Title: Forgotten Victims: Infants and Toddlers Who Witness Violence and Trauma
1Forgotten Victims Infants and Toddlers Who
Witness Violence and Trauma
- Briana S. Nelson, Ph.D., LCMFTKansas State
UniversityMarriage Family Therapy
ProgramSchool of Family Studies Human Services - bnelson_at_ksu.edu 785-532-1490
2Psychological trauma is an affliction of the
powerless. At the moment of trauma, the victim
is rendered helpless by overwhelming force. When
the force is that of nature, we speak of
disasters. When the force is that of other human
beings, we speak of atrocities. Traumatic events
overwhelm the ordinary systems of care that give
people a sense of control, connection, and
meaning. -Herman, 1997
3Objectives
- To understand the impact of witnessing violence
and trauma on infants and toddlers - To identify the immediate and long-term effects
on infants and toddlers exposed to trauma and
abuse - To gain knowledge of effective methods for
identifying and working with infants and toddlers
who may be traumatized
4Assumptions about Child Development
- Children do not develop in isolation they
develop within the context of human systems - Children both influence and are influenced by the
systems in which they are members - It is necessary to develop a conceptualization of
the systemic effects when a child is
trauma-exposed or traumatized
5What is trauma?
- ... the development of characteristic
symptoms following exposure to an extreme
traumatic stressor involving direct personal
experience of an event that involves actual or
threatened death or serious injury, or other
threat to ones physical integrity or witnessing
an event that involves death, injury, or a threat
to the physical integrity of another person or
learning about unexpected or violent death,
serious harm, or threat of death or injury
experienced by a family member or other close
associate (DSM-IV,
1994, p. 424)
6- Traumatic events that are experienced directly
by children include, but are not limited to - violent personal assault (sexual abuse or
assault, physical abuse, robbery, mugging) - being kidnapped or taken hostage
- terrorist attack
- school violence
- torture
- war
- natural or human disasters
- severe accidents
- being diagnosed with a life-threatening illness
(DSM-IV, p. 424)
7- Witnessed events include, but are not limited
to, observing the serious injury or unnatural
death of another person due to violent assault,
accident, war, or disaster... - Events experienced by others that are learned
about include violent personal assault, serious
accident, or serious injury experienced by a
family member or a close friend learning about
the sudden, unexpected death of a family member
or a close friend or learning that ones child
has a life-threatening disease. - (DSM-IV, p. 424)
8Every day in America...
- 6 children commit suicide
- 8 children are homicide victims
- 11 children are killed by firearms
- 76 babies die
- 131 children are reported as abused or neglected
- Childrens Defense Fund, 2001 report
9- In 1998, 2.9 million children were reported as
abused or neglected in the US (903,000 confirmed) - An estimated 1,100 children died as a result of
abuse or neglect in 1998 (78 were lt5 y/o) - A conservative estimate is that over 5 million
children are exposed to traumatic events every
year - 1/3 of physical abuse victims are less than one
year old - Current estimates of PTSD rates in children range
from 0-95 (average rate 37)
10But it doesnt happen to Kansas children...
- Every 13 minutes a child is reported abused or
neglected - 6,790 cases of child abuse or neglect were
substantiated in 1998 (gt2x the 1995 rate) - Every 7 days, 3 children die under 14 years of age
11Who is affected when a child is traumatized?
Larger Society Social Environment
Extended Family
Immediate Family
12How is a child affected when the system is
traumatized?
