[CORE Teen logo: the shape of a house sectioned off into triangles of different colors.] [Allison Douglas] The things that have happened to our children are things that shouldn't happen to children at all and really have changed their development and the way that they think about the world. [Kayla VanDyke] That discomfort, that fear that I had just imprinted on my soul. [Samantha Coleman Forton] We've gone through more things than most adults have or can even understand where we're coming from. [Devon Jenkins] The neglect, the abuse. [Xena Wildman-Hanlon] You don't know what it's like to be ripped away from your family or from your siblings. [Devon Jenkins] I felt little trust, I felt little love. [Caelan Soma] Trauma is like no other experience because it's not something we understand or can make sense out of. [Lena Wilson] You are just responding from one moment to the next because it's literally... Your safety depends on it. [Heather Forbes] Trauma never goes away. It is a developmental process, it is a journey of healing. [Bruce D. Perry] One of the great gifts of our species is that we are adaptable. The fact that the brain is so capable of adapting and responding to the world. [Heather Forbes] It's not gonna happen overnight. It doesn't happen through words, it happens through actions, it happens through repetition of positive experiences in a family. (lively music) [Shot of the sun shining through tree branches. CORE Teen logo appears on screen: the shape of a house sectioned off into triangles of different colors. Each section has the title of one of the CORE Teen curriculum chapters: Transitions, Continued Connections, Sexual Orientation, Gender Identity & Expression, Parental Regulation, Trauma-Informed Resource Parenting Part 1 and Part 2, Parental Adaptation, and Relationship Development. Screen zooms in on the "Trauma-Informed Resource Parenting 1" title.] [Narrator] This is Core Teen, right time training for resource parents. In this episode, we focus on the impact of stress and trauma on a child's developing brain. We'll hear from experts on brain development: [Bruce D. Perry] This interesting sequence of development is also the sequence by which the brain processes experience. [Narrator] We'll learn from veteran resource parents about the reality of parenting children who have been hurt: [Paty Carroll] He thought by me putting my hand on him that I was getting ready to let him have it. [Narrator] And we'll listen to the voices of youth: [Kayla VanDyke] I was very lost and confused for a long time. [Narrator] As we explore ways to help young people heal from trauma. [Title Card: Trauma-Informed Resource Parenting 1: Understanding Our Children's Brains] [Caelan Soma: Director, National Institute for Trauma and Loss in Children] So many people that hear the word trauma think that trauma is related to something we see in the news or on a headline or that it has to be violent. And what we know about trauma is that it is occurring every single day in the lives of people that are sitting next to us at school and are standing in the line with us at the bank. It is this chronic exposure to things like separation and loss, poverty, homelessness, abuse, neglect. It goes on and on and on. [Narrator] Trauma can be a single event or a pattern of experiences. [Bruce D. Perry: Senior Fellow, ChildTrauma Academy; Adjunct Professor of Psychiatry and Behavioral Sciences, Northwestern University] One of the most useful ways to think about trauma is the three E formulation and the three E's are the traumatic Event like a fire or watching domestic violence or being physically assaulted, for example. The second E is the Experience that the person has when they're in the midst of that event and the third E is the Effects, what are the long-term effects of having been in that event and having had that experience of fear or terror while you're in that event. And if you look at the histories of the kids you work with, one of the things that's really helpful is to think about what are the potential events in their life that may have caused an experience of fear, intense fear that now has some long-term effects in the way they think, feel and behave. [Allison Douglas] I think that's really how I think about trauma, is something that changes how your child feels in the world. Our kids often feel unsafe in a situation that makes me feel fun, like a birthday party. That sounds fun, but our kids find that really scary because they don't know what will happen there or who might be there. And so trauma really changes how kids behave and interact with the world around them. [Card: Trauma and the Stress Response] [Narrator] To understand the long-term impact of trauma, it's helpful to understand the basics of the stress response and the difference between short term or acute stress and chronic stress. [Card: Acute Stress versus Chronic Stress] [Dashboard camera footage of a car driving down a road. Trees line the sides of the road, with concrete barriers separating the opposite lanes.] [Caelan Soma] Probably the most common experience that everybody has had related to acute stress is the experience of almost getting into a car accident. [Tense music; the car comes up fast behind the vehicle in front of it and stops suddenly.] [Caelan Soma] Almost rear-ending the car in front of you, right? So when that happens, our body responds. I get sweaty, I get shaky, my heart starts racing. Then as we drive, we hope that we get to a place of safety. So that acute stress response that has come up so high can then come back down. That is a normal response. So our central nervous system is really made to respond to stress in the short term. [Card: Children from traumatic backgrounds can be in a constant state of stress] [Narrator] But many of the children in care have lived with long-term chronic stress. [Caelan Soma] Post-traumatic stress is the same