A	
  few	
  days	
  a*er	
  the	
  presenta0on,	
  we	
  will	
  send	
  an	
  evalua0on	
  and	
  links	
  to	
  an	
  
a...
To	
  receive	
  no0fica0ons	
  of	
  future	
  webinars	
  and	
  other	
  learning	
  opportuni0es	
  
from	
  the	
  Mil...
•  Webinar participants who want to get 2.0 NASW CE
Credits (or just want proof that they participated in this
training) n...
Today’s Presenter:
Kimberly Renk, Ph.D. is currently an Associate Professor of Clinical
Psychology and the Director of the...
Trauma in Young Children
Under 4-Years of Age:
Attachment, Neurobiology,
and Interventions
Kimberly Renk, Ph.D.
Associate ...
Disclosures
•  Support for initial exploration of this topic was provided via the CHIPS
(Child Intervention, Prevention, a...
Objectives
•  Review developmental concepts that are related to how young
children connect to caregivers and ultimately wi...
Important Characteristics of Early
Childhood
(Lawson & Quinn, 2013)
•  Young children are developing communication, empath...
Species Expectable Versus
Experience Dependent
(Twardosz & Lutzker, 2010)
•  Species Expectable: A range of conditions tha...
Attunement Affects
Brain Development
•  During interactions characterized by
attunement, caregivers and their infants
sync...
Borrowed from Neil
Boris, M.D.; based on
Andrew Meltzer’s work
on infant imitation.
Still Face Example
hIp://www.youtube.com/watch?v=apzXGEbZht0	
  
Why Is Attunement So Important?
1.  Selection of neuronal
pathways
2.  Emotions—development
and regulation
3.  Shaping of ...
Attachment
•  Enduring emotional tie between
infant and caregivers that
develops through repeated
interaction over time.
•...
Stages of Attachment
•  By 2 weeks of age, infants prefer the human voice.
•  By 4 weeks of age, infants prefer their moth...
Assessment of Attachment
•  Ainsworth’s Strange Situation: Presents infants with a
series of social stressors so that the ...
Attachment Classifications
(Ainsworth et al., 1978; Main & Solomon, 1986)
•  Securely Attached.
•  Insecurely Attached.
– ...
Attachment Example
hIp://www.youtube.com/watch?v=2iQ3b1-­‐43J4	
  
Resilience to Trauma
•  The concept of resilience can be important
in understanding trauma and the results of
maltreatment...
Adverse Childhood Experiences Study
(acestudy.org)
•  A large study with approximately 18,000 participants
conduced by the...
Defining Trauma
(Rice & Groves, 2005)
•  Trauma is an exceptional experience.
•  Trauma overwhelms individuals’ capacity t...
Will You Know
When It Is Trauma?
hIp://www.youtube.com/watch?v=pSe40tX-­‐oTA	
  
Events Related to Trauma
(Finkelhor, Ormrod, Turner, & Hamby, 2005)
1.  Bullying.
2.  Assault with injury.
3.  Assault wit...
Abuse and Neglect
in Young Children
•  Approximately 772,000 children were abused and/or
neglected in the U.S. in 2008 (U....
Parenting in the Midst of
Substance Misuse
•  Almost 70 million children live with one parent who
abused or was dependent ...
So Why Should We Be
Concerned with These Parents?
•  Parents who misuse substances often engage in
impaired or inadequate ...
Understanding	
  Symptoms	
  	
  
in	
  Young	
  Children	
  
(Carter	
  et	
  al.,	
  2004;	
  Egger	
  &	
  Angold,	
  2...
Signs of Trauma
•  Psychological Effects.
–  Dysregulation of affect.
–  Aggressive or sexualized/provocative behavior.
– ...
Symptom Correlates for Trauma
in Young Children
(De Young, Kenardy, & Cobham, 2011; Finkelhor et al., 2005; Lieberman & Kn...
Main Categories of
Trauma Symptoms
(Rice & Groves, 2005)
•  The child relieves or re-experiences the
traumatic event.
– Po...
Posttraumatic Stress Disorder
a la the DSM-IV-TR
(APA, 2000)
1.  The individual has been exposed to a traumatic event that...
Posttraumatic Stress Disorder
a la the DSM-IV-TR
(Continued)
3.  Persistent avoidance of stimuli associated with the
traum...
Posttraumatic Stress Disorder
a la the DSM-IV-TR
(Continued)
4.  Persistent symptoms of increased arousal, including
two o...
General Problems With Using the
DSM In Young Children
•  DSM makes no assumption that each disorder is a
completely discre...
Problems with the DSM’s PTSD
Diagnosis In Young Children
•  Diagnostic criteria for developmentally appropriate behavioral...
An Alternate System:
The DC: 0-3
(Zero to Three, 2005)
•  DC: 0-3 was developed by the Diagnostic
Classification Task Forc...
An Alternate System:
The DC: 0-3
(Continued; Zero to Three, 2005)
•  Axis I: Primary Diagnosis.
•  Axis II: Relationship C...
Posttraumatic Stress
in Young Children via the DC:0-3R
100. Posttraumatic Stress Disorder
(Zero to Three, 2005)
1.  The ch...
Posttraumatic Stress
in Young Children via the DC:0-3R
3. The child experiences a numbing of responsiveness or
development...
DSM-5 Criteria for Children Who
Are 6-Years of Age or Younger!
(American Psychological Association, 2014; Scheeringa et al...
DSM-5 Criteria (Continued)
(American Psychological Association, 2014; Scheeringa et al., 1995)
C. Persistent avoidance of ...
DSM-5 Criteria (Continued)
(American Psychological Association, 2014; Scheeringa et al., 1995)
D. Alterations in arousal a...
Results Using the
PTSD Alternative Criteria
(Scheeringa et al., 2001; Scheeringa et al., 2003; Scheeringa et al., 2005)
• ...
The Importance of
DSM-5 Criteria
•  These criteria:
– More adequately describe the
experience of young children with
PTSD....
Mutual
regulation:
Regulated
with the help
of the
caregiver
Self-
regulation
of behavior
and
emotions
Behavior and Emotion...
Main Problems with Studying the
Neurological Effects of Trauma
in Young Children
•  Many studies look at adults retrospect...
The Human Brain
(Twardosz & Lutzker, 2010)
•  Mature brains can be sensitized by
traumatic experiences.
•  But…younger bra...
Neurodevelopment and Neglect
hIps://www.youtube.com/watch?v=bF3j5UVCSCA	
  
