Childhood traumatic stress

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Childhood Traumatic Stress
National Resource Ctr. for Family-Centered
Practice and Permanency Planning
January 8, 2008 Teleconference
April Naturale, LCSW

2. What is Trauma?
• Either a physical injury caused by some
direct external force or psychological
injury caused by some extreme emotional
assault
• Can result in stress-physical, psychological
and social forces or pressures that cause
some significant modification, usually a
distortion

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Examples of Trauma
Natural events such as an accident-a fall that
results in a physical injury or fear
Man made events such as physical assault and/or
abuse, torture
Psychological events such as separation from
primary caregiver, neglect, humiliation and other
forms of psychological assault
Community events-death of a family member, large
scale accidents or disasters

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Key Concepts of Trauma
• People will have varying psychological
and emotional reactions
• Talking with a traumatized person in
crisis does not always mean talking
about the trauma
• People pace themselves when dealing
with grief,pain, sorrow and loss
• Interject normalcy and respite

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• Feel very nervous, helpless, fearful, sad or
angry
• Feel hopeless about the future
• Feel detached or unconcerned about others
• Feel numb and unable to experience love or joy
• Feel that things are unreal; dissociate
People may feel and express their reactions differently.
They may:
Normal Reactions to Stress & Trauma
Emotional and Behavioral

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Normal Reactions to Stress & Trauma
Emotional and Behavioral cont’d.
• Have an increased startle response
• Be irritable or have outbursts of anger
• Become easily upset or agitated
• Have frequent distressing dreams or memories
• Avoid people, places and things related to
the disaster
• Have trouble concentrating

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• Have an upset stomach, eat too much or too little,
or have other gastrointestinal problems
• Experience a pounding heart, rapid breathing,
sweating, or severe headache when thinking about
the disaster
• Have trouble falling asleep, staying asleep, or
sleeping too much
How people may physically and cognitively react to a
disaster varies. They may:
Normal Reactions to Stress & Trauma
Physical & Cognitive

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Normal Reactions To Stress & Trauma
Physical & Cognitive cont’d.
• Be on guard and constantly alert
• Be jumpy and startle easily at sudden noises
• Have a worsening of chronic medical problems
• Be exhausted
• Have trouble concentrating
• Elicit poor judgment
• Exhibit denial of emotions or lack memory of
events

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Adults often underestimate
what children experience
the extent of their reactions
and what they need to know
Trauma Responses in Children

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• Regression to younger development stage
(e.g.bed-wetting, thumb sucking, clinging)
• Poor school performance
• Isolation
• High Risk Behaviour such as:
-In teens, promiscuous or adult-like behavior
(e.g. taking charge)
-Use of substances such as alcohol or drugs
Common Trauma Responses
in Children

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• Impaired concentration
• Impaired learning
• Aggression
• Recklessness
• Reduced inhibitions
• Somatic complaints
• School refusal
Common Trauma Responses
in Children

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Children can develop wide range
of difficulties that may become serious
• Depression
• Anxiety
• Behaviour Disorders
• Mood Disorders
More Serious Trauma Responses
in Children

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Children suffer a dual response:
1.The impact of the trauma on themselves &
2.the emotional distress of caregivers,
parents and teachers
Adult support is a strong protective factor or
impacted adults may make at-risk children
more vulnerable
Unique Effects of Childhood Trauma

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• Disruption of child or adolescent
development
• Interfering in the growth of emotional
maturity
• Repeated exposure can affect the child's
brain and nervous system
Unique Effects of Childhood Trauma

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• Increased use of health/mental health
services
• Increased involvement with the child
welfare and juvenile justice systems
• Profound long-term consequences
Known Potential Impacts

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• Childhood traumatic grief (CTG)-
a condition which compromises child’s
capacity to negotiate normal grieving
• CTG and the loss of parental support
places children at high risk for serious
emotional difficulties and major mental
health problems
Traumatic Grief Responses

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• I know how you feel
• Let’s talk about something else
• You are strong enough to deal with this
• You’ll feel better soon
• You did everything you could
• You need to relax
• It’s good that you are alive
What Not to Say to Bereaved Children

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• Help children understand, name and accept
their feelings
• Practice and teach children (and parents)
skills of :
calming and soothing
tolerating
managing difficult feelings
Immediate Child Care Worker Tasks

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• Affirm that the reactions are common
in response to traumatic events
• Help the child make sense of the trauma
• Link children and their families with
other helpful agencies
Continuing Child Care Worker Tasks

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• Maximize caring and support
• Just answer the questions they ask
• Provide sense of safety and security in
whatever form you can
• Reassure children that adults are in control
• Tolerate regression or need to control
• Reinforce their primary role as child/student
• Return to routine
Instructions to Parents & Caregivers

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• Many children find it helpful to write
down their trauma experiences in the
form of pictures, diaries and stories
• Others use:
-photography
-musical expression
-drama performance
Therapeutic Activities

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Therapeutic Activities
A WORD OF WARNING:
When conducting therapeutic activities,
refrain from probing for feelings unless
you are the treating therapist intending
to activate trauma memory as part of
Exposure Therapy. Otherwise, just allow
and support expressive activities.

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Trauma experts in Oklahoma working with Katrina
evacuees monitored rising resentment between
host families and evacuee children. An
interventionist conducted focus groups to find out
what was most important to ‘the acting out’
children. They discovered the need to give the
evacuee families an opportunity to say thank you
and organized a class activity including shopping
together and cooking traditional Southern meals.
Case Examples: Oklahoma City

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What about Posttraumatic Stress
Disorder (PTSD)?
Experiencing, witnessing or being confronted
with an event involving actual or threatened
death or serious injury; one’s response
involves intense fear, helplessness or horror.
The event is persistently reexperienced via:
recurrent, intrusive distressing memories,
dreams; psychological distress and/or
physiological reactivity at exposure to cues,
symbols or resemblances of traumatic event.
(DSM-IVTR, 2000)

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PTSD Prevalence
Most People
will not
develop PTSD after a disaster
or other traumatic event
Many, though, may have
serious symptoms of distress

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• Select appropriate screening instruments
for children and adolescents (obtain consent)
(e.g. UCLAPTSD Index)
• Communicate the results sensitively
and ensure adequate mental health
services for those in need
• Refer to specialized service providers
Assessment and Screening

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The Psychological Tasks of
Recovery
• Regaining a sense of mastery and
control
• Resumption of age-appropriate
roles and activities
• Develop new normal-routine

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Tasks of Recovery
• Give children and families permission to
celebrate even in the midst of a trauma-
encourage the children to play, laugh, experience
joy
• Have children spend time with friends and
family…return to school asap-don’t isolate them
• Plan for emergencies: add ‘tools’ to the
children’s backpack that will help them cope(e.g.
flashlight, family picture, object of comfort,
crayons/writing pad, etc.)

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Long Term Affects of Disaster
Trauma and Stress
• Anger, resentment and conflict
• Uncertainty about the future
• Prolonged mourning of losses
• Diminished problem solving
• Isolation and hopelessness
• Health problems
• Lifestyle changes

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Longer Term Interventions
• Continuing Needs Assessment
• Psychological First Aid
• Secondary Psol Assist (Crisis Counseling)
• Outreach
• Enhanced or Intermediate Services
• Traumatic Grief and Bereavement Support
• Cognitive Behavioral Treatment