Circuits and Circumstances.Circuits and Circumstances.

The Consequences of Early RelationshipsThe Consequences of Early Relationships::A View from Interpersonal Neurobiology.A View from Interpersonal Neurobiology.

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UNICEF UK Baby Friendly Initiative.Annual Conference.24th November, 2011.

“Human relationships, and the effect of relationships on relationships, are the building blocks of healthy development. From the moment of our conception to the finality of death, intimate and caring relationships are the fundamental mediators of successful human adaptation.” (p. 27)

National Research Council and Institute of Medicine (2000) From Neurons to Neighbourhoods: The Science of Early Childhood Development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah A. Phillips, eds. Board on Children, Youth and Families, Commission on Behavioral and Social Sciences and Education. Washington D. C. :National Academy Press.

Early caregiving lays a foundation.Positive predictable interactions with nurturing caregivers profoundly stimulate and organize young brains.The quality of early caregiving has a long lasting impact on how people develop, their ability to learn, and their capacity to both regulate their own emotions and form satisfying relationships.

The brain is the only ‘computer’ that can:adapt to input by changing both its own software and hardware;automatically scrap unnecessary, unused components;dictate the interests and skills of the operator;

and, crucially, never exist on its own.

This is simply how humans have evolved.

So eat your heart out Bill Gates! So eat your heart out Bill Gates!

The evolution of human intelligence demands that brain development is completed after birth.

Good idea.Evolve bigger brain.

(for group living and problem solving)

Mother need wider hips.

Get slower.Smaller babies needed.

Brain plasticity.

Attachment.

Bad idea.Need a big skull to put it in, but then birth becomes risky.Too wide hips make running difficult, ‘bipedal locomotion’.Get eaten! Find new idea.More helpless; premature compared with most mammals.Caregiving alters the brain, &so closeness imports culture.

QuickQuick

“The evolution of human beings has consisted largely of adaptation to one another.” (p. 27)

(Wright, R. (1996) The Moral Animal London: Abacus.

Here there was a crucial change.

“Our brains coevolved with culture and are specifically adapted for living in culture – that is, for assimilating the algorithms and knowledge networks of culture.” (p.11)

“The human brain is the only brain in the biosphere whose potential cannot be realised on its own. It needs to become part of a network before its design features can be expressed.” (p.324)Merlin Donald (2001) A Mind So Rare. W.W. Norton & Co.

Flexibility enhances survival.“Rather than slowly adapting specialised structures in the brain to environmental demands over the course of evolutionary time, selection has designed a brain whose adaptation is its ability to adapt to local environmental demands throughout the lifetime of an individual, and sometimes within a period of days, by forming specialised structures to deal with these demands.”(p 142) Buller, D. J. (2005) Adapting Minds.The MIT Press.

The evolutionary significance of ‘plasticity’.As brains evolved and became more complicated their formation became more patterned by the surroundings in which they must function – the ‘knowledge networks of culture’– so that specialised circuits are formed in response to the demands of the local environment. The structural organisation of the brain reflects it’s history.“Most of human knowledge cannot be anticipated in a species-typical genome … and thus brain development depends on genetically based avenues for incorporating experiences into the developing brain.” (p.53) Neurons to Neighborhoods.

So what do we adapt to?“For the developing infant the mother essentially is the environment.” (p. 78)

(Schore, A. N. (1994) Affect Regulation and the Development of the Self: The Neurobiology of Emotional Development. New Jersey: Erlbaum.

And how do we adapt?“By initially overproducing connections that have been spread to a variety of targets, and then selecting from among these on the basis of their different functional characteristics, highly predictable and functionally adaptive patterns of connectivity can be generated with minimal prespecification of the details.” (p. 202)

Deacon, T. (1997) The Symbolic Species. London: Penguin.

“Genetic susceptibilities are activated and displayed in the context of environmental influences. Brain development is exquisitely attuned to environmental inputs that, in turn, shape its emerging architecture. The environment provided by the child’s first caregivers has profound effects on virtually every facet of early development, ranging from the health and integrity of the baby at birth to the child’s readiness to start school at age 5.”Neurons to Neighborhoods.

Early experiences can alter gene expression.(1) Early experiences spark signals between neurons. (1) Early experiences spark signals between neurons.

(2) Neural signals launch production of gene regulatory proteins inside cell.

