TRAUMA AND STRESS: CULTIVATING WELL-BEING FOR ZERO TO THREE

Transcription

1 TRAUMA AND STRESS: CULTIVATING WELL-BEING FOR ZERO TO THREE Holly Hatton-Bowers, PhD and LaDonna Werth, MS April 19 th, 2017 Recharge for Resilience Conference

2 Welcome!

3 What we hope you will take away Understanding of: Stress (positive, tolerable, toxic) Impact of stress on the developing brain Trauma and early brain development Important strategies for helping families with infants and toddlers impacted by trauma

4 What do you hope to learn in this session?

5 Important Needs of Infants and Toddlers Young children are vulnerable Co-regulation of emotions is critical, with attachment being particularly important Developing communication, selfawareness, self-control and selfregulation, sense of self, relationships Lawson & Quinn, 2013

6 Attachment: A Social Need How the primary caregiver responds to cooing, crying, bids for attention, etc. determines the quality of the attachment Secure attachment relationships are: Serve and return Nurturant Stable Committed Attunement: the act or dance of creating attachment through a series of actions and responses between child and the attachment figure

7 Early Childhood Stress Influences Developing Brain Architecture Research on the biology of stress shows that chronic, severe, and/or uncontrollable stressful experiences disrupt developing brain architecture and can lead to stress management systems that respond at lower thresholds. Attachment relationships are central in this process

8 But what is stress?

9 Types of Stress Positive Tolerable Toxic

10 Normative Danger Responses Autonomic Nervous Response System Fight Flight Freeze

11 Positive Stress Brief increase in heart rate, mild elevations in cortisol An important and necessary aspect of healthy development, especially when it occurs in the context of stable and supportive relationships.

12 Tolerable Stress Can disrupt brain architecture, but generally occur within a time-limited period Serious, temporary stress response to events, buffered by supportive relationships Source: National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the Developing Brain. (2005). Working Paper No. 3., Summer 2005.

13 Kills brain cells Prolonged Exposure to Stress and Cortisol Reduces number of cell connections Shrinks hippocampus Impairs selective attention Impairs thinking Creates anxious behavior

14 Toxic Stress Refers to strong and prolonged activation of the body s stress management systems in the absence of the buffering protection of adult support Examples Extreme poverty Physical or emotional abuse Chronic and serious neglect Enduring maternal depression Family violence Source: National Scientific Council on the Developing Child, Excessive Stress Disrupts the Architecture of the Developing Brain. (2005). Working Paper No. 3., Summer 2005.

15 Let s Shake a Bottle

16 Baby s and Stress Newborns and infants rely on their caregivers to soothe and calm them. Two physiological systems control heart rate: parasympathetic nervous system: rest and digest sympathetic nervous system: fight or flight These systems are in a constant fluctuating balance to meet your needs

17 Stress and Infants and Toddlers Because infants are not capable of meeting their own needs, they rely on caregivers to become their external stress regulator When the caregiver is consistent, predictable, and nurturing, providing patterned, repetitive stimulation, the infant develops an adaptive, flexible stress response system and builds in healthy attachment capabilities.

18 Understanding the Impact of Trauma on the Developing Child The first three years are when the brain is making the majority of its primary associations and the core neural networks organize as a reflection of early experience. Early developmental trauma and neglect have a disproportionate influence on brain organization and later brain functioning. Perry & Hambrick, 2008

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20 Encourage Abstract Thought Facilitate Socioemotional Growth Introduce Somato- Sensory Integration Establish State Regulation Perry, B Cortex Limbic Diencephalon Brainstem Abstract Thought Concrete Thought Affiliation/Reward Attachment Sexual Behavior Emotional Reactivity Motor Regulation Arousal Appetite /Satiety Sleep Blood Pressure Heart Rate Body Temperature WHAT ABOUT THE DEVELOPING BRAIN AND TRAUMA?

21 An experience, or pattern of experiences, that impair the proper functioning of the person s stress-response system, making it more reactive or sensitive. Bruce Perry, 2016 WHAT IS TRAUMA?

