Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children

293 Pages·2003·3.869 MB·English

by  Phyllis Stien, Joshua C Kendall

Psychological Trauma
and the Developing Brain
Neurologically Based Interventions
for Troubled Children
This page intentionally left blank
Psychological Trauma
and the Developing Brain
Neurologically Based Interventions
for Troubled Children
Phyllis T. Stien, MSN
Joshua C. Kendall
Routledge
Taylor and Francis Group
270 Madison Avenue
New York, NY 10016

Routledge
Taylor and Francis Group
2 Park Square
Milton Park, Abingdon
Oxon OX14 4RN

Published by
TheHaworthMaltreatmentandTraumaPress®,animprintofTheHaworthPress,Inc.,10Alice
Street,Binghamton,NY13904-1580.
©2004byPhyllisT.StienandJoshuaC.Kendall.Allrightsreserved.Nopartofthisworkmaybe
reproducedorutilizedinanyformorbyanymeans,electronicormechanical,includingphotocopying,
microfilm,andrecording,orbyanyinformationstorageandretrievalsystem,withoutpermissionin
writing from the publisher. Printed in the United States of America.
“ChartingYourBaby’sEmotionalMilestones,”fromFirstFeelingsbyStanleyGreenspanand
NancyT.Greenspan,copyright©1985byStanleyGreenspan,MDandNancyThorndikeGreenspan.
Used by permission of Viking Penguin, a division of Penguin Putnam Inc.
S.Wieland,TechniquesandIssuesinAbuse-FocusedTherapywithChildrenandAdolescents:
AddressingtheInternalTrauma,pp.55-56,copyright©1998bySagePublications,Inc.Reprinted
by Permission of Sage Publications, Inc.
PUBLISHER’S NOTE
Identitiesandcircumstancesofindividualsdiscussedinthisbookhavebeenchangedtoprotect
confidentiality. Any resemblance to actual persons, living or dead, is entirely coincidental.
Cover design by Jennifer M. Gaska.
Library of Congress Cataloging-in-Publication Data
Stien, Phyllis T.
Psychological trauma and the developing brain : neurologically based interventions for
troubled children / Phyllis T. Stien, Joshua C. Kendall.
p. cm.
Includes bibliographical references and index.
ISBN 0-7890-1787-3 (hardcover : alk. paper)—ISBN 0-7890-1788-1 (softcover : alk. paper)
1. Post-traumatic stress disorder in children—Treatment. 2. Brain—Growth. 3. Pediatric
neuropsychology.4.Pediatricneuropsychiatry.I.Kendall,JoshuaC.,1960-II.Title.
RJ506.P55S856 2003
618.92'8521—dc21
2002151041
For Karl, Erik, Pamela, and George
Shoyo and Hanna
And all the children of today and tomorrow
ABOUT THE AUTHORS
Phyllis T. Stien received her BS in nursing from the University of
Wisconsin–Madison, and her MS in psychiatric nursing from the
UniversityofCalifornia–SanFrancisco.Shehasoverthirtyyearsof
experience working as a child and family therapist, infant mental
healthspecialist,educator,andconsultant.Currently,sheisworking
asasupervisingtherapistandasamentalhealthconsultantforHead
Start and Early Childhood Education programs. She presents work-
shopsandtrainingcoursesonthepsychologyandbiologyofchildde-
velopment, behavior problems in children, childhood disorders, and
topics related to childhood maltreatment.
Joshua C. Kendall graduated summa cum laude from Yale, receiv-
ing his BA in comparative literature. He also did doctoral work in
comparative literature at Johns Hopkins. He has been a freelance
health care writer and editor for more than ten years. He has pub-
lished dozens of scholarly articles and book chapters on childhood
trauma,childdevelopment,andliterarycriticism.Hisjournalismhas
appearedinvariousnationalmagazinesandnewspapers.Hewonthe
2001NationalMagazineAwardfromtheNationalMentalHealthAs-
sociationforafeaturestoryinBusinessWeekonpsychiatricdisorders
in the workplace.
CONTENTS
Foreword ix
Frank W. Putnam
Acknowledgments xi
Introduction 1
