ABC of Ohio presents…

1. ABC of Ohio presents… Impact of Trauma on Child Development

2. Part I Complex Trauma

3. Complex Trauma(Cook, Blaustein, Spinazzola and van der Kolk, 2003)http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf Definition Children’s experience of multiple traumatic events that occur within the care giving system • Prenatal exposure to drugs/alcohol • Neglect/Institutionalization • Abuse • Abandonment/Multiple Moves • Pain/Illness/Hospitalization Involves simultaneous or sequential occurrences of child maltreatment—that are chronic and begin in early childhood

4. Complex Trauma Areas of Impairment • Attachment • AffectRegulation • Dissociation • Cognition • Biology • BehavioralControl • SelfConcept

5. ATTACHMENT Attachment is the process by which an emotional connection develops between an infant and his/her caretaker This process organizes the infant physiologically and psychologically Attachment becomes the basis for how he/she will relate to the world, learn and form relationships In addition to the basic needs such as food, shelter and clothing, the infant needs emotional care which is essential for his/her development Attachment grows through daily interactions between caretaker and infant Smiles, nurturing touch, eye contact, mutual play build trust and security in the child This first relationship becomes the blueprint for all future relationships It is also the origin of conscience development, empathy, self-esteem and cause and effect thinking Insecure attachment patterns seen in 80% of maltreated children 5

6. NEED ANGER HIGH AROUSAL RAGE TRUST GRATIFICATION 6

7. DISSOCIATION AFFECT REGULATION Difficulty with emotional self-regulation Difficulty describing feelings and internal experience Problems knowing and describing internal states Difficulty communicating wishes and desires Predisposed to earlier onset of affective problems, which is associated with more episodes and poorer outcome • Distinct alterations in states of consciousness • Two or more distinct states of consciousness • Hyperarousal & Dissociative • Begins as a protective defense mechanism and then is utilized more frequently as trauma continues

8. Think Deer….

9. Cognitive Problems with… • Irrational cognitions • Sustained curiosity/initiative • Processing new information • Focusing and completing new tasks (hypervigilence vs. hyperactivity) • Understanding own contribution to what happens to them (cause-and-effect thinking) • Object constancy • Orientation with time and space • Learning disabilities • Abstract thinking

10. Developmental Delays Cause and Effect Thinking Problem-Solving Skills Moral Development Social Skills

11. Biology Problems with… • Experiences impact brain development • Lifelong reactivity to stress • Problems with coordination, balance, body tone • Somatization • Analgesia (inability to feel pain) • Hypersensitivity to physical touch • Wide variety of medical problems: pelvic pain, asthma, skin problems, autoimmune disorders • Sensory Integration Dysfunction

12. Behavioral Control • Poor impulse control • Self destructive behavior • Aggression • Self soothing behaviors • Sleep and eating disturbances • Substance abuse • Excessive compliance or oppositional behavior • Reenactment of traumatic past

13. Self Concept • Lack of coherent sense of self • Disturbance of body image • Low self-esteem • Poor sense of separateness

14. Research Vineland Adaptive Behavioral Scales

15. Research The Vineland Measures Development… Socialization Domain • Interpersonal Relationships • Play and Leisure Time • Coping Skills Motor Skills Domain • Gross • Fine • Behavior • Internalizing • Externalizing Communication Domain • Receptive • Expressive • Written Daily Living Skills Domain • Personal • Domestic • Community

16. Chronological Age 7 years, 11 months 9 years, 1 months Communication • Receptive 1 year, 11 months 2 years, 11 months • Expressive 6 years, 4 months 6 years, 7 months • Written 9 years, 0 months 10 years, 8 months Daily Living Skills • Personal 6 years, 1 month 6 years, 6 months • Domestic 5 years, 5 months 9 years, 6 months • Community 7 years, 6 months 8 years, 7 months Socialization • Interpersonal Relationships 1 year, 1 month 1 years, 9 months • Play and Leisure Time 2 years, 9 months 5 years, 3 months • Coping Skills 1 year, 6 months 3 years, 5 months Motor Skills Domain • Gross Age Equivalent Age Equivalent • Fine 4 years,11 months 6 years, 10 months Behavior • Internalizing Clinically Significant Elevated • Externalizing Clinically Significant Elevated

