This document discusses the effects of witnessing domestic violence on children's development and behavior. Key points include: - Exposure to chronic violence at home can lead to a persisting fear response in children and symptoms like aggression, impulsivity, anxiety, or dissociation. - Factors like the type, severity, and pattern of violence, as well as the presence of a supportive caregiver, influence how children are impacted. - Techniques for helping traumatized children include helping them identify and express emotions, teaching calming strategies, and providing supportive parenting. - Untreated trauma can alter brain development and predispose children towards more impulsive and reactive behaviors. Early intervention is important.

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Discussion Point #1Discussion Point #1
Some Children are born “bad” orSome Children are born “bad” or
with a personality that iswith a personality that is
difficult.difficult.

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Domestic Violence: Affects on the
Neurobiology of the Developing Child
During Their Critical Period
James J. Gross, MC,
LPC, LMHP
November 14, 2007
Omaha, Nebraska

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Violence impacts the victims, the witnesses –
and, ultimate us all
-Bruce D. Perry, M.D., Ph.D.

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America The Beautiful and the Violent
Violence Overview – Our violent society
– Media: Exposure, desensitization; the norm in our
thinking
– Control agenda – Kids trying to control their environment
for safety, not to control parent
– Locus of Control: Egocentric, Self-Centered-not
Interdependent
– Generational violence – lack of skill base
– SA: Methamphetamine , ATOH, compounds the problem
of violence
– Social factors: Poverty, Low SES
– Emotional factors: fear, stress, anxiety

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THE IMPLICATIONS
EXPOSURE TO CHRONIC INTRAFAMILIAL VIOLENCE WILL
DEVELOP A PERSISTING FEAR-RESPONSE
– In boys = AGGRESSION, IMPULSIVE, REACTIVE AND
HYPERACTIVE SYMPTOM PRESENTATION.
– In girls = DISASSOCIATION
A unique event is deemed threatening until determined
otherwise. This stress, creates COGNITIVE DISTORTIONS
leading to MISINTERPRETING EVENTS.

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Witnessing Domestic Violence
 Symptoms and Diagnosis – SXs. ODD, ODD, Depression, Anxiety
Disorder, ADHD
 Session Signs – Violent play, defiance, re-experiencing the trauma,
acting out or acting in.
Case Study 1 & 2: Personal experiences working with children
exposed to trauma and violence
 Trauma and its effect on brain development
Stress – How it floods clear thinking esp. for kids
Regulation Model – how to retrain proper behaviors

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Pre/Post Birth Brain Development
Brain development after birth
 Amygdule completes @ 18 month
 Hippo 36th
months. Don’t have total ability to calm
own stress. Dependent on caregiver for
development of foundation of regulation
 Orbital Frontal Cortex 25y.
Timeline of Neurobiological development
 4th
week after conception fetus capable of auditory
stimuli
 2nd
trimester, fetus capable of psychological
processing
 Child to self-regulate their own stress.
Establishing their groundwork for regulation.

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Discussion Point #2Discussion Point #2
Genetics determine how theGenetics determine how the
infant will develop; personality,infant will develop; personality,
temperament, mood, etc.temperament, mood, etc.

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Witnessing Violence
Experience and Genetics…
 Reciprocal Determinism

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SX’s of Witnessing Violence
1. Withdrawal
2. Depression
3. Abnormal fears
4. Regression
5. Learning problems or a
decline in school
performance
6. Truancy
7. Bullying or a tendency to
become a victim
8. Difficulty in building or
maintaining relationships
9. Impulsiveness
10. Behavioral and emotional
problems
11. Denial or obsessive
retelling of the incident

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Avoidance criteria
For posttraumatic stress disorder in children may
include a
 restricted range of affect,
 detachment, insecure attachment
 inability to recall important aspects of the trauma,
 decreased participation in significant activities,
 a sense of foreshortened future,
 loss of skills,
 or new fears including separation fears.

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Arousal criteria
Generally present in children, including
 Sleep disturbance,
 Irritability,
 Anger outbursts,
 Difficulty with concentration,
 Hyper vigilance
 Exaggerated startle response.