Brain Development and Trauma
•  Trauma can affect how the brain functions and the
autonomic nervous system.
–  Young child...
Stress and Brain Development
•  Stress has a substantial impact on the structure
and function of limbic structures (e.g., ...
Brain Development and
Childhood Maltreatment
•  Childhood maltreatment has been related
to reductions in hippocampal volum...
Brain Development and PTSD
(De Bellis et al., 2002)
•  Maltreated children who were diagnosed
with PTSD (versus those who ...
Assessment Recommendations
(AACAP, 2010)
•  Routine inclusion of questions regarding trauma
exposure and symptoms of PTSD ...
Potential Treatments of Interest
•  Two main types of treatment programs have been showing promise
(Gleason et al., 2007):...
Child-Parent Psychotherapy
(CPP) (Lieberman & Van Horn, 2005)
•  A relationship-based intervention grounded in psychoanaly...
Child-Parent Psychotherapy
(CPP) (Lieberman & Van Horn, 2005)
•  Efficacy is supported by several randomized clinical tria...
Circle of Security Parenting Program
(Marvin, Cooper, Hoffman, & Powell, 2002)
1.  Welcome to the Circle of Security: Intr...
Circle of Security Description
hIp://www.youtube.com/watch?v=xH1CbC4No24	
  
•  Protect me
•  Comfort me
•  Delight in me
•  Organize my feelings
Circle of Security
Parent Attending to the Child’s Ne...
Trauma-Focused CBT
(Cohen & Mannarino, 2008)
•  A multicomponent model that includes:
–  Parental treatment.
–  Psychoeduc...
Adapta@ons	
  that	
  Are	
  Required	
  for	
  
Young	
  Children	
  
(Scheeringa	
  et	
  al.,	
  2007;	
  Scheeringa	
 ...
Other Treatments Being Tested
•  Posttraumatic Parenting (Shelby et al., 2010).
–  Blends parent-child dyadic treatments w...
Other Treatments Being Tested
(Continued)
•  Attachment, Self-Regulation, and Competency
Model (Arvidson et al., 2011; Law...
Future Directions
•  Trauma is “the largest single preventable cause of mental
illness” (Sharfstein, 2005).
•  More work t...
A Message About the Long-Term
Effects of Trauma…
hIps://www.youtube.com/watch?v=SPzVUGE3dds	
  
Questions?
“Never doubt that a small group of
thoughtful, committed citizens
can change the world.
Indeed, it’s the only t...
References
Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study
of the ...
References
Brunson, K. L., Eghbal-Ahmadi, M., Bender, R., Chen, Y., & Baram, T. Z. (2001). Long-term,
progressive hippocam...
References
Dube, S. R., Felitti, V. J., Dong, M. Giles, W. H., & Anda, R. F. (2003). The impact of adverse
childhood exper...
References
Houshyar, S., & Kaufman, J. (2005). Resiliency in maltreated children. In S. Goldstein & R. B.
Brooks (Eds.), H...
References
Mayes, L. C., & Truman, S. (2002). Substance abuse and parenting. In M. Bornstein (Ed.),
Handbook of parenting ...
References
Samplin, E., Ikuta, T., Malhotra, A. K., Szeszko, P. R., & DeRosse, P. (2013). Sex differences in
resilience to...
References
Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the
diagnosis of pos...
References
UNICEF. (2003). A league table of child maltreatment death in rich nations. Innocenti Report Card, 5.
Retrieved...
YouTube Video Links
Still Face (Slide 12): http://www.youtube.com/watch?v=apzXGEbZht0
Attachment (Slide 18): http://www.yo...
•  Webinar participants who want to get 2.0 NASW CE
Credits (or just want proof that they participated in this
training) n...
Military Families Learning Network
This material is based upon work supported by the National Institute of Food and Agricu...
Military Families Learning Network!
This material is based upon work supported by the National Institute of Food and Agric...
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April 3, 2014-Trauma in Young Children Under 4-Years of Age: Attachment, Neurobiology, and Interventions

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The PowerPoint presentation for a 2 hour webinar exploring how young children are particularly vulnerable to the effects of trauma, especially when their relationships with their caregivers are affected. (Find the live recording of this webinar @ https://learn.extension.org/events/1416) This presentation examines the characteristics of trauma in young children who are 4-years of age and younger, formal diagnostic criteria as well as other signs and symptoms of trauma, the neurobiological underpinnings of traumatic experiences for children, and evidence-based interventions that may be useful for remediating the effects of trauma for young children and their families.

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April 3, 2014-Trauma in Young Children Under 4-Years of Age: Attachment, Neurobiology, and Interventions