17. Chronological Age 11 years, 1 months 12 years, 5 months Communication • Receptive 1 year, 9 months 3 years, 11 months • Expressive 5 years, 11 months 7 years, 7 months • Written 9 years, 2 months 10 years, 10 months Daily Living Skills • Personal 5 years, 11 month 11 years, 3 months • Domestic 7 years, 7 months 9 years, 6 months • Community 8 years, 11 months 9 years, 6 months Socialization • Interpersonal Relationships 0 year, 11 month 3 years, 7 months • Play and Leisure Time 3 years, 2 months 9 years, 3 months • Coping Skills 2 year, 3 months 5 years, 6 months Motor Skills Domain • Gross Age Equivalent Age Equivalent • Fine Age Equivalent Age Equivalent Behavior • Internalizing Clinically Significant Elevated • Externalizing Clinically Significant Elevated

18. Chronological Age 4 years, 4 months 5 years, 7 months Communication • Receptive 1 year, 3 months 1 year, 6 months • Expressive 2 years, 6 months 3 years, 5 months • Written 4 years, 5 months 4 years, 11 months Daily Living Skills • Personal 3 years, 1 month 5 years, 0 months • Domestic 4 years, 6 months 5 years, 6 months • Community 3 years, 1 month 4 years, 5 months Socialization • Interpersonal Relationships 1 year, 1 month 2 years, 0 months • Play and Leisure Time 0 years, 4 months 0 years, 8 months • Coping Skills 1 year, 10 months 3 years, 4 months Motor Skills Domain • Gross 2 years, 1 month 4 years, 11 months • Fine 3 years, 6 months 4 years, 7 months Behavior • Internalizing Clinically Significant Clinically Significant • Externalizing Elevated Elevated

19. Chronological Age 6 y, 0m 7 y, 0 m 8y, 3m Communication • Receptive 1 y, 6 m 1 y, 11 m 2y, 2m • Expressive 3 y, 2 m 5 y, 0 m 4y, 6 m • Written 5 y, 2 m 6 y, 9 m 7y, 9 m Daily Living Skills • Personal 4 y, 7 m 6 y, 1 m 6y, 6m • Domestic 4 y, 4 m 3 y, 11 m 7y, 7m • Community 3 y, 7 m 5 y, 5 m 5y, 5m Socialization • Interpersonal Relationships 0 y, 3 m 2 y, 3 m 2y, 5 m • Play and Leisure Time 0 y, 9 m 2 y, 10 m 2y, 10m • Coping Skills 1 y, 6 m 2 y, 3 m 2y, 2m Motor Skills Domain • Gross 4 y, 5 m 5 y, 11 m 6y, 10m • Fine 6 y, 6 m 6 y, 6 m 6y, 10m Behavior • Internalizing CS CS CS • Externalizing CS CS CS

20. Part II A Tool-Box of Techniques

21. The Dynamics of the Complex Family System The Consumption and Depletion of Coping Skills “Nothing works!” “We’ve tried it all!”

22. Parenting Pearls…Control, Control, Control • What you want to control • What you need to control • What you can control • What you should not control • What you cannot control

23. Parenting Pearls… • Developmental Parenting • “Developmental interruptions result in delays that leave the individual developmentally immature”

24. Ineffective Parenting Tools Less Talk More Action! No: • Threats • Reminders • Warnings • Bribes

25. Parenting Pearls… • Too much talk causes too little listening

26. Facing Frustrations Avoid Approaching Storms Reduce Angry Reactions

27. The Emotional Roller-Coaster“Reactions” not “Consequences” Parenting, healing forming strong attachments, etc. are about reactions, notconsequences.

28. The Emotional Roller-CoasterThe Impact of Stress on the Adoptive Family Child arrives with unresolved emotions Child acts out behaviorally Parents’ own unresolved issues are triggered. Child and parent engage in negative emotional interactions.A Negative Emotional Climate is Created

29. Ineffective Parenting Tools Rewards Incentives Removal of Privileges Time Out Grounding Isolation 29 Keck and Kupecky PARENTING THE HURT CHILD

30. and Effective Coping Skills • Natural and Logical Consequences • Paradox • Joining In • Choices • Time In • Praise – “Global” vs. “Specific” • Prescribing Symptom • “Consistent” vs. “Unpredictable”

31. Pick and choose carefully Avoid control battles Win the ones you take on 31

32. Completely truthful disclosures help the child to heal and grow A Tool-Box of Techniques 32

33. The Life Book A BOOK THAT RECORDS A CHILD’S HISTORY FROM THE BIRTH PARENTS TO THE PRESENT A Tool-Box of Techniques

34. A Tool-Box of Techniques The Timeline • Allows child to place emotions in the right place • Provides for concepts of past, present and future • Helps child understand permanency – “forever”

35. A Tool-Box of TechniquesTelling the narrative “story”… • Start at the beginning • Cases of Limited information • Verbal and concrete methods • Pace- maintain emotional regulation • Value free – the child decides who to love • Use adoption language: birth mom, birth dad, etc. • Adjust language according to child’s age: chronological and developmental • Repeat, repeat, repeat!