exact thing as acute stress. The difference is that there's no safety at the end of the road. So you are in a prolonged and exaggerated state of stress. And what happens after your body is in that acute stress phase for a prolonged and exaggerated time is it creates a lot of changes in your brain and thus impacts a lot of things in your body. It impacts the way you think about things, it impacts the way you see yourself, the way you see others, the way you behave, the way you are able to or not able to manage your emotions. [Bruce D. Perry] Most of us are, at baseline, pretty well-regulated. And when we have a moderate challenge, we have a moderate internal response, but the kids that we work with frequently have what we call a sensitized stress response and what that means is they're overly reactive. So if they have a minor challenge, they'll have an overreaction. [Julie Yelverton: Adoptive Parent] It takes just a tiny trigger, especially when they're stressed about other things or feeling insecure in the family. It goes straight to, you know, like, you miss a math problem and nobody's mad at you, it's not a big deal, but they miss a math problem, their brain goes straight to, "I'm stupid, I'm bad. Nobody loves me, I shouldn't be part of this family. I wish I were dead." You know, like in seconds. [Debbie Schugg: Adoptive Parent] My kids used to have really big tantrums, like four or five, six hours long, pulling on their hair, trying to knock their teeth out, banging their heads, that kind of stuff. [Melissa Peterson: Adoptive Parent] In one visit, she knocked over a glass of juice and had a huge meltdown. I mean, it was wow, huge. [Narrator] The origins of an overly sensitized stress response can be traced to the brain and the things that happened during brain development. [Sketch of a brain. Over the top of it, an upside-down pyramid shape in four sections. From top to bottom: Cortex, Limbic, Diencephalon, Brainstem.] [Bruce D. Perry, off-screen] If you look at this simple model of the brain, part of what we're trying to illustrate with this image is that the brain is organized in a hierarchical fashion from the lowest and simplest parts all the way up to the highest and most complex parts of the brain. [Narrator] Beginning in utero, the brain develops from the bottom up. [The drawing of the brain fades, leaving the pyramid. The top section, "Cortex," is highlighted.] [Bruce D. Perry] In this top part of the brain, everybody's probably heard of the term cortex. And that part of the brain is involved in planning and speech and language and knowing right from wrong. And then when you go way down to the bottom part of the brain, this is the part of the brain that's involved in regulating heart rate, blood pressure, respiration, very simple functions. And as you go into the middle parts of the brain, you start to get more regulatory functions. [Highlight on the pyramid moves to middle two sections: Limbic and Diencephalon.] [Caelan Soma] How I like to explain it is that it's responsible for three main functions. It's responsible for sensation, it's responsible for memory, and it's responsible for affect regulation. Let's go to affect regulation for a second. So think about what makes an infant kind of stressed or dysregulated. Typically it's something related to a sensation that's not being attended to. So if you think about this infant who is hungry, that's a bit of having no control over a situation so much like when we almost rear-end the car in front of us. [Tense music; we return to the shot of the car nearly hitting the vehicle in front of it.] [Caelan Soma] When there's a disruption in sensation for an infant, that creates changes in their ability to regulate themselves. So what do they do? [Shot of a baby crying. The crying sound plays quietly behind Soma as she continues.] [Caelan Soma] They cry, they squirm, their muscles tense. They breathe heavy. How many times during the course of a week do we hope that a parent or a caregiver responds to the disrupted sensation of an infant? We hope that it's constant. So there's a disruption in sensation. It clicks on the brainstem to be activated, on alert. "Something's wrong, I need to protect myself." "My regulation is not working well," but if somebody helps, that creates a memory. [A mother embraces a sleeping baby, gently kissing their forehead.] [Caelan Soma] But what has to happen is that this has to happen over and over and over again. So a disruption, a dysregulation, and then somebody comes and kind of puts my sensations back to where they feel good. So how do we respond to an infant? Do we hold an infant and say "Hey dude, get it together," right? No, we respond to their sensation. We respond to food, dry diapers, holding, cuddling, rocking those sensations of touch. All of those things that we say are targeting sensations are really helping to calm down the brainstem. As this happens over and over and over again, sometimes seemingly thousands of times in the course of a week, we're creating memories. We're creating a deep neuronal pathway. [Card: Predictable, consistent positive experiences lead to self-regulation] [Narrator] Over time, the child learns to deal with stress. [Bruce D. Perry] So if you have healthy relational experiences, lots of learning opportunities, you are in an environment where you're loved and you get attention and you have opportunities to explore the world in a healthy way, those systems develop pretty normally and they help the brain and body work in this smooth and integrated way. But we know that there are three things that will predictably alter the development of those systems and cause problems in every part of the brain that they connect with and in the body. And those three things are: some form of Intrauterine Insult like prenatal alcohol, prenatal meth, prenatal distress for the mother. The second thing is Disruptions in