  1. 1. A  few  days  a*er  the  presenta0on,  we  will  send  an  evalua0on  and  links  to  an   archive  and  resources.       We  appreciate  your  feedback.    To  receive  these  emails,  please  enter  your   email  address  in  the  chat  box  before  we  start  the  recording.     All  chat  will  be  recorded  and  archived.   Welcome to the 
 Military Families Learning Network Webinar:
 Trauma in Young Children Under 4 Years of Age: Attachment, Neurobiology, and Interventions" This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-48755-20306.
  2. 2. To  receive  no0fica0ons  of  future  webinars  and  other  learning  opportuni0es   from  the  Military  Families  Learning  Network,  sign  up  for  the  Military  Families   Learning  Network  Email  Mailing  list  at:  h"p://bit.ly/MFLNlist   www.eXtension.org/militaryfamilies     facebook.com/militaryfamilies     bit.ly/MFLNwebinars     blogs.eXtension.org/militaryfamilies     twiIer.com/MilFamLN     Welcome to the 
 Military Families Learning Network This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-48755-20306.
  3. 3. •  Webinar participants who want to get 2.0 NASW CE Credits (or just want proof that they participated in this training) need to take the post-test provided at the end of the webinar" »  CE Certificates of completion will be automatically emailed to participants upon completion of the post-test. " »  Questions/concerns surrounding the National Association of Social Workers (NASW) CE credit certificates can be emailed to this address: MFLNmilitaryfamilyadvocate@gmail.com" »  Sometimes state/professional licensure boards for fields other than social work recognize NASW CE Credits, however, you would have to check with your state and/or professional boards if you need CE Credits for your field. " ! •  To learn more about obtaining CE Credits, please visit this website: http://blogs.extension.org/militaryfamilies/family-development/ professional-development/nasw-ce-credits/" CE Credit Information"
  4. 4. Today’s Presenter: Kimberly Renk, Ph.D. is currently an Associate Professor of Clinical Psychology and the Director of the Clinical Psychology Ph.D. program at the University of Central Florida as well as a licensed Psychologist in the state of Florida. She earned her Bachelor’s degree in Psychology from the University of Illinois, her Master’ s degree in Clinical Psychology from Illinois State University, and her Ph.D. in Clinical Psychology from the University of South Florida with a pre-doctoral internship at Louisiana State University Health Sciences Center in New Orleans, Louisiana. Although Dr. Renk has diverse clinical experience with young children, school-age children, adolescents, and adults in a variety of psychological settings, the majority of Dr. Renk’s work has addressed the needs of young children who are already experiencing emotional and behavioral problems, particularly due to stressors in their families. Throughout her graduate students and her postdoctoral work, Dr. Renk has worked with traumatized children in a variety of settings, including the completion of Infant Mental Health Fellowship training while at the Louisiana State University Health Sciences Center. Most recently, Dr. Renk has been working with Neil Boris, M.D., of Nemours Children’s Hospital to integrate evidence-based parenting interventions into the child welfare system in the Central Florida region. INSERT  PHOTO  
  5. 5. Trauma in Young Children Under 4-Years of Age: Attachment, Neurobiology, and Interventions Kimberly Renk, Ph.D. Associate Professor of Clinical Psychology Director of Clinical Training University of Central Florida Department of Psychology Orlando, Florida
  6. 6. Disclosures •  Support for initial exploration of this topic was provided via the CHIPS (Child Intervention, Prevention, and Services) Fellowship Program, National Institute of Mental Health. •  Other support for work regarding correlates of psychological symptoms in young children was provided by the UCF In-House Research Program and the National Institute of Health Loan Repayment Program. •  Thanks to my current grad students, Brea, Catherine, Jayme, Meagan, Amanda, and Annelise; to all my former students whose hard work helped propel us forward; to my research collaborator, Neil Boris, M.D.; to my husband, Rob; and my two sweet boys. =)
  7. 7. Objectives •  Review developmental concepts that are related to how young children connect to caregivers and ultimately will process trauma. •  Understand the signs and symptoms of trauma as well as the diagnostic criteria of Posttraumatic Stress Disorder for young children. •  Discuss the neurobiological underpinnings of trauma for young children. •  Begin to consider the evidence-based treatments that are currently available and adaptations that may need to be made to accommodate young children.
  8. 8. Important Characteristics of Early Childhood (Lawson & Quinn, 2013) •  Young children are developing communication, empathy, relationships, self-awareness, self-regulation, and a basic sense of self. •  Inconsistency in caregiver provisions undermines healthy child development. –  Co-regulation of emotions is critical, with attachment being particularly important. •  Young children are especially vulnerable to the impact of trauma (especially from a family member).
  9. 9. Species Expectable Versus Experience Dependent (Twardosz & Lutzker, 2010) •  Species Expectable: A range of conditions that support typical human development. –  Protection and nurturance from adults. –  Opportunities to explore and learn from the environment. –  Versus experiences that are outside of the range of human experience (e.g., abuse, trauma). •  Experience Dependent: An individual’s particular experiences are encoded in the brain through learning and memory.
  10. 10. Attunement Affects Brain Development •  During interactions characterized by attunement, caregivers and their infants synchronize neural activity in the right cortex of each brain (McHale, 2013). – Attachment allows brain rhythms to be in tune and ultimately for infants to manage stress. – Attunement is critical for later emotional regulation, with this skill guided by the right prefrontal cortex (Peck, 2003).
  11. 11. Borrowed from Neil Boris, M.D.; based on Andrew Meltzer’s work on infant imitation.
  12. 12. Still Face Example hIp://www.youtube.com/watch?v=apzXGEbZht0  
  13. 13. Why Is Attunement So Important? 1.  Selection of neuronal pathways 2.  Emotions—development and regulation 3.  Shaping of Internal Working Models/ Representations (Schore, 1999)
  14. 14. Attachment •  Enduring emotional tie between infant and caregivers that develops through repeated interaction over time. •  Explanations for attachment. –  Freud: Drive Reduction. –  Erikson: Psychosocial Explanation. –  Harlow: Animal Models. –  Lorenz: Imprinting. –  Bowlby: Evolutionary Explanation.
  15. 15. Stages of Attachment •  By 2 weeks of age, infants prefer the human voice. •  By 4 weeks of age, infants prefer their mothers’ voice. •  In the second month, eye contact is established. •  From 3 to 6 months, infants start having a social smile. •  From 6 to 9 months, infants start having a preference for their own caregiver and a preferential smile. –  Separation anxiety and stranger anxiety tend to start. •  From 12 to 24 months, proximity seeking is needed. •  Around 3 years of age, attachment becomes more reciprocal.