36. A Tool-Box of TechniquesTelling the narrative “story”… • Anticipate questions… • Say “I don’t know” as needed • “Why did my birth parents use drugs?” • “Do you think my birth mom thinks about me?” • “Do you think she is in jail?” • “Does she have any more children?” • “If they get better, can I go live with them again?” • “Why didn’t anyone in my country want me?” • “Why didn’t the orphanage ladies take me home?” • “Do you think my orphanage friends got adopted?” • “Are my birth parents alive?” • “Are my siblings safe?” • “Do you think my siblings think about me?” • “Why did you pick me?” • “What would you have done if I had been your baby?”

37. A Tool-Box of Techniques Children’s Books Journaling Art Role-plays Photos Videos

38. A Tool-Box of Techniques Nurture Repeating the “Cycle of Needs”

39. A Tool-Box of TechniquesNurture Touch • Styling hair • Scratching back • Hand on the shoulder • Hold hands while walking • Kisses • Clapping games • Hugs, hugs and more hugs! Eye contact • Staring contest • Play peek-a-boo • Look at each other and name ways you match • Candy kiss hunt • Face painting • “I love you” in soap on mirror

40. A Tool-Box of TechniquesNurture • Talking • Sing together • Read together • Talk in the car • Nursery rhymes • Trace a word on your child’s back • Identify faces What a beautiful baby!

41. A Tool-Box of TechniquesNurture • Smell • Lotion • Candle • Bake cookies • Warmth • Dry mittens in the dryer • Hot chocolate • Pup tent • Special blanket

42. A Tool-Box of TechniquesNurture • Motion • Blow bubbles • Fly a kite • Rock • Catch fireflies • Make a snow angel • Shoot baskets

43. A Tool-Box of TechniquesNurture • Food • Have a banana split for dinner • Go on a picnic • Say, “Yes, you may have a cookie after dinner • Have a tea party • Eat by candlelight with the kids • Cut sandwiches into heart shapes • Sprinkle chocolate chips on pancakes Nurture with rather than battle overfood

44. Structure The therapist and parents select and lead the activities. This helps the child develop self-control. Engagement Offers stimulation, variety and a fresh view of life-the child understands that surprises can be fun! Nurture Soothing, quieting, caretaking activities make the world feel safe, predictable and secure Challenge Helps the child take a mild age-appropriate risk. This promotes feelings of competence and confidence. Stresses cooperation A Tool-Box of Techniques - Theraplay

45. Improved flexibility, strength, balance, muscle tone Increases the individual’s awareness of their breathing, and then teaches way to regulate breathing. This is important for calming down. Pizer, Ann. Benefits of Yoga. [online]. http://yoga.about.com/od/beginningyoga/a/benefits.htm A Tool-Box of TechniquesYOGA • Taming the Monkey Mind • This is the mind that jumps from thought to thought like a monkey jumps from tree to tree. • Emphasis is on being in the present moment. The mind gains the ability to focus and concentrate. • Stress relief via stretching. • Stress-related tension is stored in the body, making a person feel tight, and often causing pain.

46. Helps in relieving discomfort from gas, colic, and constipation Improves blood circulation aids in digestion Improves quality and amount of sleep Enhances development of the nervous system and Stimulates neurological development (brain function and brain development) Reduces aggression (Cozolino) A Tool-Box of TechniquesInfant Massage • Increases alertness and heightened awareness • Reduces stress hormones • Improves immune function • Stimulates oxytocin, the “nurturing hormone” • Deepens bonding: • Stimulates growth and healthy development of body, mind and spirit • Relaxing and soothing International Association of Infant Massage. What are the Benefits of Infant Massage? http://www.iaim.ws/faqs.html

47. The Dynamics of the Complex Family SystemExpectations • I want to help a child in need • I am unable to have children • I heard an ad on the radio • Love will be enough • I know what they have been through • My spouse or partner wants to adopt • I thought a child would strengthen our marriage • A relative’s child needs my help • I want my children to have more siblings • I want to adopt a young child • I don’t want to deal with birth parents • I didn’t expect to adopt (foster parents)

48. The Dynamics of the Complex Family SystemExpectations – Additional Layers I expect … • my partner to support me • parenting to resolve past issues • my faith to remain strong • my extended family and friends to be supportive • to be supported by professionals • to be supported by society at large

49. The Dynamics of the Complex Family SystemExpectations Typically-Developing Children “I expect to have a playmate”

50. The Dynamics of the Complex Family SystemExpectations The Adoptee • “I think you will abuse me.” • “I think I am moving somewhere else.” • “I think you are another orphanage.” • “I am unlovable.”