Attachment, Trauma and the Brain

Attachment, trauma and the brain.

[This article was originally published on March 21, 2017 by Terry Levy, Ph.D., B.C.F.E. and can be found on LinkedIn]

In utero and early attachment experiences significantly affect the wiring of the brain, because the young child’s brain grows more than at any other time in life, and relationships shape the developing brain. Compromised attachment and traumatic stress trigger an alarm reaction, altering the neurobiology of the brain and central nervous system. Traumatized children and adults often have impaired wiring in the brain’s limbic system and altered levels of stress hormones, resulting in anxiety, depression, and self-regulation problems. Effective treatment and therapeutic parenting can rewire the limbic system and reduce the biochemistry of stress.

The infant’s brain, especially the limbic region, is an “open loop system,” because it relies on attuned and nurturing input from attachment figures for healthy growth and development. Relationship experiences in the early stages of life are most important in shaping the development of brain and behavior.

Brain development in infancy is “experience dependent;" the baby’s brain, specifically the limbic system, relies on sensitive and attuned care from attachment figures for healthy growth and functioning. Early attachment experiences play an essential role in shaping the architecture of the brain and building connections between parts of the brain. Chronic stress associated with lack of safe and secure attachment can impair the formation of brain circuits and alter levels of stress hormones, resulting in emotional and biological dysregulation, anxiety and depression.

Brain development begins two weeks after conception and continues most rapidly during the first three years of life. Our brains are basically social in nature. Prenatal stress produces increased norepinephrine (arousal and agitation) and decreased levels of dopamine and serotonin (depression, anxiety, emotional dysregulation). Brain circuits are being created rapidly in the first year of life, and are largely determined by the quality of the infant–caregiver relationship and the level of stress. Babies are right-hemisphere dominant, responding primarily to preverbal and nonverbal emotional communication—facial expressions, eye contact, touch, tone of voice, and feelings of love, security and safety. The infant’s right brain and the attachment figure’s right brain are attuned during moments of connection. This is called “limbic resonance," and is the fundamental building block of secure attachment. This also leads to the child’s ability to self-regulate and to the formation of the child’s core beliefs ("internal working model"). The sensitive and loving parent and caregiver calms and soothes the baby’s emotions and stress response, and over time the child learns self-regulation. Early experiences of secure or insecure attachment are encoded into the implicit (preverbal and unconscious) memory systems in the limbic brain, and become mindsets and expectations that guide subsequent behavior (e.g., attachment figures are safe or unsafe, accepting or rejecting). Studies have found that infant attachment security predicts self-control when children begin their school years.

Chronic and toxic stress can impair the proper development of brain circuitry, resulting in anxiety and self-control problems. Several brain regions are involved in the ability to learn self-control skills. The prefrontal cortex, located behind the forehead, is involved in attention and organizational skills, including following rules, suppressing impulses, reasoning, and decision making. The orbitofrontal cortex, located behind the eyes, is involved in decision making and reward, especially when the decision involves delay of gratification (google the “marshmallow test”). The anterior cingulate receives messages from various brain regions and regulates cognitive and emotional responses. It is involved in controlling behavior in challenging situations and adjusting behavior when a strategy is not working. These brain regions develop normally under conditions of safety and low to moderate stress, but development is impaired when there are high levels of stress and interpersonal trauma (attachment disorder).

Research and clinical experience have shown that an effective way to activate the neurobiology of attachment in the limbic systems of traumatized children and adults is to utilize the "Limbic Activation Process." This is basically the same strategy that humans have been using for millennium, and is biologically programed into us for the purpose of creating attachment. This is a therapeutic experience that provides the social, emotional, mental and physical milieu for the release of neurochemicals of attachment (dopamine, endorphins, oxytocin). It increases feelings of safety, calmness and security. Our brains are programmed for attachment and love, and this therapeutic experience awakens these feelings between parents and children and adults couples. Research has shown that physical closeness and affection, such as safe and loving touch and hugs, reduce blood pressure, lower stress hormones, increase oxytocin, and promote calmness, trust and secure attachment.

Dr. Levy is the a licensed clinical psychologist and the director at Evergreen Psychotherapy Center/ Licensed Clinical Psychologist.

