#traumainformed – Catherine's Field of Ideas

Fight, Flight, or Freeze (FFF) Responses

The brain is an interesting muscle. It can do so much and yet we don’t utilize more than ten percent of its capabilities. It is responsible for all the other muscles and functions in our body, and it is multitasking all the time (consciously and unconsciously). It has this neat thing called neuroplasticity, meaning despite any damage to some of its parts the muscle can be strengthened and experience some healing. In trauma this is evident in the fight or flight response, which has been expanded to include freeze and fawn. You can read more about these responses here, but it is important to understand the basic brain structures in this response system.

Back in the caveman days we needed to stay alive, so our bodies needed a way to keep us safe without overworking our muscles when it was not necessary. Imagine a sabretooth tiger slowly coming to the cave opening-it is crouched low to the ground, its head is lower, and ears are back, the mouth is open slightly reveling fangs and there is drool. Our amygdala senses there is a danger, checks with the hippocampus quickly (which remembers another time when it saw this scene and it was not safe), and quickly tells the hypothalamus to make the body run (flight), grab a weapon and defend itself (fight), or be really still (freeze). This all happens extremely fast, because if there was too much time to think our ancestors would have been eaten and we would not be here reading this. This is a survival response.

In order to do any of these effectively the body makes some major changes. Pupils dilate to see better, goosebumps appear on the skin as hair stands up to better sense the environment, breathing becomes quicker and shallower, and the heart rate increases-that way the muscles have more blood and oxygen to work better. Other tasks are less important and they stop, like digestion (butterflies in the stomach) and urination.

However, our body cannot remain in this heightened state for too long or it will become overworked, sometimes causing unhealthy physical effects. The prefrontal cortex is able to talk to the hippocampus and the amygdala to determine when the situation is once again safe and works to return the body to its usual functioning. In addition, if that “sabretooth tiger” was simply your neighbors’ cat walking by, the hippocampus will find it in its memory, share it with the cortex and the whole system is shut down almost immediately because there is no danger. This process is much slower than the FFF response. This all looks something like this:

How does trauma impact the FFF Response

For children who have experienced complex trauma, they never know when or where the abuse may come from. Therefore, they always operate on the FFF response to a stimulus. Unfortunately they have learned that they cannot predict who or what is safe so everything starts to become a threat; they do not have the luxury to check with their memory and determine if there is something different this time that may mean they are safe. Like any muscle that we work out all the time, the FFF response becomes very strong, and the more logical thinking parts of the brain begin to atrophy. Scientists have seen images of trauma victims’ brains that show the reasoning centers of their brains are much smaller than those without trauma. At the very core they are thinking differently. They must always be ready to keep themselves safe for their own survival.

Behaviors indicative of children with complex trauma

So now we know what is happening in the brain. Many of the kids we are educating or raising are now in safe environments that no longer require the FFF response to always be on. So how can you tell when the response system is activated, even when it does not need to be?

Trembling-increased hormones caused by the FFF response can cause muscles to shake as they are preparing for hard work
Hyperventilating-the shallower quicker breath meant to oxygenate the blood faster
Complaints of “chest pains” -increased heart rate pumping blood faster to the system
Sweating-perspiration increases to keep the body from overheating during the survival response
Hypervigilance-always scanning and watching for potential danger, always “in the ready”
Tunnel Vision-focus on one stimulus causing distress and unable to shift focus. This could be on an object, behavior, or topic of conversation.

Providing a supportive environment/Trauma Informed Care

There are many ways to be supportive to a child who needs to learn how to manage their survival response and become better at assessing the people and situations around them. They need tools that can help delay the automatic survival response long enough to let the thinking parts of the brain exercise and grow stronger, helping them make better decisions. The great thing is, the more they work out the brain, the stronger the atrophied parts can become, and they will heal. Sensory Modulation is a great tool that helps children learn ways to retrain their survival response.

Sight-pictures of pets/family/friends they find pleasant and safe, Defocus books where they look for patterns, Seek and find books where they have to locate specific objects
Sound-music and sounds the child finds pleasant. This may take some adult supervision for appropriateness. Playing or resuming playing a musical instrument. A loved one’s voice pre-recorded.
Smell (*warning: smell is the fastest way to trigger a positive or negative reaction, smell works directly on the amygdala)-favorite perfume of a loved one, favorite food, favorite dessert
Taste-fireballs, favorite food/drink, salty things, sour things
Vestibular rocking, swinging
Tactile-manicures, head rubbing/scratching, soft or hard items, favorite blanket or material,

This is a basic outline and understanding of how trauma impacts the brain of a child and how we can support resiliency. It is important with any of these tools to offer choice whenever possible. This can be empowering to a child who has felt their life was completely beyond their control, including their safety. Just because you like something does not mean they have to like the same things. Help them identify what they find helpful. These can change from day to day. Once thy find these things take the time to show interest and learn about them. That way, when the brain is thinking in pure survival mode, the child can rely on you to provide those coping tools. And don’t forget the power of play. Play is where children work out their struggles and can find/practice good coping skills.

