the impact of psychological trauma on development and learning

Implications for education, social Implications for education, social service systems, and treatmentservice systems, and treatment

The Impact of The Impact of Psychological Trauma Psychological Trauma on Development and on Development and

LearningLearning

Definition of a Definition of a traumatic eventtraumatic event

A traumatic event is any event A traumatic event is any event or events, which overwhelms or events, which overwhelms our core capacity to cope. our core capacity to cope.

It results in an experience of It results in an experience of personal threat to our safety personal threat to our safety and/or the integrity of our and/or the integrity of our identity.identity.

Complex Trauma Multiple and/or chronic exposure Multiple and/or chronic exposure

to developmentally adverse to developmentally adverse interpersonal victimization interpersonal victimization

physical, sexual and emotional physical, sexual and emotional abuse and neglect abuse and neglect

domestic and community domestic and community violence violence

What Is Child What Is Child Traumatic Stress?Traumatic Stress?

Child traumatic stress refers to the Child traumatic stress refers to the physical and emotional responsesphysical and emotional responses of a of a child to events that threaten the life or child to events that threaten the life or physical integrity of the child or of physical integrity of the child or of someone critically important to the child someone critically important to the child (such as a parent or sibling).(such as a parent or sibling).

Traumatic events overwhelm a child’s Traumatic events overwhelm a child’s capacity to cope and elicit feelings of capacity to cope and elicit feelings of terror, powerlessness, and out-of-control terror, powerlessness, and out-of-control physiological arousalphysiological arousal..

Types of Traumatic Types of Traumatic StressStress

Acute trauma is a single traumatic event that is Acute trauma is a single traumatic event that is limited in time. Examples include:limited in time. Examples include: Serious accidentsSerious accidents

Community violenceCommunity violence

Natural disasters (earthquakes, wildfires, floods)Natural disasters (earthquakes, wildfires, floods)

Sudden or violent loss of a loved oneSudden or violent loss of a loved one

Physical or sexual assault (e.g., being shot or raped)Physical or sexual assault (e.g., being shot or raped)

During an acute event, children go through a During an acute event, children go through a variety of feelings, thoughts, and physical variety of feelings, thoughts, and physical reactions that are frightening in and of reactions that are frightening in and of themselves and contribute to a sense of being themselves and contribute to a sense of being overwhelmed.overwhelmed.

Types of Traumatic Types of Traumatic StressStress

Chronic trauma refers to the experience Chronic trauma refers to the experience of multiple traumatic events. of multiple traumatic events.

These may be multiple and varied These may be multiple and varied events—such as a child who is exposed events—such as a child who is exposed to domestic violence, is involved in a to domestic violence, is involved in a serious car accident, and then becomes serious car accident, and then becomes a victim of community violence—or a victim of community violence—or longstanding trauma such as physical longstanding trauma such as physical abuse, neglect, or war.abuse, neglect, or war.

The effects of chronic trauma are often The effects of chronic trauma are often cumulative, as each event serves to cumulative, as each event serves to remind the child of prior trauma and remind the child of prior trauma and reinforce its negative impact.reinforce its negative impact.

Statistics on Impact of Statistics on Impact of TraumaTrauma•61% of men and 50% of women in

the U.S. will experience at least one traumatic event in a lifetime. •5% of men and 10% of woman in the general population have PTSD (Kessler, et. Al., 1995)

•30-70% of persons in outpatient treatment and 40-72% of those in inpatient treatment report histories of trauma (Newman et. al., 1998)

•75% of persons in substance abuse were victims of physical or sexual violence (SAMHSA,

2000)

U.S. Prevalence One in four children/adolescents One in four children/adolescents

experience at least one potentially experience at least one potentially traumatic event before the age of 16.traumatic event before the age of 16.11

In a 1995 study, 41% of middle school In a 1995 study, 41% of middle school students in urban school systems students in urban school systems reported witnessing a stabbing or reported witnessing a stabbing or shooting in the previous year.shooting in the previous year.22

Four out of 10 U.S. children report Four out of 10 U.S. children report witnessing violence;witnessing violence;8% report a lifetime prevalence of sexual 8% report a lifetime prevalence of sexual assault, and 17% report having been assault, and 17% report having been physically assaulted.physically assaulted.33

1. Costello et al. (2002). J Traum Stress;5(2):99-112.2. Schwab-Stone et al. (1995). J Am Acad Child Adolesc Psychiatry;34(10):1343-1352.3. Kilpatrick et al. (2003). US Dept. Of Justice. http://www.ncjrs.gov/pdffiles1/nij/194972.pdf.

