Rebuilding Lives

Camilla Batmanghelidjh set up Kids Company, a UK based charity that supports over 36,000 young children, who have experienced abuse. In recognition of her work, in 2013 she was named one of the UK's 100 most powerful women by BBC Radio 4's Woman's Hour, and appointed an honorary Commander of the Order of the British Empire (CBE).  Kids Company works to rebuild abused children's lives, firstly by boosting resilience, as Camila explains to Hannah Critchlow...

Camilla -   The way we wrap resilience around vulnerable children is by considering their practical, emotional and aspirational needs.  So, we'll buy children underwear, toothbrush, find them somewhere to live.  A third were under 14 who arrive at our street level centres are sleeping on the floor.  We'll buy them a bed and then we look at giving them attachment figures either by strengthening the people who care for them within their family or by getting our staff to function as substitute parental figures so that the children can have this sense of a caring adult who's there for them through thick and thin. And then through the adult's imagination, we try and imagine the children into the future and help the children think about what they might want to achieve in the future.

Hannah - I can imagine that quite a lot of these children will have observed quite a lot of violence in their early years.  And so, they've acquired that kind of violence, aggressive way of defending themselves almost in social situations.  How on Earth do you deal with that and how do you try and build a more reasonable outlook?

Camilla -   The majority of the children who come to our street level centres, their primary way of protecting themselves is through violence.  They sometimes choose violence as a defence mechanism.  So, they'll carry knives, sometimes firearms.  In fact, UCL looked at our kids - our 16 to 24-year olds and they found that 1 in 5 of them had been shot at and/or stabbed with 50% witnessing shootings and stabbings in the last year. 

The children are realistic if you like, about the violence they're exposed.  Within the confines of their own possibilities, i.e. them, left to themselves to fend for themselves, they work out different ways of protecting themselves.  But there is another layer of violence which is what I call intentional violence.  The second layer of violence they have is what I call responsive violence. 

The kids actually completely lose it emotionally.  In fact, they have words for this.  They call it, "I flipped or I switched."  What they mean by that is that their stress levels get to such a point where it's almost as if their brain blows and they enter a space of extraordinary rage during which they can smash up a space, they can hurt people.  They don't actually even see people properly.  They often superimpose the faces or the behaviours of past perpetrators on staff and then end up attacking staff, imagining that it was a perpetrator in the past that is in the here and now.  So, there is some kind of an explosive reactive violence that they're capable of.  It lasts about 45 minutes during which the child is completely overwhelmed and after which, the child often says to us, "God!  I don't know what happened."  They can't believe what the destruction they have generated because it almost like an out-of-body experience for them. 

When I first started working with these children 18 years ago, the one thing that struck me, I actually brought a group of scientists to look at these children's behaviours to try and acquire a better understanding of what was happening.  What the scientists have found collectively is that as a result of chronic childhood maltreatment, the brain functioning of these children is different.  Because of that, their perceptions and the way they compute other people's behaviours reactions and emotions are completely different.

Hannah -   Professor Eamon Mccory from University College London has worked with Camilla and describes his findings, scanning the brains of children who have been abused.

Eamon -   Chldren who have experienced abuse at home is that there's a heightened response in threat related centres of the brains involved in anticipatory brain processing.  So, it seems that maltreatment at home is associated with a heightened sensitivity to possible threats, but also an increased anticipation that that might be associated with negative outcome in terms of possibly being hit or struck.  But in addition, we carried out an fMRI study where we show angry faces, representing a threat too.  Also, in a subliminal way, so kids have no conscious experience of having perceived threat and we still see a very similar pattern of results.  So, even when children aren't aware of the threat in their environment, early adversity seems to etch in the brain in a way to make it attentive to environmental cues that may signal possible threats.

Hannah -   Is there any way that you can kind of change the brain back to normal as it were, so that they're not hypersensitive to kind of anger and potential threats in the environment?

Eamon -   So, that's a brilliant question.  At UCL, we're coming now with the first longitudinal study of kids who have experienced maltreatment using fMRI and that is going to allow us to address that very question.  Because what you really need to look at is whether in some children, do those brain differences normalise?  So, when they're moved into say, foster family, when they receive certain kinds of intervention, do those brain response normalise in line with other typically developing kids?  And so, what we really have to do is follow kids up over time and measure those brain responses and see whether they change.  So, we're currently halfway through now, a 4-year ESRC funded study where we're doing exactly that and we just finished stage 1 and we're hoping in about a year and half's time to be able to bring all of the kids back and see how they've developed.  We're looking both at brain structure and brain function, and we would predict that some of the kids will have faired pretty well and we expect to show some normalisation of brain response.  But it's unclear whether some differences might persist and that's what we're going to be looking at.

