Adversity and Toxic Stress in Early Childhood and Its Enduring Effects on Adult Diseases
Yoonsuh Moh, MA, CRC, LGPC
The George Washington University
Yoon Suh Moh, Ph.D., NCC, CRC, LPC
Adversity and Toxic Stress in Early Childhood and Its Enduring Effects on Adult Diseases
Yoonsuh Moh, MA, CRC, LGPC
The George Washington University
Yoon Suh Moh, Ph.D., NCC, CRC, LPC
Perspectives on Human Development
The process of development is understood as a function of "nature dancing with nurture over time"
Development is driven by an ongoing, inextricable interaction between biology (as defined by genetic predispositions) and ecology (as defined by the social and physical environment)
Ecobiodevelopmental Framework
For Understanding the Evolution of Human Health and Disease across The Life Span
Biology
Physiological adaptations and disruptions
Health & Development
Learning, behavior, and physical & mental well-being
Ecology
The social and physical environment
Biology
Health &
Development
Ecology
Epigenetics
Neuroscience
Life Course Sciences
The Center on the Developing Child at Harvard University
Significant Stress and Its Lasting Effects
Significant stress in the lives of young children is viewed as a risk factor for the genesis of health-threatening behaviors as well as a catalyst for physiologic responses that can lay the groundwork for chronic, stress-related diseases later in life
The Impact of Early Adversity on Children's Development
The Center on Developing Child at Harvard University
Clinic the mouse!
https://developingchild.harvard.edu/resources/inbrief-early-childhood-mental-health-video/
Trauma
Trauma is defined as a psychological event that has happened to an individual whose involuntary autonomic nervous system becomes overwhelmed... and the reality of trauma is that the residues of the past are currently active in the nervous system (Levin, 2010).
"Trauma is not about the residues that left inside you, but the physical sensation, emotions and feelings that are happening in the present that don't belong here" (Van der Kolk, 2005).
Conceptual Taxonomy
3 Distinct Types of Stress Responses in Young Children
Positive Stress Response
Tolerable Stress Response
Toxic Stress Response
The National Scientific Council on the Developing Child
Physiological Responses to Stress
Activation of the hypothalamic-pituitary-adrenocortical axis
Activation of the sympathetic-adrenomedullary system
Incleased levels of stress hormones (corticotropin-releasing hormone (CRH), cortisol, norepinephrine, and adrenaline)
Stress
Elevated inflammatory cytokines
The response of the parasympathetic nervous sytem
Biological Manifestations of Toxic Stress
Alterations in immune function 19
Increases in inflammatory markers
Associated with poor health outcomes
Cardiovascular disease
Liver cancer, asthma chronic obstructive pulmonary disease
Poor dental health
Depression 17, 18
Alterations in immune function 5
Increases in inflammatory markers
Cardiovascular diseases
Liver cancer, asthma
Depression 2, 3
Structural and functional disruptions in the brain that lead to a wide range of physical and mental illnesses later in adult life 1
Chronic obstructive pulmonary disease
Less diversity in gut microbial communities and gastrointestinal disturbances 6
The timing of specific environmental insults during sensitive developmental periods 4
Understanding The Biology of Stress
Fetal exposure to maternal stress can influence later stress responsiveness
Early postnatal experiences with adversity are thought to affect future reactivity to stress, perhaps by altering the developing neural circuits controlling these neuroendocrine responses
Toxic Stress and the Developing Brain
Ex. Abundant glucocorticoid receptors are found in the amygdala, hippocampus, and prefrontal cortex (PFC)
