Trauma’s Effect on Brain Function

1. Trauma’s Effect on Brain Function Mr. Todd Breinich and Dr. Molly Flood cc: forced rhubarb - https://www.flickr.com/photos/48659830@N02

2. Trauma

3. About 10 percent of the school population -9 to 13 million children struggle with mental health problems. Nancy Papport and Jessica Minahan Managing Disruptive Behavior

4. What’s the Real Challenge? “ Kids do well if they can, and if they aren’t doing well it’s because there is something getting in the way.” Ross Green

5. WHAT? Defining Trauma 3Es Individual trauma results from • an event, series of events, or set of circumstances • that is experienced by an individual as physically or emotionally harmful or threatening and • that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being. www.SAMHSA.gov

6. Spectrum of Trauma: Acute Trauma Chronic Trauma Complex Trauma Toxic Stress Secondary/Vicarious Trauma

7. https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime#t-16117https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime#t-16117

8. ADVERSE CHILDHOOD EXPERIENCES (ACEs) STUDYKaiser Permanente and CDC, 1998 THE STUDY: • 17,000 mostly white, college-educated, employed adults were screened for 10 prominent childhood traumatic experiences as part of their routine healthcare at Kaiser. Each type of trauma was awarded one point. THE RESULTS: • 68% of participants experienced at least one type of trauma. • ACE scores of 4 or more resulted in four times the risk of emphysema or chronic bronchitis; over four times the likelihood of depression; and 12 times the risk of suicide. • ACE scores were directly related with early initiation of smoking and sexual activity, adolescent pregnancy, and risk for intimate partner violence. Trauma and Resilience: An Adolescent Provider Toolkit; Adolescent Health Working Group 2013

9. The World HAS Changed… Trauma and ACES are pervasive and can impact childhood development and school performance • The majority of public school children in US grow up in poverty-- more susceptible to ACES which impact development (Layton, 2015; Luby et al, 2013). • Greater than 28% of children will experience physical abuse • 20.7% will experience sexual abuse • 14. 8% will experience neglect (ACES, 2013)

10. Toxic Stress from Adverse Childhood Events…. • Leads to changes in neurodevelopment • Produces symptoms of dysregulation, hyper-arousal, sensory sensitivity, avoidance and dissociation • Impacts cognition, memory and visual processing • May lead to inattention, aggressiveness with other children, academic and social challenges at school National Center for Mental Health Promotion and Youth Violence Prevention, 2012)

11. The Power of the ACE Study ACES • Are common • Are highly interrelated • Pile up/ cumulative impact • Account for many health and social problems • Affect people regardless of race, gender, and socioeconomic status

12. Trauma Impacted Youth Can have difficulty with: • Managing “big” emotions • Chronic irritability/anxiety that interferes with problem solving • Empathy • Expressing concerns/needs in words • Taking into account the wider context of a situation • Appreciating how one’s behavior impacts other people • Working in groups/connecting with others The Sanctuary Model: Designing and Implementing Trauma-Informed School Based Programs, The Sanctuary Institute

13. Stress & Brain Health Brain Health impairment - Genetics or Environment Brain’s first priority is to ensure our Survival. “Toxic Stress” increases the likelihood of Brain Health problems Some children demonstrate resilience, most experience ongoing difficulties with emotion regulation, adaptability, social skills, and self-concept.

14. Trauma and the Brain Youth in a “triggered” state, the “learning brain” goes offline. Verbal warnings or rational arguments that make demands on these higher functions may escalate the situation as youth are physiologically unable to access these functions when they are in a triggered state.

17. Reptilian Brain (Action Brain) • Located at base of brain. • Greatest development is from birth to 4 years of age • Only part of the brain that is “online” at birth • Automatic Functions • Breathing • Balance • Defensive Responses • Fight/Flight/Freeze • Heart Rate • Blood Pressure • Detects danger and releases hormones (adrenaline) • At same time it turns off the Neo Cortex part of the brain

18. Paleo mammalian Brain (Emotional Brain)(limbic system) • Emotions - Pleasurable or Scary? • Mediates feelings & thoughts • Monitors Danger • Located above Brainstem • Consists of Amygdala, Hippocampus, Thalmus, Hypothalmus, Basal Ganglia & Cingulate Gyrus