  16. 16. Assessment of Attachment •  Ainsworth’s Strange Situation: Presents infants with a series of social stressors so that the manner in which the infants cope can be observed. –  Eight episodes: •  Caregiver, baby, observer in play room (30 sec). •  Caregiver, baby, observer (3 min). •  Caregiver, baby, stranger (3 min). •  Caregiver leaves (3 min). •  Caregiver returns; stranger leaves (3 min). •  Caregiver leaves (3 min). •  Stranger returns (3 min). •  Caregiver returns and stranger leaves (3 min). •  Other Measures of Attachment Include: –  The Still-Face Procedure. –  The Crowell Paradigm/Parent-Child Relationship Assessment.
  17. 17. Attachment Classifications (Ainsworth et al., 1978; Main & Solomon, 1986) •  Securely Attached. •  Insecurely Attached. – Anxious/Avoidant. – Anxious/Resistant. – Disorganized/Disoriented. •  Attachment can help to ensure that the brain structures involved with social cognition are organized appropriately and that children are prepared to interact with others.
  18. 18. Attachment Example hIp://www.youtube.com/watch?v=2iQ3b1-­‐43J4  
  19. 19. Resilience to Trauma •  The concept of resilience can be important in understanding trauma and the results of maltreatment. – The focus is on the processes by which children develop into well-adjusted adults despite adverse circumstances (Houshyar & Kaufman, 2005). – Brain plasticity: The ability of the brain to respond to experience by modifying its structure and function (Twardosz & Lutzker, 2010).
  20. 20. Adverse Childhood Experiences Study (acestudy.org) •  A large study with approximately 18,000 participants conduced by the Kaiser Permanente group. •  This study examined the health and social effects of adverse childhood experiences (e.g., abuse, household dysfunction) over individuals’ lifetimes. •  Poor outcomes (e.g., suicide attempts, drug use) increased as the number of adverse experienced increased.
  21. 21. Defining Trauma (Rice & Groves, 2005) •  Trauma is an exceptional experience. •  Trauma overwhelms individuals’ capacity to cope. –  The child’s age and developmental stage affect the impact of trauma. –  The circumstances of the trauma matter. –  The social environment affects impact. •  Trauma can be acute or chronic. •  Trauma can alter children’s perception that parents can provide protection and safety.
  22. 22. Will You Know When It Is Trauma? hIp://www.youtube.com/watch?v=pSe40tX-­‐oTA  
  23. 23. Events Related to Trauma (Finkelhor, Ormrod, Turner, & Hamby, 2005) 1.  Bullying. 2.  Assault with injury. 3.  Assault with a weapon. 4.  Exposure to shooting, bombs, riots. 5.  Nonsexual genital assault. 6.  Robbery by a non-sibling peer or adult. 7.  Physical abuse by a caregiver. 8.  Witnessing domestic violence. 9.  Sexual assault. 10.  Murder of someone close to a child.
  24. 24. Abuse and Neglect in Young Children •  Approximately 772,000 children were abused and/or neglected in the U.S. in 2008 (U. S. Department of Health and Human Services, 2011). –  Abuse and neglect cost our society $103.8 billion annually, with approximately $33 billion of this estimate being the result of lost productivity to society (Wang & Holton, 2007). •  The youngest of our children are overrepresented and are most vulnerable to abuse and neglect experiences (Fantuzzo, Brouch, Beriama, & Atkins, 1997; Osofsky & Lieberman, 2011). –  Approximately of 56% of maltreatment victims were younger than 7-years of age (U.S. Department of Health and Human Services, 2009). –  The U.S. ranks third among 27 industrialized nations for number of child deaths from maltreatment (UNICEF, 2003).
  25. 25. Parenting in the Midst of Substance Misuse •  Almost 70 million children live with one parent who abused or was dependent on alcohol or an illicit substance. –  The youngest of children are over-represented in this sample (SAMHSA, 2009). •  Substance misuse by parents is present in 25 to 80 percent of cases in the child welfare system (e.g., Child Welfare Information Gateway, 2003). •  Parents who misuse substances are the least likely to be reunified successfully with their children and are the most likely to have children with long stays in foster care once children enter the child welfare system (Gregoire & Schultz, 2001).
  26. 26. So Why Should We Be Concerned with These Parents? •  Parents who misuse substances often engage in impaired or inadequate parenting practices (Mayes & Truman, 2002). –  Abuse and neglect (Kelley, 1998). –  Verbal and physical aggression (Ammerman, Kolko, Kirisci, Blackson, & Dawes, 1999). –  Behaviors prompted by emotional dysregulation (Khantzian, 1999). –  Poor attachment, attunement, responsiveness, and adaptability (Hans, Bernstein, & Henson, 1999).
  27. 27. Understanding  Symptoms     in  Young  Children   (Carter  et  al.,  2004;  Egger  &  Angold,  2006;  Zeanah  et  al.,  1997)    •  Understanding symptoms in this population has lagged behind our understanding of older children and adolescents. –  Resistance to thinking about symptoms in young children. –  Stigma that goes along with diagnosing young children. –  Challenges in making diagnoses in young children. –  Lack of developmental sensitivity in current criteria. –  Limited availability of sound assessment measures. –  Rapid developmental changes in young children. –  Cognitive and communication immaturity. –  Unique role of the parent-child relationship. •  Children’s experience of parents’ trauma is qualitatively and quantitatively different than direct exposure.
  28. 28. Signs of Trauma •  Psychological Effects. –  Dysregulation of affect. –  Aggressive or sexualized/provocative behavior. –  Fearfulness. –  Regression or falling behind in development and behavior/effects on learning. –  Relationships with parents and others may suffer/avoidance of intimacy/attachment problems. •  Physical symptoms. (Lowenthal,  1998;  Rice  &  Groves,  2005)  
  29. 29. Symptom Correlates for Trauma in Young Children (De Young, Kenardy, & Cobham, 2011; Finkelhor et al., 2005; Lieberman & Knorr, 2007; Scheeringa & Zeanah, 2008; Scheeringa et al., 2003) •  Posttraumatic stress disorder. •  Emotional difficulties, such as anxiety and depression. •  Behavioral difficulties, such as ADHD and Oppositional Defiant Disorder. •  Attachment difficulties with caregivers and interaction difficulties with family members. •  Difficulties achieving developmental tasks. •  Difficulties coping and with frustration tolerance. •  Comorbid socioecological conditions (e.g., poverty) may be likely.
  30. 30. Main Categories of Trauma Symptoms (Rice & Groves, 2005) •  The child relieves or re-experiences the traumatic event. – Posttraumatic play. – Preoccupation with the traumatic event. – Triggers that remind the child of the trauma. – Nightmares and sleep disturbances. •  Hyperarousal. •  Withdrawn or avoidant behavior (or both).
  31. 31. Posttraumatic Stress Disorder a la the DSM-IV-TR (APA, 2000) 1.  The individual has been exposed to a traumatic event that includes: 1.  Experiencing, witnessing, or confronting an event (or events) that involved actual or threatened death, serious injury, or a threat to physical integrity. 2.  A response involving intense fear, helplessness, or horror. 2.  The traumatic event is persistently re-experienced in one or more of the following ways: 1.  Recurrent, intrusive recollections of the event(s). 2.  Recurrent distressing dreams. 3.  Acting or feeling as if the traumatic even were recurring. 4.  Intense psychological distress with cue exposure. 5.  Physiological reactivity with cue exposure.
  32. 32. Posttraumatic Stress Disorder a la the DSM-IV-TR (Continued) 3.  Persistent avoidance of stimuli associated with the trauma and numbing of responsiveness, as indicated by three of the following: 1.  Efforts to avoid things associated with the trauma. 2.  Efforts to avoid things that arouse recollections of the trauma. 3.  Inability to recall an important aspect of the trauma. 4.  Markedly diminished interest or participation in usual activities. 5.  Feeling detached or estranged from others. 6.  Restricted range of affect. 7.  Sense of a foreshortened future.