Structural Changes: Alter the size and neuronal architecture of these areas
Functional Changes: Lead to functional differences in learning, memory, and aspects of executive functioning
Toxic stress in young children can lead to permanent changes in brain structure and function
The Role of The Amygdala in Physiologic Stress Response in Early Childhood
The amygdala is an activator of the physiologic stress response
The amygdala contains large numbers of both CRH and glucocorticoid receptors, begining early in life, which faciliate the establishment of a positive feedback
Significant stress in early childhood can trigger amygdala hypertrophy and result in a hyperresponsive or chronically activated physiologic stress reponse, along with increased potential for fear and anxiety
BrainFacts 3D Brain:: http://www.brainfacts.org/3d-brain#intro=false&focus=Brain-limbic_system-amygdala
Damage to The Amygdala in Early Childhood
Neurobiolgoical studies indicate that damage to the amygdala in early chilhood is accompanied by profound and long-lasting changes in the formation of social bonds and emotionality (Bachevalier, 1994 cited Schore 2003b
The Role of Hippocampus in Physiologic Stress Response in Early Childhood
Exposure to high levels of stress of cortisol inhibits neurogenesis in the hippocampus that plays an important role in the encoding of memory and other fucntions
Toxic stress limits the ability of the hippocampus to promote contexual learning, making it more difficult to discriminate conditions for which there may be danger versus safety
Chronic stress diminishes the capacity of the hippocampus to turn off elevated cortisol and can lead to impairments in memory and mood-related functions that are located in this brain region
Damage to The Hippocampus in Early Childhood
In the overwhelming levels of stress, the hippocampus loses its ability to carry out its cruicial function of mediating the cortex and the amygdala and consolidating information from short-term to long-term memory and spatial navigation (Rothschild, 2003)
Disconnection from the cortex means the neural pathway responsible for linking cognitive reasoning to emotional response is cut off (Rothschild, 2003; Schore 2003a, 2003b)
Frequent detachments between the cortex and hippocampus can cause a poor connection to be formed between the left and right hemisphere. This causes emotional memory to be less accessible to verbal consciousness (Schore, 2003a. 2003b)
The Role of Prefrontal Cortex (PFC) in Physiologic Stress Response in Early Childhood
Exposure to stress and elevated cortisol results in dramatic changes in the connectivity within the PFC, which limits its ability to inhibit amygdala activity, and thereby impair adaptive responses to stress
PFC participates in turning off the cortisol response and has an important role in the top-down regulation of autonomic balance (i.e., sympathetic versus parasympathetic effects) and in the development of executive functions (e.g., decision-making, working memory, behavioral self-regulation, & mood and impulse control)
PFC also suppresses amygdala activity, allowing for more adaptive responses to potentially theatening or stressful experiences
Changes in Architecture and Connectivity within and between The Hippocampus and PFC
The hippocampus and PFC both play a significant role in modulating the amygdala's inhibition of the stress resonse, toxic stress-induced changes in architecture and connectivity within and between the hippocampus and PFC might account for the variability seen in stress-responsiveness, appearing to be both more reactive to even
mildly adverse experiences and less capable of effective coping with future stress
The Right Hemisphere and Its Role
The right hemisphere is more advanced than the left hemisphere from about the 25th week until the second or third year.
