Recovery Time

We have established that the children who have been raised in an abusive and/or neglectful environment have verified brain damage and the theme of our work is to provide rehabilitation through changing their Renvironment.  Predominantly this is focused on schools but these principled interventions work even better if they are applied around the clock which can occur in special settings such as juvenile detention centres.

However, one of the frustrations for teachers or supervisors is the length of time it takes for any real change to occur.  There are two things to consider about this; the first is the extended time interval required for real neurological change to be entrenched that drive new behaviours, the second is the difficulty in changing deep held beliefs.  The focus of this Newsletter is on the first of these problems, the impediment of time!  

Changing the neurological organisation of the brain in any permanent sense requires the extinguishing of the existing circuits and the construction of a replacement path.  This is known as plasticity.  This plasticity varies throughout the brain, from the brain stem, through the limbic system and on to the cerebrum.  Behaviours learned in the brain stem are extremely non-plastic, that is they are very hard to change.  This makes sense as those behaviours are designed to support our physical wellbeing, such as breathing, blood pressure, balance, etc. that are vital for our survival and this resistance to change protects us.

Those social/emotional lessons that are stored in the limbic system are also hard to change.  This is where our affective memories are stored and these are the organisation of our sense of self.  We develop our sense of self in the early years and the behaviours that accompany this have been learned because they have provided the ‘best way’ to survive in the environment in which they are learned.  It is in this area our beliefs are maintained and, although arguably easier to change than those maintaining our physical security, they are also ‘hard-wired’ making change a time-consuming event.

The importance of both the physical and socio-emotional functions are important to our survival and so it makes sense to protect them from change; this is why they are so locked into the brain circuitry.

The part of the brain that remains relatively plastic, that is reasonably easy to change is the cerebrum and cerebral cortex, mostly in the frontal area associated with reasoning, planning and problem solving.  Those other areas of the cerebrum are associated with the development of fundamental skills that complement our survival mechanisms, things such as vision, speech, etc. are also developed in the early years and most likely share the non-plasticity of the lower levels of the brain.  These are:

• Parietal Lobe- associated with movement, orientation, recognition, perception of stimuli
• Occipital Lobe- associated with visual processing
• Temporal Lobe- associated with perception and recognition of auditory stimuli, memory, and speech

There is not the behavioural need to change these although there is a case for mediation for students who did not receive the appropriate level of stimulation in the developing years.

 Although I have seen no research that would describe the level of plasticity in these areas a clue to the difficulty is in the problems faced by children who have been born with cataracts that have not been removed before about eight months.  Up until this time the conditions in the occipital lobe are extremely plastic, this is referred to as its ‘window of opportunity’ when the brain’s neurons are surrounded with supporting materials, principally myeline the material that sustains and enhances the circuit. After that time has passed the myeline that has not been used along with the unemployed neurons are removed in a process called pruning.  This makes the circuit even more efficient and long-lasting it also makes the behaviour controlled by the neural path non-plastic.

The difficulty faced by many teachers who work with these children is that their day to day teaching focuses on those frontal areas, associated with reasoning, planning and problem solving, the stuff of the curriculum.  We see how relatively quickly children can learn new material.  We are also exposed to a range of intervention programs, almost exclusively based in the cognitive behaviour therapy model to help children deal with their dysfunctional behaviour.  We make the mistake of assuming the pace children learn say history or mathematics should be the same pace they learn to change their behaviour!

The real rate of change that can be expected from the deep-seated brain damage from abuse or neglect is best understood when it is compared to brain damage that is a result of a physical trauma, say a motor vehicle accident.  People and families that work with such casualties expect the road to recovery to be slow and very difficult for the patient.  Although this process can be frustrating usually the victim and their support are very committed to make the effort to get better, or to recover as much functionality as they can.

Rehabilitation is basically placing the patient in an environment that will stimulate the behaviour that is required to function in that environment.  For example, if the individual needs to learn to walk again they will work through a process where the legs are exposed to conditions that demand a ‘walking’ response that will encourage new pathways to form.  This can take months even years to recover even if only partially.  The thing is the community knows the ethics of providing this support and the economic value of the intervention.  The thing is, these victims did not deliberately choose to have their disability and their prospects of having a ‘successful’ life is hindered by their injury.

It takes a rare individual to take the same view of a teenager whose dysfunctional behaviour is expressed in a violent outburst in their classroom or sits in the back of the classroom completely disengaged in learning.  It takes an even exceptional political/bureaucratic system that would provide the same level of support for this victim of an acquired brain injury.  It is easy to feel compassion for the victim of a motor vehicle accident who may well have lost their ability to dampen their behaviour, become compulsive.  It is much harder to have that same compassion for a ‘compulsive’ child when we have no evidence of the ‘accident’ they suffered by being born into the wrong family!

The thing is, these kids can be helped, we have the same ethical responsibility to take up this challenge.  Despite the obvious decency of taking on the task there is a measured economic advantage for the community if we do.  There is the access to such an amount of untapped human resources and the reduction in the financial burden of providing institutional interventions, such as detentions centres, courts, etc. that attempt to control these behaviours.

For teachers, there needs to be proper training in the techniques of providing the correct therapeutic environment and the encouragement to ‘stay the distance’ through the long period of recovery.  It will be worth it!