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Chapter 3: How We Learn: A Physiological Model In chapter 1, social learning theories were presented to help gain an understanding of how humans learn to socialize with others. In chapter 2, this information was applied to the attachment and attunement processes. To gain a better understanding of attachment disorders and RAD, it is also important to know how the brain develops and functions and how behavioral and social learning processes are stored and retrieved for later use. The Building of Brain Structure The brain is not fully developed at birth. The brain tissue of a twenty-eight-week-old fetus has about 124 million neurons ready to take in whatever information is presented, but these neurons are not hardwired. This lack of hardwiring permits for more flexibility for allowing the child to adapt to whatever situation he finds himself in. As the child takes in new information, the neurological structure grows with new neurons being added to old ones. These new neurons are actually connected to each other, with a newborn child having about 253 million neurons while an eighteen-month-old has about 572 million neurons. Connections between neurons increase at a speed of 3 billion a second eventually totaling one thousand trillion. If a young child is born into a family that speaks English, French, and Spanish, the child will retain enough language-related neurons to be able to communicate and add information in these three languages. Thus, the more the child is exposed to during the early years of life, the more brain structure the child will have to work with in later years. This is why early childhood experiences are so important. <insert box 3.1> If not used, the neurons are eventually depleted.1 By the time a child is ten, half of the original one thousand trillion neurons are gone. It is as if the brain is preprogrammed with more neurons than we could ever possibly use so that the brain has the ability to adapt to whatever environment it is born into and then discard what it does not need. Parts of the Brain The brain is a complex phenomenon, and we are just beginning to explore and understand how it functions. Brain research has exploded over the past decade with our understanding of the brain in the past ten years topping everything we had known in prior years. We now have the technology to give empirical evidence to some of our understanding of how the brain functions through the use of magnetic resonance imagery (MRI), and positron emission tomography (PET) scans. MRIs use magnets that are connected to a computer to create detailed pictures of the inside of the body or brain. PET scans are a kind of computerized tomography machine that is able to pinpoint in brilliant color the regions in the brain where nerve cells are working during a particular task. The brain is much more complicated than I am going to present here, and there are many more sections and functions of the brain than will be discussed in this chapter. But for the sake of understanding the role of the brain and body in relation to the attachment process, the brain will be divided into three parts: the brainstem, or cerebellum; the midbrain, where the limbic system is located; and the frontal cortex. The brain develops in sequential order, from the brainstem to the frontal cortex, and the organization of the brain is use dependent.2 The cerebellum is the oldest part of the brain, and it controls the basic and most essential functions necessary to life, including involuntary responses like blood pressure regulation, heart rate, and body temperature. The midbrain controls the senses and bodily functions such as sleep and appetite. The limbic system controls emotion and impulses. It also controls our sexuality, our passion for life, and our reactions to circumstances. The frontal cortex controls logic, problem solving, planning, cognition and other higher-order functions. The brain takes in information from our senses (e.g., sight, sound, taste, touch, and smell). There are more senses than these five, such as sensitivity to gravitational pull or ultraviolet light, but these are the primary senses that humans use. With every experience we encounter, the brain takes information from these senses and tries to make sense of that information. The brain does this by pairing the new information with what the brain already knows. In this way, neurons are built upon neurons in intricate structures that are interrelated, including experiences from the past as well as those from the present.3 If you have ever walked into a bakery, breathed in and suddenly remembered being at your grandmother’s house for a holiday dinner, you will understand a little bit about how these experiences are built upon each other. The smell of baking bread in the present instantly conjures up a memory of another time when you smelled baking bread and the two experiences are paired and connected to each other. When we take in information the experience is first processed through the cerebellum. This part of the brain controls the automatic functions of the body such as pulse rate, eye dilation, muscle tension, and breathing. Before an individual is even aware that the brain is taking in and processing information, the cerebellum is already at work. Almost anyone who has ever driven a car for any length of time can recall an instance when they narrowly escaped a car accident by hitting the break or veering to the side just in the nick of time to avoid a collision. The behavioral reaction of stepping on the break or veering to the side was initiated before the driver was cognitively aware of what was occurring. The incoming information then passes to the limbic system which contains an area called the amygdala. The amygdala is the coordinating center of the limbic system, with a cluster of nerves that serves to take in information from the outer world and send messages to other parts of the brain and body in response. The amygdala is a critical component of properly coordinating our experiences, perceptions, memory, and response behaviors. Here, the incoming information is appraised, and a value is assigned to it. In the amygdala an emotion of panic, fear, or perhaps anger is assigned to the experience. This assignment of value is then shared with other parts of the brain, such as the frontal cortex, where decisions are made about what action to take. In the case of the near collision, if the driver was fearful of what almost happened, she might decide to pull over and collect her wits for a moment before continuing on. If she became angry, however, she could decide to take action, step on the gas and chase the car down to get the license number so she can report the incident to the police. Over time, the assignment of emotion is done without our being cognitively aware of what we are doing or thinking. From infancy we begin to learn to read the social cues of others which include eye contact, facial expressions, body language, and