Childhood Trauma

Childhood TraumaNatasha Harmon, MSChildrens Home + AidToday GoalsRealize that you may be seeing the impact of trauma in children you serveRecognize how trauma affects all individuals involved Respond by asking the important questions and by trying to do what you canThe human brain & how it is affected by trauma4CortexLimbicMidbrainBrainstemAbstract ThoughtConcrete ThoughtAffiliation"Attachment"Sexual BehaviorEmotional Reactivity"Arousal"Appetite/SatietyBlood PressureHeart RateBody TemperatureSleepMotor RegulationComplexity and PlasticityBrain Development (Perry)44Brain develops from the bottom up and inside outPhysical (breathing, heart, blood pressure)lower brain I may refer to as the primal brain because we dont have logical thinking when acting out of this brainEmotional (happiness, aggression, attachment)Thinking (planning, consequences, impulse control)- This is the portion of the brain that is first to go when dysregulated

Dr. Dan Siegel-Flipping you lid-when a child becomes dysregulated they immediately loose their sense of thought, emotional regulation, impulse control, attachment and react from their primal brain we will talk more about what to do when this happens later

Brain DevelopmentNeurons are chemical messages

-Message comes in and the neurons fire-More times the same message is repeated the thicker the neuron connection-The experience children have with their environment determines which neurons and synapses survive and which do notDont lose it you may lose it as a young child5Brain DevelopmentCritical Periods- for some aspects of brain development, timing is critical. Important abilities will be lost or diminished if they dont develop at the right time (e.g. vision, attachment, language)Childhood experiences impact how the brain developsTraumatic experiences interfere with normal brain development when they occur during a period when the brain is developingAdolescence is a critical period as well. Dont just assume that all critical periods occur in infancy or at younger ages.

With early, persistent or chronic trauma, the brain gets bathed in stress hormones and the child then is on constant alert6Brain DevelopmentEvents can cause changes in the brain. A single, powerful experience can affect our brain for life. Repeated smaller experiences can also change our brain. Practice (sports, art, studies, etc.)- the more we repeat things the stronger the brain connections becomeThis is why there is always hope that youth can get better with new, positive experiences

So when something is repeated time and time again- it sticks. This is how babies learn and I am sure that you have repeated things like the numbers1-10 or the ABCs more times than you can count to your children to help them learn. Its important to remember that just like the good stuff that is repeated, the bad stuff that is repeated sticks too! So try to remember this when working with children who have been traumatized.

As we talk about practice/repetition I think about memorySome would argue that babies dont make memories. I would challenge that because although they may not have words it doesnt mean that the baby doesnt have feelings and events can leave lasting impressions with them. We often talk about body memories and how children may be triggered by something and not be able to identify the connection to the trauma.

EXAMPLE!! A former client would scream and cry when she was taken to visitations with her biological mother when she was very young. No physical abuse or neglect was occurring during these supervised visits so many were confused as to why she had such extreme behaviors. She didnt have language to identify what she was scared of or what she remembered from her past but it was evident that her biological mother had made a lasting, negative impression on her by her behaviors.7Brain Development

Lets look at the effects of trauma on the brainhow much trauma and how long the child is exposed affects brain development. Trauma impacts brain size and the brains connections. See how the child with extreme neglect has more holes/gaps-suggesting less connections

8Teenage DevelopmentPhysical AppearanceEmotional rollercoasterCognitive-Always the last to develop

When teens hit puberty we see a burst of new brain cells and more development occurs. Physical appearance is first this is how we know a teen is in puberty-we see the hair on boys faces, breast development in girls

Then comes the emotional development-this is tied up with forming their identity and dealing with pressures like leaving the nestSome may feel like emotional rollercoaster is too kind!! It is a very challenging time for the teen and parents

Cognitive development takes a long time and this isnt completed until 25 years oldThink of car insurance-when your child turns 16 and you put them on your insurance it is very expensivewhat happens when they are 25?? It goes down. Also, you cant rent a car in most places until 25.it seems these organizations knew about this--Cognitive development is when impulse control gets developed.9Cognitive DevelopmentScience has taught us that the part of the brain that develops last during adolescence is the prefrontal lobe, which controls:Complicated Decision-MakingThinking AheadPlanningComparing Risks and Rewards

