CHILDHOOD TRAUMA AND ITS RELATIONSHIP TO PTSD.!! Andrea DuBose, LMSW

Transcription

1 CHILDHOOD TRAUMA AND ITS RELATIONSHIP TO PTSD!! Andrea DuBose, LMSW

2 "There are words that Never Show on the body that are deeper and more harmful than anything that bleeds" Laurel K. Hamilton, Mistral's Kiss!

3 ?????????????? What is the first thing that comes across your mind when you think about childhood trauma?

4 What Inspired Me to Choose This Topic? Working with children who have experienced some form of trauma Being a Mentor for several children Adult Family members who have experienced childhood trauma

5 Definition of Trauma A serious shock or injury to the body as from violence or an accident! An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis! A deeply distressing or disturbing experience! An event or situation that caused great distress and disruption! Trauma is defined by the experience of the survivor.

6 Trauma Trauma means different things to different people. Children may be traumatized by events that do not bother adults in the same way. Not all traumatic experiences create emotional distress in children. However, some traumatic experiences can create Post Traumatic Stress Disorder (PTSD). PTSD occurs when people are unable to cope with their lives as the result of trauma. PTSD results from a child's perspective of an event.

7 Traumatic Events That May Affect Children Ongoing bullying Physical, sexual or emotional abuse Neglect Physical assault Violence witnessed or discussed National disasters Serious accidents

8 Falls or sport injuries Serious medical procedures, such as surgery Sudden death of someone else Loss of a loved one Forced separation early in life from a primary caregiver Parental divorce A loved one in jail

9 Symptoms to Look for in Children suffering from PTSD ( The symptoms of PTSD in children can be varied and different by age) Setbacks in toilet training Eating or sleeping disturbances Re-enactment of the traumatic event Irritability Fearfulness Helplessness Anxiety Clinginess Aggression Rage

10 Restlessness Stomachaches and headaches Depression Social problems Defiance Drug use

11 STATISTICS "Knowledge is the life of the mind." - Abu Bakr 60 % of adults report experiencing abuse or other difficult family circumstances during childhood. 26% of children in the United States will witness or experience a traumatic event before they turn four. Four of every 10 children in America say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury.

12 Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse. More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied. 1 and 5 children witnessed violence in their family or the neighborhood during the previous year. Among 536 elementary and middle school children surveyed in an inner city community, 30% had witnessed a stabbing and 26% had witnessed a shooting.

13 Young Children exposed to five or more significant adverse experiences in the first three years of childhood face a 76% likelihood of having one or more delays in their language, emotional or brain development. As the number of traumatic events experienced during childhood increases: depression, alcoholism, drug abuse, suicide attempts, heart and liver disease, pregnancy problems, high stress, uncontrollable anger, and family, financial, and job problems.

14 Studies show that children who have been through one or more traumas may be misdiagnosed with ADHD, bipolar disorder, depression, anxiety and other mental illnesses. At the same time the trauma might trigger the mental illness. Women who experienced severe physical or severe abuse during childhood are much more likely to have a food addiction. This is due to the fact that stress may cause them to overeat high-sugar and high-fat.

15 Children who have experienced Trauma are: 15 times more likely to attempt suicide 4 times more likely to become an alcoholic 4 times more likely to develop a sexually transmitted disease 4 times more likely to inject drugs 3 times more likely to use anitdepressent medication 3 times more likely to be absent from work 3 times more likely to experience depression 3 times more likely to have serious job problems 2.5 times more likely to smoke 2 times more likely to develop chronic obstructive pulmonary disease

16 DSM-IV-TR Diagnostic Criteria for Post-traumatic Stress Disorder (Code )

17 A. The person has been exposed to a traumatic event in which both of the following were present the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

18 B. The traumatic event is persistently reexperienced in one (or more) of the following ways 1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. 2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

