Hsv 6350 Module I Part 1 Neurobiology Of Trauma Dr. Mark Sloane

The Impact of Child Trauma & The Impact of Child Trauma & Prenatal Alcohol Exposure on Prenatal Alcohol Exposure on

Neurobiological Development & Neurobiological Development & FunctionFunction

Western Michigan UniversityWestern Michigan UniversityCollege of Health & Human ServicesCollege of Health & Human Services

HSV 6350-105HSV 6350-105Special Topics Course: Child TraumaSpecial Topics Course: Child Trauma

Module I , Part IModule I , Part I

Mark A. Sloane, DOCenter for Behavioral Pediatr ics

WMU Children’s Trauma Assessment CenterKalamazoo, MI

Western Michigan University

Western Michigan University SW MI Children’s Trauma Assessment Center

Module 2Module 2

• Brief review of normal brain Brief review of normal brain developmentdevelopment

• Review of “Brain-Behavior Connections” Review of “Brain-Behavior Connections” in FASD & child traumatic stressin FASD & child traumatic stress

• Neurodevelopmental Function in FASD Neurodevelopmental Function in FASD & child traumatic stress& child traumatic stress

• Treatment overview in FASD & child Treatment overview in FASD & child traumatic stresstraumatic stress

The Harsh Reality…The Harsh Reality…

• Research continually demonstrates the Research continually demonstrates the harmful effects of child traumatic stress & harmful effects of child traumatic stress & prenatal alcohol exposure prenatal alcohol exposure

• We have a We have a reactivereactive system rather than a system rather than a proactiveproactive system system

• We minimize the impact to these children We minimize the impact to these children to to protect ourselvesprotect ourselves from the from the overwhelming awareness of how overwhelming awareness of how damaging their experiences aredamaging their experiences are

Exploring the “Why” Behind Exploring the “Why” Behind Problematic BehaviorProblematic Behavior

• Requires a Requires a reframingreframing of often long- of often long-standing paradigms re the etiology of “bad standing paradigms re the etiology of “bad behavior”behavior”

• Multiple factors: This is Multiple factors: This is complexcomplex !!!!!!• Requires a Requires a community-wide shiftcommunity-wide shift of of

thinking differentlythinking differently• The power of the The power of the trans-disciplinarytrans-disciplinary

mindsetmindset

Paradigm Shift:Paradigm Shift: Reframing Our Understanding of BehaviorReframing Our Understanding of Behavior

• ““Bad” behavior in children & adolescents is Bad” behavior in children & adolescents is often about faulty & defective brain wiringoften about faulty & defective brain wiring

• It is not disrespect because the child isIt is not disrespect because the child is ““BAD BAD ” ”

• Perceived “bad” children: Perceived “bad” children: – Do Do NOTNOT have adequate skills of flexibility/adaptability… have adequate skills of flexibility/adaptability…– Often have low frustration tolerance…Often have low frustration tolerance…– and also have significant difficulty applying these skills and also have significant difficulty applying these skills

when they are most needed. (Greene, 2001)when they are most needed. (Greene, 2001)

Our typical response to “bad” Our typical response to “bad” behavior in childrenbehavior in children

• These kids get al l kinds of labelsThese kids get al l kinds of labels– Educational System (special education classifications)Educational System (special education classifications)– Medical System (DSM-IV diagnostic categories)Medical System (DSM-IV diagnostic categories)– Legal System (at-risk teen, juvenile delinquent) Legal System (at-risk teen, juvenile delinquent)

• They often get labels that imply they areThey often get labels that imply they are BAD BAD oror NAUGHTY NAUGHTY

• ADHD, Oppositional Defiant Disorder (ODD), Conduct ADHD, Oppositional Defiant Disorder (ODD), Conduct Disorder, Bipolar Disorder (& even PTSD)Disorder, Bipolar Disorder (& even PTSD) diagnoses do diagnoses do NOTNOT capture the full extent of the neurodevelopmental & capture the full extent of the neurodevelopmental & neurobehavioral impact for kids with problem behaviorsneurobehavioral impact for kids with problem behaviors

These labels just don’t fit!!!

The challenge of dealing with The challenge of dealing with difficult children…difficult children…

• ““It may be when we no longer know what to It may be when we no longer know what to do… do…

• we come to our we come to our real workreal work … …

• And…when we no longer know which way And…when we no longer know which way to go… to go…

• we have begun our we have begun our real journeyreal journey .” .”

Wendell BerryWendell Berry

News FlashNews Flash::We live in strange times!We live in strange times!

