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Young Lives Today Scotland 14th March 2006 Trauma and the links with High risk behaviour in adolescents Richard Cross (Operations Manager), CareVisions Group Ltd UKCP registered Psychotherapist Author of ‘Invitation to Change’ - therapeutic interventions for Anti Social Youth (New Zealand Corrections Dept) e-mail: email@example.com telephone: 08700 428889
Outline of Presentation • Why Look at the effects of trauma? • What are the affects? • What can we do to help? • What if we do nothing? • Conclusion.
Indications of the Problem… Child Protection Registers • YEAR ENDED 31 MARCH 2002: 2,018 Children (0-15 yrs / 2.1 per 1000) (Scottish Executive), • Year ended 31st March 2001: 26,840 – England, 2,126 – Wales, 1,414 – Northern Ireland (Department of Heath)
Trauma & Dissociation • Trauma can be understood to mean a profound emotional shock (Oxford Dictionary 1992) • Dissociation = disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following childhood maltreatment. (see Marlene Steinberg (2001) ‘The Stranger in the Mirror’ Dissociation the Hidden Epidemic)
Why Study Trauma? Numerous studies link trauma and criminal behaviour. • Mann (1995) – Found 74% of a small sample of adolescents offenders held with secure conditions were experiencing symptoms consistent with PTSD. • Boswell (1995) - Amongst those committing the most serious of crimes, over 90% experienced childhood trauma in the form of abuse and/or loss and frequently both.
Why Study Trauma? • Burgess et al (1987) - found a link between sexual abuse and the occurrence of drug abuse, juvenile delinquency and criminal behaviour a few years later. • Dissociation may mediate the ‘cycle of violence’ – research indicates pathological dissociation in adolescent offenders 14.3 – 28.3 % (Moskowitz, 2004)
Aggression Impulsivity Impaired empathy Anger Disregard for the future Substance abuse Risk-seeking behaviour Reactivity Trauma Symptoms and Conduct Disorder We need to look beneath the behaviour?
The Mechanism • Belief system • Behavioural re-enactment • Other mental health problems • Developmental impact • Physiological response • (Mal)adaptive coping strategies
Response to sexual trauma Re-enactment Visualisation Flashbacks Triggering of memories Inappropriate sexual activities Avoidance People / places Things that remind of abuse Dissociation Hyperarousal Startle Nightmare & Sleep difficulties Irritability Distractibility
Sense of trust and safety are undermined: I am not safe. The world is a dangerous and a scary place. I have to fight and be strongto keep myself safe. Provide an environment that feels safe: I am safe here. Adults will keep me safe here. I can learn how to keep myself safe. I must not do things to make others feel unsafe, and others must not do things to make me feel unsafe either. How children are affected by trauma: Belief system
Behavioural Re-enactment • Young people can expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. • In behavioural re-enactment of the trauma, the self may play the role of : victim/perpetrator/rescuer. • Three key ways: Harm to Others; Self-destructiveness; Re-victimization. • Children seem more vulnerable than adults to compulsive behavioural repetition and loss of conscious memory of the trauma.
Drug use – self medication - Young people may attempt to deal with symptoms associated with trauma through self medicating behaviour.
Developmental Impact • Survivors of childhood trauma can have mild to severe deficits in being able to: • self-soothing • seeing the world as a safe place • trusting others • organized thinking for decision-making • avoiding exploitation
Physiological Response • The normal physiological responses to extreme stress lead to states of physiological hyper arousal and anxiety. • When this happens repeatedly, our bodies learn to live in a constant state of “readiness for war”: • Poor impulse control • scanning • aggression • distrust
(Mal)adaptive CopingStrategies • It is useful to think of all trauma "symptoms" as adaptations. These symptoms represent the childs attempt to cope the best way they could with overwhelming feelings and events. • They have been used to shield and defend themselves as much as possible from harm at the time of the abuse, e.g. hyper vigilance, dissociation, avoidance and numbing.
Breaking The Chain of Abuse Avoidance Fear Safety Containment Attachment Openness….. Detachment Disintegration
What can we do? Nurturing safe Environment Therapeutic Parenting Team Assessment e.g. Trauma Symptom Child Checklist (Briere) • Safety • Containment • Attachment Formal Therapy ‘Potential Space’ For recovery Foundation Openness….Communication….Predictability…. Integrated working
Safety & Stabilisation • Be warm, empathic and understanding • BE NURTURING, COMFORTING AND AFFECTIONATE, BUT BE SURE THAT THIS IS IN AN APPROPRIATE 'CONTEXT‘, • Avoid exploring the trauma until: The young person is safe and risk has been minimised as to possibility of further exposure. • Help the young person develop the skills to manage the emotions and symptoms arising from the trauma. • The relationship and the nature of the environment can “hold” the young person on their process of recovery.
What can we do cont? • PROVIDE A CONSISTENT, PREDICTABLE PATTERN FOR THE DAY, • WATCH CLOSELY FOR SIGNS OF: • RE-ENACTMENT (e.g., in play, drawing, behaviours), • AVOIDANCE (e.g., being withdrawn, daydreaming, avoiding other children) • HYPER REACTIVITY (e.g., anxiety, sleep problems, behavioural impulsivity)
Using Drawing – with high risk adolescents • Simple is best, • Let young person create own symbols, • Remember safety must be in place first, • Young person has developed self care strategies, • Remember, at times process might need to return to stabilisation phase.
He is laughing at me. If I don’t hit him first he will hit me! Walking down street and see ‘Joe… who I don’t like. 6/10
If we do nothing…… the Legacy? • Increase in distress • Higher Criminal Justice costs. • We will be letting our children down • We won’t be doing everything we can to stop victimisation, • Higher society costs (Mental health, Health, social services). • What might lay ahead for the ‘children of the children’.
Trauma and High Risk Behaviour - Summary • Trauma / dissociation regularly features in the lives of young people who are offending, • Trauma can have a significant impact on young people and may link to offending behaviour. • We can break the ‘cycle’… There are effective treatments for trauma and it’s effects – treat it.