The Adopted Child: Trauma and Its Impact

The Adopted Child: Trauma and Its Impact

Adopted at the age of six months, Joseph was a fussy and sometimes hard to soothe infant. Feeling as though this was just normal infant difficulties with the adjustment of adoption, Pat and Robert paid it little attention. When Joseph reached the age of two and began to bite the other children in daycare, they chalked it up to the dreaded two-year old stage of which everyone assumes to be okay. Though the biting never quite ceased that year, with a few modifications, Joseph made it through the year. The teachers raved about how smart he was. By the time he was six, the increasing duration of the school day seemed almost more than he could bear. Sometimes screaming for hours at a time, Joseph would do no work and then would spend the remainder of the day in isolation. Prone to striking out when others attempted to soothe him, Joseph had now grown accustomed to attempting to runaway from the school personnel when his behavior would escalate. On many occasions this would lead to Joseph being restrained by the security guards, principal, or coaches. Eventually Joseph began to stack up a list of schools attended and suspended from. By the time Joseph had hit the 5th grade, his increasingly violent outburst coined with outward defiance had gained him two different stays at local residential treatment centers. Not knowing where else to turn or what else to do, and after failed attempts at therapy, and more than eight psychiatric medications had proved of little benefit other than causing Joseph to appear “zombie-like,” Pat and Robert felt their only other option was to send Joseph to a boys boarding school.

[This article was written by Bryan Post of the Post Institute, November 6, 2016]

Unfortunately, the above story is not an uncommon plight that adoptive parents face. Though not always leading to a disruption or out-of-home placement, many adoptive families struggle for years to create the peaceful family of which they had dreamed. Regrettably, one of the main barriers preventing such family harmony is one of the least understood when it comes to understanding the plight of the adopted child. The barrier is trauma.

Whether adopted from birth or later in life, all adopted children have experienced some degree of trauma. Trauma is any stressful event which is prolonged, overwhelming, or unpredictable. Though we are familiar with events impacting children such as abuse, neglect, and domestic violence, until recently, the full impact of trauma on adopted children has not been understood.

What Science Is Now Revealing

Scientific research now reveals that as early as the second trimester, the human fetus is capable of auditory processing and in fact, is capable of processing rejection in utero. In addition to the rejection and abandonment felt by the newborn adoptee or any age adoptee for that matter, it must be recognized that the far greater trauma often times occurs in the way in which the mind and body system of the newborn is incapable of processing the loss of the biological figure. Far beyond any cognitive awareness, this experience is stored deep within the cells of the body, routinely leading to states of anxiety and depression for the adopted child later in life.

Because this initial experience has gone for so long without validation, it is now difficult for parents to understand. Truth be told, the medical community still discounts this early experience. Nevertheless, this early experience is generally the child’s original trauma. From that point forward many more traumas may occur in the child’s life. These include premature birth, inconsistent caretakers, abuse, neglect, chronic pain, long-term hospitalizations with separations from the mother, and parental depression. Such life events interrupt a child’s emotional development, sometimes even physical development, subsequently interrupting his ability to tolerate stress in meaningful relationships with parents and peers.

An important aspect of trauma is in recognizing that simply because a child has been removed from a traumatic environment, this does not merely remove the trauma from the child’s memory. In fact, stress is recognized to be the one primary key to unlocking traumatic memories. Unfortunately for both the adopted child and family, the experience of most traumas in the child’s life is that the traumatic experiences typically occur in the context of human relationships. From that point forward, stress in the midst of a relationship will create a traumatic re-experiencing for the child, leading the child to feel threatened, fearful, and overwhelmed in an environment which otherwise may not be threatening to other people.

10 Keys to Healing Trauma in the Adopted Child:

1. Trauma creates fear and stress sensitivity in children.

Even for a child adopted from birth, their internal systems may already be more sensitive and fearful than that of a child remaining with his biological parents. You must also consider the first nine months in which the child developed. These early experiences as well could have major implications.

2. Recognize and be more aware of fear being demonstrated by your child.

Be more sensitive and tuned in to the small signals given such as clinging, whining, not discriminating amongst strangers, etc. All are signs of insecurity which can be met by bringing the child in closer, holding, carrying, and communicating to the child that he is feeling scared, but you will keep him safe.

3. Recognize the impact of trauma in your own life.

One of the single greatest understandings parents can have is a self-understanding. Research tells us that far more communication occurs non-verbally than verbally. Understanding the impact of past trauma in your own life will help you become more sensitive to when your reactions are coming from a place other than your existing parent/child experience. Re-experiencing past trauma is common when parents are placed in an ongoing stressful environment.

