CHILDHOOD TRAUMA: THE PSYCHOLOGICAL IMPACT Gabrielle A. Roberts, Ph.D. Licensed Clinical Psychologist Advocate Children s Hospital
What is a Trauma? Traumatic event: Witnessing or experiencing a frightening, dangerous, or violent event that threatens the life or safety of the child or others present (family, community members). Acute trauma: Results from a single event Complex trauma: Results from prolonged exposure to trauma, experiencing multiple traumatic events over time, or different traumatic events occurring at the same time. (Bassuk et. al., 2006)
Stress Defined Positive Stress Response Tolerable Stress Response Toxic Stress Response
Common Causes of Trauma Physical abuse Sexual abuse Emotional abuse Neglect Community, school or family violence Substance abuse in family Refugee/war experiences Sudden loss of a loved one (including sudden parent-child separation) Sudden injury/accident Personal injury Natural disaster Terrorism Acute and chronic illness Illness in child Illness in parent or family member
Acute Trauma: Impact Fight Flight or Freeze
Acute Trauma: Symptoms Changes in behavior Changes in mood Cognitive changes
Acute Trauma: Resilience & Recovery What determines how a child will experience the event?
Posttraumatic Stress Disorder (PTSD) Recurrent, involuntary and intrusive distressing memories Recurrent distressing dreams Dissociative reactions (e.g., flashbacks, sense of unreality) Intense or prolonged psychological distress at exposure to internal or external cues related to the event(s) Marked physiological reactions to internal or external cues Avoidance of stimuli associated with the event(s) (internal and external) Negative alterations in cognitions and mood Marked alterations in arousal and reactivity associated with the event(s)
Complex Trauma
Can you stop the fight? If you can t, welcome to my life.
Complex Trauma: Impact Altered world view Irrational beliefs Distrust Depression, anxiety disorders, ADHD, learning disabilities, PTSD, Reactive Attachment Disorder, personality disorders, Oppositional Defiant Disorder, Conduct disorder Delayed developmental milestones
I wish that I was never brought to this world.
Complex Trauma: Physical Functioning & Health Alterations in brain development and architecture Sleep problems Increased medical problems and somatic complaints Problems with balance and coordination
if I did something wrong, they beat me.
Complex Trauma: Self Image / Self Concept Self esteem Body image Self confidence Self efficacy Helpless/powerless Unlovable, unworthy
Complex Trauma: Managing Emotions Anger Hostile attributions Fear Sadness Poor emotion regulation Difficulty identifying & expressing feelings Poor frustration tolerance Flat affect, inappropriate affect Numbing, disassociation
Complex Trauma: Attachment & Relationships Difficulty with attachment making good relationship choices maintaining healthy relationships emotion identification and perspective taking trusting others Poor interpersonal boundaries Negative beliefs about self in relationships Expect rejection, others not reliable
Complex Trauma: Attachment & Relationships they believed that I [could] change, but after a while they thought differently and apparently they thought right.
Complex Trauma: Impact on Behavior Poor inhibition Maladaptive coping strategies/ Self-destructive behavior Poor problem solving Oppositional behavior / difficultly with limit setting Aggression and fighting Stealing Hoarding Lying Withdrawal, isolation Avoidance Difficulty taking responsibility Overly responsible/ overly compliant Regression Sleep problems Eating disorders Hygiene problems Poor peer choices School behavior problems/ avoidance
Complex Trauma: Impact on School Problems with executive functioning Lower IQ Learning disorders Memory problems Difficulty processing novel information Processing speed and working memory deficits Poor problem solving Emotional interference
Community Violence Victimization Witnessing Hearing Altered brain development PTSD, anxiety Anger, aggression Suicidal ideation, hopelessness Withdrawal, disassociation Substance abuse Hyperarousal Violence, conduct problems Exposure to danger Transgenerational problems
How do we build a saucer?
References American Academy of Pediatrics (2014). Adverse childhood experiences and the lifelong consequences of trauma (www.aap.org/traumaguide). American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Washington, DC. Bassuk, E., Konnath, K.,& Volk, K. (2006). Understanding traumatic stress in children. The National Center on Family Homelesness. Blaustein, M. & Kinniburgh, K. (2010). Understanding Triggers. In Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience Through Attachment, Self-Regulation, and Compentency. Guilford Press. Children and trauma: Update for mental health professionals. Produced by 2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents. American Psychological Association (http://www.apa.org/pi/families/resources/children-trauma-update.aspx). Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (Eds.). (2003). Complex trauma in children and adolescents: White paper from the National Traumatic Stress Network Complex Trauma Task Force. Effects (2018). The National Child Traumatic Stress Network (https://www.nctsn.org/what is childtrauma/trauma-types/complextrauma/effects). Fowler, P., Tompsett, C., Braciszewski, J., Jacques-Tiura, A., & Baltes, B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolscents. Development and Psychopathology, 21, 227-259. Fox, N. & Shonkoff, J. (2011). How persistent fear and anxiety can affect young children s learning, behaviour, and health. Early Childhood Matters: June 2011 (8-14).
References In Brief: The impact of early adversity on children s development. The National Symposium on Early Childhood Science and Policy. (www.developingchild.harvard.edu). Key Concepts: Toxic Stress (2017). Center on the Developing Child at Harvard University (https://developingchild.harvard.edu/science/key-concepts/toxic-stress/. Lee, E., Larkin, H. & Esaki, N. (2017). Exposure to community violence as a new adverse childhood experience category: Promising results and future considerations. Families in Society: The Journal of Contemporary Social Services, 98 (1), 69-78. Lynn-Whaley, J, & Sugarmann, J. (2017). The relationship between community violence and trauma: How violence affects learning, health, and behavior. Violence Policy Center (www.vpc.org). Meltzer, H., Doos, L., Panos, V., Ford, T., & Goodman, R. (2009). The mental health of children who witness domestic violence. Child and Family Social Work, 14 (491-501). Understanding the effects of maltreatment on brain development (2015). Child Welfare Information Gateway (https://www.childwelfare.gov/pubs/issue-briefs/brain-development). * Anonymous contributions from inspirational teens on the front lines.