1. The Impact of Child Trauma &The Impact of Child Trauma &
Prenatal Alcohol Exposure onPrenatal Alcohol Exposure on
Neurobiological Development &Neurobiological Development &
FunctionFunction
Western Michigan UniversityWestern Michigan University
College of Health & Human ServicesCollege of Health & Human Services
HSV 6350-105HSV 6350-105
Special Topics Course: Child TraumaSpecial Topics Course: Child Trauma
Module I , Part IModule I , Part I
Mark A. Sloane, DO
Center for Behavioral Pediatrics
WMU Children’s Trauma Assessment Center
Kalamazoo, MI

2. Western Michigan University

3. Western Michigan University
SW MI Children’s Trauma Assessment Center

4. Module 2Module 2
• Brief review of normal brainBrief 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 FASDNeurodevelopmental Function in FASD
& child traumatic stress& child traumatic stress
• Treatment overview in FASD & childTreatment overview in FASD & child
traumatic stresstraumatic stress

6. The Harsh Reality…The Harsh Reality…
• Research continually demonstrates theResearch continually demonstrates the
harmful effects of child traumatic stress &harmful effects of child traumatic stress &
prenatal alcohol exposureprenatal alcohol exposure
• We have aWe have a reactivereactive system rather than asystem rather than a
proactiveproactive systemsystem
• We minimize the impact to these childrenWe minimize the impact to these children
toto protect ourselvesprotect ourselves from thefrom the
overwhelming awareness of howoverwhelming awareness of how
damaging their experiences aredamaging their experiences are

7. Exploring the “Why” BehindExploring the “Why” Behind
Problematic BehaviorProblematic Behavior
• Requires aRequires a reframingreframing of often long-of often long-
standing paradigms re the etiology of “badstanding paradigms re the etiology of “bad
behavior”behavior”
• Multiple factors: This isMultiple factors: This is complexcomplex !!!!!!
• Requires aRequires a community-wide shiftcommunity-wide shift ofof
thinking differentlythinking differently
• The power of theThe power of the trans-disciplinarytrans-disciplinary
mindsetmindset

8. Paradigm Shift:Paradigm Shift:
Reframing Our Understanding of BehaviorReframing Our Understanding of Behavior
• ““Bad” behavior in children & adolescents isBad” 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
““BADBAD ””
• Perceived “bad” children:Perceived “bad” children:
– DoDo NOTNOT have adequate skills of flexibility/adaptability…have adequate skills of flexibility/adaptability…
– Often have low frustration tolerance…Often have low frustration tolerance…

10. Our typical response to “bad”Our typical response to “bad”
behavior in childrenbehavior in children
• These kids get all kinds of labelsThese kids get all 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
BADBAD oror NAUGHTYNAUGHTY
• ADHD, Oppositional Defiant Disorder (ODD), ConductADHD, Oppositional Defiant Disorder (ODD), Conduct
Disorder, Bipolar Disorder (& even PTSD)Disorder, Bipolar Disorder (& even PTSD) diagnoses dodiagnoses 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

11. These labels just don’t fit!!!

12. The challenge of dealing withThe challenge of dealing with
difficult children…difficult children…
• ““It may be when we no longer know what toIt may be when we no longer know what to
do…do…
• we come to ourwe come to our real workreal work……
• And…when we no longer know which wayAnd…when we no longer know which way
to go…to go…
• we have begun ourwe have begun our real journeyreal journey.”.”

14. News FlashNews Flash::
We live in strange times!We live in strange times!
• Modern Western society hasModern Western society has
benefited (beyond the dreams ofbenefited (beyond the dreams of
our ancestors) from many advancesour ancestors) from many advances
in:in:
– TechnologyTechnology
– CommunicationsCommunications
– TransportationTransportation
– Social JusticeSocial Justice
– EconomyEconomy
…however….

15. News Flash:News Flash:
We live in strange times!We live in strange times!
• Our society seemsOur society seems incapableincapable ofof
ensuring that our children grow upensuring that our children grow up
in environments that are:in environments that are:
– SafeSafe
– PredictablePredictable
– Rich in positive relationshipsRich in positive relationships
– HumaneHumane

16. News Flash:News Flash:
We live in strange times!We live in strange times!
• Hundreds of thousands of children areHundreds 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 atThese kids are at great riskgreat risk for emotional,for emotional,
behavioral, social, cognitive, and physicalbehavioral, social, cognitive, and physical
health problemshealth problems
• The overall costs are incalculableThe overall costs are incalculable
• How can we really measure the lost potentialHow can we really measure the lost potential
here?here?

