Research and Diagnosis

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There is just too much great research to cover in this issue. But I'll make a start.

The best information I've read on early brain development is in the January-April, 2001, issue of Infant Mental Health Journal (Volume 22, number 1-2). The whole issue is devoted to research on the impact of attachment and trauma on the brain in the first three years of life. The two articles I found most interesting were by Allan Schore, whose book, Affect Regulation and the Origin of the Self, opened up many of these issues. His two articles are entitled "Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health," and "The Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, and Infant Mental Health." Both are heavy going, really requiring more understanding of brain physiology and neuroanatomy than I possess, but nevertheless I read them like a potboiler. In my review, I will try to skip the more technical language (probably wouldn't use it right anyway!), but I will try to convey some of the insights Schore offers.

In his article on the attachment relationship, Schore makes the basic point that those parts of the brain developing fastest in the first two years of life are primarily in the right hemisphere, areas "specialized for the organization of new learning and the capacity to adapt to a rapidly changing environment Because these same neurobiological structures mediate stress-coping capacities for the rest of the lifespan, early interpersonal stress-inducing and stress-regulating events have long-enduring effects" (pp. 16-17) Why is the attachment relationship so important for the development of these structures and the child's ability to cope with stress and change? Schore cites research, including his own, indicating that both mother's and baby's right hemispheres become "entrained" with each other's, something each of them is biologically prepared to do. The mother's capacity to regulate her infant's emotional state-to comfort and soothe, to repair the bond after an affective break, and to amplify positive states in the infant-actually become the infant's capacity to do the same things. Thus, the "infant's immature and developing internal homeostatic systems are co-regulated by the caregiver's more mature and differentiated nervous system" (p. 26). The result of successful regulation through a secure attachment relationship is that the infant develops a "control system [that] integrates the psychological and biological spheres of mind and body[and] is known to play an essential role in the processing of interpersonal signals" (p. 36). The same control system allows the child to plan based on past negative experiences, and to make split second decisions as to how to behave given internal emotions. All of these processes occur primarily during the first 2 years of life, and function later in life below the conscious level, so that the individual is not aware they have an option of doing anything differently. Ever wondered why attachment therapy is so difficult??

The article on trauma presents the mirror image of the attachment article. The traumatized early developing brain, starting even before birth, learns to regulate in such a way that it is not able to cope with stressors, nor is it able to respond appropriately to social signals or internal emotional or physiological signals. "In the developing brain states organize neural systems, resulting in enduring traits" (p. 212.) In addition, the infant stressed by trauma or loss experiences high levels of stress hormones which can actually cause brain cell death, producing "permanent functional impairments of the directing of emotion into adaptive channels" (p.212). The systems regulating release of stress and "comfort" hormones are also dysregulated. Schore goes on to explain how these types of dysregulation may lead to disorganized attachment, poor control of aggressive impulses, and to sociopathy and violence, as well as poor human relationships.

Other articles in this issue include two additional contributions to an understanding of attachment and early brain development, one on the impact on our world of an inadequate understanding of these principles, and articles on implications for early childhood education and pediatric practice. Copies of the journal can be obtained from Wiley Press at (212) 850-8789 or email Neil Adams . Send copies to any policy makers you know who can wade through the thick language. A simpler to read article by Bruce Perry is available on the web at www.childtrauma.org. This article is one of several excellent ones he has available at this website, and is entitled "Violence and Childhood: How Persisting Fear Can Alter the Developing Child's Brain." He makes many similar points to those made by Schore, without as much depth, but with clear statements about the implications for our future, and for clinical treatment. Given the findings reported above, it is not surprising that recent research by Mary Dozier at the University of Delaware has found that infants in the foster care system are quite likely to develop disorganized attachments unless their foster mother has a secure attachment model herself. Dozier has developed a fairly simple training program for foster parents of infants to teach them to help their infants develop attachment security. At the recent meeting of the Society for Research in Child Development and in not yet published articles, she reports that, after training, 21% of foster mothers with secure attachment models had infants with disorganized attachment, while 62.5% of mothers with insecure attachment models had children with disorganized attachments. The implications of this for policy and training are enormous.

Finally, a recent issue of Development and Psychopathology, (Volume 12, 2000), presented a series of articles on policy implications of recent research on brain development and on children with histories of institutional rearing. Geraldine Dawson, Sharon Ashman, and Leslie Carver review much of the brain research cited above, as well as research on the importance of early intervention, and the deleterious impact on the young child of maternal depression, especially when chronic. They suggest future research to fill in holes in our understanding and make a series of policy recommendations focusing on the importance of policies emphasizing prevention, by providing resources to families and communities struggling to provide better care to their young children. The article on research and policy related to internationally adopted institutionally reared children is by Megan Gunnar, Jacqueline Bruce, and Harold Grotevant. They discuss the range of difficulties these children exhibit, and point to our lack of understanding of why one child may do well and another may do poorly.

Despite the very difficult problems many children and families face post-adoption, they point out that there is some evidence that postadoption experiences may improve outcomes. Recommendations include the importance of preadoption disclosure of the unknown but significant likelihood of serious problems in post-institutionalized children, providing parents ample time without pressure to decide on an adoption, and providing substantially increased postadoption services to families. Both of these articles would be good ones to provide to policy makers of your acquaintance. They need to understand that our concerns are backed by an increasing body of hard science, and that it is time for us to begin to put children first. If we don't, we will pay heavily later.

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