War of the Worlds: Long Term Effects of Early Maltreatment

Transforming lives through the power of mentoring Friends for Youth’s Mentoring Institute February 2011 Webinar

Webinar Logistics – Adding Comments•  All attendees muted for best sound•  “Raise your hand” to be unmuted – works best for telephone or headset-to-computer connections; please monitor background noise•  Type questions and comments in the question box; responses will either be direct to you or possibly shared with all attendees Sarah Kremer, ATR-BC John Stirling, MD Program Director Director Center for Child Protection Friends for Youth’s Santa Clara Valley Mentoring Institute Medical Center

Slides posted toSlideShareLink and brief surveyincluded in follow-upemail

John Stirling, MDCenter for Child ProtectionSanta Clara Valley Medical CenterSan Jose CA

  I have not yet found any corporate sponsors  I do not own any pharmaceutical stock  I do have a deep personal and financial interest in how well our children grow up.

  Lives w/ single mother since parents separated 8yr ago  Evaluated for sexual abuse at age 5, recanted disclosure  Runaway, cuts self, suicide attempt

  Adopted at 5mo, “inadequate caretaker”  “Never met a stranger”  Poor school performance  Behavior issues: explosive, violent

  Parents divorced when he was 2yo, lives with mother and stepfather  Academically accomplished, but behaviors challenging  Violence, “explosive”  Meds: Concerta, Tenex, Risperdal

  problems with interpersonal functioning  cognitive functioning  mental health disorders, including PTSD  substance abuse disorders  affective / conduct disorders  anxiety disorders  eating disorders Briere, 1997; Nader, 1997; Saigh et al., 1999

  Abused and neglected kids  Suffer a wide variety of insults including  Prenatal exposures,  Chronic activation of the threat response, and  Lack of parental support to provide  Coping tools (self-regulation) that enable  Cognitive and interpersonal learning

  What is abuse?  What does it give children?  What does it take away?  Who’s at risk?  What can we do?  What’s with the title?

  Child traumatic stress refers to the physical and emotional responses of a child to events that threaten the life or physical integrity of the child or of someone critically important to the child (such as a parent or sibling).  Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal. 12 12

•  Acute trauma is a single traumatic event that is limited in time. Examples include: –  Serious accidents –  Community violence –  Natural disasters (earthquakes, wildfires, floods) –  Sudden or violent loss of a loved one –  Physical or sexual assault 13 13

  Chronic trauma refers to the experience of multiple traumatic events.  These may be multiple and varied events—such as a child who is exposed to domestic violence, is involved in a serious car accident, and then becomes a victim of community violence—or longstanding trauma such as physical abuse, neglect, or war.  The effects of chronic trauma are often cumulative, as each event serves to remind the child of prior trauma and reinforce its negative impact. 14

Remember:  The foster care system was conceived to help children who had suffered severe trauma.

Physical Abuse Sexual Abuse ~40% Neglect

Domestic Child 20 –Violence Abuse 40% Family dysfunction?

  The brain is not mature at birth  Experience determines its architecture  Timing can be critical  Relationships are critical for social and emotional development  Effects of adversity

StressHypothalamic / pituitary stimulation Adrenal cortisol release

Studies show abuse victims have:  Enhanced pituitary sensitivity - Duval, 2004  Cortisol spikes w/ trauma reminders - Elzinga, 2003  Higher cortisol levels, abnl variation - Ciccetti, 2001  Cortisol spikes, higher baseline - Bugenthal, 2003  Heightened inflammatory response - Altemus, 2003

  Cerebral cortex ◦  EEG changes ◦  smaller callosum  Limbic system ◦  neuronal changes ◦  decreased size  Brainstem/ Cerebellum ◦  altered transmitters

  Cognitive (left brain) ◦  Vocabulary ◦  Logical reasoning  Experiential (right brain) ◦  Emotional awareness ◦  Self-regulation

Criteria include:  Intrusive memories  Persistent arousal  Avoidance of “trigger” events…after an event that aroused fear, horror, helplessness

“There is no such thing as a baby; there is a baby and someone.” - D.W. Winnicott

 Attachment Regulation Cognition

  Overview of attachment theory  Styles of attachment  Disorders of attachment  Interventions

Bowlby’s definition of attachment:  “Any form of behavior that results in a person seeking proximity  to some other differentiated and preferred individual,  usually conceived as stronger and/or wiser.”

