Early Cortical Shock Neonatal Seizures, ADHD and Autism - a Swedish Study

• Children with neonatal seizures were about twice as likely to develop ADHD

• They were about three times as likely to be diagnosed with autism

These results reflect a growing body of research linking early neurological events with later neurodevelopmental outcomes. While it makes sense that early neurological events shape development, we also need to hold a wide and discerning clinical lens.

If we hold complexity - and the limits of the medical model - what might be the through-line from early chronic dysregulation and certain presentations of autism and adhd?

Looking at the process of neurodevelopment through how the nervous system creates patterns of meaning, gives us a potential map. If we can understand that there are underlying neurophysical ‘choice points’, that tier how a growing system creates order, we can see - like a little octopus organising its shells - how the nervous system creates its own particular, internal ecology.

 

Early, Learnt Pattern Formation

From the earliest stages of life, the nervous system is busy organising itself. Though nascent, it is constantly calibrating:

• thresholds of safety

• responses to activation

• how energy is mobilised and contained

All of this occurs before language, before conscious memory, and before relational meaning is fully formed. A neonatal seizure occurs during this delicate window. It introduces intense, dysregulated activation into a system that is still establishing its baseline, still in the process of building it’s neurophysical map. With early ruptures, the immature system has to register this event (or events) physiologically and organise itself around it.

The interstial system has to work out how to make sense of incoming information.

The Predictive Model

 From these early experiences, the nervous system builds a predictive model. While it requires the brain to do so, this model is physiological, not psychological. It’s an internal map of the neurophysical system, and it is how the baby knows itself. The nervous system extends throughout the entire body, head to toe. It includes the brain; the spinal cord; and the peripheral nerves that travel throughout the body. For a long time, this is the baby's only identity.

In an infant, information processing is largely autonomic, it happens without conscious control. The brain is still forming, and personal identity, conscious experience of self, is still very much amorphous. Bottom up processing is dominant and the vagus nerve is the major conduit of information between the brain and body. Through the vagal pathways, sensory experience is registered, organised, and updated across the whole neurophysical system.

To keep itself safe, and to learn about the world, the system organises:

• expectations of activation

• timing and speed of response

• whether to mobilise, or conserve energy

These responses are automatic and become embedded within the nervous system.

The infant’s nervous system is in a continual process of response and discovery. It is designed to protect the integrity of the body, and is designed to explore.

What Happens in the Body During Early Cortical Shock

 During early cortical shock, the body shifts quickly into a state of widespread neurological and physiological disruption. The baby is moved from a gentle, open flow, state, to one of high vagal constriction: with disorganised neural activity, disrupted brain signalling, and disrupted motor control. The nervous system moves into a state of defence:

• Autonomic instability: irregular heart rate, breathing, blood pressure, and temperature regulation

• Vagal system response: reduced ventral regulation, increased sympathetic activation, and dorsal vagal engagement (protective immobilisation)

• Incomplete resolution: activation rises sharply, without the stable return to baseline, shaping early physiological patterns.

Sometimes, the system gets stuck.

Patterns of learning in the immature system, can become embedded within the predictive model - and the vagal system then carries out responses in alignment with that model.

It does what it knows.

The baby, with no conscious - ventral vagal - control, has little to no way, to move out from the state and it can get stuck in a learnt pattern of collapse or defence. This can become part of the intrinsic, internal architecture, the internal map, and becomes:

“Who I know myself to be”.

These are not conscious choices.

 

Pattern Becomes Baseline

 Without some kind of re-learning, these responses become consistent, and they start to form the nervous system’s baseline. As development continues, these early patterns are reinforced by experience, and can be recognised in presentations of ADHD and autism:

• fluctuating attention and shifting activation

• reduced capacity to sustain engagement

• withdrawal, stillness, or inertia

• difficulty transitioning between states

• inability to locate restorative stillness

The theory: the nervous system has learnt a pattern of flight/fight or immobilise - and has not has enough opportunity to explore interstitial states of safety . States of safety, or deep rest, can become something the system does not trust, nor recognise.

Why Talking and Behavioural Strategies Have Limits

These early patterns are established before language and before cognitive processing develop, they are held within physiological processes. Language-based approaches engage the brain, and behavioural strategies are just that - surface level solutions - that leave the underlying organisation untouched. The nervous system remains guided by the early predictive model, and while outward modifications are made, the system continues to respond according to what it has learned. It will always revert back to what it knows.

Life can then become an uphill battle, where the nervous system calls the shots.

Working With the System

 If patterns are formed early, then change needs to occur at the same level - through direct nervous system experience. In order to redirect change, we need to safely introduce experiences that support:

• regulated activation

• completion of response cycles

• increased internal stability

• renewed relationship with the body

All of this requires a deep levels of safety, meaning, connection - and an understanding that there are many treasures to be found in the deep. We need to be mindful of the beauty, sovereignty, and creativity of each and every human system.

We don’t want to throw the baby out with the bathwater!

Felt and Observable Change

 As the nervous system reorganises,

• activation can become more modulated, with less abrupt escalation

• transitions between states become smoother and more accessible

• engagement can be sustained for longer periods

• immobilisation becomes less dominant

• restorative stillness becomes more accessible

• balance and coordination improve

These changes emerge spontaneously, as the nervous system reorganises itself into a more efficient and coherent form.

Self-Organisation

The nervous system is a template the sets the stage for all our future experience. In ways, it is like a safety net that is supposed to catch us when we fall, something we can rely upon to help us navigate and interface with our world.

If there has been an early rupture, the system can feel like a net with holes. Where it is supposed to catch our fall, we fall through: and we can end up thinking this is who we are, and this is all we can be.

Yet!

When we work with the nervous system, and support the introduction of new patterns, something stirs. Something deep, quiet and profound. Something that has long protected us - is finally safe enough, to come out to play.

This can happen at any age.

Hopefully, we will get better and better at neonatal care, and supporting the early nervous system to come back into a state of gentle alignment. Certainly, from what I see with people who often have had very serious early ruptures, and very early surgeries, there is much we can do safely, carefully, and intelligently, to allow the system to learn something new. This can happen at any age.

The great joy is that we get to watch a new hero emerge - the same person - just with greater stamina, flexibility and personal authority to play in the depths, or on the surface - as they see fit.

We get to be who we want to be.