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War of the Worlds: Long Term Effects of Early Maltreatment


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This Webinar was presented on Tuesday, February 15, 2011, as part of the free monthly series from Friends for Youth's Mentoring Institute with Special Presenter John Stirling, M.D.

Clinicians caring for victims of early abuse or neglect are often puzzled at their inability to respond to a more consistent and caring environment, including mentoring. This presentation synthesizes concepts from developmental neurobiology, attachment theory, and family ecology to help participants understand the obstacles faced in leaving abuse behind, and to suggest paths to more effective therapy. Mentoring is an important component in treatment and there will be a special focus on understanding the Big Picture regarding early trauma, including the physiologic response to stresses, learned helplessness, and intrauterine drug exposure, to show how these children and youth react differently and need special handling.

Published in: Education, Health & Medicine
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War of the Worlds: Long Term Effects of Early Maltreatment

  1. 1. Transforming lives through the power of mentoring Friends for Youth’s Mentoring Institute February 2011 Webinar
  2. 2. 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
  3. 3. Slides posted toSlideShareLink and brief surveyincluded in follow-upemail
  4. 4. John Stirling, MDCenter for Child ProtectionSanta Clara Valley Medical CenterSan Jose CA
  5. 5.   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.
  6. 6.   Lives w/ single mother since parents separated 8yr ago  Evaluated for sexual abuse at age 5, recanted disclosure  Runaway, cuts self, suicide attempt
  7. 7.   Adopted at 5mo, “inadequate caretaker”  “Never met a stranger”  Poor school performance  Behavior issues: explosive, violent
  8. 8.   Parents divorced when he was 2yo, lives with mother and stepfather  Academically accomplished, but behaviors challenging  Violence, “explosive”  Meds: Concerta, Tenex, Risperdal
  9. 9.   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
  10. 10.   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
  11. 11.   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?
  12. 12.   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
  13. 13. •  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
  14. 14.   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
  15. 15. Remember:  The foster care system was conceived to help children who had suffered severe trauma.
  16. 16. Physical Abuse Sexual Abuse ~40% Neglect
  17. 17. Domestic Child 20 –Violence Abuse 40% Family dysfunction?
  18. 18.   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
  19. 19. StressHypothalamic / pituitary stimulation Adrenal cortisol release
  20. 20. 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
  21. 21.   Cerebral cortex ◦  EEG changes ◦  smaller callosum  Limbic system ◦  neuronal changes ◦  decreased size  Brainstem/ Cerebellum ◦  altered transmitters
  22. 22.   Cognitive (left brain) ◦  Vocabulary ◦  Logical reasoning  Experiential (right brain) ◦  Emotional awareness ◦  Self-regulation
  23. 23. Criteria include:  Intrusive memories  Persistent arousal  Avoidance of “trigger” events…after an event that aroused fear, horror, helplessness
  24. 24. “There is no such thing as a baby; there is a baby and someone.” - D.W. Winnicott
  25. 25.  Attachment Regulation Cognition
  26. 26.   Overview of attachment theory  Styles of attachment  Disorders of attachment  Interventions
  27. 27. 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.”
  28. 28.   Evolutionary advantage: A secure child can explore!
  29. 29.   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.
  30. 30.   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?
  31. 31.   Secure ◦  expectations rewarded, comfort available  Avoidant ◦  rejects caregiver  Anxious ◦  clings, fearful of separation  Disordered ◦  approach/avoidance
  32. 32.   Secure (56-65%)  Insecure ◦  Avoidant (20-25%) ◦  Ambivalent (10-20%) ◦  Disorganized (5-10%)
  33. 33. Child Parent  Secure   Nurturing  Avoidant   Dismissive  Ambivalent   Preoccupied  Disorganized   Disorganized
  34. 34. “Recovery” can depend on:  Neuronal growth  Behavioral compensation  Minimizing secondary trauma  … with a little help from your friends
  35. 35. Most conditions will get better if you don’t make them worse!
  36. 36.   Persistent fear/alert state  Poor differentiation of affect  Dysregulation of affect …and thus may be hard to parent!
  37. 37. One Positive Feedback Cycle Parent Stress childmaltreatment challenges Attachment problems
  38. 38. A critical period for secure attachment? There’s no data!
  39. 39.   Complex PTSD  Attention-Deficit Hyperactivity Disorder  Oppositional Defiant Disorder  Major Depression or Bipolar Disorder  Autism Spectrum Disorders  “Reactive Attachment Disorder”
  40. 40. 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
  41. 41. Diagnosis  Must take into account early stresses  Looks for maladaptive adaptations
  42. 42. Therapy  Remember that early trauma affects not only perception, but ability to learn  Should involve both hemispheres  Cannot involve only the child!
  43. 43.   Meds control symptoms, don’t “cure”  Many types ◦  Antidepressants ◦  Antianxiety agents ◦  Stimulants for attention ◦  Antipsychotics  Usevaries widely  None are approved for use in children!
  44. 44.   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
  45. 45. “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
  46. 46. “It ain’t over ‘til it’s over.” - Yogi Berra
  47. 47.
  48. 48. Slides posted toSlideShareLink and brief surveyincluded in follow-upemail
  49. 49. 650-559-0200•  Products and resourcesfor mentoring programs•  Trainings for programstaff, mentors, and mentees•  Individual consultations Check out our Blog