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  •   Brain Development Altered by Violence

    By Dale Russakoff
    Washington Post Staff Writer
    Saturday, May 15, 1999; Page A3

    LITTLETON, Colo.—More than a week had passed since Krystie DeHoff felt bullets and bombs explode all around her, since she ran in horror past young, dead bodies to safety. Now she was inching toward normality, shopping at King Soopers grocery, when the most innocent sound--a baby crying in his mother's arms--set the Columbine High School massacre in motion again, this time in her mind. Her heart raced, her muscles coiled. She heard not a baby, but her classmates, shrieking. "All I could think was: MAKE HIM STOP!" she said.

    Josh Lapp was at Beau Jo's pizza the other day when a similarly ordinary noise--something dropping with a bang in the kitchen--flashed him back to the Columbine High library, with gunshots killing students all around him. "It's like I'm always there," Lapp said. "If kids are playing outside screaming, if there's a moan on a television show, sometimes just seeing friends brings it back."

    These kinds of flashbacks--known clinically as post-traumatic stress symptoms and prevalent among Vietnam veterans--are widespread among students at Columbine High. Even more common are disorienting fears: Strapping jocks afraid of the dark. Normally studious teenagers unable to listen in class, focused only on scoping out the quickest escape route. Adolescent girls unable to sleep except with their parents.

    And the Columbine students are the lucky ones. Most child witnesses to violence in America live in inner cities, where shootings occur repeatedly, and where parents often are as traumatized by them as children. And counselors rarely come calling on them in the aftermath of horrors, as they have in Littleton.

    Recent breakthroughs in brain research have revealed alarming dimensions to the problem. Particularly for young children, traumatic experiences such as witnessing violence--much less experiencing it--can alter a developing brain's anatomy and chemistry in ways that inhibit learning, concentration, attachment, even empathy. In some cases, the changes can predispose children to impulsive violence later in life, researchers say.

    Just as Lapp and DeHoff found themselves suddenly on alert in the face of seemingly neutral cues, the research shows that the traumatized brain stores sensory reminders of horror in combination with the neurochemical reactions they triggered. Sights, sounds and smells associated with danger--in DeHoff's and Lapp's cases, loud noises and cries--trigger the fear reaction before rational thought can intervene. For Lapp, DeHoff and most Columbine students, these symptoms likely will subside, according to Lakewood, Colo., trauma specialist Duayne Mullner, as their return to "normal" life replaces the traumatic associations with more positive ones.

    But the younger the witnesses, the more intimate their losses, the more up-close the bloodshed, and the more it recurs, the longer changes can persist, according to the research--and the more profound the toll on school performance, social development and overall emotional health.

    "It is significantly more damaging than traditional infectious diseases--those we can treat with antibiotics," said neurobiologist and psychiatrist Bruce Perry. "If you influence the way the brain functions in ways that become chronic and permanent, that's fixed. Impulsive violence is only a piece of what we're finding. The big picture is the lost potential of kids."

    This is the dark side of heartening evidence in the last few years that the brain is shaped dramatically by stimuli in early childhood--findings that have mobilized parents to coo, cuddle, sing and read to babies as never before in hopes of boosting intelligence and emotional health. In the words of Perry, of the Baylor College of Medicine, the brain organizes itself in response to experience, becoming "the stored reflections of the collective experiences of the developing child." In other words: Experience can become biology.

    Although the research remains in its infancy, and there is considerable debate over how long these changes last, or why so many children navigate extreme horrors virtually unscathed, the findings are redefining violence in America as something larger than a law enforcement problem--rather, as a public health threat, like lead in paint and toxins in water, that takes its gravest toll on children.

    Years into a triumphant decline in the rate of violent crime nationally, the research is spurring unusual collaborations among science, medicine and law enforcement to return to the urban war zones of the last decade and attend to the "silent victims" overlooked in the bloodshed. It also has brought new focus to the impact of rising domestic violence on children--by far the largest population in battered women's shelters.

    "The advances in scientific understanding are creating a major public obligation," said Farris Tuma, who heads the National Institute of Mental Health's expanding children-and-trauma research program. "When children are being abused, we have clear procedures for removing them from the danger. What do we do for children in a community where they're continually exposed to violence that we know has enormous implications for whether they can develop normally?"

    Perry estimates that more than 5 million children in the United States witness or experience traumatizing violence every year, including a reported 3 million who see or hear domestic violence, 1 million who are victims of abuse or neglect and others who are exposed to community violence. A pioneer in the study of post-traumatic stress disorder (PTSD) in Vietnam veterans, Perry said his research shows there is now much more PTSD among "veterans of childhood," as he calls them, than among veterans of Vietnam.

