Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, November 20, 2015

Does Trauma Stop Development?

When you explore some of the beliefs of unconventional, “alternative” therapists like Nancy Thomas, one idea that often emerges is that development stops when a child experiences psychological trauma.  This idea serves as justification for treatment methods involving ritualistic re-enactment of normal early-childhood experiences, based on the assumption that recapitulation of early experiences will cause development to “start over” and follow a desirable pathway. That assumption would be remotely plausible only if it were true that trauma stopped development--  and even if it were plausible, such treatments would have to be supported by systematic evidence in order to be truly acceptable.

But let’s look at the idea that development stops after trauma. Presumably this view of development—which is actually speaking of cognitive and emotional development, especially the latter—is based on analogies to specific aspects of development and specific types of trauma. It’s clear that serious traumatic brain injury can stop some aspects of development and slow others. For example, a child who receives radiation therapy for brain cancer can end up with such serious brain damage that she is never conscious again, although her life may continue for some time. She grows, but slowly, and unless she receives careful physical treatment her limbs become distorted into a “fetal” position. Much of her development has slowed, and some has stopped, but as long as she is alive she will continue to change in some ways over time—and that is what development is: changes with age.

Now let’s consider less drastic physical trauma. Suppose, for example, a child is nutritionally deprived in early life. The result will be slowed growth, but also some much more subtle problems. The bones will ossify (become hardened by absorbing calcium into their structure), but they will not do so in the order typical of well-nourished children. Development does not stop, but continues in a way that is distorted or “detoured”  rather than following a typical developmental pattern.

The effects of trauma and deprivation also depend on “critical periods” of development. A young baby who loses half of the brain through injury will develop largely normal cognitive and emotional abilities; an older child will be permanently handicapped by such a loss, sustained when  neuroplasticity is less. A malnourished infant or toddler may have slowed brain growth and development; he will “catch up” developmentally if nutrition is corrected by about age 4, but not after that, no matter how excellent the later diet may be. It’s a mistake to assume that an event that may be traumatic at one age--  abrupt separation from familiar people at age three, for instance--  is also traumatic at other ages; separation at birth does not in itself  cause emotional trauma (although learning about that separation years later may be distressing).

The effects of any kind of trauma or deprivation are also determined in part by a range of factors other than the one that seems most important. Babies exposed to lead in the environment develop better when their diets and general health are good, while lead exposure has a more serious impact on those who are poorly nourished. Similarly, infants and young children who are exposed to terrifying or painful events do better when competent parents and good family relationships serve to buffer the effects of the trauma. Events that influence development all work together, so an apparent trauma cannot be considered as having a predictable outcome all by itself.  

Research by famous names like Michael Rutter suggests that children who have suffered from trauma and deprivation in poor care settings will in most cases develop normal cognitive and emotional abilities. Better recovery is likely to occur for those who move to family care or to enriched institutional care when they are still infants or toddlers. This situation seems analogous to what we see in children who are brain-injured or nutritionally deprived—“catch up” growth is possible up to a limited age. Because emotional and cognitive life depend on brain functions, it is plausible that emotional and cognitive development follow the same rules as brain development and allow for recovery from trauma or deprivation by intervention fairly early in life.

Finally, it’s important to realize that there are individual differences in children’s vulnerability, or its mirror image, resilience. For reasons of genetic or other factors in early development, some children “rise above” traumatic experiences relatively easily, while others have lasting and potentially serious effects.

Whatever roles all these factors may play in a child’s response to trauma, the result of traumatic experiences is a matter of distortion of development or changes in developmental trajectory, not of “stopped development”. Brain-injured children, for example, continue to grow and develop along the lines permitted by their injury; they do not simply stop and remain exactly as they were, without learning or emotional maturation proceeding at all. Treatment of trauma works by fostering positive change in areas where the child is not doing well, and exactly how that can be done depends on the child’s age and environment. Part of this process is recognition of the behavior problems that have emerged from trauma (like anxiety and anger about certain situations) as well as of those that occur for different reasons. 

It’s clear that one size of trauma does not fit all, and neither does one size of treatment help guide distorted development back onto a desirable trajectory.


20 comments:

  1. During World War 2, many Russian children have a slowdown in growth.
    This was a consequence of malnutrition and difficult living conditions. This usually occurs with older children in the family. They assumed the role of parents and responsibility for younger brothers and sisters. Psychological trauma affected the earlier maturing .14-year-old child could look like
    12-year-old but this kid do and talked like an adult. At school performance is not affected. Quite the contrary. These children were very responsible in school work. Many people who lived through that time say "I soon became an adult." I think the mental development does not stop after stress or trauma, but if the injury is chronic ..... then the child can become an adult prematurely.