Something dumb after high school forgive yourselfblame your undeveloped brain

I find this interesting because often adolescence is the time when we make teen decide major life decisions such as whether or not to attend college/ enter employment field/choose majorwhen really they are still developing in these areas. I guess if you figured it out the first time you were LUCKY!!!10Teens CognitionTeens make decisions differently than adults. They rely more on their emotional centers than their thinking centersThey often think before they act but they are using a different set of values to make these decisionsThey often choose actions that are much riskier than adults would choose

You may be thinking tell me something I didnt know.

Given its lack of development, the teen brain will default to the emotional center, rather than the frontal lobe when making a decision.

So when we say why didnt you think about this when the teen has done somethingtruth is they may have thought about it but just used different logic!

11The Brain is complex..did you get all that???

REMEMBER: BOTTOM up development

Physical processes, emotional processes then cognitive12So..what is childhood trauma?Childhood TraumaThe experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects.National Institute of Mental Health

Overwhelming, uncontrollable experiences that psychologically impact victims by creating in them feelings of helplessness, vulnerability, loss of safety and loss of controlBeverly James

We will discuss event, experience and effects in greater detail soon.

I have found that when a child feels a loss of safety and control they are greatly impacted by this experience and dysregulated behavior often is the result14Childhood TraumaEvent One time or chronicExperience whether the event is experienced as scary or threateningEffect - long-lasting and life altering

The three es Event- can be single event such as accident, illness, natural disasterOR could be repeated event or repeated exposure

EXAMPLE?? World Trade Center attacks is an example of a 1x event that was scary and had life-altering effects for some.15Adverse Childhood Experiences(ACEs)Growing up (prior to age 18) in a household with:Recurrent physical abuseRecurrent emotional abuseSexual abuseEmotional or physical neglectFelitti, 2009

ACEs are experiences which most agree would be considered traumatic and thus have an impact on the child16Adverse Childhood ExperiencesGrowing up (prior to age 18) in a household with:An alcohol or drug abuserAn incarcerated household memberSomeone who is chronically depressed, suicidal, institutionalized or mentally illMother being treated violentlyOne or no biological parentsFelitti, 2009

Presence of stress in childs environment American Academy of Pediatricians17Beyond ACEsBeing a victim of crime

Community violence

Traumatic lossBeyond ACEs other experiences that can be traumatic--

Traumatic loss-being an adoption preservation counselor I have seen the effects of traumatic loss and reoccurrences of loss and how deeply these can impact children. Dr. Purvis and Cross from Texas Christian University who are leaders in trauma work have stated that Relationship trauma can only be healed relationallyI found this to be very powerful and motivating reminding us that a child who has gone through relationship trauma will need extensive repair done in this area.18ExperienceDefinition says emotionally painful or distressful

Scary or threatening

Age matters What is threatening for a 3 year old may not be threatening to a 15 year old

Bottom line feels scary, threatening your safety-it can be traumatic-THIS can be DIFFERENT For everyone

Now what about that memory/impression thing? Heres where it really comes in to play.Example: 15 year old who I work with: when the parents start yelling and she feels confronted she immediately starts crying, saying I dont know to anything she is asked and she starts to wring her handsshe is reacting from a place of fear-Does she remember doing this as child in her abusive home? No but she has done this for as long as we know. I feel it is because she has similar memories of getting yelled at and this may have been her response as a younger child.

19Prenatal Experience (Henry, Sloane & Black-Pond)Children exposed to prenatal alcohol combined with childhood trauma have significantly greater severe neurodevelopmental deficits in :AttentionLanguage MemoryThese children have also been shown to have greaterOppositional/Defiant BehaviorInattentionHyperactivityImpulsivitySocial problems

This study by Henry, Sloane & Black-Pond in 2007 looked at the effects of prenatal alcohol exposure combined with other childhood trauma. They compared children with prenatal alcohol exposure to children who experienced other childhood trauma and they found children with both types of trauma experienced more sever neurodevlopmental deficits and had greater behavioral problems. 20EffectsA childs brain development responds to the childs experiences

StressAlarm System as a Survival Mechanism

After TraumaChild overreacts to normal situationsChild is on constant alertChild may over-interpret signs of danger

What do you do when you are worried? How does it feel?

