The Role of the Emotional Brain

Chapters:

1. Introduction
2. The Limbic System
3. Stress
4. Mirror Neurons
5. Challenging Behavior
6. Evidence-Based Practice

CHAPTER 1: Introduction

VAN DIJK: I think the biggest improvements and new insights come from the field of neurobiology. Since we... scientists are able, let's say, to look into the brain and see what kind of activity, what part of the brain is involved. The discovery of new neurons they've never thought of, let's say, later than ten years ago. And studying these things, you can relate them to the intuition, which is the basis of sciences.

Intuition and, as you said, observation. I observed certain behavior traits in children and I picked them up and worked on them, but I never understood why it was so important.

So in my early publications, there are a lot of intuitive type of things, which I did and were successful, and a lot of people all over the world tried to do the same thing, imitated it, and found a way in all sorts of curricula, but I never understood why this and this was so effective until adjacent field of science said, "Hey, fellow, that is what you are looking for."

So what I tried to do is to bridge the gap between what's out there in the medical field and in the field of neurobiology and even in chemistry and the daily practice, and I think with my experience, I hope to bridge the gap and that new approaches are profiting from these new findings.

CHAPTER 2: The Limbic System

VAN DIJK: We are so focused on cognition, developing of concept, developing of language, developing... And I must confess, my early work was on communication because, and I hope that I'm not cursing in the church, I was thinking, too, when these kids, when these people, have language, when they can communicate, they are fine.

But then I saw very fine deaf-blind people communicating very well but who were very unhappy. They were depressed, they had a lot of stress. So gradually, I found also that cognition without emotions is a dichotomous assumption. We really should go back and introduce again the total human being, including his emotions.

But if you look into all the curriculum, even mine here, you know, there is formulation of concepts, communication, signing, but about emotions, you won't find anything about laughing, about crying, and particularly about joy.

Why... we always talk about quality of life. That's what we all... all parents want good quality of life for the kids. Is that 30,000 words? Is that mathematician... mathematics? No, it is to be a positive person. When are you a positive person? When are you a happy person? And I have a very simple definition that are when you have in your life moments of joy. Think about it.

NARRATOR: In a video clip, Dr. Jan van Dijk sits next to a young boy who is in a wheelchair. The boy is nonverbal and has some visual impairment.

Dr. van Dijk is speaking to the boy in Dutch. At one point, the boy sits up quickly. Dr. van Dijk laughs enthusiastically, and the boy shares the laugh and smiles broadly.

VAN DIJK: When were you happy? When somebody really, when you were sad, put his arms on yours? Not all big words, but just being with you, that you felt the empathy, the empathy of that person. When a mother receives the smile of a child, when a child receives the smile of the mother, then you see the excitement, then you see the joy.

That is what we all want: quality of life. And that quality of life is not mainly in the higher structures of the cortical area, but are the connections deep in the brain. And deep in the brain, there are areas which, when we do something, gives us rewards, and when we are anxious and we can think over our anxiety, we relax.

NARRATOR: The areas to which Dr. van Dijk is referring are known as the limbic system. In a computer-generated illustration of the human brain, the various structures of the limbic system are shown in the location where they are found relative to the cerebral cortex.

VAN DIJK: So gradually, I came to learn that we skip, that we forget the most existential part of the human being: emotions. By the same token, I have seen so many children and adults now where cognition is so limited, and people go on and on and on and try year after year, hitting the same rock, but nothing happens, only the person becomes more frustrated, unhappier, than he'd always been before.

Looking to those persons, my question was, "How can you still invest in this person that they experience moments of joy?" To be with them. To smile with them, to touch them, to attune to them. And we know now, from the research on mother-child interaction, that chemicals are released in the brain which gives that very pleasant feeling.

NARRATOR: In a video clip, an infant is resting face-up on her mother's thighs. The mother opens and closes her fist in the child's field of vision. Careful observation of the child's eyes discloses the infant is looking alternately at the hand and then back to her mother's face.

VAN DIJK: Now, in good attunement with a child, these positive feelings are released on the base of chemicals, oxytocin, endorphins, which makes it rewarding for the educator to be with that child and which makes it rewarding for that person. And those are the moments of optimal joy on this limbic system.

