Complex Trauma in Children and Adolescents

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1 Complex Trauma in Children and Adolescents Sara Coffey, D.O. Assistant Professor Department of Psychiatry and Behavioral Sciences Oklahoma State University Center for Health Sciences

2 Overview of trauma across the lifespan Trauma and School Performance and Learning Trauma and Treatment Vicarious Traumatization Professional Self Care

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6 Overview of trauma across the lifespan Trauma and School Performance and Learning

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8 Trauma and School There is a dose-response relationship between adverse childhood experiences and student learning. Are two-and-one-half times more likely to fail a grade Score lower on standardized achievement test scores Have more receptive or expressive language difficulties Are suspended or expelled more often Are designated to special education more frequently

9 Developmental Trauma Disorder 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Affective and Psychological Dysregulation Attention and Behavioral Dysregulaiton Self and Relational Dysregulation PTSD symtpoms Functional Impairment Constellations of Interpersonal Trauma Symptoms in Child Welfare: implications Of Developmental Trauma Framework. Kiseil, Torgesen, Griffin. J Fam Viol 29:1-14

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12 Trauma s Impact on Academic Performance, Behavior, and Relationships Problem solving and analysis Limited experience attending to complex communication and difficulty extracting key ideas Organizing Narrative Material Bring a linear order to the chaos of daily experience Which requires the ability to transition episodic memory to semantic memory Needs consistent, predictable routines from familiar reliable care givers

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14 Overview of trauma across the lifespan Trauma and Treatment Trauma and School Performance and Learning

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16 Overview of trauma across the lifespan Trauma and Treatment Trauma and School Performance and Learning

17 PTSD in Children 6 and Younger Exposure to trauma 1+ Intrusion Symptoms Memories (play) Dreams Flashbacks (play) Psychological Distress Psychological Reactivity 2+ Arousal Irritable/angry Hypervigilant Exaggerated startle Concentration Sleep disturbances 1+ Avoidance/Cognition Memories, Thoughts, Feelings External Events Negative emotional state Diminished interest socially withdrawn Reduced positive emotion Lasts more than 1 month Significant Distress Not attributable to substance or medical condition

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19 Adverse Childhood Events Emotional Abuse Physical Abuse Sexual Abuse Mother Treated Violently Household Substance Abuse Mental Illness in Household Parental Separation or Divorce Criminal household member Emotional Neglect Physical Neglect

20 Developmental Trauma Disorder: Exposure 1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death). 2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

21 Triggered pattern of repeated dysregulation in response to trauma cues Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness. Affective Somatic (physiological, motoric, medical) Behavioral (e.g. re-enactment, cutting) Cognitive (thinking that it is happening again, confusion, dissociation, depersonalization). Relational (clinging, oppositional, distrustful, compliant). Self-attribution (self-hate and blame).

22 Persistently Altered Attributions and Expectancies Negative self-attribution Distrust protective caretaker Loss of expectancy of protection by others Loss of trust in social agencies to protect Lack of recourse to social justice/retribution Inevitability of future victimization

23 Functional Impairment Educational Familial Peer Legal Vocational

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26 Psychoeducation and Parenting skills Relaxation skills Affective modulation skills PRACTICE acronym: Cognitive coping and processing Trauma narrative In vivo mastery of trauma reminders Conjoint child parent sessions Enhancing future safety and development

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29 ARC Treatment Model Attachment Regulation Competencies

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34 SSRI s Zoloft (sertraline) Prozac (fluoxetine) Celexa (citalopram)

35 Adrenergic Agents, etc. Antiadrenergic Medications Alpha-2 Agonist Beta-Blockers Prazosin Clonidine Propranolol Guanfacine

36 Other Agents Second-Generation Antipsychotics Mood Stabilizers Risperidone (Risperdal) Quetiapine (Seroquel) Carbamazepine (Tegretol) Valproic Acid (Depakote) Anithistamines Cycproheptadine (Periactin) Other Antidepressants Imipramine (Tofranil) Nefazadone (Serzone)

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39 Comorbidity

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41 Burnout, Vicarious trauma and Secondary Trauma Burnout: emotional exhaustion, a reduced feeling of accomplishment. Occurs as result of general occupational stress. Vicarious traumatization: harmful changes in professionals views of themselves, others, and the world as a result of exposure to traumatic material Secondary traumatic stress: a syndrome among professional helpers that mimics Post traumatic stress disorder and occurs as a result of exposure to traumatic material

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44 Secondary Traumatic Stress Increase in arousal May Re-experience own personal trauma Avoidance Changes in memory and perception Alterations in sense of self-efficacy Sleeplessness Fear Chronic Exhaustion

45 Secondary Traumatic Stress Barriers to detection Self-blame Shame Denial Self-Sacrifice Job-Security Pressure Cost

46 Overview of trauma across the lifespan Trauma and School Performance and Learning Trauma and Treatment Vicarious Traumatization Professional Self Care

47 Secondary Traumatic Stress Prevention

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51 Final Thoughts Traumatic Events Happen You are imperative in its detection There are ways to prevent and treat it Trauma effects those of us who work with it You are a vital component in the healing process

52 Questions