orientation to child trauma
TRANSCRIPT
Module I
Orientation to Child Trauma Assessment
Part IPart I
A Review of the Community Session A Review of the Community Session with CTACwith CTAC
Project GoalProject Goal
Introduce and embed trauma informed Introduce and embed trauma informed knowledge and practices knowledge and practices
• culturally competentculturally competent• evidence supported/basedevidence supported/based• responsive to the needs of traumatized responsive to the needs of traumatized
children and their familieschildren and their families
Changes Desired: Changes Desired:
•System changeSystem change
•Service deliveryService delivery
•Child & Family outcomes Child & Family outcomes
DHSCMH
SCHOOLS
COURTS
Resource
Parents
The Team
Cultural & Linguistic Competence
Yvette D. Hyter, Ph.D., CCC-SLPSpeech-Language PathologistWestern Michigan University
Children's Trauma Assessment Center
Why this information is important
World is becoming more global.
U. S. is becoming more diverse
U. S. counties are following the same trend
Image from Office of Languages, Canada
Culture is like an Iceberg
• What is visible?
• What is underneath the surface?
Photo courtesy of L. Hyter (1997) Ting-Toomey, 1999
Every Living Being has Culture
Degazon, C. E. (2008)
•Organizing structures includeChild rearing
practices
Religion
•Family structure
•Physical space
•Communication
Diversity within Cultures
Diversity includes– Immigrant status– Race– Ethnicity– Socioeconomic status
and it includes – Social class– Sexual orientation– Gender identity– Disability
Pathway to Cultural & Linguistic Competence
Awareness Sensitivity Reciprocity Competence
Open to others; learning about cultural histories, values, beliefs (Adams, 1995)
Aware of differences & similarities that have an effect on values and behavior; no value judgments (Stafford et al., 1997)
Coordinated behaviors, attitudes, and policies that allow effect service across multiple cultural & linguistic groups (Cross et al., 1989
Recognition underlying taken-for-granted assumptions, how they guide behaviors and affect those that do not hold them (Kalyanpur & Harry, 1999)
Reflect, Revise, Retry
Know Your Self and your group
Understand History
Learn from others
Eliminate ethnocentrism
Learn from mistakes made
Tear down barriers
Be accountable
Honor Uniqueness
Center other experiences
Hyter, 2009
The Brain-Behavior The Brain-Behavior ConnectionConnection
Neurobiological & Neurodevelopmental Neurobiological & Neurodevelopmental Impact of Impact of Traumatic Stress & Prenatal Traumatic Stress & Prenatal
Alcohol Exposure Alcohol Exposure
in Children & Adolescents: in Children & Adolescents:
Understanding Difficult BehaviorsUnderstanding Difficult Behaviors
Mark A. Sloane, DO, FACOP, FAAPMark A. Sloane, DO, FACOP, FAAPKalamazoo, MIKalamazoo, MI
18 February 200918 February 2009
Mind (Brain)-Boggling Mind (Brain)-Boggling NumbersNumbers
• 100 BILLION100 BILLION
• 10001000
• 100 TRILLION100 TRILLION
Neurons in the Neurons in the human brainhuman brain
Potential Potential connections for connections for single neuronsingle neuron
Total possible Total possible neuron connectionsneuron connections
Building the brainBuilding the brainFrom simple to complex:From simple to complex:
Hierarchy of brain functionHierarchy of brain function
Brain-stem
Diencephalon
Limbic
NeocortexAbstract ThoughtAbstract ThoughtConcrete ThoughtConcrete ThoughtExecutive FunctionExecutive Function
AttachmentAttachmentSexual BehaviorSexual Behavior
Emotional RegulationEmotional RegulationMotor RegulationMotor Regulation
MotivationMotivationArousalArousalSleepSleep
BP / Heart RateBP / Heart RateRespiratory DriveRespiratory DriveBody TemperatureBody TemperaturePerry 2006Perry 2006
All sensory input All sensory input enters hereenters here
The Delicate Balance:The Delicate Balance:Brain control of emotion / Brain control of emotion /
behaviorbehaviorTop-Down Top-Down ““BrakesBrakes”” (Prefrontal Cortex) (Prefrontal Cortex)
Bottom-Up Bottom-Up “Accelerator”“Accelerator” (Brainstem/Limbic System) (Brainstem/Limbic System)
So… now let’s talk about So… now let’s talk about the the
acceleratoraccelerator
Wake up!!!Wake up!!!
