Trauma, Learning, Memory & Development

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! ! ! ! ! ! ! Evin Phoenix Trauma, Learning, Memory and Behavior Excelsior College May 22, 2015


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! Introduction

! Trauma is a complex, common, challenging, confounding and dynamic issue that has only recently begun to be understood from holistic perspectives (Suzuki et al 2014). People of all ages, backgrounds, cultures and genders can experience trauma. However, when trauma strikes in early childhood (early childhood trauma or ECT), and particularly when trauma is chronic as opposed to acute, it can result in complex symptoms that can confuse mental health care providers as well as the individual suffering with the issue, making it particularly hard to live with and treat (Suzuki et al, 2014). ECT can also cause lasting physiological as well as psychological developmental issues, especially when the trauma continues through adulthood, and sometimes results in PTSD (Suzuki et al, 2014). Recently, one study developed a self-report test called the Aversive Childhood Experiences (ACE) questionnaire to examine the type and degree of trauma experienced in order to further understand treatment with trauma-informed therapy (Starecheski, 2014). This self-administered questionnaire presents nominal-dichotomous items to evaluate and scale the possible abuse or neglect experienced as a child on a scale with high sensitivity (level one through ten based on ten questions) (Mitchell & Jolley, 2014). This paper will describe an overview of the interaction of biopsychology and behavior and the conspiracy of factors that cause developmental issues with learning and memory, especially in children. Cutting-edge research on trauma and recovery will be summarized, as well as ideas for future studies. Finally, successful, empirically-supported treatment modalities of healing will be discussed with the hope of demystifying trauma. 


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! The interaction of biopsychology and behavior of trauma in development

! There are many different kinds of trauma. From minor traumas, such as when a beloved character of many years is violently killed off a favorite television show, to deeper traumas, such as being bullied in school, to even deeper traumas, such as losing a pet or loved one, being abused or assaulted, or witnessing acts of violence. The trauma that results from these events is largely dependent both on the severity and frequency of the experience, as well as the personal characteristics of personality and resilience of the individual, and possibly by the connectedness and support of their community as well. However, when trauma strikes in childhood, the results can last a lifetime, as children are in formative developmental years. When trauma exists within the framework of the caregiving system of a child’s family and caretakers, complex trauma exposure occurs (Kisiel et al 2014). Such childhood trauma is a strong predictor of psychopathology (Rinne-Albers et al 2013). Trauma can affect the development of the immune system, the brain, cognition, emotions, behavior, and even change DNA according to the revolutionary concepts of neuroplasticity (Berk, 2014). This becomes even more alarming when considering how such neuroplastic DNA changes result in intergenerational (transgenerational) trauma, or the carrying over of cognitive and biopsychological issues from ancestral trauma (Goodman 2013). This complexity of ecosystemic factors of trauma, especially as they relate to the young child, has resulted in a growing understanding of trauma in a holistic sense. Much recent research on early childhood trauma (ECT) points to relationships between ECT and issues in adulthood that were previously thought to be unrelated, such as clinical de-

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pression (Mandelli et al 2015), heightened levels of cortisol (a significant risk factor for many life-threatening illnesses and diseases) (Kempke et al 2015), higher blood pressure and social isolation (Norman et al 2015), chronic fatigue syndrome (Kempke et al 2013), severe mental illness (SMI), substance abuse and violence (Bruce et al 2015), bipolar disorder (Anand et al 2015), schizophrenia (Li et al 2015), emotional regulation in adulthood (Thomaes et al 2015), social anxiety disorder (Bishop et al 2015), psychosis (Duhig et al 2015) and more. In fact, one meta analysis of dozens of studies showed that emotional abuse and neglect were most strongly correlated with adult depression, with physical and sexual abuse showing a weaker relationship to depression in adulthood (Mandelli et al 2015). This research shows how powerful trauma is in terms of affecting cognitive and physical health. Perhaps there were once ideas in another time that one should simply “get over it” if they experienced trauma, whether it was a personal event such an accident in the home or a large-scale trauma such as war. We are only just beginning to understand how trauma can affect us long after the event itself, and in unexpected ways. One thing that serves as a protective factor against trauma is the presence of caregivers in formative years who are warm and emotionally responsive, who also provide and model consistent empathy (Briggs et al 2014). Mothers who have unresolved trauma are often not as capable of maintaining these characteristics, and often fail to best interpret the emotions of their children (Briggs et al 2014), resulting in incomplete or inadequate emotional responses to the child. This may result in confusion, self-doubt, shame, and guilt on part of the child. Additionally, these mothers may also punish their children more aggressively, with higher rates of severe physical punishment, neglectful behavior, and psychological hostility (Briggs et al 2014). In this way, a cycle begins, where the children of the mother with unresolved trauma raise their own children

