Dr. Steve Parese Danbury, NC

1. Leave Me Alone!” Getting Through to Traumatized Youth Insights and Strategies for Staff Who Work With Troubled Youth Dr. Steve Parese Danbury, NC

2. Do you work every day with “Difficult Kids?”

3. Today’s Agenda • What is childhood trauma, and how does it impact behavior? • What self-defeating patterns are common among troubled youth? • What can we do to therapeutically manage traumatized youth?

4. “Are You a Survivor?” • What does it take to survive through hard times? 01/24/2011 4

5. Worst Case Scenario SURVIVAL QUIZ 1. How to survive a bull stampede (a) Lay down and curl into a ball. (b) Run alongside the bulls. (c) Kneel in the street and pray for Divine Intervention! 5

6. Worst Case Scenario SURVIVAL QUIZ 1. How to survive a bull stampede (a) Lay down and curl into a ball. (b) Run alongside the bulls. (c) Kneel in the street and pray for Divine Intervention! 6

7. Worst Case Scenario SURVIVAL QUIZ 2. How to signal rescuers when lost (a) Light three fires in a triangle shape during day. (b) Wait until nightfall and light one large fire. (c) Bang out SOS in Morse Code on pots and pans 7

8. Worst Case Scenario SURVIVAL QUIZ 2. How to signal rescuers when lost (a) Light three fires in a triangle shape during day. (b) Wait until nightfall and light one large fire. (c) Simply dial 911 on your satellite cell phone, silly! 8

9. Worst Case Scenario SURVIVAL QUIZ 3. How to take a punch to the head (a) Turn at the last minute and take it on the jaw. (b) Move into the blow, take it on the forehead. (c) Push your best friend in front of you and let HIM/HER “take one for the team!” 9

10. Worst Case Scenario SURVIVAL QUIZ 3. How to take a punch to the head (a) Turn at the last minute and take it on the jaw. (b) Move into the blow, take it on the forehead. (c) Push your best friend in front of you and let HIM/HER “take one for the team!” 10

11. Worst Case Scenario SURVIVAL QUIZ 4. How to purify water on the trail (a) Add a dash of salt, boil, then drain into container. (b) Boil water vigorously for 1 minute. (c) Add sassafras leaves and allow to sit in sun 4 hours. 11

12. Worst Case Scenario SURVIVAL QUIZ 4. How to purify water on the trail (a) Add a dash of salt, boil, then drain into container. (b) Boil water vigorously for 1 minute. (c) Stop by your local 7-11 for a bottle of Aquafina! 12

13. Worst Case Scenario SURVIVAL QUIZ 5. How to defend vs grizzly bear attack (a) Drop to the ground and cover the back of your neck. (b) Make eye contact and slowly back away. (c) Set out a bottle of honey and make soft happy sounds! 13

14. Worst Case Scenario SURVIVAL QUIZ 5. How to defend vs grizzly bear attack (a) Drop to the ground and cover the back of your neck. (b) Make eye contact and slowly back away. (c) Set out a bottle of honey and make soft happy sounds! 14

15. So again…“Are You a Survivor?” 01/24/2011 15

16. Many difficult youth are simplySURVIVINGin a hostile world. 01/24/2011 16

17. Grrrrrrrrr....In your groups:List 6-8 typical problem behaviors, especially those that really get on your nerves.

18. Working with traumatized youth requires “COURAGEOUS PATIENCE” “COURAGEOUS PATIENCE” -- Dr. Sandra Bloom

19. Psychological Insight #1 Many troubled youth are survivors of years of traumatic life events. Some of their most difficult and annoying behaviors may stem from deeper issues, and so require more subtle interventions than simple punishment.

20. Part 1 What is childhood trauma, and how does it impact behavior?

21. What is Childhood Trauma? Psychological Trauma: Lasting and debilitating psychological condition resulting from traumatic events which completely overwhelm an individual’s ability to cope with emotions involved. Childhood Trauma: Psychological trauma stemming from severe and often repeated incidences of physical, sexual, or psychological abuse, chronic neglect, or exposure to violence during early childhood.

22. How Prevalent is it? 18% of all adult men 26% of all adult women Have had sexually or physically abusive childhood experiences 5.8 million children referred to CPS in 2007 794,000 confirmed victims of severe physical, sexual, or psychological abuse or neglect. 1,760 deaths as a result of abuse, 50% infants.

23. What is the Impact? 1. DIRECT RESULTS OF ABUSE/NEGLECT: a. Physical injuries: Bruises, broken bones, & malnutrition b. Psychological injuries: (PTSD) 1. Dissociation: Disconnect with reality. 2. Hyperarousal: Heightened psychological and physical tension. 3. Re-experiencing: Nightmares or flashbacks.

24. What is the Impact? 2. INDIRECT RESULTS OF ABUSE/NEGLECT a. Long term physical changes 1. Disabilities: 20%-25% permanent physical injury/disability, and 10%-25% developmental disability. 2. Brain damage: Malnutrition, TBI or prolonged sexual abuse --> 7%-8% smaller brain size. 3. Hormonal changes: Irreversible changes to catecholamine levels in blood even years after the abuse.

25. What is the Impact? 2. INDIRECT RESULTS OF ABUSE/NEGLECT a. Long term mental, emotional, & behavioral 1. TODDLERS & YOUNG CHILDREN (ages 2-5) a. Deep anxiety: Fear of separation; excessive clinging; crying, whimpering, screaming.

26. What is the Impact? 2. SCHOOL AGE CHILDREN (ages 6-11) a. Internalizing symptoms: Extreme withdrawal; irrational fears; depression, anxiety or guilt. b. Externalizing symptoms: Irritability and impulsivity; outbursts of anger and aggression.

27. What is the Impact? 3. ADOLESCENTS (ages 12-17) a. Internalizing symptoms: Avoidance; depression & withdrawal; sleep problems; suicidal thoughts; self-injurious behaviors. b. Externalizing symptoms: Fighting peers; unprovoked aggression; direct defiance; substance abuse; criminal behavior.

28. What is the Impact? 4. GENDER DIFFERENCES: a. Girls = internalizing symptoms (dissociation, surrender, self-harm). b. Boys = externalizing symptoms (hyperarousal, flight-or-flight, aggression). c. Victims of sexual abuse = avoidance of physical contact or oversexualized behavior

29. Kelly ClarksonBecause of You

30. Kelly ClarksonBecause of You I will not make the same mistakes that you did…

31. I will not let myself cause my heart so much misery

32. I will not break the way you did (you fell so hard)

33. I've learned the hard way to never let it get that far

34. Because of you, I never stray too far from the sidewalk

35. Because of you, I learned to play on the safe side so I don't get hurt

36. Because of you, I find it hard to trust not only me but everyone around me

37. I am afraid I am afraid I am afraid I am afraid I am afraid I am afraid I am afraid Because of you…

38. I lose my way And it’s not too long before you point it out

39. I cannot cry because I know that’s weakness in your eyes

40. I’m forced to fake a smile a laugh every day of my life

41. My heart can’t possibly break When it wasn’t even whole to start with

42. Because of you, I never stray too far from the sidewalk

43. Because of you, I learned to play on the safe side so I don't get hurt

44. Because of you, I find it hard to trust not only me but everyone around me

45. I am afraid I am afraid I am afraid I am afraid I am afraid I am afraid I am afraid Because of you…

46. I watched you die I heard you cry every night in your sleep

47. I was so young you should have known better than to lean on me

48. You never thought of anyone else you just saw your pain

49. And now I cry in the middle of the night for the same damn things

50. Because of you, I never stray too far from the sidewalk