(3) Gene regulatory proteins attract or repel enzymes that add or remove epigenetic markers. (3) Gene regulatory proteins attract or repel enzymes that add or remove epigenetic markers.

(4) Epigenetic “markers” control where and how much protein is made by a gene, effectively turning a gene on or off, thus shaping how brains and bodied develop.

(4) Epigenetic “markers” control where and how much protein is made by a gene, effectively turning a gene on or off, thus shaping how brains and bodied develop.

Chromosome.

DNA strands encircle histones that determine whether or not the gene is ‘readable” by the cell.

DNA strands encircle histones that determine whether or not the gene is ‘readable” by the cell.

Gene – a specific segment of a DNA strand.

Gene – a specific segment of a DNA strand.

The brain is comprised of four areas.diencephalon

limbic system

cortexbrain stem

Growth of the brain occurs from the inside out and the bottom upYou are born with 100 billion brain cells, neurons, but these are largely unconnected.There can be about 15,000 synaptic connections for each cellThey can wire up at the rate of 1.8 million per second!You have more than 2 million miles of neuronal fibres!

Growth from the bottom up and inside out.

Any developmental insult may have a cascade effect on the growth of all ‘downstream’, later maturing, brain areas that will receive input from the affected neural system.

Abstract thought.Concrete thought.

Affiliation.Attachment.

Sexual behaviour.Emotional reactivity.

Motor regulation.Arousal.

Appetite/satiety.Sleep.

Blood pressure.Heart rate.

Body temperature.

(The autonomicfunctions)

(Thalamus &hypothalamus)

Neocortex(cerebral cortex)

Limbic system

Diencephalon

BrainstemDevelopment:plasticity

complexity.

Awareness

Anatomy of the brain.

Note how the brainis divided in two.

Neurons.Many intrauterine and perinatal insults can alter migration of neurons and have a profound impact on functioning.e.g. infection, lack of oxygen, malnutrition, psychotropic drugs, lead poisoning, ionising radiation, stress and alcohol.

Neurons have 3 sequential levels of information exchange, or messenger systems:1) The communication across the synapse, that - 2) changes the internal biochemistry of the cell, which - 3) activates mRNA (messenger ribonucleic acid)& protein synthesis to change brain structure.

Principal internal structure of a Multipolar Neuron.

View of a synapse.

Neurotransmitters

It is the process ofsynaptic transmissionthat stimulates each neuron to survive,grow and be sculpted by experience.

Axon

Dendrite

Neuron and synapse.

Multi-polar neuron.

This is a dynamic,continually changing,structure whose mainfunction is cell to cellsignalling.

Pre-synapticterminal buttons

The neuron cell bodies,dendrites and glial cellsmake up ‘grey matter’.

Experience-expectant brain growth.• This take place when the brain is primed to receive

particular classes of information from the environment in order to build basic skills.

• Since the brain over-produces synapses they are ‘forced’ to compete. This over-abundance of synapses occurs during sensitive periods

• Neurons that fire together wire together.• The ‘fittest’, or most used and

useful, synapses are selected; and in neural development this is defined by the level of electrical activity.

Initial growth of synapses.

Birth. 15 months. 2 years.

Highly active synapses – receiving more electrical impulses and releasing a greater amount of neurotransmitters – stimulate their post-synaptic targets more efficiently.

This heightened electrical activity also triggers molecular changes that stabilise the synapse.

The axons of stabilised neurons become coated in myelin, an electrical insulator. It plays a role in the transfer of energy to neurons and may also support neuronal functioning.

This shows by an increase in white matter and a decrease in grey matter.

Less active synapses fail to stabilise, and so eventually regress. It is a matter of: “Use it or lose it!” right from the start. Synaptic pruning fine-tunes the functional networks of the brain. For the first 8 months after birth the rate of creating new synapses far outstrips that of pruning. By age 1, and through early childhood, the rate of reabsorbing redundant connections gains on the rate of creating new synapses. By adolescence, in most cortical areas, this process again reaches equilibrium.

Fewer but faster connections.A second wave of proliferation and pruning within the cerebral cortex occurs in late childhood; and the final, critical part of this, affecting the higher mental functions, occurs in the late teens. This overproduction, or exuberance, occurs in the parietal lobes – logic and spatial reasoning, connects senses with motor abilities and creates the experience of a sense of our body in space; and the temporal regions – linked to auditory processing, language and memory functions.

