Screening & Assessment of Trauma for IEP's . Chris Dunning, Ph.D. Professor Emerita University of Wisconsin-Milwaukee email@example.com. Workshop Objectives. Increase ability to identify effects of child traumatic experience presenting at school
Chris Dunning, Ph.D.
University of Wisconsin-Milwaukee
Academic tasks that are difficult when experiencing trauma related conditions
(associating concepts appropriately)
LONG-TERM STRESS REACTIONS
UNHEALTHY (Uncommon)Stephen Brock 2008
Acute Stress Disorder
Post Traumatic Stress Disorder
Effects of ACEs*
*Adverse Childhood Experiences
Fractures due to re-enactment
Other substance abuse
IV drug use
Teen pregnancy – including paternity
Pseudo-epilepsyHealth Issues Related To Adverse Experiences In Childhood
to any of the following before the age of 18:
Substance Abuse In Household
Violence Between Adults
Mental Illness In Household
Incarcerated Household Member
6%Figure ES2. Prevalence of Individual ACEs in Wisconsin
Key finding 1: Expanding definition of childhood stress, trauma and “maltreatment” had real life significance beyond the event.
Key Finding 2: Adverse childhood experiences can have an astonishingly broad based, harmful influence on adult health. (And the beginnings of a health impact are evident while in childhood.)
Key finding 3: The health effects of adverse childhood experiences may not appear for decades.
Key Finding 5: The more kinds of adverse childhood experiences a participant reported the greater the risk for more health problems (co-morbidity).ACE Study
12% reduction in left hippocampal volume in abuse-related PTSD
Bremner et al., Am. J. Psychiatry 1995; 152:973-981. Bremner et al., Biol. Psychiatry 1997; 41:23-32. Gurvits et al., Biol Psychiatry 1996;40:192-199.Stein et al., Psychol Med 1997;27:951-959. DeBellis 1999-no change in children with PTSD
J Douglas Bremner, MD, Emory University
(De Bellis et al., 1999)
DSI is a neurologically based disorder, like ADHD and learning disabilities.
A child with DSI has an inability to organize sensory input for use in daily living, which includes school, play, and family life.
The child has either a hyposensitivity or a hypersensitivity to sensory input, such as an overreaction to the feel of clothing or to the texture of food.
DSI is similar to ADHD in that it impacts learning, but is not a learning disability. DSI overlaps with ADHD in symptoms of inattention and restlessness
Nonverbal Learning Disorder
(NVLD) is a type of learning disability where the child has deficiencies in nonverbal reasoning.
NVLD overlaps with both ADHD and DSI: the child with NVLD can have the sensory sensitivity of a child with DSI and the impulsiveness, disorganization, and hyperactivity of a child with ADHD or with DSI.Examples of Exclusions/OverlapSo what is it? DSI, NVLD, ADHD, PTSD?
Tactile Perceptual Problem: Trouble taking information in through the sense of touch. Some tactile handicaps are:
Soft Neurological Signs: Signs of central nervous system dysfunction that can be observed;
Chronic exposure to trauma may result in
deficits in the ability to identify internal emotional experience
difficultieswith safe expressionof emotions
impaired capacity to modulateemotional experience
regression in behavior and physical control needs
1. Regression to childish/dependent behavior
3. Changes in eating patterns
4. Changes in sleeping patterns
5. Gender differences
6. School problems
7. Disciplinary Referrals
2. Academic achievement
3. Academic performance
4. Grade retention
5. Adult outcome
6. School behavior
Organizing narrative material
Cause & effect
Taking another's perspective
Engaging in curriculum
Reactivity & impulsivity
Childhood trauma creates difficulty with:
•Decline in academic performance
•Outbursts of anger, hyperactivity, impulsivity
All are symptoms often associated with LD
1. Motivation and persistence in academic tasks
2. Development of short-and long-term goals
3. Sequential memory
4. Ordinal positioning
5. Procedural memory
6. Attention/Working memory
All cognitions have an emotional context.
•Educators must emotionally engage students
•Learning does not occur without positive emotional engagement.
•When in an acute emotional state, frontal lobes are “off-line.”
•You have input and output.
•Between input and output, organization needs to take place.
•Have to have organization of input to get output.
•Executive functioning is the conductor
Internal experiences are difficult to articulate
Difficulty often in trusting adult during assessment since often a “trusted adult” perpetrated abuse
Resist disclosure—fearing further fragmentation of self or family
Concern about disclosure of unusual symptoms since they may be viewed as “crazy”
Symptoms may be confused with schizophrenia-like symptoms (eg. Hearing voices)
Symptom pattern may change over time and age/development
Other symptoms may draw more attention
3 Basic approaches to assessment of trauma and post-traumatic sequelae through tools and instruments:
IF YES, What was this person’s relationship to your child?