  33. 33. Posttraumatic Stress Disorder a la the DSM-IV-TR (Continued) 4.  Persistent symptoms of increased arousal, including two of the following: 1.  Difficulty falling or staying asleep. 2.  Irritability or outbursts of anger. 3.  Difficulty concentrating. 4.  Hypervigilance. 5.  Exaggerated startle response. 5.  Duration of the symptoms for more than one month. 6.  The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  34. 34. General Problems With Using the DSM In Young Children •  DSM makes no assumption that each disorder is a completely discrete entity. •  Individuals may not fit cleanly in a diagnostic category or be alike in important ways, even in the same diagnosis. •  DSM gives less attention to disorders of infancy and childhood than to those of adulthood. •  DSM has a relative lack of emphasis on situational and contextual factors (e.g., the parent-child relationship) contributing to disorders.
  35. 35. Problems with the DSM’s PTSD Diagnosis In Young Children •  Diagnostic criteria for developmentally appropriate behavioral manifestations are needed (Lieberman et al., 2011). –  None of the traumatized children examined by Scheeringa et al. (2003) met criteria (although 26% did with developmentally appropriate accommodations). •  Diagnostic criteria that do not depend on verbalizations from the individual are needed (Scheeringa, 2007). –  Adult observers may help but may not know completely if symptoms are occurring. •  Symptoms that indicate an internal experience may not be detectable, even by an informed observer (Scheeringa, 2007).
  36. 36. An Alternate System: The DC: 0-3 (Zero to Three, 2005) •  DC: 0-3 was developed by the Diagnostic Classification Task Force of the Zero to Three/National Center for Clinical Infant Programs. •  It is currently in its second edition. •  It is intended to provide a comprehensive system for classifying problems during the first 3-4 years of life. •  It also is based on a multi-axial system.
  37. 37. An Alternate System: The DC: 0-3 (Continued; Zero to Three, 2005) •  Axis I: Primary Diagnosis. •  Axis II: Relationship Classification. •  Axis III: Physical, Neurological, and Developmental Conditions. •  Axis IV:Psychosocial Stress. •  Axis V: Functional Emotional Developmental Level.
  38. 38. Posttraumatic Stress in Young Children via the DC:0-3R 100. Posttraumatic Stress Disorder (Zero to Three, 2005) 1.  The child has been exposed to a traumatic event. 2.  The child shows evidence of re-experiencing the traumatic events by at least one of the following: 1.  Posttraumatic play. 2.  Recurrent and intrusive recollections of the traumatic event. 3.  Repeated nightmares. 4.  Physiological distress. 5.  Recurrent flashbacks or dissociation.
  39. 39. Posttraumatic Stress in Young Children via the DC:0-3R 3. The child experiences a numbing of responsiveness or development problems, with at least one of the following: 1.  Increased social withdrawal. 2.  Restricted range of affect. 3.  Diminished interest or participation in activities. 4.  Efforts to avoid recollection triggers. 4. The child experience increased arousal as noted by at least two of the following: 1. Difficulty going to sleep. 2. Difficulty concentrating. 3. Hypervigilance. 4. Exaggerated startle response. 5.  Increased irritability, anger, or tantrums. 5. The pattern of symptoms persist for at least one month.
  40. 40. DSM-5 Criteria for Children Who Are 6-Years of Age or Younger! (American Psychological Association, 2014; Scheeringa et al., 1995) A. Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: 1.  Directly experiencing trauma. 2.  Witnessing traumatic events occurring to others. 3.  Learning that trauma occurred to parents or caregivers. B. Intrusive symptoms (one or more of the following): 1.  Recurrent, involuntary, and intrusive distressing memories of the trauma. 2.  Recurrent distressing dreams related to the trauma. 3.  Dissociative reactions (flashbacks) in which the child acts as if the trauma is recurring. 4.  Intense or prolonged psychological distress at exposure to cues that symbolize the trauma. 5.  Marked physiological reactions to reminders of the trauma.
  41. 41. DSM-5 Criteria (Continued) (American Psychological Association, 2014; Scheeringa et al., 1995) C. Persistent avoidance of stimuli associated with the trauma (one or more of the following): 1.  Avoidance or efforts to avoid physical reminders of the trauma. 2.  Avoidance or efforts to avoid interpersonal situations that act as reminders of the trauma. 3.  Increased frequency of negative emotional states. 4.  Diminished interest or participation in activities (e.g., restriction of play). 5.  Socially withdrawn behavior. 6.  Reduction in the expression of positive emotions.
  42. 42. DSM-5 Criteria (Continued) (American Psychological Association, 2014; Scheeringa et al., 1995) D. Alterations in arousal and reactivity associated with the trauma (two or more of the following): 1.  Irritable behavior and angry outbursts. 2.  Hypervigilance. 3.  Exaggerated startle response. 4.  Problems with concentration. 5.  Sleep disturbance. E.  Duration of the symptoms for more than one month. F.  Disturbance causes clinically significant distress or impairment. G.  Disturbance is not due to a substance or another medical condition.
  43. 43. Results Using the PTSD Alternative Criteria (Scheeringa et al., 2001; Scheeringa et al., 2003; Scheeringa et al., 2005) •  12% of the diagnostic criteria present in children who were younger than 48 months were detected via direct observation. –  Other criteria could be inferred from parent report, although avoidance criteria were still difficult. •  26% of young children (20-months to 6-years) met the alternate criteria (vs. no children meeting the DSM-IV-TR criteria). •  Children showed more of the alternative criteria than the original criteria. •  These criteria predicted degree of functional impairment one and two years later as well as diagnostic status two years later.
  44. 44. The Importance of DSM-5 Criteria •  These criteria: – More adequately describe the experience of young children with PTSD. – Predict long-term functional impairment in young children. – Can be assessed using parent report and via observational assessment.
  45. 45. Mutual regulation: Regulated with the help of the caregiver Self- regulation of behavior and emotions Behavior and Emotion Regulation Across Development (Slide borrowed from N. Boris) Trauma May Impair Both Mutual and Self- Regulation
  46. 46. Main Problems with Studying the Neurological Effects of Trauma in Young Children •  Many studies look at adults retrospectively. –  There is no way to know if a trauma experience prompted the differences that may be found in brain anatomy. •  Precise information about children’s environment and experiences are not always available. •  Children often experience multiple types of trauma. •  Animal models may be helpful but often are not a perfect model comparison.
  47. 47. The Human Brain (Twardosz & Lutzker, 2010) •  Mature brains can be sensitized by traumatic experiences. •  But…younger brains can be much more profoundly affected. – The immature brain is still organizing itself. – The immature brain is dependent on information from the environment. – Different parts of the brain are responsive at different sensitive periods.
  48. 48. Neurodevelopment and Neglect hIps://www.youtube.com/watch?v=bF3j5UVCSCA  