The maturation of grey matter in the cortex.The regions that mature last – not until early adulthood –

are associated with higher-order functions such asplanning, reasoning and impulse control.

A decrease in grey matter showsincreased myelination.

Decreases in grey matter reflect selection ofneurons, organisation of neural networks andenhanced processing efficiency. This occurs in a wavethat starts at the back of the brain and progresses to the front.

The prefrontal cortex (the area of ‘sober second thought’, or the ‘chief executive’) is the last part of the brain to mature. Adults depend on this area of the brain to process emotional information, resist impulses and exert voluntary control. Unexpected stress may exhaust the prefrontal cortex resources of the adolescent, undermining executive functioning. Teenagers still rely heavily on the amygdala to process emotions, and frequently read the cues wrongly so the emotion gets wrongly labelled.

By eliminating seldom-used pathways the brain leaves room for sturdier, more efficient, neural networks.And:Like all Darwinian selection, this process of synaptic pruning is an extremely efficient method for adapting the baby’s neural circuits to the exact demands imposed by his or her social , relationship-based, environment.

As the maturing brain becomes more specialized in order to assume more complex functions, it is then

less capable of reorganizing and adapting.

But this does not imply it is impossible. See: Schwartz, J. M. & Begley, S.(2002) The Mind and the Brain. New York: Harper Collins.

“During brain growth there is a constant sorting and juggling of nerve cells and connections. Those that make a match with their environment thrive, and the others wither.” (p.124.)

And so:“Impoverished environments appear to have the opposite effect of rich and varied surroundings. They suppress brain development.” (p. 158)

Bownds, M. D. (1999) The Biology of the Mind. Bethseda: Fitzgerald Science Press.

Plus experience-dependant plasticity.Our nervous system forms in an ecological dialogue with our physical and social environment. The brain creates, strengthens and discards synapses and neuronal pathways in response to the environment. In later years it organises itself in a “use-dependant” fashion, where growth is initiated by the unique experience of the individual. Synaptogenesis occurs in those brain regions involved in processing particular events.

‘Plasticity is a double-edged sword that leads to both adaptation and vulnerability.’(p.94) Neurons to Neighborhoods.

Windows of opportunity.Birth to 6 months old. Brain growth is unmatched during the first six months of life. The most critical windows during this stage are vision, vocabulary, andemotional development. Because the windows for vision and emotions shut so early, it is important to pay attention to them during this stage.

6 to 12 months old. With connections primarily established for sight, the critical windows during this stage are speech and emotional development. The foundations for governing emotions are established. Language capacity grows tremendously during this period, and this is a good time to introduce the natural sounds of other languages.

12 to 18 months old.

Most of the critical windows of human brain development are open during this stage. At no other time is the brain so receptive and responsive. Many of the neurologicalconnections that govern a lifetime of skill and potential are beginning to take shape.

18 to 24 months old.

Children in this stage are gaining more control of their bodies, and their motor skills are developing. They are becoming more aware of other people’s feelings and beginning to learn to share. Language and vocabulary remain important. Attention should be given to maths and logic as well.

2 to 3 years old. By the age of three, much of a child’s brain growth and density is complete. The brain patterns that will guide a child’s development are already well established. The critical windows for some skills such as speech begin to close, so vocabulary building is important.Brain patterns for music begin to develop at the end of this stage.

The windows of opportunity. AGE IN YEARS.

Pre 0 1 2 3 4

Motor development.

Emotional control.

Vision.

Social attachment.

Language / Vocabulary.

Second language.

Math / logic.

Music.

The baby’s environment is defined by relationships.

Neglect is the absence of critical relationship- based organising experiences at key times during development.

Windows of vulnerability.

The temporal lobes receive and integrate inputs from the senses, and combine them with deep primitive drives from the limbic system and brain stem. They also deal with hearing, learning, memory skills, emotions and identifying trustworthy and familiar people.

P.E.T. scan of a normal two year old.

PET scan of the brain of a Romanian orphan institutionalised shortly after birth shows the effects of extreme deprivation in infancy.Global neglect has been followed by atrophy of ‘unnecessary’ areas.

For a direct comparison.Normal 2-year old. 2-year orphan.

