The Effects Of Trauma On Children And Adolescents

The Effects of Traumaon Children andAdolescentsDon Mitckess, LCPC, CRADCConsultantStudent Assistance CenterPrevention First

Central Questions Do kids in my school havetrauma that isn’t beingidentified, and if so, whatcan I do? What is a trauma lens? What does it mean to see achild through a trauma lens?

Trauma Principle#1If everything istrauma, nothing istrauma.

Trauma Principle#2It is the child’sexperience of theevent, not the eventitself, that istraumatizing.

Trauma Principle#3If we don’t look for oracknowledge trauma inthe lives of children andadolescents, we end upchasing behaviors andlimiting the possibilitiesfor change.

Trauma Principle#4The behavioral andemotionaladaptations thatmaltreated childrenmake in order tosurvive are brilliant,creative solutions,and are personallycostly.

Trauma Principle #5Since trauma chaos,structure healing

Trauma Principle#6If you don’t ask,they won’t tell.

Child Traumatic Stressis Common More than 1 in 4 American childrenwill experience a serious traumaticevent by their 16th birthday. Children with developmentaldisabilities are 2 - 10 times morelikely to be abused or neglected. Children are at greatest risk of sexualabuse between 7 - 13. Four of every20 girls will be sexually assaultedbefore age 18; one or two of every20 boys.

Child Traumatic Stress isCommon Exposure to community violence isa growing source of trauma forchildren. 3400 primarily 6th graders screened inthe Madison Metropolitan & SunPrairie School District for exposure tocommunity violence. Nearly 1000 kids (29%) reportedsubstantial exposure to violence. Almost 400 (11.5%) of the kidsscreened reported both exposure totrauma and clinically significantsymptoms of child traumatic stress.

Child Traumatic Stress &Foster Care A national study of adult "fostercare alumni" found higher rates ofPTSD (21.5%) compared with thegeneral population (4.5%). Compare with rates in Americanwar veterans: 15% in Vietnam 6% in Afghanistan and 12-13% in Iraq Foster care alumni have higherrates of major depression, socialphobia, panic disorder, generalizedanxiety, addiction, and bulimia(Pecora, et al., 2003).

Child Traumatic Stress &Foster Care A study of children in foster carerevealed PTSD: in 60% of sexually abused children 42% of the physically abused children. 18% of foster children who had notexperienced either type of abusehad PTSD (Dubner & Motta, 1999), possiblyas a result of exposure to domesticor community violence (Marsenich,2002). One out of three children enteringfoster care, ages 6 to 8, met criteriafor PTSD (Dale et al. 1999).

Child Traumatic Stressis Serious Interferes with children’sability to concentrate andlearn Can delay development oftheir brains/bodies Leads to depression,substance abuse, healthproblems, school failure,delinquency, and futureemployment problems

Child Traumatic Stressis Serious Changes how children view theworld and their own futures,their behavior, interests, andrelationships with family andfriends Takes a toll on families andcommunities

Child Traumatic Stressis Serious Educational impact Learning problems Lower GPA More absences More negativecomments inpermanent record

Child Traumatic Stressand Juvenile Justice Criminal/juvenile justice impact Increases risk of arrest asjuveniles/adults Increases risk of committingviolent crime Increases risk of perpetration ofdomestic violence Increased risk of problem druguse as an adult

Child Traumatic Stressand Juvenile Justice“Recognizing [traumatic]victimization as a potentialsource of abusive behaviordoes not excuse suchbehavior, but may provide abasis for preventing ortreating it more effectively.”Julian Ford, 2005

Child Traumatic Stressis Serious Health impact: Smoking, including earlyonset of regular smoking Sexually transmitted diseasesand hepatitis IV drug use and alcoholism Heart disease, diabetes Obesity Unintended pregnancy Avoidance of preventativecare

Child Traumatic Stressis LastingChild traumatic stresshas powerful andlasting effects Adverse Childhood ExperiencesStudy or ACE Study (Anda &Felitti) Kaiser Permanente & US Centers forDisease Control Retrospective look at the childhoodsof nearly 18,000 HMO members Identified 9 ACEs .one point percategory .total number ofcategories ACE score

Child Traumatic Stressis LastingAdverse Childhood Experiences:Growing up ( 18) in a householdwith: Recurrent physical abuse Recurrent emotional abuse Emotional or physical neglect Sexual abuse Mother being treated violently. An alcohol or drug abuser. An incarcerated household member. Someone who is chronicallydepressed, suicidal, institutionalizedor mentally ill. Absent parent(s).

Child Traumatic Stressis Lasting Powerful relationship between ouremotional experiences as children and ourphysical and mental health as adults. ACE Score of 4 or is 4.6 timesmore likely to be suffering fromdepression than ACE Score of 0. ACE Score of 4 is 12.2 times morelikely to attempt suicide than scoreof 0. At higher ACE Scores, theprevalence of attempted suicideincreases 30-51 fold. ACE Score (male) of 6 is 46 timesmore likely to become an IV druguser compared to ACE Score of 0.

Child Traumatic Stressis LastingMany other measures of adulthealth have a strong, gradedrelationship to what happened inchildhood. The higher the ACEScore the more likely the illness. heart disease diabetes obesity unintended pregnancy sexually transmitted diseases alcoholism

The Under-recognizedTraumaNational survey (1998) of 12 to 17year olds:8% reported sexual assault inlifetime17% reported physical assault inlifetime39% reported witnessing violence inlifetimeStudy (1995) of adolescents:2% experienced direct assault23% experienced assault andwitnessed violence48% witnessed violence27% no violence

The Under-recognizedTrauma“Rates of interpersonal violenceand victimization of 12-17 yearolds in the US are extremelyhigh, and witnessing violenceis common.”US Department of Justice , 2003Exposure to violence: 7 out of 10adolescents vs 4 out of 10adults. Youth ViolenceResearch Bulletin, 2002

What do kids learnfrom trauma?Negatives: Traumatic expectations of theworld No one can protect Laws don’t really work Learned helplessness

What do kids learnfrom trauma?Positives: How to conduct themselvesin the midst of danger Others do protect andrescue Helpful support is availableafter trauma Increased compassion

Traumatic StressTraumatic Stress is theresponse to events that cancause death, loss, seriousinjury, or threat to a child’swell being or the well beingof someone close to thechild.

