Trauma’s impact on children a potential legacy of pain

1. Trauma’s impact on childrena potential legacy of pain Marjorie Withers, LCPC

2. Workshop dedicated • To children and families who have shared their stories: • Who have reached for their core of resilience and coped with feelings and memories: • And To those that have been their heroes whether it was an auntie, a teacher, a therapist, a fireman or another child. • NO ONE IS EXEMPT FROM THE AFTERMATH OF TRAUMA

3. Definition of Trauma • Horrific event beyond the scope of normal human experience. ( American Psychiatric Assoc., 1980) • Includes events that are perceived as life threatening. • Engenders: Fear, hopelessness, horror, helplessness. • Witnessing violence, and or being a victim of violence. • Being diagnosed with a life threatening disease. • Natural disasters, accidents, House fires loss caused by violence. • War, gang war.

4. Kinds of Trauma • Complex trauma (repeated abuse) • Early childhood trauma (before age 6) • Domestic Violence • Death of a parent or family • Community /school violence • Natural Disasters • Wars • Medical Trauma • Abuse, physical, sexual, neglect

5. Effects of Trauma on Children • Effects cognition • Effects affect/feelings • Effects behavior • Effects neurophysiology • Effects physiology • Responses are coping adaptations

6. Impact on Physiology Traumatic event Prolonged Alarm Reaction Altered Neural System

7. Prevalence of Trauma in Children in United States • Over 5 million children a year experience trauma. • Estimated 2 million from sexual or physical abuse. • Unknown number more terrorized by Domestic Violence in their home • Natural disasters, car accidents, life threatening illnesses, community violence. • By age 18, one out of four will have been effected by family or community violence.

8. Recent studies indicate increase in the numbers of children effected by trauma • 84% of second year college students have experienced at least one major trauma. • Poverty and substance abuse and social turmoil increase exposure rates of trauma. • Multi layers of trauma • Concept of Historical Trauma • Impacts on future generations

9. Trauma knows no age limits • In- Utero effects of trauma (increase cortisol levels). Anxious babies • Infant and toddlers exposed to violence towards a parent have changes in behavior. • Exposure to violence impacts child as much as violence to a child. • Pre-verbal children show signs and symptoms of trauma similar to those of older children.

10. Break • Think of children you have known and what trauma may have effected them. • What would you do for them if you knew they were trauma effected? ********************************** BRETHING BREAK:

11. Impact of Trauma and its ramifications • Trauma can change behavior in multitudes of ways that may be confused with other diagnoses. • Frequently misdiagnosed as: • ADHD • Oppositional Defiant Disorder • Learning Disability • ADD

12. Disruptive Behaviors Fighting Anger “Don’t Care” attitude Criminal behaviors Non compliance with teachers, medical providers. Poor frustration tolerance Substance Abuse Revert to behaviors of earlier stages/ages Depression Anxiety Loss of interest Poor Concentration Distracted Hyper vigilance Startle response Absences Suicidal thoughts/behaviors Hopeless & Helpless Partial list of potential related symptoms:

13. Numbness Avoidance Hyper arousal Intrusive thoughts Flashback Hyperventilation Anxiety Crying Inability to focus Fear Helpless/hopeless Memory disruptions Negative feelings Loss of safety Feeling out of control Time (slowed down or sped up) Physical symptoms Post Traumatic Stress Symptoms

14. Dissociation Detached Numb Compliant Decrease Heart Rate Suspension of time De-realization “crazy like behavior” Fainting/light headed Hyperarousal Hypervigilance Anxious Reactive Alarm response Increase Heart Rate Freeze: Fear Flight: Panic Flight: Terror (Bruce Perry, PhD) Differential Response to trauma

15. Role of attachment on the impact of trauma. • Foundation of childhood trust and resilience. • Attached child has more skills for seeking safety and comfort. • Attachment can be effected by trauma and need repair such as when a toddler or young child looses their mother or attached figure. • Child feels betrayed by parent inability to keep them safe.

16. Small Groups: • What are the major traumas you see in the children you work with? • What the most common symptoms you see? • What interventions or supports seem to help the child? • Share with large group:

17. Lunch • Acute Post Traumatic Period • Trauma and memory at cellular level • Repeated replaying • Hypervigilant • Increased startle response • May have increased breathing rate • Fear, Panic, flashbacks, intrusive thoughts *******************************

18. Self Protection in children • Avoidance • Dissociation as protection • Longer symptoms go on the more chance of having PTSD

19. Annie • Annie was 5 when her mother was killed in a car accident. • Annie was in the car and kept calling her mother. • It took the rescue people 3 hours to get Annie out.

20. Annie’s responses • Would not let go of her father • Screamed at night for her mother and would be unable to go to sleep again. • Annie would not interact with others when she returned to school. • She would get scared and start running around the class.

21. Intervention • Calming skills • Reassurance • Safe place • One adult talking with her • Access to things that she enjoyed…coloring • Inclusion of Annie’s best friend when she wanted to rejoin an activity

22. Therapy with father • Help family deal with the loss of mother separate from the accident • Information about the accident as Annie needs or wants it. • Place where she can remember it in playroom • Teaching father and significant others calming skills that work for Annie. • Breathing • Routine development and plan for nights.

23. Role of a caring significant other • Children report difference a caring adult makes: • “My aunt was always there after my mom died” • She made me feel safe and special

24. Children taking the blame • Fear that they should have or could have • Protected • Saved • Avoided • Prevented Kept trauma from occurring (wish for control) Need for correction of untrue thoughts or assumption

25. Child needs • Stress management skills • Coherent narrative of what happened • Changing misassumptions that the experience caused…it happened because I was bad…changed to bad things can happen even to good kids. • Involvement of parents or safe loving involved adult • Normalcy restoration

26. Summary • You can make a difference • Children are resilient when given tools • Mastery of soothing skills • Mastery of stress management skills • Time, love, reassurance, dependable environment that encourages safety planning. • Trauma reactions are not pathological. • Healing from wound to scar • I am a survivor…..I am Loved, loveable and I can soothe myself.