Childhood Traumatic Stress

National Resource Ctr. for Family-Centered Practice and Permanency Planning January 8, 2008 Teleconference April Naturale, LCSW 1

What is Trauma?

• Either a physical injury caused by some direct external force or psychological injury caused by some extreme emotional assault • Can result in stress-physical, psychological and social forces or pressures that cause some significant modification, usually a distortion

Examples of Trauma

Natural events such as an accident-a fall that results in a physical injury or fear Man made events such as physical assault and/or abuse, torture Psychological events such as separation from primary caregiver, neglect, humiliation and other forms of psychological assault Community events-death of a family member, large scale accidents or disasters

3

Key Concepts of Trauma

•

People will have varying psychological and emotional reactions • Talking with a traumatized person in crisis does not always mean talking about the trauma • People pace themselves when dealing with grief,pain, sorrow and loss • Interject normalcy and respite

4

Normal Reactions to Stress & Trauma

Emotional and Behavioral People may feel and express their reactions differently.

They may: • Feel very nervous, helpless, fearful, sad or angry • Feel hopeless about the future • Feel detached or unconcerned about others • Feel numb and unable to experience love or joy • Feel that things are unreal; dissociate

5

Normal Reactions to Stress & Trauma

Emotional and Behavioral cont’d.

• Have an increased startle response • Be irritable or have outbursts of anger • Become easily upset or agitated • Have frequent distressing dreams or memories • Avoid people, places and things related to the disaster • Have trouble concentrating

6

Normal Reactions to Stress & Trauma

Physical & Cognitive How people may physically and cognitively react to a disaster varies. They may: • Have an upset stomach, eat too much or too little, or have other gastrointestinal problems • Experience a pounding heart, rapid breathing, sweating, or severe headache when thinking about the disaster • Have trouble falling asleep, staying asleep, or sleeping too much

7

Normal Reactions To Stress & Trauma

Physical & Cognitive cont’d.

• Be on guard and constantly alert • Be jumpy and startle easily at sudden noises • Have a worsening of chronic medical problems • Be exhausted • Have trouble concentrating • Elicit poor judgment • Exhibit denial of emotions or lack memory of events

8

Trauma Responses in Children

Adults often underestimate what children experience the extent of their reactions and what they need to know

9

Common Trauma Responses in Children

• • • •

Regression to younger development stage (e.g.bed-wetting, thumb sucking, clinging) Poor school performance Isolation High Risk Behaviour such as: -In teens, promiscuous or adult-like behavior (e.g. taking charge) -Use of substances such as alcohol or drugs

10

Common Trauma Responses in Children

• Impaired concentration • Impaired learning • Aggression • Recklessness • Reduced inhibitions • Somatic complaints • School refusal

11

More Serious Trauma Responses in Children

Children can develop wide range of difficulties that may become serious • Depression • Anxiety • Behaviour Disorders • Mood Disorders

12

Unique Effects of Childhood Trauma

Children suffer a dual response: 1. The impact of the trauma on themselves & 2. the emotional distress of caregivers, parents and teachers Adult support is a strong protective factor or impacted adults may make at-risk children more vulnerable

13

Unique Effects of Childhood Trauma

• Disruption of child or adolescent development • Interfering in the growth of emotional maturity • Repeated exposure can affect the child's brain and nervous system

14

Known Potential Impacts

• Increased use of health/mental health services • Increased involvement with the child welfare and juvenile justice systems • Profound long-term consequences

15

Traumatic Grief Responses

• Childhood traumatic grief (CTG) a condition which compromises child’s capacity to negotiate normal grieving • CTG and the loss of parental support places children at high risk for serious emotional difficulties and major mental health problems

16

What Not to Say to Bereaved Children

• I know how you feel • Let’s talk about something else • You are strong enough to deal with this • You’ll feel better soon • You did everything you could • You need to relax • It’s good that you are alive

17

Immediate Child Care Worker Tasks

• Help children understand, name and accept their feelings • Practice and teach children (and parents) skills of : calming and soothing tolerating managing difficult feelings

18

Continuing Child Care Worker Tasks

• Affirm that the reactions are common in response to traumatic events • Help the child make sense of the trauma • Link children and their families with other helpful agencies

19

Instructions to Parents & Caregivers

• Maximize caring and support • Just answer the questions they ask • Provide sense of safety and security in whatever form you can • Reassure children that adults are in control • Tolerate regression or need to control • Reinforce their primary role as child/student • Return to routine

20

Therapeutic Activities

• Many children find it helpful to write down their trauma experiences in the form of pictures, diaries and stories • Others use: -photography -musical expression -drama performance

21

Therapeutic Activities

A WORD OF WARNING: When conducting therapeutic activities, refrain from probing for feelings unless you are the treating therapist intending to activate trauma memory as part of Exposure Therapy. Otherwise, just allow and support expressive activities.

22

Case Examples: Oklahoma City

Trauma experts in Oklahoma working with Katrina evacuees monitored rising resentment between host families and evacuee children. An interventionist conducted focus groups to find out what was most important to ‘the acting out’ children. They discovered the need to give the evacuee families an opportunity to say thank you and organized a class activity including shopping together and cooking traditional Southern meals.

23

What about Posttraumatic Stress Disorder (PTSD)?

Experiencing, witnessing or being confronted with an event involving actual or threatened death or serious injury; one’s response involves intense fear, helplessness or horror. The event is persistently reexperienced via: recurrent, intrusive distressing memories, dreams; psychological distress and/or physiological reactivity at exposure to cues, symbols or resemblances of traumatic event. (DSM-IVTR, 2000)

24

PTSD Prevalence

Most People will not develop PTSD after a disaster or other traumatic event Many, though, may have serious symptoms of distress

25

Assessment and Screening

• Select appropriate screening instruments for children and adolescents (obtain consent) (e.g. UCLAPTSD Index) • Communicate the results sensitively and ensure adequate mental health services for those in need • Refer to specialized service providers

26

The Psychological Tasks of Recovery

•

Regaining a sense of mastery and control • Resumption of age-appropriate roles and activities • Develop new normal-routine

27

Tasks of Recovery

• • •

Give children and families permission to celebrate even in the midst of a trauma encourage the children to play, laugh, experience joy Have children spend time with friends and family…return to school asap-don’t isolate them Plan for emergencies: add ‘tools’ to the children’s backpack that will help them cope(e.g. flashlight, family picture, object of comfort, crayons/writing pad, etc.)

28

Long Term Affects of Disaster Trauma and Stress

• Anger, resentment and conflict • Uncertainty about the future • Prolonged mourning of losses • Diminished problem solving • Isolation and hopelessness • Health problems • Lifestyle changes

29

Longer Term Interventions

• • • • • • •

Continuing Needs Assessment Psychological First Aid Secondary Psol Assist (Crisis Counseling) Outreach Enhanced or Intermediate Services Traumatic Grief and Bereavement Support Cognitive Behavioral Treatment

30