Remember, it’s not “What’s wrong with you?” but rather “What happened to you?“

Now, have a little fun and find these important words in the word search below:

For a long time, the concept of “trauma” did not exist. What happened at home was to stay at home, and if bad things happened you were supposed to “get over it” and “move on”. It wasn’t until the 1970’s that the term “post-traumatic stress” became a common term-primarily related to symptoms experienced by returning Vietnam Veterans. It wasn’t until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 when trauma was officially recognized by the American Psychiatric Association as a diagnose (PTSD). Over the next forty years the PTSD diagnosis has undergone a variety of changes as a result of ongoing research and new technology. We are now more aware of the variety of traumatic experiences and the life-changing effects they have on individuals. More specifically, the concept of complex childhood trauma has been shown to impact someone from the DNA to their life-expectancy. Although the call to include complex trauma as a stand-alone diagnosis in the DSM-V (2013) was unsuccessful many of its features have now been incorporated into the current PTSD diagnosis. This better, more comprehensive understanding of trauma would not have been possible without the hard work of many disciplines who have studied trauma and the brain. In turn, it takes multiple disciplines to also successfully treat it.

Neuroscience/Biology

Using MRI in children experiencing complex trauma, as well as adult survivors of childhood abuse, it has become clear these experiences cause lifelong changes in several important brain structures. There are proven effects on working memory, white and grey matter of the prefrontal cortex, the corpus collosum, hippocampus, and brain volume (De Bellis & Zisk, 2014). These changes impact a person’s ability to organize their thinking, process information, and make decisions. And these changes are only the beginning. Changes are also occurring at the DNA and hormonal levels, exacerbating the biological effects and having significant impact on the overall health and wellness of trauma survivors. This information is crucial in understanding trauma as more than a memory or experience, but helped bring trauma into light as a whole health issue.

Here’s another way to look at it. A child is in a car accident and suffers an injury to the brain. After the accident the child has difficulty remembering things and struggles more at school. Aware of the injury and the change in the child’s abilities due to the known physical injury, teachers and parents may alter their expectations and provide supports. They may not expect that child to maintain high honor roll grades and may celebrate their success if they do. The same is true of the brain that it is affected by abuse. We need to understand it is an injury to the organic brain requiring appropriate expectations, support, and praise for success.

Education

With more information available about the impact of trauma on an individual, school systems are beginning to look at traditional structures and policies as they relate to trauma and student success. For some districts this is an active process with trauma-informed principles being instituted on every level. For other districts struggling with meeting basic educational needs of their students due to budget cuts and low attendance, to name a few, instilling trauma informed principles is more difficult to implement. With trauma comes anxiety, hypervigilance, behavioral problems, and inattention that are often are addressed through disciplinary measures and reflected in poor grades. For children who are already being victimized and have an enormous sense of self-shame these consequences push them away from, rather than foster, a potential resiliency component. Schools run the risk of increasing the Pipeline to Prison phenomenon of many schools.

The Education Law Center in Pennsylvania released a comprehensive article for educators explaining trauma as it impacts student learning and offering numerous recommendations and best-practices for supporting the academic success of trauma victims. These can be helpful for both educators and parents advocating for their children in academic settings. Here are just a few of their recommendations:

Recommendations for Classroom Learning

Specific strategies such as including discovering and building on the student’s individual interests and competencies; maintaining predictable routines and expectations; maintaining expectations for the student that are consistent with those of his/her peers; and providing positive behavioral supports.
Language-based teaching approaches can help students process information and alleviate their fears. Students who have experienced trauma often pay more attention to nonverbal cues than verbal communication, so using multiple forms of communicating can be helpful
School evaluations, including psychological, speech and language, functional behavioral, and occupational therapy evaluations, should assess the role of trauma and identify needed supports.

Recommendations at the Policy Level

School discipline policies are trauma-informed when they balance accountability with an understanding of traumatic behavior
Teach students the school and classroom rules while reinforcing that school is not a violent place and abusive discipline is not allowed at school
Minimize disruptions to education with an emphasis on positive behavioral supports and behavioral intervention plans; · Respect confidentiality while using open communication and relationship-building with families
Ensure ongoing monitoring of new policies, practices and training.

Occupational Therapy (OT)

The role of OT is to enhance the physical and mental health of individuals by focusing on education, play, social activities, and activities of daily living. They use discipline specific tools to identify and assess factors that may be impacting full participation in any of the above areas. When it comes to trauma, the American Occupational Therapy Association, Inc (AOTA) states “Occupational therapy practitioners can serve an important role in addressing trauma at the universal, targeted, or intensive levels of intervention. They are invaluable members of the mental health team because of their knowledge of the cognitive, social and emotional, and sensory components of activity and its impact on behavior (AOTA, 2015).” When it comes to working with children, occupational therapists with training in trauma and sensory-based interventions are qualified to provide sensorimotor arousal regulation, teach mindfulness strategies to reduce stress and increase coping skills, provide environments and opportunities intentionally designed to increase a sense of mastery, connection, and resiliency, and provide opportunities to facilitate the development of likes, interests, and motivators. OT’s will often provide services at home, school, hospital, and in the community as part of multidisciplinary teams because of their knowledge of the cognitive, social and emotional, and sensory components of behavior (AOTA, 2015).

For further information on the role of occupational therapists in helping children with complex trauma refer to the complete document published by the AOTA by clicking the image below.

So who else is in the village………

Many different disciplines are looking at the impact of trauma and trauma informed care. It is being implemented in many aspects of children’s daily life and will hopefully encourage better outcomes for adult survivors of childhood complex trauma. These are just a few of the disciplines asking the questions and making an impact, and certainly not a comprehensive list of people looking at trauma. What we do know is that all these professionals and viewpoints are necessary to develop the full picture of trauma and resiliency. It really does take a village to raise a child.

Tag Archives: #traumainformed

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