The Effects of Trauma on Young Children

1. The Effects of Trauma on Young Children Stacey Ryan, LCSW Infant Toddler Specialists of Indiana Conference August 23-25 2006

2. Types of Trauma • Witnessing violence (domestic and other) • Natural disaster • Terrorism • Accidents • Abuse/Neglect • Loss of caregiver

3. Do Young Children Experience Trauma? • Children under 12 months account for 44% of deaths from child abuse and neglect • Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome

4. Young children and sexual abuse • Infants and toddlers may account for as many as 10% of substantiated sexual abuse • Appearance of sexualized behavior is more likely than physical findings • The younger the child when abused, the more likely sexualized behavior appears

5. Young children and domestic violence • Child sees attachment figure injured • Attachment figure cannot protect self; child is unsure if she can protect him • Attachment figure may in turn injure the child

6. Assessing severity of trauma • Closeness of people involved to the child • What the child saw • Child’s developmental level • Reactions of important adults

7. How Young Children Understand Traumatic Events and Experiences • Cognitive and emotional capacity determines how child experiences trauma • Level of understanding can also affect memory • 2-3 year olds do not understand the finality of death • Young children may believe they caused a traumatic event

8. Clinical Patterns in Abused/Neglected Infants Gaensbauer & Mrazek (1981) observed 4 clinical patterns: • Developmentally and Affectively retarded group • Depressed Group (sad and sensitive to change) • Ambivalent Group (rapid shifts in emotion) • Angry Group (emotional intensity and low frustration tolerance)

9. Effects of Trauma • Can appear immediately or after days, weeks • May remind young child of previous traumas, making reaction more severe

10. Effects of Trauma • Physical & Self-Regulation Effects • Traumatic Reminders • Development • Play • Behavior • Relationship

11. Physical and Self-Regulation Effects • Self-regulation is important task of infancy • In babies and young children, problems with self-regulation look like: Sleep problems Eating problems Exaggerated startle Hypervigilance

12. Physical and Self-Regulation Effects • Exposure to traumatic events seems to change the way the infant reacts to future stressors • Animal and human studies shows changes in hormones and brain chemicals after trauma • These brain changes can be long lasting, leading the child to feel numb or anxious

13. Traumatic reminders • Can be difficult to identify in nonverbal child • Sensory (siren, smell) • Dreams • Re-experiencing the event • Irrational fear of benign objects

14. Developmental Effects of Trauma • Developmental delays are expected—developmental assessment is advised • Problems may occur in development of attachments and other social emotional skills • Regression is possible

15. Effects on Play Skills • Repetitive actions • Driven quality • Constricted quality • Preoccupation with separation, loss, and reunion

16. Effects on Behavior—infants and toddlers • Increased irritability/inability to soothe • Sleep disturbance • Emotional distress; sadness • Fears of being alone; clinging; refusal to separate • Motor agitation • Temper tantrums

17. Effects on Behavior—toddlers and preschoolers • Being too clingy with adults • Not able to be comforted when upset • Problems with exploration: either reckless or too inhibited • Aggression toward caregivers, peers, animals • Angry noncompliance

18. Effects on Relationship • Difficulty forming positive relationships • Poor sense of self • Lowered self esteem • Expectation of being treated poorly • Loss of secure base • Loss of sense of trust

19. Long Term Effects of Trauma • Persistent grief reactions (Bowlby) Protest: efforts to find the parent through crying, calling, and searching Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities Detachment: apparent indifference to reminders; selective forgetting*

20. Long Term Effects of Trauma • Increased risk for academic problems • Substance use and abuse • Early pregnancy • Criminal involvement • Psychiatric symptoms and disorders • Experiencing abuse as a child is linked to abusing one’s own child

21. Abused children as parents • Harsh discipline • Failure to respond to child’s needs • Inconsistent limit setting • Inability to express affection • Inability to enjoy interactions with child • Minimize or deny child’s painful experiences

22. Young children and neglect • Failure to provide for child’s physical and emotional needs • Leaving child alone for long periods • Leaving child for long periods with varied and unreliable caregivers • Effects of neglect can be as devastating as physical or sexual abuse

23. Effects of neglect • Lack of play and other developmental skills • May hoard food • Unfamiliar with things we take for granted • Expects to take care of self or siblings • Challenges adult authority • Lacks trust in adults • Avoids adults when upset; hard to soothe

24. Expected difficult reactions to placement in foster care • Previous relationship failures lead the child to behave in ways that alienate foster parents • Caregivers misread behaviors and respond in ways that increase problems • Child responds to loss of attachment figure with behavioral, emotional, and physiological dysregulation

25. Expected difficult behaviors of children in care • Acting like they do not need caregivers, even under threatening conditions • Acting angry when adult makes efforts to soothe • Turning away when hurt • Behaving aggressively toward caregivers • Behaving aggressively toward peers • Problem behavior after visits

