Childhood Trauma , the Neurobiology of Adaptation , and " Use-dependent " Development of the Brain : How " States " Become " Traits "

Childhood trauma has profound impact on the emotional, behavioral, cognitive, social, and physical functioning of children. Developmental experiences determine the organizational and functional status of the mature brain. The impact of traumatic experiences on the development and function of the brain are discussed in context of basic principles of neurodevelopment. There are various adaptive mental and physical responses to trauma, including physiological hyperarousal and dissociation. Because the developing brain organizes and internalizes new information in a use-dependent fashion, the more a child is in a state of hyperarousal or dissociation, the more likely they are to have neuropsychiatric symptoms following trauma. The acute adaptive states, when they persist, can become maladaptive traits. The clinical implications of this new neurodevelopmental conceptualization of childhood trauma are discussed.  Le trauma de l'enfance a un impact profond sur le fonctionnement emotionnel, comportemental, cognitif, social et physique des enfants. Les experiences en matiere de developpement determinent !'organisation et le fonctionnement du cerveau arrive a maturite. L'impact d'experiences traumatiques sur le developpement et le fonctionnement du cerveau sont discutes dans le contexte de principes de bases de neurodeveloppement. II existe plusieurs responses mentales et physiques d'adaptation au trauma, parmi lesquelles !'excitation physique intense et de Ia dissociation. Parce que le cerveau qui se developpe organise et internalise les nouvelles "informations" d'une maniere liee a !'utilisation et en dependant, plus un enfant se trouve dans un etat d'excitation ou de dissociation et plus il risque d'y a voir des symptomes neuropsychiatriques apr($ le trauma. L'"etat" adaptatif aigu peut devenir persistent et conduire a des "traits" d'inadaptation. Les implications cliniques de cette nouvelle conceptualisation de neurodeveloppement du trauma de l'enfance sont discutees. Address correspondence to Bruce D. Perry, M.D., Ph.D., Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. The clinical work and clinical research related to this paper has been supported, in part, by the CIVITAS Initiative and Mr. Alan Grant. Special acknowledgments are due to Andrew Vachss for helpful insights, commentary, and editorial assistance on earlier versions of this manuscript. 271  El trauma de Ia niiiez tiene un impacto profundo en el funcionamiento emocional, de conducta, cognitivo, social y fisico de los niiios. Las experiencias en el desarrollo determinan Ia condici6n funcional y de organizaci6n de un cerebro maduro. Se discute el impacto de las experiencias traumaticas en el desarrollo y el funcionamiento del cerebro en el contexto de los principios basicos del neurodesarrollo. Hay varias respuestas mentales y ffsicas que se adaptan con respecto al trauma, incluyendo el hiperdespertamiento fisiologico y Ia desunion. A causa de que el cerebra en desarrollo organiza e internaliza nueva informaci6n en forma de "uso-dependencia," mientras mas el nifio esta en estado de hiperdespertamiento o desuni6n, mas propenso esta a padecer de sintomas neurosiquiatricos con posterioridad al trauma. EI estado agudo de adaptacion puede convertirse en persistente y conducir a rasgos de maladaptaci6n. Se discuten las implicaciones clinicas de esta nueva conceptualizaci6n del neurodesarrollo del trauma en Ia nifiez. ~-=~~-~~~~~•~-~%®1i'IM~.ft•~·••~.tl~~.•~~~•~••u•~~&~~-•~~ ®~~~.d-Lk8®&··~·~®~-~~~~~.~-~u~a~&®R~~~-~~~~-~~. M&R• ®.lili4'1Jl!illl ~ ''? JJ~«*'llccl>li t t:. ~·i;:%11· ~JtB[.;ft-JtJfi\'M • .J!t~(t,J&Jt; ~ L c 11. fi'J" tJJf:'cc "ffl'll!~&.,.\IX. f'l:(£{1:;~7.>®<:, ~·®12Ht. t:11$ f.'ffi'JtJJiE:IX~iE!l L'\"-n>. !XIl!i" O)t:lf*>'CtJ'. ~~>t;fi'JtJ "Uk*>'Cfi'J) ~~~tll< ;.:~~.1;<>o 1]' 1Jil.M9\..~I? < ~. _0)'11f L 1'1$ilRm!$lL~O)Ii\!tf'(i{Lil!:l'~d~\'?'c:tia t t:.. Adults interpret the actions, words, and expressions of children through the distorting filter of their own beliefs. In the lives of most infants and children, these common adult misinterpretations are relatively benign. In many cases, however, these misinterpretations can be destructive. The most dramatic example occurs when the impact of traumatic events on infants and young children is minimized. It is an ultimate irony that at the time when the human is most vulnerable to the effects of traumaduring infancy and childhoodadults generally presume the most resilience. This destructive misperception has permeated the mental health field. In the last 10 years, our society has spent billions of dollars studying and treating adult trauma victims, primarily male combat veterans-this despite the fact that many more females are traumatized by rape in our society than males by combat. In comparison, few resources have been dedicated to research or treatment focusing on childhood trauma, and only a fraction of those on studying or treating the traumatized infant (Perry,