Toxic Stress and Trauma
In the previous Newsletter (Stress – 2 May 2022) we discussed the effect stress has on students. In this essay we concentrated on the emotional arousal that occurs in our day to day interaction with our environment in our efforts to survive. In most cases this process of constant, homeostatic adjustment back to equilibrium is healthy. However, researchers studying stress in children have proposed three separate responses to stress that have different outcomes, positive, tolerable and toxic. The process described in the last Newsletter describes the characteristics of positive stress which operates to maintain the body in a healthy state.
However, too many children are exposed to threats that result in levels of stress that challenge their ability to ‘survive’. These are the times when they become so frightened the effect on their physical organisation is to prepare them for a fight/flight response. This 'readiness’ is achieved by the elevation of their heart rate, the secretion of hormones including adrenaline and noradrenaline along with other reactions such as the dilation of the pupils in their eyes. One of the release hormones is cortisol which operates to assist in the restoration of the brain’s neurological status after the stress has been removed; this is the return to equilibrium. Paradoxically, if the stressful situation is not resolved the continual secretion of cortisol has an erosive impact on the brain as we will discuss later.
Tolerable stress refers to levels of elevated stress that trigger an intense response but these are either resolved with the support of a parent or carer or they are only present for a short time. Toxic stress is experienced if the conditions that activated are not quickly resolved and the intense stress continue for long periods of time, weeks, months or even years.
The experience of these toxic conditions at an age when children are just learning how to behave in their environment is untimely as they have yet to develop any personal defence strategies and must rely on the support of their parents, or adult carers to assist in their return to equilibrium. As will be shown this support is not always available.
The results of this intense or chronic stress is the over development of those regions of the brain that are involved in the fight/flight - fear response. The constant firing of the neural pathways associated with fear are strengthened while the potential, positive alternate pathways are pruned, that is, the neural material is removed making the fear response more efficient. This results in an exaggerated ability to detect any possible threat, they become hyper-vigilant in any social environment.
The flip-side of this predisposition is the reduction in the child’s neural pathways that recognise more nurturing characteristics, they become inept at recognising kindness and compassion. Unless aware of this incapacity teachers can become discouraged when their attempts to cultivate a positive relationship seem to be snubbed. This is not the child’s rejection of their efforts it is their inability to recognise and respond appropriately.
In physiological terms the stress response follows the pattern illustrated below. The stimulus enters through the cerebellum where it is identified as an immediate threat. From there it goes to the thalamus, instantly on to the amygdala which initiates the fear response. This continual stimulation means the amygdala becomes enlarged which in turn makes it acutely aware of potential threat. At these times the information does not get to the hippocampus and on to the frontal lobes blocking the information from the conscious mind. Because of this any thoughtful response is not available, it is almost impossible to ‘will away’ heightened emotions once they are present.
Continued exposure of children to these conditions of elevated stress leads to early childhood Post-Traumatic Stress Disorder (PTSD). This is because their very foundations of expected survival are challenged.
Traumatised people portray ‘snapshots’ of their unsuccessful attempts to defend themselves in the face of threat. This inability to return to a state of calm means they are unable to discharge the energies associate with the preparation to defend themselves. They remain in a state of readiness, fixated in an aroused state with the accompanying cortisol.
Although PTSD in children is usually associated with abuse it is worth noting that even if they live in a positive environment they can also become traumatised. Generally they function with the expectation that they will comfortably survive and this gives them the confidence to plan and act. However, there can be times when these expectations are shattered through the experience of:
- Unexpected life-threatening events such as car accidents, earthquakes, severe illness, the death of a loved one, anything that threatens their stable view of the world.
- They come face to face with human vulnerability, they witness the injury to another person that demonstrates the fragility of life and in an instant the world changes through events that are out of their control.
- They come face to face with the capacity for others to preform what can only be called evil in the world.
One can only imagine the huge number of cases of early childhood PTSD that is currently being produced in Ukraine.
The result of continuous, early childhood PTSD is a permanent change to the brain’s structure which results in an intellectual disability. The following changes have been observed:
- Amygdala is increased in size – this makes the child more attuned to potential threats and an exaggerated response to any actual threat.
- Hippocampus reported to have a 12% reduction in size – this decreases the ability to create memories and to liaise with the frontal lobes where cognitive decisions can be made.
- Prefrontal lobes are 20% smaller and have lesions on the surface. This is damage to what is called the executive of the brain and the level of damage here leads to major cognitive dysfunction.
- Cerebellum is reduced in size – this is the ‘relay station’ between the external environment and our expectations. A decreased efficiency in this process should mean a reduction in the accuracy of this process.
- Reduced efficacy of the corpus callosum. This reduces the coordinated response from both hemispheres.
The illustration below is of an extremely neglected and damaged three year-old-child.
The overall reduction in size is distressing and the damaged areas, the darkened parts throughout the cross section represent lesions and scar tissues.
Early childhood PTSD is predominantly the result of childhood abuse and the heart-breaking fact is that in most cases the perpetrators are primary care-givers. What makes this upsetting is that these cognitive injuries are permanent. This means a child born with a neurotypical brain is subjected to behaviours that produce these injuries as a consequence of an adult’s cruel behaviour. This appalling situation is exacerbated by the fact that children being wholly egocentric think it is their fault they are treated this way. They develop what I describe as toxic shame which I will address in the next Newsletter.
It is so hard for so many of the dysfunctional students that are the focus of our work. They have been abused with resulting permanent brain damage through no fault of their own. Their efforts to survive have seen them develop behaviours that some adults find repulsive. This plus their ingrained sense of worthlessness, their toxic shame has left them with no expectation to succeed or be accepted into normal society and so they act to fulfil their destiny.
In our competitive society welded to the hypocrisy of meritocracy these children are blamed for their failures when in reality we should be blamed for letting this happen! The best they can hope for is to be in the classroom of a teacher who understands this and will hang-in with them longer that they expect!