Imagine feeling that way 24/7

Can change the shape of the part of the brain that triggers danger** 2 children exposed to the same trauma may demonstrate very different symptoms and behaviors

21Perrys Dominant Response TypesHyper arousalFlight or FightHyper-vigilantEasily OffendedOver-reactiveAvoidant

DissociationFreeze/NumbOverwhelmedNonresponsiveSelf-MutilationPassing Out

Boys: thought to use this more than girls flight or fight however many girls I know identify with the fight response

Girls: dissociation-The little girl who I told you about earlier who used to scream when on visits with bio mom eventually stopped screaming and she would appear non responsive or dissociative after the visits for about 3 days back with her foster mom

Babies: somatic appetite, sleep, startle, FAILURE TO THRIVE

Adolescents with both response types huge risk-takers22More EffectsEmotionsTrouble calming downTrouble understanding others emotional expressionsPoor emotional awareness-less feeling words

CognitionLearning problemsEarly delays in language developmentInformation processing problems

Physically Abused Children See Anger Where Others See FearGraphic by: Seth Pollak, courtesy PNAS

Study was done that showed how much difficulty children who have experienced trauma have reading facial expressions. They default to anger.

Abigail Baird did another study on teens reading facial expressions. She found that teens can read their parents facial expressions but with models they couldnt read them correctly. So if your child misinterprets your facial expression it may truly be their lack of development in this area. 24More EffectsPhysiological (Body System)Trouble regulating body (eating, sleep)Physical complaintsSelf mutilationBehavior ControlHigh risk behaviors (sexualized, aggressive)Impulsive BehaviorsSocial RelationshipsBoundary problems with othersTrouble forming and keeping relationships

More EffectsExposure to Trauma Increases the Risk for:Major Mental IllnessSubstance AbuseAIDS and Sexually Transmitted DiseasesAcademic DifficultiesImpaired Physical HealthTrauma increases the odds for Major Depression nearly 2foldTrauma significantly increases risk for alcohol and drug abuse in adolescentsTrauma impacts school readiness, school performance and increases the likelihood of dropping out of high school

National Child Traumatic Stress Network states that about 75% of youth in the juvenile justice system have trauma symptoms

26This is intense! How can I help?Perrys key conceptsResilience: Not everyone exposed to adverse experiences is traumatizedRecovery-Brains respond to repeated stimuli (practice more of the good stuff)Even as adults, brains are capable of learning and changingSo FINALLY some positive news!!!

2) So we can help children heal by rehearsing some positive coping strategies and techniques

28Create a safe environment Be consistent-rewards & consequencesBe predictable- have a routine and structureReassure them that you a safe personFelt safetyBe consistent with these children. They can be very impulsive and safety can be a risk factor for these children thus if you are consistent that can provide a feeling of safety.

Be predictable-most of these children do not do well with change and can become very emotional when unexpected things occur.EXAMPLE: (A.L.) Client we had in our program-would be upset if his mom would not sit in on his session because I needed her to sign paperwork for her sister who I was working with. He would hyper focus on her absence, he would get aggressive and very agitated. He often would be able to stand the change for maybe 5 minutes then he would be so anxious and dysregulated that he would come get her. He needed the safety of the routine in the office environment. **EQUAL BALANCE OF NURTURE AND STRUCTURE are important for these children-1 cup nurture for every 1 cup structure

Reassure them that you are a safe person- You have to do this by words and behaviors. We often talk about felt safety This is how safe the child feels-it does not matter how safe you tell a child a situation is! If he doesnt feel safe he will not be able to regulate. Its all about his felt safetyCreate Felt Safety by attending to the childs physical and emotional needs, respond appropriately and interact with child appropriately.29SupportEvery child needs 3 supportive adults in their lives as they grow upMentors should stay in the childs life at least 6 months to be effectiveOften very helpful for parents to be in a group setting to have others recognize the complexities of their childrens behaviorsSEARCH institutue-3 supportive adults

Mentors- Be careful about coming into the kids life and leaving as this could be considered a great loss to a fragile child. 30Help Them Soothe ThemselvesRecognize these youth can be challengingTry to keep your emotional reactions in check and stay calmWhen a child has gone to the primal brain-they will need your help to regulatePraise them for any coping strategies they use to calm downeven after a meltdownAs you have heard today, these children can have a host of complexities and they can be challenging to work with.