4. Reduce external sensory stimulation when possible.

Decrease television, overwhelming environments, number of children playing together at one time, and large family gatherings. When necessary that these events take place, keep the child close, explain to him that he may become stressed and he can come to you when needed.

5. Do Time-In instead of Time-out.

Rather than sending the stressed out and scared child to the corner to think about his behavior, bring him into to you and help him to feel safe and secure. Internally, this will then permit him the ability to think about his actions. Though time-in is not a time for lecturing, it will allow your child an opportunity to calm his stress and then think more clearly. Another effective key is to let the child decide how much time-in he needs.

6. Do not hit traumatized children.

Doing so will only identify you as a threat. The biblical verse spare the rod, spoil the child speaks to the raising of sheep. A rod is used to guide the sheep and the staff to pull him back into line when he strays. Hitting children, just like sheep, will cause them to become frightened of you and in many instances to runaway or hit back.

7. There is never enough affection in the world.

A very simple technique for time is the affection prescription 10-20-10. Give a child 10 minutes of quality time and attention first thing in the morning, 20 minutes in the afternoon, and 10 in the evening. Following this prescription of time has proven to have a great impact on the most negative behavior.

8. Encourage an IEP in the classroom to develop an understanding of the child’s stress and fear.

This may assist in addressing such vital areas as homework, playground, peer interaction, lunchtime, and physical education. All are common areas of reduced structure and increased stress.

9. Educate yourself regarding the impact of stress and trauma on families.

Try not to scapegoat your child for their difficulties, but rather take responsibility for creating the environment necessary for healing his hurtful experiences. There are many resources available. A few of note are: www.postinstitute.com, www.bryanpost.com, www.childtraumaacademy.org (Dr. Bruce Perry’s organization), www.drdansiegel.com, www.mindsightinstitute.com (Dr. Daniel Siegel), www.oxytocincentral.com and www.child.tcu.edu (Dr. Karyn Purvis)

10. Seek support.

Parenting a child with trauma history can take its toll on the best of parent. Seek out a support system for occasional respite care, discussing of issues, and the sharing of a meal. Such small steps can go a long ways during particularly stressful times.

In closing, never forget that you are a great parent. During times of stress you won’t always feel like it, but both you and your child were meant to be together. Your child will teach you far more about yourself than you may have ever realized without him. Give yourself time to refuel, connect, and communicate. And finally, a secure parental relationship is the single greatest gift you can give your child. When the parental relationship is secure this will permit the child a foundation to grow from.

The bad news: trauma can be inherited. The good news — so can resilience

We tend to understand where our physical traits come from. We may have our mother’s eyes or our father’s chin. But when it comes to personality traits, we tend to think of them as our own. Psychologists go one step farther. They see things like anxiety or depression stemming from personal experiences which shaped us. Some studies however reach back even farther, are in fact passed down from parents or even grandparents.

[The original article is found on BigThink by Philip Perry]

Neurosis, anxiety, an adventuresome spirit, can these be inherited? That was the question on the minds of two researchers back in 1992. Then molecular biologist and geneticist Moshe Szyf and neurobiologist Michael Meaney, both of Montreal’s McGill University, met after a conference and had a few beers in a nearby bar. They started discussing inheritable traits, and Meaney theorized that certain emotional traits could be passed down through genes inside the brain. Szyf though skeptical was intrigued.

DNA inhabits the nuclei of cells. Since the 1970’s, scientists had wondered what tells each cell to transcribe certain genes and discard others. It was found that molecules in the methyl group earmarked certain genes, tagging them for transcription. Because of the discovery of these methyl groups and their position, each sitting beside a corresponding gene, the field of epigenetics was born. The Greek prefix epi meaning over from. At first, it was thought that epigenetic changes only occurred in the fetal stage of life. Over time, scientists discovered that changes in diet, exposure to certain elements in the environment, and other encounters also changed our DNA.

Artist’s rendition of DNA methylation. By Christoph Bock (Max Planck Institute for Informatics) - Own work, CC BY-SA 3.0

What Prof. Meaney hypothesized was that a parent who experienced a trauma could have certain changes in their brain which might lead to epigenetic changes that were passed on, inhabiting the neurons of their children’s brains or even their grandchildren. That rumination bore an entirely new field, behavioral epigenetics. That means if you had a parent or grandparent who lived through a genocide, war, saw someone murdered, or who suffered a different trauma, say at the hands of an abusive or neglectful parent, you carry traits for the emotional impact in your genes.