Let’s talk about arousal …
No energy / tired & sleepy (Eeyore)No energy / tired & sleepy (Eeyore)
Op
tim
al “
Gold
ilocks” A
rou
sal
Op
tim
al “
Gold
ilocks” A
rou
sal
Way too wound-up / “wild” (“Tigger - on Way too wound-up / “wild” (“Tigger - on crack”)crack”)
Arousal Genesis / RegulationArousal Genesis / Regulation
Too wound-up (Tigger)Too wound-up (Tigger)
Role of Anxiety & Panic Role of Anxiety & Panic in Mood / Emotion Generationin Mood / Emotion Generation
• Fight-Flight-Freeze conceptsFight-Flight-Freeze concepts
• Anxious boys and girls can look Anxious boys and girls can look differentdifferent
• Anxiety / Panic Anxiety / Panic Anger/explosiveness Anger/explosiveness
• Multiple causes for this in kidsMultiple causes for this in kids– Genetic Genetic – Environmental (traumatic stress)Environmental (traumatic stress)
Next, let’s talk about the… Next, let’s talk about the…
BRAKESBRAKES
The Prefrontal Cortex: The Prefrontal Cortex: The home ofThe home of Executive Executive
FunctionFunctionExecutive Function:
The The “brakes” “brakes” of the of the brainbrain
• Working memoryWorking memory
• Attention regulationAttention regulation
• Planning / organizingPlanning / organizing
• Impulse controlImpulse control
• Mental flexibilityMental flexibility
• Self-monitoringSelf-monitoring
Experience alters brain Experience alters brain structurestructure
• These sculpted changes are These sculpted changes are structural structural changeschanges seen in response to the seen in response to the specific environmentspecific environment
• Allow the child’s brain to become the Allow the child’s brain to become the best brain best brain for the given surroundingsfor the given surroundings– Implications for traumatic stressImplications for traumatic stress– Implications for foster care placementsImplications for foster care placements
Building (& Rebuilding) the Building (& Rebuilding) the BrainBrain
Neural systems can be changed / treatedNeural systems can be changed / treatedbut some systems are but some systems are easiereasier to change to change
Brain-stem
Diencephalon
Limbic
Neocortex
ComplexityComplexity Plasticity &Plasticity &Ease of changeEase of change
Child Traumatic Stress & Child Traumatic Stress & the Developing Brainthe Developing Brain
Traumatic Stress & the Traumatic Stress & the Child’s Developing BrainChild’s Developing Brain
• Research reveals a Research reveals a strong linkstrong link between all between all types of types of childchild abuse /neglectabuse /neglect and the and the subsequent development of subsequent development of psychiatric psychiatric illness in adulthoodillness in adulthood
• New findings link child traumatic stress with New findings link child traumatic stress with variety of variety of adult medical illness adult medical illness
VJ Felitti, MDVJ Felitti, MD
Traumatic Stress & the Traumatic Stress & the Child’s Developing BrainChild’s Developing Brain
•Early childhood traumatic stress to Early childhood traumatic stress to the developing brain results in: the developing brain results in:
– Physical “hard wired” brain changes that Physical “hard wired” brain changes that ::
•Cause abnormal functioning (including memory)Cause abnormal functioning (including memory)
•Contribute to problematic behaviors Contribute to problematic behaviors
•Contribute to developmental delaysContribute to developmental delays
•Result in child being unable to Result in child being unable to realize potentialrealize potential
So…what about neglect???So…what about neglect???
But…this
case only
involves
neglect!
Impact of Severe NeglectImpact of Severe Neglect
Complex Trauma: SummaryComplex Trauma: Summary
• Affects the Affects the structurestructure & & functionfunction of of the brain in ways that negatively affect the brain in ways that negatively affect allall stages of development: stages of development:
– Social Social
– Emotional Emotional
– Cognitive Cognitive
Complex Trauma Complex Trauma
AndAnd
Developmental Trauma Developmental Trauma DisorderDisorder
Connie Black-Pond MA, LMSW, LPCConnie Black-Pond MA, LMSW, LPC
Children who experienced complex trauma Children who experienced complex trauma have endured multiple interpersonal have endured multiple interpersonal traumatic events from a very young agetraumatic events from a very young age
The trauma was usually caused by adults The trauma was usually caused by adults who should have been caring for and who should have been caring for and protecting the childprotecting the child
What is Complex Trauma?What is Complex Trauma?
