Childhood Trauma

1. Childhood Trauma Natasha Harmon, MS Children’s Home + Aid

2. Today Goals • Realize that you may be seeing the impact of trauma in children you serve • Recognize how trauma affects all individuals involved • Respond by asking the important questions and by trying to do what you can

3. The human brain & how it is affected by trauma

4. Complexity and Plasticity Abstract Thought Cortex Concrete Thought Affiliation "Attachment" Sexual Behavior Limbic Emotional Reactivity Motor Regulation "Arousal" Appetite/Satiety Midbrain Sleep Blood Pressure Brainstem Heart Rate Body Temperature Brain Development (Perry)

5. Brain Development Neurons are chemical messages -Message comes in and the neurons fire -More times the same message is repeated the thicker the neuron connection -The experience children have with their environment determines which neurons and synapses survive and which do not

6. Brain Development • Critical Periods- for some aspects of brain development, timing is critical. Important abilities will be lost or diminished if they don’t develop at the right time (e.g. vision, attachment, language) • Childhood experiences impact how the brain develops • Traumatic experiences interfere with normal brain development when they occur during a period when the brain is developing

7. Brain Development • Events can cause changes in the brain. A single, powerful experience can affect our brain for life. • Repeated smaller experiences can also change our brain. • Practice (sports, art, studies, etc.)- the more we repeat things the stronger the brain connections become • This is why there is always hope that youth can get better with new, positive experiences

8. Brain Development

9. Teenage Development • Physical Appearance • Emotional rollercoaster • Cognitive-Always the last to develop

10. Cognitive Development Science has taught us that the part of the brain that develops last during adolescence is the prefrontal lobe, which controls: • Complicated Decision-Making • Thinking Ahead • Planning • Comparing Risks and Rewards

11. Teen’s Cognition Teens make decisions differently than adults. • They rely more on their “emotional” centers than their “thinking” centers • They often think before they act but they are using a different set of “values” to make these decisions • They often choose actions that are much riskier than adults would choose

12. The Brain is complex..did you get all that???

13. So..what is childhood trauma?

14. Childhood Trauma The experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects. National Institute of Mental Health Overwhelming, uncontrollable experiences that psychologically impact victims by creating in them feelings of helplessness, vulnerability, loss of safety and loss of control—Beverly James

15. Childhood Trauma • Event – One time or chronic • Experience – whether the event is experienced as scary or threatening • Effect - long-lasting and life altering

16. Adverse Childhood Experiences(ACEs) Growing up (prior to age 18) in a household with: • Recurrent physical abuse • Recurrent emotional abuse • Sexual abuse • Emotional or physical neglect Felitti, 2009

17. Adverse Childhood Experiences Growing up (prior to age 18) in a household with: • An alcohol or drug abuser • An incarcerated household member • Someone who is chronically depressed, suicidal, institutionalized or mentally ill • Mother being treated violently • One or no biological parents Felitti, 2009

18. Beyond ACEs • Being a victim of crime • Community violence • Traumatic loss

19. Experience • Definition says “emotionally painful or distressful • Scary or threatening • Age matters – What is threatening for a 3 year old may not be threatening to a 15 year old

20. Prenatal Experience (Henry, Sloane & Black-Pond) • Children exposed to prenatal alcohol combined with childhood trauma have significantly greater severe neurodevelopmental deficits in : • Attention • Language • Memory • These children have also been shown to have greater • Oppositional/Defiant Behavior • Inattention • Hyperactivity • Impulsivity • Social problems

21. Effects • A child’s brain development responds to the child’s experiences • Stress • Alarm System as a Survival Mechanism • After Trauma • Child overreacts to normal situations • Child is on constant alert • Child may over-interpret signs of danger

22. Perry’s Dominant Response Types Dissociation • Freeze/Numb • Overwhelmed • Nonresponsive • Self-Mutilation • Passing Out Hyper arousal • Flight or Fight • Hyper-vigilant • Easily Offended • Over-reactive • Avoidant

23. More Effects • Emotions • Trouble calming down • Trouble understanding others’ emotional expressions • Poor emotional awareness-less “feeling” words • Cognition • Learning problems • Early delays in language development • Information processing problems

24. Physically Abused Children See Anger Where Others See Fear Graphic by: Seth Pollak, courtesy PNAS

25. More Effects • Physiological (Body System) • Trouble regulating body (eating, sleep) • Physical complaints • Self mutilation • Behavior Control • High risk behaviors (sexualized, aggressive) • Impulsive Behaviors • Social Relationships • Boundary problems with others • Trouble forming and keeping relationships

26. More Effects Exposure to Trauma Increases the Risk for: • Major Mental Illness • Substance Abuse • AIDS and Sexually Transmitted Diseases • Academic Difficulties • Impaired Physical Health

27. This is intense! How can I help?

28. Perry’s key concepts • Resilience: Not everyone exposed to adverse experiences is traumatized • Recovery-Brains respond to repeated stimuli (practice more of the “good stuff”) • Even as adults, brains are capable of learning and changing

29. Create a safe environment • Be consistent-rewards & consequences • Be predictable- have a routine and structure • Reassure them that you a safe person • “Felt safety”

30. Support • Every child needs 3 supportive adults in their lives as they grow up • Mentors should stay in the child’s life at least 6 months to be effective • Often very helpful for parents to be in a group setting to have others recognize the complexities of their children’s behaviors

31. Help Them Soothe Themselves • Recognize these youth can be challenging • Try to keep your emotional reactions in check and stay calm • When a child has gone to the primal brain-they will need your help to regulate • Praise them for any coping strategies they use to calm down—even after a meltdown

32. Soothing Suggestions • Lollipops, drinking cold drink through the straw • Chewing gum • Hydration • Food every 2 hours • Deep Pressure/Weights • Exercise • Magic Mustache

33. IDEAL Response® (Purvis & Cross) • Immediate • Direct • Efficient • Action-based • Leveled at the behavior-not at the child

34. Efficient Response • Respond using engagement • Use the least threatening form of engagement possible • Playful engagement • Structured engagement-choices/compromise • Calming engagement • Protective engagement

35. Choices • Give choices to help teach cooperation rather than get into a power struggle • Choices should be simple • Gives child sense of appropriate control

36. IDEAL Response® (Purvis & Cross) • Immediate • Direct • Efficient • Action-based • Leveled at the behavior-not at the child

37. Action-Based Response: Behavior Re-do’s • Why don’t you try that again, this time with respect? If at first you don’t succeed try, try again!

38. IDEAL Response® (Purvis & Cross) • Immediate • Direct • Efficient • Action-based • Leveled at the behavior-not at the child

39. We are learning more than we ever have about the brain and trauma. Brains and Behaviors can change—there is hope!Thank you!