A grandfather who was neglected as a child for instance, may have experienced depression, and so passed that predisposition onward. It works in the positive sense too. If your grandfather had loving, nurturing parents, you get a genetic boost in the psychological and behavioral sense. How far does this epigenetic influence go? It’s pretty hard to parse out, even for scientists.

Meaney was able to prove that certain emotional traits were passed down by studying female rats and their pups. He and colleagues gathered data reaching back to the 1950’s. Those baby rats handled by researchers, for as little as five minutes a day, during the first few weeks after birth, were calmer and less stressed than those who were never handled. Meaney and colleagues found this was not due to human handling.

Instead, mother rats were more likely to groom their pups after humans had touched them. They also tended to give them more room for suckling. This extra attention led to better adjusted pups. Meaney showed that the more attention an infant rat received, the lower their stress hormone level in adulthood was. He said, "What we had done up to that point in time was to identify maternal care and its influence on specific genes.” It was after this experiment that Meaney met Szyf. 

The pair conducted an array of experiments. They began by selecting highly attentive mother rats and those who were neglectful. The offspring of neglectful mothers were more anxious and easily startled. Researchers took the offspring of these rats in adulthood and examined their brains, specifically the hippocampus. This is the area that has to do with stress, anxiety, and the formation of memories.

Those who had neglectful mothers had observable changes in the methylation of the genes there. These changes produced more glucocorticoid receptors, which interact with the stress hormone. More of them means a higher sensitivity to stress. Those with diligent mothers did not display such changes.

Next, Meaney and Szyf took a group of pups raised by neglectful mothers. They injected their brains with a drug called trichostatin A. This removes methyl groups. None of the skittishness seen in their mothers was found in this group. Their brains were once again examined, and no epigenetic changes were found. “It was like rebooting a computer,” Szyf said.

In a 2008 study, the pair found that neglectful mother rats had fewer estrogen receptors in their brain. When their female offspring matured, this resulted in fewer estrogen receptors in their brains, which led to neglect of their own young. Meaney and Szyf had discovered what is now called postnatal inheritance, or epigenetic changes from the environment that are written into our DNA, and then passed down to the next generation. These two scientists have published 24 papers on the subject since.

Next, the researchers moved on to human subjects. In a 2008 study, Meaney and Szyf examined the brains of those who committed suicide, and compared them with those who had died for other reasons. Among the suicidal, neural genes in the hippocampus showed excessive methylation. Since their brains were so methylated, researchers concluded that suicidal subjects must have been abused as children. This could be why someone who had neglectful or abusive parents must struggle to overcome the trauma they endured. Methyl groups in their neural genes bind them to feelings of anxiety, hopelessness, malaise, or worry. Of course, due to ethical concerns, examining the brains of living humans is out of the question. Professor Szyf however has located signs of epigenetic methylation in blood samples.

In one experiment, Szy and researchers from Yale recruited 14 Russian children brought up in an orphanage, and 14 others raised by their parents. Each gave a blood sample which was examined. Orphans had far more methylation than those who were raised by their parents. Areas of the brain important for communication and brain development were most affected.

The study concluded that separation from biological parents causes early stress that effects the person’s genome, long-term. This in turn could explain why adopted children may be more susceptible to damage from harsh parenting styles, on the part of adoptive parents. Study co-author, psychologist Elena Grigorenko wrote, “Parenting adopted children might require much more nurturing care to reverse these changes in genome regulation.”

The most exciting revelation was from a study last year out of New York’s Mount Sinai hospital. 32 holocaust survivors and their children had their genes analyzed. A methylation tag was found in a stress-related gene in parents and children alike. “The gene changes in the children could only be attributed to Holocaust exposure in the parents,” said Rachel Yehuda, lead researchers on the study.

More research must be done to understand the processes involved. How epigenetic changes are passed on from parent to offspring still remains Unknown. Though we may despair that our parents or grandparents trauma lives on in us, Prof. Yehuda says other, related methylation tags may make us more resilient, which could be passed down too.

Some researchers take it a step further. It could be that many or even most of our emotional and psychological tendencies, whether we are intellectual or tactile, communicative or quiet, emotional or stoic, forgetful or possess a perfect memory, might all arise from epigenetic changes passed down from our ancestors. What’s more, this breakthrough could lead to big changes in how we treat psychiatric conditions. Big Pharma and small biotech startups alike are already hunting for compounds, hoping to launch the next generation of drugs for psychiatric disorders, ones that are more effective, with very few, if any, side effects.