Larger Society Social Environment
Extended Family
Immediate Family
13Characteristics of Childhood Traumas
- Acute vs. Chronic
- Single event vs. multiple events
- Age of onset
- Relationship to perpetrator
- Adult vs. peer perpetrator
- Intrafamilial vs. extrafamilial
- Parental response
14Cycle of Violence
15Characteristics that Distinguish Traumatic from
Normative Stressors
- the amount of time one has to prepare
- previous experience with the stressor
- sources of guidance/support available
- the extent to which others have experienced the
event - the amount of time in a crisis state
- sense of loss of control or helplessness
- sense of loss
- disruption and destruction
16- danger experienced by those exposed to the event
- emotional impact of the event
- medical problems associated with exposure to the
event - personal role in the stressor event
- pretrauma vulnerability
- intensity and duration of the event
- postevent responses
17Early Intervention in At-Risk Families
Recognizing Childrens Reactions to Abuse and
Trauma
- Cognition
- Affect
- Interpersonal relations
- Behavior
- Symptom formation
- Spiritual/moral
18Effects specific to preschool-age children
- Children typically only develop verbal memory of
a traumatic event between 2 ½ to 3 years of age - Even then, most recollections are spotty and
incomplete - Most common symptoms reported in younger victims
of trauma fall under the category of behavioral
effects, rather than cognitive symptoms
19Effects specific to preschool-age children
- withdrawal
- reenactments and play involving traumatic themes
- anxious attachment behaviors/separation fears
- regression to previous levels of developmental
functioning - disruptions in sleeping and toileting
- startle responses/freezing behaviors
20- repeated retelling of traumatic event
- increased aggressive, anti-social, and
hyperactive behaviors - changes in behavior, mood, personality
- general or trauma-specific fears
- psychosomatic symptoms
21Effects specific to school-age children
- decline in school performance
- increased inner behaviors
- repeated retelling of traumatic event
- isolation of affect
- constant anxious arousal/hypervigilance
- fearfulness/fear of recurrence
- sleep disturbances
- behavioral problems
- regression to previous levels of developmental
functioning
22- visual image and traumatic memory intrusion
- problems relating to peers
- more elaborate reenactments
- psychosomatic symptoms
- loss of interest in pleasurable activities
- feelings of personal responsibility
23Effects specific to adolescents
- acting-out behavior
- self-criticism
- fear of repetition of event in the future
- efforts to avoid overwhelming feelings
- hypervigilance
- social withdrawal
- thoughts of revenge and action-oriented responses
to trauma - acute awareness and distress related to intrusive
trauma images and memories - increased vulnerability to psychiatric disorders
- flight into adulthood
24The 3 Rs of Trauma Recovery
- Reliving
- Releasing
- Reorganizing
- (Johnson, 1998)
25Long-term Consequences The Adult Survivor
- Many adults continue to be affected by traumatic
experiences in childhood and adolescence - Often the connection between early experiences
and continuous cycles of problematic behavior are
not recognized - Traumatized child--Traumatized parent?
26Family System Effects
- Parents may constantly search for ways to make
sense of or explain the traumatic event their
child has experienced - Often attempt to reduce their sense of
helplessness or lack of power - The family may serve as a resource for increased
support and coping or an obstacle that blocks the
traumatized childs adjustment and recovery - Trauma membrane
27- Parental reaction to the childs trauma is of
primary importance in dealing with trauma in
children - The reactions of parents or significant others
may have a greater negative impact on children
than the childrens own direct exposure or
severity of their trauma experiences - When parents or caretakers are distressed, it may
impede their ability to assist their children
with their own stress reactions
28- Parents who must deal with the sudden
traumatization of someone they love who must
cope with the physical, emotional, and behavioral
changes that often follow trauma and who must
face their own uncertainty and personal
vulnerability are clearly candidates
forsecondary traumatization (Barnes, 1998, p.
