Forgotten Victims: Infants and Toddlers Who Witness Violence and Trauma - PowerPoint PPT Presentation

Forgotten Victims: Infants and Toddlers Who Witness Violence and Trauma

Briana S. Nelson, Ph.D., LCMFTKansas State UniversityMarriage & Family Therapy ProgramSchool of Family Studies & Human Services

bnelson@ksu.edu 785-532-1490

Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning. -Herman, 1997

• To understand the impact of witnessing violence and trauma on infants and toddlers
• To identify the immediate and long-term effects on infants and toddlers exposed to trauma and abuse
• To gain knowledge of effective methods for identifying and working with infants and toddlers who may be traumatized

• Children do not develop in isolation; they develop within the context of human systems
• Children both influence and are influenced by the systems in which they are members
• It is necessary to develop a conceptualization of the systemic effects when a child is trauma-exposed or traumatized

“... the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate” (DSM-IV, 1994, p. 424)

• violent personal assault (sexual abuse or assault, physical abuse, robbery, mugging)
• being kidnapped or taken hostage
• terrorist attack
• school violence
• torture
• war
• natural or human disasters
• severe accidents
• being diagnosed with a life-threatening illness (DSM-IV, p. 424)

“Events experienced by others that are learned about include… violent personal assault, serious accident, or serious injury experienced by a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one’s child has a life-threatening disease.”

(DSM-IV, p. 424)

• 6 children commit suicide
• 8 children are homicide victims
• 11 children are killed by firearms
• 76 babies die
• 131 children are reported as abused or neglected

Children’s Defense Fund, 2001 report

• An estimated 1,100 children died as a result of abuse or neglect in 1998 (78% were <5 y/o)
• A conservative estimate is that over 5 million children are exposed to traumatic events every year
• 1/3 of physical abuse victims are less than one year old
• Current estimates of PTSD rates in children range from 0-95% (average rate 37%)

• Every 13 minutes a child is reported abused or neglected
• 6,790 cases of child abuse or neglect were substantiated in 1998 (>2x the 1995 rate)
• Every 7 days, 3 children die under 14 years of age

Child

Larger Society

Social Environment

Extended Family

Immediate Family

Child

Larger Society

Social Environment

Extended Family

Immediate Family

• Acute vs. Chronic
• Single event vs. multiple events
• Age of onset
• Relationship to “perpetrator”
• Adult vs. peer perpetrator
• Intrafamilial vs. extrafamilial
• Parental response

• the amount of time one has to prepare
• previous experience with the stressor
• sources of guidance/support available
• the extent to which others have experienced the event
• the amount of time in a “crisis” state
• sense of loss of control or helplessness
• sense of loss
• disruption and destruction

• emotional impact of the event
• medical problems associated with exposure to the event
• personal role in the stressor event
• pretrauma vulnerability
• intensity and duration of the event
• postevent responses

• Cognition
• Affect
• Interpersonal relations
• Behavior
• Symptom formation
• Spiritual/moral

• Children typically only develop verbal memory of a traumatic event between 2 ½ to 3 years of age
• Even then, most recollections are spotty and incomplete
• Most common symptoms reported in younger victims of trauma fall under the category of behavioral effects, rather than cognitive symptoms

• withdrawal
• reenactments and play involving traumatic themes
• anxious attachment behaviors/separation fears
• regression to previous levels of developmental functioning
• disruptions in sleeping and toileting
• startle responses/“freezing” behaviors

• increased aggressive, anti-social, and hyperactive behaviors
• changes in behavior, mood, personality
• general or trauma-specific fears
• psychosomatic symptoms

• decline in school performance
• increased inner behaviors
• repeated retelling of traumatic event
• isolation of affect
• constant anxious arousal/hypervigilance
• fearfulness/fear of recurrence
• sleep disturbances
• behavioral problems
• regression to previous levels of developmental functioning

• problems relating to peers
• more elaborate reenactments
• psychosomatic symptoms
• loss of interest in pleasurable activities
• feelings of personal responsibility

• acting-out behavior
• self-criticism
• fear of repetition of event in the future
• efforts to avoid overwhelming feelings
• hypervigilance
• social withdrawal
• thoughts of revenge and action-oriented responses to trauma
• acute awareness and distress related to intrusive trauma images and memories
• increased vulnerability to psychiatric disorders
• flight into adulthood

• Reliving
• Releasing
• Reorganizing

(Johnson, 1998)

• Many adults continue to be affected by traumatic experiences in childhood and adolescence
• Often the connection between early experiences and continuous cycles of problematic behavior are not recognized
• Traumatized child--Traumatized parent?