26. Why do we see behavior problems after visits with family? • Visits with parents are traumatic reminders of events that led to the separation or of the separation itself • Both the child and parent may feel anxious and angry • Supervised visits increasing parents feelings of incompetence • Child feels safer expressing angry feelings toward foster parent/family

27. How Foster Care Helps • One of the most important things a foster parent can do is to help young children have positive relationships • Doing this will help with development and behavior • To do it right, you have to pay attention to attachment

28. Arousal-Relaxation Cycle Child experiences a need Child feels upset Child feels content Adult satisfies need

29. Are there children with no attachments? • There are children with no attachments • It is more likely that a child have an attachment problem rather than no attachment at all • The child will develop an attachment with the adult that is available

30. Why do children form attachments to abusive parents? • Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them • Children prefer the familiar, even when what is familiar is frightening

31. Insecure Attachments • Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance. • Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby

32. Insecure Attachments • Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them • Infant is afraid of the person they look to for reassurance and nurturance • Infant behavior is unorganized and bizarre • These patterns are common when children are abused or they witness domestic violence

33. Long term Effects of Disorganized Attachments • Aggression with peers • Dissociative behaviors

34. Role of Foster Parent in Attachment • Help the child develop a healthy attachment • Help child extend attachment to you and improved behaviors to birth family, new fosterfamily, or adoptive family

35. How Foster Parents Can Help • Work with the parents • Avoid judgments about the biological parents • Provide transitional objects to child • Provide family pictures • Have a plan for the first visit

36. How Foster Parents Can Help Responding to parent anger • Listen • Be non-reactive • Acknowledge how difficult it is to be away from child

37. How Foster Parents Can Help • Recognize that the child needs you, even when they do not show it • Understand rejecting behaviors as old coping methods • Listen • Put words to behaviors • Attend to your own reactions • Encourage touch, but do not force it

38. How Foster Parents Can Help at Home • Safety • Routine that shows an adult is “in control” • Soothing sensory activities • Stop activities that result in re-enactment (including television) • Advocate to reduce moves to provide continuity

39. Question and Answer

40. Factors in Determining Types of Interventions, (Osofsky & Fenichel, 1994) • Safety and Stability of Current Living Situation • Child’s Developmental Capacities to Make Use of Certain Types of Interventions • Quality of Pre-Traumatic and Current Care-Giving Environment • Type of Violent Event or Situation • Acuteness vs. Chronicity of Trauma • Actual and Psychological Proximity of the Violent Events • Post Traumatic Symptoms in Child and Caregiver • Strengths and Protective Factors in Infant

41. Goals for Intervention (Lieberman & Van Horn, 2005) • Return to Normal Development • Increase Capacity to Respond to Trauma. • Maintain Regular Levels of Arousal • Re establish Trust in Bodily Sensations • Restore Reciprocity in Close Relationships • Normalize Reactions to Trauma • Encourage a Differentiation Between Reliving and Remembering • Place the Traumatic Experience in Perspective

42. Common Intervention Needs (Osofsky & Fenichel, 1994) • Improving the caregivers ability to attend to and provide for the child’s needs • Further develop caregiver’s ability to interpret child’s feelings, reactions and support child • Address cognitive distortions child may have regarding trauma • Assist the child in re experiencing trauma in affectively tolerable doses • Assist the child and caregiver in coping with any losses

43. Results of Interventions Assist Child in Understanding… • Stressful body experiences can be alleviated with help of others and coping strategies • Adults can support and protect child • Child is not to blame • Can talk about emotions rather than only acting them out • Life can contain elements of mastery, fun and hope

44. Methods for Intervening • Using Play, Physical Contact and Language to Promote Developmental Progress • Offering Unstructured Reflective Developmental Guidance • Modeling Appropriate Protective Behavior • Interpreting Feelings and Actions • Providing Emotional Support/Empathetic Communication • Offering Crisis Intervention and Concrete Assistance

45. Areas of Clinical Concern include… • Play • Sensorimotor Disorganization • Fearful Behavior • Self Endangering Behavior • Aggression Toward Parent • Aggression Toward Peers • Parental Use of Physical Discipline • Parental Use of Threats, Criticisms of Child • Relationship with Perpetrator

46. Play • Encouragement of Play with Dyad • Help the Parent Understand and Support Use of Play • Allow the Parent to Be Main Supporter to Child

47. Sensorimotor Disorganization • Help the Parent Understand How these behaviors Affect Them (triggers feelings of rejection, anger and frustration in parent) • Develop New Meanings for Parent

48. Child Fears • Support Parent Understanding of Fears • Bring Attention to Cues Child Gives Regarding Fears • Develop with Parents Strategies for Containing Fears

49. Aggression Toward Parent • Give Parents Meaning for This Behavior • Assist Parents In Containing Feelings Regarding this Behavior • Develop Strategies for Controlling Anger/Aggression

50. Aggression Toward Peers • Build Understanding of Reasons for Behavior • Clinician Gives Resources for Deescalating Behavior • Empower Parents to Take Action and Assist Child