Neglect, neuroscience … and not being helpless!

1. Neglect, neuroscience …and not being helpless! James McTaggart Educational Psychologist

2. Outline • Some background on brain functions and development • How neglect impacts on this at critical stages • Early years • Adolescence • Implications for intervention • Bearing in mind • Rural context • Your own experiences of intervention

3. On not losing hope …

4. Not the whole story • Vanderwert et al. (2010) ‘Timing of Intervention Affects Brain Electrical Activity in Children Exposed to Severe Psychosocial Neglect’, PLoS ONE. 2010, Vol. 5 Issue 7, p1-5. • Measured brain activity in 8 year olds • Been in institutional care/foster care

5. Really, don’t lose hope!

6. Everyday life Almas A N et al. PNAS 2012;109:17228-17231

7. The brain’s jobs …

8. Summary so far … • The human brain has many tasks • Some more important than others • Depending on assessment of situation • These are handled by multiple systems • The systems need to be co-ordinated • And they can over-ride each other

9. Of sheep and marshmallows • Consider what would happen if you offered a marshmallow to: • A washing machine • A sheep • Me • Me not having eaten for three days • A gelada baboon • A child of 4

10. More marshmallows • Consider what would happen if you put a marshmallow in front of: • A washing machine • A sheep • Me • Me not having eaten for three days • A gelada baboon • A child of 4

11. An experiment … • The Stanford marshmallow study • Replicated many times • Predicts • Adolescent adjustment • Academic performance and IQ • Body mass index and health • Credit rating • DO NOT try it at home!

12. Developmentally speaking • Innate abilities require input to develop • Example of language • Born with all speech sounds • Rapidly pruned • Universal grammar • but need for baby talk, otherwise delays • Long term effects

13. Joined up development • Two key processes: • Specific areas and functions • Connections and co-ordination • Language as getting things done • Connections with planning, actions, emotions • experience determines • Relevant knowledge • Relevant actions

14. “I’m hungry” Hunger felt “what do I do about hunger?” Scream the place down? Nothing? Cry?

15. A key brain system • The HPA axis • A basic stress and arousal system • Healthy functioning: • Survival need leads to stress • HPA system activates, releases chemicals • Triggers stress reduction response • It has to be calibrated

16. HPA axis

17. Auction! • A tunnock bar • The Mona Lisa • A return trip to Peterhead

18. HPA Development • Gradual matching of stress to response • Possible stressors give the dimensions of neglect • Basic care and nutrition • Safety • Relational warmth • Stimulation and soothing • Experiences set the levels of response • AND build top-down control connections

19. Neglect/abuse and the HPA • Stress during critical periods • Hyper-reactivity • Long term downgrading of brain areas • Deprivation studies in primates – variable foraging • Emerging evidence for puberty as a critical period

20. Eyes: Oh, look at all these people! Amygdala: Yikes, look at all these people - FEAR HPA system: OK, major stress event Motor systems: Defend and attack!

21. Eyes: Oh, look at all these people! Cortex: One of these people is Mrs Smith Amygdala: Yikes, look at all these people - FEAR Memory: she always looks after me Cortex: No, this is a MINOR stress event HPA system: Sorry, false alarm, MINOR stress event Motor systems: Keep calm and carry on

22. Putting it together: HPA • HPA: I need: • To learn a range of response strengths • To tell how much I should respond • Ways to turn myself up or down • Fast connections with the cortex so we can sort things out • Motor systems: We need: • Action plans for different HPA levels • Fast connections with the cortex • so we can find out what to do • And check the plan before acting • Cortex: I need: • Enough good memories to balance the bad ones • Knowledge about how I tick • Ideas for what to do • Space and time to think • Fast connections to everywhere else so I can • Find out what it happening • Influence what is done

23. Prevention and support • The HPA needs to learn • What is really stressful and what is not • A range of response strengths • The memory needs to have • Enough experiences of becoming OK • Ideas for what can be done • The cortex needs to have • Time to intervene • Strong enough connections with other areas • The motor systems need to have • Automated knowledge of what can be done • A wide menu

24. Making it effective • Consistency and repetition • Interventions that match the brain systems • Patterns that can grow, strengthen and quicken connections • A long time

25. Parenting or intervention? • Wrap-around consistency • Long lasting, anticipating future need • Skills training • Modelling • Soothing and safety • Mentoring and scaffolding • Safe and real practice • Locus of control

26. The temperature of the water • Good enough parental/parent-type care • Basic care • Ensuring safety • Emotional warmth • Stimulation • Guidance and boundaries • Stability • Here are also the risk factors

27. Maturing the PFC • Prefrontal cortex provides overall control and executive function – INHIBITION! • Sensitivity • Appropriate and consistent response to signals • Scaffolding • Age appropriate problem solving and shared support • Mind-mindedness • Mental terms when talking • Adolescence is also a critical period

28. HPA and Cortex together • Exposure to early stress • Executive function • Problem solving • Decision making • Cognitive flexibility • Memory and attention • Language impairment and problem solving • Baby talk at 6 months and later speech

29. Whole village • GP • Bus • Village hall • Rural strengths and risks • Libraries • Employability services

30. Intervention made simple • Prevention • So that the HPA does not become hyperaroused • To establish adaptive scale of response • To evolve adaptive menu of responses • To strengthen and quicken adaptive connections • Aspects of early care • Responsiveness to need • Scaffolding • Mental-mindedness

31. A neglected group? • Growing evidence that adolescence is a critical period in itself • Evidence for environmental enrichment and HPA function (tentative) • Key risk is of supervisory neglect • Or overwhelming responsibility • Link with offending behaviour • Especially with adolescent onset neglect

32. Some developmental aspects • Executive function • Decision making • Risk taking • Sleep patterns

33. Particular dilemmas • Life gets more complex just as executive skills decline • Seek more independence just when need guidance • How we interpret adolescents and younger children

34. Protective (rural?) factors • Autonomy within a safe environment • School attainment reduces offending risk • Stability of placements

35. Intervention thoughts • Universal • Referral is not early • Community • Social connections • Family resilience • Practical support for parents • At risk targetting? • Early does not mean brief, or early • Total wrap round replacement experiences • Intermittence is worse! • Not just verbal, but verbal matters

36. Some things to read • www.childwelfare.gov • NSPCC: Neglect Matters, a guide for young people • Blakemore & Frith: The Learning Brain • james.mctaggart@highland.gov.uk