  49. 49. Brain Development and Trauma •  Trauma can affect how the brain functions and the autonomic nervous system. –  Young children can continue to show fear symptoms, even if threatening stimuli are no longer present (McHale, 2013). –  Young children can show high resting heart rates, high stress hormones, and poor sleep patterns (McHale, 2013). –  Prolonged stress of trauma can result in the shrinkage of the areas of the brain responsible for learning, memory, and regulation of affect and emotions (Newberger, 1997). •  Young children’s stress response system develops rapidly during the first three years of life and can be altered by stress. –  Nonetheless, the early postnatal period is a particularly vulnerable time.
  50. 50. Stress and Brain Development •  Stress has a substantial impact on the structure and function of limbic structures (e.g., the hippocampus, frontal cortex (Bremner, 2005). – The brain is particularly susceptible during the early postnatal period (Brunson et al., 2001). •  Abuse and neglect has been related to reductions in the volume of the corpus callosum (Teicher et al., 2004). •  Hormones (e.g., norepinephrine, cortisol) also play a significant role in the stress response (Bremner, 2005).
  51. 51. Brain Development and Childhood Maltreatment •  Childhood maltreatment has been related to reductions in hippocampal volume and to diagnosable psychiatric illness (Teicher et al., 2012). •  Childhood emotional abuse also was associated with reduced hippocampus volume in males (Samplin et al., 2013). – Childhood emotional abuse was associated with higher levels of subclinical psychopathology for both males and females.
  52. 52. Brain Development and PTSD (De Bellis et al., 2002) •  Maltreated children who were diagnosed with PTSD (versus those who were not diagnosed): –  Had decreased volume in the corpus callosum, prefrontal cortices, and temporal lobes and smaller amounts of prefrontal cortical white matter. –  Had smaller intracranial, cerebral, and prefrontal measurements. –  Had increased volume in the superior temporal gyrus. –  Had larger volumes of cerebrospinal fluid in the frontal lobes.
  53. 53. Assessment Recommendations (AACAP, 2010) •  Routine inclusion of questions regarding trauma exposure and symptoms of PTSD (particularly given the particularly damaging effects of cumulative stressors, (Dube et al., 2003). •  The inclusion of parents/caregivers in the assessment process as well as an assessment of the parent-child relationship given its protective value for young children’s regulation of symptoms (Gunnar & Quevedo, 2007). •  The assessment of comorbid disorders. •  The use of trauma-focused psychotherapies as first line treatments. –  Attend directly to trauma symptoms. –  Enhance functioning and developmental trajectory.
  54. 54. Potential Treatments of Interest •  Two main types of treatment programs have been showing promise (Gleason et al., 2007): –  Child-Parent Psychotherapy (Lieberman & Van Horn, 2008). –  Cognitive Behavioral Treatments (Trauma-Focused Cognitive- Behavioral Therapy; Cohen, Berliner, & Mannarino, 2000; Cohen, Mannarino, & Deblinger, 2006). –  Also… The Circle of Security (Cooper, Hoffman, Marvin, & Powell, 1999). •  Certainly prevention efforts are warranted, but treatments must address the sequelae of these experiences in our youngest children (McKinney et al., 2006; Renk et al., 2002; Renk et al., 2008). •  It is also worth noting that no single treatment approach will be applicable to all children (Cohen, Berliner, & Mannarino, 2000).
  55. 55. Child-Parent Psychotherapy (CPP) (Lieberman & Van Horn, 2005) •  A relationship-based intervention grounded in psychoanalytic, attachment, and trauma theory. –  It includes social learning and CBT interventions for change. •  Core premise includes the idea that young children rely on their parents for protection and safety. –  Trauma can alter the perception that parents can provide these things. •  Therapists support the parent-child dyad with play, words, and interactions to express and respond to emotional needs, breaks the taboo of silence about the trauma, that modulates unmanageable traumatic stress, and that restores trust.
  56. 56. Child-Parent Psychotherapy (CPP) (Lieberman & Van Horn, 2005) •  Efficacy is supported by several randomized clinical trials with samples varying in child age, presenting issues, and backgrounds. •  Outcomes include: –  Reductions in child and mother psychological symptoms. •  PTSD, Depression, Co-Morbid Diagnoses, Behavior Problems (Ghosh Ippen et al., 2011). –  More positive child attributions for parents, for themselves, and for relationships. –  Improvement in child-mother relationship quality and attachment. –  Improvement in child cognitive functioning (Lieberman et al., 2011).
  57. 57. Circle of Security Parenting Program (Marvin, Cooper, Hoffman, & Powell, 2002) 1.  Welcome to the Circle of Security: Introduction to program. 2.  Exploring Our Children’s Needs All the Way Around the Circle: Increase parents’ observation and inferential skills. 3.  “Being With” on the Circle: Build a parent-child relationship where children’s feelings can be shared and a secure attachment can be built. 4.  Being With Infants on the Circle: Teach attunement to infants’ shifts in attention and emotion. 5.  The Path to Security: Steps to promoting security. 6.  Exploring Our Struggles: Be “bigger, stronger, wiser, and kind”. 7.  Rupture and Repair in Relationships: Learn that children sometimes act out in an effort to manage their needs. 8.  Summary and Celebration.
  58. 58. Circle of Security Description hIp://www.youtube.com/watch?v=xH1CbC4No24  
  59. 59. •  Protect me •  Comfort me •  Delight in me •  Organize my feelings Circle of Security Parent Attending to the Child’s Needs I need you to Support My Exploration Welcome My Coming To You I need you to •  Watch over me •  Help me •  Enjoy with me •  Delight in me I need you to I need you to ©  Cooper,  Hoffman,  Marvin,  &  Powell  (1999)  
  60. 60. Trauma-Focused CBT (Cohen & Mannarino, 2008) •  A multicomponent model that includes: –  Parental treatment. –  Psychoeducation. –  Relaxation and stress management skills. –  Active expression and modulation skills. –  Cognitive coping skills. –  Trauma narrative and cognitive processing of the child’s traumatic experience. –  In vivo desensitization to trauma reminders. –  Conjoint parent-child sessions. –  Enhancing safety and future development.
  61. 61. Adapta@ons  that  Are  Required  for   Young  Children   (Scheeringa  et  al.,  2007;  Scheeringa  et  al.,  2011)   •  Scheeringa’s Adaptation to Young Children. –  Includes both cognitive and behavioral techniques, but behavioral techniques are emphasized. –  Sessions 1-4: Teach children about symptoms. –  Session 5: “Tell the story.” –  Sessions 6-10: Exposures. –  Session 11: Relapse prevention. –  Session 12: Review and graduation.
  62. 62. Other Treatments Being Tested •  Posttraumatic Parenting (Shelby et al., 2010). –  Blends parent-child dyadic treatments with trauma-focused interventions to create an evidence-informed posttraumatic treatment. –  For 3- to 8-year old children. •  Intergenerational Trauma Treatment Model (Copping et al., 2001; Lawson & Quinn, 2013). –  Designed to address complex trauma using cognitive-behavioral methods. –  Builds caregivers’ capacity to directly address children’s trauma-related symptoms (via group sessions), and considers caregivers’ own traumatic experiences (via individual sessions). –  Addresses interaction skills. –  Children from 27 families experienced improvements in children’s conduct and social relations; caregivers’ depression also improved.