• Parents may constantly search for ways to make sense of or explain the traumatic event their child has experienced
• Often attempt to reduce their sense of helplessness or lack of power
• The family may serve as a resource for increased support and coping or an obstacle that blocks the traumatized child’s adjustment and recovery
• “Trauma membrane”

• The reactions of parents or significant others may have a greater negative impact on children than the children’s own direct exposure or severity of their trauma experiences
• When parents or caretakers are distressed, it may impede their ability to assist their children with their own stress reactions

• If parents have different reactions or coping styles, a cycle of tension may occur in the couple relationship that negatively affects the child
• Some parents may be overwhelmed by the traumatic event and minimize the effects on themselves and/or their child

• Children may experience secondary traumatic stress as a result of parental traumatization, through:
• Direct witnessing of a parent’s trauma (e.g., domestic violence, sexual assault)
• Direct experiencing of the post-traumatic reactions of symptoms in the parent (e.g., nightmares, flashbacks, startle responses)

• Siblings of traumatized children may experience feelings of guilt, fear, anxiety, and secondary trauma symptoms
• Surprisingly, the issue of sibling abuse has been relatively unaddressed in clinical and empirical literature
• Because of the impact of the child’s trauma on parents, secondary stress reactions in siblings may be overlooked or ignored

• Symptoms present in a traumatized child can affect those with whom the child interacts at all system levels

• Certain individuals manage to succeed in spite of the odds
• Interplay between the child’s basic traits and the environment
• Post-traumatic growth

• Personality factors
• Agreeable
• Social
• Compassionate
• Internal locus of control
• Cognitive factors
• Creativity
• Insight
• Initiative
• World-view beyond trauma

• Ability to manage affective reactions
• Broad range of emotions
• Sense of humor
• Behavioral factors
• Persistence
• Ability to generate relationships with peers and adults
• Resourcefulness
• Ability to self-soothe

• “Secondary Traumatic Stress (STS) is the experience of tension and distress directly related to the demands of living with and caring for someone who displays the symptoms of post-traumatic stress disorder (PTSD)” (Figley, 1998)
• Because of the emotional connection, being in close, prolonged contact with a traumatized person becomes a constant stressor
• Family members and professionals often experience symptoms of traumatization

• Symptoms = “communicable” “infect” “mimic”
• Symptoms are considered “secondary” because they occur in those who have not directly experienced the event.
• May resemble PTSD-like symptoms, but may be less intense
• Therapists may not be aware of or they may deny secondary trauma effects
• “Savior”/”Rescuer”

• Sharing the survivors’ nightmares
• Sharing the hopelessness of survivors
• Feelings of aggression
• Confronting one’s own vulnerability and moral values
• Feelings of numbing and avoidance
• Victim blaming/dehumanizing
• Other PTSD-like symptoms

• Professionals should acknowledge the effects of secondary trauma on themselves and their colleagues and take regular, ongoing actions to insure the welfare of professionals and to preserve their ability to deliver quality services;
• Professionals should not work alone but instead should seek out or create arrangements in which they have regular and open input from other professionals regarding the effects of secondary trauma and its impact on the services they deliver,
• Professionals should recognize an ethical duty to self care (Munroe, 1995)

• Recognize the value of multiple perspectives
• Watch and listen to the children
• Use development as a guide for action with adult and child
• Identify factors related to poor growth, learning and relationships within the family system and work for change in the system
• Help promote strengths and find opportunities to increase resiliency in children

• More prevention will reduce the need for intervention
• Training non-mental health professionals
• Recognizing potentially traumatic events
• Societal awareness and education

• Barnes, M. F. (1998). Understanding the secondary traumatic stress of parents. In C. R. Figley (Ed.), Burnout in families: The systemic costs of caring (pp. 75-89). Boca Raton, FL: CRC Press.
• Herman, J. L. (1997). Trauma and recovery (2nd edition). New York: BasicBooks
• Johnson, K. (1998). Trauma in the lives of children: Crisis and stress management techniques for teachers, counselors, and student service professionals (2nd edition). Alameda, CA: Hunter House.
• Monahon, C. (1993). Children and trauma: A guide for parents and professionals. San Francisco: Jossey-Bass.
• Nelson, B. S., & Schwerdtfeger, K. L. (2002). The systemic impact of traumatized children. In D. Catherall (Ed.), Handbook of stress, trauma, and the family. Washington DC: American Psychological Association. (Peer-reviewed chapter submitted for publication; revise and resubmit).
• Pynoos, R. S., Steinberg, A. M., & Goenjian, A. (1996). Traumatic stress in childhood and adolescence: Recent developments and current controversies. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 331-358). New York: Guilford.