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    1. But I think this was only possible because the children had already undergone an important early period of brain development while they were well-nourished. Also, they had opportunities to take responsibility and to behave like adults that are not available when adults are in charge.

      Similar outcomes were seen in the Dutch "hunger winter" generation.

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  2. https://www.youtube.com/watch?v=HdKvdb8af7o

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    1. youtube says this doesn't exist-- any suggestions?

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  3. To say that development "stops" with trauma, one would have to use oversimplified notions of both child development and trauma. I'm not a specialist and even I can see that.

    I mean, in my own family, I've known several persons who went through serious trauma as children, and they became fully functioning adults. My own mother suffered from a life-threatening meningitis around the age of 2 and she lost part of the developmental progress she had made so far, becoming for a time unable to walk. She also more or less lost the use of an eye. But she quickly regained the lost ground, except for bad vision in one eye. She became a bright pupil, went to university, worked as a teacher and raised four children of her own. Not everything went well in her life, but it had nothing to do with any kind of blocked emotional or intellectual development!

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    1. In case anyone wants to argue that your example is "only" a physical trauma, I want to point out that for anyone, especially a toddler, this must have been tremendously frightening, and as it would have involved some separation from home and familiar caregivers, would have been emotionally traumatic for a young child.

      Thanks for this contribution!

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  4. Yes. You're right. Before the war, life has began to improve and the children managed to get a period of full life and happiness of children. This has enabled these children do not break down and stand up.
    I do not understand what's wrong with You Tube ......
    This link does not relate to science. This Film on the autobiographical novel "French Lessons" - the story of a Russian writer Valentin Rasputin. He describes his post-war childhood. France and language of French lessons, this story is not relevant. Rasputin wrote about the lessons of kindness which he had received as a child by a teacher of the French language. Young teacher from Ukraine realized that the boy systematically malnourished. She cheated and sent him a package as if it were his mother sent him to school these products. But the boy knew that his mother could not send him hematogen apples and pasta. Apples in his village is not yet ripe. Macaroni and hematogen was not in his village. He figured out who could make him this gift and sending back to the teacher. The point is .... that this girl is not surrendered yet still managed to feed the boy with the help of various other tricks ..
    http://briefly.ru/rasputin/uroki_frantcuzskogo/
    https://www.youtube.com/watch?v=HdKvdb8af7o

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  5. http://my.mail.ru/mail/gurov.ale/video/4/121.html

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  6. Dr. Mercer wrote:"It’s a mistake to assume that an event that may be traumatic at one age-- abrupt separation from familiar people at age three, for instance-- is also traumatic at other ages; separation at birth does not in itself cause emotional trauma (although learning about that separation years later may be distressing). "

    This is exactly what I have been saying for years as a non-believer in a universal Primal Wound in adoptees! The distress that many adoptees feel, and it is real and painful, does not occur at separation shortly after birth, but when the child realizes what being surrendered and adopted means, usually somewhere between the ages of 3 and 7. But there are a great many believers who do not want to hear that and insist that I am dismissing adoptee pain and trauma altogether. It is either believe in PW or you are an insensitive jerk who hates adoptees, or if you are adopted yourself, 'in denial".

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    1. An interesting little piece supporting PW: http://adoptionmagazine.com/adoptee-view/adoptee-view-what-can-a-tiny-baby-know/VICetKrSt8. (I had trouble getting at this, but it comes up if you google "what does a tiny baby know".) A reader kindly called my attention to this.

      The interesting part is that by identifying this as an "adoptee view", the magazine washes its hands of responsibility for what's said. It's an adoptee opinion! Adoptees are entitled to their opinions! If you argue against it you hate [something]!

      Any thoughts as to how to counter these "opinions"?

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  7. I think this is an interesting discussion. I dont think development stops. If development stopped because of infant trauma, most of the world population wouldnt mature. That makes no sense. I do think, as Jean says, that development is distorted. Now, the whole primal wound argument. I am of the school of thought that attachment does begin in utero and that attachment happens through the birthing process. When a child is born, both mother and baby recieve a surge of oxytocin, which is the hormone that helps are brains form attachment pathways. I am not sure at what stage of development a fetus brain produces those hormones but it coyod be argued thst attachment does happen in utero because oxytocin is also released through touch and physical closeness. Some aldoptees who have not been informed of their adoption still figure it out because they feel like something is missing or like they dont belong. How do you explain that without the argument being based on early attachment?

    I HATE attachment therapy. I think it is very thinly disguised abuse. But I also dont want the pendulum to swing the other way where I throw the baby out with the bath water so to speak. Some things are clearly black and white and some things arent. I think adoptees and foster children DO have some very real "wounds" and emotional development issues to work through but you dont work through that by regressing to a different age. Our brains have amazing plasticity and can develop new pathways at any age. The way to heal attachment wounds is to have a corrective attachment experience. There are specific things you can do to number one, produce oxytocin and number two, learn new ways of developing secure attachment habits. Talk therapy is wonderful for this. Holding therapy is not. Regression is not.

