Transcript njatsa.org
CHILD ABUSE PROFESSIONAL TRAINING
SERIES #4
HOW DOES CHILD SEXUAL ABUSE AND WITNESSING DOMESTIC
VIOLENCE ALTER AND AFFECT THE COURSE OF DEVELOPMENT?
Fawn McNeil-Haber, PhD
CHILDHOOD TRAUMA
“Repeated trauma in adult life erodes the structure of the
personality already formed, but repeated trauma in childhood
forms and deforms the personality. The child trapped in an
abusive environment is faced with formidable tasks of
adaptation. She must find a way to preserve a sense of trust in
people who are untrustworthy, safety in a situation that is
unsafe, control in a situation that is terrifyingly unpredictable,
power in a situation of helplessness. Unable to care for or
protect herself, she must compensate for the failures of adult
care and protection with the only means at her disposal, an
immature system of psychological defenses.”
- Judith Herman, 1992
CHILDHOOD
Rapid brain development
most rapid between birth and 5 years old
by 3 years old ~ 85% of adult volume
Primed to learn from our experiences
Early development and experiences provides a foundation for
later development.
The following slides are provided courtesy of The
National Child and Traumatic Stress Network's
Caring for Children Who Have Experienced Trauma:
A Workshop for Resource Parents (2010)
NORMATIVE DEVELOPMENTAL TASKS
Infants and toddlers
Preschoolers
Attachment
Security
Trust
Emotion regulation
Autonomy
Recognition of and response
to emotional cues
Autonomy
Agency
Initiative
Emotion regulation
Self control
DEVELOPMENTAL TASKS
School-aged
Adolescence
Sustain attention for
learning and problem
solving
Control Impulses
Becoming Industrious
Emotional Awareness
Complex reasoning
Friendships
Manage anxieties
Independence
Relationships
Achievement
Identity (Values)
Abstract thought
Anticipate and consider
consequences of behavior
Control behaviors for long
term goals
Accurately judge danger
and safety
In what ways does trauma impact these
normative developmental tasks?
COMPLEX TRAUMA
Children’s experiences of multiple traumatic events
that occur within the caregiving system
Neglect
Emotional abuse
Physical abuse
Sexual abuse
Witnessing Domestic Violence
(Cook et. al, 2003)
CHILD SEXUAL ABUSE
A sexual act imposed on a child who lacks emotional,
maturational, and cognitive development to understand and
consent to such acts.
1 in 5 girls
1 in 10 boys
70% of sexual assaults occur before age 18
> 90% of offenders are known to and trusted by victims
Crime of control, betrayal, secrecy, isolation, intimidation and
helplessness
A crime that is misunderstood by most adults including nonoffending parents
(Finklerhor & Jones, 2012; Snyder, 2000)
DOMESTIC VIOLENCE EXPOSURE
Commonly defined as a behavior, or pattern of behaviors, that
occurs between intimate partners with the aim of one partner
exerting control over the other through aggression, coercion,
abuse and/or violence.
43% of female victims and 25% of male victims of DV live in
households with children (Bureau of Justice Statistics)
Occurs disproportionately in home with children under 5 (Taylor
et. al, 1994)
45%-70% also physically abused1
15 times more likely to be physically abused or neglected1
Evidence for a raised cooccurrence of DV and CSA1
The ability to parent is compromised1
1.(Holt et al, 2008)
SIMPLE VS. COMPLEX TRAUMA
Simple
Complex
Non-interpersonal
Limited exposure (single
event)
Shorter duration
Occurrence at later
developmental stage
Support of caretaker/family
Secure attachment with
with primary caretaker(s)
Interpersonal
Multiple exposures/types
Longer duration
Occurrence at an earlier
developmental stage
Limited or no support
Insecure attachment with
primary caretakers
(Lanktree & Briere, 2008)
COMPLEX TRAUMA
Mental, Emotional, Biological and Behavioral effects of
experiencing recurrent childhood abuse.
Seven domains of impairment
Attachment
Biology
Affect Regulation
Dissociation
Behavioral Control
Cognition
Self Concept
(Cook et. al, 2003)
ATTACHMENT
The emotional bond between an infant and caregiver serves to
create safety and security for that child.
Secure attachment
Insecure attachments (avoidant and resistant)
Disorganized attachments
Attachment continues to evolve throughout childhood and
adulthood.
DISORGANIZED ATTACHMENTS
“For some infants the caregiving environment so bizarre,
threatening, unpredictable, violent or frightening that not only
are the infants insecure, but they also cannot organize a
strategy for ensuring protective access to their caregivers.”
When in need of comfort, these infants demonstrate undirected,
odd, and contradictory behaviors.