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Experiences can lead to Fear for Survival

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Case study:
Sarah in Arizona – I’m afraid!
 I get scared when I hear my dad’s car
 I don’t sleep good, and I’m afraid all the time
 He said he was coming back to kill us both
Course of Treatment
– Personal Strength, desensitization techniques, CBT
– Resources

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Case Study:
Holly in Nebraska – I hate you!
 I hate you! Go away! I’m going to kill you!
 I don’t have to tell you anything. You can’t make me!
 Oh, did I hurt you? No I didn’t. I didn’t do anything!
Disasso ciatio n
 Course of Treatment
– Resistance from mom – “She has to know my authority!”

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Disclaimer

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Trauma
– The brain and it’s changing chemistry
 Increasing cortical levels
 Thus…fight or flight, or “freeze” response
 thus…increased stress/anxiety due to heightened
cortical level
 Therefore, a more rapidly triggered response.

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Flight, Flight or Freeze
 Upon encountering a novel event (ie. A
request) perceived as a threat
 Freeze misperceived as anger
 Thus, defiance is a “freeze-based” state, not
defiance!
 Reaction patterns: Boys become “hyper-
aroused”; Girls hypo-aroused

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Fight, Flight or Freeze
 Amygdala fear receptor
 Unconscious Thought
 Hippocampus/Orbital Frontal Cortex—
Executive Functioning
 Executive Function-Regulation
 Stress “Overwhelms” the EF; causing
“Confused” and “Distorted” thinking
 Have a working knowledge of the brain

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Tabla Rasa
Resilient
1. Marked by the ability
to recover readily, as
from misfortune.
2. Capable of returning
to an original shape or
position, as after
having been
compressed.
Malleable
1. Capable of being shaped or
formed, as by hammering or
pressure: a malleable metal.
2. Easily controlled or
influenced; tractable.
3. Able to adjust to changing
circumstances; adaptable.

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Neuron Development
Brain at birth Brain at 3 years

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IT IS THE BRAIN
 ‘LOWER’ PARTS OF THE BRAIN (BRAINSTEM &
MIDBRAIN).
 MOST COMPLEX FUNCTIONS (LANGUAGE, ABSTRACT
THINKING), BY ITS MOST COMPLEX CORTICAL
STRUCTURES.
 THE HIERARCHY OF INCREASINGLY COMPLEX
FUNCTIONS IS MEDICATED BY THE HIERARCHY OF
INCREASINGLY COMPLEX BRAIN AREAS.

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Upper brain modulates the lower, more
primitive portions
AS THE MORE COMPLEX LIMBIC, SUB-CORTICAL AND
CORTICAL AREAS ORGANIZE, THEY BEGIN TO
MODULATE, MODERATE AND ‘CONTROL’ THE MORE
PRIMITIVE AND ‘REACTIVE’ LOWER PORTIONS OF THE BRAIN

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Recognizing this client yet?
BOTH A LACK OF CRITICAL NURTURING EXPERIENCE AND
EXCESS EXPOSURE TO TRAUMATIC VIOLENCE WILL
ALTER THE DEVELOPING CNS, PREDISPOSING TO A
MORE IMPULSIVE, REACTIVE AND VIOLENT INDIVIDUAL.
-Bruce Perry, MD, PhD

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EXPERIENCE-BASED CONFLICT
RESOLUTION MODELS
 Develop Relationship always
 Regulation Model
 Emotive, Physical Exercises
 Non directive
 Play and observation
 Expressive art, play
 Role play

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Some strengths to search for in your
practice
 STRONG SUPPORT FAMILY NETWORK
 STRONG STABLE ADULT
 PREDICTABILTY OF THREAT

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1. EFFECTIVE ASSESSMENT
1. EMOTIONAL, BEHAVIORAL, COGNITIVE, SOCIAL AND
PHYSIOLOGICAL FUNCTIONING.
a. THE USE OF STATE-DEPENDENT APPROACH
a. WHEN THE CHILD IS IN A STATE OF HYPER-AROUSAL- THIS
CHILD WILL NOT EASILY BE TAUGHT COMPLEX COGNITIVE
INFORMATION.
a. NON VERBAL
b. FACIAL EXPRESSIONS,
c. TONE OF VOICE –
Child SEARCHING FOR THREAT
Intervention strategies

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Techniques of Active Listening
 Paraphrasing -- repeating back
in one's own words what the
other person just said.
 Clarifying -- asking for more
information, such as“ What did
you mean when you said that?"
"How long have you been
feeling this way?"
 Reflecting -- listening beyond
the words to try echoing back
the feelings underlying the
speaker's statements.
 Encouraging -- letting the
speaker know you are
interested by phrases such
as "Tell me more."
 Summarizing -- voicing
back the speaker's main
points.
 Validating -- expressing an
understanding of what the
speaker has said and felt.

