Trauma and children’s development

1. Trauma and children’s development Abi Gewirtz, Ph.D., Associate Professor, Dept. of Family Social Science & Institute of Child Development, University of Minnesota

2. Overview • Domestic violence, homelessness, and maltreatment – what do we know? • How does exposure to traumatic stress affect children’s development? • Short-term and longer-term reactions and challenges • Trauma, risk, and resilience • Parents and children • Effects of parents’ own trauma history on parenting • Impact of parenting on children

3. The cycle of violence Both follow-up and follow-back studies have consistently shown a direct link between exposure to violence and subsequent perpetration of violence. For example, Widom (2001) reported that child victims of violence and neglect were 59% more likely to be arrested as juvenile, 28% more likely to be arrested in adulthood, and 30% more likely to be arrested for a violent crime.

4. Defining trauma In its definition of posttraumatic stress disorder, the Diagnostic and Statistical Manual uses this definition of trauma: an event or events the person experienced, witnessed, or was confronted with that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

5. Homelessness and maltreatment: threats to children’s development • Homelessness • Child’s basic needs for shelter not met • Extreme poverty, food insecurity • Parent’s own challenges – history of foster care is strongly associated with homelessness as an adult • Likely associated challenges (examples): • Stability, security, routine, structure • Parenting challenges (parents who don’t have their own positive parenting role models) • Families who are homeless live within a broader context of prejudice and disempowerment

6. Impact of traumatic events on children’s development

7. Children’s responses to violence are determined by an interplay of factors: • Details of the event, including nature of injuries, child’s relationship to victim and perpetrator, child’s proximity to event • Child’s developmental status, including cognitive and emotional capacities, phase-specificconcerns • Family and community context of event, e.g., isolated event or chronic exposure • Availability of supportive response from family and other community institutions

8. Infants and young children – expected development -need protection and nurturing -need reliability and consistency in care-taking to respond to situations of uncertainty -caregiving is basis for secure attachment

9. Infants under stress • disturbances of sleep and eating • inability to be soothed • constant crying • more generalized fears such as stranger or separation anxiety • avoidance of situations that may or may not be related to the trauma

10. Preschoolers (18mths-3) – expected development • Want to explore but seek attachment figures to diminish apprehension. • Increased capacities: physical, cognitive, language development • normal struggles around separation

11. Preschoolers – impact of violence • disruption of expectations of protective figures (attachment difficulties) • agitated motor behavior or extreme passivity. • eating and/or sleeping disturbances • inconsolable crying

12. Transition to school (ages 4-6) – expected development • play: to express feelings and ideas • increased cognitive capacities • increased sophistication of language • less action • reality and fantasy

13. Impact of violence on 4 – 6 year olds • regression: loss of previously attained milestones (e.g. toilet training) • preoccupation with words or symbols that may or may not be related to the trauma. • posttraumatic play in which themes of the trauma are repeated • nightmares • temper tantrums

14. School age – expected development • rely less on cues from caretakers and understand situations of potential threat . They invoke fantasies of superhuman powers to protect themselves • mastery and control, separation - individuation, self awareness - self esteem, energy directed to school and learning (mastery motivation system), increased language sophistication, reality - fantasy, etc.

15. Violence and school-aged children • Disillusionment with the outside world • poor academic performance • lying • stealing • fighting • sleep and eating disturbances • clinging • false bravado

16. School age contd. • experience "time skew" and "omen formation” regarding the trauma • Time skew refers to a child mis-sequencing trauma related events when recalling the memory. • Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

17. School age contd. posttraumatic play -a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety. An example of posttraumatic play is an increase in shooting games after exposure to a school shooting. reenactment of the trauma - more flexible than PT play- involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

18. Puberty/early adolescence – expected development • psychological concomitant to physical changes • preoccupation with body • sense of distinctiveness • change in relationship with parents • peer pressure

19. Impact of violence on early adolescents • feelings of inadequacy • unrealistic feelings of guilt • exaggerated preoccupation with body • somatic manifestations • acting out: • unsafe sex, criminal and illegal activities, drugs, pregnancies, etc.

20. Adolescence – typical development • revival and culmination of previous developmental issues • sexual and aggressive urges foster autonomy and independence • adult physical and cognitive maturation without the emotional component • identity definition and personality resolution (2nd opportunity)

21. Impact of violence on adolescents • can act as younger children • inadequate solutions that can be physically dangerous to self and others • 2nd opportunity for separation and individuation experienced as threatening

22. Adolescence contd Symptoms more closely resemble PTSD in adults Traumatic play still evident Traumatic reenactment still evident More likely than younger children or adults to exhibit impulsive and aggressive behaviors.