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with unresolved trauma. This perpetuates a system of transgenerational abuse and trauma that is difficult to break from. In 2012, the American Academy of Pediatrics issued a statement on toxic stress on the developing child, asking primary care doctors and pediatricians to be the first responders identifying and addressing trauma in children, especially given that there is less stigma and much more access than mental health care workers (Briggs et al 2014). However, doctors are not prepared to deal with trauma and its affects on development, and there is much more to be done to address this epidemic. One longitudinal study by Peterson (2014), revealed that giftedness of a child can serve as a protective factor against traumatizing experiences, a fascinating possibility that warrants much additional research. In the study, a young woman was interviewed over a fifteen year period as she graduated high school, college, and received her master’s degree and became a professor. Her giftedness and insight allowed her to excel in many developmental areas, such as identity development, emotional growth, establishing her own family, interacting with peers, social development, and the establishment of a successful career (Peterson 2014). Other studies have noted that high intelligence and giftedness can serve as protective factors against the effects of child abuse and neglect because the child receives praise and recognition for their skills and talents outside the home, resulting in increased resilience in development (Berk, 2014). This could serve the adult by protecting against hopelessness as well as learned helplessness. An Illinois study of over 16,000 children found that children exposed to violence and emotional trauma experienced significantly high levels of attention disruption, emotional dysregulation, affective and physiological disruptions, behavior problems, as well as symptoms of PTSD (Kisiel et al 2014). They were also more likely to be hospitalized for psychiatric care, as

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well as have difficulty functioning on a daily basis (Kisiel et al 2014). This relationship has not yet been investigated enough with neuroimaging studies to determine how trauma changes the structure of the brain in children, but some research has shown differences in the corpus callosum (Rinne-Albers et al 2013), which joins the two brain hemispheres. It seems as no surprise then that trauma is correlated with so many cognitive and behavioral issues, given that this is the area of the brain that links all interhemispheric communication. Other studies have found that repeated stress, especially in critical neurodevelopment years, hinders the development of neurons as well as causes the decay of dendrites, which carry messages along the neural pathways (Rinne-Albers et al 2013). As pointed out by Rinne-Albers (et al 2013), this inhibits the development of memory ability and learning, as well as other issues. The cognition of memory comes from the hippocampus, which can be altered by chronic exposure to trauma, and is associated with the development of PTSD (Rinne-Albers et al 2013). The amygdala is also affected by trauma, which can result in dysfunction and dysregulation with the emotional aspects of memory, as well as the behavior that results from the excitability of neurons (Rinne-Albers et al 2013).

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! Research-based treatment programs to address trauma & and learning

! Cutting-edge research has much to offer as new frameworks are built and new treatments designed to address the urgent and critical issue of exposure to complex trauma and adverse childhood experiences. The

Transgenerational Trauma and Resilience Genogram (TTRG)

(Goodman 2013) is one such model for helping clinicians identify and treat patterns of trauma. This is a model that maps out generational trauma with an ecosystemic view, helping to absorb the totality and complexity of the issue. Fascinatingly, while it includes contemporary resiliencebased treatments and assessments, it also addresses sociopolitical factors that are often present with transgenerational trauma (Googman 2013). This serves as an incredibly comprehensive approach to a radical framework, especially as the counseling field continues to understand the systemic and ecological nature of trauma. Another emerging treatment is the Healthy Steps Program (Briggs et al 2014). This is a program that is aligned with the primary-care-based interventions recommended by the previously mentioned policy statement by the American Pediatric Association. In the intervention program, early childhood development specialists are placed alongside pediatricians in a co-management context to address identified trauma patients (Briggs et al 2014). Importantly, the framework allows for the critical flexibility needed to tailor treatments to local populations. Research points to Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children (Salloum et al 2014). TF-CBT was developed into a stepped model for young traumatized children, an empirically-supported modality of healing (Salloum et al 2014). Most

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importantly, it is accessible, cost-effective, efficient, and effective (Salloum et al 2014). But this speaks to a need for improving developmental trauma identification and treatment frameworks as well as evidence-based interventions. The Stepped Care TF-CBT program is not widely known or utilized, and there is much confusion accompanying the treatment of trauma. One suggestion that could pose widespread implications for improving access to preventative care as well as treatment for children exposed to trauma is to get a framework into schools. The notion of trauma-informed schools is perhaps the best idea yet in reaching populations of children exposed to trauma, as the structure is already in place. One study suggested several techniques to build trauma-informed communities, such as a focus on safety in school culture, trauma and learning training for staff, the nurturing of openly communicative student-staff/teacher relationships, the development of best practices based in strength-based leadership, restorative justice programs that provide compassionate and not punitive responses to poor behavior, and working to better identify students who have been exposed to trauma (Walkley & Cox 2013).

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! Conclusion

! Trauma is a monstrous problem that casts a shadow on the rest of the life of a survivor, especially for children exposed to complex trauma in developmental years. Only recently has research identified how patterns become systemic in family systems, and how ancestral transgenerational trauma can cause lasting effects. There are several evidence-based trauma-identification and treatment programs for children who have experienced trauma. However, implementation is nowhere near universal, and accessibility needs to be improved. Furthermore, more research is needed to understand the complex neuropsychobiological relationship between exposure to trauma, especially complex and chronic trauma, and the neurological development of children. These issues are critical to understanding how to improve the quality of life for children everywhere and even prevent further trauma from occurring as such research informs practices of schools, communities, caregivers and parents.

