Childhood Traumatic Stress

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Childhood Traumatic Stress

• National Resource Ctr. for Family-Centered
  Practice and Permanency PlanningJanuary 8, 2008
  Teleconference
• April Naturale, LCSW

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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

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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

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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

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Normal Reactions to Stress TraumaEmotional and
Behavioral
People may feel and express their reactions
differently.
They may

• 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

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Normal Reactions to Stress Trauma Emotional and
Behavioral contd.

• 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

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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

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Normal Reactions To Stress Trauma Physical
Cognitive contd.

• 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

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Trauma Responses in Children

• Adults often underestimate
• what children experience
• the extent of their reactions
• and what they need to know

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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

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Common Trauma Responses in
Children

• Impaired concentration
• Impaired learning
• Aggression
• Recklessness
• Reduced inhibitions
• Somatic complaints
• School refusal

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More Serious Trauma Responses in
Children

• Children can develop wide range
• of difficulties that may become serious
• Depression
• Anxiety
• Behaviour Disorders
• Mood Disorders

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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

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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

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Known Potential Impacts

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

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Traumatic Grief Responses

• Childhood traumatic grief (CTG)-
• a condition which compromises childs
• 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

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What Not to Say to Bereaved Children

• I know how you feel
• Lets talk about something else
• You are strong enough to deal with this
• Youll feel better soon
• You did everything you could
• You need to relax
• Its good that you are alive

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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

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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

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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

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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

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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.
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Case Examples Oklahoma City

• Trauma experts in Oklahoma working with Katrina
  evacuees monitored rising resentment between 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 opportunity to say thank you and organized a
  class activity including shopping together and
  cooking traditional Southern meals.

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What about Posttraumatic Stress Disorder (PTSD)?

• Experiencing, witnessing or being confronted
  with an event involving actual or threatened
  death or serious injury ones 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)

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PTSD Prevalence

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

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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

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The Psychological Tasks of Recovery

• Regaining a sense of mastery and control
• Resumption of age-appropriate roles and
  activities
• Develop new normal-routine

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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
  familyreturn to school asap-dont isolate them
• Plan for emergencies add tools to the
  childrens backpack that will help them cope(e.g.
  flashlight, family picture, object of comfort,
  crayons/writing pad, etc.)

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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

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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