(Cassidy & Mohr, 2001)
ATTACHMENT
Uncertainty about the reliability and predictability of the world
Problems with boundaries
Distrust and suspiciousness
Inappropriate help seeking (e.g.social isolation;
undiscriminating affection)
Interpersonal difficulties
Difficulty attuning to other people’s emotional states
Difficulty with perspective taking
Difficulty enlisting other people as allies
(Cook et. al, 2003)
BIOLOGY
Brain development
Hypersensitivity to physical contact
Somatization
Increased medical problems across a wide span, e.g., pelvic
pain, asthma, skin problems,autoimmune disorders,
pseudoseizures
(Cook et. al, 2003)
AFFECT REGULATION
Involves the ability to identify emotion and regulate the
experience of emotion
Begins at a very young age and continues throughout
childhood
AFFECT REGULATION
Difficulty with emotional self-regulation
Depression, Anger, Anxiety
Difficulty describing feelings and internal experience
Problems knowing and describing internal states
Difficulty communicating wishes and desires
(Cook et. al, 2003)
DISSOCIATION
Three primary functions of dissociation:
1.
Automatization of behavior in the face of psychologically
overwhelming circumstances
2.
Compartmentalization of painful memories and feelings
3.
The detachment from one’s self when confronting extreme
trauma
(Putnam, 1997)
DISSOCIATION
Distinct alterations in states of consciousness
Amnesia
Two or more distinct states of consciousness, with impaired
memory for state-based events
(Cook et. al, 2003)
BEHAVIORAL CONTROL
Refers to a person's ability to control their impulsive and manage
and direct their behavior in a responsible manner.
When attachment, affect regulation, biological functioning and
perceptual integration has been compromised behaviors
become dysregulated.
BEHAVIORAL CONTROL
Poor modulation of impulses
Self-destructive behavior
Aggression against others
Pathological self-soothing behaviors
Communication of traumatic past by reenactment in day-today behavior or play (sexual,aggressive, etc.)
Difficulty understanding and complying with rules
Sleep disturbances
Eating disorders
Substance abuse
Excessive compliance
Oppositional behavior
(Cook et. al, 2003)
COGNITION
Refers to higher brain functioning needed for
Executive Function
Academic Advancement
Abstract Reasoning
Sustained Attention
Flexibility
Creativity
COGNITION
Difficulties in attention regulation and executive functioning
Lack of sustained curiosity
Problems with processing novel information
Problems focusing on and completing tasks
Difficulty planning and anticipating
Problems understanding own contribution to what happens to
them
Learning difficulties
Problems with language development
Problems with orientation in time and space
(Cook et. al, 2003)
SELF CONCEPT
The mental image or perception that an individual has of
his/herself and his/her abilities
SELF CONCEPT
Lack of a continuous, predictable sense of self
Poor sense of separateness
Disturbances of body image
Low self-esteem
Shame and guilt
Feeling stigmatized
POST TRAUMATIC STRESS DISORDER
Exposed to a traumatic event that involved actual or threatened
death or serious injury, or a threat to the physical integrity of
oneself or others resulting in:
Recurrent intrusive recollections
Avoidance of reminders
nightmares, intrusive thoughts, physical/emotional distress
of thoughts, of feelings, feeling distant, difficulty feeling positive
feelings
Increased physical arousal
sleep difficulties, concentration difficulties, anger, hypervigilance
TRAUMA SYMPTOMS FOR CSA
(BIRTH TO AGE 8)
Eating disorders
Fear of sleeping alone
Nightmares/Night terrors
Separation anxiety
Thumb- or object-sucking
Enuresis (wetting accidents)
Encopresis (soiling)
Language regression
Sexual talk
Excessive masturbation
Sexual acting out, posturing
Crying spells
Hyperactivity
Change in school behavior
Regular tantrums
Excessive fear (including of
men or women)
Sadness or depression
Suicidal thoughts
Extreme nervousness
TRAUMA SYMPTOMS FOR CSA
(AGE 9 THROUGH ADOLESCENCE)
Fear of being alone
Nightmares/Night terrors
Peer problems
Fights with family
Poor self esteem
Memory problems
Intrusive recurrent thoughts
or flashbacks
Excessive guilt/shame
Mood swings
Sexual acting out
Overly compliant
Self mutilation
Hypervigilance
Substance abuse
Avoidant, phobic behaviors
including sexual topics
Sadness or depression
Suicidal thoughts or
gestures
Excessive nervousness
Violent fantasies
TRAUMA SYMPTOMS FOR DVE
Birth to 5
6 to 11
Sleep disruption
Eating disruptions
Withdrawal
Separation anxiety
Inconsolable crying
Regression
Anxiety, fears
Increased aggression
Impulsive behavior
Sleep disruptions
School Difficulties
Aggression/Difficulty with
peer relationships
Concentration problems
Withdrawal and/or
emotional numbing
School avoidance and/or
truancy
TRAUMA SYMPTOMS FOR DVE
12-18
Adulthood
Antisocial behavior
School failure
Impulsive/reckless behavior
School truancy
Substance abuse
Running away
Abusive dating relationships
Depression
Anxiety
Withdrawal
Depression
Child Maltreatment
Substance Abuse
Intimate Partner Violence
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
Ace Score 0-10
•
~ 2/3 experienced 1+ ACEs
emotional abuse
physical abuse
1 in 5 reported 3+
sexual abuse
http://www.cdc.gov/ace/prevalence.htm
neglect
lack of emotional support
domestic violence exposure
separated/divorced parents
mentally ill household member
alcoholic household member
household member who went to prison
•
http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
ADVERSE CHILDHOOD EXPERIENCES (ACE)
STUDY
Alcoholism and alcohol
abuse
Chronic obstructive
pulmonary disease (COPD)
Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease
Liver disease
http://www.cdc.gov/ace/findings.htm
Risk for intimate partner
violence
Multiple sexual partners
Sexually transmitted
diseases (STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual
activity
Adolescent pregnancy
Do all children who witness domestic
violence grow up to become domestic
violence perpetrators?