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! References

! Anand, A., Koller, D. L., Lawson, W. B., Gershon, E. S., & Nurnberger, J. I. (2015). Research report: Genetic and childhood trauma interaction effect on age of onset in bipolar disorder: An exploratory analysis. Journal Of Affective Disorders, 1791-5. doi:10.1016/j.jad.2015.02.029 Berk, L. (2014). Development through the lifespan (6th ed.). Boston, MA: Allyn and Bacon. Bishop, M., Rosenstein, D., Bakelaar, S., & Seedat, S. (2014). An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder. Annals Of General Psychiatry, 13(1), 1-24. doi:10.1186/1744-859X-13-16 Briggs, R. D., Silver, E. J., Krug, L. M., Mason, Z. S., Schrag, R. A., Chinitz, S., & Racine, A. D. (2014). Healthy Steps as a moderator: The impact of maternal trauma on child socialemotional development. Clinical Practice In Pediatric Psychology, 2(2), 166-175. doi:10.1037/cpp0000060 Bruce, M., & Laporte, D. (2015). Childhood trauma, antisocial personality typologies and recent violent acts among inpatient males with severe mental illness: Exploring an explanatory pathway. Schizophrenia Research, 162285-290. doi:10.1016/j.schres.2014.12.028 Duhig, M., Patterson, S., Connell, M., Foley, S., Capra, C., Dark, F., & ... Scott, J. (2015). The prevalence and correlates of childhood trauma in patients with early psychosis. The Australian And New Zealand Journal Of Psychiatry

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Goodman, R. D. (2013). The transgenerational trauma and resilience genogram. Counselling Psychology Quarterly, 26(3/4), 386-405. doi:10.1080/09515070.2013.820172 Kempke, S., Luyten, P., De Coninck, S., Van Houdenhove, B., Mayes, L. C., & Claes, S. (2015). Effects of early childhood trauma on hypothalamic–pituitary–adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome. Psychoneuroendocrinology, 5214-21. doi:10.1016/j.psyneuen.2014.10.027 Kisiel, C., Fehrenbach, T., Torgersen, E., Stolbach, B., McClelland, G., Griffin, G., & Burkman, K. (2014). Constellations of Interpersonal Trauma and Symptoms in Child Welfare: Im plications for a Developmental Trauma Framework. Journal Of Family Violence, 29(1), 1-14. doi:10.1007/s10896-013-9559-0 Li, X., Li, Q., Liu, J., Zhang, L., Tang, Y., & Wang, C. (2015). Childhood trauma associates with clinical features of schizophrenia in a sample of Chinese inpatients. Psychiatry Research, doi:10.1016/j.psychres.2015.06.001 Mandelli, L., Petrelli, C., & Serretti, A. (2015). Review: The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, doi:10.1016/j.eurpsy.2015.04.007 Norman, G. J., Hawkley, L., Ball, A., Berntson, G. G., & Cacioppo, J. T. (2013). Perceived social isolation moderates the relationship between early childhood trauma and pulse pressure in older adults. International Journal Of Psychophysiology, 88(Psychophysiology of Relationships), 334-338. doi:10.1016/j.ijpsycho.2012.12.008 Peterson, J. S. (2014). Giftedness, Trauma, and Development: A Qualitative, Longitudinal Case Study. Journal For The Education Of The Gifted, 37(4), 295-318.

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! ! Rinne-Albers, M. W., van der Wee, N. A., Lamers-Winkelman, F., & Vermeiren, R. M. (2013). Neuroimaging in children, adolescents and young adults with psychological trauma. Eu ropean Child & Adolescent Psychiatry, 22(12), 745-755. doi:10.1007/s00787-013-0410-1 Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive And Behavioral Practice, 2197-108. doi:10.1016/j.cbpra.2013.07.004 STARECHESKI, L. (2015, March 2). Take The ACE Quiz - And Learn What It Does And Doesn't Mean. National Public Radio. Retrieved May 28, 2015, from http://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-andlearn-what-it-does-and-doesnt-mean Suzuki, A., Poon, L., Papadopoulos, A. S., Kumari, V., & Cleare, A. J. (2014). Long term effects of childhood trauma on cortisol stress reactivity in adulthood and relationship to the occurrence of depression. Psychoneuroendocrinology, 50289-299. doi:10.1016/j.psyneuen.2014.09.007 Thomaes, K., Dorrepaal, E., van Balkom, A. M., Veltman, D. J., Smit, J. H., Hoogendoorn, A. W., & Draijer, N. (2015). [Complex PTSD following early-childhood trauma: emotionregulation training as addition to the PTSD guideline]. Tijdschrift Voor Psychiatrie, 57(3), 171-182. Walkley, M., & Cox, T. L. (2013). Building Trauma-Informed Schools and Communities. Chil dren & Schools, 35(2), 123-126.