January 7, 2019

Is all trauma the same?

This blog post has been written by Dr Joe Tucci, CEO of the Australian Childhood Foundation.

I spent some time recently reading through the literature on poly-victimisation. I remember listening to David Finkelhor more than a decade ago presenting findings from his research that found that many of the children who had been identified as experiencing sexual abuse had also experienced bullying at school, been exposed to family violence and had been physically assaulted as well. This research resonated with me. As a child protection worker early in my career and then as a therapist, children told me about their lived experiences of violation. Many times, they described how they had been terrorised by adults who tortured their siblings or others in the family, then sexually assaulted them and also failed to pay them any attention unless it was for their own self-interest.

Over the past thirty years, the constructs we have used have varied according to whether it was more important to assemble and integrate the abuse types (such as when we used the word – maltreatment) or it was more important to differentiate between abuse types, even producing subcategories of certain types of abuse such as emotional abuse (rejecting, corrupting, isolating).

As knowledge about interpersonal trauma began to be elucidated, the view emerged that abuse and neglect resulted in a similar impact on the brain and body of children – trauma, regardless of the type of abuse or neglect served to prolong the activation of the stress response in children, disrupting their neurobiological architecture.

But this view is being challenged by recent research highlighted by Martin Teicher from Harvard University and his team. Of course, Martin has been one of the leading researchers in the field of childhood trauma for over thirty years. So he is important to listen to, at least from my perspective.

Teicher argues that trauma is not all the same. It does differ according to the type of abuse and neglect that children experience.

He has found that different types of abuse and neglect lead to different alterations in brain structure and functioning.  For example, experiences of verbal abuse appear to affect part of children’s brains which are implicated in language development. Some children who are exposed to verbal abuse also show aggressive behaviour due to frustration with their experience of not being able to communicate effectively. Similarly, children who are witness to family violence have parts of their visual cortex affected which leads them to experiencing difficulties with processing visuo-spatial information.

Even more importantly, Teicher points to research which highlights that there appear to be gender differences in the way that different types of abuse and neglect affect boys and girls. Boys under the ages of seven who experience neglect seem to suffer from decreased size and functioning of the hippocampus and the corpus callosum, meaning they are less able to be supported to change the way that they respond to emotional/sensory memories and are left to repeat complex behaviour that results from these brain changes. Equally, girls have sensitive developmental periods for their hippocampus being most likely to be affected at the ages of 10-11 and 15-16 when they experience sexual abuse.

Recent research showing that new models of neuronal networks suggest that children who experience abuse or neglect have had specific relay points in their network architecture become compromised so that they are prevented from spreading maladaptive information throughout the network. This finding supports his proposition that the experience of the abuse and neglect itself helps to create adaptive neuronal connections and formations within the brain/body system to help children survive even the most “dire” traumatic exposure.

The implications for practice are that children’s care and support needs are experienced in real time and must be sensitively configured in the environment that they find themselves in. Children’s state and its expression in challenging or complex behaviour arises when there is a mismatch between the demands they experience in their environment in the present and the way that children’s internal systems have developed to protect them from the full impact of the threat and violation they have experienced from their past. It is in these moment to moment ruptures between past and present that carers and others in the child’s network find themselves offering unique opportunities to children to re-experience their past through different reactions to them in the here and now.

Teicher suggests that it is critical to gather and analyse a detailed history of the type and timing of the experiences of trauma in children’s lives. He believes that therapeutic input needs to become more and more attenuated to the specific consequences of different types of abuse which occur at different times for children according to their gender and other background factors.

It has been an important reflection for me over the past few weeks – the neuroscience research continues to evolve. Knowledge does not stand still. We have to ensure our understanding is up to date. New results mean that we may need to change some of our approaches.

The best way I know how to keep my work contemporary is to follow the researchers and authors who have transformed the field with their analysis and conclusions. Martin Teicher is one of these people.

It is the reason why we have invited him out to Australia for a series of workshops in March!

Click here to find out how you can attend. He has an important message to deliver for all of us working with children and adults who have experienced abuse-related trauma.