A developmental model of childhood traumatic stress
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A Developmental Model of Childhood Traumatic Stress. Traumatic Stress. PROXIMAL SECONDARY STRESSES. PROXIMAL TRAUMATIC REMINDERS. APPRAISAL & RESPONSE TO DANGER. RESISTANCE & VULNERABILITY. ACUTE DISTRESS. ECOLOGY OF THE CHILD. CHILD INTRINSIC FACTORS. RESILIENCE. ADJUSTMENT.

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A developmental model of childhood traumatic stress l.jpg

A Developmental Model of Childhood Traumatic Stress


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Traumatic Stress

PROXIMAL SECONDARY STRESSES

PROXIMAL TRAUMATIC REMINDERS

APPRAISAL & RESPONSE TO DANGER

RESISTANCE & VULNERABILITY

ACUTE DISTRESS

ECOLOGY OF THE CHILD

CHILD INTRINSIC FACTORS

RESILIENCE

ADJUSTMENT

PROXIMAL PSYCHOPATHOLOGY

PROXIMAL DEVELOPMENT

ONGOING ADJUSTMENT

REPEATED OR SEQUENTIAL TRAUMATIZATION

DISTAL TRAUMA REMINDERS

DISTAL SECONDARY STRESSES

DISTAL DEVELOPMENT

DISTAL PATHOLOGY


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Traumatic Stress

  • Alarm Reactions

  • Context

  • Complexity

  • Objective features

  • Subjective experience

  • Coping strategies

  • Loss

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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The Complexity of Traumatic Experiences

  • Context

  • Multiple traumatic moments, even within a relatively circumscribed situation.

  • Changes in foci of attention or concern

  • Radical shift in attention or concern when physical integrity is violated

  • Additional traumatic moments after cessation of violence or threat

  • Additional dimensions to traumatic experiences

  • Disturbances in evolving developmental expectations regarding danger

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Proximal Trauma Reminders

  • External and Internal Cues

  • Constellation

  • Pattern of Occurrence

  • Pattern of Reactivity

  • Challenge to Regulation of Aggression

  • Trauma and Loss Reminders

  • Reminders of Prior Trauma

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Proximal Secondary Stresses

Changes in Family Living Circumstances, Resources

Change in Community Resources

Change in Family Constellation and Function

Change in Availability and Utilization of Social Support

Need to Assume New Responsibilities

Medical / Surgical Care, Rehabilitation

Altered Role Performance

Issues of Accountability

Acquisition of New Social Skills

Intercurrent Trauma, Loss, Life Adversity

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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APPRAISAL AND RESPONSE TO DANGER

RESISTANCE AND VULNERABILITY

ACUTE DISTRESS

RESILIENCE

ADJUSTMENT


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Proximal Development

  • Selective Attention / Cognition / Learning

  • Mechanisms of Emotional Regulation

  • Self-Attributions

  • Autonomous Strivings

  • Perceptions of Self-Efficacy

  • Specific Psychodynamic Concerns

  • Impulse Control

  • Moral Development

  • Sense of Historical Continuity

  • Skills of Social Competency

  • Interpersonal and Intrafamilial Transitions

  • Biological Maturation, including brain structures and physiological and hormonal changes

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Proximal Psychopathology

PTSD

Depression

Complicated Bereavement

Phobic Disorder

Separation Anxiety Disorder

Other Anxiety Disorders

Sleep Disorder

Attachment Disorder

Dissociative Disorder

Somatization Disorder

Substance Abuse

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Ecology of the Child

  • Family / Parental Factors

    • Similar grouping as Child Intrinsic Factors

    • Parental physical illness

    • Parent past exposure to trauma and loss

    • Reactivity to reminders

    • Loss and secondary stresses

    • Current responsiveness

    • Current trauma and loss-generated psychopathology

  • Developmental Cycle of the Family

    • Family Structure and Function

  • School Milieu and Responsiveness

  • Peer Milieu and Responsiveness

  • Social Ecology and Responsiveness

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Child Intrinsic Factors

Genetic

Temperament

Alarm Propensity

Anxiety Sensitivity

Organization of Stress Response Systems

Acquired Developmental Competencies

Phase-Specific Concerns

Pre-existing Psychopathology

Prior Experience

Threats to Attachment

Trauma and Loss

Coping with Prior Danger

Modes of Attachment

Coping Repertoire

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Distal Trauma Reminders

  • Context in Everyday Life

  • Recognition Difficulty

  • Reactivity and Negative Self-Attributions

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Repeated or Sequential Traumatization

  • Complex impact on development

  • Various exposures at different points

  • Changing nature of similar traumatic stress

  • Incomplete recovery

  • Chronic anticipatory strategies

  • Debilitating conflict over accountability

  • Capitulatory emotional regulation, avoidance, and control of physical or psychological pain

  • Latent negative self-images

  • Harmful tension reduction behaviors

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Distal Secondary Stresses

  • Chronicity of Proximal Stresses

  • Adverse Life Circumstances

  • Accommodation to Physical Disability

  • Judicial / Reparation Proceedings

  • Disclosure and Communication about Previous Trauma

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Distal Development

  • Emerging Personality

    • Fear, courage, and fearlessness

    • Trauma, loss, and danger expectancies

    • Embedded attributions to self, other, and social agencies

    • Enduring intervention themes

    • Adult self-care and protective behavior

  • Interaction of proximal disturbances on specific future developmental tasks

  • Interpersonal academic and occupational functioning

  • Parental functioning

  • Decision-making, aspirations, and motivations

  • Political ideology and social contact

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Distal Pathology

  • PTSD and other psychiatric disorders

  • Physical health problems

  • Chronic developmental disturbances

  • Adverse life trajectory outcomes

  • Increased vulnerability to future life stresses

  • Difficulties in treatment situation

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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Proximal Psychopathology

  • Acute Stress Disorder

  • PTSD

  • Depression

  • Complicated Bereavement

  • New Onset Attention Deficit Disorder

  • Separation Anxiety Disorder

  • Other Anxiety Disorders

  • Sleep Disorder

  • Attachment Disorder

  • Conduct Disorder

  • Eating Disorder

  • Phobic Disorder

  • Dissociative Disorder

  • Somatization Disorder

  • Substance Abuse

Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.


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