The Effects of Trauma on Young Children

Stacey Ryan, LCSWAngela M. Tomlin, Ph.D.IAITMH2006

Types of Trauma

Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Abuse/Neglect Loss of caregiver

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 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

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

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 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 InfantsGaensbauer & 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

Can appear immediately or after days, weeks

May remind young child of previous traumas, making reaction more severe

Effects of Trauma

Physical & Self-Regulation Effects Traumatic Reminders Development Play Behavior Relationship

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 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

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 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

Repetitive actions

Driven quality

Constricted quality

Preoccupation with separation, loss, and reunion

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 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

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

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 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

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

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 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 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 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? 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

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

Child experiences a need

Child feels upset

Adult satisfies need

Child feels content

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?

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

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 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 Aggression with peers Dissociative behaviors

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 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 HelpResponding to parent anger Listen Be non-reactive Acknowledge how

difficult it is to be away from child

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 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

Question and Answer

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) 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) 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… 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

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… 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

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 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

Support Parent Understanding of Fears Bring Attention to Cues Child Gives

Regarding Fears Develop with Parents Strategies for

Containing Fears

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

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 Explore with Parent Feelings and Concerns Contain Own Emotions and Reactions Educate on Reasons Physical Punishment

May Worsen Symptoms

Parental Criticism

Focus on Effects of Relationship Acknowledge Parent Issues/Feelings Build Awareness of Child Experience

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) 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

Discussion

Questions/Comments

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

Speak for the babies..

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….

Stacey (yphsdir@cmhcinc.org) Angie (atomlin@iupui.edu)

The Effects of Trauma on Young Children

Stacey Ryan, LCSWAngela M. Tomlin, Ph.D.IAITMH2006