You'll see a little child living across me seven weeks. I see the mother interacting and smiling and putting out her tongue, and with seven weeks... and then she moves her hand, and with seven weeks, the child puts out her hand. And there is such a tremendous joy between both of them that I said, by gosh, if you see this, grown-up and adults or children with little potential, we still are able... when we consider that whole limbic area, the good memories of rewards, the good memories of really attuned contact, we might contribute significantly to their quality of life.

So that is an approach which gives so much hope and perspective even for children who "fail" cognitively.

CHAPTER 3: Stress

VAN DIJK:Are we not, for a long time, excusing ourselves by looking... by accusing the brain and really not knowing what the brain actually contributes to that behavior?

My challenge is that even when the brain has structures which are abnormal and dysfunctioned, that the way the environment deals with it predicts to a large extent the outcome of that person. And that brings me to a point which I would like to put forward very much, and that's about stress.

NARRATOR: In a video clip of the young boy in the wheelchair, we see Dr. van Dijk gently stroking the boy's hand. The boy moves his hand away slightly, and Dr. van Dijk reaches out further to continue stroking. Suddenly, the boy pulls his hand away and arches back into his chair.

VAN DIJK: To put it a little bit provocative is that we as persons, educators, we cause, very often, very much stress in our children. And stress is the most hideous thing a person can have.

The thing now is that we can measure the stress. And as a scientist, you should be surprised. Well, I'm surprised all day. I'm the most surprised of my own mistakes. I said, "That child's not under stress. He can do that, he can take that."

But now, we are able to measure it by measuring the cortisol level. And then we see... and it's done, and then we see that the stress patterns of these children are completely different from normal stress patterns.

NARRATOR: In a video clip, Dr. van Dijk sits on a couch, facing a young girl in a wheelchair who is visually impaired and nonverbal. He holds her right hand in his left and asks her for her other hand, which rests on the arm of her wheelchair. When the girl does not respond, he brushes her hand and gently attempts to lift it. She pulls her hand up and away.

VAN DIJK: Some of them have a continuously high level of stress during the day, and when there's continuously stress, it breaks down all new developments in neural networks. So in education, my slogan is: you try to put it on, you try to put it up, but in fact, you're knocking it down. If you look with your eyes of the stress model, to education, to education, then the effect of what a teacher does with that impaired child is as limited as five percent.

NARRATOR: In a video clip, Dr. van Dijk is laughing and talking with the boy in the wheelchair. As the boy begins to swing his arm in a wiping motion, a self-soothing behavior, Dr. van Dijk begins to sing in rhythm with the boy's arm motions.

(Van Dijk singing in Dutch)

VAN DIJK: My son and I did a study on one child interacting with a teacher of... experience of 20 years, experience in this field, and he was known as a good teacher.

And we broke up all the interactions with hundreds and hundreds of bits, and the moments they were really attuned of all this small observation was five percent. Was five percent. And you saw a lot of self-abuse, you saw a lot of irritation in the child, because... suppose that we are talking now, that there would be a complete misunderstanding, that you are thinking, "I don't understand what he's talking about," and I'm thinking, "I don't understand this question," you know, "What's going on here?"

Gradually the irritation would grow between us. Suppose that would happen during 24 hours of the day. Then all learning and all development would just be at stake. So the main issue is, how can we refrain from stress?

NARRATOR: In a video clip, Dr. van Dijk sits beside the boy who is in a wheelchair. After spending time together, Dr. van Dijk now recognizes that when the boy blinks repeatedly, it is a sign that he is enjoying the activity. Dr. van Dijk acknowledges to the boy that he sees him blinking, and the boy appears pleased and happy.

VAN DIJK: How can we, me as an educator, as a parent, as a teacher with a child, do it in such a way that there is time of relaxation to absorb the information, to take initiative that the adult is responsive, that there is a real dialogue going on?

CHAPTER 4: Mirror Neurons

VAN DIJK: In human nature, there is a brain system which interprets mutual emotions, all right? Particular, positive emotions. And that's the positive emotions. They are stored in the amygdala. The positive emotions-- smiling. Negative emotion, the child turns away. The positive emotion is there.

