Posts Tagged ‘ exposure to interpersonal trauma ’

How Early Exposure To Trauma Affects Children’s Cognitive Development – And What Can Be Done About It

Monday, April 30th, 2012

Unfortunately some babies, toddlers, and children are exposed to maltreatment and trauma – they can be witnesses to physical and emotional abuse, sexual abuse, and partner violence, and also experience it directly. Prior research has shown that such exposure may have lasting negative effects on cognitive development. The lead author of a key new study – Dr. Michelle Bosquet Enlow of Children’s Hospital Boston – took the time to expand on her current findings and the implications for intervention. Below are her responses to specific questions I posed.

Could you briefly give a description of what you examined in your research?

Our research specifically studied child exposure to maltreatment (the large majority, though not all, at the hands of the mother) and domestic violence against the mother. These kinds of trauma exposures may require additional considerations compared to other types of traumas that do not involve the parent (for example, being involved in a serious car accident, death of a non-parental family member). For example, when the caregiver is the perpetrator of the trauma, the child may need to be removed from the caregiver’s custody and some of the answers below may not be as applicable.

Do we know yet what the mechanism might be that affects cognitive/brain development? How does trauma affect the developing brain especially early in life?

There are many ways that trauma may affect the developing brain. Certain types of trauma, such as physical abuse or neglect, may cause direct injury to the brain, for example through injury to the head or malnutrition. We also know that when humans face a stressor, especially an extreme stressor like a trauma, the body prepares to react to the stressor. Chronic or severe stressors can cause changes in how the body secretes and processes a number of hormones that affect how the brain functions. These effects may be particularly strong in early life when the brain is developing so rapidly. Any changes to the brain during this critical time may affect how the brain is organized, and therefore have lifelong consequences. Also, infants and young children have fewer coping resources to manage stress, given their immaturity and dependence on their caregivers. We know that caregivers have a critical role in fostering children’s cognitive development. Sensitive, warm, consistent, empathic caregiving is key. Finally, for many children, trauma exposure can lead to emotional difficulties, like depression and posttraumatic stress disorder (PTSD). This is true even for very young children. These difficulties can interfere with learning new skills. For example, a child with PTSD may be preoccupied by disturbing memories of the trauma and have difficulty sitting still and paying attention. This can make it difficult to pick up new cognitive skills.

If a baby/toddler is exposed, what can be done with respect to intervention? What could a parent or caretaker do to minimize the effects?

Caregivers are absolutely essential to children’s recovery after a trauma. First, caregivers need to make sure that they are taking proper care of themselves so that they can be most helpful to their child. Sometimes, a caregiver and child suffer the same trauma (for example, being in a car accident together). Just knowing that your child has suffered a trauma can be very upsetting to the caregiver. This may cause feelings of guilt, helplessness, depression, and anxiety and difficulties with sleep, appetite, and concentration. Caregivers should seek out help for themselves if they feel that they are having symptoms that are getting in the way of their ability to function or care for their child. They may talk to their primary care physician or seek out a counselor.  They should make sure to get enough sleep and eat right and exercise if possible.

The other really important step caregivers can take is to help the child to feel safe again. Maintaining routines, such as the same bedtime rituals every night, is very important. Keep in mind that the child’s behaviors may change—for example, the child may become more clingy, have difficulty separating from the caregiver, have nightmares or resist going to bed, or not want to eat or want to eat a lot. The caregiver should do her best to be patient and remember that these are normal reactions. The child is not trying to manipulate anyone.  If possible, the caregiver should try to minimize separations, at least temporarily. If a separation is necessary, the child should be left with someone she knows and trusts. A familiar object to keep while the caregiver is gone, like a photograph of the caregiver, may help. The child may need extra hugs and lap time to feel reassured. If the caregiver feels the need to talk about the trauma with someone, she should make sure that the child cannot overhear the conversation. However, if the child wants to talk about the trauma, she should be allowed to do so. She may need to talk through what happened and get reassurances that she is now safe. If the caregiver has concerns about the child, she should talk with the child’s pediatrician. There are counselors who treat traumatized children, even very young children. These counselors can be very helpful in giving caregivers advice about ways to help their child. For example, we treat traumatized children and their families in the Psychosocial Treatment Clinic in the Outpatient Psychiatry Service at Children’s Hospital Boston.

Any suggestions to help parents in a compromising situation seek out help to prevent exposing their baby to trauma?

If parents are feeling stressed, they should seek out help for themselves, for example by calling a parenting helpline or by talking with their primary care physician or a counselor or friends and family. Physicians and counselors should be able to help parents find resources if needed to get out of a domestic violence situation or to get help if there is child abuse or neglect. The National Child Traumatic Stress Network has helpful information regarding child trauma, including information for parents and caregivers. Their website is www.nctsnet.org<http://www.nctsnet.org>.

Image depicting overcoming trauma via therapy courtesy of Shutterstock.com

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