Conclusion This chapter examined the impact of trauma within a developmental context and highlighted the unique ways in which children respond to trauma. The common DSM-5 diagnoses that are used to classify childhood challenges but do so without proper consideration for underlying trauma symptoms were reviewed. Covert, interpersonal traumas commonly observed in children were differentiated from the overt traumas often seen in adults. For instance, attachment failures (e.g., chronic unresponsive or insensitive caregiving) were positioned as developmentally pertinent traumas that alter developmental trajectories with long-term negative outcomes. Various examples highlighted how overlooking trauma as an etiological factor and attending only to surface symptoms often result in ineffective
trauma treatment. The available child-specific trauma diagnoses were examined and the two primary diagnoses, PTSD for children six years or younger and DTD, were compared and contrasted. Clinicians should be aware of both disorders and use clinical judgment when attempting to classify child trauma. Finally, this chapter considered the role of trauma during infancy, an often-forgotten developmental period, and reviewed the nuanced observations clinicians need to make when assessing for infant mental health. Clinicians must be aware of the complexities of childhood trauma, and they must learn to assess, diagnose, and treat childhood trauma differently from adult trauma.
THE NEUROBIOLOGY OF TRAUMA
Advances in technology have uncovered the biological effects of trauma on underlying physiological mechanisms. Previously reserved only for medical practitioners, at least a minimal knowledge of the biological mechanisms involved in trauma can translate to more effective professional practice for social workers, mental health counselors, psychologists, and marriage and family therapists. Trauma can wreak havoc on biological systems, and providers are not only more informed when they understand all the effects of trauma, they can also better tailor clients’ treatments with this information in mind. This chapter will present basic background information on the neurobiological mechanisms involved with and affected by trauma. For example, the various structures of the brain are presented to help the reader understand which structures are involved in general memory storage, the encoding of traumatic events, and memory storage of traumatic material. By revealing the connection between brain structure and brain function, neuroscience provides insights into the ways that experiences shape mental processes and create neural network patterns in the brain. Trauma is a psychophysical experience, and clinicians should consider the effect of trauma on the physical encoding of information and see how trauma is encoded and stored within the various parts of the body—how trauma “gets under the
skin” (McEwen, 2020, p. 4). This information can then inform the nature of trauma treatment and increase understanding of how various types of intervention can help to move the healing process forward. The infant brain is not fully developed and continues to mature long after birth. It lays down new neural networks throughout the life span. Although this growth takes place primarily during the first several years of life, neuroscience has shown that the process continues throughout an individual’s life (Doom et al., 2018). The organization of self in the developing brain of the infant and child occurs within the context of relationships with others. According to Allan Schore (2021), other people act as an external psychobiological regulator of the experience- dependent growth of an infant’s brain. Humans continue to grow and develop as relational beings in response to and in tandem with the ways that others relate to them. This relational matrix is often disrupted in the presence of a history of trauma. Prolonged relational disruption affects the core of self as well as the neurobiology of self. Studies have shown that childhood experiences, including neglect and traumatic stress, change the biology of the brain and impact the mental health of the growing child (Doom et al., 2018; McEwen, 2020).
Anatomy of the Brain In the service of understanding how the brain itself is affected by trauma, it is useful to examine brain physiology and anatomy. (See Figure 4-1.) A three-dimensional model and easy visual mnemonic can assist clinicians with remembering the brain’s physioanatomy and can be used to provide an explanation of neuroanatomy to clients. It can be found in the palm of a person’s hand (Siegel, 2012). Figure 4-1. Anatomy and Physiology of the Brain
Note . From Western Schools, © 2018.
A useful exercise for the clinician and client is as follows: First, make a fist with the thumb tucked inside. The forearm represents the spinal cord; the wrist then becomes the base of the skull (the brainstem). The fingers themselves represent the cortex
(which houses the brain’s cortical structures [cortices], including prefrontal cortex and orbitofrontal cortex). Turn the hand to view the fingernails. The third and fourth fingernails represent the prefrontal and orbitofrontal cortices, areas important in decision
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 77
Powered by FlippingBook