Brain Changes

All children are exposed to some stressful events—and that’s not necessarily a bad thing. “A certain amount of stress builds resilience and coping strategies. Nobody is arguing for a completely stress-free childhood—that’s not realistic,” says Michael W. Yogman, MD, chair of the American Academy of Pediatrics’ Committee on Psychosocial Aspects of Child and Family Health.

But unremitting, serious stressors, like exposure to domestic violence, can cause long-lasting changes to the brain that can create serious vulnerabilities, especially for kids who don’t have supportive caregiving help and comfort to develop positive coping strategies.

A study by the Centers for Disease Control and Kaiser-Permanente looked at adults who reported adverse childhood experiences, including exposure to domestic violence. It found that the more adverse experiences people had as children, the more likely they were to have adverse outcomes as adults related to health, behavior and opportunity, such as:

• Poor academic achievement
• Alcoholism and alcohol abuse
• Illicit drug use
• Smoking, beginning at an early age
• Depression
• Suicide attempts
• Poor work performance
• Financial stress
• Early initiation of sexual activity
• Adolescent pregnancy
• Risk for intimate partner violence
• Risk for sexual violence
• Sexually transmitted diseases
• Unintended pregnancies
• Ischemic heart disease
• Liver disease
• Chronic obstructive pulmonary disease

Chronic stress can also make it more likely that people will experience autoimmune diseases such as rheumatoid arthritis, lupus, Crohn’s disease and ulcerative colitis, as well as be at greater risk for cancer, stroke and heart disease.

In addition, the constant bombardment of stress hormones caused by exposure to domestic violence can affect every aspect of a child’s functioning. By examining images of the brain through something called a functional MRI, researchers found evidence that exposure to trauma changes the brain.

Neena McConnico, Ph.D., director of the Child Witness to Violence Project at Boston Medical Center, explains that in any stressful situation your body’s stress response system, the fight or flight response is activated. Your heart races, your palms sweat, and you feel anxious. When the stressful event subsides—a near-miss car accident, for example—your body returns to its baseline.

She says, “With chronic exposure to violence or trauma, the stress response system doesn’t function the way it should. You don’t necessarily get those moments in time to go back to baseline. Over time, that impacts the way that certain areas of the brain are structured, and it’s particularly damaging in the 0- to 5-year-old timeframe when a lot of brain development is happening.” She says the frontal lobes and cortex—the parts of the brain that control the ability to regulate emotions and behaviors—see the most impact.

“They saw anger, then really terrible things happened. When they see a healthy, normal, mild expression of anger, their body reacts almost like a flashback, even though in reality this is a very different situation,” explains Lawrence J. Cohen, Ph.D., a Boston, Mass., based licensed psychologist.

It's important to know that the same traumatic events can affect different people differently. Even children in the same family, exposed to the same violence, will have different reactions. “Some people are born with better coping strategies, and some are more sensitive to stress than others,” Yogman says.

Some children, those who don’t have good coping skills or who may be more sensitive, could become obsessed with aggressive play, violent video games or actual weapons in an attempt to get some sense of security. Others might be bossy, have tantrums or become withdrawn or passive.

Helping Kids Heal

The first step in helping kids recover from exposure to domestic violence is to end the exposure. “It’s a terrible thing no matter who is being violent, but when it’s a person you count on to be your protector, it’s profoundly unsettling to your basic sense of safety and security in the world,” says Cohen. Once they are in a safe place, there are various strategies that can help children who were exposed to domestic violence begin to heal.

Give them lots of love and affection. Children who have been exposed to trauma may reject or not trust your affection, but just keep giving it to them.

Let them have their own feelings. They may not have the same feelings you have or other people have and that’s okay. Whatever they are feeling is the right feeling.

Be reassuring but honest. Don’t promise that you won’t let anything bad happen to them. Instead, tell them you will do everything you can to keep them safe.

Share your coping strategies. You can tell a child that sometimes you get scared or overwhelmed too, and when that happens you take some deep breaths, or talk to a friend, or practice yoga.

Encourage gentle physical activity. When children witness violence they may feel as though their body is not a safe place to be, and they dissociate, or detach from their bodies. A walk in the woods, yoga or rocking in a chair can help them reintegrate the nervous system and feel safe, Cohen says.

Have them care for an animal. Just be sure to supervise them carefully since the child may act out aggressively toward the animal.

Interrupt inappropriate behavior. But don’t punish a child for acting out. “By acting out a child is trying to show what happened in the best way they know how. From their point of view, if you punish them you are punishing them for telling you what happened to them,” Cohen says.

Let them play. “Play is a very important factor in resilience,” Yogman says. “Play helps kids learn problem solving and collaborative work, and play is a window through which parents can understand the ways kids learn.” Play may bring out many feelings and reenactment with stuffed animals or dolls. “There might be a lot of death, destruction and violence, but as long as it’s symbolic, it’s very healing,” Cohen says.

Help them find therapy. Cognitive behavioral therapy can help mitigate the effects of exposure to traumatic events in childhood. Older children may need more intensive services to overcome problems such as bullying, poor academic performance, depression, behavioral problems, suicidal thoughts and substance abuse.

Respect their feelings about themselves, related to the abuser. “Children identify very strongly with their parents and don’t get to pick and choose that identity. They don’t get to say, ‘My father is violent sometimes, and I’m like him in these ways but different in other ways.’ That’s too sophisticated for child. They can have a deep sense of ‘I’m like that,’ which can be very disturbing,” Cohen says. Plus, children can have deep loyalty and love for the violent person that can tear them up inside.

Teach parents how to help. Parents can learn the skills they need to be there for their kids and to be responsive when their kids are distressed.

Communities Can Make a Difference

“We can’t only intervene with kids, we need to intervene with parents and with neighborhoods and communities that support kids’ recovery from adverse experiences,” says Yogman.

A strong support network ideally includes:

• Parental leave policies
• Quality child care
• Safe neighborhoods and playgrounds
• Interventions to fight poverty and food insecurity

It’s never too late to help a child who’s been exposed to domestic violence. “It’s not that you can’t fix things later on, but it’s more expensive and takes more comprehensive interventions,” Yogman says. For both preventing exposure to trauma and intervening afterwards, the earlier the better. “Once you’ve modified the brain early on, it takes more work to fix it,” he adds.

To get a sense of the experiences that might affect your children’s health, answer the questions under the Adverse Childhood Experience Quiz heading.