• Modern Western society has Modern Western society has benefited (beyond the dreams of benefited (beyond the dreams of our ancestors) from many advances our ancestors) from many advances in:in:– TechnologyTechnology– CommunicationsCommunications– TransportationTransportation– Social JusticeSocial Justice– EconomyEconomy …however….

News Flash:News Flash:We live in strange times!We live in strange times!

• Our society seems Our society seems incapableincapable of of ensuring that our children grow up ensuring that our children grow up in environments that are:in environments that are:– SafeSafe– PredictablePredictable– Rich in positive relationshipsRich in positive relationships– HumaneHumane

News Flash:News Flash: We live in strange times!We live in strange times!

• Hundreds of thousands of children are Hundreds of thousands of children are terrorized, abused, neglected, maltreated, terrorized, abused, neglected, maltreated, exposed to alcohol/drugs each yearexposed to alcohol/drugs each year

• These kids are at These kids are at great riskgreat risk for emotional, for emotional, behavioral, social, cognitive, and physical behavioral, social, cognitive, and physical health problemshealth problems

• The overall costs are incalculableThe overall costs are incalculable• How can we really measure the lost potential How can we really measure the lost potential

here? here?

News Flash:News Flash: We live in strange times!We live in strange times!

• How “advanced” is our society How “advanced” is our society when…when…– We have to create vast expensive government We have to create vast expensive government

agencies whose sole purpose is to protect agencies whose sole purpose is to protect children from their parents!children from their parents!

– These very agencies (despite our best efforts) These very agencies (despite our best efforts) truly failtruly fail these unfortunate children by… these unfortunate children by…• Recreating the chaos, fragmentation, trauma, and Recreating the chaos, fragmentation, trauma, and

neglect these kids experienced in their biological neglect these kids experienced in their biological homeshomes

A Step Closer…A Step Closer…to understanding these kidsto understanding these kids

The Brain – Behavior The Brain – Behavior ConnectionConnection

Normal Brain Development Normal Brain Development and Organizationand Organization

Brain GlossaryBrain Glossary

• Neuron (nerve cell)Neuron (nerve cell)– ““Raw material” of the brainRaw material” of the brain– 100 billion neurons at birth (most of what we 100 billion neurons at birth (most of what we

will need throughout life)will need throughout life)• Synapse Synapse

– The connection between neuronsThe connection between neurons– 1,000 trillion synapses by age 31,000 trillion synapses by age 3– 500 trillion synapses by adolescence500 trillion synapses by adolescence

• Due to “pruning” (discarding)Due to “pruning” (discarding)

Brain Development / LearningBrain Development / Learning

• The process of creating, strengthening, & The process of creating, strengthening, & discarding synapsesdiscarding synapses

• Synapses organize the brain by forming Synapses organize the brain by forming neuronal pathways that connect the parts of the neuronal pathways that connect the parts of the brain governing everything we do:brain governing everything we do:– BreathingBreathing– SleepingSleeping– ThinkingThinking– FeelingFeeling

Neurobiology of DevelopmentNeurobiology of Development

• Nature Nature PLUSPLUS nurture !!! nurture !!!• ““Hard-wired” genetic programs (blueprints) are Hard-wired” genetic programs (blueprints) are

continuously modified by the environment (from continuously modified by the environment (from conception conception →→ death) death)

• Brain “sculpts” itself in response to the Brain “sculpts” itself in response to the environment environment AT THE SAME TIMEAT THE SAME TIME it is it is developing (via genetic blueprints)developing (via genetic blueprints)

• ““These interactions organize our brain’s These interactions organize our brain’s development and thus shape the person we development and thus shape the person we become” become” (Shore 1997)(Shore 1997)

From simple to complex:From simple to complex:Hierarchy of brain functionHierarchy of brain function

Brain-stem

Diencephalon

Limbic

NeocortexAbstract ThoughtConcrete ThoughtAff i l iat ion w/ mate

AttachmentSexual Behavior

Emotional ReactivityMotor Regulation

ArousalAppetite / Satiety

SleepBP / Heart Rate

Respiratory DriveBody TemperaturePerry 2006

All sensory input enters here

Neural systems change in a Neural systems change in a use-use-dependentdependent fashion during fashion during

developmentdevelopment

• Healthy organization of all neural Healthy organization of all neural networks depends upon:networks depends upon:– PatternPattern– FrequencyFrequency– TimingTimingof key experiences during developmentof key experiences during development

