Nurses Have an Important Role in the Care of Children With Complex Developmental Trauma
March 02, 2021 05:00am
Contemporary Clinic ® interviewed Bethany Hall, the owner of Healing Connection, on how understanding Complex Developmental Trauma (CDT) can be an important component of approaching care for pediatric populations affected by CDT.
Contemporary Clinic® interviewed Bethany Hall, the owner of Healing Connection, on how understanding complex developmental trauma (CDT) can be an important component of approaching care for pediatric populations affected by CDT.
Alana Hippensteele: So Bethany, what is complex developmental trauma, or CDT, and how does it affect the lives of children with CDT?
Bethany Hall: So, there's a lot of different types of trauma. There's acute trauma, which we're all living right now in the middle of a global pandemic. So, we have things that come in our lives that hopefully we all hope and pray won't be forever—they're for an acute period of time and they raise our stress level. So that's acute trauma.
Then there's chronic trauma, which some people in the pandemic are living [through], where they may be displaced from their homes, they may start a struggle with substance abuse, or venture into depression that they've never had before.
But complex developmental trauma is very unique. Complex developmental trauma is trauma that occurs usually early in the life of a child. So, in those really formative years of development of brain, which is 0 to 3, sometimes some experts say 0 to 5, and it is chronic. So, it's something that goes on over a long period of time.
The interesting thing about complex developmental trauma is it also often almost always involves a primary caregiver. So that doesn't necessarily have to be mom or dad, if it was a grandma that child was placed with or relative care. But some type of abuse or neglect or household dysfunction is involved with a primary caregiver.
Then how it affects the lives of children, honestly, I could go on about this for hours, but trauma in those early years of life is just very detrimental and wide-reaching in their effects. So, they affect a child's brain in a lot of ways in that early neglect. When they have neglect in those early periods of life or abuse, oftentimes their brains are less developed overall globally, so just the brain mass will be smaller. There's been studies that show imaging of brains of children that were on a severe spectrum, like children that were left in an orphanage to lay in their beds for hours and hours a day from a very young age, and their brains are actually significantly smaller in size and mass.
It also has an effect on the prefrontal cortex, which is the front part of the brain. So that area of the brain often has rapid development from birth to 3. So, when a child experiences significant neglect in those early years, they lack the development of that prefrontal cortex. So then you say, well, what does that matter, right? So, the prefrontal cortex is the part of the brain that controls what we call executive functioning, so that's where we learn how to regulate our emotions, the centers for language and cognition, abstract thought, future planning, and future orientation, empathy, all of those things.
So, when a child grows up in a chaotic and unpredictable environment, their bodies stress response systems also take a hit. So, in addition to what's going on in the chemistry and the development of the brain, their stress responses, or that the very back part of their brain, the fight, flight, or freeze portion of their brain, often gets either over or under responsive. So, because of this constant battery of experiences on that portion of the brain, they either become either over responsive or under responsive to future stressors. So, in comparison to their peers, an equal stressor may cause them to numb out much more quickly or to a deeper level or may cause them to explode. So physically, we're talking about a lot of changes in the brain.
It also causes a whole gamut of emotional changes. So, when a child fails in those early ages to connect to a primary caregiver, that causes a lot of relational problems later on down the line. So, it causes them to have difficulties in attachment with other family members, and then even interactions with friends, spouses, bosses all of that, because it affects our ability to self-regulate, our ability to learn well. So, they may have learning disabilities, our understanding of our own self-concept, and our future orientation. So, there's a lot of ways that this affects—what we say at Healing Connection—we say it affects the ‘brain, body, belief system, biology.’
So, there's a lot of different ways that trauma affects children, and as a medical community, we're probably going to talk more about the ACE study, but it looked at adverse childhood experiences, and it shows from a public health standpoint, there's a huge risk of increased high-risk behavior, such as substance abuse, smoking, chronic illnesses, such as heart disease, hypertension, hyperlipidemia, cancer, and even premature death. So, this definitely has a large far-reaching effect and a very prolonged effect in the lives of these children.