17. News Flash:News Flash:
We live in strange times!We live in strange times!
• How “advanced” is our societyHow “advanced” is our society
when…when…
– We have to create vast expensive governmentWe have to create vast expensive government
agencies whose sole purpose is to protectagencies 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, andRecreating the chaos, fragmentation, trauma, and
neglect these kids experienced in their biologicalneglect these kids experienced in their biological
homeshomes

18. A Step Closer…A Step Closer…
to understanding these kidsto understanding these kids
The Brain – BehaviorThe Brain – Behavior
ConnectionConnection

19. Normal Brain DevelopmentNormal Brain Development
and Organizationand Organization

20. 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 we100 billion neurons at birth (most of what we
will need throughout life)will need throughout life)
• SynapseSynapse
– 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)

21. Brain Development / LearningBrain Development / Learning
• The process of creating, strengthening, &The process of creating, strengthening, &
discarding synapsesdiscarding synapses
• Synapses organize the brain by formingSynapses organize the brain by forming
neuronal pathways that connect the parts of theneuronal pathways that connect the parts of the
brain governing everything we do:brain governing everything we do:
– BreathingBreathing
– SleepingSleeping
– ThinkingThinking
– FeelingFeeling

22. Neurobiology of DevelopmentNeurobiology of Development
• NatureNature PLUSPLUS nurture !!!nurture !!!
• ““Hard-wired” genetic programs (blueprints) areHard-wired” genetic programs (blueprints) are
continuously modified by the environment (fromcontinuously modified by the environment (from
conceptionconception →→ death)death)
• Brain “sculpts” itself in response to theBrain “sculpts” itself in response to the
environmentenvironment AT THE SAME TIMEAT THE SAME TIME it isit is
developing (via genetic blueprints)developing (via genetic blueprints)
• ““These interactions organize our brain’sThese interactions organize our brain’s
development and thus shape the person wedevelopment and thus shape the person we
become”become” (Shore 1997)(Shore 1997)

23. From simple to complex:From simple to complex:
Hierarchy of brain functionHierarchy of brain function
Brain-
stem
Diencephalon
Limbic
Neocortex
Abstract Thought
Concrete Thought
Affiliation w/ mate
Attachment
Sexual Behavior
Emotional Reactivity
Motor Regulation
Arousal
Appetite / Satiety
Sleep
BP / Heart Rate
Respiratory Drive
Body TemperaturePerry 2006
All sensory input
enters here

24. Neural systems change in aNeural systems change in a use-use-
dependentdependent fashion duringfashion during
developmentdevelopment
• Healthy organization of all neuralHealthy organization of all neural
networks depends upon:networks depends upon:
– PatternPattern
– FrequencyFrequency
– TimingTiming
of 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 languagerich environment to develop optimal language
functionfunction

25. 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

26. The brain develops most rapidlyThe brain develops most rapidly
earlyearly in lifein 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 inIt 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 aIt is much more difficult to re-organize a
poorly organized brainpoorly organized brain due todue to
traumatic stress and / or FASDtraumatic stress and / or FASD

27. Neural systems can be changed…Neural systems can be changed…
but some systems are easier to changebut some systems are easier to change
Brain-
stem
Diencephalon
Limbic
Neocortex
Complexity Plasticity &
Ease of change

28. 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

29. The Brain-Behavior ConnectionThe Brain-Behavior Connection
• GeneticsGenetics
– Neurodevelopmental strengths /Neurodevelopmental strengths /
weaknessesweaknesses
– Temperament / PersonalityTemperament / Personality
– Family history of:Family history of:
• Attentional disordersAttentional disorders
• Learning disordersLearning disorders
• Mood disordersMood disorders
• Neuropsychiatric disordersNeuropsychiatric disorders

30. The Brain-Behavior ConnectionThe 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

31. The Brain-Behavior ConnectionThe 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 systemInfluence 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)

32. Brain-Behavior Connection:Brain-Behavior Connection:
Embracing ComplexityEmbracing Complexity
Genetic
Risk
Trauma
Prenatal
Exposure
Genetic
Potential
Behavior

33. Effects of Traumatic Stress onEffects of Traumatic Stress on
“Normal” Individuals“Normal” Individuals
Normal
Gene
Normal
Behavior
normal
development
Normal
Circuit
Normal
Gene
normal
development
Normal
Circuit
T
R
A
U
M
A
Normal
Behavior
Neurodevelopmental
Delays
Neurobehavioral
Symptoms
Stahl 2002

34. Effects of Prenatal AlcoholEffects of Prenatal Alcohol
Exposure on “Normal” IndividualsExposure on “Normal” Individuals
Normal
Gene
Normal
Behavior
normal
development
Normal
Circuit
Normal
Gene
abnormal
development
Compromised
Circuit
Normal
Behavior
Neurodevelopmental
Delays
Neurobehavioral
Symptoms
P A
R L
E C
N O
A H
T O
A L
L

35. Worst-case scenario:Worst-case scenario:
The “Triple-Whammy”The “Triple-Whammy”
Vulnerable
Gene
+MH Family
History
Development
Compromised
Circuit
Most severe:
Neurobehavioral
Symptoms
Neurodevelopmenta
l
P A
R L
E C
N O
A H
T O
A L
L
Abnormal
T
R
A
U
M
A
Normal
Behavior

36. Influence of Prenatal AlcoholInfluence of Prenatal Alcohol
ExposureExposure

37. Fetal Alcohol SyndromeFetal Alcohol Syndrome
•FAS is among theFAS is among the mostmost
commoncommon of the knownof the known
causes of cognitivecauses of cognitive
impairmentimpairment
– A major public health problem.A major public health problem.
– How common is it? (1-3/1000 liveHow 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 professionalsWhy don’t more professionals
know about it?know about it?