    "There are children who have been through 10 years of this," said Robert Pynoos, who heads the Trauma Psychiatry Program at the University of California at Los Angeles and has treated childhood PTSD from inner-city Los Angeles to earthquake-ravaged Armenia to Bosnia. "Let's not follow the Vietnam model and wait years to commit to treating it."

    After decades of focusing almost exclusively on adult trauma, research institutions are tackling the large, unanswered questions about child trauma: What kinds of violence, witnessed at what ages, can set the destructive process in motion? And how does it vary depending on a child's genetic makeup and environment? The NIMH has increased its research budget in the area of children and violence by 60 percent in the last five years.

    Perry's breakthrough came in the mid-1980s, while studying the neurobiology of rats and observing that minor stresses administered in infancy permanently changed their neurotransmitter receptors--the brain's transit system for stress hormones. Meanwhile, as a psychiatrist, he was treating severely abused children--all hyperactive and impulsive, with symptoms that defied existing diagnoses.

    Perry said he ultimately realized that, neurobiologically, the abused children had much in common with Vietnam veterans he treated for PTSD. "They had high resting heart rates, increased startle response; they would eat but they didn't gain weight," he said. "They had the physiology of permanent fear." Perry later found the same signs and symptoms in children who had only witnessed violence, particularly recurring domestic violence.

    "There's a myth that children are resilient," Perry said. "If anything, we now know that children are more vulnerable to trauma than adults."

    In the normal brain, an evolutionarily perfected stress-response mechanism switches on and off, priming the mind and body for danger, returning systems to equilibrium once danger passes. But in extreme trauma, reminders of the incident can keep flipping the switch, overstimulating stress hormones, causing the heart to race, the body to cool, the mind to focus narrowly on survival.

    Through imaging and other technologies, researchers are optimistic that they can understand the brain circuitry that wires the body for this "fight or flight" response, and ultimately even modify it--with medication, therapy, community-based programs or combinations of the three. Perry and others have found that the drug Clonidine, used for hypertension in adults, re-regulates brain chemistry in some severely traumatized children. This has raised the tantalizing possibility that some kinds of impulsive violence--along with other devastating effects of child trauma--one day may be treatable, almost as depression and anxiety are now.

    Across the country from Littleton, a partnership between Yale's Child Study Center and the New Haven police has been applying the latest findings for seven years, one child at a time. In a city where one in five families lives in poverty, cops and clinicians have evaluated 2,000 children within minutes of their exposure to violence, diagnosing traumatic symptoms in hundreds.

    As children and families witness horrors, beat cops trained by Yale in child development alert Yale clinicians, who work with parents to explain how to comfort traumatized children, how to spot symptoms of deeper trouble and how to call for help. Community police stop in on families regularly, giving children their pager numbers to call. Police and clinicians refer many children to after-school programs, school counselors, academic tutors, psychotherapy--"building emotional scaffolding," as Steven Marans, a Yale child psychologist and psychoanalyst who runs the partnership, calls it.

    Weeks before the Littleton massacre, Marans was summoned on a school violence case that dramatized the differences between child witnesses at Columbine and those in the inner city. The incident involved a second-grade boy who had pulled a knife on a classmate for making a slur about his mother.

    Marans discovered that the boy's mother was murdered when he was a toddler. So was another close family member. In the background noise of his childhood, gunfire was a familiar sound. Suspecting that early trauma contributed to his outburst, Marans ordered a full evaluation. The young perpetrator was arrested, but he also was enrolled in intensive treatment--psychotherapy, family counseling, special education, after-school activities. Yale doctors also are assessing the role of brain chemistry.

    "Intervening when a kid witnesses violence is just a portal," said Steve Berkowitz, a psychiatrist on the Yale team. "We are not a replacement for good families, good standards of living, good environments. You're trying to make incremental change, and possibly allow for things to grow from it."

    Although most Littleton students enjoy those blessings, trauma specialists say it still could take years for those who witnessed the worst carnage to recover. The outlook for the schoolboy with the knife is more problematic.

    With the boy's permission, Marans recently showed his team of police and clinicians a picture the young perpetrator had drawn in their first meeting. It was his apartment house: a narrow, vertical box colored solid brown, with not a flower or tree in sight.

    "It's bad," the boy had said. "I hear shooting all the time." Marans termed the picture "one of the sparsest drawings of a house I've ever seen from a child."

    He asked others for reactions, and a police officer pointed out three blue patches and a tiny sun in an otherwise blank sky. What did Marans make of these? "Hope springs eternal," he answered.

    © Copyright 1999 The Washington Post Company

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