• ExampleExample : Child must be exposed to language-: Child must be exposed to language-rich environment to develop optimal language rich environment to develop optimal language functionfunction

Brain develops in sequential fashion: Brain develops in sequential fashion: from simple to complexfrom simple to complex

Brain-stem

Diencephalon

Limbic

Neocortex

Development begins here

The brain develops most rapidly The brain develops most rapidly earlyearly in life in life

• By age 4, the brain is 90% of adult size!By age 4, the brain is 90% of adult size!• It is much easier to organize the brain in It is much easier to organize the brain in

healthy ways in early childhood…healthy ways in early childhood…• It is much more difficult to re-organize a It is much more difficult to re-organize a

poorly organized brainpoorly organized brain due to due to traumatic stress and / or FASD traumatic stress and / or FASD

Neural systems can be changed…Neural systems can be changed…but some systems are easier to change but some systems are easier to change

Brain-stem

Diencephalon

Limbic

Neocortex

Complexity Plasticity &Ease of change

The Brain-Behavior connection: The Brain-Behavior connection: three primary componentsthree primary components

• GeneticsGenetics – What you inherit from both parentsWhat you inherit from both parents

• Intrauterine environmentIntrauterine environment – During pregnancyDuring pregnancy

• Extrauterine environmentExtrauterine environment– After pregnancyAfter pregnancy

The Brain-Behavior ConnectionThe Brain-Behavior Connection

• Genetics Genetics

– Neurodevelopmental strengths / Neurodevelopmental strengths / weaknessesweaknesses

– Temperament / PersonalityTemperament / Personality– Family history of: Family history of:

• Attentional disorders Attentional disorders • Learning disordersLearning disorders• Mood disordersMood disorders• Neuropsychiatric disordersNeuropsychiatric disorders

The Brain-Behavior Connection The Brain-Behavior Connection (cont.)(cont.)

• Intrauterine environmentIntrauterine environment

– Exposure to drugs (legal / illegal)Exposure to drugs (legal / illegal)– Exposure to alcoholExposure to alcohol– Maternal stressMaternal stress– Maternal nutritionMaternal nutrition

The Brain-Behavior Connection The Brain-Behavior Connection (cont.)(cont.)

• Extrauterine environmentExtrauterine environment– Parental attachment / nurturingParental attachment / nurturing – Parental style / psychopathologyParental style / psychopathology– Overall family climateOverall family climate– Influence of extended family system Influence of extended family system – Inadequate nutritionInadequate nutrition– Exposure to violence, natural disastersExposure to violence, natural disasters– Exposure to neglectExposure to neglect– Exposure to abuse (verbal / emotional / Exposure to abuse (verbal / emotional /

physical / sexual)physical / sexual)

Brain-Behavior Connection:Brain-Behavior Connection:Embracing ComplexityEmbracing Complexity

GeneticRisk

TraumaPrenatalExposure

GeneticPotential

Behavior

Effects of Traumatic Stress on Effects of Traumatic Stress on “Normal” Individuals“Normal” Individuals

NormalGene

NormalBehavior

normaldevelopment

NormalCircuit

NormalGene

normaldevelopment

NormalCircuit

TRAUMA

NormalBehavior

Neurodevelopmental Delays

NeurobehavioralSymptoms

Stahl 2002

Effects of Prenatal Alcohol Effects of Prenatal Alcohol Exposure on “Normal” IndividualsExposure on “Normal” Individuals

NormalGene

NormalBehavior

normaldevelopment

NormalCircuit

NormalGene

abnormaldevelopment

Compromised Circuit

NormalBehavior

Neurodevelopmental Delays


P AR LE CN OA HT OA L L

Worst-case scenario: Worst-case scenario: The “Triple-Whammy” The “Triple-Whammy”

VulnerableGene

+MH Family

History

DevelopmentCompromised

Circuit

Most severe:


Neurodevelopmental

Delays

P AR LE CN OA HT OA LL

AbnormalTRAUMA

Normal Behavior

Influence of Prenatal Alcohol Influence of Prenatal Alcohol ExposureExposure

Fetal Alcohol SyndromeFetal Alcohol Syndrome

•FAS is among theFAS is among the mostmost commoncommon of the known of the known causes of cognit ive causes of cognit ive impairmentimpairment

– A major public health problem.A major public health problem.– How common is it? (1-3/1000 live How common is it? (1-3/1000 live births in US?) births in US?) – Regional variationsRegional variations– How does it affect the CNS? How does it affect the CNS? – What can we do about it? What can we do about it? – Why don’t more professionals Why don’t more professionals

know about it?know about it?