    Just some thoughts from a well read former adoptee and foster kid.

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  8. If you show interest and read biographies of famous successful people if you can find that many of them have been traumatized as a child and did not have an easy life joyful. However, they become good people and have achieved great success in life. Perhaps the child physiology, genetics, and the people with whom the child interacts are critical in the development of the child and in the development of his personality. If there is no communication or the child is in the criminal environment ...... it can greatly affect its development. But the gap with their parents (with family) can leave a heavy mark on the soul of the child, but will not affect his intellectual development.
    Benito Juarez, Mexican president, orphaned at age 3.
    Lee Majors, actor, orphaned at age 2, raised by his aunt and uncle.
    George Lopez, comedian, raised by a grandmother.
    Marilyn Monroe, entertainer, raised in foster care.
    Barbara Stanwyck, actress, raised in foster homes from age 2.
    Leo Tolstoy, was a Russian writer regarded as one of the greatest of all the topic, orphaned at age 2.
     This list could go on indefinitely .........

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  9. We must talk about the successful, highly intelligent people who have become orphaned and were injury in early childhood. Perhaps this is the main evidence.

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  10. This is a reply to Megzmarie, but it seems the reply function is not working today so I have to put it as a comment.

    The reason it is thought that attachment does not begin prenatally, or even in the first months of life, is that very young babies do not seem disturbed by changes of caregiver. Attachment is defined as a strong preference for familiar people and avoidance of strangers, and these are easily observable behavioral signs.

    If you want to define attachment as something that cannot be observed from behavior, I think you will have to give some idea of how we would know that it is there.

    Given that there are adoptees who are never "told" but feel somehow out of place-- I would say there are quite a few alternative hypotheses to prenatal attachment. One would be that the adoptive parents have not been able to feel as strongly positive toward the child as they might; this could occur because of post-adoption depression among other things. Another possibility would be that the existence of a secret alters the family dynamics in a way the child experiences as "something wrong". A third would be that a child who is different in appearance, etc., from the adoptive family may have overheard many statements about the differences. Now, the fact that there are alternative hypotheses doesn't mean that your hypothesis is wrong, but it does remind us that just because we can think of something, this doesn't necessarily mean that what we think is true.

    I would be interested to know what you mean by a corrective emotional experience. This term, suggested by Franz Alexander many years ago, has been picked up by attachment therapists like Levy and Orlans, so I am curious when I see it used.

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  11. I mean that you can develop a secure attachment relationship even as an adult and this can help heal the previous attachment trauma and insecure attachment patterns. That is what I mean by "corrective experience" and yes I see what you are saying with regard to alternative hypothesis to uterin attachment. In my experience babies do give preference to specific caregivers. I dont know the research but I do know a few babies.

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    1. Just keep in mind that for some people "corrective emotional experience" has a specific meaning, which may not be what you want to convey-- I agree that babies can respond better to some caregivers than to others, but this may be because caregivers like some babies better than others and behave slightly differently with them.

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  12. The meaning I am conveying is based in real (not fringe) research. I know of no other meaning.

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  13. I'm just pointing out that some people do assign another meaning to that term.

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  14. It seems that the "good news" is that all these "early traumas"(even including drastic famine periodically taken place in human history) only result in some elevated "risk" for vulnerable persons, the majority of people able to survive them are able to stay mentally and physically healthy in further life or successfully rehabilitated (as, e.g., there is shown in recent study of mental health of the survivors of famine in China happened at the end of 50 - beginning of 60-th of XX cent. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726543/ ). Also one can remind the famous study of "children of the garden island" (http://www.scientificamerican.com/article/children-of-the-garden-island/ ). And as about "risks", what to do, human life is full of risks from birth, and "early trauma" seems to be only one many other possible risks. But in general humanity has a great experience how to deal with this, including helping the most vulnerable. Bur wrong (and not healthy) approaches like "Attachment Therapy" concepts and practices help nothing, only making the situation worse, evidently being themselves the reason of traumas and creating additional significant "factors of risk".

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    1. It's certainly true that resilience seems to make all the difference, but until we can identify which people are resilient, we need to do as much as we can to prevent traumatic experiences for all children. I would include in that recommendation the prohibition of all pseudotherapies/alternative psychotherapies which, as you say, are traumatic in themselves. The concept of potentially harmful treatments for child mental health issues is receiving more and more attention these days, and I have recently been asked to write an article on this topic for the Journal of Clinical Child and Adolescent Psychology, which I hope will help convey the importance of this matter.

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