Und

erst

andi

ng t

he D

evel

opm

enta

l U

nder

stan

ding

the

Dev

elop

men

tal

Eff

ects

of

Tra

uma

Eff

ects

of

Tra

uma

Vic

ky K

elly

Psy

.D.,

LC

SW, M

HA

, V

icto

ria.

Kel

ly@

stat

e.de

.us

MY

TH

S

•A

ll it

take

s is

love

.

•T

ime

heal

s a

ll w

ound

s.

•Li

ttle

child

ren

don’

t rem

em

ber

wh

at

happ

ens,

so

we

can

mov

e th

em

with

im

puni

ty.

•O

ur tr

aditi

onal

ther

apeu

tic “

tool

boxe

s”ar

e

suffi

cien

t.

Com

plex

Tra

uma

(NC

TS

N)

•E

xpos

ure

to m

ultip

le tr

aum

atic

eve

nts

that

oc

cur

with

in th

e ca

reg

ivin

gre

latio

nshi

p –

the

syst

em

that

is s

uppo

sed

to b

e th

e s

ourc

e of

sa

fety

and

sta

bilit

y in

a c

hild

’s li

fe.

•M

altr

eatm

ent �

emot

iona

l dys

regu

latio

n�lo

ss o

f se

cure

ba

se

�lo

ss o

f dire

ctio

n �in

abili

ty to

det

ect

or r

esp

ond

to d

ange

r �

revi

ctim

izat

ion

Rel

atio

nal T

raum

a:R

elat

iona

l Tra

uma:

A C

ompl

ex T

raum

a P

ersp

ecti

veA

Com

plex

Tra

uma

Per

spec

tive

Tra

uma

of th

e m

altr

eatm

ent i

tsel

f.

+ L

oss

of th

e pa

rent

as

a so

urce

of s

ecu

rity

and

com

fort

.

+ O

verw

helm

ing

inte

rna

l dis

tre

ss w

ith n

o a

ssis

tanc

e in

reg

ulat

ing.

Impa

ct o

f N

egle

ct

NC

TSN

Dat

a

9,33

6 ch

ildre

n an

d yo

uth

serv

ed n

atio

nally

:

�70

% m

ultip

le fo

rms

of tr

aum

a

�48

% s

igni

fican

t beh

avio

ral p

robl

ems

�41

% s

igni

fican

t aca

dem

ic p

robl

ems

�31

% s

igni

fican

t atta

chm

ent

�11

% s

uici

dalit

y

Pyn

oos

, et a

l, 20

08

Dia

gnos

tic

Pro

blem

s

•P

ost-

Tra

umat

ic S

tres

s D

isor

der

(PT

SD)

CA

NS

Stu

dy 7

668

abus

ed c

hild

ren

in fo

ster

car

e: 6

3%

had

trau

ma

sym

ptom

s, b

ut n

early

95%

did

not

mee

t cr

iteria

fo

r P

TS

D

•D

evel

opm

enta

l Tra

uma

Dis

orde

r (p

ropo

sed)

Dev

elop

men

tal T

raum

a D

isor

der

Dom

ains

of

Impa

irm

ent

Pro

pose

d

Be

ssel

va

n de

rK

olk

MD

ww

w.tr

aum

acen

ter.

org

Dev

elop

men

tal T

raum

a D

isor

der

Dom

ains

of

Impa

irm

ent

•A

ttach

men

t

•B

iolo

gy/P

hysi

olog

y

•A

ffect

Reg

ulat

ion

•D

isso

cia

tion

•B

ehav

iora

l Con

trol

•C

ogni

tions

•S

elf C

once

pt

Dev

elop

men

tal E

ffec

ts

Inte

rper

sona

l

Sen

se o

f Sel

f

Abi

lity

to T

hink

Em

otio

nal

Reg

ulat

ion

Bra

in D

evel

opm

ent &

Phy

siol

ogy

Dis

tres

s-R

elie

f Cyc

le

Dis

tre

ss

Em

path

ic

Atta

chm

ent

Car

egi

ving

Rel

ief

Ben

efits

•R

ecip

roci

ty (

giv

e &

take

)

•E

ffect

ance

( I c

an

effe

ct b

ehav

ior

in o

ther

s�

ther

efor

e, “

I mat

ter”

)

•T

rust

•In

tere

st �

Atte

ntio

n

•R

ewar

d �Jo

y

•E

arly

tem

plat

es

of a

ffect

reg

ulat

ion

Att

unem

ent

�In

crea

ses

regu

latio

n (“

feel

ing

felt

by”)

•S

ympa

thy

vs. E

mpa

thy

Dis

tres

s �N

o R

elie

f

Dis

tre

ss

Fai

lure

of

Atta

chm

ent

Em

path

ic

Car

e

Pro

long

ed D

istr

ess

Lia

bilit

ies

•Im

paire

d re

cipr

ocity

;

•Im

paire

d se

nse

that

“I m

atte

r”

•Im

paire

d tr

ust;

•Im

paire

d in

tere

st �

atte

ntio

n;

•Im

paire

d re

war

d �jo

y;

•Im

paire

d af

fect

reg

ulat

ion.

