Inclusive Education and Diversity in Early YearsRegional ECCD Conference

ARAB RESOURCE COLLECTIVE5-7 November 2009

Effects of Continuous Extreme Stress on Early Childhood Development

Presented by

Rita MerhejClinical Psychologist

Lebanon

Outline

• Born and Raised in a Chronic Stress Zone

• The Physiological impact of stress on early child (brain) development

• The “Achievement Gap”

• Psycho-behavioral implications on child development

Born and raised in a Chronic Stress Zone

Stress is when you perceive an imbalance between the demands of an unpredictable situation and the resources you need to cope with them.

Examples of stressors (Holmes and Rahe’s list) :• death of spouse (100) • divorce (60) • fired at work (45) • retirement (40) • sex difficulties (35) • moving to new residence (15) • vacation (10)• minor financial loan (10)• minor violation of the law (5)

Chronic Stress : stress that continues over a long period of time :

Examples: having a serious illness, being the victim of discrimination, living near a noisy airport

Catastrophic events : sudden, unexpected, life-threatening experiences or traumas.

Examples : sexual assault, military combat, natural disaster, terrorist attacks

Millions of children are born and raised in zones of Chronic stress characterized by :

Catastrophic events of a Repetitive nature…

Example : the “Gaza Syndrome”

Children in some Arab countries live exceptionally stressful experiences where traumas are excessive, repeated and of long duration :

• The whole society feels threatened, support systems are very fragile and could break down anytime.

• The resulting psychological and behavioral symptoms from this situation have been called by some experts the “Gaza Syndrome”

Psychological and Behavioral Symptoms

The repetitiveness and escalation of stressors in the life of the young child produce symptoms that transcend the known Post-Traumatic Stress Disorder (PTSD) symptoms:

• Most important is the inhibited anger where the child represseshis anger and aggression as if waiting for the moment of revenge.

• This latent anger hurts the child : he is in a state of continuous tension, and this is often accompanied with sleep disorders and hate feelings toward the others, usually translated in aggressive behavior toward any person who triggers these feelings in him (ex: if his friend teases him while playing, he will hit him violently)

In such High Stress contexts:

• It is impossible to fulfill the child’s physiological and material needs

• It is impossible to deliver affection, security and protection

• His daily normal routine is entirely disrupted

• He does not have opportunities to learn new exciting things

• He is given responsibilities that are beyond his age, maturity and capabilities

• He does not get the attention, support and appreciation he needs from his environment (too busy attending to higher priority emergency survival issues)

• He does not have hope in a better tomorrow

• His social skills are affected by the on-going changes and breakdown in societal and moral values around him

Child’s Response: FIGHT or FLIGHT

FIGHTAggressive behavior : child identifies

with the “Aggressor” so maybe he will stay alive (survival instinct).

Concepts (justice and moral values) become linked to the aggressive reality of war, and to the social and media teachings he is exposed to (which glorify violence, revenge and fanaticism).

Idea that killing is an acceptable way to resolve conflicts (even a moral act).

FLIGHTIsolation from others and

withdrawal away from all that causes pain an hurt.

Oblivion of the traumatic dimension of the event and obsessive focus on the trivial elements of the event (“banalization” of the pain)

Role of the Environment: a Buffer

In Arab and Islamic societies, stress is received in a collective way (not individually)

The bonds within the nuclear and extended families are very strong

So is the social bond between the community, neighborhood or city members

Great role played by Religion in reinforcing faith and social bonding and unity

These factors play an important role in reducing and absorbing the effects of stress

Factors affecting Child’s Responses

• Responses vary from one child to another (age, temperament, family relationships…)

• Child’s perception of the Traumatic event:

Ex: death of the father : did he die as a “martyr”, a hero, or was it a purely hazardous death?

• The Child’s intellectual maturation: his capacity to understand and interpret the stressful event

• The Child’s ability to express himself

Physiology of Stress in Child Development

The Physiological impact of stress on early child (BRAIN) development

• At birth, the baby’s brain is not complete. This is why the first years of life are crucial in the completion of the brain’s development

• For a healthy brain development, a baby needs:

good nutrition

good stimulation

a stable and safe environment

positive learning opportunities

When exposed to Danger or a Fearful Stimulus:

The body enters into a state of alarm:

The hypothalamus delivers neurotransmitters into the blood vessels to alert different glands of the body to secrete the appropriate hormones.

►the neurotransmitters trigger the Sympathetic Nervous System to secrete Adrenalin and Noradrenalin.

Adrenalin (or Stress Hormone):

• Produces energy

• Responsible for the physiological symptoms that put the body in a state of alert to prepare it to face danger :

muscle tension

accelerated heartbeat

increase in blood pressure

acceleration of breathing rate

dilation of the pupil

What if the Stressful situation is of long duration (chronic) and repeated ?