DO ALL CHILDREN WHO WITNESS DV GROW UP
TO BECOME DV PERPETRATORS?
Family of Origin Violence is one of risk factors in Intimate
Partner Violence (Franklin et. al, 2011)
Several studies to suggest that many children show resilience
in the face of interparental violence.
54% of 2-4 yr. olds showed positive adaptation. (Martinez-Toreya,
2009)
31% of 8-14 yr. olds in a DV shelter didn't exhibit any signs of
maladjustment. (Gyrch et. al, 2000)
67% of 8-16 yr. olds in a community sample score below clinical
cutoffs on internalizing and externalizing. (Spilsbury et. al, 2008)
118 studies were analyzed. Results 37% of DV exposed children
were doing similarly or better than non-witnesses. (Kitzmann,
2003)
WHY DO PEOPLE RESPOND DIFFERENTLY TO
THE "SAME" TRAUMATIC EVENT?
Risk and Protective factors
Pre-trauma factors
Factors specific to the trauma
Post-trauma factors
RESILIENCY FACTORS
Having a supportive parent who can:
1. Believe and validate their child’s experience
2. Tolerate the child’s affect
3. Manage their own emotional response
(Cook, et. al, 2003)
RESILIENCY FACTORS
Easy disposition
Positive beliefs about self
Positive Temperment
Internal locus of control
external attribution of
blame
High degree of mastery
Spirituality
High self esteem in one area
Positive attachment to
emotionally supportive and
competent adults
Motivation to act effectively
Development of cognitive
and self regulation abilities
RISK FACTORS
Poverty, which is related to poor educational achievement (a
protective factor)
Parental unemployment
Alcohol use
Poor social supports
Violence with a weapon
Witnessing sexual abuse against the mother
Co Occurrence of Physical Abuse
Self blame appraisals
DO ALL CHILDREN WHO EXPOSED TO
DOMESTIC VIOLENCE GROW UP TO HAVE
VIOLENT RELATIONSHIPS?
Nope
REFERENCES
Bureau of Justice Statistics, Intimate Partner Violence in the U.S. 1993-2004, 2006.
Cassidy, J., & Mohr, J.J. (2001). Unsolvable fear, trauma, and psychopathology: Theory, research, and clinical considerations related to disorganized
attachment across the life span. Clinical Psychology: Science and Practice, 8, 275-298.
Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (2003). Complex Trauma in Children: White Paper from the National Child Traumatic Stress Network
Complex Trauma Task Force. [White Paper] Retrieved from http://www.nctsn.org/sites/default/files/assets/pdfs/ComplexTrauma_All.pdf
Finklerhor, D. & Jones, L. (2012). Have sexual abuse and physical abuse declined since the 1990s? Crimes Against Children Research Center, C267.
Franklin, C.A., Menaker, T.A., & Kercher, G.A. (2011). The effects of Family-of-Origin Violence on Intimate Partner Violence. Retrieved from
http://dev.cjcenter.org/_files/cvi/7935%20Family%20of%20Origin%20Violence.pdf
Grych, J.H., Jouriles, E.N., Swank, P.R., McDonald, R., & Norwood, W.D. (2000). Patterns of adjustment among children of battered women. Journal of
Consulting and Clinical Psychology, 68, 84-94.
Herman, J. L. (1992). Trauma and Recovery. New York: Basic Books
Holt, S., Buckley, H., & Whelan, S. (2008). The impact of exposure to domestic violence on children and young people: A review of the literature. Child Abuse
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Kitzmann, K.M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Childwitness to domestic violence: Ameta-analytic review. Journal of Consulting and
Clinical Psychology, 71(2), 339–352.
Lanktree, C. & Briere, J. (2008). Integrative Treatment of Complex Trauma for Children (ITCT-C): A guide for the treatment of multiply-traumatized children
aged eight to twelve years. Retrieved from http://www.johnbriere.com/Child%20Trauma%20Tx%20Manual%20(LC%20PDF).pdf
Martinez-Torteya, C., Bogat, A., von Eye, A., & Levendonsky, A.A., (2009). Resilience among children exposed to domestic violence: The role of risk and
protective factors. Child Development, 80 562-577.
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NY: Guilford Press.
Spilsbury, J.C., Kahana, S., Drotar, D., Creeden, R., Flannery, D.J., & Friedman, S. (2008). Profiles of behavioral problems in children who witness domestic
violence. Violence and Victims, 23, 3-17.
Snyder, H N. (2000). Sexual assault of young children as reported to law enforcement: Victim, incident, and offender characteristics. National Center for
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