Traumatic StressTraumatic Stress causes the primalfight or flight or freeze response.Traumatic Stress involves terror,helplessness, horror.Traumatic Stress results in physicalsensations -- rapid heart rate,trembling, sense of being in slowmotion.

Traumatic StressNot every event that isdistressing necessarily results intraumatic stress.An event that results in traumaticstress for one person may notnecessarily result in traumaticstress for another.

Traumatic StressThe thing that upsetspeople is not whathappensbut what they think itmeans.Epictetus

Trauma SymptomsSubjective Characteristics of Trauma Appraisal of event:uncontrollable or malicious? Appraisal of action:ineffective or effective? Appraisal of self: helpless andshameful or brave andcapable? Appraisal of others: impotentor dangerous vs safe andprotective?

Traumatogenic Factors Age Relational vs non-relational Relationship betweenvictim and perpetrator Severity/Duration/Frequency Protection Caregiver response Responsibility and blame Community or societalresponse

Risk FactorsPoor, anxious, or disruptedattachment Prior trauma Pre-existing anxiety ordepression, especially maternaldepression Neurological issues Prematurity Caregiver with “active” traumasymptoms Caregiver with AODA issues Own AOD use Poverty

Protective Factors Secure attachment to caregiver Caregiver’s resolved traumaissues Two-parent family The “resiliency” factor andtemperament Intelligence/neurologicalresources Shielding adult No blame placed on the child Affirming and protective parentalresponse Caregiver’s ability to toleratechild’s reactions Spirituality

DiagnosisAcute Stress Disorder: One or more symptom(s)lasts for a minimum of 2days and a maximum of 4weeksPTSD: One or more symptom(s)occurs more than 1 monthpost event

Symptoms of Post-traumaticStress Disorder1. Re-experiencingImageryMisperceiving dangerNightmaresDistress when cuedBody memories2. AvoidanceNumbing outDissociationDetachmentDiminished interestSelf isolation3. Increased arousalAnxietySleep disturbancesHypervigilance Irritability or quick to angerStartle response Physical complaints

Limitations of PTSDDiagnosis Conceptualized from an adultperspective Identified as diagnosis viaVietnam vets and adult rapevictims Focuses on single eventtraumas

Limitations of PTSDDiagnosis Failsto recognizechronic/multiple/on-goingtraumas Is not developmentallysensitive Most traumatized children donot meet full diagnostic criteriaIsolated traumatic incidents tend to producediscrete conditioned behavioral and biologicalresponses to reminders of the trauma, suchas are captured in the PTSD diagnosis. Incontrast, chronic maltreatment or inevitablerepeated traumatization, such as occurs inchildren who are exposed to repeatedmedical or surgical procedures, have apervasive effects on the development of mindand brain.

Complex TraumaThe traumatic stress field has adopted the termComplex Trauma to describe the experience ofmultiple and/or chronic and prolonged,developmentally adverse traumatic events,most often of an interpersonal nature (e.g.,sexual or physical abuse, war, communityviolence) and early-life onset. These exposuresoften occur within the childs caregiving systemand include physical, emotional, andeducational neglect and child maltreatmentbeginning in early childhood. Complex Trauma is: the experience of multiple traumasdevelopmentally adverseoften within child’s caregiving systemrooted in early life experiencesresponsible for emotional, behavioral,cognitive, and meaning-makingdisturbances

Complex Trauma andthe Brain“Chronic trauma interferes withneurobiological development(Ford, 2005) and the capacityto integrate sensory, emotionaland cognitive information intoa cohesive whole.” (van derKolk, 2005)

Consequences ofComplex TraumaProlonged and chronic traumaleads to: Dysregulated emotions - rage,betrayal, fear, resignation,defeat, shame. Efforts to ward off therecurrence of those emotions avoidance via substanceabuse, numbing out, selfinjury. Reenactments with others

ReenactmentRecreating the trauma in newsituations, often with new people,through tension reducing behaviorsExamples: after a serious car accident,adolescent begins to driverecklessly after rape adolescent becomeshypersexual after being physically abusedadolescent gets into fist fightsMany problems of traumatized children can beunderstood as efforts to minimize objective threatand to regulate their emotional distress. Unlesscaregivers understand the nature of such reenactments they are liable to label the child asoppositional, rebellious, unmotivated, andantisocial.

Reenactment Recreates old relationships withnew people Tests the negative internalworking model for “proof” thatit’s right:I am worthlessI am unsafeI am ineffective in the worldCaregivers are unreliableCaregivers are unresponsiveCaregivers are unsafe and will ultimately rejectme.

Reenactment Provides opportunity formastery Vents frustration and anger Mitigates building anxiety Contributes to sabotage Pushes caregivers in ways theymay not expect to be pushedWhen professionals are unaware of childrens need toadjust to traumatizing environments and expect thatchildren should behave in accordance with adultstandards of self-determination and autonomous,rational choices, these maladaptive behaviors tend toinspire revulsion and rejection. Ignorance of this factis likely to lead to labeling and stigmatizing children forbehaviors that are meant to insure survival.