Are Effects on Brain Development Due to Psychological Trauma in Childhood Permanent?

 

Romanian children who had been stuck in orphanages in which they had almost no direct interactions with their caretakers had been studied extensively by a group of researchers, as described in the book Romania’s Abandoned Children: Deprivation, Brain Development, and the Struggle for Recovery  by Charles A. Nelson, Charles H. Zeanah, and Nathan Fox.

Generally, the longer these children were in the orphanages, and the earlier they got there, the more damage to their cognitive abilities, social skills, and stress tolerance there was later in childhood after they were adopted by foster families. Some of them even showed reduced circumferences of their skulls. Hard to imagine that was not permanent damage. Most affected children did seem to show some recovery in their development after adoption, but did not seem to get back completely to normal. 

They were not followed much past adolescence in the original study. However,  according to a follow-up study described by the BBC, many of these young children adopted by UK families in the early 90s are still experiencing mental health problems even in adulthood (https://www.bbc.com/news/health-39055704).

Despite being brought up by caring new families, this newer long-term study of 165 Romanian orphans found emotional and social problems were commonplace. Initially, all 165 had struggled with developmental delays and malnourishment. While many who spent less than six months in an institution showed remarkable signs of recovery by the age of five or six, children who had spent longer periods in orphanages had far higher rates of social, emotional and cognitive problems during their lives. 

Common issues included difficulty engaging with other people, forming relationships, and problems with concentration and attention levels which continued into adulthood. This group was also three to four times more likely to experience emotional problems as adults, with more than 40% having had contact with mental health services. Despite their low IQs returning to normal levels over time, they had higher rates of unemployment than other adopted children from the UK and Romania.

Interestingly, one in five of them seemed to have been unaffected by the neglect they experienced. A small percentage, to be sure, but if the types of experiences these children had cause permanent brain damage, how is this even possible?

In current literature about the effects on the brain of trauma, the common opinion expressed by experts is that they are irreversible. Brain changes that are seen in various neurological evaluative procedures - such as different brain scans - do not seem to go away.

I, on the other hand, have theorized that the effects of trauma on the brain may be reinforced by continued interactions with primary attachment figures, whether they be natural or adoptive parents. If this is going on, the brain changes would not go away. Neural plastic changes leading to this would not happen.

But, people may say, many of these traumatized Romanian orphans were adopted into loving families! If what I believe may be true actually is true, why do scars remain in 80% of these orphans?

Answering this question definitively is extremely difficult to do. Surely, due to variations in the genetics of the orphans, some may have been more vulnerable to permanent brain damage than others. I mean, smaller skulls? But again, on average, and not in all of them. Also, the experiences of the orphans in the orphanage probably varied significantly, with a few of them possibly exposed to more helpful caretakers than the others.

What is rarely discussed is how difficult it is to raise children who have been traumatized in the way the orphans had been. They were difficult children with huge behavior problems, and how to provide proper boundaries in a loving manner is something that many parents of very normal children have difficulty doing. No matter how well intentioned the parents may be. Some of these parents might get help from knowledgeable family therapists, but most do not. So in some ways, the children may be continuously further traumatized by angry and frustrated parents who don’t have a clue as to how to best interact with them.

In the original study, there was some preliminary evidence that interventions by therapists with the adoptive parents were helpful, but such interventions did not usually take place. Even when they did, the quality of therapy the parents receive could vary widely.

So addressing the family dynamics of these adoptive families of adult survivors of the Romanian orphanage, so that these behavioral and cognitive deficits are no longer being triggered and reinforced, might possibly lead in many cases to a reversal of both the psychological deficits as well as the brain changes caused by the original trauma.

I like to think so.

Family Dynamics and the Brain: Implications for Psychotherapy

IMO, the most important contribution of neurobiology to psychotherapy is our understanding, albeit quite partial and preliminary, of the mechanisms by which we are programmed to respond to attachment figures. This understanding is sort of what is meant by sociobiology, if I may use a politically incorrect term. 

I found early on in treating personality disorders in therapy that I was no match for a patient’s parents in triggering or reinforcing their problematic (or even their positive) behavior patterns in the long term. I could coach them on how to be assertive with difficult family members ‘til the cows came home, and this might even work for a time, but after a while the old patterns of self-defeating behavior almost invariably re-emerged unless something was done about this.

Even so-called “oppositional” behavior follows this path: oppositional children think and later automatically respond to their family as if the family wants or needs them to be a black sheep for various reasons.

Therapy outcome studies seldom follow patients with self-destructive or self-defeating behavior patterns for more than a year after therapy ends, but the few studies I’ve seen that do are consistent with this clinical experience. So I had to figure out a way to help patients to make changes in their long term repetitive dysfunctional interactions with attachment figures.

When mothers and their babies interact, huge numbers of synaptic connections in the brain are made every second (see https://developingchild.harvard.edu/science/key-concepts/serve-and-return/). These large numbers are “pruned” significantly during adolescence. We don’t know exactly how or why certain synapses are retained, but I suspect it is those that keep us aligned with the social behavior of our kin group and tribe. There is preliminary evidence that the pruning is dependent, much like the strength of many brain neural connections, on how often a particular neural pathway is stimulated.

Another factor involved is something called the myelination of neurons in existing neural pathways. This is the process of coating the body of each neuron with a fatty coating called myelin, which protects the neuron and helps it conduct signals more efficiently. This process does not become complete until an individual reaches late adolescence.

With these two processes, we lose some flexibility in the brain, but the proficiency of signal transmission improves. Since we are talking in particular about those that form during interactions in infancy, it is reasonable to suspect that these interactions continue to do this. In particular, behaviors that occur in response to social cues may become more automatic in order to preserve higher thinking ability for novel situations.

In addition to this, fear tracks formed early in life in particular are not as plastic as are other tracks in the brain. They never really go away, although they can be overridden by newly formed neural pathways. (Lott, D. A. [2003]. Unlearning fear: calcium channel blockers and the process of extinction. Psychiatric Times, May, 9-12).

According to Neuroscientist David Eagleman on his PBS show, The Brain, about 80% of our behavior is done automatically in response to environmental cues (especially social cues, I might add) without any conscious deliberation. In a sense they are subconscious.

This does not mean that we lack the capacity to decide to think about and break the social rules we are usually bound by. We certainly can – this is where the family systems theorists have been wrong. But when we do, we are often faced with massive invalidation by our families, which is extremely powerful in delivering the message, “You’re wrong, change back.” When we distance ourselves from our social alliances, our level of the attachment hormone oxytocin dips and we start to feel unsafe.

The negative feelings generated by this invalidation is probably the biological price we pay if we don’t: the highly disturbing feeling of groundlessness described so eloquently by Irvin Yalom. This is nature’s way of telling us to behave ourselves for the good of our kin group. This has survival value for the group.

The implications for therapy are clear. In order to prevent problematic automatic behavior patterns that have been and that are continually reinforced through this powerful process, neither insight into which behaviors are performed automatically, nor which automatic belief systems keep us on the straight and narrow for our kin group, is usually enough. These patterns need to be interrupted at their source in order to help patients extinguish bad habits of thinking (or, more often, not thinking) and behavior.