The state of chronic physiological alarm (chronic overarousal) due to the continuous overflow of stress hormones, can stay for a long period

• The human being can live in such a state for a long time but on the expense of his internal resources that weaken over time, and with the high probability of a malfunctioning in his Immune System:

1. He becomes highly vulnerable to infections, allergies, ulcers, cancerous tumors, arthritis (Selye’sdiseases of adaptation)

2. Chronic overarousal also contributes to coronaryheart disease (CHD), leading to heart attacks.

On a developmental level:

There is a strong relationship between:

• the child’s exposure to chronic stress (living in a state of continuous physiological overarousal)

and

• the development of his brain functions during his first years.

A chronic state of physiological overarousal

Has negative effects on the child’s:

1) Physical health

2) Psychological health

3) Intellectual health

Physical health

• Allergies

• Infections

• Sleep disorders

• Eating disorders

• Enuresis

• Migraines

• Stomach pains

Psychological health

• Nightmares

• Behavioral regression

• Depression

• Aggression

Intellectual health

Between the 1st and 2nd year of life, the baby’s brain is busy building a communication neural network between:

the frontal cortex (thinking, awareness, logic, planning, decision-making) AND other areas of the brain in the Limbic system, mainly sites of Emotions and Memory (amygdale and hippocampus).

Chronic physiological overarousal also affects structure and function of hippocampus (site of short-term memory in the brain → the memory we need to store and process information in order to learn).

Implications:

The more the child is exposed to chronic and high stress,

the more his brain will remain in a state of physiological alert

the less his frontal lobe will be able to establish and organize those neural links that allow him to process and understand the situation around him,and relate incoming sensory experiences to cognition and logical thought

So…

• At the behavioral level, the child remains in a chronic state of fear and impulsivity (physiological overarousal)

• At the mental/intellectual level, this will negatively affect the normal growth of the cortex is hampered, preventing the child from acquiring basic cognitive skills (language, expressive and receptive skills, reading and mathematical reasoning)

What does this mean ?•Generations and generations of children are born and raised in high chronic stress zones and they are not really “using their brains”!

•The continuous exposure to high stress/traumas is leaving their brains inactive because the brain is too busy managing the overarousal physiological responses proper to survival and self-defense and self-protection

•This is happening at the expense of the development of higher mental functions which are supposed to develop during the early years of a child’s life to prepare him for more complex cognitive operations, needed for scholastic achievement..

EffectsThese children cannot:1. Concentrate and Pay sustained adequate attention to a

topic because of too many unexpected distractions, no environment stability, too much danger, hypersensitivity to chaotic unpredictable sensory stimulations signaling catastrophic events

2. Persevere on and complete a task because they got accustomed to frequent sudden interruptions of daily routine, forced displacement, painful surprising events that destroy their everyday routine

3. Be motivated to learn and become successful members of society because their reality steals away their dreams and ambitions

Additional EffectsHigh degree of forgetfulness due to poor concentration and attention

Loss of ability for creativity (as reflected in his drawings and play)

Increased distractibility due to anxiety and fear-dominated thoughts (mostly fear of losing parents or recurrence of the traumatic event)

Increase in hesitation before acting and taking initiatives due to anxiety and fear

.

Additional effects (continued)•Obsessive thinking: instead of being open for new thoughts and receptive to useful information, he remains under the influence of painful memories which contribute to increase anxiety and fear and block the process of learning

►obsessive thinking leads to catastrophizationof the event and its effects which results in low self-esteem :“what happened is so terrible that I can never overcome it because I am a weak person.”

Additional effects (continued)

Increase in imagination: the child fantasizes that he prevented the trauma from happening or a different outcome had resulted.

this could be a coping defense strategy (used in drawing and playing),

but when the child realizes what really happened, he feels guilty when he thinks about what he could have done to prevent the event.

Additional effects (continued)

Some children develop functional fixedness: the child freezes when facing the trauma again and doesn’t do anything to protect himself.

►major source of concern for psychologists because :

(1) it endangers the child’s life

(2) it could be a sign of learned helplessness (the child feels completely incapable to fight the trauma so he adopts a total resignation attitude).

There is a significant difference in the level of scholastic performance and intellectual achievement between children raised in safe and stable environments and those living in areas of high tension and hostilities where all basic requirements for decent living are missing (security, education, medical care…)

► the achievement gap

Let’s remember that to develop in a healthy way, the brain needs:

• Opportunities for positive social interaction in a stable, relaxed, secure environment

• Opportunities for learning new things (concepts, relations, words…)

• Opportunities for play and constructive exploration

(plus : safety, good hygiene, good nutrition, proper medical care, etc…)

A call of warning and a call for acting!

• Generations of children are growing in zones of tension and military hostilities

• It is high time we realize the dangerous implications on our children’s mental health and mental development

• It is high time to intervene for ensuring a stable, and safe environment for them where they can grow in the warmth of their families and go to school to learn and acquire healthy social and moral values