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IMPORTANT FACTORS IN THE
DIFFERENTIAL IMPACT (OF VIOLENCE)
ON THE DEVELOPING CHILD INCLUDE:
 The type and severity of the violence
 The pattern of the violence
 The presence of a supportive, understanding,
nurturing, willing, caregiver
 The age of the child and their developmental
stage

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…is there still more??
– Jailed parents
– But he promised
– The foster care system – I can’t handle this child
– We’ve gotta take care of ourselves
– You can’t trust adults…they always lie
– Adoption - They don’t really love us…they just couldn’t
have their own kids
– I was just a part of the packaged deal

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DV INTERVENTIONS FOR CHILDREN
1. Help children recognize their own emotions.
2. Give children words to express their feelings and be able to talk to
others about their emotions.
3. Help children learn how to calm themselves when they are upset.
4. Use moments when children are upset as an opportunity for
intimacy or teaching. This creates a parent-child relationship in
which children feel comfortable coming to parents with their worries
and fears.
5. Guide children in problem solving so children develop their own
answers.

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Is it Obvious by Now??
 Hidden victims?
 Our responsibility
 Do we need a Movement?
 Are we already in a Movement?
 Have you joined the Movement?

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The Bigger Picture…
 The tendency to deal with family violence cases as separate
incidents rather than as symptoms of a broader social
pattern of disorder and dysfunctional behavior has also
contributed to the difficulty of developing a research base to
identify the origins of family violence.

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Movement Ideas
To a great extent, child abuse and battered women's movements
have been successful in asserting that the moral and legal
responsibility for violence rests with the person who commits
the violent act, not the victim, regardless of the circumstances.

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Movement - Police
* Police responding to domestic violence calls should address the
immediate safety, shelter, and medical needs of children in the
household as well as the battered parent.
* Protective orders against abusers should cover both the victim and the
victim's children. These orders might provide for removal of the abuser
from the home, child custody and support arrangements, and
supervised visitation. In some cases, the order might prohibit the abuser
from visiting the children entirely.
* Arrest should be mandatory when an abuser violates child-related
protective orders, including custody or visitation orders.
 The report, "The Impact of Domestic Violence on Children," was released during the (American Bar Association) ABA's annual
meeting in August. It proposed several legal reforms aimed at protecting battered parents and their children from further harm:

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Recommended Procedures for the On-Scene
Responding Law Enforcement Officer
1. If children are present, they should be shielded from witnessing further violence
or the arrest of parents if logistically practical. However, the officer who does so
must take safety into consideration. Shielding the children is usually best
accomplished by back-up officers, if available, who can isolate or remove the
children from the immediate scene.
2. An age-appropriate explanation of the situation should be made to the children
as soon as practical.
3. It is helpful for the officer or the child care or protective services workers to give
the young child something to hold such as a teddy bear or other stuffed animal.
4. Children may need to be relocated to an emergency shelter with relatives or
other responsible adult caretakers or to a location where the child feels safe.
Every effort should be made to keep siblings together in a shelter or in foster
care.

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Movement – Legal
* Convicted batterers and people subject to protective orders should be
barred from possessing firearms.
* Judges hearing child custody and visitation disputes should consider a
history of domestic violence in making their decisions. "Where there is
proof of abuse, batterers should be presumed by law to be unfit
custodians for their children," the report said.
* The report also urged lawyers to make legal services more available and
affordable to domestic violence victims and cited a "profound shortage"
of community legal services for low-income victims. "It is
unconscionable that an indigent parent victimized by domestic violence
is turned away from a legal aid office or placed on a long waiting list
because of program capacity barriers," the report said.