19. Cortex/ Neomammalian Brain(Thinking Brain ) Cortex • 5/6 of our brain is Executive Functioning • Thought/ Reasoning • Self-Awareness • Narrative, sense of self • The “Motherboard”

20. Neurobiological Effects of Trauma

21. Survival Brain vs Learning Brain Normal alarm systems in our brain/body that let us know when we are under threat and mobilize fight, flee (flight) or freeze in the face of a threat. Continuous threats/trauma, the brain/body is put into a chronic state of fear, activating the “survival brain” (mid/lower areas of the brain). Overactive alarm system in the developing brain that develops within the context of trauma can be more easily triggered into survival brain by “trauma reminders” or “triggers” even when there is no actual threat. Trauma and Resilience: An Adolescent Provider Toolkit; Adolescent Health Working Group 2013

22. Primary Categories of Response Fight: Physical Arousal • Aggression • Trouble concentrating • Hyperactivity Flight: Withdrawal and Escape • Social isolation • Avoidance of others • Running away Freeze: Stilling and Constricting • Constricted emotional expression • Stilling behavior • Over compliance and denial of needs

23. Triggers . . . • Rarely clear • Often unnoticed • Can be invisible (sensory oriented) • Can seem trivial • Uncontrolled factors -don’t always make sense • Less functional versions of ourselves

24. Behaviors we see…

25. https://vimeo.com/109042767 Explaining the Brain to Children and Adolescents

26. Trauma-Informed Educators… • Appreciate for the high prevalence of traumatic experiences among students • Understand the profound neurological, biological and social effects of trauma and violence • Engage with students in a manner that recognizes and addresses trauma-related issues • Are collaborative, supportive, and skilled (adapted from Harris and Fallot, 2001) And NASMHPD, 2003-present)

27. Approaches to Avoid • Punish. • Lecture. • Control, Coerce, SHAME. • Sarcasm (ex: truancy) • Demand immediate action (TBI example). • Survivors, whose behavior reflects adaptation to adverse circumstances, limited skills, and physiological imbalances. Children therefore should not to be viewed as “bad,” “manipulative,” or “attention seeking.” • Differentiate between “good child” with “bad behavior”.

28. Approaches to Avoid • Taking it personally (you want them to apologize). • Power struggles (arguing)-Becoming emotionally engaged. • Following student. Hodashttp://www.parecovery.org/documents/Hodas_Direct_Care_Worker.pdf

29. Adult Responses • Give them nothing-flat affect (human reaction is to escalate). • Is there a way to predict some of your difficult times/triggers and come up with some supports or solutions? • Don’t criticize their reaction • GIVE THEM CHOICES!!!

30. Validate-Listen-Problem Solve • Listen- they just want to be heard. • How can I help? • What do you wish I understood about you? • How can I help you in this moment (gives them a sense of control)…….

31. “It is easier to prevent a behavior from occurring, than to deal with it after it has happened.” Behavior Mantra

32. Trauma informed careCOMBATING CHILDHOOD TRAUMA:pbis STRATEGIES Rachel Eisenberg, Ph.D., NSCP Laina Stricker, M.Ed., BCBA Stacy Delaney, BSN, LPN PAPBS Coaches Day January 25, 2018

33. Agenda • Risk Factors • Discussion: Child and Community Stressors • Addressing Risk in Early Childhood

34. Risk Factors

35. What is Trauma? Substance Abuse and Mental Health Services Administration (SAMHSA)

36. What is Unique About Trauma in Early Childhood? • Early association between traumatic sights or sounds and harmful events • Cognitive capacity to rationalize, anticipate, or prevent the traumatic event • Dependence on caregiver who also may be experiencing trauma Zero to Six Collaborative Group, National Child Traumatic Stress Network (2010)

37. How Does Trauma Impact Children? • Risk/trauma = setting event(s) that may happen long before behavior, but may impact behavior • Behavior is learned over time

38. What Are Risk Factors That May Result in Trauma for Young Children? • Physical harm • Chronic or serious illness • Accidents • Abuse • Neglect • Social isolation • Substance abuse in home • Parental conflict • Domestic violence • Poor parent-child interactions • Community violence • Low socio-economic status • Anti-social peer group • Child aggression • Behavior problems • Attention deficits • Stressful life events Children ages 0-5 experience hospitalization or death more than any other age group for: drowning, burns, falls, choking, poisoning More than half (52.5%) of toddlers and preschoolers have experienced a severe stressor in their lifetime. 10% of children have witnessed stabbings or shootings; half of these occurrences were in the home 66% of children in Head Start witness or are victims to community violence Children ages 0-3 make up 31.9% of maltreatment victims Child Welfare Information Gateway (2004); Zero to Six Collaborative Group, National Child Traumatic Stress Network (2010)

