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.