Impo

rtan

ce o

f M

isat

tune

men

t

If m

anag

ed e

ffect

ivel

y te

ach

es:

�N

egat

ive

fee

lings

ca

n be

end

ured

;

�C

are

give

r (o

ther

s) a

s re

sour

ce;

�F

rust

ratio

n to

lera

nce

;

�In

crea

ses

resi

lienc

e;

�In

tera

ctiv

e re

pair.

Mis

attu

nem

ent

Mis

attu

nem

ent :

Not

Han

dled

: N

ot H

andl

ed

•F

ailu

res

in in

tera

ctiv

e re

pair;

•D

ysre

gula

ted

sham

e an

d ov

erw

helm

ing

affe

cts�

ove

rwhe

lm c

opin

g;

•Im

paire

d vo

cabu

lary

for

inte

rnal

sta

tes;

•N

ot in

tern

aliz

ing

care

give

r a

s re

sour

ce;

•A

ffect

ive

bia

ses.

Unr

elie

ved

Dis

tres

s

•A

rous

al �

cort

isol

stre

ss r

esp

onse

;

•N

umbi

ng (

endo

geno

us o

piod

s);

•F

ree

zing

;

•C

ompu

lsiv

e s

elf-

relia

nce

;

Con

diti

oned

Fea

r R

espo

nses

(LeD

oux)

Thi

nkin

g B

rain

Sen

sory

Am

ygda

la

Inpu

t

Stim

ulus

Rea

ctio

n

Con

diti

oned

Fea

r R

espo

nses

Con

diti

oned

Fea

r R

espo

nses

(LeD

oux)

Thi

nkin

g B

rain

Tha

lam

usE

mot

iona

l B

rain

Am

ygda

la

Stim

ulus

Rea

ctio

n

Dev

elop

men

t of

the

Hem

isph

eres

•Le

ft H

emis

pher

e

•D

evel

ops

late

r

•R

espo

nsiv

e to

sta

bilit

y

•P

rom

otes

inhi

bitio

n

•R

ight

Hem

isph

ere

•D

evel

ops

earli

er

•R

espo

nsiv

e to

ac

tivat

ion

(cha

nges

in

the

envi

ronm

ent)

•P

rom

otes

act

ivat

ion

Rol

es o

f the

Hem

isph

eres

Lef

t•

Lang

uage

•S

eque

ntia

l, lo

gica

l

•C

onte

nt

•S

ocia

l em

otio

nsG

uilt

& r

emor

se

Prid

e

•In

hibi

tion

Rig

ht•

Non

verb

al

com

mun

icat

ion

•C

onte

xt

•P

rimar

y em

otio

ns

•S

elec

tive

atte

ntio

n

•T

actil

e pe

rcep

tions

•In

tern

al r

epre

sent

atio

n

Mal

trea

tmen

t an

d E

ffec

ts o

n So

cial

Inf

orm

atio

n P

roce

ssin

g

•D

isto

rted

per

cep

tions

•H

ostil

e a

ttrib

utio

nalb

ias

(Ke

n D

odge

)

•Im

paire

d ab

ility

to th

ink

abou

t one

’s

thou

ghts

and

feel

ings

•C

oncl

usio

ns

•Li

mite

d re

call

and

diffi

culty

ass

oci

atin

g cu

rren

t beh

avio

rs w

ith p

ast m

altr

eat

men

t.

Inte

rnal

Wor

king

Mod

elIn

tern

al W

orki

ng M

odel

Secu

reSe

cure

•I a

m lo

vabl

e, w

orth

y,

capa

ble,

goo

d…..

•O

ther

s ar

e ba

sica

lly

good

, hel

pful

, ca

ring…

•T

he w

orld

is a

saf

e &

pr

edic

tabl

e pl

ace.