So there is a system which, at the subcortical level, not conscious of anything at all, all deep happening in the brain, mirrors the emotions at a very early stage of the adult. It mirrors the emotions in which vision, the face, the smile, as I said, the feelings of warmth, which releases oxytocin in both mother and child. So right from the beginning emotions are attuned. And I have called that (makes ringing sound) resonance, because you resonate. I felt that. I felt that.

When I did this, and the kid felt it, you know, he joined in with this type of activity. When he did this. So at a very low, let's say primitive, level of the brain, we can mirror each other's actions and emotions. That has opened up for me a whole pool of thoughts, and... because if I'm right, that's so important that my face and my emotions are mirrored in the other person.

NARRATOR: In a video clip, the young boy in the wheelchair turns his head to the left to face Dr. Van Dijk, who responds by leaning closer to the boy. This is the initiation of an interaction much like a game of peek-a-boo, which the two share.

VAN DIJK: Again, I would refer you to that little girl, seven weeks, Nova, and you will see in Nova... and I'm playing... asked the mother to play with mirror neurons. And the mother smiles, and you see the smile on the child's face. The mother put out the tongue, and the child put out the tongue.

NARRATOR: In a video clip, we see the infant Nova and her mother. As Nova's mother sticks her tongue out, we can see Nova imitate her mother, sticking out her own tongue.

VAN DIJK: What about being blind? Okay. And stroke. We have some evidence that in children who have no face recognition... and face recognition, of course, so important, even when you are what we say blind. That's not, again, a good concept in the framework.

We should say, does the child have any face recognition? Even when the doctor says blind, I still can say... Thus the child perceives-- we say the contours, yeah?-- of my face. Well, there is research showing that... a significant difference between blind kids-- blind kids-- who still can recognize the changing face, and the ones who cannot.

NARRATOR: In a video clip, a father sits facing his daughter, who is in a wheelchair. The father leans in closely to engage the young woman, who is visually impaired and nonverbal, and they gaze at one another.

When the girl's head drops towards her chest, her father raises his finger to his mouth in a shushing motion. She responds by lifting her head up and raising her right arm towards his face.

VAN DIJK: When a blind child, a deaf-blind child, has no mirror neural, that whole system does not develop... on this system our emotional system is built up. Okay. How should I go then?

Just say, let's say, 70% of those children are emotionally very shallow. How could I compensate for that? By touch. By touch. Are there mirror neurons for touch? For hearing, we know. (vocalizes melody) Yep. For vision, we know. But touch? It has to be.

When there are for vision, when there are for touch, there must be... or for hearing, they must also be there for touch. Probably they are all spread out in our nervous system. So the challenge for when people accept this framework of thinking, the challenge would be for getting the whole limbic system, the emotional system, going, to look very intensively how you can mirror your emotions via touch.

NARRATOR: In a video clip, Dr. Van Dijk sits facing the young woman in the wheelchair. Their right hands rest together, palm to palm, and Dr. Van Dijk moves them back and forth rhythmically. When the young woman stops following his motions, Dr. Van Dijk gently taps her palm in an attempt to reengage. She imitates the gesture, and the two now clap together.

VAN DIJK: And that would be... when I have to set up an early intervention program, I would sit around with the team and say, Okay, how could we, with emotions, stressing, by touching, my moving along, perhaps using also the other senses, how could we mirror our mutual emotions... when the child approaches me and you approach a child having the same way of touching, how would we go about that?

I think that would be... that would be the solution of many emotional problems in these children.

CHAPTER 5: Challenging Behavior

VAN DIJK: Now knowing about the limbic system, how easily you can stir up fairly intensive emotions, and at the long run, the behavior comes back again, I think we have to supplement behavioral approach by attachment approach. We have an approach, and then still in play intervention, in positive approach, and getting into attunement. Finding a way that you can release that rewarding chemical. That's the best rewards, and not the token.

NARRATOR: In a video clip, we see the closeup of a young boy's hands resting on a tray which is attached to the arms of his wheelchair. Dr. Van Dijk's hand is also visible as he prompts and encourages the boy to imitate his movements. As the shot pulls out, we see the boy blinking repeatedly, a sign he is enjoying the interaction. A smile crosses his face.

