Orientation To Child TraumaPresentation Transcript
Module I Orientation to Child Trauma Assessment
A Review of the Community Session with CTAC
Introduce and embed trauma informed knowledge and practices
responsive to the needs of traumatized children and their families
Child & Family outcomes
DHS CMH SCHOOLS COURTS Resource Parents
Cultural & Linguistic Competence Yvette D. Hyter, Ph.D., CCC-SLP Speech-Language Pathologist Western 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 include
Child rearing practices
Diversity within Cultures
and it includes
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 Ten Principle Practices Eliminate ethnocentrism Cultural Competence Learn from mistakes made Tear down barriers Be accountable Honor Uniqueness Center other experiences Hyter, 2009
The Brain-Behavior Connection Neurobiological & Neurodevelopmental Impact of Traumatic Stress & Prenatal Alcohol Exposure in Children & Adolescents: Understanding Difficult Behaviors Mark A. Sloane, DO, FACOP, FAAP Kalamazoo, MI 18 February 2009
Mind (Brain)-Boggling Numbers
Neurons in the human brain
Potential connections for single neuron
Total possible neuron connections
Building the brain From simple to complex: Hierarchy of brain function Brain- stem Diencephalon Limbic Neocortex Abstract Thought Concrete Thought Executive Function Attachment Sexual Behavior Emotional Regulation Motor Regulation Motivation Arousal Sleep BP / Heart Rate Respiratory Drive Body Temperature Perry 2006 All sensory input enters here
The Delicate Balance: Brain control of emotion / behavior Top-Down “ Brakes ” (Prefrontal Cortex) Bottom-Up “Accelerator” (Brainstem/Limbic System)
So… now let’s talk about the accelerator
Wake up!!! Let’s talk about arousal …
No energy / tired & sleepy (Eeyore) Optimal “Goldilocks” Arousal Way too wound-up / “wild” (“Tigger - on crack”) Arousal Genesis / Regulation Too wound-up (Tigger)
Role of Anxiety & Panic in Mood / Emotion Generation
Anxious boys and girls can look different
Anxiety / Panic Anger/explosiveness
Multiple causes for this in kids
Environmental (traumatic stress)
Next, let’s talk about the… BRAKES
The Prefrontal Cortex: The home of Executive Function
The “brakes” of the brain
Planning / organizing
Experience alters brain structure
These sculpted changes are structural changes seen in response to the specific environment
Allow the child’s brain to become the best brain for the given surroundings
Implications for traumatic stress
Implications for foster care placements
Building (& Rebuilding) the Brain Neural systems can be changed / treated but some systems are easier to change Brain- stem Diencephalon Limbic Neocortex Complexity Plasticity & Ease of change
Child Traumatic Stress & the Developing Brain
Traumatic Stress & the Child’s Developing Brain
Research reveals a strong link between all types of child abuse /neglect and the subsequent development of psychiatric illness in adulthood
New findings link child traumatic stress with variety of adult medical illness
VJ Felitti, MD
Traumatic Stress & the Child’s Developing Brain
Early childhood traumatic stress to the developing brain results in:
Physical “hard wired” brain changes that :
Cause abnormal functioning (including memory)
Contribute to problematic behaviors
Contribute to developmental delays
Result in child being unable to realize potential
So…what about neglect???
But…this case only involves neglect !
Impact of Severe Neglect
Complex Trauma: Summary
Affects the structure & function of the brain in ways that negatively affect all stages of development:
Children who experienced complex trauma have endured multiple interpersonal traumatic events from a very young age
The trauma was usually caused by adults who should have been caring for and protecting the child
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 Complex Trauma Behavioral Control Cognition Attachment Dissociation Affect Regulation Biology Self Concept
Generalized Expectancies of the Traumatized Child
Loss of caregiver
Loss of protection
Loss of trust in social system
Lack of recourse
Inevitability of future victimization
What do we see?
Disruptions of affect regulation
Disturbed attachment patterns
Rapid behavioral regressions and shifts in emotional states
Loss of autonomous strivings
Aggression towards self and/or others
Failure to achieve developmental strides
Loss of bodily regulation: sleep, food and self care
Negative working models of their world
Anticipatory and traumatic reactions
Self hatred and self blame
Chronic sense of ineffectiveness/helplessness
May suffer from distinct alterations of states of consciousness:
Difficulties with attention
Disorientation in time and space
Unable to identify internal states - alexythimia
The child’s age and developmental stage
The child’s perception of the danger faced
Whether the child was the victim or a witness
The child’s relationship to the victim or perpetrator
The child’s past experience with trauma
The challenges the child faces following the trauma
The presence/availability of adults who can offer help, reassurance, and protection
Other factors that affect a child’s experience of a potentially traumatic event include:
If we don’t look for or acknowledge trauma in the lives of children and adolescents, we end up chasing behaviors and limiting the possibilities for change.
The behavioral and emotional adaptations that maltreated children make in order to survive are brilliant, creative solutions, and are personally costly.
If you don’t ask, they won’t tell.
Traumatic Expectations of the World
How Children Respond to Trauma
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,
Structure = healing
Sensory Processing Disorder Ben J. Atchison, PhD, OTR, FAOTA Department of Occupational Therapy Western Michigan University
Sensory Processing is..
Key Idea is:
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
This atypical responsiveness has a significant impact on the quality of life
for these children and their families by limiting their participation in home, school,
There are five key limitations or disabilities commonly demonstrated by
children with disturbances in sensory modulation
Parham and Mailloux (1995)
(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-SLP Speech-Language Pathologist Western Michigan University Children’s Trauma Assessment Center [email_address] , 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
Understand social relations
Greenspan, S. (1993) cited in Nelson, N. W.
The ability to
Coggins, Timler, & Olswang, 2007 influence others understand and interpret social situations
Social Communication Framework Higher Order Executive Functions Decision making and strategic planning processes Social Communicative Behaviors Social Communicative Competence Using language in interpersonally appropriate ways to successfully influence people and interpret events Coggins, T. E., Timler,G. R. & Olswang, L.. B. (2007). Social Cognition Understanding why people act in certain ways and what they are likely to do next. Language Sentence Structure Word meanings/relationships Language use
Benefits of Social Communication:
Development of positive peer interactions
Higher levels of prosocial behaviors
Boosts self esteem
Supports positive mental health
Supports interactions throughout the life span
Hey!.....Here’s a good idea!... Let’s finish with a group… stress test!!!
The next picture contains 2 identical dolphins. It has been recently used in national stress research.
Notice the two dolphins jumping out of the water. The dolphins are identical. A closely monitored, scientific study revealed that, in spite of the fact that the dolphins are identical, a person under stress would find differences in the two dolphins. The more differences found between the dolphins, the more stress that person is experiencing.
Look closely at the photo and if you find more than one or two differences, you need to go on vacation.
Are You Ready…For the Next Step? Are You Ready for the Next Step?
You Are Ready….IF…
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