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The Effects of Trauma on Young Children. Stacey Ryan, LCSW Angela M. Tomlin, Ph.D. IAITMH 2006. Types of Trauma. Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Abuse/Neglect Loss of caregiver. Do Young Children Experience Trauma?.

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the effects of trauma on young children

The Effects of Trauma on Young Children

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.

IAITMH

2006

types of trauma
Types of Trauma
  • Witnessing violence (domestic and other)
  • Natural disaster
  • Terrorism
  • Accidents
  • Abuse/Neglect
  • Loss of caregiver
do young children experience trauma
Do Young Children Experience Trauma?
  • Children under 12 months account for 44% of deaths from child abuse and neglect
  • Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome
young children and sexual abuse
Young children and sexual abuse
  • Infants and toddlers may account for as many as 10% of substantiated sexual abuse
  • Appearance of sexualized behavior is more likely than physical findings
  • The younger the child when abused, the more likely sexualized behavior appears
young children and domestic violence
Young children and domestic violence
  • Child sees attachment figure injured
  • Attachment figure cannot protect self; child is unsure if she can protect him
  • Attachment figure may in turn injure the child
assessing severity of trauma
Assessing severity of trauma
  • Closeness of people involved to the child
  • What the child saw
  • Child’s developmental level
  • Reactions of important adults
how young children understand traumatic events and experiences
How Young Children Understand Traumatic Events and Experiences
  • Cognitive and emotional capacity determines how child experiences trauma
  • Level of understanding can also affect memory
  • 2-3 year olds do not understand the finality of death
  • Young children may believe they caused a traumatic event
clinical patterns in abused neglected infants
Clinical Patterns in Abused/Neglected Infants

Gaensbauer & Mrazek (1981) observed 4 clinical patterns:

  • Developmentally and Affectively retarded group
  • Depressed Group (sad and sensitive to change)
  • Ambivalent Group (rapid shifts in emotion)
  • Angry Group (emotional intensity and low frustration tolerance)
effects of trauma
Effects of Trauma
  • Can appear immediately or after days, weeks
  • May remind young child of previous traumas, making reaction more severe
effects of trauma10
Effects of Trauma
  • Physical & Self-Regulation Effects
  • Traumatic Reminders
  • Development
  • Play
  • Behavior
  • Relationship
physical and self regulation effects
Physical and Self-Regulation Effects
  • Self-regulation is important task of infancy
  • In babies and young children, problems with self-regulation look like:

Sleep problems

Eating problems

Exaggerated startle

Hypervigilance

physical and self regulation effects12
Physical and Self-Regulation Effects
  • Exposure to traumatic events seems to change the way the infant reacts to future stressors
  • Animal and human studies shows changes in hormones and brain chemicals after trauma
  • These brain changes can be long lasting, leading the child to feel numb or anxious
traumatic reminders
Traumatic reminders
  • Can be difficult to identify in nonverbal child
  • Sensory (siren, smell)
  • Dreams
  • Re-experiencing the event
  • Irrational fear of benign objects
developmental effects of trauma
Developmental Effects of Trauma
  • Developmental delays are expected—developmental assessment is advised
  • Problems may occur in development of attachments and other social emotional skills
  • Regression is possible
effects on play skills
Effects on Play Skills
  • Repetitive actions
  • Driven quality
  • Constricted quality
  • Preoccupation with separation, loss, and reunion
effects on behavior infants and toddlers
Effects on Behavior—infants and toddlers
  • Increased irritability/inability to soothe
  • Sleep disturbance
  • Emotional distress; sadness
  • Fears of being alone; clinging; refusal to separate
  • Motor agitation
  • Temper tantrums
effects on behavior toddlers and preschoolers
Effects on Behavior—toddlers and preschoolers
  • Being too clingy with adults
  • Not able to be comforted when upset
  • Problems with exploration: either reckless or too inhibited
  • Aggression toward caregivers, peers, animals
  • Angry noncompliance
effects on relationship
Effects on Relationship
  • Difficulty forming positive relationships
  • Poor sense of self
  • Lowered self esteem
  • Expectation of being treated poorly
  • Loss of secure base
  • Loss of sense of trust
long term effects of trauma
Long Term Effects of Trauma
  • Persistent grief reactions (Bowlby)

