Babies Cant Wait: Traumatic Stress In Infancy and Early Childhood

1
Babies Cant WaitTraumatic Stress InInfancy
and Early Childhood

• Alicia F. Lieberman, Ph.D.
• Irving B. Harris Endowed Chair in Infant Mental
  Health
• Professor and Vice Chair for Academic Affairs
• University of California San Francisco Dept. of
  Psychiatry
• Director, Child Trauma Research Project at San
  Francisco General Hospital
• alicia.lieberman_at_ucsf.edu

2
Normative, Developmentally Appropriate Stress
A Continuum from Stress to Trauma
Emotionally Costly Stress
Traumatic Stress
3
What is Trauma?

• A traumatic stressor involves
• Actual or threatened death or injury to the child
  or others
• Threat to the physical or psychological integrity
  of the child or others
• 
  (DC0-3R,
  2005)

4
Childhood Adversity and Traumatic Stress

• Maltreatment and Exposure to Violence affect
• Brain development
• Physical and mental health
• Emotional regulation
• Attachment and other relationships
• Ability to learn
• Traumatic stress may become Developmental Trauma
  Disorder

(Cook et al., 2003 Pynoos et al., 1999)
5
Can Young Children Remember Trauma?

• Implicit Memory
• - Engages early-maturing brain regions
• -
• - Functions outside awareness
• - Experimentally shown in infants
• Explicit Memory
• - Focal attention for encoding
• - Subjective recollection for retrieval
• - Verbal recall
• (Schachter, 1987)

6
Can Young Children Remember Trauma?

• Memorability
• Quality of events worth remembering
• Enduring over unfolding development
• Unique, dramatic, eliciting intense emotion
• Retrieval
• Once children acquire language, they
• narrate traumatic events that occurred
• while they were pre-verbal
• Accuracy versus misunderstanding
• (Nelson, 1994 Gaensbauer, 1995 Terr,
  1988)

7
Psychobiology Of Childhood Traumatic Stress

• Chronically elevated levels of stress hormones
• Lower levels of cortisol
• (mood enhancing neurotransmitter)
• Anatomical differences in brain structures
  related to memory and planning
• Smaller brain volume, larger fluid-filled
  cavities, less connective matter
  
  (DeBellis
  Putnam, 1994, DeBellis et. al., 1999ab)

8
The Body Remembers
(As cited by Felitti Anda, 2003 Source CDC)
9
Adverse Childhood Experiences Last A Lifetime

• Emotional, physical or sexual abuse
• Domestic violence against the mother
• Household member with mental illness
• Household member with substance abuse
• Household member ever imprisoned
• Absence of one or both parents
• Physical or emotional neglect
• Predict the 10 leading causes of adult
  death/disability
• (ACE Study, Felitti et al. 1998)

10
Mental Health Signs in Infants

• Re-experiencing trauma (flashbacks, nightmares)
• Numbing (social withdrawal, play constriction)
• Increased arousal (attention problems,
  hypervigilance)
• Prolonged grief
• Crying, calling, searching
• Lethargy
• Disruption of biological rhythms
• Developmental regression
• Detachment
• Anxiety, depression, anti-social behavior

11
Early Intervention Works

• Randomized studies show that helping parents
  and caregivers provide better care results in
• Lowered stress hormones
• Higher IQ
• Decreases in problem behaviors
• Lower school drop-out rates
• Less criminal behavior
• Less risk health behaviors
• Fewer unwanted pregnancies

12
A Compelling Conclusion

• The overarching question of whether we can
  intervene successfully in young childrens lives
  has been answered in the affirmative and should
  be put to rest.
• However, interventions that work are rarely
  simple, inexpensive, or easy to implement.
• (From Neurons to
  Neighborhoods, 2000)

13
What Can We Do?Begin at the Beginning

• Babies cant wait!
• 85 of child abuse victims
• majority of child abuse fatalities
• most frequent witnesses of domestic violence

What babies learn now can last a lifetime
Nourish their emotional health! (NICHD Early
Child Care Research Network, 1999 Oser Cohen,
2003)
14
A Continuum of Services
Normative Stress
Costly Stress
Traumatic Stress
Prevention
Intervention
Treatment