Fetal Alcohol SyndromeFetal Alcohol Syndrome

• ““Discovered” in 1968 & Discovered” in 1968 & 19731973

• Specific pattern of facial Specific pattern of facial featuresfeatures

• Evidence of Central Evidence of Central Nervous System (CNS) Nervous System (CNS) dysfunction / damagedysfunction / damage

• Growth deficiencyGrowth deficiency

Photo courtesy of Teresa Kellerman

FAS: only the tip of the iceberg!FAS: only the tip of the iceberg!

Fetal Alcohol Spectrum Fetal Alcohol Spectrum Disorders (FASD)Disorders (FASD)

• Fetal Alcohol SyndromeFetal Alcohol Syndrome

• Alcohol-related Alcohol-related Neurodevelopmental Disorder Neurodevelopmental Disorder (ARND) (ARND) (“mild-moderate” FAS)(“mild-moderate” FAS)

• Prenatal Exposure to AlcoholPrenatal Exposure to Alcohol (clinically suspected to have FAS but (clinically suspected to have FAS but appear appear physically normal physically normal ))

Adaped from Streissguth

Smooth philtrum Thin upper

lip

↓ palpebral fissure (small

eyes)

FASD: Critical Facial Abnormalities

Hoyme, H. E. et al. Pediatrics 2005;115:39-47

Assessment of FAS:Lip-Philtrum guides


Measurement of palpebral fissures in FAS

Chudley, A. E. et al. CMAJ 2005;172:S1-21S

FAS Assessment: Measuring palpebral fissure length


Genetic Disorders with some of the Craniofacial Features of FAS

Williams Syndrome DeLange Syndrome VCFS

Fetal Alcohol Syndrome:Fetal Alcohol Syndrome: It doesn’t always look like thisIt doesn’t always look like this

FASFAS : : It can also look like this!It can also look like this!

…and this!…clinical examples of FAS: transcending race

Adapted from Sulik & Johnston, 1982

……and even this!!!...and even this!!!...Facial features of FAS in a mouseFacial features of FAS in a mouse

Smalleyes

Flatphiltrum

Normal control mouse FAS mouse

Courtesy of Ann Streissguth

Growing up with FASGrowing up with FAS

Hippocampus

Amygdala

Cingulate

Hypothalamus

Major brain areas affected byprenatal alcohol exposure

Thalamus CorpusCallosum

SensorimotorCortex

Cerebellum

DorsolateralPre-frontal

Cortex (PFC)

Brainstem(Locus Ceruleus, Raphe, Ventral Tegmentum)

Other key brain structures also affected by prenatal alcohol exposure

OrbitalPFC

CorpusCallosum

Severe brain damage caused by Severe brain damage caused by prenatal alcohol exposureprenatal alcohol exposure

photo: Clarren, 19865-day old infants

Severe FAS Normal Brain

Corpus callosum abnormalit ies in FASDCorpus callosum abnormalit ies in FASD

Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

Mechanisms of cellular damage by Mechanisms of cellular damage by ethanol in FASDethanol in FASD

• Timing is everything!Timing is everything!• Binge drinking vs chronic alcohol useBinge drinking vs chronic alcohol use• John Olney John Olney (Wash U. – St. L) (Wash U. – St. L) mouse model:mouse model:

– GABA A & glutamate (NMDA) receptor dysfunctionGABA A & glutamate (NMDA) receptor dysfunction– Serotonin system dysfunctionSerotonin system dysfunction– Disrupted synaptogenesis (neurons making Disrupted synaptogenesis (neurons making

connections with other neurons)connections with other neurons)– Results in Results in ↑↑ programmed cellular suicide programmed cellular suicide

(apoptosis)(apoptosis)

Risk Factors for FASD: Risk Factors for FASD: Why doesn’t every fetus exposed to Why doesn’t every fetus exposed to

alcohol look the same?alcohol look the same?