Bonding and Attachment in the first years of life. And the third thing is Traumatic Experiences. And so when you think about the child that you live with, many of those children have had all three of those things. They've had some form of intrauterine insult. They've had bonding disruptions when they were young and then they've been exposed to all kinds of events that are potentially traumatic. And so it's no surprise then that they have a cascade of problems from the top part of their brain all the way down to the bottom part of their brain. [Narrator] As we've seen, the brain develops from the bottom to the top. This sequence of development is the same process by which the brain processes experience. [Animation of the upside-down pyramid with the parts of the brain. Each section fades into view, starting at the bottom with Brainstem, then going up to Diencephalon, then Limbic, then Cortex at the top.] [Bruce D. Perry] The fact that the brain processes experience sequentially means that the first part of the brain that gets "dibs" on processing information is the lowest and dumbest part of your brain. [Lisa Morrison: Clinical Therapist, The Village Network] We call it our lizard brain, it's part of the brain that you have in common with the lizards. It's the thing that keeps you alive, but it sometimes runs you into walls. [Bruce D. Perry] So lizards are not very future-oriented. They don't think about the consequences of their behavior. They literally think about the moment. And so the more threatened you are, the more you're using these more primitive parts of your brain for problem solving and for behaving and so forth. [Lena Wilson: Vice President, Child and Family Samaritas] You are just responding from one moment to the next because it's literally... Your safety depends on it. [Heather Forbes: Author and Developmental Trauma Therapist, the Beyond Consequences Institute] Because our teens' brains are wired for fear, they're always going to be down in the part of the brain that's called the midbrain. This is the part of the brain where life happens in the next 15 seconds. There is no next week. [Elizabeth Richmond: Chair, Illinois Adoption Advisory Council; Adoptive Parent] When kids have had trauma, it affects them all the way down to their core. And so I've had kids sit in my office and talk about feeling like their brain is spinning inside their head, [CLoseup of a colorful top spinning wildly] [Elizabeth Richmond] Which was basically, "I can't hold my brain inside my head and I feel this way a lot. And so no, I'm not listening to you talk about math and at home, I didn't hear you telling me to do my chores." And so when you can think about how that would feel, it really makes you think about how you need to step back and figure out how to make the head stop spinning before the child can really engage in the rest of the world. [Bruce D. Perry] The simplest way to think about this is that in order for you to connect with your child and communicate something to the top part of the brain, first of all, the lower part of the brain has to be regulated. And if it's regulated enough, then you can connect, you can relate and that's sort of the middle part of the brain. And if you've been able to be regulated and connect, then you can reason with your child. [The pyramid with the parts of the brain returns. Beside the bottom "Brainstem" section, the word "Regulate" appears. Beside the middle "Diencephalon" and "Limbic" sections, the word "Relate" appears, and beside the top "Cortex" section, the word "Reason" appears.] [Bruce D. Perry] Your child will hear you, will hear what you're saying. In reality, this sequence of engagement is about communication. It's about, how am I going to effectively get what's in my cortex? How does it get from this top part of my brain through the middle part of my brain out my mouth into their lower part of their brain through the middle part of their brain to the top part of their brain? That process has lots of little landmines that can blow it up, as you well know if you have parented a child who's experienced developmental trauma. [Silhouettes of a parent and child appear, with drawings of the brain visible in their heads. Dots of varying colors that correlate to different parts of the brain light up as the parent and child interact with each other.] [Narrator] Over time, caregivers can begin to predict what may trigger these landmines. [Card: Learning to Recognize a Child's Triggers] [Caelan Soma] A trigger is anything that causes that child to be like thinking that something isn't quite right. "I smell something I don't like. I see something I don't like. I hear something I don't like." [Mina Pinckney: Resource Parent] It could be ketchup, it could be a sound. It could be a smell that could throw them off and you don't know why they acting that way. There's something in their past that was traumatic and they heard it or thought and they're gone. They're off the hook. [Caelan Soma] When they hear a siren, when they smell smoke, when they smell the smell of alcohol on somebody's breath, when they see a certain tattoo on a certain part of a body, all of those things can be triggers. [Heather Forbes] Maybe even coming to dinner is a trigger because maybe in their family of origin, the dinners were completely chaotic. Maybe that's when dad came in or mom came in and that's when the violence began was a dinner. [Tiffany Krzoski: Resource Parent] We were at McDonald's in the play area, and an ambulance went by and he kind of had a panic attack and it took me a while to realize why he was kind of shut down and I had to stop and I had to think of okay, what has just happened in the last couple minutes that made him this way. I was like we were sitting here and that boy yelled, that one hit that one, an ambulance went by. I was like "Oh," I was like, "Okay buddy." I was like, "Are you sad because