the effects of trauma on young children stacey ryan, lcsw angela m. tomlin, ph.d. iaitmh 2006
TRANSCRIPT
The Effects of Trauma on Young Children
Stacey Ryan, LCSWAngela M. Tomlin, Ph.D.IAITMH2006
Types of Trauma
Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Abuse/Neglect Loss of caregiver
Do Young Children Experience Trauma?
Children under 12 months account for 44% of deaths from child abuse and neglect
Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome
Young children and sexual abuse Infants and toddlers may account for as many
as 10% of substantiated sexual abuse
Appearance of sexualized behavior is more likely than physical findings
The younger the child when abused, the more likely sexualized behavior appears
Young children and domestic violence
Child sees attachment figure injured
Attachment figure cannot protect self; child is unsure if she can protect him
Attachment figure may in turn injure the child
Assessing severity of trauma
Closeness of people involved to the child
What the child saw
Child’s developmental level
Reactions of important adults
How Young Children Understand Traumatic Events and Experiences Cognitive and emotional capacity determines
how child experiences trauma Level of understanding can also affect
memory 2-3 year olds do not understand the finality of
death Young children may believe they caused a
traumatic event
Clinical Patterns in Abused/Neglected InfantsGaensbauer & Mrazek (1981) observed 4
clinical patterns: Developmentally and Affectively retarded
group Depressed Group (sad and sensitive to
change) Ambivalent Group (rapid shifts in emotion) Angry Group (emotional intensity and low
frustration tolerance)
Effects of Trauma
Can appear immediately or after days, weeks
May remind young child of previous traumas, making reaction more severe
Effects of Trauma
Physical & Self-Regulation Effects Traumatic Reminders Development Play Behavior Relationship
Physical and Self-Regulation Effects Self-regulation is important task of infancy In babies and young children, problems with
self-regulation look like:
Sleep problems
Eating problems
Exaggerated startle
Hypervigilance
Physical and Self-Regulation Effects Exposure to traumatic events seems to
change the way the infant reacts to future stressors
Animal and human studies shows changes in hormones and brain chemicals after trauma
These brain changes can be long lasting, leading the child to feel numb or anxious
Traumatic reminders
Can be difficult to identify in nonverbal child
Sensory (siren, smell)
Dreams
Re-experiencing the event
Irrational fear of benign objects
Developmental Effects of Trauma Developmental delays are expected—
developmental assessment is advised
Problems may occur in development of attachments and other social emotional skills
Regression is possible
Effects on Play Skills
Repetitive actions
Driven quality
Constricted quality
Preoccupation with separation, loss, and reunion
Effects on Behavior—infants and toddlers Increased irritability/inability to soothe Sleep disturbance Emotional distress; sadness Fears of being alone; clinging; refusal to
separate Motor agitation Temper tantrums
Effects on Behavior—toddlers and preschoolers Being too clingy with adults
Not able to be comforted when upset
Problems with exploration: either reckless or too inhibited
Aggression toward caregivers, peers, animals
Angry noncompliance
Effects on Relationship
Difficulty forming positive relationships Poor sense of self Lowered self esteem Expectation of being treated poorly Loss of secure base Loss of sense of trust
Long Term Effects of Trauma
Persistent grief reactions (Bowlby)
Protest: efforts to find the parent through crying, calling, and searching
Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities
Detachment: apparent indifference to reminders; selective forgetting*
Long Term Effects of Trauma
Increased risk for academic problems Substance use and abuse Early pregnancy Criminal involvement Psychiatric symptoms and disorders Experiencing abuse as a child is linked to
abusing one’s own child
Abused children as parents
Harsh discipline Failure to respond to child’s needs Inconsistent limit setting Inability to express affection Inability to enjoy interactions with child Minimize or deny child’s painful experiences
Young children and neglect
Failure to provide for child’s physical and emotional needs
Leaving child alone for long periods Leaving child for long periods with varied and
unreliable caregivers Effects of neglect can be as devastating as
physical or sexual abuse
Effects of neglect Lack of play and other developmental skills May hoard food Unfamiliar with things we take for granted Expects to take care of self or siblings Challenges adult authority Lacks trust in adults Avoids adults when upset; hard to soothe
Expected difficult reactions to placement in foster care Previous relationship failures lead the child to
behave in ways that alienate foster parents Caregivers misread behaviors and respond in
ways that increase problems Child responds to loss of attachment figure
with behavioral, emotional, and physiological dysregulation
Expected difficult behaviors of children in care Acting like they do not need caregivers, even
under threatening conditions Acting angry when adult makes efforts to
soothe Turning away when hurt Behaving aggressively toward caregivers Behaving aggressively toward peers Problem behavior after visits
Why do we see behavior problems after visits with family? Visits with parents are traumatic reminders of
events that led to the separation or of the separation itself
Both the child and parent may feel anxious and angry
Supervised visits increasing parents feelings of incompetence
Child feels safer expressing angry feelings toward foster parent/family
How Foster Care Helps
One of the most important things a foster parent can do is to help young children have positive relationships
Doing this will help with development and behavior
To do it right, you have to pay attention to attachment
Arousal-Relaxation Cycle
Child experiences a need
Child feels upset
Adult satisfies need
Child feels content
Are there children with no attachments? There are children with no attachments
It is more likely that a child have an attachment problem rather than no attachment at all
The child will develop an attachment with the adult that is available
Why do children form attachments to abusive parents?
Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them
Children prefer the familiar, even when what is familiar is frightening
Insecure Attachments
Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance.
Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby
Insecure Attachments
Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them
Infant is afraid of the person they look to for reassurance and nurturance
Infant behavior is unorganized and bizarre These patterns are common when children
are abused or they witness domestic violence
Long term Effects of Disorganized Attachments Aggression with peers Dissociative behaviors
Role of Foster Parent in Attachment Help the child develop a healthy attachment
Help child extend attachment to you and improved behaviors to birth family, new fosterfamily, or adoptive family
How Foster Parents Can Help Work with the parents Avoid judgments about the biological parents Provide transitional objects to child Provide family pictures Have a plan for the first visit
How Foster Parents Can HelpResponding to parent anger Listen Be non-reactive Acknowledge how
difficult it is to be away from child
How Foster Parents Can Help Recognize that the child needs you, even
when they do not show it Understand rejecting behaviors as old coping
methods Listen Put words to behaviors Attend to your own reactions Encourage touch, but do not force it
How Foster Parents Can Help at Home Safety Routine that shows an adult is “in control” Soothing sensory activities Stop activities that result in re-enactment
(including television) Advocate to reduce moves to provide
continuity
Question and Answer
Factors in Determining Types of Interventions, (Osofsky & Fenichel, 1994) Safety and Stability of Current Living Situation Child’s Developmental Capacities to Make Use of
Certain Types of Interventions Quality of Pre-Traumatic and Current Care-Giving
Environment Type of Violent Event or Situation Acuteness vs. Chronicity of Trauma Actual and Psychological Proximity of the Violent
Events Post Traumatic Symptoms in Child and Caregiver Strengths and Protective Factors in Infant
Goals for Intervention (Lieberman & Van Horn, 2005) Return to Normal Development Increase Capacity to Respond to Trauma. Maintain Regular Levels of Arousal Re establish Trust in Bodily Sensations Restore Reciprocity in Close Relationships Normalize Reactions to Trauma Encourage a Differentiation Between Reliving and
Remembering Place the Traumatic Experience in Perspective
Common Intervention Needs (Osofsky & Fenichel, 1994) Improving the caregivers ability to attend to and
provide for the child’s needs Further develop caregiver’s ability to interpret child’s
feelings, reactions and support child Address cognitive distortions child may have
regarding trauma Assist the child in re experiencing trauma in
affectively tolerable doses Assist the child and caregiver in coping with any
losses
Results of Interventions Assist Child in Understanding… Stressful body experiences can be alleviated
with help of others and coping strategies Adults can support and protect child Child is not to blame Can talk about emotions rather than only
acting them out Life can contain elements of mastery, fun and
hope
Methods for Intervening
Using Play, Physical Contact and Language to Promote Developmental Progress
Offering Unstructured Reflective Developmental Guidance
Modeling Appropriate Protective Behavior Interpreting Feelings and Actions Providing Emotional Support/Empathetic
Communication Offering Crisis Intervention and Concrete Assistance
Areas of Clinical Concern include… Play Sensorimotor Disorganization Fearful Behavior Self Endangering Behavior Aggression Toward Parent Aggression Toward Peers Parental Use of Physical Discipline Parental Use of Threats, Criticisms of Child Relationship with Perpetrator
Play
Encouragement of Play with Dyad Help the Parent Understand and Support Use
of Play Allow the Parent to Be Main Supporter to
Child
Sensorimotor Disorganization Help the Parent Understand How these
behaviors Affect Them (triggers feelings of rejection, anger and frustration in parent)
Develop New Meanings for Parent
Child Fears
Support Parent Understanding of Fears Bring Attention to Cues Child Gives
Regarding Fears Develop with Parents Strategies for
Containing Fears
Aggression Toward Parent
Give Parents Meaning for This Behavior Assist Parents In Containing Feelings
Regarding this Behavior Develop Strategies for Controlling
Anger/Aggression
Aggression Toward Peers
Build Understanding of Reasons for Behavior Clinician Gives Resources for Deescalating
Behavior Empower Parents to Take Action and Assist
Child
Parental Use of Physical Punishment Explore with Parent Feelings and Concerns Contain Own Emotions and Reactions Educate on Reasons Physical Punishment
May Worsen Symptoms
Parental Criticism
Focus on Effects of Relationship Acknowledge Parent Issues/Feelings Build Awareness of Child Experience
Relationship with Perpetrator Educate on Child Needs/Experiences Support/Listen to Parent Concerns/Feelings Mutually Develop Strategies
What Evaluation Research Tells Us (Landy & Menna, 2006) Home Visiting is Critical Component Need to Distinguish Between Early Intervention and
Prevention Starting Early is Critical Intensity and Duration Counts Ongoing Assessment is Critical Services Most Effective for Moderate Levels of Risk Need for Well Trained Service Providers Use a Variety of Approaches
Treatment Videos
Discussion
Questions/Comments
Experience Case Based Discussion Structured way of thinking and talking about
situations with families Method for promoting Reflective Supervision
and Further Learning 3 Phases:
Understanding the Experience Exploring and Sharing the Collective
Knowledge and Experience of the Group Summarizing Discussion and Identifying Next
Steps
Another Way to Help
Speak for the babies..
Want to learn more?
Indiana Association for Infant and Toddler Mental Health (iaitmh.org)
317/638-3501 EXT 221 Zero to Three (zerotothree.org) The Center for Social and Emotional
Foundations for Early Learning (csefel.uiuc.edu)
Contact us….
Stacey ([email protected]) Angie ([email protected])
The Effects of Trauma on Young Children
Stacey Ryan, LCSWAngela M. Tomlin, Ph.D.IAITMH2006