and guidance from caregiver 29

30 Development of Self-Regulation Managing impulses and emotions is related to connections in the frontal cortex How well these skills develop depend to a large extent on having a caring adult emotionally available to model, guide, and support self-regulation Road to Self-Regulation Self-regulation involves promoting effective connections between the structures of the limbic system and the cortex Become aware of emotions, then decide how to act, or not act, on them These skills begin to develop in preschool years - continue developing actively through adolescence 30

31 Is Behavior Really the Problem? Emotion > Behavior Anger = Fear/Defense Stressed-out children often ACT angry and aggressive when their threat systems are activated When we respond with anger or punishment, we simply intensify this response When we respond with empathy and protective limits, we calm their threat system 31

32 Coaching Impulse Control and Coping Join with the child loan your cortex Identify and empathize with feelings first Pair language with action to promote cooperation and problem solving Model optimism and mutual support Promote empathy with others and repair of relationships Maximize positive emotion FLIP It Approach Feelings (label, empathize) Limits (state limit with kindness) Inquiry (what would help you feel better/cope?) Prompts (problem solve together; suggest creative ways child might manage feelings) Sperry, R. W. (2011) FLIP It: Transforming Challengi 32

33 Coaching through Stories Self-regulation through narrative Stories provide order, meaning, and hope Beginning, middle, and end Builds connections between limbic and cortical brain I like to be told - Mister Rogers Kinds of Narrative Picture sequences of routines Acting out stories with dolls Picture books related to similar situations Verbal planning of play and other activities Creating specific social stories to help with problem behaviors Writing about difficult experiences Pennebaker, J.W. (2004) Writing to Heal; Wilson, T. 33

34 Role of Experience Repeated use strengthens brain connections If connections are not used, they are more likely to be pruned away The brain grows itself for the environment it experiences Emotion and relationships appear to play particularly important roles in shaping the brain s development Implications for Parents, Teachers, & Caregivers Your empathy, compassion, emotional and behavioral regulation are models for your children Your emotional well-being affects your ability to guide and support young children Quality of relationship with each child is a tool for supporting the development of selfregulation 34

35 Be the Grown-Up Bigger Stronger Wiser Calm KIND! Encouraging Connections 35