you're thinking about what happened with your mom?" [Paty Carroll: Resource Parent] One time the little boy I had, he had been physically beaten. I went to put my hands on him and he drug me all over my kitchen. [Laughs] It was horrible. Yeah, he did cause he thought by me putting my hand on him that I was getting ready to let him have it. And I guess he decided "I'm gonna let her have it before she lets me," and I had to keep telling him over and over again, "I'm not trying to hurt you, I'm not trying to hurt you. Just trying to talk to you." [Narrator] In situations of real or perceived danger, the cortex shuts down and the primitive brain takes over. [In the visualization of the brain pyramid, all the other sections disappear and the bottom "Brainstem" section is left alone. It grows and flashes erratically.] [Bruce D. Perry] It's interpreting the present based upon a whole set of memories and associations that were created in that child's past. And if the past was characterized by unpredictability, by threat, by chaos, what's going to happen is if the present has any sensory cue or any quality that's reminiscent of that past, the child is gonna act in the present as if they're being hurt in the past. [Caelan Soma] So it could be completely unrelated to the here and now, but the trigger is connected to a memory. [Bruce D. Perry] And their brain will act as if they're under threat and shut down their cortex and they won't think about the consequences of their behavior, they'll just behave and the behavior will be primitive and aggressive. And so they'll hit the kid who bumped into them in the hallway and then the teacher will go, "What were you thinking?" And the reality is he wasn't thinking, he was reacting. [Caelan Soma] "I don't know. I don't know why I just punched her in the face. I don't know why I just flipped over that desk. I just, she looked at me and I thought this or he tapped my shoulder and all this..." [snaps fingers] "It was just like this." And it's cause our body is responding, not our thinking brain. [J. Stuart Ablon: Director, Think:Kids, Massachussetts General Hospital; Associate Professor, Harvard Medical School] And realizing that some of that behavior, particularly behavior that's very disrespectful, defiant, scary, aggressive, unsafe, realizing that that behavior flows from the impact of trauma is crucial. [Megan Newkirk: Resource Parent] A lot of times, your teenagers are not teenagers. A lot of times you'll get those 13, 14, 15-year-olds that have that behavior of a seven or eight year old. [Caelan Soma] In trauma, we throw away the chronological age completely. You want to look at every child from where they are developmentally. [Heather Forbes] It's hard with our teenagers because we're like "Well, they're too old for that." No they're not. Developmentally, emotionally and socially, they're much further behind. [Bruce D. Perry] The adult world kind of puts high value on reasoning, on cortical stuff. And so when we see a child who's not paying attention, we say things like, "Pay attention." Or we see people that are getting all stirred up and we say things like, "Calm down." That's not effective. And so words have limitations. [Lisa Morrison] You can't scream at them to calm down because it could be like, "No." [Bruce D. Perry] So you can't just tell somebody to calm down and expect them to calm down, it doesn't work. [Sabra Starnes: Adoptive Parent] Really, a child's not able to connect with you at that time or it needs to be more non-verbal connection at that time. When a child is dysregulated, they need to feel you. They need to see you. [Bruce D. Perry] You have to think of some other kind of relational communication to help somebody calm down. Some other regulatory activity that you can recruit to help the regulatory part of them calm down, like, "Let's go for a walk." [Lisa Morrison] So let's go for a walk together. And what that does is the child gets regulated, you get regulated, you get to be a human being who demonstrates to them what it looks like to say, "I'm not okay right now. This is what I need to do." And it makes not being okay okay. It also provides... It's like the whole thing can be a lesson. [Bruce D. Perry] This is where you have to learn how to be present, but you need to be present and instead of being face-to-face, be parallel. [Lisa Morrison] It's almost similar to like the parallel play, but it's parallel doing something. It's noninvasive, you're not even really looking at the kid cause some of these kids are not particularly fond of face to face or eye contact, but it's the close proximity, kind of like feeling out another person. [Promise Adams-Brown: Foster Care Alumna] Just, you know, chill with them for a minute, do what they do. Just spend time with just walking in on their life for a minute and just chill with them. Don't sit there like you're gonna do a interview with them, but just sit there and chill with them and see what they're interested in and see what they're talking about or what's happening in the street. [Lisa Morrison] So even like, breaking eye contact to color and then just chatting about what's on TV, that can be much less confrontational and frightening than, like, "So tell me everything that you've ever experienced," cause they're not gonna do that. [Promise Adams-Brown] Basically just, you know, step in their lives and just take a peek. [Lisa Morrison] We always say where I work that if the kid can't find peace, you have to be it. You have to bring that peace. If they can't find calm, you have to be it. [Bruce D. Perry] If you're in parallel, you're regulated, what's gonna happen is they're gonna get regulating stuff, they're gonna be relationally with you and they're going to quiet down. Regulate, relate, and then reason. (calming music) [Title Card: Trauma-Informed Parenting 1: Understanding Our Children's Brains] [CORE Teen Logo]