  Evolutionary advantage: A secure child can explore!

  Child forms EXPECTATIONS regarding relationship with primary CAREGIVER.  Child learns to BEHAVE (in predictable ways) based on those expectations  Child learns AFFECT REGULATION ◦  Caregiver interaction guides responses to emotionally distressing situations. ◦  Governs how emotions are perceived.

  VIEW OF OTHERS ◦  Can I count on this person to be available? ◦  Can I predict interactions?  VIEW OF SELF ◦  Am I desirable/worthy of support?What can a person reasonably expect of others?

  Secure ◦  expectations rewarded, comfort available  Avoidant ◦  rejects caregiver  Anxious ◦  clings, fearful of separation  Disordered ◦  approach/avoidance

  Secure (56-65%)  Insecure ◦  Avoidant (20-25%) ◦  Ambivalent (10-20%) ◦  Disorganized (5-10%)

Child Parent  Secure   Nurturing  Avoidant   Dismissive  Ambivalent   Preoccupied  Disorganized   Disorganized

“Recovery” can depend on:  Neuronal growth  Behavioral compensation  Minimizing secondary trauma  … with a little help from your friends

Most conditions will get better if you don’t make them worse!

  Persistent fear/alert state  Poor differentiation of affect  Dysregulation of affect …and thus may be hard to parent!

One Positive Feedback Cycle Parent Stress childmaltreatment challenges Attachment problems

A critical period for secure attachment? There’s no data!

  Complex PTSD  Attention-Deficit Hyperactivity Disorder  Oppositional Defiant Disorder  Major Depression or Bipolar Disorder  Autism Spectrum Disorders  “Reactive Attachment Disorder”

Traumatized children are a unique group of kids:  Trauma-altered physiology  Often lack resilience; “empty toolbox”  “Fish out of water” – We (providers and parents) can’t expect simple and quick adaptation

Diagnosis  Must take into account early stresses  Looks for maladaptive adaptations

Therapy  Remember that early trauma affects not only perception, but ability to learn  Should involve both hemispheres  Cannot involve only the child!

  Meds control symptoms, don’t “cure”  Many types ◦  Antidepressants ◦  Antianxiety agents ◦  Stimulants for attention ◦  Antipsychotics  Usevaries widely  None are approved for use in children!

  Abused and neglected kids  Suffer a wide variety of insults including  Prenatal exposures,  Chronic activation of the threat response, and  Lack of parental support to provide  Coping tools (self-regulation) that enable  Cognitive and interpersonal learning

“God grant me the strength to change those things I can, the grace to accept those I cannot, and the wisdom to know the difference.” - Serenity Prayer

“It ain’t over ‘til it’s over.” - Yogi Berra

NCTSNet.orgCAevidencebasedclearinghouse.org

Slides posted toSlideShareLink and brief surveyincluded in follow-upemail

www.mentoringinstitute.org 650-559-0200•  Products and resourcesfor mentoring programs http://www.facebook.com/pages/Friends-for-Youth/105093182858863•  Trainings for programstaff, mentors, and mentees http://twitter.com/friendsforyouth•  Individual consultations Check out our Blog http://www.friendsforyouth.blogspot.com/

War of the Worlds: Long Term Effects of Early Maltreatment

by Friends for Youth, Inc. on Feb 15, 2011

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War of the Worlds: Long Term Effects of Early Maltreatment — Presentation Transcript