Early warnings

Understanding
how the brain develops its pathways during a child’s maturity is the key to
therapeutic work at a Lancashire attachment centre. Sheila Fearnley and Barbara
Fleetwood describe their programme and the philosophies behind it

There
is a growing understanding of the neurological impact on babies’ brains of
their early life experiences, and these are being applied in therapeutic
practice in the UK as well as in the US, where much of the research has been
taking place.

As
early as 1996 practitioners at the Keys Attachment Centre in Rossendale,
Lancashire, were beginning to note the need to monitor neurological development
in the children they were working with.

From
the centre’s early findings in practice it introduced neurological exercises to
aid assessments, specifically noting left or right brain-hemisphere
development, and finding that many of the children referred to Keys could be
identified as either left or right brain functioners.

Keys
has now developed a therapeutic treatment programme for children and young
people, and which also helps families and carers understand the children they
are living with. The programme aims to maintain the sanity of the family as
well as sustain the mental health of the child.

The
work being pioneered at Keys is underpinned by its experience of child
development, including neurological development. It seems common sense to the
staff there that in understanding that the brain develops its pathways in the
first precious years, anything interrupting that development must have an
impact on how pathways form and, therefore, how a child then processes,
accesses and uses the information it receives.

With
this knowledge, it is clear that practitioners have to be more mindful of the
impact trauma has on the developing brain.

We
are all aware that the brain is both an amazing and complex organ. It is what
allows us to feel, laugh, speak, create and act. The brain is where all the
qualities of humanity – positive and negative – are developed. The brain’s job,
simply, is to sense, perceive, process, store and act on information, both
externally and internally, to promote an individual’s survival.

To
be able to do this the brain has evolved both an efficient and logical
structure. At birth the human brain is underdeveloped. In early childhood it is
most receptive to environmental input.

As
it develops, the brain operates on a use it or lose it principle,¹
where only the connections and pathways that are frequently activated are
retained.

A
developing child is constantly assessing whether his needs are ignored, or met
lovingly. Applying this thinking to a child who is traumatised through abuse
can explain why the child often becomes "stuck" in a traumatised
state, recreating and practising ways of surviving outside of the actual
experience. For example, an abused child may live internally in the state of
the abusive experiences to inform himself he has survived the actual abuse.

When
threatened, both our minds and bodies produce adaptive responses. Our mental
states change when in a highly aroused phase, and we know that as well as
thinking differently when we are stressed, our physiology changes.

Researchers
at Keys postulate that traumatised children are re-traumatised as they come up
against the outside world and relationships, and consequently discover their
way is not the way to exist. It is a shock to have brought into their
consciousness the awareness that the functional, but negative, survival
strategies they have utilised so well are being challenged. This strategy is
what has, in the child’s view, protected him or her and, indeed, facilitated
his or her survival.

Now
someone in the outside world is asking, or even demanding, that the child let
those defence mechanisms go. It does not make sense to traumatised children. It
seems to them that these behaviours, whatever they are, have kept them safe.
More importantly, they have stopped other people getting in, emotionally.

To
survive, the children have to change their belief systems about everything they
have experienced or understood. The notion of "fight or flight" has
been extended to include three psychological defence mechanisms we all have and
use when threatened: freeze, flight and fight. These facilitate our ability to
deal with experiences and situations, in varying degrees.

To
stop the bombardment and intrusion of the external messages that we cannot
understand, we will:

–
Freeze. Mental overload can immobilise us both physically and psychologically.
Fahlberg² talks of the "frozen child"; families talk of
having an "unemotional child, even a lodger".

–
Flight. To "fly away" emotionally is a powerful defence mechanism.
This psychological state of flight is both powerful and confusing. It can be as
a result of the mental pain being so great it cannot be borne in reality, and
the only way to deal with it is to disengage from reality.

–
Fight. Some of the traumatised children who Keys has been working with fight
"to the death". Their internal constructs are what tell them who they
are, and therefore they fight hard not to change their destructive behaviours
as to do so would mean becoming "someone else".

Certain
brain structures, connections and biochemical processes have been identified by
Schore, Perry and others as relevant to the attachment process.

Schore³
states: "The early social environment, mediated by the primary care-giver,
directly influences the evolution of structures in the brain that are
responsible for the future socio-emotional development of the child."

The
general principles of growth of the developing brain are:

–
The growth of the brain occurs in critical periods and is influenced by the
social environment.

–
The infant brain develops in stages and becomes hierarchically organised.

–
Genetic systems that programme brain development are activated and influenced
by the post-natal environment. The social environment changes over the stages
of infancy and induces the reorganisation of brain structures.

Within
this framework, those at Keys understand what an awesome task it is for some
children to believe in a world that is safe, secure, warm, loving and theirs –
a world that many children and adults take for granted.

At
Keys, the traumatised child is on a continuum of emotional health (see box).
The aim of its therapeutic treatment programme is to help clients move towards
adequate, then good, functioning and, if possible, onto optimal health. At any
point in the continuum, the child continues to grow and develop. A child who is
ill or tired, or has had a difficult experience may temporarily function
further to the left than normal.

The
potential damage to the developing brain cannot and should not be
underestimated, neither should the impact of living with a neurologically
traumatised child.

However,
research on the developing brain is hopeful. It suggests opportunities for
change into adulthood and provides no evidence that there is an age beyond
which the right intervention cannot make a difference.

The
work at Keys indicates that there is a great need for further research on the
neurological effects and impact of early trauma for some children.

¹
B D Perry, Neurological Sequelae of Childhood Trauma: PTSD in Children.
In Catecholamines Function in Post-traumatic Stress Disorder: Emerging
Concepts, M Murburg (editor) American Psychiatric Press, 1994

²
V I Fahlberg, A Child’s Journey Through Placement, Perspectives Press,
1991

³
A N Schore, Affect Regulation and the Origin of Self, Lawrence
Erlbaum, 1994

Sheila
Fearnley and Barbara Fleetwood are co-founders of Keys Attachment Centre, and,
respectively, clinical director and managing director Keys Attachment Centre,
tel: 01706 227226

The continuum of emotional heath at Keys

Emotional
impairment
Functioning impaired in several dimensions of development resulting in
severe regression or blocks in development.

Marginal
functional
Copes if given structure and extra help. Blocks in development may impede
progress in certain areas.

Adequate
functioning
Lags behind in some dimensions of development or has limited periods of
regression.

Good
functioning
Functioning well in all or most areas of development. Lags or regression seldom
occur.

Optimal
functioning
Functioning well in all dimensions, good self-esteem and mastery of tasks.