19 3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

20 4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

21 C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: 1. efforts to avoid thoughts, feelings, or conversations associated with the trauma 2. efforts to avoid activities, places, or people that arouse recollections of the the trauma 3. inability to recall an important aspect of the trauma

22 4. Markedly diminished interest or participation in significant activities 5. Feeling of detachment or estrangement from others 6. Restricted range of effect (e.g., unable to have loving feelings) 7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

23 D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: 1. difficulty falling or staying asleep 2. irritability or outbursts of anger 3. difficulty concentrating 4. hypervigilance 5. exaggerated startle response

24 E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Specify if: Acute: if duration of symptoms is less than 3 months. Chronic: if duration of symptoms is 3 months or more.

25 Treatment Trauma Focused Cognitive Based Therapy Works for children who have experienced any trauma, including multiple traumas. Is effective with children from diverse backgrounds. Works in as few as 12 treatment sessions. Has been used successfully in clinics, schools, homes, residential treatment facilities, and inpatient settings. Works for children in foster care. Is recognized as being one of the most effective interventions for children who have significant psychological symptoms related to trauma exposures. Helps children and families recover from the negative effects of traumatic experiences.

26 Components of TF-CBT (Summarized by the acronym PRACTICE) Psychoeducation is provided to children and their caregivers about the impact of trauma and common childhood reactions. Parenting skills are provided to optimize children's emotional and behavioral adjustment. Relaxation and stress management skills are individualized for each child and parent. Affective expression and modulation are taught to help children and parents identify and cope with a range of emotions. Cognitive coping and processing are enhanced by illustrating the relationship among thoughts, feelings, and behaviors. This helps children and parents modify inaccurate or unhelpful thoughts about the trauma. Trauma narration, in which children describe their personal traumatic experiences, is an important component of the treatment.

27 In vivo mastery of trauma reminders is used to help children overcome their avoidance of situations that are no longer dangerous, but which remind them of the original trauma. Conjoint child-parent sessions help the child and parent talk to each other about the child's trauma. The final phase of the treatment, Enhancing future safety and development, addresses safety, helps the child to regain developmental momentum, and covers any other skills the child needs to end treatment.

28 Goals for Treatment Give hope to children and parents. Help the parent or caregiver to understand their own feelings about the trauma the child has been exposed to. Empower the child Create safe environment for the child. Overcome general feelings of depression. Reduce emotional distress about the child's trauma. Provide children with a safe and reparitive experience so that development and potential may be realized. Trauma is by nature intrusive. Therefore, the helper's interventions should be facilitative, not another intrusion.

29 Treatment should include communicating, educating, and healing for both the child and parent or caregiver. In the case of molestation or rape, the major goal is not allowing the child to blame self for the behavior of the adult or child perpetrator. Create psycho-education in regards to body awareness in the case of molestation or rape as well.

30 Build Resilience The Power to Cope With Adversity Resilience is the ability to cope with the stress caused by such challenging situations. Two important ways that early childhood professionals can help parents and young children foster resilience include identifying strengths and building on resources. On a daily basis, parents can build their child's resilience by: teaching self-care emphasizing the positive building a strong parent-child bond encouraging soical skills maintaining a daily routine nurturing positive self-esteem practicing self-reflection

31 References free dictionary.com The Adversive Childhood Experiences (ACE) study - Felitti, V.J. Anda, R.F. Nordenberg, D.F. Relationship of Childhood Abuse and household dysfunction to many of the leading causes of death in adults (American Journal of Prevenitive Medicine 14(4), "Building Resilience in Children and Youth Dealing with Trauma," Substance Abuse and Mental Health Services Administration, U.S Department of Health and Human Services ( trauma_resilience.asp) How to implement Trauma-Focused Cognitive Behavioral Therapy. The National Child Traumatic Stress Network. National Center for Mental Health Promotion and Youth Violence Prevention, "Childhood Trauma and its Effect on Healthy Development, "July 2012." DSM PTSD Criteria Masten, A. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56,