Understand It to Change It
Yesterday I had the privilege of attending the Love Wins Mental Health Conference, organized by The Ana Grace Project and hosted by Western Connecticut State University. The keynote speaker was Dr. Bruce Perry, and after his incredible presentation, we had the opportunity to attend 2 breakout sessions (from a choice of 6). If you don't know who Dr. Perry is, he is basically a rock star in the world of child trauma. I cannot recommend his books enough (though I have only so far read The Boy Who Was Raised As A Dog - which I believe should be required reading for all therapists, social workers, teachers, coaches, anyone with contact with children). The two breakout sessions I attended were Traumatic Bereavement in Adults (taught by Dr. Laurie Pearlman) and Collaborative Problem Solving - Working With Challenging Youth (taught by Dr. Stuart Ablon).
The audience was a mix of educators, brain health professionals, parents, faith leaders, community volunteers. It was incredible. My head is still reeling from the all of the information, and the excitement of knowing that we are part of something extremely important in terms of changing the way society as a whole approaches what is essentially human suffering. I wish all of you could have been there yesterday. Many points were made that I found validating, about what I know either through my obsessive research, or through what I have personally experienced with my friends and clients, and the kids I have worked with over the last 5 summers at the ACHIEVE/Race4Chase Youth Triathlon Camp in Waterbury, CT. Many points were made that I hadn't considered before, and I wish more people knew. I will try to summarize some key points here, which I hope you will find helpful. The unfortunate reality is that we are all surrounded by people, children and adults, who have experienced trauma, so the more we know, the more effective we can be at lessening their pain and preventing further violence. (Please note that I am only summarizing the keynote lecture and one of the breakout sessions; my next blogpost will be about the second breakout, by Dr. Pearlman, on traumatic bereavement. Also, please note that I am not an expert note-taker and I am definitely not doing justice to experts' teachings).
Dr. Bruce Perry's Keynote Presentation
1. When we create memories, what is happening is information is coming in through our senses and our brain is interpreting this information. The memory is stored in all parts of the brain (until recently it was thought it was the hippocampus that did this job) - and events that provoke a strong emotion tend to create a more vivid memory. And here's the thing - memories are also stored in every biological tissue in your body.
2. Your brain is sort of a hierarchy, with the brainstem at the bottom of the totem pole and the cortex at the top.
3. When something happens, your body kicks into its automatic stress response, basically shutting down the biological processes you don't need and superpowering those you do need, to protect you in the situation. This will affect your breathing, your heart rate, digestion, ability to sleep, appetite, metabolism, etc. Stress is not bad, since its purpose is to protect us, but the challenge is when it becomes our new normal.
4. The lowest parts of the brain can't tell time, but they can still form associations. So, if you know a child who for some reason is disruptive in, say, Mr. Russo's class, and Mr. Russo is a perfectly nice teacher but he has an earring and a buzz cut - it may be that the child witnessed his mother being beaten by her boyfriend, when the child was 5 years old, and the boyfriend had an earring and a buzz cut. The child may associate this look with violence, even if he's unable to articulate it or cognitively make the connection. The lower part of his/her brain doesn't realize that Mr. Russo is in the present, which is safe; instead, the body's stress kicks in because on some level the child is now back to the terrifying experience that happened 3 years ago.
5. Two types of reactions to stress are Dissociative and Arousal. Dissociative means, inescapable helplessness. It is characterized by basically checking out, being meek, being "compliant." Arousal means, action, having an active role. It can show up as springing into action, being combative, being loud. The younger you are, the more likely you are to dissociate during a traumatic event or series of events (eg abuse). Females are more likely to dissociate, as are those undergoing torture or pain. Those who observe or witness violence are more prone to arousal.
6. The kids we send to the brain health professionals are typically the ones who piss us off; the ones who fall into the arousal category. We tend to ignore the ones in the dissociative category because they are “compliant" - so we are happy they are peaceful and don't realize they are deeply hurting.
7. Sexual abuse typically leads to the dissociative response.
8. Kids who love to read and play video games, very popular dissociative activities, may be victims of trauma. They often have good grades EXCEPT IN MATH. Math builds sequentially, so you can’t dissociate (tune out) without missing key foundations.
9. Resilience comes from stress, but it’s the controllability and dose of the stress that will determine the level of resilience, the amount of sensitization and tolerance.
10. We now know that the brain is constantly changing and we can to some extent guide the change, which is a relatively new belief (with plenty of science to back it up), and it’s called neuroplasticity. It is easier to change a dynamic system if it is moving faster, which is why it’s easier to change a child than an adult.
11. You create change with Specificity. If you want to create a new response, habit, skill, you need to activate the specific neural network associated with that new change, and you need to do this with the right frequency (pattern). If, for example, you want to learn to swim, you need to do it, not just watch someone else do it. In behavior, this also applies. We can model the correct behavior for a child, but they won't make it a conditioned response until they do it themselves, and practice it often.
12. We can change a child’s behavior, by engaging in therapeutic, meaningful interactions even if it’s in 2 second spurts on a frequent basis.
13. The way to build resilience is to activate the stress response in predictable, moderate and controlled ways.
14. While therapy certainly has its place, the most important factor is relational milieu. A meaningful interaction lasting 2 minutes can be more therapeutic than a 45 minute appointment, especially for reluctant children.
15. ACE (adverse childhood experience) scores are important predictors of health conditions such as heart disease, diabetes 2, depression, etc – but relational scores (i.e. the extent and depth of your social support network) are actually more important when it comes to resilience. Relational poverty is more toxic than high ACE scores.