39. What Are Risk Factors That May Result in Trauma for Young Children? • Emotional abuse/neglect • Physical abuse/neglect • Sexual abuse • Mother treated violently • Substance abuse in home • Mental illness in family • Parental separation or divorce • Bullying • Incarcerated household member • Witnessing community violence • Witnessing sibling abuse • Discrimination • Homelessness • Natural disasters • War ACEs: Childhood traumatic stressors that can impact how a child learns and behaves, and can affect long-term health outcomes ACEs Connection (2015)

40. Outcomes of Trauma Risk FactorsAGES 0-6 National Child Traumatic Stress Network (2010)

41. How Are Children in Socioeconomically Disadvantaged Settings at Greater Risk? • History of maternal mental illness • High maternal anxiety • Parental rigidity in attitudes, beliefs, & values about child development • Few positive parent-child interactions in infancy • Head of household in “unskilled” job • Low maternal education • At-risk minority status • Single parenthood • Stressful life events • Large family size • Poor cognitive skills in preschool • Lower social-emotional resilience Number of risk factors: 0: better cognitive and social skills 1-4: 4 point lower cognitive score per risk factor ≥5: 12.3 times as likely to have clinical mental health symptoms Even if children had strong cognitive skills and good mental health at young age (4), environmental risk factors limited cognitive development by ages 13 and 18. Sameroff & Rosenblum (2006)

42. Discussion What types of risk do you notice in your schools or early childhood centers? How do you see traumatic stressors impact the communities in which you work? Think about…. Families Staff Program resources Broader community

43. Addressing Risk in Early Childhood PBIS Strategies to Support Children Strengthening social skills through teaching problem solving Families Teaching expectations at home Staff Training staff to identify and acknowledge prosocial behavior

44. Reducing Risk and Increasing Resilience Protective Factors School Families Protective Factors Child Protective Factors

45. Risk and Protective Factors for Children • Risk Factors: • Chronic Health Issues • Anti-social peer group • Child aggression • Behavior problems • Protective Factors: • Good health • Hobbies and interests • Good peer relationships • Active coping style • Good social skills Child Welfare Information Gateway (2004)

46. Strengthening Protective Factors Among Children: Teaching Problem Solving • Teaching problem solving: • Define the problem • Generate alternatives • Make a decision • Practice the alternative response • Implement and evaluate decision Fox & Hemmeter (2014); Kazdin (2010)

47. Risk and Protective Factors for Families • Risk Factors: • High parental conflict • Social isolation • Substance abuse • Poor parent-child interaction • Protective Factors: • Secure attachments • Positive and warm parent-child relationship • Supportive family environment • Household rules/structure Child Welfare Information Gateway (2004); National Child Traumatic Stress Network (2010)

48. Strengthening Protective Factors Among Families: Teaching Rules & Providing Structure • Helping families in creating a behavior matrix. • What do the program’s expectations look like in your home? • Identifying the difference between “stop” rules and “start up” rules. • Supporting families in how to acknowledge/ reinforce pro-social behaviors. • How do you praise your child for demonstrating the household rule (using your attention to increase behavior)? Fox & Hemmeter (2014); Patterson & Forgatch (2005)

49. Social/Environmental Risk and Protective Factors • Risk Factors: • Low socioeconomic status • Stressful life events • Social isolation/lack of social support • Poor schools • Protective Factors: • Access to health care and social services • Consistent parental employment • Good schools • Supportive adults outside of the family who serve as role models/mentors to the child Child Welfare Information Gateway (2004)

50. Strengthening Protective Factors Among School Staff: An Effective Work Force • Strengthening relationship between staff and students by training staff to… • Clarify expectations across school settings • Teach replacement behavior • Acknowledge prosocial behavior • Building positive interactions with adults outside of the family • Encouraging staff to demonstrate system-wide expectations so that… • Staff are more effective role models • Program functions better Fox & Hemmeter (2014); Hemmeter, Snyder, Fox, & Algina (2016)