38. Fetal Alcohol SyndromeFetal Alcohol Syndrome
• ““Discovered” in 1968 &Discovered” in 1968 &
19731973
• Specific pattern of facialSpecific pattern of facial
featuresfeatures
• Evidence of CentralEvidence of Central
Nervous System (CNS)Nervous System (CNS)
dysfunction / damagedysfunction / damage
• Growth deficiencyGrowth deficiency
Photo courtesy of Teresa Kellerman

39. FAS: only the tip of the iceberg!FAS: only the tip of the iceberg!
Fetal Alcohol SpectrumFetal Alcohol Spectrum
Disorders (FASD)Disorders (FASD)
• Fetal Alcohol SyndromeFetal Alcohol Syndrome
• Alcohol-relatedAlcohol-related
Neurodevelopmental DisorderNeurodevelopmental 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
appearappear physically normalphysically normal ))
Adaped from Streissguth

40. Smooth philtrum
Thin upper
lip
↓ palpebral
fissure (small
eyes)
FASD: Critical Facial Abnormalities

41. Hoyme, H. E. et al. Pediatrics 2005;115:39-47
Assessment of FAS:
Lip-Philtrum guides

42. Hoyme, H. E. et al. Pediatrics 2005;115:39-47
Measurement of palpebral fissures in FAS

43. Chudley, A. E. et al. CMAJ 2005;172:S1-21S
FAS Assessment:
Measuring palpebral fissure length

44. Hoyme, H. E. et al. Pediatrics 2005;115:39-47
Genetic Disorders with some of the
Craniofacial Features of FAS
Williams Syndrome DeLange Syndrome VCFS

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

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

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

48. Adapted from Sulik & Johnston, 1982
……and even this!!!...and even this!!!...
Facial features of FAS in a mouseFacial features of FAS in a mouse
Small
eyes
Flat
philtrum
Normal control mouse FAS mouse

49. Courtesy of Ann Streissguth
Growing up with FASGrowing up with FAS

50. Hippocampus
Amygdala
Cingulate
Hypothalamus
Major brain areas affected by
prenatal alcohol exposure
Thalamus Corpus
Callosum

51. Sensorimotor
Cortex
Cerebellum
Dorsolateral
Pre-frontal
Cortex (PFC)
Brainstem
(Locus Ceruleus, Raphe,
Ventral Tegmentum)
Other key brain structures also affected
by prenatal alcohol exposure
Orbital
PFC
Corpus
Callosum

52. Severe brain damage caused bySevere brain damage caused by
prenatal alcohol exposureprenatal alcohol exposure
photo: Clarren, 1986
5-day old infants
Severe FAS Normal Brain

53. Corpus callosum abnormalities in FASDCorpus callosum abnormalities in FASD
Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

54. Mechanisms of cellular damage byMechanisms 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 OlneyJohn 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 makingDisrupted synaptogenesis (neurons making
connections with other neurons)connections with other neurons)
– Results inResults in ↑↑ programmed cellular suicideprogrammed cellular suicide
(apoptosis)(apoptosis)

55. Risk Factors for FASD:Risk Factors for FASD:
Why doesn’t every fetus exposed toWhy 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 timingDevelopmental timing of alcohol exposureof 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

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

57. Traumatic Stress & the Child’sTraumatic Stress & the Child’s
Developing BrainDeveloping Brain
• Research reveals aResearch reveals a strong linkstrong link betweenbetween
all types ofall types of childchild abuseabuse and theand the
subsequent development ofsubsequent development of psychiatricpsychiatric
illness in adulthoodillness in adulthood
• Until recently, many/most MH professionalsUntil recently, many/most MH professionals
felt that these psychiatric conditionsfelt that these psychiatric conditions
developed viadeveloped via psychologicalpsychological means:means:
– ““software” problems amenable tosoftware” problems amenable to
reprogramming (talk therapy) or simply erasablereprogramming (talk therapy) or simply erasable
(“Just get over it”)(“Just get over it”)