The neurobiological impact of abuse.“Because childhood abuse occurs during the critical formative time when the brain is being physically sculpted by experience, the impact of severe stress can leave an indelible imprint on its structure and function. Such abuse, it seems, induces a cascade of molecular and neurobiological effects that irreversibly alter neural development.” (p.56)

Martin H. Teicher. Scars that won’t heal: the neurobiology of child abuse. Scientific American, March 2002. pp.54-61.

• The organising brain requires patterns of sensory and emotional experience to create the patterns of neural activity that will guide the neurobiological processes involved in development.

• In the face of interpersonal trauma, all the systems of the social brain become shaped for offensive and defensive purposes.

• A child growing up surrounded by trauma and unpredictability will only be able to develop neural systems and functional capabilities that reflect this disorganisation.

The orbitofrontal cortex and trauma.The orbitofrontal cortex is the brain system involved in social adjustment, the control of mood, drive and responsibility and those traits that are seen to define the personality of an individual. It is the site of the attachment control system.This is the only area of the brain that is one synapse away from the cortex, limbic structures & brain stem, and so integrates them into a functional whole.

Orbital frontal cortex.

The maturation of the orbitofrontal regions occurs completely post-natally, and their development is positively or negatively shaped by early relationship-based experiences.The sensitive caregiver is acting as an auxiliary cortex to begin with, in terms of affect regulation this is how circumstances etch in matching circuits.Thus, the system that is being shaped by relationship-based attachment experiences is the same one that will eventually regulate the expression of aggression.

An inefficient right orbitofrontal system will be unable to modulate the response of the amygdala to emotionally significant and stressful stimuli, e.g. an interpersonal threat, a sense of defeat or a feeling of shame.

Orbital-frontalcortex

Hypothalamus controlsautonomic nervoussystem through pituitarygland & adrenal cortex.

The HPA axis is programmedby early caregiving behaviour.

Linking thalamus, amygdala and cortex.

Busy translatingthe sight of dangerinto preparing tofight, flee or freeze.

Thalamus AmygdalaActivation of emotions

before cognitive processes occur.

Here we have regulation ofemotions bycognitive processes.

Controls theemotional responses.

Sensoryinput

Sensory gateway tocognitive processorganised throughcortex & hippocampus. The fast, primitive, track

HippocampusThe slow trackPrefrontalcortex

“Abuse and neglect in the first years of life have a particularly pervasive impact. Pre-natal development and the first two years are the time when the genetic, organic, and neurochemical foundations for impulse control are being created. It is also the time when the capacities for rational thinking and sensitivity to other people are being rooted - or not - in the child’s personality.” (p. 45)

Karr- Morse, R. & Wiley, M. (1997) Ghosts From the Nursery. New York: Atlantic Monthly Press.

Pathway to the stress response.

Signal ofdanger; e.g. maltreatment, absence of No response. caregiving.

or

Fight or flight,hyperarousal.

Freeze & fade.‘Terror without solution’

Dissociation, orhypoarousal.

The infant is making a bidfor interactiveregulation.

Affect regulation occurs.

Inappropriateresponse.

Sensitivecaregiverresponse.

Return to calm state.

The stress response.

Long-term response via bloodstream. (ACTH, cortisol)

Short-term stress response is via the spinal cord; noradrenaline and adrenaline released by sympathetic nerve endings & adrenal medulla.

The two opposite neurochemical response patterns to threat.

(1) The hyperarousal continuum:this comprises the defensive “fight or flight” responses.The initial stages of threat trigger the sympathetic system’s alarm reaction. If the threat materialises then the full fight or flight survival response becomes activated.

• Internal imagery can activate and stimulate the same brain systems as do actual sensory perceptions.

• These brain systems will be reactivated when the child meets a reminder of the trauma, or even when this is thought of or dreamt.

• Over time specific reminders may generalise.

• This use-dependent activation leads to sensitisation of the brain stem and midbrain neurotransmitter systems.

Persistent threat is a form of toxic stress. Thus the components of the fear response become sensitised, putting the child in a persisting fear state (a state becomes a trait) that causes exaggerated reactivity. He or she may become hyperactive, over-sensitive and hypervigilant, and move quickly from anxiety to terror. This may cause persistent hyperarousal disorders such as ADHD, PTSD and conduct disorders. It also negates the capacity for rational thought.