16. Our culture is becoming so compartmentalized and screen-based that most kids are experiencing a fraction of needed opportunities to get healing or protective benefits because they’re living in communities that are relationally impoverished.
17. The typical American kid spends 11 hours/day on a device.
18. A trauma victim needs to learn to self-regulate; having a meaningful interaction with another person is a significant way to promote physiological regulation.
19. Our schools and parenting typically go about it all wrong. If Billy can’t read, we get him a tutor. Instead, we should get him a running coach, because first he needs to become physiologically regulated so that his cognitive (thinking) brain can go to work on learning to read.
20. The achievement gap isn’t about the color of your skin – it’s about your regulatory health.
21. The cortex isn’t fully developed until age 31.
22. A developmentally traumatized kid can’t engage in therapy until s/he is physiologically regulated. In other words, if the child is dissociated (tuned out) or in an aroused state (combative), they are completely incapable of thinking and learning.
23. To regulate kids, you need to replicate the experience of being in-utero, the main part being to simulate the rhythm of the mother’s heartbeat. This can be done with an activity that involves a pattern of repetitive rhythmic activity, which regulates people and provides access to the cortex. Music, dancing, physical activity/sports. (Unfortunately, the traditional brain health model is to sit the child down and order him to be quiet or to talk – which only makes things worse).
24. Self-care is KEY to anyone who is a caregiver or a helper to survivors. Exercise, sleep, spend lots of time with loved ones, eat well.
Dr. Albon: Collaborative Problem-Solving (CPS)
25. CPS Philosophy: Kids do well if they can. (Unfortunately, the way we parent and teach kids is that they do well if they want to).
26. Conventional wisdom is that kids are challenging because of poor parenting. We assume that kids are “good” because they want to be.
27. “Discipline” means “teach” but we take it to mean “punish.”
28. Consequences (rewards, punishments, ignoring) teach basic lessons and provide outward motivation. But they do not teach complex thinking skills, build relationships, or help kids stay regulated.
29. “If you give a dog a name, eventually he will answer to it.” (Dr. Ablon’s grandfather used to say this a lot). Most kids who challenge us go through life being told and treated as if they’re no good, and that’s what they become.
30. Traditional school discipline measures don’t work because 90% of the kids don’t need it and the 10% that do get hit by them aren’t helped, they just get worse.
31. These kids can’t do better because they lack the cognitive skills: flexibility/adaptability, frustration tolerance, problem-solving. They effectively have a learning disability (not a “discipline problem.”)
32. The key to CPS (Collaborative Problem Solving) is to maintain authority and compliance via collaboration rather than power and control. When we react by imposing threats and punishments, we are becoming part of the problem because we are merely furthering their stress response - chances are, their trauma was at the hands of someone that held power and control over them, so our "solution" is actually perpetuating the problem.
33. Kids need to be assessed the way they are with any potential learning disability, based on 5 areas:
· Language and communication
· Attention and working memory
· Emotion and self-regulation
· Flexible thinking
· Social thinking
34. After the assessment, CPS involves 3 steps:
· Empathize – clarify the child’s concern
· Share the adult concern
· Collaborate – brainstorm, assess and choose a solution
35. Teach the new skills through real problem solving. You have to activate the neural network you are trying to change. Trying to teach skills by e.g. simulating a scenario in a computer game will not change the behavior. Real life problem solving is the only way to do it, and it needs to happen frequently.
36. If the child’s behavioral issues occur in a certain setting, such as the classroom, then the teacher needs to at that instant use the opportunity to teach the child the skills s/he needs – rather than sending the child to the school counselor. The teaching needs to happen every time the incidents arise. The resulting behavioral improvements will make the 2-10 minute “interruptions” to do this teaching worth it because it will greatly reduce the amount of teaching time that is lost because of “classroom management issues.”
37. In schools we already have differentiated instruction for learning disabilities. Why don’t we do it for behavior?
If any of this speaks to you, I hope you will click on the hyperlinks I provided in the beginning of this blog entry and learn more. Read their books, sign up for their courses, present it to your principals and superintendents. Thank you so much for reading this. Please visit The Ana Grace Project to see the amazing stuff that is being done, borne out of the tragic Sandy Hook Elementary School shooting on Dec. 14, 2012. As Nelba, Ana Grace's grieving mom, pointed out during the conference, the big shootings are the ones that create the sensational news, while violent acts are occurring every single day and not deemed newsworthy. The information and inspiration provided by this conference is the stuff that, when acted upon, alters the course of the world. We don't have to wait for the useless politicians to enact the necessary policies - we can be instruments of change RIGHT NOW. Just do it. LOVE WINS.
12/4/2015 10:37:19 pm
Very well said I enjoyed reading this
12/7/2015 11:29:58 am
Thank you so much for reading - and commenting.
12/5/2015 08:05:56 am
Thank you!!!! Key pieces are in my brain AND it's so nice to have this outline!!! Thank you!!! 💜
12/7/2015 11:31:17 am
Thanks, Denise - I'm glad the outline is useful for you. I may have to edit it because I keep thinking of other points that felt important and I forgot to list. So much great information!
12/6/2015 06:23:14 pm
Love Dr. Bruce Perry and his work. I am glad for your notes because they are indicative of his current work. Also, CPS is also an area I would like to explore more. Thank you for sharing such useful information!
12/7/2015 11:32:22 am
Thank you, Dayna, for reading and for your feedback. Keep me posted on your explorations. Such important work!
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Wellness coach, athlete, mom, entrepreneur. I love helping people mindfully reboot their health & joy.