many other forms of nonverbal communication. These cues help us assign meaning to the situation in a very rapid manner. Over time and repetition of similar experiences, these assigned meanings become set so that eventually we act and behave in ways that we do not consciously think through ahead of time. We may instantly become tense and apprehensive when presented with a math test if we have had experiences in the past with taking math tests. We may associate flowers with love, church with peace, and any number of other objects, events, or experiences with a particular emotion. In the case of a child who has suffered repeated trauma such as abuse, the amygdale may become overly sensitive and be always on the alert to send out an arousal response in order to help protect the child. This creates a cycle of responses that feed each other. The child is hypersensitive and is thus unnecessarily overstimulated at times. This overstimulation causes the child to react with a stronger behavioral response, which may then escalate the behaviors of those in the environment. Sometimes, because the amygdale is overstimulated when it should not be, incoming perceptions may also be distorted. In such cases, the brain responds to the perception of threat, not an actual threat, and the chemical changes that take place intensify the feeling of being threatened, even when there is no actual threat.4 Internally generated images then distort new information that comes in. Not only are categorical emotions (e.g., anger, fear, happiness) created, but an overall emotional state of mind is also created (e.g., remaining in a chronic state of hyperarousal or anger). NonTraditional Behavior Management Strategies Chapter seven introduced many commonly used behavior management strategies that can be used with any child. Some researchers suggest that children with RAD don’t do very well with traditional behavior management techniques so in this chapter, nontraditional behavior management strategies are discussed. When working with very difficult behavior, one of the first strategies that must be in place is for the adults to be well rested and have emotional and backup support. Rest and Respite Working with children with RAD can be exhausting. Experts suggest starting the treatment of RAD with rest and respite.1 Respite means taking a break (e.g., emotionally, physically, psychologically) from caregiving responsibilities. The importance of doing this before treatment starts cannot be stressed enough. All too often in my clinical practice I meet well-meaning foster or adoptive parents who are eager to get into the treatment stage thinking they can overlook this important step, only to find themselves burned out and exhausted far too early in the process. I cannot stress this point enough. Changing behavior in a child with attachment issues is difficult work. The child’s behavior typically gets worse before it gets better. As new expectations and boundaries are put into place, the child needs to test these boundaries and rules. Defensive behavioral patterns the child has used are being taken away and replaced with other patterns. Often, a child regresses significantly. During therapy, a four-year-old girl I once worked with became quite abusive to her siblings and her caregivers. She terrorized the family pets and even killed a family cat. When procedures were put into place to stop these behaviors, the girl began self-abusing (e.g., banging her head on the floor, biting her wrists). When people were employed to keep her from doing this during the day, she resorted to self-abuse at night when no one was around. Therefore, a twenty-four-hour watch had to be put in place while the correction process was ongoing. This is not uncommon. I have seen many children who, when kept from acting out these deeds during the day, became nocturnal, getting up during the night to follow through on their plans. I cannot count on my fingers how many parents have related horror stories of finding their child standing over them during the night with a knife or scissors in his hand. This increase in intensity and duration disrupts the caregivers’ schedule and their ability to rejuvenate and rest. Without proper rest, even the most dedicated caregiver will show signs of stress. A stressed, tired parent will have a more difficult time dealing with the increase in problematic behavior. Every parent that ever started attachment therapy with me who did not take my advice to get the necessary rest they needed up front came back to me later and told me they wished they had followed my advice. Next, the family must develop a list of potential resources that might be able to help them during the process. This might be someone who can help take a shift during a twenty-four hour watch or someone who would be able to help out with the daily care of siblings. Other useful support resources would be to procure child care for an evening so the parents can go out on a date. RAD stresses every subgroup of the family system, including sibling relationships. The resource person may be able to take over responsibility with a sibling (e.g., by taking the child to a baseball game) or take care of the child with RAD so the parent can take the sibling to the game. The respite list might include another parents siblings, relatives, neighbors, church members, Internet forum groups, professionals, school personnel, hired help, or other parents of children with RAD. The list should be exhaustive, and it is important to compile the list before starting therapy, when everyone is rested and thinking clearly. Attunement It is through attunement that social awareness of self and others, as well as attachment, takes place. This is done by re-creating positive experiences, both of physical care and playful fun, with the child. Eye contact is critical, as is giving and receiving social language, both verbal and nonverbal. According to Nancy Thomas, “The caregiver’s job is to offer the love. The child’s job is to take it.”2 Attunement activities may include physical acts such as finger plays and games, tickling, high fives, arm wrestling, playful wrestling, playing ball, rolling cars around together on the floor, doing art activities together, playing in water, shaving cream or another medium. Attunement activities can also include sharing stories and conversation, telling jokes, making up silly stories together, or sharing eye contact. The important part about attunement is the give-and-take aspect of the relationship, and eye contact. I keep infantile objects in my play-therapy room, and children and teenagers alike will use these objects. One child may wrap a doll in a blanket, feed it a bottle, and cuddle with it, while another child may take on the role of the infant and use these objects himself, such as wrapping up in a doll blanket and getting into a fetal position, or putting a pacifier or bottle in his mouth. I do not discourage these behaviors but simply accept the child’s need to engage in them. |