  63. 63. Other Treatments Being Tested (Continued) •  Attachment, Self-Regulation, and Competency Model (Arvidson et al., 2011; Lawson & Quinn, 2013). –  Developed for the treatment of complex trauma. –  Treatment is focused on caregiver attachment, children’s self- regulation, children’s competency, and trauma experience integration. –  Informed by attachment theory and building parents’ skills to assist their children. –  Children (N=21) should significant improvements on the CBCL. •  Stepped Care Trauma-Focused Intervention (Salloum, no date). –  Parents help to provide the intervention. –  For 3- to 7-year old children.
  64. 64. Future Directions •  Trauma is “the largest single preventable cause of mental illness” (Sharfstein, 2005). •  More work that examines infants and preschoolers (Lieberman et al., 2011). •  More examination of trauma in young children (Lieberman et al., 2011) across service providers (e.g., pediatricians; Lieberman & Knorr, 2007). •  Having interventions that are applicable to young children and their families readily accessible (Lieberman et al., 2011), particularly in community settings (de Arellano et al., 2005). –  National Child Traumatic Stress Network: www.nctsn.org •  Understanding how to best address trauma issues when concurrently experienced by parents and children. –  Low functioning in parents is related to low functioning in children after trauma (Kilpatrick & Williams, 1998; Scheeringa & Zeanah, 2001). –  Trauma has a deleterious impact on parenting (Appleyard & Osofsky, 2003).
  65. 65. A Message About the Long-Term Effects of Trauma… hIps://www.youtube.com/watch?v=SPzVUGE3dds  
  66. 66. Questions? “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it’s the only thing that ever has.” –Margaret Mead
  67. 67. References Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Oxford England: Lawrence Erlbaum. American Psychiatric Association. (2004). Diagnostic and statistical manual of mental disorders- Fourth edition-Text revision. Washington, DC: Author. American Psychiatric Association. (2014). Diagnostic and statistical manual of mental disorders-Fifth edition. Washington, DC: Author. Ammerman, R. T., Kolko, D. J., Kirisci, L., Blackson, T. C., & Dawes, M. A. (1999). Child abuse potential in parents with histories of substance use disorders. Child Abuse and Neglect, 23, 1225-1238. Appleyard, K., & Osofsky, J. D. (2003). Parenting after trauma: Supporting parents and caregivers in the treatment of children impacted by violence. Infant Mental Health Journal, 24 (2), 111-125. American Academy of Child and Adolescent Psychiatry (AACAP). (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 414-430. American Psychological Association (APA). (2000). Diagnostic and statistical manual of mental disorders-Fourth edition-Text revision. Washington, DC: Author. Arvidson, J., Kinniburgh, K. M., Howard, K., Spinazzola, J., Strothers, H., Evans, M., …Blaustein, L. M. E. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child and Adolescent Trauma, 4, 34-51. Bremner, J. D. (2005). Does stress damage the brain? Phi Kappa Phi Forum, 85, 1-7.
  68. 68. References Brunson, K. L., Eghbal-Ahmadi, M., Bender, R., Chen, Y., & Baram, T. Z. (2001). Long-term, progressive hippocampal cell loss and dysfunction induced by early-life administration of corticotropin-releasing hormone reproduce the effects of early-life stress. Proceedings of the National Academy of Sciences, 98, 8856-8861. Carter, A. S., Briggs-Gowan, M. J., & Davis, N. O. (2004). Assessment of young children’s social- emotional development and psychopathology: Recent advances and recommendations for practices. Journal of Child Psychology and Psychiatry, 45 (1), 109-134. Child Welfare Information Gateway. (2003). Substance abuse and child maltreatment. Retrieved from http://www.childwelfare.gov/pubx/factsheets/subsabuse_childmal.cfm. Cohen, J., & Mannarino, A. (2008). Disseminating and implementing trauma-focused CBT in community settings. Trauma, Violence, and Abuse, 9, 214-226. Cohen, J., Mannarino, A., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press. Cooper, G., Hoffman, K., Marvin, R., & Powell, B. (1999). Secure circles of security. Unpublished material, Centre for Clinical Intervention, Spokane, WA, and University of Virginia. Copping, V. E., Warling, D. L., Benner, D. G., & Woodside, D. W. (2001). A child trauma treatment pilot study. Journal of Child and Family Studies, 10, 467-475. de Arellano, M. A., Waldrop, A. E., Deblinger, E., Cohen, J. A., Danielson, C. K., & Mannarino, A. R. (2005). Community outreach program for child victims of traumatic events: A community-based project for underserved populations. Behavior Modification, 29 (1), 130-155. De Young, A. C., Kenardy, J. A., & Cobham, V. E. (2011). Trauma in early childhood: A neglected population. Clinical Child and Family Psychology Review, 14, 231-250.
  69. 69. References Dube, S. R., Felitti, V. J., Dong, M. Giles, W. H., & Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Preventive Medicine, 37, 268-277. Egger, H. L., & Angold, A. (2006). Common emotional and behavioral disorders in young children: Presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry, 47 (3-4), 313-337. Fantuzzo, J. W., Boruch, R., Beriama, A., Atkins, M., & Marcus, S. (1997). Domestic violence and children: Prevalence and risk in five major U. S. cities. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 116–122. Finkelhor, D., Ormrod, R., Turner, H., & Hamby S. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10 (1), 5-25. Ghosh Ippen, C., Harris, W. W., Van Horn, P., & Lieberman, A. F. (2011). Traumatic and stressful events in early childhood: Can treatment help those at highest risk? Child Abuse and Neglect, 35, 504-513. Gleason, M. M., Egger, H. L., Emslie, G. H., Greenhill, L. L., & Kowatch, R. A. (2007). Psychopharmacological treatment for very young children: Contexts and guidelines. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1532-1572. Gregoire, K. A., & Schultz, D. J. (2001). Substance-abusing child welfare parents: Treatment and child placement outcomes. Child Welfare, 80, 433-452. Gunnar, M. R., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145-173. Hans, L. L., Bernstein, V. J., & Henson, L. G. (1999). The role of psychopathology in the parenting of drug-dependent women. Development and Psychopathology, 11, 957-977.
  70. 70. References Houshyar, S., & Kaufman, J. (2005). Resiliency in maltreated children. In S. Goldstein & R. B. Brooks (Eds.), Handbook of resilience in children (pp. 181-200). New York: Kluwer Academic/ Plenum. Kelley, S. J. (1998). Stress and coping behaviors of substance-abusing mothers. Journal for Specialists in Pediatric Nursing, 3, 103-110. Khatzian, E. J. (1999). Treating addiction as a human process. Lanham, MD: Jason Aronson. Kilpatrick, K. L., & Williams, L. M. (1998). Potential mediators of post-traumatic stress disorder in child witnesses to domestic violence. Child Abuse and Neglect, 22, 319-330. Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: Evidence-based practice in clinical settings. Journal of Clinical Psychology in Session, 69, 497-509. Lieberman, A. F., Chu, A., Van Horn, P., & Harris, W. W. (2011). Trauma in early childhood: Empirical evidence and clinical implications. Development and Psychopathology, 23, 397-410. Lieberman, A. F., & Knorr, K. (2007). The impact of trauma: A developmental framework for infancy and early childhood Psychiatric Annals, 37 (6), 416-422. Lieberman, A. F., & Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: Guilford. Lowenthal, B. (1998). The effects of early childhood abuse and the development of resiliency. Early Child Development and Care, 142, 43-52. Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. Affective development in infancy (pp. 95-124). Westport, CT: Ablex Publishing. Marvin, R., Cooper, G., Hoffman, K., & Powell, B. (2002). The circle of security project: Attachment- based intervention with caregiver-preschool child dyads. Attachment & Human Development, 4, 107-124.
