I have just returned from the 21st Annual International Trauma Conference in Boston. This conference is directed by Bessel van der Kolk and the staff of the Trauma Center at the Justice Resource Institute (http://www.jri.org/). As usual this conference offered a unique combination of science and practice. In this article I will attempt to extract a few central ideas that I think can immediately add value to our every day work.
The conference focused a great deal on the contributions of neurofeedback, both in understanding the brain and it treatment. In addition, information continues to grow about the parts of the brain, their purposes, and the ways in which a developmental path which includes neglect, trauma and attachment disruption can derail their functioning.
The most emergent theme for me in this conference was the idea of rhythm. All human functioning depends on the establishment of rhythm, and perhaps our basic rhythms start with the mother’s and baby’s heartbeat. When infants are born, they can almost immediately respond to music. Presenters such as Ed Tronick, PhD (Infants’ Reactivity and Coping With Stress: Here Today, Gone Tomorrow?) demonstrated the exquisite musicality of the mother/baby attuned interactions, and how the tune is often led by the baby. Our interactions with babies emphasize rhythm (such as baby songs) and any parent can confirm how important routines and predictability are to the regulation of the infant’s emotions. All this rhythmic interaction has many functions for the growth and development of the baby. One result is becoming socialized to the rhythms of human interaction and social communication.
It is clear that the children we work with did not have either the attuned communication or stable rhythms in their daily lives.
This suggests an area of intervention that we do not utilize enough. Rhythmic interaction between people offers opportunity for attunement without words. This can be done in many ways: bouncing a ball back and forth, dancing, singing together, drumming, listening to music and clapping the beat, swinging, etc. These activities could easily be incorporated more into our daily lives, school and recreational activities.
I attended a workshop on SMART: Sensorimotor Arousal Regulation Treatment for Traumatized Children presented by Anne Westcott, LICSW, Elizabeth Warner, PsyD, Jane Koomar, PhD, OTR/L, FAOTA, and Alex Cook, PhD. This treatment integrates knowledge from child development, occupational therapy sensory regulation, and sensory motor psychotherapy. At their clinic they have outfitted a treatment room with various OT equipment such as cushions, large balls, wedges, etc. They utilize bodily work and rhythmic interactions between the child, the therapist and the care giver to produce regulation and a window of opportunity for connection. With this support the child can often talk about difficult topics in a way they otherwise cannot. They will soon be releasing a manual for this treatment.
Through careful research using fMRIs and Neurofeedback, more evidence has been gathered about the biological result of trauma. One important finding is that the area of the brain that is responsible for self reflection is significantly impaired. Children who have grown up in disruptive situations have less ability to think about themselves. They also have considerably less ability to recognize and interpret their own internal sensations. They cannot identify the sensation, associate it with a specific need, or figure out what to do about it. This includes the sensations of hunger, thirst, satiety, needs to eliminate, pain, and tiredness.
Think how significant this is to understanding the daily struggles we experience. Not being able to observe ones self- that has implications for the ever popular concept of taking responsibility for one’s actions. Not being able to notice and interpret bodily signals- that can be part of the explanation for the constant hygiene and toileting problems these children experience.
Inability to recognize and identify bodily sensations can also lead to serious social problems.
In examining brain waves of traumatized children, researchers discover that some parts of the child’s brain are over active and some are under active- often at the same time. Children especially have difficulty moving between states, such as between sleep and wakeful attention, or excitement and calm.
Researchers have also learned that the sleep problems experienced by children with trauma may be more significant than previously thought. We have all noticed that large numbers of our kids cannot get to sleep, or wake up, or have nightmares. However, it is now known that even when these kids appear to be sleeping they spend much less time in deep sleep than other children- and deep sleep is what is restorative and nourishing.
Understanding the biology behind the behavior we see can be helpful in not taking it personally, having patience, and deliberately designing interventions to target certain kinds of brain changes.
The presenters gave many examples of how neurofeedback had helped children, including for ADHD and even for schizophrenia. Neurofeedback also improved the musical performances of both skilled musicians and novice nine year olds, as reported by John Gruzelier, MD in Neurofeedback and its Benefits for Psychological Integration and Creativity.
Margaret E. Blaustein, PhD earned a standing ovation with her presentation Lessons from Kids and Families on the Treatment of Developmental Trauma. She brought the voices of the children and families into the conference, relating her ten lessons. They included both seeing the oak tree in every acorn (the strengths in the kids and families) and sometimes admitting that life sucks. Her strongest message was that traumatized kids are complex and deserve a thoughtful, complex intervention from us.
And as Ed Tronick, PhD said in his presentation Infants’ Reactivity and Coping With Stress: Here Today, Gone Tomorrow: The best tool is a "polymorphic stress resolver: an adult who unconditionally cares in all ways and at all levels."
That would be us.
I cannot write about this conference without mentioning the campaign led by Bessel van der Kolk to establish a new diagnosis to be included in the DSM V: Developmental Trauma Disorder. With a diagnosis that more completely and accurately captures the reality of children and adults that grow up with neglect, trauma and attachment disruptions, we can have research, medication, and treatments that really make a difference. To learn more about this diagnosis and the criteria for it, visit http://www.traumacenter.org/announcements/DTD_papers_Oct_09.pdf. To contribute badly needed funds to its establishment, see http://www.traumacenter.org/products/DTD_Field_Trial.php.
Every presenter was passionate about the importance of this change in our system.
I am sure I have only scratched the surface of the ideas presented at the conference. If you were there, or have any opinions on these subject, please click on "comment" and add your thoughts.
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