Trauma in Infancy: Multimodal Intervention

Transcription

1 Trauma in Infancy: Multimodal Intervention The effects of trauma in early childhood Previous Experience Trauma Trauma Consequences Neglect Overstimulation Witnessing Violence Drug Exposure Composite of Relationships Attachment Working Models and Trauma Itself 1

2 Related to Anxiety fears crying daredevil behavior Memory and reexperience posttraumatic play aggressive behavior temper outbursts Sensorimotor functioning: hyperactivity short attention span Constellation of symptoms Sleep difficulties onset, maintaining, terror Overwhelming fear dissociation freezing behaviors Cognitive: overstimulation difficulty process refractory to learn Avoidance behavioral inhibition listlessness sadness, feeding problems 2

3 Levels of Intervention Provide Safety, Reduce Tension Provide Normative Experiences Provide Compensatory Experiences Promote Adaptive Behavior Understand and Deal with Symptoms and Regressive Behavior 3

4 Levels of Intervention Intervention with the Child Intervention with Caretakers May Be Perpetrators or Facilitators of Trauma Intervention with Social Environment Cultural Milieu Others Involved 4

5 Levels of Intervention II Dealing with the Effects of Trauma Sense of Mastery and Efficacy Sense of Control and Safety Working Through of Experiences Re-living Re-processing Integration of Experiences in Everyday Life 5

6 Levels of Intervention III Play Repetition of Reassuring Experiences Coping and Gradual Progressive Exposure Small Doses Relaxation Biofeedback Suggestion Pharmacotherapy 6

7 Play Reenactment Debriefing Reexperiencing Exploring Resolution Repeated Controlled Exposure Cognitive and Behavioral: Offer Solutions Alternatives Changing Vulnerability Traumatic Play Therapeutic Play Spontaneous and Creative 7

8 Toddler and Older Infant Cognitive and Behavioral Techniques Narration of Experiences. Lack of Control Diminish Guilt. Assign Responsibility Labeling of Feelings. Expression of Feelings Understanding Reactions and Symptoms Provide Alternatives. Behavioral Techniques for Coping and Changing Behavior 8

9 Compensatory Experiences Sensitive Caretaking Containment Reassurance Help Self-regulation and Relaxation Biofeedback Hand Temperature Abdominal Breathing Muscle Contraction Coping with Stimuli and Environment Massage Deep Pressure Sensory Diet Stimulus Diet 9

10 Sleeping Problems Understanding Reassurance. All Co-sleeping Responsiveness to Fear and Disruptions Transitional Objects Behavioral Intervention. Gradual Mastery Chaining and Gradual Modification Pharmacotherapy If Severe 10

11 Trauma in Infancy: Multimodal Intervention Behavioral Dysregulation Aggression Temper Outbursts Hyperactivity Short Attention Span Dissociation Freezing Behavior Cognitive Resistance Containment Symbolic Expression Empathy Play Time Circles of Communic. Engagement Other Regulation Holding Interaction Integration Pharmacotherapy Clonidine Propranolol SSRI 11

12 Trauma in Infancy: Multimodal Intervention Sensitization Empathy Understanding Meaning of Behavior Tailor Caretaking to Emotional Functioning of Child and Developmental Profile Intervention with Caretakers Caretakers as Cotherapists Provide Coaching and Consultation Practical Alternatives Working Alliance Long-term Nature of Problem 12