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Discussion Point #3Discussion Point #3
What is the “shift” in your thinkingWhat is the “shift” in your thinking
now about working with angry,now about working with angry,
defiant children?defiant children?

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #1
The brain is organized in a hierarchical fashion, such that all
incoming sensory input enters the lower parts of the brain.
Clinical Implications
 Transference and counter Transference are also related to the
neurobiological principle of “association.” In order to break these
inaccurate and false associations, the client must have the
opportunity for new, healthy associations, to allow the brain to break
false associations, or to decrease the over-generalization of trauma-
related associations. I.e. Child sexual abuse by a male. If over
generalization to the entire male population, child will need time to
generate new healthy experiences with males.

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #2
Neurons and Neural systems are designed to change in a
“use-dependant” fashion.
Clinical Implications
 Use of repetition to help change use-dependent dysfunctional systems.
I.e. If attachment is insecure, use of animals to reconnect may work.
Animal is unconditional. Have the child hold or carry a stuffed animal
around to love, and watch over, care for.
 For these mal-treated children, Consistent, Predictable, Patterned and
Frequent!

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #3 The Brain Develops in a Sequential Fashion
The brain at birth is underdeveloped. Starting from the lowest, most
regulatory regions of the brain, and proceeding upward toward the
more complex parts of the brain responsible for more complex
functioning.
 sequential development and sensitivity
 use-dependent organization
The stress response systems originate in the lower parts of the brain and
help regulate and organize higher parts of the brain; if they are poorly
organized and regulated themselves, they disregulate and
disorganize higher parts of the brain.
Clinical Implications
 The key to therapeutic intervention is to remember that the stress-
response systems originate in the brainstem and dienchephalon.

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #4 The Brain Develops most rapidly early in life.
 0-5 Discussion Critical Period!
 Malleability versus Resilient
Clinical Implications
 The Implication is that early childhood traumatic or maltreatment
experiences have a disappropriate capacity to cause significant
dysfunction, in comparison to similar experiences or forms of
maltreatment later in life.
 This principle informs policy, programming and practice.
 Early intervention works! This is why we work with children!
 Unfortunately, the medical model waits until aberrant behaviors/
symptoms become “out of hand,” or “control.”

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #5
Neural systems can be changed, but some systems are easier
to change than others.
 The general belief of therapy is that it can “change” the present state.
With this in mind, the brain is seen as continuing to be “malleable,”
that is, ability to change and re-conform to change. Thus, the brain
is able to be “influenced, modified and changed.”
This degree of “plasticity” is dependent on two factors –
 the stage of development
 The area or system of the brain.

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Notes on Neuro Sequential Model of
Therapeutics -Bruce Perry
Principle #5 cont.
Clinical Implications:
 Trauma-related systems are related to dysfunction of neuro systems in
the lower, less plastic parts of the brain. The number of repetitions
required to change brainstem neuro development changes is greater
than the number required to change the cortical neural organization.
In other words, it is easier to change beliefs than feelings.

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Youth Violence
A Public Health Issue
We overwhelmingly conclude, on the basis of the body of
psychological research on violence, that violence is not a
random, uncontrollable, or inevitable occurrence. Although we
acknowledge that the problem of violence involving youth is
staggering, there is overwhelming evidence that we can
intervene effectively in the lives of young people to reduce and
prevent their involvement in violence
The American Psychological Association's Commission on Violence and Youth (quoted in
Lantieri and Patti, 1996)

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Weighing In…
Widespread ignorance of the intimate relationships between
cultural belief systems, childrearing practices and the
development of vigilant behaviors will doom any attempts to
truly understand and prevent violence.
Dodge, et al, 1991

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Our Challenge as Society
Change our childrearing practices
Change the malignant and destructive view that children are the
property of their biological parents
Children belong to the community, they are entrusted to parents.
Incubated in Terror: Neurodevelopmental Factors in the Cycle of
Violence-
Bruce D. Perry, M.D., Ph.D.

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Interdependence
 There is no more specific ‘biological’ determinant than a
relationship.
 Social animals belonging to a greater “whole,” a family, a clan.”
Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence-
Bruce D. Perry, M.D., Ph.D.

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Relationship!!!Relationship!!!
Speak to your children…Speak to your children…
not at them…not at them…