• Dose of alcoholDose of alcohol (mom’s blood alcohol level = (mom’s blood alcohol level = fetal blood alcohol level)fetal blood alcohol level)

• Pattern of exposurePattern of exposure : binge > chronic drinking: binge > chronic drinking• Developmental t imingDevelopmental t iming of alcohol exposure of alcohol exposure• Genetic variationsGenetic variations• Synergistic reactions with other drugsSynergistic reactions with other drugs• Interaction with nutritional variablesInteraction with nutritional variables• Socio-economic statusSocio-economic status• Possible neuroprotective factorsPossible neuroprotective factors

Child Traumatic Stress & Child Traumatic Stress & the Developing Brainthe Developing Brain

Traumatic Stress & the Child’s Traumatic Stress & the Child’s Developing BrainDeveloping Brain

• Research reveals a Research reveals a strong linkstrong link between between all types of all types of childchild abuseabuse and the and the subsequent development of subsequent development of psychiatric psychiatric i l lness in adulthoodil lness in adulthood

• Until recently, many/most MH professionals Until recently, many/most MH professionals felt that these psychiatric conditions felt that these psychiatric conditions developed via developed via psychologicalpsychological means: means: – ““software” problems amenable to software” problems amenable to

reprogramming (talk therapy) or simply erasable reprogramming (talk therapy) or simply erasable (“Just get over it”)(“Just get over it”)

Traumatic Stress & the Child’s Traumatic Stress & the Child’s Developing BrainDeveloping Brain

• Early childhood traumatic stress Early childhood traumatic stress to the developing brain results in: to the developing brain results in: – Physical (not always permanent) changes Physical (not always permanent) changes

::• ““Hard-wired” neurological changesHard-wired” neurological changes• Causes abnormal CNS organization / function Causes abnormal CNS organization / function • Profound implications re behavior / Profound implications re behavior /

development / learning / cognitiondevelopment / learning / cognition• Prevents realization of genetic potentialPrevents realization of genetic potential

What does traumatic stress change What does traumatic stress change in the brain?in the brain?

• AttachmentAttachment• Affect / Emotion RegulationAffect / Emotion Regulation• Information ProcessingInformation Processing

Hippocampus

Amygdala

Cingulate

Hypothalamus

Major brain areas affected bytraumatic stress

Thalamus CorpusCallosum

SensorimotorCortex

Cerebellum

DorsolateralPFC

Brainstem(Locus Ceruleus, Raphe, Ventral Tegmentum)

Other key brain structures also affected by traumatic stress

OrbitalPFC

CorpusCallosum

It’s It’s deja vudeja vu all over again!!! all over again!!!

Yogi BerraFamous US philosopher

Neurobiologic “Controversy” Neurobiologic “Controversy”

• Two prominent researchers in FASD (Ed Two prominent researchers in FASD (Ed Riley) & traumatic stress (Martin Teicher) Riley) & traumatic stress (Martin Teicher) recently met and were recently met and were unableunable to to differentiate their MRI research slidesdifferentiate their MRI research slides

• New strategies greatly needed to research New strategies greatly needed to research these two groups these two groups separatelyseparately

• Here is a brief look at some recent Here is a brief look at some recent functional MRI research…functional MRI research…

Recent Neuroscience ResearchRecent Neuroscience Research

• New brain research has dramatically New brain research has dramatically altered our thinking about traumatized / altered our thinking about traumatized / FASD childrenFASD children

• New neuroimaging methods have driven New neuroimaging methods have driven this research:this research:– Quantitative MRI (Magnetic Resonance Imaging)Quantitative MRI (Magnetic Resonance Imaging)– Functional MRIFunctional MRI– PET (Positron-Emitted Tomography)PET (Positron-Emitted Tomography)– SPECT (Single-Photon Emitted Computed SPECT (Single-Photon Emitted Computed

Tomography)Tomography)– MRS (Magnetic Resonance Spectroscopy)MRS (Magnetic Resonance Spectroscopy)– DTI (Diffusion Tensor Imaging)DTI (Diffusion Tensor Imaging)

Adult ADHD Neuroimaging Study Adult ADHD Neuroimaging Study

• 8 Adults with ADHD8 Adults with ADHD• 8 Controls8 Controls• George Bush, MD, PhDGeorge Bush, MD, PhD• Functional MRIFunctional MRI• Performed Stroop test while in fMRI Performed Stroop test while in fMRI

scannerscanner

Stroop TestStroop Test

RedRed BlueBlue GreenGreen YellowYellow

xxxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx



MGH-NMR Center & Harvard-MIT CITP. Adapted from Bush, et al. Biol Psychiatry. 1999;45:1542-1552.

1 x 10-3

1 x 10-2

1 x 10-3

y = +21 mm y = +21 mm

Normal control ADHD

Anterior Cingulate Cortex

Frontal StriatalInsular network

fMRI shows decreased blood flow to the anterior cingulate and increased flow in the frontal striatum in adult ADHD patients

Neuroimaging and ADHDNeuroimaging and ADHD

1 x 10-2

OK…it’s time to make it real!OK…it’s time to make it real!