23. Eating Sleeping Toileting Attention & Concentration Withdrawal Avoidance Fearfulness Re-experiencing /flashbacks Aggression; Turning passive into active Relationships Partial memory loss Short Term Effects: Acute Disruptions in Self Regulation

24. Long Term Effects: Chronic Developmental Adaptations • Depression • Anxiety • PTSD • Personality • Substance abuse • Perpetration of violence

25. Trauma, risk and resilience Trauma & Cumulative Risk Overlap • Risks ‘pile up’ (Rutter, 1985) • Secondary adversities during trauma events (Pynoos et al., 1996) • Multi-problem families risk for trauma (Widom, 1989; 1999) • Other risks contribute to posttraumatic stress disorder

26. Trauma, Resilience, & Parenting • Resilience: capacity to recover functioning following cessation of the traumatic event (Luthar et al., 2000). • Effective parenting is a key correlate of resilience (e.g. Masten et al., 1999).

27. Why be concerned with trauma and posttraumatic stress in parents? • Associations between adult trauma and: • Child distress and child PTSD • Parenting impairments • Parents’ difficulties interacting with child serving systems • How might parents respond differently to other adults when they are dealing with traumatic stress? • And most important, how might they deal differently with their children?

28. How does adult PTSD affect parenting? • Growth in fathers’ PTSD is associated with self-reported impairments in parenting one year after return from combat • Gewirtz, Polusny, DeGarmo, Khaylis, & Erbes, (2010), Journal of Consulting and ClinicalPsychology, 78, 5, 599-610

29. Parenting practices predict children’s recovery from a traumatic incident • Mothers’ observed parenting is associated with steeper reductions in child-reported traumatic stress over a period of four months following a domestic violence incident • Gewirtz,Medhanie, & DeGarmo, (2011), Journal of FamilyPsychology, 25, 29-38.

30. Interventions that buffer parenting show improvements to child internalizing and stress regulation • Parent training directed at mothers only resulted in improvements to child internalizing (later associated with reductions in externalizing) (DeGarmo, Patterson, &Forgatch 2005) • Foster parent training associated with changes in children’s cortisollevels (Fisher et al., 2000; 2006)

31. How does trauma impact parenting? • Parents who are traumatized may be: • Suffering from PTSD and related disorders (e.g., depression, anxiety) • Using drugs to mask the pain • Disempowered • Parents of children who have become “parentified” (i.e. responsible beyond their years)

32. How might parents’ trauma histories affect their parenting? • A history of traumatic experiences may: • Compromise parents’ ability to make appropriate judgments about their own and their child’s safety and to appraise danger; in some cases, parents may be overprotective and, in others, they may not recognize situations that could be dangerous for the child. • Make it challenging for parents to form and maintain secure and trusting relationships, leading to: • Disruptions in relationships with infants, children, and adolescents, and/or negative feelings about parenting; parents may personalize their children’s negative behavior, resulting in ineffective or inappropriate discipline. • Challenges in relationships with caseworkers, foster parents, and service providers and difficulties supporting their child’s therapy.

33. Trauma history can: • Impair parents’ capacity to regulate their emotions. • Lead to poor self-esteem and the development of maladaptive coping strategies, such as substance abuse or abusive intimate relationships that parents maintain because of a real or perceived lack of alternatives. • Result in trauma reminders—or “triggers”—when parents have extreme reactions to situations that seem benign to others. These responses are especially common when parents feel they have no control over the situation, such as facing the demands of the child welfare system. Moreover, a child’s behaviors or trauma reactions may remind parents of their own past trauma experiences or feelings of helplessness, sometimes triggering impulsive or aggressive behaviors toward the child. Parents also may seem disengaged or numb (in efforts to avoid trauma reminders), making engaging with parents and addressing the family’s underlying issues difficult for caseworkers and other service providers. • Impair a parent’s decision-making ability, making future planning more challenging. • Make the parent more vulnerable to other life stressors, including poverty, lack of education, and lack of social support that can worsen trauma reactions.

34. Traumatized parents may… • Find it hard to talk about their strengths (or those of their children) • Need support in managing children’s behavior • Have difficulty labeling their children’s emotions, and validating them • Have difficulty managing their own emotions in family communication • When posttraumatic stress symptoms interfere with daily interactions with children, parents should seek individual treatment

35. Traumatized parents • Trauma and adversity affect children’s adjustment because they impair parenting: • Disrupt emotion socialization of parents • Increase experiential avoidance • Increase emotion dismissing • Increase withdrawal and coercion, bids for attention and other atypical family processes • emotion socialization includes: • discussion of emotions, • teaching about and responding to children’s emotions • responding to own emotions • increase coercive parenting

36. Resources • www.NCTSN.org • Birth parents with trauma histories in the child welfare system • Six fact sheets on parent trauma for child welfare stakeholders • Psychological first aid for families in shelters :http://www.nctsnet.org/sites/default/files/assets/pdfs/PFA_Families_homelessness.pdf • Facts on trauma and homeless children http://www.nctsnet.org/sites/default/files/assets/pdfs/Facts_on_Trauma_and_Homeless_Children.pdf

38. Thank you! Abi Gewirtz agewirtz@umn.edu