Hannah -   And collaborator, Professor Katya Rubia from King's College London on her findings.

Katya -   We did this task, an inhibition task where people are forced to make mistakes in 50% of the trials.  So, we were particularly interested in error monitoring because children with child abuse been shown to have problems with processing negative feedback.  So, what we basically found is they had enhanced activation in an error processing network in the brain.  We think that this is because they're hypersensitive to negative feedback and probably due to their experience because whenever they did a mistake, probably led to physical abuse.  They slow down more when they do a mistake and this is interesting because this has also been found in people with anxiety.  And of course, these children have very high anxiety.  So, they're basically living in fear of making mistakes.  Doing the motion processing task, they had abnormal enhanced activation in fear processing regions - the anterior medial prefrontal cortex which is crucial for fear.  So, we think this is because they have, due to their experience with physical abuse in childhood, there's hypersensitive to the motion of fear.  Lastly, during concentration, we found reduced activation in concentration area.

Hannah -   By looking at anatomy and activity, we can see that children who suffer from child abuse also suffer brain damage.  The circuits in their brains are hypersensitive to threats.  Susceptible to fear, they find concentrating difficult and their brains are hard wired to freeze up when making decisions and their conditions where they might experience punishment.  Looking at statistics, those who suffered child abuse are 9 times more likely to become involved in criminal activity and 30% of abused and neglected children or later, abuse their own children, continuing the cycle.  Could these brain circuits ever be rewired back to normal to restore the child's behaviour and break the vicious cycle of criminality and abuse?  Back to Camilla on how spending up to 2 years with Kids Company seems to do just that.

Camilla -   They look specifically at 12 to 17-year old highly criminal boys that after 15 months, these dramatic improvements in their emotional processing.  But also, that you could see changes in brain functioning when the kid's brains were looked at and I think it's the closest we've got to being able to evidence the potency of love and its impact on brain functioning.

Hannah -   Wow!  So, you can actually see the hard wiring of the child's brain being affected by being exposed to stress and early life and then you can see how that correlates in terms of the rehabilitation programme with improved behaviour in these teenagers after being with you for - between a year and 2 years.

Camilla -   Yes.  The other interesting evidence that's coming through is that in conditions when you punish this type of child, actually, the error networks of the brain go into overdrive, i.e. the kids end up making more and more mistakes.  They don't correct their behaviour when they're punished whereas the control group who haven't been maltreated have a capacity to correct.  I think what this proves is the underlying chronic anxiety state that is prevalent in these children even if they appear to be invincible and very aggressive, and non-caring.  Actually, underneath it, what you've got is a terrorised kid with high levels of anxiety.

Hannah -   So, you're saying that basically, these children, because they've suffered such trauma in early life, it's affected their brain in such a way that they can't process punishment in a way that a normal child would.

Camilla -   Yes, that's true.  They don't process punishment in a way that's corrective.  In fact, punishment make more errors.

Hannah -   In that case, does this have ramifications for youth offenders programme rehabilitation schemes with the prison for example in UK?

Camilla -   It's a great question you ask actually because in fact, if you'll look across the world in youth offending programmes and child custody programmes, there is an above 75% re-offending rate internationally.  The only really successful programme of youth custody that has been around was one in turkey where the model was closest to family care, i.e. care behaviour formed the majority of the intervention.  That programme ended up being the most successful out of international penal interventions in relation to vulnerable children.  But in England, the re-offending rate is just under 80% in child custody, youth offending, and youth custody.  Now, if this had been a school that was failing at the rate of just under 80% or a heart hospital, people would've come shut it down and said it doesn't work.  In fact, I think what this research is demonstrating is going to turn the penal reform programme right around on its head because a.) it means that the children do not have the neuronal capacity to control their own behaviours appropriately.  I.e. it's not that their brain is like another normal child and then they happen to make poor moral choices which you imagined that through punishment, you can correct, i.e. you can make them make better choices.  That is not the case.  What the researcher is showing is that these kids' brains are so damaged that in the first place, they don't stop, they don't think, they don't have the capacity to retrieve the memory of being punished to use it to correct their behaviours.  In fact, you're looking at an invisible brain injury if you like.  It's arguable whether we could describe them as criminals.  I think we have to completely remove this word and start thinking about the fact that these kids have got impaired abilities to control their emotions, and their energy.  In years to come, we look back on our behaviour now in relation to vulnerable children, and it will classed as a type of absurd witchcraft that came from irrationality.  Because we are so sure that their behaviour is a product of poor moral choices, we almost absorb ourselves of the responsibility to protect them and care for them appropriately.