The effects of adrenaline and cortisol.

Adrenaline (or epinephrine in America) is a component of the sympathetic nervous system. It triggers increases in activity that support vigilance, focus attention, increase heart rate, shunt blood to muscles and away from the digestive system, break down fat stores thus making energy available to cells, and dampen the activity of the immune system.

Cortisol is a steroid hormone that plays a myriad of roles in stress physiology. It helps to break down protein stores, liberating energy for use by the body. It also suppresses the immune system, inhibits physical growth, and affects many aspects of brain functioning including emotions and memory. It is toxic to growing brain cells. It is also released when the baby experiences a lack of stimulation & touch.

These are PET scans of two three year olds; note the reduction in brain volume as a result of neglect.

(2) The dissociative continuum:this comprises the freeze, or surrender, response.The parasympathetic system is the ‘rest and digest’ branch of the ANS, concerned with self- maintenance and conserving bodily resources. When over-activated it leads to a ‘freezing’ reaction that slows the heart and breathing, shutting down the body rather than mobilising it.Babies and toddlers can neither fight nor flee. In the stage of early alarm the infant can only use his limited repertoire of behaviour to attract the attention of the caregiver.

If this strategy is ineffective, so there is no soothing response, the child will abandon the early alarm response which will then be extinguished.Such a defeat response of ‘learned helplessness’ is common in neglected & abused children.In the face of persisting threat the only ‘escape’ may be to dissociate and physically and cognitively freeze. Such mental mechanisms of defence involve disengaging from the external world and only attending to stimuli from the internal world, thus becoming disconnected from reality. Again, a state may become a trait.

STRESS!

Heightenedarousal.

Insensitive caregiver.

Sensitivecaregiver.

Homeostaticrecovery.

Dysregulatedstress response.

Infant learns to tolerate internal

challenges.

Under or overactivity becomes

a hard-wired feature of stress response

system.

States

Traits

Super nanny!

When the stress response becomes software.

ADAPTIVE STYLE AND THE DEVELOPMENT OF SYMPTOMSA

d a

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AROUSAL

DISSOCIATION

Dissociation

Dissociation

and

Hyperarousal

No

Chronic

Symptoms

Hyperarousal

and

Dissociation

Hyperarousal

Can we help?Infant mental health teams are slowly becoming established around the U.K. This is a strength- based approach that focuses on parental empowerment and involvement, aiming to improve sensitivity and responsiveness within the family. Intervention is directed primarily at the relationship between baby and parent.

Perhaps there is a better way!

References and resources.

Text of “Circuits and Circumstances” in Journal of Child Psychotherapy) Vol. 27, No.3, 2001. 237-255.

Good websites:www.childtrauma.orgwww.zerotothree.org

www.brainconnection.comMartin Teicher. Scars that won’t heal: the neurobiology of

child abuse. Scientific American, March 2002. pages 54- 61.

Infant Mental Health Journal. Contributions from the Decade of the Brain to Infant Mental Health.

Vol. 22, No. 1-2, 2001.

Lise Eliot. (2001) Early Intelligence. Penguin.M.Deric Bownds. (1999) The Biology of the Mind.

Fitzgerald Science Press.Sue Gerhardt. (2004) Why Love Matters: How Affection

Shapes a Baby’s Brain. Brunner-Routledge.Allan N. Schore. (2003) Affect Regulation and

Disorders of the Self and Affect Regulation and Repair of the Self. Norton.

Shonkoff & Phillips. (Eds) (2000) From Neurons to Neighborhoods. National Academy Press.

Robin Karr-Morse & Meredith Wiley. (1997) Ghosts From the Nursery. Atlantic Monthly Press.

Cohen, J, A., Perel, J. M., DeBellis, M. D., Friedman, M. J., & Putnam, F. W. (2002) Treating traumatized children: Clinical implications of the psychobiology of posttraumatic stress disorder. Trauma, Violence and Abuse. 3 (2) 91-108.

Louis Cozolino. (2002) The neuroscience of psychotherapy. W. W. Norton & Co.

Lewis, T., Amini. & Lannon, R. (2000) A General Theory of Love. Vintage Books.

Bruce Perry & Maia Szalavitz (2006) The Boy Who Was Raised As A Dog. Basic Books.

Goleman, D. (2007) Social Intelligence. Arrow Books.