Sources: Cook et al. (2005). Psychiatry Ann,35(5):390-398; van Der Kolk & Courtois. (2005) J Trauma Stress, 18:385-388.
The term Complex trauma (or Developmental Trauma Disorder) describes exposure to chronic (repeated) trauma and the impact of such exposure (traumatic stress) on the child.
Domains Impacted by Domains Impacted by Complex TraumaComplex Trauma
BehavioralControl
Cognition
Attachment
Dissociation
Affect Regulation
BiologySelf Concept
Functional ImpairmentFunctional Impairment
ScholasticScholastic FamilialFamilial Peer Peer LegalLegal VocationalVocational
Generalized Expectancies Generalized Expectancies of the Traumatized Childof the Traumatized Child Negative self-attributeNegative self-attribute Loss of caregiverLoss of caregiver Loss of protectionLoss of protection Loss of trust in social systemLoss of trust in social system Lack of recourseLack of recourse Inevitability of future Inevitability of future
victimizationvictimization
What do we see?What do we see?
Disruptions of affect regulationDisruptions of affect regulation Disturbed attachment patternsDisturbed attachment patterns Rapid behavioral regressions and Rapid behavioral regressions and
shifts in emotional statesshifts in emotional states Loss of autonomous strivingsLoss of autonomous strivings Aggression towards self and/or othersAggression towards self and/or others Failure to achieve developmental Failure to achieve developmental
stridesstrides
Loss of bodily regulation: sleep, food Loss of bodily regulation: sleep, food and self careand self care
Negative working models of their worldNegative working models of their world Somatic problemsSomatic problems Anticipatory and traumatic reactionsAnticipatory and traumatic reactions Self hatred and self blameSelf hatred and self blame Chronic sense of Chronic sense of
ineffectiveness/helplessnessineffectiveness/helplessness
May suffer from distinct alterations May suffer from distinct alterations of states of consciousness:of states of consciousness: AmnesiaAmnesia Difficulties with attentionDifficulties with attention Disorientation in time and spaceDisorientation in time and space Unable to identify internal states - Unable to identify internal states -
alexythimiaalexythimia
The child’s age and developmental stageThe child’s age and developmental stage
The child’s perception of the danger facedThe child’s perception of the danger faced
Whether the child was the victim or a witnessWhether the child was the victim or a witness
The child’s relationship to the victim or perpetratorThe child’s relationship to the victim or perpetrator
The child’s past experience with traumaThe child’s past experience with trauma
The challenges the child faces following the traumaThe challenges the child faces following the trauma
The presence/availability of adults who can offer The presence/availability of adults who can offer help, reassurance, and protectionhelp, reassurance, and protection
Other factors that affect a child’s experience of a potentially traumatic event include:
If we don’t look for or If we don’t look for or acknowledge trauma in the acknowledge trauma in the
lives of children and lives of children and adolescents, we end up adolescents, we end up chasing behaviors and chasing behaviors and
limiting the possibilities for limiting the possibilities for change.change.
The behavioral and emotional The behavioral and emotional adaptations that maltreated adaptations that maltreated children make in order to children make in order to
survive are brilliant, survive are brilliant, creative solutions, and are creative solutions, and are
personally costly.personally costly.
If you don’t ask, If you don’t ask, they won’t tell.they won’t tell.
Traumatic Expectations of the Traumatic Expectations of the WorldWorld
How Children Respond to How Children Respond to TraumaTrauma
A strong relationship with a competent, caring adult
Feeling connected with positive role models/mentors
Being able to reach out to others for help
Having his or her talents/abilities recognized and appreciated
Having empathy and caring for other people
Good communication and social skills
A sense of humor
Factors that may help a child “bounce back” from traumatic events include:
Trauma = chaos,Trauma = chaos,
Structure = healingStructure = healing
Sensory Processing Disorder
Ben J. Atchison, PhD, OTR, FAOTA
Department of Occupational Therapy
Western Michigan University
Sensory Processing is..
