Appendix

However, this early pattern of brain growth does not mean that development or organization of the brain is finished. Indeed, important neurodevelopmental processes continue to take place throughout childhood and adolescence as the brain’s systems become more complex. Major cortical restructuring and myelination continue into early adult life.

THE HUMAN BRAIN DEVELOPS sequentially in roughly the same order in which its regions evolved. The most primitive, central areas, starting with the brainstem, develop first. As a child grows, each successive brain region (moving out from the center toward the cortex), in turn, undergoes important changes and growth. But in order to develop properly each area requires appropriately timed, patterned, repetitive experiences. The neurosequential approach to helping traumatized and maltreated children first examines which regions and functions are underdeveloped or poorly functioning and then works to provide the missing stimulation to help the brain resume a more normal development.

PEOPLE PROCESS, STORE, AND RETRIEVE information and then respond to the world in a manner that depends upon their current physiological state (in other words, their response is “state-dependent”). If a child has been exposed to extreme or pervasive threat or trauma, his stress system may become sensitized and he may respond to ordinary experiences as though they are threatening. Depending on his individual response to stress, he may move primarily along the dissociative or the arousal continuum, but either change will reduce his ability to learn cognitive information, such as schoolwork.

As a result his brain may be in a very different state than that of other children around him in a classroom. As the chart illustrates, a calm child will process information very differently from one who is in an “alarmed” state, whether he tends toward a dissociative or a hyperaroused response. Even if two children have identical IQs, the calmer child can more readily focus on the words of the teacher and, using her neocortex, engage in abstract thought and learning.

As a child moves along the continuum of arousal, the part of the brain in control of his functioning shifts; the more distressed or threatened he is, the more primitive the behaviors and responses. During this state-related shift in cognition the child’s sense of time is altered and the range of future planning is foreshortened. The threatened child is not thinking (nor should she think) about months from now: she is focused on the current threat.

This has profound implications for understanding the thoughts, reactions, and behavior of traumatized children. For these youth immediate reward is most reinforcing; delayed gratification is almost impossible. They are quite literally unable to consider the potential consequences of their behavior because of the physical arousal state of their brains.

As a result considered reflection about behavior—including violent behavior—is impossible for the child in an alarm state. Cut adrift from the internal regulating capabilities of the cortex, the brainstem acts reflexively, impulsively, and often aggressively to any perceived threat.

Adapted from: Perry, B. D. “Fear and learning: trauma-related factors in education.” New Directions for Adult and Continuing Education, 110 (2006, Summer): 21–27.

THIS FIGURE ILLUSTRATES TWO stress-reactivity curves; the straight line is the reactivity curve of a “neurotypical” individual. This shows the linear relationship between the level of challenge, stress or threat and the appropriate proportional shift in internal state in the brain required to adapt and cope with the stressor. With minor stressors, there are minor shifts in the internal state—and with major stressors, a larger shift in internal state occurs. The top curved line illustrates the altered, sensitized stress-reactivity curve caused by patterns of extreme, unpredictable or prolonged stress activation. In this case, there is a significant over-activity at baseline and an overreaction even in the face of relatively minor challenges.

The results are profoundly disruptive for subsequent development, as these over-reactions to novelty and stress will inhibit and distort the accurate processing of new experiences—even if the new experiences are predictable, consistent, nurturing, and enriching.

A major consequence of this sensitization is that it narrows the ‘developmental’ window (see hatched areas). Simply stated, in order to develop, learn or heal (i.e., make new associations in neural networks), the individual has to be exposed to novel experiences that, in turn, create novel patterns of neural activity.

For optimal development (or learning or therapeutic change), this novelty has to have a “Goldilocks” effect—enough novelty to challenge and expand the existing comfort zone (the set of previously acquired and mastered capabilities) but not so much novelty (or demand) that the capacity of the individual to process and assimilate is overwhelmed.

When someone has sensitized stress-response system(s), exposure to any novelty or unpredictability can rapidly move the person from active-alert to a state of fear, thereby interfering with the process of learning. The more sensitized the stress response, the narrower this therapeutic or learning “window” is, the smaller the dose of novelty that can be tolerated, and the less likely it will be that the child can benefit from typical developmental experiences. The end result is a profound frustration in parents and educators, resulting from the seemingly endless number of repetitions required for a child to master a concept or learn a behavior.

The key is to somehow shift this overly-reactive stress response either temporarily, by using some regulatory activity or, ideally, chronically by providing regular opportunities to experience controllable, predicable and moderate (for the individual) activations of their stress response systems.

When resources become limited and there are economic, environmental, or social threats (Column 2), the organization becomes less capable of complex, abstract problem solving. Any “inflections”—major changes in organizational—direction tend to be serendipitous or accidental. All government systems are usually in this state; they stumble into the future, with a focus on self-preservation. The practices and programs are responsive to the immediate future (e.g., the next funding cycle, the next election cycle) and all aspects of functioning in the group regress. The least powerful are ignored or controlled to minimize any excessive drain on the most powerful.

In the organization under direct threat (Column 3), the focus of all problem solving becomes the moment. Organizational inflections are “forced” (e.g., consent decrees, bankruptcy). The solutions to current problems tend to be reactive and regressive. The more out of control the external situation is, the more controlling, reactive, and oppressive the internally focused actions of this group will become. In each of these situations, the supervisory styles will create employees that will reinforce the organization’s structure: in a safe and abstract-thinking group the staff will be more likely to receive and benefit from enrichment and education, thereby optimizing their potential for creativity, abstraction, and productivity. In contrast, staff in organizations under threat will be more likely to reflect their impulsive, concrete, and reactive supervision—and be so dysregulated that their interactions with clients, students, parents, and children will be incapable of helping any of them regulate. They will be ineffective—and sometimes actually destructive, further creating distress and unpredictability for the very people they are charged to engage, respect, help, and heal.