Overview of the New Neurobiology 7
Organization of This Book 13
Chapter 1. Brain Growth and Organization 17
How the Brain Grows 19
How the Brain Organizes 25
Chapter 2. Birth to Five: Factoring in Biology 39
Interaction, Brain Maturation, and the Stages
of Development 40
Conclusion 67
Appendix:ChartingYourBaby’sEmotionalMilestones 68
Chapter 3. PTSD: Biology Impinging on Behavior 73
Identifying PTSD in Children 75
The Two Types of PTSD 79
ThePsychobiologyofPTSD 81
Conclusion 96
Chapter 4. Complex PTSD in Children:
Brain and Behavior 97
Child Maltreatment: The Scope of the Problem 98
Complex PTSD: A Psychobiological Syndrome 100
Brain Impairments Associated with Complex PTSD 101
The Effects of Maltreatment on a Child’s Psyche 112
Conclusion 132
Chapter 5. Healing the Brain: An Interactive Approach
to Treating PTSD and Complex PTSD in Children 133
Therapeutic Goals: An Overview 134
Demystifying the Therapy Process 139
Stage One: Safety and Stabilization 141
Stage Two: Symptom Reduction and Memory Work 147
Stage Three: Developmental Skills 168
Adjuncts to Therapy: Reconnecting to the Body 175
Conclusion 182
Chapter 6. Complex PTSD Compounded by Attachment
Problems: Billy’s Story 183
Children in the Child Welfare System 184
Introducing Billy 186
Analysis 187
Treatment 192
Conclusion 202
Chapter 7. Early Experience and Psychobiology:
Translating Scientific Advances into Policy
Prescriptions 203
The Two Approaches: White House Conferences I and II 205
The Underlying Sociological Ills 212
What’s Been Working So Far: Interventions to Build On 221
Principles for the Future 223
Conclusion 228
Notes 229
References 233
Index 253
Foreword
Foreword
I am always amazed by the ability of our society to overlook the
consequences of child maltreatment. To be sure, everyone knows
abouttheexistenceofchildabuse.Itisinthenewspapersandontele-
vision almost daily, especially recently with the Catholic Church
scandals. But many of these are only reports of individual cases, a
few sparse details, with little, if any, follow-up. If the child died or
was kidnapped, or if the perpetrator is convicted, then a more in-
depth story with pictures may be published. What is missing from
thesereportsissomeaccountofthedamagedonetothechild,andto
society.Withoutsuchanaccount,wecannotreallyunderstandwhatit
means for that child, or for us.
AsIhavelongargued,childmaltreatmentisthesinglemostcostly
publichealthproblemintheUnitedStatestoday.Itisamajorcontrib-
utor to scourges ranging from alcohol, tobacco, and drug abuse, to
mentalillness,AIDS,andviolentcrime.Ofcourse,childabuseisnot
solelyresponsibleforeverycasewiththeseoutcomes,butitisacriti-
cal risk factor that is preventable.
Why does child maltreatment have such powerful influences on
mentalandphysicalhealth,onone’sbehaviortowardselfandothers?
In the last decade, we have begun to learn just how deeply physical
andsexualabuseandneglectcanaffectthemindsandbrainsofchil-
dren.Thisbookbringstogethermuchofthisnewinformation.Even
more significant, the authors also integrate these scientific findings
with burgeoning knowledge of normal child development. As a re-
sult,webegintoappreciatehowfundamentallydamagingchildabuse
canbe,andhowitcanshapealifeforever.Thebookalsoemphasizes
what we may be able to do to prevent or repair this damage.
Asascientificfield,thesurfacehasbarelybeenscratched. Itwill
probably be decades before we fully understand the mechanisms by
which the many neurobiological systems affected by maltreatment
lead to the negative outcomes associated with child abuse and ne-
glect.Certainly,someofthecontentinthisbookwillberevisedaswe
ix