Its important for you to keep your emotions in check and not REACT to their behaviors; RESPONDwith care and compassion. Even if the child is having a meltdown at an inopportune time it will not help for you to yell or get worked up. They need you to be calm and help get them calm. This takes practicebut remember the more you do it the easier it will come to you

Again when a child has gone to their primal brainthere is not teaching or correcting that can be done until they are regulated again. So help them to calm down and later come back to the lesson.

PRAISE, PRAISE, PRAISE!!! Remember if a child can use any coping strategy to calm down you want to praise this because it is hard to do! Praise and help them practice these strategies often so they also become easier and more natural to implement.

31Soothing SuggestionsLollipops, drinking cold drink through the strawChewing gumHydrationFood every 2 hoursDeep Pressure/WeightsExerciseMagic Mustache

Traumatized children often do not get a lot of sensory exposure during their first years of life so it has been proven beneficial to provide them rich, safe sensory activities. Snacks, activities (such as deep pressure activities, weighted blankets) and other physical exercises provide good sources of sensory input

Utilize the sucking reflex-which is very soothing to many children-Have them suck on a lollipop or popsicle or drink something cold through a strawChewing gum also seems to provide some sensory input and can help soothe a child

Also, make sure they are plenty hydrated as some dysregulation has been shown to come from this

Drs. Purvis and Cross (Texas Christian University) suggest a child should have something to eat every 2 hours to help regulate blood sugar and keep those bodily systems regulated Magic Mustache I also learned from Dr. Purvis and Dr. Cross-there is a pressure point about our lip, if we apply some pressure it and hold it for 10 seconds, it can help to soothe us

**Find what works for themsome kids really like sour treats to help regulate!

32IDEAL Response (Purvis & Cross)ImmediateDirect EfficientAction-basedLeveled at the behavior-not at the childImmediate Response-Respond to the behavior in the moment, less than 3 seconds is preferred

Direct-NOT Forceful-still have to be nurturing and connecting. To do this you want to use eye contact, ask permission before you touch them(especially if hostile) and try to ensure their felt safety

Lets discuss the efficient response on the NEXT SLIDE

33Efficient ResponseRespond using engagementUse the least threatening form of engagement possible

Playful engagementStructured engagement-choices/compromiseCalming engagementProtective engagementEfficient-you want to respond to them using engagement. Try to use playful engagement as it is the least threatening. You may have to use more strict forms of engagement such as calming or protective engagement if the child is unable to regulate themselves and you need to ensure their safety.

You can use more structured engagement if the child is emotionally present utilizing strategies such as choices and compromise

Lets talk more about choices on the next slide34ChoicesGive choices to help teach cooperation rather than get into a power struggleChoices should be simpleGives child sense of appropriate controlGive choices 1 or 2-point to fingers35IDEAL Response (Purvis & Cross)ImmediateDirect EfficientAction-basedLeveled at the behavior-not at the childGetting back to the IDEAL response we will discuss the Action-based response

36Action-Based Response: Behavior Re-dosWhy dont you try that again, this time with respect?If at first you dont succeed try, try again!Behavior Re-dos are very important for many reasons: give the child the opportunity to learn how to do the appropriate action/give the brain a chance to practice this appropriate action again and hopefully strengthen that brain connection/ allowing yourself a chance to praise the child for trying again and doing it right

37IDEAL Response (Purvis & Cross)ImmediateDirect EfficientAction-basedLeveled at the behavior-not at the childFinally you want to ensure that your response is leveled at the childs behavior, not the child.

Remember this behavior is not a character flawthey behave this way because of their trauma so dont react to the child-RESPOND to the behavior.

38We are learning more than we ever have about the brain and trauma. Brains and Behaviors can changethere is hope!Thank you!