  71. 71. References Mayes, L. C., & Truman, S. (2002). Substance abuse and parenting. In M. Bornstein (Ed.), Handbook of parenting (Second edition, Volume 4; pp. 329-359). Hillsdale, NJ: Erlbaum. McHale, J. P. (2013). The importance of quality early education in the child welfare system: Considerations from a co-parenting and attachment framework. Presentation given for a “Just in Time Florida Training Video”. Retrieved from centervideo.forest.usf.edu/qpi/qualityearlyed/ qualityearlyed.htm. McKinney, C., Sieger, K., Kanter Agliata, A., & Renk, K. (2006). Children’s exposure to domestic violence: Striving toward an ecological framework for interventions. Journal of Emotional Abuse, 6 (1), 1-23. Newberger, J. J. (1997). Brain development research-Wonderful window of opportunity to build public support for early childhood education. Young Children, 52, 4-9. Osofsky, J.D. & Lieberman, A.F. (2011). A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children. American Psychologist, 66 (2), 120-128. Peck, S. D. (2003). Measuring sensitivity moment-by-moment: A microanalytic look at the transmission of attachment. Attachment and Human Development, 5, 38-63. Renk, K., Donnelly, R., Roddenberry, A., & Baksh, E. (2008). Child and adolescent sexual abuse: Prevention endeavors. In C. Hilarski, J. S. Wodarski, & M. Feit (Eds.), Handbook of social work in child and adolescent sexual abuse (pp. 229-251). Binghamton, NY: Haworth Press, Inc. Renk, K., Liljequist, L., Steinberg, A., Bosco, G., & Phares, V. (2002). Prevention of child sexual abuse: Are we doing enough? Trauma, Violence, and Abuse: A Review Journal, 3 (1), 57-73. Salloum, A. (No date). Care for children after trauma. Retrieved from http://http://intra.cbcs.usf.edu/ PersonTracker/common/file/acv-118.pdf.
  72. 72. References Samplin, E., Ikuta, T., Malhotra, A. K., Szeszko, P. R., & DeRosse, P. (2013). Sex differences in resilience to childhood maltreatment: Effects of trauma history on hippocampal volume, general cognition and subclinical psychosis in healthy adults. Journal of Psychiatry Research, 47, 1174-1179. Scheeringa, M. S. (2007). A research agenda for posttraumatic stress disorder in infants, toddlers, and preschool children. In W. E. Narrow, M. B. First, P. J. Sirovatka, & D. A. Regier (Eds.), Age and gender considerations in psychiatric diagnosis: A research agenda for DSM-V (pp. 151-162). Arlington, VA: American Psychiatric Association. Scheeringa, M. S., Peebles, C. D., Cook, C. A., & Zeanah, C. H. (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 52-60. Scheeringa, M. S., Salloum, A., Arnberger, R. A., Weems, C. F., Amaya-Jackson, L., & Cohen, J. A. (2007). Feasibility and effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder in preschool children: Two case reports. Journal of Traumatic Stress, 20 (4), 631-636. Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma- focused cognitive-behavioral therapy for posttraumatic stress disorder in three- through six year- old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52 (8), 853-860. Scheeringa, M. S., & Zeanah, C. H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14 (4), 799-815. Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37 (3), 508-518.
  73. 73. References Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 34 (2), 191-200. Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (5), 561-570. Scheeringa, M.S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 44 (9), 899-906. Sharfstein, S. (2006). From the president. Psychiatric News, 41, 3. Shelby, J., Avina, C., & Warnick, H. (2010). Posttraumatic parenting: A parent-child dyadic treatment for young children’s posstraumatic adjustment. In C. E. Schaefer (Ed.), Play therapy for preschool children (pp. 69-87). Washington, DC: APA Press. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. (2009, April 16). The NSDUH report: Children living with substance-dependent or substance- abusing parents: 2002 to 2007. Rockville, MD: U. S. Department of Health and Human Services. Teicher, M. H., Anderson, C. M., & Polcari, A. (2012). Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum. Proceedings of the National Academy of Sciences, 109, 563-572. Teicher, M. H., Dumont, N. L., Ito, Y., Vaituzis, C., Geidd, J. N., & Anderson, S. L. (2004). Childhood neglect is associated with reduced corpus callosum area. Biological Psychiatry, 56, 80-85. Twardosz, S., & Lutzker, J. R. (2010). Child maltreatment and the developing brain: A review of neuroscience perspectives. Aggression and Violent Behavior, 15, 59-68.
  74. 74. References UNICEF. (2003). A league table of child maltreatment death in rich nations. Innocenti Report Card, 5. Retrieved from http://http://www.unicef-irc.org/publications/pdf/repcard5e.pdf. U.S. Department of Health and Human Services. (2009). Child maltreatment 2007. Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm07/chapter3.htm. U.S. Department of Health and Human Services, Administration for Children and Families, Administra- tion on Children, Youth and Families, Children’s Bureau. (2011). Child Maltreatment 2010. Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can. Zeanah, C. H., Boris, N. W., & Scheeringa, M. S. (1997). Psychopathology in infancy. Journal of Child Psychology and Psychiatry, 38, 81-99. Zero to Three. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood-Revised edition (DC: 0-3R). Washington, DC: Author.
  75. 75. YouTube Video Links Still Face (Slide 12): http://www.youtube.com/watch?v=apzXGEbZht0 Attachment (Slide 18): http://www.youtube.com/watch?v=2iQ3b1-43J4 Domestic Violence PSA (Slide 22): http://www.youtube.com/watch?v=pSe40tX-oTA Science of Neglect (Slide 48): https://www.youtube.com/watch?v=bF3j5UVCSCA Circle of Security (Slide 58): http://www.youtube.com/watch?v=xH1CbC4No24 Patrick Stewart (Slide 65): https://www.youtube.com/watch?v=SPzVUGE3dds
  76. 76. •  Webinar participants who want to get 2.0 NASW CE Credits (or just want proof that they participated in this training) need to take the post-test provided at the end of the webinar" »  CE Certificates of completion will be automatically emailed to participants upon completion of the post-test. " »  Questions/concerns surrounding the National Association of Social Workers (NASW) CE credit certificates can be emailed to this address: MFLNmilitaryfamilyadvocate@gmail.com" »  Sometimes state/professional licensure boards for fields other than social work recognize NASW CE Credits, however, you would have to check with your state and/or professional boards if you need CE Credits for your field. " ! •  To learn more about obtaining CE Credits, please visit this website: http://blogs.extension.org/militaryfamilies/family-development/ professional-development/nasw-ce-credits/" CE Credit Information"
  77. 77. Military Families Learning Network This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-48755-20306. Family Development! April 18, 2014 @ 11:00 am EST Novel Communication Tools: Using Text4Baby & Just in Time Parenting to Meet the Needs of Parent https://learn.extension.org/events/1459 UPCOMING EVENTS
  78. 78. Military Families Learning Network! This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Policy, Children and Youth, U.S. Department of Defense under Award Numbers 2010-48869-20685 and 2012-48755-20306. Military Caregiving, Family Development,
 Personal Finance, Network Literacy" Find all upcoming and recorded webinars covering: http://www.extension.org/62581

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