Inse

cure

Inse

cure

•I a

m b

ad, d

efec

tive,

un

wor

thy,

un

lova

ble…

•O

ther

s ar

e hu

rtfu

l, co

erci

ve, r

ejec

ting…

•T

he w

orld

is a

da

nger

ous

, cha

otic

pl

ace.

Per

cept

ions

+ B

elie

fs � ���

Beh

avio

r

Impo

rtan

ce o

f a

Impo

rtan

ce o

f a

Coh

eren

t N

arra

tive

Coh

eren

t N

arra

tive

•M

ake

sens

e of

life

exp

erie

nce

s;

•C

halle

nge

ear

ly e

go-c

entr

ic b

elie

fs;

•In

tegr

ate

posi

tive

and

nega

tive

feel

ings

;

•A

cqui

re g

rea

ter

secu

rity

in a

ttach

men

t.

Eff

ects

of

Tra

uma

on t

he S

elf

Eff

ects

of

Tra

uma

on t

he S

elf

Syst

emSy

stem

•“F

alse

sel

f”;

•P

rofo

und

sham

e;

•E

arly

mal

adap

tive

sche

mas

or

life

scrip

ts:

Aba

ndon

men

t, M

istr

ust,

Def

ectiv

enes

s/sh

ame

Eff

ects

of

Tra

uma

on

Eff

ects

of

Tra

uma

on

Inte

rper

sona

l Fun

ctio

ning

Inte

rper

sona

l Fun

ctio

ning

•D

efic

its in

em

path

y

•D

efic

its in

so

cial

em

otio

ns;

•D

efic

its in

pro

-so

cial

beh

avio

rs;

•D

efic

its in

mor

al d

evel

opm

ent.

Em

path

y T

rain

ing

•A

ttune

men

t

•E

mpa

thy

(su

bjec

tive)

•E

mpa

thy

(inte

rpe

rson

al)

�R

ecog

nizi

ng fe

elin

gs (

affe

ctiv

e)

�T

akin

g pe

rsp

ectiv

e of

oth

er

Tou

chst

ones

of

Stra

tegy

Tou

chst

ones

of

Stra

tegy

•S

afet

yfirs

t an

d fo

rem

ost!!

!!

•D

evel

opm

enta

l (no

t chr

onol

ogic

al)

age

•D

ete

rmin

e “W

on’

t”ve

rsus

“C

an’t”

•C

orre

ctiv

e e

xper

ienc

es

of a

ttune

men

t so

the

child

“fe

els

felt

by”

anot

her

•M

akin

g se

nse

of e

xper

ienc

e

•A

pplie

d de

velo

pmen

tal p

sych

olog

y

Adv

ocac

y

•E

sta

blis

hing

per

man

ency

•P

reve

nt m

ultip

le p

lace

me

nts

•E

duca

te p

are

nts

(birt

h, fo

ster

, ado

ptiv

e) to

re

cogn

ize

tra

uma

rea

ctio

ns a

nd

find

wa

ys to

co

pe in

con

stru

ctiv

e w

ays

•A

dvoc

ate

for

the

Dev

elop

men

tal T

raum

a D

isor

der

Dia

gnos

is (

ww

w.d

sm5.

org)

Sele

cted

Ref

eren

ces

•w

ww

.nct

sn.o

rg

•Le

doux

, J (

1998

). T

he

Em

otio

nal B

rain

.

•P

olla

ck, S

D, e

t al

(201

0). E

ffect

s of

ea

rly d

epriv

atio

n.

Chi

ld D

evlo

pmen

t, 81

, 22

4 –

236.

•T

eich

er, M

H, e

t al

(200

3). T

he

neur

obio

logi

cal

cons

eque

nces

of e

arly

st

ress

and

chi

ldho

od

mal

trea

tmen

t. N

euro

scie

nce

and

Bio

beha

vior

Rev

iew

, 27

, 33

–44

.

Ref

eren

ces

Con

t’d

•P

erry

, B.D

. (20

06).

A

pply

ing

prin

cipl

es o

f ne

urod

evel

opm

ent t

o cl

inic

al w

ork

with

m

altr

eate

d ch

ildre

n. In

N

B W

ebb

(Ed.

),

Wor

king

with

tr

aum

atiz

ed y

outh

(27

-5

2). N

Y: G

uilfo

rd.

•P

ynoo

s, R

. (20

08).

R

evie

w o

f NC

TS

N

Cor

e D

ata.

NC

TS

N.

•va

n de

rK

olk,

BA

(2

005)

. D

evel

opm

enta

l T

raum

a D

isor

der.

P

sych

iatr

ic A

nnal

s.