By: Jon G. Caldwell, D.O.
During my first meeting with Rebecca (as I will call her), I asked about her family history of mental and emotional difficulties, which can tell me something about her genetic susceptibilities, and about her early life experience with caregivers. These two elements of the evaluation often provide critical information about the unique way in which nature and nurture contribute to human development (see my previous article on this topic).
When I asked Rebecca these questions, an unforgettable look flashed across her face that was part shame and part longing as she explained to me that she was adopted and had no “valuable information” to offer on these topics. All she knew was that she had been adopted by an American family from a Romanian orphanage at the age of two. In fact, to her surprise, this little bit of information proved to be extremely valuable as we tried to better understand how her challenges in adulthood were related to her early childhood experiences.
In the last several decades, as geographic and political borders began to break down, the deplorable conditions of many orphanages around the world came to light, including those in Romania. In some cases this exposure led to policy changes, gradual improvements in orphanage conditions and a wave of adoptions by people from other countries. It also offered scientists a rare opportunity to study children who had experienced early deprivation and adversity and to follow these children as their environmental conditions changed after adoption.
Research of this kind has confirmed that early social experience plays a critically important role in human development. Indeed, we come into the world with a brain that has evolved to capitalize on the social environment, which under favorable conditions is full of rich opportunities for learning and completely embedded in a milieu of meaningful social relationships. Unfortunately, this doesn’t describe many orphanages around the world, where children are kept in cribs or cots for long periods with little access to toys or books and caregiver-to-child ratios can be as high as one caregiver for twenty children. This issue is terribly important because, for better or for worse, the early social environment appears to lay the foundation for cognitive, emotional and social development.
In fact, there appears to be sensitive periods early in life, during which time the brain has an overabundance of neurons that are just waiting to capture information from the outside world. During these sensitive periods, certain brain circuits are more easily shaped by environmental input and may also be more susceptible to environmental insult. After the sensitive period has ended, the brain actually “prunes” or cuts back those neural connections that aren’t necessary for success in the environment of upbringing.
However, as you might expect, children raised in deprived circumstances may not receive adequate brain stimulation during sensitive periods of development, and this is bound to negatively affect the neural pruning process as well. Fortunately, the brain’s mechanisms of neural pruning are balanced with its incredible capacity for “neural plasticity” – which is the brain’s ability to continually change in response to environmental demands. Thus, even when environmental conditions are suboptimal during a particular sensitive period, it doesn’t mean that development can’t or won’t take place, but it can mean that development might proceed along a somewhat atypical trajectory, bringing with it some challenges for the child and the child’s caregivers.
Early social experiences with caregivers and family members are important for the development of adaptive emotional and behavioral regulation (i.e., self-regulation). Children everywhere encounter stressful situations on a daily basis and typically they must rely on caregivers to help them resolve these situations and to aide them in regulating their nervous system so that the toxic effects of stress are ameliorated in a timely fashion. In typical rearing environments, children experience repeated cycles of nervous system activation and caregiver-facilitated deactivation and these cycles get written into the child’s neurobiology until it becomes a natural, self-regulatory response pattern for the developing child.
Individuals like Rebecca who were raised in adverse environments often do not receive the short- and long-term benefits that come with this kind of nervous system regulation and organization. Often, these children are forced into a sort of social hibernation where they must shut-down their natural impulses to seek closeness and security from caregivers. Some of these children will learn to sooth themselves, but these make-shift measures are by no means optimal and it is likely that many of these children do not experience the much-needed social-emotional brain development that comes through interacting with sensitive and responsive caregivers.
Despite these concerns, the research on Romanian orphans illustrates the power of neural plasticity and provides some degree of hope because many of these orphans show significant developmental gains in certain areas after they are adopted. The first area of development to show progress after adoption is often physical health; these children can rather quickly experience improvements in weight, height and fine and gross motor skills. In fact, many these children may not be physically different from their peers by the time they start school.
Somewhat surprisingly, these children often make gains in the cognitive domain too – they seem to catch up in terms of reading and writing, and general intelligence is often similar to their school-aged peers. Yet, a proportion of children who were in an orphanage have some lasting problems with attention, concentration, focus, distractibility, impulsivity, and poor organizational skills. It seems as though the neural circuits involved in “executive function” (i.e., attention, cognitive flexibility, planning, goal-directed behavior, etc.) are very sensitive to suboptimal rearing environments.
Of interest, the areas that seem to be most affected by early deprivation are the social and emotional domains. Children raised in orphanages frequently have challenges in terms of regulating their emotions, calming themselves, coping with difficulties, initiating and maintaining friendships, and negotiating close relationships. Because these children often make noticeable physical and cognitive gains after adoption, the lingering social-emotional issues can be confusing to the child and caregivers. Of course, these social-emotional issues can be compounded if the adoptive home environment is less-than-nurturing or if the child encounters any form of trauma later in childhood.
Even after leaving the orphanage, some of these children have difficulty learning to trust caregivers and to make their attachment needs known in adaptive ways. There can be a tendency on the part of these children to avoid showing vulnerable emotions and outward displays of affection and they may seem indifferent to, or afraid of, intimacy and closeness. On the other hand, some of these children may show signs of heightened separation anxiety, clingy and anxious behavior, and they might have strong fears of abandonment. Some children display signs of both of these extremes in their relationships with caregivers – the so-called “push-pull” pattern where they desperately want companionship but at the same time seem to fear closeness or fear that it won’t last. This sort of picture is sometimes referred to as “reactive attachment”.
That being said, it is important to stress that a warm and nurturing home environment will go a long way to buffering many of the social-emotional difficulties associated with early adversity. Over time, sensitive and responsive parenting practices, coupled with consistent and caring limit-setting, can gradually establish a sense of trust and security. Within the safety and security of the caregiver-child attachment relationship, the child’s nervous system can be re-organized in a way that supports greater self-regulation. This socially enriched environment can stimulate new brain pathways in the adopted child that will eventually underpin a greater capacity to regulate emotions and maintain close relationships.
Like Rebecca, some individuals who have experienced early social deprivation require additional support and treatment later in life. This may come as a result of ongoing issues from early childhood that were never quite resolved or previously resolved issues that resurface due to subsequent experiences of loss/death, abandonment, betrayal or traumatic experiences. While the resurfaced issues can usually be handled by traditional treatment methods, it can be very helpful if the treatment providers also have an understanding of how early social deprivation and trauma can influence social-emotional functioning late in life.
The Meadows treatment model is designed to specifically address the core developmental issues related to early childhood neglect and abuse. Treatment at The Meadow also helps individuals to understand how these core developmental issues are related to secondary symptoms, like shame, anger, low self-esteem, co-dependency, love addiction/avoidance, anxiety, depression and addictive behaviors of all kinds. Through various forms of expertly delivered treatment, individuals at The Meadows build on these insights by gaining actual experience in learning to esteem themselves from within and regulate their own nervous systems more effectively. Gradually, as individuals at The Meadows feel more comfortable with themselves, they are aided in forming safe and meaningful relationships with family members and significant others.
For many individuals who come to The Meadows, the experience of early social adversity starts to become a vital part of a broader life story that no longer carries with it the pain of the past, but instead offers the promise of a brighter future.
Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell’s clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.