Children who have experienced trauma may find it more difficult to regulate their emotions and behaviours than other children. Understanding the impact trauma can have on brain development can help inform practical responses to these children’s needs.

This short article describes how practitioners can use strategies that help calm children’s bodies in order to help calm their minds and emotions – specifically, the Regulate–Relate–Reason approach used in Berry Street’s Take Two program.

Stages of brain development

Optimal brain organisation depends on young children repeatedly having the right experiences at the right times, within safe and predictable relationships with their carers. According to the Neurosequential Model, there are three main stages of brain development in the early years (Perry, Pollard, Blakley, Baker, & Vigilante, 1995).

1. The lower parts of the brain are the first to organise, beginning in utero until around two years of age. These parts help us to stay alive, to move and to use our bodies.
2. The middle parts of the brain are the second to organise, typically between the ages of one and four years. These parts help us to feel and connect, and to form a sense of belonging and relational safety.
3. The cortex is the third part to organise, typically between the ages of three and six years. This part is responsible for speech and language, thinking, reflection and planning.

Many children who have experienced abuse, neglect and other traumas miss out on these critical experiences. When working with children and young people who have experienced trauma, therapeutic interventions should work towards re-organising those parts of the brain first affected. This means supporting children to regulate their body before they can regulate their emotions.

Capacity to self-regulate

One of the most important functions of development is the capacity to self-regulate (Beeghly, Perry, & Tronick, 2016). Infants and young children depend on their caregivers to help them when they feel distressed or overwhelmed. As an infant matures, they can develop self-soothing strategies, such as thumb-sucking, rocking and actively seeking the comfort of a preferred carer.

Caregivers use sensory strategies to help soothe young children, such as familiar songs, favourite teddies, a preferred drink – not so much the words spoken to them. We don’t tell an infant to calm down, we help them to feel calmed.

Take Two’s approach to therapeutic practice

Berry Street's Take Two program is a Victoria-wide therapeutic service helping children overcome the developmental trauma they have suffered when adults have been unable to care for or protect them.

The Neurosequential Model of Therapeutics underpins Take Two’s approach, providing a framework for working with children to:

• understand the reasons for challenging and confusing behaviours
• guide intervention planning towards effective, developmentally informed strategies (Perry, 2020).

Calming the body, before calming the mind

At Take Two, many of the children we work with lack the skills to self-regulate in age-appropriate and safe ways. This is usually because their sensory systems are organised around preparing for threat and danger, or coping in the absence of caregiving.

Their lower-brain areas are highly active, even when there is no actual threat, and they are in a state of ongoing stress. This undermines their ability to form trusting relationships with others and their capacity to learn. In most cases, these children need help to calm their body, before we can help them to calm their mind. Table 1 lists the behaviours and symptoms associated with early trauma and neglect.

Source: Perry, 1997

Working therapeutically with children

A useful framework to guide sequenced therapeutic interventions is Regulate–Relate–Reason. To maximise efficacy, we should support the child to feel physically and emotionally regulated, then establish relational connection, before moving towards reasoning.

At Take Two, we often start with providing the child opportunities for positive, frequent sensory inputs (i.e. things that are experienced by the senses) to support a child’s physical and emotional regulation. When used repeatedly throughout a child’s day and week, sensory inputs help to calm their lower brain systems and provide a foundation for social engagement (relate) and higher-level thinking (reason).

Examples of sensory inputs include:

• weighted blankets and toys
• bedtime routines that include warm, scented baths and massages
• chewable necklaces
• play dough
• fidget toys
• thick drinks sucked through straws
• swings for rocking
• music via headphones
• trampolines.

These sensory inputs are chosen through careful observation to meet the specific needs of a child – in consultation with an occupational therapist, where needed.

Other activities, such as dancing, walking outside, swimming, playing ball games, cooking and gardening, will also help when used regularly over time. When children engage in these activities alongside safe, predictable caregivers and other adults, they learn to associate feeling good (regulate) with their relationships (relate). As a result, their day-to-day functioning is improved.

Helping children regulate their bodies and emotions, and build safe relationships, allows the child’s thinking brain (reason) to be active. As a result, they are much more able to benefit from therapeutic, healing activities and interactions.

Conclusion

The Regulate–Relate–Reason approach can be used successfully by practitioners working with vulnerable families. Helping stressed and frightened individuals to feel calmer, in control of their bodies and able to think more clearly will assist with better outcomes for therapeutic interventions.

Related resources and further reading

• The ChildTrauma Academy 
  This website provides a range of educational resources to help promote the health and welfare of children, with a focus on child abuse and neglect, early childhood development and trauma.
• Neurosequential Network 
  This website provides resources and information on the Neurosequential Model as it applies to a range of areas, including education, early childhood and caregiving.
• Take Two 
  The Take Two website provides more information about the program and a range of resources designed to inform carers, practitioners and service providers.
• Developmental differences in children who have experienced adversity 
  This four-part series of CFCA practitioner resources on developmental differences is intended to help guide professionals supporting vulnerable children and their families.
• Developmental differences in children who have experienced adversity: Emerging evidence and implications for practice 
  This CFCA webinar outlined emerging evidence on the impact of early adversity on children’s development and discussed implications for practice.
• The effect of trauma on the brain development of children: Evidence-based principles for supporting the recovery of children in care 
  This CFCA practitioner resource provides an overview of what we know from research about cognitive development in children who have experienced trauma, and provides principles to support effective practice responses to those children's trauma.

References

• Beeghly, M., Perry, B. D., & Tronick, E. (2016). Self-regulatory processes in early development. In S. Maltzman (Ed.), The Oxford handbook of treatment processes and outcomes in psychology: A multidisciplinary, biopsychosocial approach. Oxford: Oxford University Press.
• Perry, B. D. (1997). Incubated in terror: Neurodevelopmental factors in the ‘cycle of violence’. In J. D. Osofsky (Ed.), Children in a violent society (pp. 124–149). New York: Guilford Press.
• Perry, B. D. (2020). The Neurosequential Model: A developmentally-sensitive, neuroscience-informed approach to clinical problem solving. In J. Mitchell, J. Tucci, & E. Tronick (Eds.), The handbook of therapeutic child care: evidence-informed Approaches to working with traumatized children in foster, relative and adoptive care (pp. 137–158). London: Jessica Kingsley Publishers.
• Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and ‘use-dependent’ development of the brain: How ‘states’ become ‘traits’. Infant Mental Health Journal, 16(4), 271–291.