Detection
Registration
Modulation
Response
Key Idea is:
ADAPTIVE RESPONSE
Meaningful
Purposeful
Organized
Sensory Processing Disorder (SPD)
Sensory Modulation Disorder Sensory-Based Motor Disorder Sensory Discrimination Disorder
SOR SUR SS
SOR=Sensory Over-reactivity-Low threshold
SUR=Sensory Under-reactivity-High Threshold
SS=Sensory Seeking/Craving-High Threshold
Miller, et al, (2007) , Mar.April AJOT
Dsypraxia Postural Disorders
Visual
Auditory
Tactile
Position/Mvt
Taste
Smell
Children with a trauma history demonstrate significant prevalence of sensory
modulation disorders
Atchison (2008)
This atypical responsiveness has a significant impact on the quality of lifefor these children and their families by
limiting their participation in home, school,and community activities
Cohn, Miller, & Tickle-Degnen, 2000; Dunn, 2001;Dunn & Westman, 1997; Miller, Reismann McIntosh, & Simon, 2001; Parham &
Mailloux, 1995) and countless parent testimony…
There are five key limitations or disabilities commonly demonstrated by
children with disturbances in sensory modulation
Parham and Mailloux (1995)
Including…
(1)Decreased social skills and participation in play
(2) Disturbances in self-confidence–self-esteem
(3) Difficulties with daily life skills and at school
(4) Anxiety, disturbances in attention, and disturbances in the ability to regulate reactions to others
(5) Disturbances in skill development
Social Communication
Yvette D. Hyter, Ph.D., CCC-SLPSpeech-Language PathologistWestern Michigan University
Children’s Trauma Assessment Center
[email protected], 269-387-8025
“A new world of complex relationships and feelings opens up when the peer group takes its place along side the family as the emotional focus of the child’s life.
Greenspan, S. (1993) cited in Nelson, N. W.
Early Peer Relationships Contribute To:
• Work in groups
• Deal with disappointment
• Enjoy friendships
• Understand social relations
Greenspan, S. (1993) cited in Nelson, N. W.
Social Communication
The ability to and
Coggins, Timler, & Olswang, 2007
influence othersunderstand and interpret
social situations
Social Communication Framework
Higher Order Executive Functions Decision making and strategic planning processes
Social Communicative Behaviors
Social Communicative CompetenceUsing language in interpersonally appropriate ways to successfully influence people and interpret events
Coggins, T. E., Timler,G. R. & Olswang, L.. B. (2007).
Social CognitionUnderstanding why people act in certain ways and what they are likely to do next.
LanguageSentence Structure
Word meanings/relationshipsLanguage use
Benefits of Social Communication:
• Development of positive peer interactions
• Higher levels of prosocial behaviors
• Less aggression
• Boosts self esteem
• Supports positive mental health
• Supports interactions throughout the life span
Hey!.....Here’s a good idea!...Hey!.....Here’s a good idea!...Let’s finish with a group… Let’s finish with a group…
stress stress test!!!test!!!
Stress TestStress Test
• The next picture contains 2 identical dolphins. It has been The next picture contains 2 identical dolphins. It has been recently used in national stress research.recently used in national stress research.
• Notice the two dolphins jumping out of the water. The Notice the two dolphins jumping out of the water. The dolphins are identical. A closely monitored, scientific study dolphins are identical. A closely monitored, scientific study revealed that, in spite of the fact that the dolphins are revealed that, in spite of the fact that the dolphins are identical, a person identical, a person under stressunder stress would find would find differences differences in in the two dolphins. The more differences found between the the two dolphins. The more differences found between the dolphins, the more stress that person is experiencing.dolphins, the more stress that person is experiencing.
• Look closely at the photo and if you find more than one or Look closely at the photo and if you find more than one or two differences, you need to go on two differences, you need to go on vacation. vacation.
Are You Ready…For the Next Step?
Are You Ready for the Next Step?
You Are Ready….IF…
•Commitment
•Energy
•Passion
•Teaming
This presentation is part of a comprehensive professional education and training project created by the SW Michigan
Children’s Trauma Assessment Center funded by a grant from the Substance Abuse and Mental Health Services, Department of
Health and Human Services which funds the National Children’s Trauma Stress Network