VAN DIJK: Complementary approaches gives first of all a more human, humanistic attitude towards this behavior. Because very often this behavior message fails because parents and teachers don't want to do that. Where you do overcorrection — you know, the child has spit on the floor, and has to pick it up and pick it up and pick it up and pick it up — I've seen it, all these things.

And that goes against human empathy for other human beings, and that's why it fails often. Not in the eyes of the clinician. But the child should live, or that person should live, in a normal circumstance. What is the problem with the amygdala is that when you have one negative experience, as it were, it's spread out to all sorts of things we cannot trace.

NARRATOR: In a graphic illustration of the brain, the amygdala is shown in its relative location and highlighted in blue.

VAN DIJK: Let's say the child is hit like this. Even when a branch of the tree is moving like that, he is like that. So that's... that is why traumatic experiences, traumatic experience, really can... we all know about sexual abuse. One traumatic experience can ruin your whole life. "Oh, but only sexual things."

No, it is broad. Every association area. Because the amygdala protects us from being destroyed, yeah? It is the organ which detects fears to save ourselves. So not only fear, but it can be... so that's why it has developed in mankind and also in animals, that when something is a little bit similar to what I have experienced, back off, you know? And that's why abuse and sometimes, let's say, operations that she'll have to go on, or separations, or marital discord, but in particular abuse, can really destroy. And we have to restore trust again.

That's trust, trust, trust, trust. But the amygdala is a very strong thing. So we must have consistency in handling it. So that is why we have so much, according to my simple opinion, to change our thinking, or to deepen our thinking of human beings who are bereft by their senses and sometimes of a good, warm environment. Because if that environment is not fully supportive, then their life is based on very little, right?

Yeah. So in this way I see challenging behaviors.

CHAPTER 6: Evidence-Based Practice

VAN DIJK: There is one key now which I learned over the last years, and that's evidence-based practice. Evidence based is that we have studies now-- and it's very interesting-- by a colleague, Professor Janssen, Marlene Janssen, I work with very closely. And she was looking to challenging behaviors, stressful children, or children who are very passive.

We all know that, you know, when they have to put on the socks, they lift up the feet, and you have to knock on them, "Lift up the feet," yeah, who don't do anything, and sit there and rock. When she analyzed this behavior, she looked to the teacher's approach. And as I said, they miss out completely.

The moment the child wants to do any initiative, the teacher looks away. Or when the child leans back, the teacher does not interpret that the child wants to interpret the situation, but jumps at it, because that emptiness is felt as a negative thing. Analyzing this behavior, discussing it with the teachers, either on an individual basis or within a group, keeping notes through the whole protocol, and by doing this, ten sessions of one hour and a half, nothing doing anything on the child, no, nothing, but just changing teacher's behavior, you saw that the target behavior in the child either diminished when caused challenging behavior, or more initiative, more... in a very significant way.

NARRATOR: In a video clip, a woman attempts to feed a boy who is in a wheelchair. The boy seems more interested in a self-soothing behavior, moving his right arm in a wiping motion, than in the food the woman offers with a fork.

When she interrupts the motion, grabbing his arm, he attempts to push the fork away with his left hand. In a clip taken sometime later, the woman is now encouraging the boy, tapping his hand. When the boy responds by opening his hand, she grasps it, and together they engage in the wiping motion.

VAN DIJK: So the big hope is that when we focus on parent and teacher training, that with a limited amount of time, you can, by changing that behavior, not looking to the child, but only focusing on the teacher's behavior, the target behavior in the child becomes significantly better.

And that's... that's a tendency, a finding which can be repeated over and over again. So I think that when we approach our problems with the new insight we have gained over the years, some significant gains can be reached.

More interesting is that after you say goodbye to the teacher, and you do your follow-up, the teacher regresses to what he did before. But the child keeps his gains longer than the teacher. So, like you have to go with your car for lubrication to the garage, the teacher, the parents, need continuously, continuously further training, help, supervision, so forth.

So that's the fascinating thing, that we can reduce stress, that we can learn a more pleasant thing, a more motivational thing, by just changing the interaction between the educator and the child. And that is evidence based.