Protest: efforts to find the parent through crying, calling, and searching

Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities

Detachment: apparent indifference to reminders; selective forgetting*

long term effects of trauma20
Long Term Effects of Trauma
  • Increased risk for academic problems
  • Substance use and abuse
  • Early pregnancy
  • Criminal involvement
  • Psychiatric symptoms and disorders
  • Experiencing abuse as a child is linked to abusing one’s own child
abused children as parents
Abused children as parents
  • Harsh discipline
  • Failure to respond to child’s needs
  • Inconsistent limit setting
  • Inability to express affection
  • Inability to enjoy interactions with child
  • Minimize or deny child’s painful experiences
young children and neglect
Young children and neglect
  • Failure to provide for child’s physical and emotional needs
  • Leaving child alone for long periods
  • Leaving child for long periods with varied and unreliable caregivers
  • Effects of neglect can be as devastating as physical or sexual abuse
effects of neglect
Effects of neglect
  • Lack of play and other developmental skills
  • May hoard food
  • Unfamiliar with things we take for granted
  • Expects to take care of self or siblings
  • Challenges adult authority
  • Lacks trust in adults
  • Avoids adults when upset; hard to soothe
expected difficult reactions to placement in foster care
Expected difficult reactions to placement in foster care
  • Previous relationship failures lead the child to behave in ways that alienate foster parents
  • Caregivers misread behaviors and respond in ways that increase problems
  • Child responds to loss of attachment figure with behavioral, emotional, and physiological dysregulation
expected difficult behaviors of children in care
Expected difficult behaviors of children in care
  • Acting like they do not need caregivers, even under threatening conditions
  • Acting angry when adult makes efforts to soothe
  • Turning away when hurt
  • Behaving aggressively toward caregivers
  • Behaving aggressively toward peers
  • Problem behavior after visits
why do we see behavior problems after visits with family
Why do we see behavior problems after visits with family?
  • Visits with parents are traumatic reminders of events that led to the separation or of the separation itself
  • Both the child and parent may feel anxious and angry
  • Supervised visits increasing parents feelings of incompetence
  • Child feels safer expressing angry feelings toward foster parent/family
how foster care helps
How Foster Care Helps
  • One of the most important things a foster parent can do is to help young children have positive relationships
  • Doing this will help with development and behavior
  • To do it right, you have to pay attention to attachment
arousal relaxation cycle
Arousal-Relaxation Cycle

Child experiences a need

Child feels upset

Child feels content

Adult satisfies need

are there children with no attachments
Are there children with no attachments?
  • There are children with no attachments
  • It is more likely that a child have an attachment problem rather than no attachment at all
  • The child will develop an attachment with the adult that is available
why do children form attachments to abusive parents
Why do children form attachments to abusive parents?
  • Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them
  • Children prefer the familiar, even when what is familiar is frightening
insecure attachments
Insecure Attachments
  • Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance.
  • Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby
insecure attachments32
Insecure Attachments
  • Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them
  • Infant is afraid of the person they look to for reassurance and nurturance
  • Infant behavior is unorganized and bizarre
  • These patterns are common when children are abused or they witness domestic violence
long term effects of disorganized attachments
Long term Effects of Disorganized Attachments
  • Aggression with peers
  • Dissociative behaviors
role of foster parent in attachment
Role of Foster Parent in Attachment
  • Help the child develop a healthy attachment
  • Help child extend attachment to you and improved behaviors to birth family, new fosterfamily, or adoptive family
how foster parents can help
How Foster Parents Can Help
  • Work with the parents
  • Avoid judgments about the biological parents
  • Provide transitional objects to child
  • Provide family pictures
  • Have a plan for the first visit
how foster parents can help36
How Foster Parents Can Help