22 Trauma does not just affect children, it literally changes the wiring of the brain. Jack Shonkoff, MD, Director, Harvard Center for the Developing Child

23 Types of Trauma Complex trauma Family violence Medical trauma Natural disasters Community and school violence Neglect Physical abuse Sexual abuse Traumatic grief Refugee and war zone trauma Source: Adapted from The National Child Traumatic Stress Network,

24 Adverse Childhood Experiences TOP 10 Areas of Trauma Psychological Abuse Physical Abuse Sexual Abuse Loss of a Parent (for any reason) Mother treated violently Substance Abuse Mental Illness Criminal behaviors in the household

25 Experience creates Expectation which alters Perception

26 Developmental Effects of Trauma Ages 0-2 Physiological Have a poor appetite, low weight, and/or digestive problems Have poor sleep habits Experience nightmares or sleep difficulties

27 Hibel et al 2009.

28 Developmental Effects of Trauma Ages 3-6 Cognitive Have difficulties focusing or learning in school Develop learning disabilities Show poor skill development Emotional Act out in social situations Are verbally abusive Are unable to trust others or make friends Are anxious, fearful and avoidant Lack self-confidence Physiological Experience stomachaches and headaches Wet the bed or self after being toilet trained Trauma specific Imitate the abuse Believe they are to blame for the abuse

29 False Associations The brain makes associations between sensory signals that co-occur in any given moment in time. This capacity allows us to survive but it also makes us vulnerable to false associations.

30 Important points to remember All behavior has meaning Symptoms are adaptations Build on success not deficits

31 HOW TO CULTIVATE WELL-BEING FOR INFANTS AND TODDLERS

32 Safety Because trauma including that caused by neglect, whether deliberate or inadvertent causes an overload of the stress response systems, which is marked by a loss of control, treatment for traumatized children must start by creating an atmosphere of safety. ~ (Perry & Szalavitz, 2006, p. 154)

33 Predictability, Consistency, Supportive, Stable, and Regulated = Safety (Hodgdon et. al, 2013)

34 Affect Management When caregivers modulate their own affect and emotional responses, they can create an emotionally safe environment in which children a can learn

35 Remember the bottom up approach Reason Relate Regulate Bruce Perry,

36 Breathing Techniques for the Caregiver Controlled breathing, help calm emotional control centers of the brain (app MyCalmBeat) 5 breaths in and out With toddler teach controlled breathing ( belly breadth)

37 Consistent Response Caregivers respond in a consistent way to both positive (desired) and negative/unsafe behaviors. Predictability reduces the child s need for control.

38 Routines and Rituals Routines increases predictability and the child s ability to anticipate next steps. Establishing routines helps reduce trouble spots (transitions, unstructured activities/days). Consider beginning the day with predictable, structured, patterned, rhythmic music and movement activities. Studies have indicated that children have increased self-regulation throughout the day when sensory integration occurs early.

39 How do you promote these concepts in a home visiting environment? Affect management Consistent Response Routines and Rituals

40 Use Reflection Provider Reflection Processes the mindful considerations of one s actions. (Gilkerson & Shahmoon-Shanok, 2000) Provider Reflective Process Assessment Scales (PRPAS) Heller & Ash, 2016 Mindfulness Mindfulness is an open-hearted, moment to moment, non- judgmental awareness (Kabat-Zinn, 2005, p. 24).

41 PRPAS Examines Self-Knowledge (Self-awareness, seeks growth) Self-Regulation (emotional breathing space, hold uncomfortable emotions, awareness of emotional climate) Collaboration (Exploration, Resists Pressure to Fix, Impact of Words and Actions) Process (Relationships influence change, Attends to Process Authentic Attitude (Openness, Acceptance, Curiosity) Multiple Perspectives (consider personal history, experiences, culture) Heller & Ash, (2016)

42 Reflection Activity

43 Coping Tools: Supportive Trauma Interventions for Educators (STRIVE) SIGHT: Calming an focusing: Green color SOUND: Calming and comforting: low pitched white noise SOUND: Calming and focusing: noise cancelling headphones TOUCH: Calming and distracting: kinetic sand TOUCH: Tension release: stress eggs TOUCH: Tension release: Theraputty Identify Feelings: Emotion cards Reflection: mindfulness exercise, depth breathing McConnico, Boynton-Jarret, Bailey, & Nandi, 2016

44 Take Aways Trauma is a unique individual experience For infants and toddlers, exposure to trauma and overwhelming stress can impact the developing brain Take the time to listen and understand children and this can mitigate trauma and toxic stress Relationships are key to healing Reflection and mindfulness can build relationships, understanding and lead to children s healing

45 Let s Reflect! What are your key take aways? What questions do you have about the material we discussed? What additional strengths are you able to recognize in your work and practices? In the children you care for? Families you help support? What strategies did you see or hear that might be useful in your role and work?

46 Thank you!

47 Resources Leiberman, A.F., Van-Horn., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44, doi: /01.chi Lieberman AF, Knorr K. (2007). The impact of trauma: A developmental framework for infancy and early childhood. Pediatr Ann., 36 (4): Osofsky JD, Lieberman AF. (2011). A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children. Am Psychol.,66(2): Zero to Three