Childhood Traumatic Stress

1. Childhood Traumatic Stress National Resource Ctr. for Family-Centered Practice and Permanency PlanningJanuary 8, 2008 Teleconference April Naturale, LCSW

2. What is Trauma? Either a physical injury caused by some direct external force or psychological injury caused by some extreme emotional assault Can result in stress-physical, psychological and social forces or pressures that cause some significant modification, usually a distortion

3. Examples of Trauma Natural events such as an accident-a fall that results in a physical injury or fear Man made events such as physical assault and/or abuse, torture Psychological events such as separation from primary caregiver, neglect, humiliation and other forms of psychological assault Community events-death of a family member, large scale accidents or disasters

4. Key Concepts of Trauma • People will have varying psychological and emotional reactions • Talking with a traumatized person in crisis does not always mean talking about the trauma • People pace themselves when dealing with grief,pain, sorrow and loss • Interject normalcy and respite

5. Normal Reactions to Stress & TraumaEmotional and Behavioral People may feel and express their reactions differently. • Feel very nervous, helpless, fearful, sad or angry • Feel hopeless about the future • Feel detached or unconcerned about others • Feel numb and unable to experience love or joy • Feel that things are unreal; dissociate They may:

6. Normal Reactions to Stress & Trauma Emotional and Behavioral cont’d. • Have an increased startle response • Be irritable or have outbursts of anger • Become easily upset or agitated • Have frequent distressing dreams or memories • Avoid people, places and things related to the disaster • Have trouble concentrating

7. Normal Reactions to Stress & Trauma Physical & Cognitive How people may physically and cognitively react to a disaster varies. They may: • Have an upset stomach, eat too much or too little, or have other gastrointestinal problems • Experience a pounding heart, rapid breathing, sweating, or severe headache when thinking about the disaster • Have trouble falling asleep, staying asleep, or sleeping too much

8. Normal Reactions To Stress & Trauma Physical & Cognitive cont’d. • Be on guard and constantly alert • Be jumpy and startle easily at sudden noises • Have a worsening of chronic medical problems • Be exhausted • Have trouble concentrating • Elicit poor judgment • Exhibit denial of emotions or lack memory of events

9. Trauma Responses in Children Adults often underestimate what children experience the extent of their reactions and what they need to know

10. Common Trauma Responses in Children • Regression to younger development stage (e.g.bed-wetting, thumb sucking, clinging) • Poor school performance • Isolation • High Risk Behaviour such as: -In teens, promiscuous or adult-like behavior (e.g. taking charge) -Use of substances such as alcohol or drugs

11. Common Trauma Responses in Children • Impaired concentration • Impaired learning • Aggression • Recklessness • Reduced inhibitions • Somatic complaints • School refusal

12. More Serious Trauma Responses in Children Children can develop wide range of difficulties that may become serious • Depression • Anxiety • Behaviour Disorders • Mood Disorders

13. Unique Effects of Childhood Trauma Children suffer a dual response: • The impact of the trauma on themselves & • the emotional distress of caregivers, parents and teachers Adult support is a strong protective factor or impacted adults may make at-risk children more vulnerable

14. Unique Effects of Childhood Trauma • Disruption of child or adolescent development • Interfering in the growth of emotional maturity • Repeated exposure can affect the child's brain and nervous system

15. Known Potential Impacts • Increased use of health/mental health services • Increased involvement with the child welfare and juvenile justice systems • Profound long-term consequences

16. Traumatic Grief Responses • Childhood traumatic grief (CTG)- a condition which compromises child’s capacity to negotiate normal grieving • CTG and the loss of parental support places children at high risk for serious emotional difficulties and major mental health problems

17. What Not to Say to Bereaved Children • I know how you feel • Let’s talk about something else • You are strong enough to deal with this • You’ll feel better soon • You did everything you could • You need to relax • It’s good that you are alive

18. Immediate Child Care Worker Tasks • Help children understand, name and accept their feelings • Practice and teach children (and parents) skills of : calming and soothing tolerating managing difficult feelings

19. Continuing Child Care Worker Tasks • Affirm that the reactions are common in response to traumatic events • Help the child make sense of the trauma • Link children and their families with other helpful agencies

20. Instructions to Parents & Caregivers • Maximize caring and support • Just answer the questions they ask • Provide sense of safety and security in whatever form you can • Reassure children that adults are in control • Tolerate regression or need to control • Reinforce their primary role as child/student • Return to routine

21. Therapeutic Activities • Many children find it helpful to write down their trauma experiences in the form of pictures, diaries and stories • Others use: -photography -musical expression -drama performance

22. Therapeutic Activities A WORD OF WARNING: When conducting therapeutic activities, refrain from probing for feelings unless you are the treating therapist intending to activate trauma memory as part of Exposure Therapy. Otherwise, just allow and support expressive activities.

23. Case Examples: Oklahoma City Trauma experts in Oklahoma working with Katrina evacuees monitored rising resentmentbetween host families and evacuee children. An interventionist conducted focus groups to find out what was most important to ‘the acting out’ children. They discovered the need to give the evacuee families an opportunityto say thank you and organized a class activity including shopping together and cooking traditional Southern meals.

24. What about Posttraumatic Stress Disorder (PTSD)? Experiencing, witnessing or being confronted with an event involving actual or threatened death or serious injury; one’s response involves intense fear, helplessness or horror. The event is persistently reexperienced via: recurrent, intrusive distressing memories, dreams; psychological distress and/or physiological reactivity at exposure to cues, symbols or resemblances of traumatic event. (DSM-IVTR, 2000)

25. PTSD Prevalence Most People will not develop PTSD after a disaster or other traumatic event Many, though, may have serious symptoms of distress

26. Assessment and Screening • Select appropriate screening instruments for children and adolescents (obtain consent) (e.g. UCLAPTSD Index) • Communicate the results sensitively and ensure adequate mental health services for those in need • Refer to specialized service providers

27. • Regaining a sense of mastery and control • Resumption of age-appropriate roles and activities • Develop new normal-routine The Psychological Tasks of Recovery

28. Tasks of Recovery • Give children and families permission to celebrate even in the midst of a trauma-encourage the children to play, laugh, experience joy • Have children spend time with friends and family…return to school asap-don’t isolate them • Plan for emergencies: add ‘tools’ to the children’s backpack that will help them cope(e.g. flashlight, family picture, object of comfort, crayons/writing pad, etc.)

29. Long Term Affects of Disaster Trauma and Stress • Anger, resentment and conflict • Uncertainty about the future • Prolonged mourning of losses • Diminished problem solving • Isolation and hopelessness • Health problems • Lifestyle changes

30. Longer Term Interventions • Continuing Needs Assessment • Psychological First Aid • Secondary Psol Assist (Crisis Counseling) • Outreach • Enhanced or Intermediate Services • Traumatic Grief and Bereavement Support • Cognitive Behavioral Treatment