Responding to parent anger

  • Listen
  • Be non-reactive
  • Acknowledge how difficult it is to be away from child
how foster parents can help37
How Foster Parents Can Help
  • Recognize that the child needs you, even when they do not show it
  • Understand rejecting behaviors as old coping methods
  • Listen
  • Put words to behaviors
  • Attend to your own reactions
  • Encourage touch, but do not force it
how foster parents can help at home
How Foster Parents Can Help at Home
  • Safety
  • Routine that shows an adult is “in control”
  • Soothing sensory activities
  • Stop activities that result in re-enactment (including television)
  • Advocate to reduce moves to provide continuity
factors in determining types of interventions osofsky fenichel 1994
Factors in Determining Types of Interventions, (Osofsky & Fenichel, 1994)
  • Safety and Stability of Current Living Situation
  • Child’s Developmental Capacities to Make Use of Certain Types of Interventions
  • Quality of Pre-Traumatic and Current Care-Giving Environment
  • Type of Violent Event or Situation
  • Acuteness vs. Chronicity of Trauma
  • Actual and Psychological Proximity of the Violent Events
  • Post Traumatic Symptoms in Child and Caregiver
  • Strengths and Protective Factors in Infant
goals for intervention lieberman van horn 2005
Goals for Intervention (Lieberman & Van Horn, 2005)
  • Return to Normal Development
  • Increase Capacity to Respond to Trauma.
  • Maintain Regular Levels of Arousal
  • Re establish Trust in Bodily Sensations
  • Restore Reciprocity in Close Relationships
  • Normalize Reactions to Trauma
  • Encourage a Differentiation Between Reliving and Remembering
  • Place the Traumatic Experience in Perspective
common intervention needs osofsky fenichel 1994
Common Intervention Needs (Osofsky & Fenichel, 1994)
  • Improving the caregivers ability to attend to and provide for the child’s needs
  • Further develop caregiver’s ability to interpret child’s feelings, reactions and support child
  • Address cognitive distortions child may have regarding trauma
  • Assist the child in re experiencing trauma in affectively tolerable doses
  • Assist the child and caregiver in coping with any losses
results of interventions assist child in understanding
Results of Interventions Assist Child in Understanding…
  • Stressful body experiences can be alleviated with help of others and coping strategies
  • Adults can support and protect child
  • Child is not to blame
  • Can talk about emotions rather than only acting them out
  • Life can contain elements of mastery, fun and hope
methods for intervening
Methods for Intervening
  • Using Play, Physical Contact and Language to Promote Developmental Progress
  • Offering Unstructured Reflective Developmental Guidance
  • Modeling Appropriate Protective Behavior
  • Interpreting Feelings and Actions
  • Providing Emotional Support/Empathetic Communication
  • Offering Crisis Intervention and Concrete Assistance
areas of clinical concern include
Areas of Clinical Concern include…
  • Play
  • Sensorimotor Disorganization
  • Fearful Behavior
  • Self Endangering Behavior
  • Aggression Toward Parent
  • Aggression Toward Peers
  • Parental Use of Physical Discipline
  • Parental Use of Threats, Criticisms of Child
  • Relationship with Perpetrator
slide46
Play
  • Encouragement of Play with Dyad
  • Help the Parent Understand and Support Use of Play
  • Allow the Parent to Be Main Supporter to Child
sensorimotor disorganization
Sensorimotor Disorganization
  • Help the Parent Understand How these behaviors Affect Them (triggers feelings of rejection, anger and frustration in parent)
  • Develop New Meanings for Parent
child fears
Child Fears
  • Support Parent Understanding of Fears
  • Bring Attention to Cues Child Gives Regarding Fears
  • Develop with Parents Strategies for Containing Fears
aggression toward parent
Aggression Toward Parent
  • Give Parents Meaning for This Behavior
  • Assist Parents In Containing Feelings Regarding this Behavior
  • Develop Strategies for Controlling Anger/Aggression
aggression toward peers
Aggression Toward Peers
  • Build Understanding of Reasons for Behavior
  • Clinician Gives Resources for Deescalating Behavior
  • Empower Parents to Take Action and Assist Child
parental use of physical punishment
Parental Use of Physical Punishment
  • Explore with Parent Feelings and Concerns
  • Contain Own Emotions and Reactions
  • Educate on Reasons Physical Punishment May Worsen Symptoms
parental criticism
Parental Criticism
  • Focus on Effects of Relationship
  • Acknowledge Parent Issues/Feelings
  • Build Awareness of Child Experience
relationship with perpetrator
Relationship with Perpetrator
  • Educate on Child Needs/Experiences
  • Support/Listen to Parent Concerns/Feelings
  • Mutually Develop Strategies
what evaluation research tells us landy menna 2006
What Evaluation Research Tells Us (Landy & Menna, 2006)
  • Home Visiting is Critical Component
  • Need to Distinguish Between Early Intervention and Prevention
  • Starting Early is Critical
  • Intensity and Duration Counts
  • Ongoing Assessment is Critical
  • Services Most Effective for Moderate Levels of Risk
  • Need for Well Trained Service Providers
  • Use a Variety of Approaches
treatment videos
Treatment Videos
  • Discussion
  • Questions/Comments
experience case based discussion
Experience Case Based Discussion
  • Structured way of thinking and talking about situations with families
  • Method for promoting Reflective Supervision and Further Learning
  • 3 Phases:
          • Understanding the Experience
          • Exploring and Sharing the Collective Knowledge and Experience of the Group
          • Summarizing Discussion and Identifying Next Steps
another way to help
Another Way to Help
  • Speak for the babies..
want to learn more
Want to learn more?
  • Indiana Association for Infant and Toddler Mental Health (iaitmh.org)
  • 317/638-3501 EXT 221
  • Zero to Three (zerotothree.org)
  • The Center for Social and Emotional Foundations for Early Learning (csefel.uiuc.edu)
contact us
Contact us….
  • Stacey (yphsdir@cmhcinc.org)
  • Angie (atomlin@iupui.edu)
the effects of trauma on young children61

The Effects of Trauma on Young Children

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.

IAITMH

2006