How old was your child? The first time:________ The last time:________ The most stressful:________
Was your child strongly affected by one or more of these experiences? yes no unsure
Has someone ever physically assaulted your child, like hitting, pushing, choking, shaking, biting, or burning? Or punished your child and caused physical injury or bruises. Or attacked your child with a gun, knife, or other weapon? (This could be done by someone in the family or by someone not in your child’s family). Yes No Unsure
IF YES, What was this person’s relationship to your child?
Was a weapon used? unsure no yes Type?
How old was your child? The first time? The last time? The most stressful?
Was your child strongly affected by one or more of these experiences? yes no unsureExample: TESI Items
Trauma Type Yes/Suspected/No/Unknown Age(s) Experienced (Check each box as appropriate – example sexual
abuse from ages 6–9 would check 6, 7, 8, and 9)
1. Sexual Abuse or Assault/Rape
2. Physical Abuse or Assault
3. Emotional Abuse/Psychological Maltreatment
5. Serious Accident or Illness/Medical Procedure
6. Witness to Domestic Violence
7. Victim/Witness to Community Violence
8. Victim/Witness to School Violence
9. Natural or Manmade Disasters
10. Forced Displacement
11 . War/Terrorism/Political Violence
12. Victim/Witness to Extreme Personal/Interpersonal Violence
13 . Traumatic Grief/Separation (does not include placement in foster care)
14 . Systems-Induced Trauma
Child Stress Disorder Checklist-Saxe
Acute Stress Checklist for Children (ASC-KIDS)Kassam-AdamsAssessing Trauma’s Impact
I felt in a daze-like I didn’t know what was going on
Pictures or sounds from what happened keep popping into my mind
I can’t stop thinking about it
I try not to think about what happened
I want to stay away from things that remind me of what happened
Since this happened, I get angry or bothered more easily
A sudden noise really makes me jumpASC-KIDS Items
2. Social withdrawal
3. Cognitive restructuring
5. Blaming others
6. Problem solving
7. Emotional regulation
8. Wishful thinking
9. Social support
I Tried to Forget
I Watched TV/Played a Game
I Stayed by Myself
I Kept Quiet About the Problem
I Tried to See the Good Side of Things
I Blamed Myself for Causing the Problem
I Blamed Someone Else/Causing/Problem
I Tried/Fix the Problem/Thinking of Answers
I Tried/Fix the Problem/Doing Something or
Talking with Someone
I Yelled, Screamed, got Mad
I Tried to Calm Myself Down
I Wished the Problem had Never Happened
I Wished I Could Make Things Different
I Tried to Feel Better Spending Time with Others like Family, Grownups, or Friends
I Didn’t do Anything Because the Problem Couldn’t be FixedKidcope
Allows for computation of severity scores for Criterion A1 and A2, Criterion B, C, and D.
Measure is split into the Youth Trauma Screen (trauma exposure and distress) and the PTSD Index (trauma symptoms). .
Construct validity: Part I items predict severity of peritraumatic dissociation and PTSD symptoms.UCLA PTSD Index for DSM-IV–(Revision 2)(Rodriguez, Steinberg, & Pynoos, 2002)
My child has dreams about what happened or other bad dreams (B)
My child feels alone inside and not close to other people (C)
My child tries not to talk about, think about or have feelings about what happened (C)
My child feels jumpy or startles easily, for example, when he/she hears a loud noise or when something surprises him/her (D)
My child has trouble concentrating of paying attention (D)
My child feels that some part of what happened is his/her fault (AF)
My child is afraid that the bad things will happen again (AF)UCLA PTSD Index Items
Group Trauma Interventions
Individual Trauma Interventions
Interventions for Schools
CBITS (Child Behavioral
Intervention for Trauma
Life Skills/Life Story
This is not the End really-work
continues on Developmental Trauma Disorder
A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including:
A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and
A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse
B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization
B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions)
B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states
B. 4. Impaired capacity to describe emotions or bodily states
C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues
C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking
C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation)
C. 4. Habitual (intentional or automatic) or reactive self-harm
C. 5. Inability to initiate or sustain goal-directed behavior
D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation
D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness
D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers
D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults
D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others
E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D.
F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months.
Scholastic: under-performance, non-attendance, disciplinary problems, drop-out, failure to complete degree/credential(s), conflict with school personnel, learning disabilities or intellectual impairment that cannot be accounted for by neurological or other factors.
Familial: conflict, avoidance/passivity, running away, detachment and surrogate replacements, attempts to physically or emotionally hurt family members, non-fulfillment of responsibilities within the family.