What does all of this mean to What does all of this mean to health professional students?!health professional students?!

• 5 CNS pathways to explosive / 5 CNS pathways to explosive / inflexible kids:inflexible kids:– Executive Function SkillsExecutive Function Skills– Language-Processing SkillsLanguage-Processing Skills– Emotion regulation SkillsEmotion regulation Skills– Cognitive Flexibility SkillsCognitive Flexibility Skills– Social SkillsSocial Skills

Ross Greene, 2005

Traumatic Stress / FASD Traumatic Stress / FASD and the Developing Brain:and the Developing Brain:

Executive Function: Making it realExecutive Function: Making it real

• Working Memory Working Memory (“RAM” of the brain)(“RAM” of the brain)– Allows efficient multi-taskingAllows efficient multi-tasking

• Separation of affectSeparation of affect– Regulating arousal to achieve goals (e.g. learning)Regulating arousal to achieve goals (e.g. learning)

• Organization & planningOrganization & planning– Facilitates problem-solvingFacilitates problem-solving

• Shift ing cognit ive setShift ing cognit ive set– Allows child to smoothly transition from their own Allows child to smoothly transition from their own

agenda to the supervising adult’s agendaagenda to the supervising adult’s agenda


Language Processing: Making it realLanguage Processing: Making it real

• Often unnoticed, often unassessedOften unnoticed, often unassessed• Problems identifying internal emotionsProblems identifying internal emotions• Lack the capacity to “inform the world” that Lack the capacity to “inform the world” that

they are they are frustratedfrustrated• Problems with conflict resolutionProblems with conflict resolution

Teacher: “Use your words, young man!”Teacher: “Use your words, young man!”Student: “(expletives deleted)”Student: “(expletives deleted)”


Emotional Control: Making it realEmotional Control: Making it real

• Impaired abil i ty of the right brain Impaired abil i ty of the right brain to communicate w/ the left brainto communicate w/ the left brain– Via Corpus Callosum (connects R with L)Via Corpus Callosum (connects R with L)– Balance problemsBalance problems– Sensory processing problemsSensory processing problems– Anger / explosiveness (Anger / explosiveness (↓↓ self-calming) self-calming)– Loss of logical left brain function Loss of logical left brain function

(language / memory) when stressed(language / memory) when stressed



• Traumatized / FASD kids often Traumatized / FASD kids often have significant diff iculty have significant diff iculty regulatingregulating emotional experience emotional experience ::

– Problems Problems expressingexpressing emotions in a safe emotions in a safe mannermanner

– Impaired Impaired modulationmodulation of emotional of emotional experienceexperience



• ““Fight-Flight-Freeze” phenomenon is Fight-Flight-Freeze” phenomenon is common & underappreciatedcommon & underappreciated– Hypersensitive / overactive F-F-F system often a Hypersensitive / overactive F-F-F system often a

daily battle for traumatized / FASD childrendaily battle for traumatized / FASD children– Fear / Anxiety Fear / Anxiety ⇒⇒ Anger connection Anger connection

• ““Look in their eyes during a meltdown (if you dare) and Look in their eyes during a meltdown (if you dare) and you will often see fear” …MASyou will often see fear” …MAS

– Amygdala is the key player hereAmygdala is the key player here


Cognitive Flexibility: Making it realCognitive Flexibility: Making it real

• Concrete / literal thinkersConcrete / literal thinkers• Rigid behavioral templates for specific Rigid behavioral templates for specific

situationssituations• Rule-driven (to a fault)Rule-driven (to a fault)• Over-focus on detailsOver-focus on details• Overlap with the autistic spectrumOverlap with the autistic spectrum

Traumatic Stress / FASD Traumatic Stress / FASD and the Developing Brain:and the Developing Brain:Social Skills: Making it realSocial Skills: Making it real

• Impulse control problemsImpulse control problems• Pragmatic language impairmentPragmatic language impairment• Inaccurate interpretation of social Inaccurate interpretation of social

informationinformation• Unable to predict social outcomesUnable to predict social outcomes

Time to find your happy place!

End of Part 1 / Module 2End of Part 1 / Module 2

• Please proceed to Part 2, Module 2Please proceed to Part 2, Module 2

Hsv 6350 Module I Part 1 Neurobiology Of Trauma Dr. Mark Sloane

Health & Medicine

Transcript of Hsv 6350 Module I Part 1 Neurobiology Of Trauma Dr. Mark Sloane