58. Traumatic Stress & the Child’sTraumatic Stress & the Child’s
Developing BrainDeveloping Brain
• Early childhood traumatic stressEarly childhood traumatic stress
to the developing brain results in:to the developing brain results in:
– Physical (not always permanent) changesPhysical (not always permanent) changes
::
• ““Hard-wired” neurological changesHard-wired” neurological changes
• Causes abnormal CNS organization / functionCauses 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

59. What does traumatic stress changeWhat does traumatic stress change
in the brain?in the brain?
• AttachmentAttachment
• Affect / Emotion RegulationAffect / Emotion Regulation
• Information ProcessingInformation Processing

60. Hippocampus
Amygdala
Cingulate
Hypothalamus
Major brain areas affected by
traumatic stress
Thalamus Corpus
Callosum

61. Sensorimotor
Cortex
Cerebellum
Dorsolateral
PFC
Brainstem
(Locus Ceruleus, Raphe,
Ventral Tegmentum)
Other key brain structures also affected
by traumatic stress
Orbital
PFC
Corpus
Callosum

62. It’sIt’s deja vudeja vu all over again!!!all over again!!!
Yogi Berra
Famous US philosopher

63. Neurobiologic “Controversy”Neurobiologic “Controversy”
• Two prominent researchers in FASD (EdTwo prominent researchers in FASD (Ed
Riley) & traumatic stress (Martin Teicher)Riley) & traumatic stress (Martin Teicher)
recently met and wererecently met and were unableunable toto
differentiate their MRI research slidesdifferentiate their MRI research slides
• New strategies greatly needed to researchNew strategies greatly needed to research
these two groupsthese two groups separatelyseparately
• Here is a brief look at some recentHere is a brief look at some recent
functional MRI research…functional MRI research…

64. Recent Neuroscience ResearchRecent Neuroscience Research
• New brain research has dramaticallyNew brain research has dramatically
altered our thinking about traumatized /altered our thinking about traumatized /
FASD childrenFASD children
• New neuroimaging methods have drivenNew 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 ComputedSPECT (Single-Photon Emitted Computed
Tomography)Tomography)
– MRS (Magnetic Resonance Spectroscopy)MRS (Magnetic Resonance Spectroscopy)
– DTI (Diffusion Tensor Imaging)DTI (Diffusion Tensor Imaging)

65. Adult ADHD Neuroimaging StudyAdult 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 fMRIPerformed Stroop test while in fMRI
scannerscanner

66. Stroop TestStroop Test
RedRed BlueBlue GreenGreen YellowYellow
xxxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx
RedRed BlueBlue GreenGreen YellowYellow
RedRed BlueBlue GreenGreen YellowYellow

67. 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 Striatal
Insular 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

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

69. What does all of this mean toWhat 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

70. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
Executive Function: Making it realExecutive Function: Making it real
• Working MemoryWorking 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
• Shifting cognitive setShifting cognitive set
– Allows child to smoothly transition from their ownAllows child to smoothly transition from their own
agenda to the supervising adult’s agendaagenda to the supervising adult’s agenda

71. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
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” thatLack the capacity to “inform the world” that
they arethey 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)”

72. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
Emotional Control: Making it realEmotional Control: Making it real
• Impaired ability of the right brainImpaired ability 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 functionLoss of logical left brain function
(language / memory) when stressed(language / memory) when stressed

73. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
Emotional Control: Making it realEmotional Control: Making it real
• Traumatized / FASD kids oftenTraumatized / FASD kids often
have significant difficultyhave significant difficulty
regulatingregulating emotional experienceemotional experience ::
– ProblemsProblems expressingexpressing emotions in a safeemotions in a safe
mannermanner
– ImpairedImpaired modulationmodulation of emotionalof emotional
experienceexperience

74. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
Emotional Control: Making it realEmotional Control: Making it real
• ““Fight-Flight-Freeze” phenomenon isFight-Flight-Freeze” phenomenon is
common & underappreciatedcommon & underappreciated
– Hypersensitive / overactive F-F-F system often aHypersensitive / overactive F-F-F system often a
daily battle for traumatized / FASD childrendaily battle for traumatized / FASD children
– Fear / AnxietyFear / Anxiety ⇒⇒ Anger connectionAnger connection
• ““Look in their eyes during a meltdown (if you dare) andLook 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

77. Traumatic Stress / FASDTraumatic Stress / FASD
and the Developing Brain:and the Developing Brain:
Cognitive Flexibility: Making it realCognitive Flexibility: Making it real
• Concrete / literal thinkersConcrete / literal thinkers
• Rigid behavioral templates for specificRigid 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

78. Traumatic Stress / FASDTraumatic 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 socialInaccurate interpretation of social
informationinformation
• Unable to predict social outcomesUnable to predict social outcomes

79. Time to find your happy place!

80. End of Part 1 / Module 2End of Part 1 / Module 2
• Please proceed to Part 2, Module 2Please proceed to Part 2, Module 2