Trauma Informed Practice: from the bottom up
As research into the area of trauma progresses, it is becoming increasingly clear that the adults working with traumatised children are not always aware of the range of ways in which they can be impacted alongside attachment, which in contrast is well documented.
Dr Shoshanah Lyons, Clinical Psychologist and Clinical Director of Beacon House, a specialist mental health and trauma team based in Sussex, explains the various ways that children respond to trauma. She notes that while children who have experienced a single traumatic event might show signs of Post Traumatic Stress Disorder (PTSD), those who have had multiple early life traumas are likely to show symptoms of developmental trauma. This is a set of problems which affect all areas of a child’s development, impacting on them through adolescence and into adulthood.
Beacon House approaches the repair of developmental trauma with reference to the Neuro-Sequential Model of Therapeutics (Perry, 2008). This approach is based on the premise that although developmental trauma can be repaired, its success is dependent on the nature, sequence, timing and duration of support. What is important is that treatment, parenting and education must be organised in the order in which the brain needs to heal. In other words, impairment to the brain must be addressed starting with the primitive brain, followed by the limbic system and finally the cortical system, in that order. Repair must begin from the bottom up.
Development of the human brain
The brain develops in the following order as the children move from birth to adolescence;
The first part of our brain to develop is the brainstem. This is sometimes referred to as our ‘lizard’ or ‘primitive’ brain is responsible for sensory, somatic and movement development. It is also part of our brain that is responsible for keeping us safe. It is where our ‘fight, fight or freeze’ response originates and it is constantly on high alert in order to prevent danger.
Secondly, the limbic part of our brain develops, sometimes referred to as the ‘mammal’ brain. This is the part of our brain responsible for forming attachments and developing and regulating our emotions and behaviour.
The third part of our brain to develop is our cortical brain, also referred to as the ‘human’ brain. This is the area responsible for the things which are unique to humans, such as thinking, planning, inhibiting and learning. Academic learning happens in this part of the brain.
Supporting children and young people with developmental trauma
Van der Kolk (2007) noted that children with developmental trauma essentially suffer impairment to the development of their brain. The result is that it does not function as it is meant to, with impairment in the following areas:
Somatic/sensory - located in the brainstem
Attachment - located in the limbic brain
Emotional regulation - located in the limbic brain
Behavioural regulation - located in the limbic brain
Self esteem - located in the cortical brain
Dissociation - located in the cortical brain
Cognitive difficulties- located in the cortical brain
Since the brain develops in the sequence outlined above, damage in one part of the brain impacts on development in it and subsequent areas of the brain. This explains why developmentally traumatised children usually have difficulty in areas including attachment, emotional and behavioural regulation, self esteem, dissociation and cognitive development as these are aspects for which more mature parts of the brain than the brainstem are responsible.
Dr Lyons explains, “the problem for traumatised children is that when they transition into a safe environment, the primitive brain does not turn off, so the child stays continuously in survival mode. We see these children operating constantly in fight/flight/freeze mode, and normal everyday events signal danger to their brain. The child is developmentally stuck in their brainstem, very little information can get passed up to the higher parts of their brain. Whilst they are stuck here, they cannot form secure attachments, manage their emotions or behaviour, think, learn or reflect, because they are simply trying to stay alive in a world that they feel is highly dangerous.”
How does this present day-to-day?
Helen Oakwater, writer, coach and adoptive parent, invites teachers and other professionals to consider what lies beneath the child or children whose behaviour is preventing them from being able to even settle in a classroom let alone to begin learning.
“Unlike the other kids in the playground, who were born to mothers who avoided unpasteurised cheese, alcohol and took folic acid, my kids developed inside a woman who continued her chaotic lifestyle, including binge drinking and antisocial behaviour. Once they were born, they weren’t spoiled by grannies and aunties nor cooed at constantly in a world of warmth that cherished every smile on their chubby faces.”
Their world was cold, wet, painful, lonely: they were neglected, maltreated and left to fend for themselves while their birth parents struggled with drug dependency, withdrawal and the thrice daily challenge of funding the next hit. Lying in a cot, a belly knotted with hunger, shivering with cold, the thin blanket soaked in urine, tasting the vomited milk and listening to shouting and crashing doors is traumatic for an infant. This sensory experience is entwined with the fear that they might die. A ‘knowing’ that their cries are unheard. The terror that lengthy solitude might end only when an adult‘s rough handling inflicts physical pain. The sense of worthlessness, hopelessness and helplessness pervades every cell of the neglected child: minute by minute, hour upon hour, day after day. This sensory experience creates the legacy of trauma.”
Helen goes on to explain how early experiences such as these can leave a legacy of trauma. “Sometimes children are abused by other adults while their parents were comatose or even watched. Yes, it is ugly. Yes, it is unspeakably awful. Yes, it still happens and yes such ghastliness leaves a legacy. It is this legacy of trauma which generates ‘nonsensical’ behaviour a few years later. It is this painful history that causes a seven-year old adopted child to run round the classroom, because as a toddler he learned that constant moving keeps you safe; if ‘they’ can’t catch you ‘they’ can’t hurt you. However, he can’t verbalise why he is running, so don’t bother asking.”
It’s not surprising that children who experienced trauma in their early lives continue to experience its effects even when they are in a safer environment. Helen highlights the misconception that, “‘all the horrid stuff’ will be forgotten if a child is picked up and put in a nice new home with caring, loving adults. It’s not. It’s stored in the implicit, sensory memory, inaccessible with words.”
The Trauma Informed School Approach
The ‘trauma informed’ approach to education is one in which the school places high priority on supporting children and young people suffering with trauma or mental health difficulties, understanding the reasons causing dysregulated or challenging behaviour and how this acts as a barrier to education and learning. Such schools know that when children who have experienced several difficult life experiences do not receive support in the right way, at the right level and at the right time, there is a high likelihood that they will go on to experience severe mental and physical health problems.
Once schools are aware of the educational impact of trauma, it is important that they take steps to ensure that trauma sensitivity is at the heart of how the school is run. While this might look different in different schools, it is important that there is a shared definition of what it means to be a trauma informed school so that all stakeholders share and can work towards a common vision.
Trauma informed/sensitive schools share the following 6 characteristics:
There is shared understanding among all staff about what developmental trauma is and how it presents;
There is both agreement and strategies in place to ensure that all children are supported to feel physically, socially, emotionally and academically safe;
Processes are in place to address the needs of children and young people in holistic ways, taking into account the quality of their relationships, ability to self-regulate, academic ability and their physical and emotional wellbeing;
The school explicitly places importance on connecting children and young people to the school community, ensuring that they feel safe and secure and providing them with a range of opportunities to practise new skills in a safe and secure way;
Then school embraces a team approach in which all staff are responsible for all children and young people;
School leadership anticipates and adapts to the changing needs of the children and young people in their care.