The right hemisphere is konwn for its dominant role in affect regulation, and generation of coping strageties that support survival in the face of stresss and challenges Schore, 2003
It is also specilized to process socio-emotional information at levels beneath awareness and fast-acting regulatory operation Schore, 2003
It is also responsible for regulation of both emotional and bodily states, and for performing essential functions in the assessment of visual or auditory emotional communicative signals Shore 2003
It is the right hemisphere that traumatic pain is stored, in the form of implicit-procedural memory Shore 2003
Damaged Brain
Perry and Pollard (1997)
The effects of early relational trauma on reduction of brain volume due to neglect, as demonstrated by a brain scan
Toxic Stress and The Early Childhood Roots of Lifelong Impairments in Physical and Mental Health
Create structural and functional disruptions that lead to a wide range of physical and mental illnesses later in adult life 10
The cumulative burden of stress over time (e.g., from chronic maltreatment)
The timing of specific environemental insults during sensitive developmentlal periods (e.g., from first trimester rubella)
Risk Factors for Poor Health
Adoption of unhealthy lifestyles
Exacerbation of socioeconomic inequalities
Risk factors for poor health
The Association between Adverse Childhood Experiences (ACE) and Unhealthy Life Styles
Adolescents with a history of multiple risk factors are more likely to initiate drinking alcohol at younger age and more likely to use alcohol as a means of coping with stress than for social reasons 11
Adoption of unhealthy lifestyles as a coping mechanism might explain why higher ACE exposures are associated with tobacco use, ilicit drug abuse, obesity, and promiscuity 13, 14
Adolesceents and adults who manifest higher rates of risk-taking behaviors are more liekly to have trouble maintaining supportive social networks and at higher risk of school failture, gang membership, unemploymnet, poverty, homelessness, violent crime, incarceration, and becoming single parents
People with this high-risk group who become parents themselves are less likely to be able to provide relationships that are needed to protect their cildren from the damage of toxic stress 14, 15
Correlates of Early Deaths
Up to 40% of early deaths have been estimated to be the result of behavioral or lifestyle patterns 3
25% to 30% of early deaths are thought to be attributable to either inadequcies in medical care or socioeconomic circumstances 3
The extent to which toxic stress in early childhood to cause physiologic disruptions that persist into adulthood and lead to adult disease
?
"How Childhood Trauma Affects Health Across the Lifetime"
Dr. Nadine Burke Harris' TED talk
Click the mouse to play to the video clip!
https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en
The Repair of Early Trauma: A Bottom Up Approach
Click the mouse to play to the video clip!
https://www.youtube.com/watch?v=FOCTxcaNHeg
Clinical Implications for Counselors
Art psychotherapy interventions for those who have experienced relational trauma through interpersonal neurobiology (2006)
Van der Kolk (2005) notes that the diagnosis of PTSD is not developmentally sensitive and does not adequately describe the effect of exposure to childhood trauma on the developing child
A need for an extra channel of communication beyond verbal means to connect with survivors of adverse childhood experiences
The communicative and expressive importance of the dimension of art making within art theraphy as a right hemisphere activity to access the right hemisphere, and as a somatosensory activity, to connect with the limbic sysem
Two main routes for the perception of feeling
The Representation of Emotions through Art psychotherapy
Emotions use the body as their theater, and are most importantly expressed through changes in the representation of body state (Damasio, 2000).
Emotions are primarily represented in the brain in the form of transient changes in the activity pattern of somatosensory structures.
Emotions are biologically determined processes, depending on innately set brain devices, and can be engaged automatically without conscious delibertaion (Damasio, 2000; LeDoux, 1998)
The process of art as a sensorimotor, bodily based activity could serve as a significant window of expression
These processes and their underlying emotions are emplified in the process of art making and indirectly recorded in the form of artwork that is external, visible, and tangible
Self-soothing Processes in The Form of Touch
High Impulse Emotions, Anger & Frustration
Skin contains two different types of sensory receptors.
Touch leads to mild sedation, decrease in blood pressure and aids in autonomic nervous system regulation and cardiovascular health (Cozolino, 2006).
High impulse affects (e.g., anger and frustration) are a manifestation of the combination of prolonged hyper-arousal and instinctural reflex of disconnection from part of the cortex.
This is further complicated by the confusion and frustration arising from the inability to explain oneself due to the non-verbal nature of instinctual response and implicit encodings of emotional memory, and inaccessible to the lanauge- and logic-based left brain.
Express, Amplify, Record, Trace Down
A Prolonged State of Hypo-arousal, Dissociation
A dissociative tendency manifested within therapeutic intervention is a common phenomenon among survivors of adverse childhood experiences. This tendency is a common form of emotional dysregulation resulting from a prolonged state of hypo-arousal as the part of survival response at a time of overwhelming relational trauma (2003b).
Interventions such as art psychotherapy help to allow dissociated, unconscious emotions to emerge and be expressed and articulated in a concrete, external manner which is visible and tangible.
The concrete form encourages acknowledgement and later reflection on these emotions that might otherwise be denied or dissociated.
References
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