76)
29- It is important to note the familys current
level of adaptation and the amount of disruption
caused by trauma - If parents have different reactions or coping
styles, a cycle of tension may occur in the
couple relationship that negatively affects the
child - Some parents may be overwhelmed by the traumatic
event and minimize the effects on themselves
and/or their child
30- Parents who are able to manage and regulate their
reactions to traumatic events will be more likely
to effectively support and protect their child in
his/her recovery
31Impact of Parental Trauma on Children
- Children may experience secondary traumatic
stress as a result of parental traumatization,
through - Direct witnessing of a parents trauma (e.g.,
domestic violence, sexual assault) - Direct experiencing of the post-traumatic
reactions of symptoms in the parent (e.g.,
nightmares, flashbacks, startle responses)
32Impact of Childrens Trauma on Other Subsystems
- Siblings of traumatized children may experience
feelings of guilt, fear, anxiety, and secondary
trauma symptoms - Surprisingly, the issue of sibling abuse has been
relatively unaddressed in clinical and empirical
literature - Because of the impact of the childs trauma on
parents, secondary stress reactions in siblings
may be overlooked or ignored
33- In taking an ecological perspective of trauma,
the circle of impact should be expanded beyond
the immediate family system - Symptoms present in a traumatized child can
affect those with whom the child interacts at all
system levels
34Resiliency
- Certain individuals manage to succeed in spite of
the odds - Interplay between the childs basic traits and
the environment - Post-traumatic growth
35Resiliency Factors
- Personality factors
- Agreeable
- Social
- Compassionate
- Internal locus of control
- Cognitive factors
- Creativity
- Insight
- Initiative
- World-view beyond trauma
36- Affective factors
- Ability to manage affective reactions
- Broad range of emotions
- Sense of humor
- Behavioral factors
- Persistence
- Ability to generate relationships with peers and
adults - Resourcefulness
- Ability to self-soothe
37Secondary Traumatic Stress
- Secondary Traumatic Stress (STS) is the
experience of tension and distress directly
related to the demands of living with and caring
for someone who displays the symptoms of
post-traumatic stress disorder (PTSD) (Figley,
1998) - Because of the emotional connection, being in
close, prolonged contact with a traumatized
person becomes a constant stressor - Family members and professionals often experience
symptoms of traumatization
38- Also referred to as compassion fatigue, vicarious
traumatization, trauma transmission, burnout - Symptoms communicable infect mimic
- Symptoms are considered secondary because they
occur in those who have not directly experienced
the event. - May resemble PTSD-like symptoms, but may be less
intense - Therapists may not be aware of or they may deny
secondary trauma effects - Savior/Rescuer
39Secondary trauma in professionals may include the
following
- Sharing the survivors nightmares
- Sharing the hopelessness of survivors
- Feelings of aggression
- Confronting ones own vulnerability and moral
values - Feelings of numbing and avoidance
- Victim blaming/dehumanizing
- Other PTSD-like symptoms
40Secondary Traumatic Stress Guidelines
- Professionals should acknowledge the effects of
secondary trauma on themselves and their
colleagues and take regular, ongoing actions to
insure the welfare of professionals and to
preserve their ability to deliver quality
services - Professionals should not work alone but instead
should seek out or create arrangements in which
they have regular and open input from other
professionals regarding the effects of secondary
trauma and its impact on the services they
deliver, - Professionals should recognize an ethical duty to
self care (Munroe, 1995)
41Suggestions for Parents and Child Care Workers
- Recognize the value of multiple perspectives
- Watch and listen to the children
- Use development as a guide for action with adult
and child - Identify factors related to poor growth, learning
and relationships within the family system and
work for change in the system - Help promote strengths and find opportunities to
increase resiliency in children
42Where do we go from here?
- More prevention will reduce the need for
intervention - Training non-mental health professionals
- Recognizing potentially traumatic events
- Societal awareness and education
43- When one thinks about how a traumatic event
impacts one child and then begins to piece
together the number of people with whom that one
child has contact throughout his or her life, the
realization that a single event does not have a
single victim becomes clear. The repercussions
from trauma are infinite. Beginning to identify
and understand these repercussions on traumatized
children is critical to prevent further loss of
innocence.
44Recommended References
- Barnes, M. F. (1998). Understanding the secondary
traumatic stress of parents. In C. R. Figley
(Ed.), Burnout in families The systemic costs of
caring (pp. 75-89). Boca Raton, FL CRC Press. - Herman, J. L. (1997). Trauma and recovery (2nd
edition). New York BasicBooks - Johnson, K. (1998). Trauma in the lives of
children Crisis and stress management techniques
for teachers, counselors, and student service
professionals (2nd edition). Alameda, CA
Hunter House. - Monahon, C. (1993). Children and trauma A
guide for parents and professionals. San
Francisco Jossey-Bass. - Nelson, B. S., Schwerdtfeger, K. L. (2002). The
systemic impact of traumatized children. In D.
Catherall (Ed.), Handbook of stress, trauma, and
the family. Washington DC American Psychological
Association. (Peer-reviewed chapter submitted for
publication revise and resubmit). - Pynoos, R. S., Steinberg, A. M., Goenjian, A.
(1996). Traumatic stress in childhood and
adolescence Recent developments and current
controversies. In B. A. van der Kolk, A. C.
McFarlane, L. Weisaeth (Eds.), Traumatic
stress The effects of overwhelming experience on
mind, body, and society (pp. 331-358). New York
Guilford.