DCF 2011:DCF 2011: 15,500 calls15,500 calls 4908 investigations4908 investigations 1037 children in custody 1037 children in custody (DCF 2011 Annual Report) (DCF 2011 Annual Report)

DCF intakes w/ domestic violence identified DCF intakes w/ domestic violence identified • 18921892 (Domestic Violence Fatality Review Commission Report, 2009)(Domestic Violence Fatality Review Commission Report, 2009)

Children served by Network ProgramsChildren served by Network Programs• 12121212 (VT Network Against Domestic and Sexual Violence, 2011)(VT Network Against Domestic and Sexual Violence, 2011)

Emergency Room Injury Child Victims Emergency Room Injury Child Victims • 15,012 (10% referred to CMH)15,012 (10% referred to CMH)

Percentage in DCF custody served by CMHPercentage in DCF custody served by CMH• 24% 24% (February 6, 2004).Vermont Mental Health Performance Indicator Project. Young Trauma Victims served (February 6, 2004).Vermont Mental Health Performance Indicator Project. Young Trauma Victims served

in Mental Health Programs.in Mental Health Programs.

Vermont Children Affected by Vermont Children Affected by TraumaTrauma

Children with Disabilities

Incidence per 1,000

Children w/out Disabilities

Children w/ Disabilities

Physical Abuse 4.5 9.5

Sexual Abuse 2.0 3.5

Emotional Abuse(Goldson, 2002)

2.9 3.5

Neglect, physical abuse, and emotional abuse are most often perpetrated by immediate family members.Sexual abuse is largely perpetrated by extrafamilial members (Sullivan and Knutson, 2000).

Domestic and Sexual Violence in Vermont

VT Network Against Domestic and Sexual Violence:

•Served 1,025 victims of sexual assault

•7317 individuals who experienced domestic violence

•responded to 10,250 hotline crisis calls in FY 2011.

51% of all VT homicides involved 51% of all VT homicides involved domestic violence from 1994-domestic violence from 1994-20102010

95% of all violent crime in VT 95% of all violent crime in VT involved intimate partners involved intimate partners (VT Div of (VT Div of Crim Justice, 2007)Crim Justice, 2007)

VT ranked sixth in the nation for VT ranked sixth in the nation for per capita murder of women by per capita murder of women by men in single incidents w/ single men in single incidents w/ single victims victims

Domestic Violence and Domestic Violence and VT CrimeVT Crime

Prevalence of Child AbusePrevalence of Child AbuseChild Abuse World-WideChild Abuse World-Wide

■ 73 million boys73 million boys

■ 150 million girls150 million girls

Are Sexually abused annuallyAre Sexually abused annually

■ 53,000 children are murdered each 53,000 children are murdered each yearyear

World Health OrganizationWorld Health Organization

7 Domains of Impairment in 7 Domains of Impairment in Children Exposed to Complex Children Exposed to Complex

TraumaTrauma1. ATTACHMENT:1. ATTACHMENT: Uncertainty about the reliability and predictability of the Uncertainty about the reliability and predictability of the

worldworld Problems with boundariesProblems with boundaries Distrust and suspiciousnessDistrust and suspiciousness Social isolationSocial isolation Interpersonal difficultiesInterpersonal difficulties Difficulty attuning to other people’s emotional statesDifficulty attuning to other people’s emotional states Difficulty with perspective takingDifficulty with perspective taking Difficulty enlisting other people as alliesDifficulty enlisting other people as allies


TraumaTrauma

2. BIOLOGY:2. BIOLOGY: Sensorimotor developmental problemsSensorimotor developmental problems Hypersensitivity to physical contactHypersensitivity to physical contact AnalgesiaAnalgesia Problems with coordination, balance, body toneProblems with coordination, balance, body tone Difficulties localizing skin contactDifficulties localizing skin contact SomatizationSomatization Increased medical problems across a wide Increased medical problems across a wide

span, e.g., pelvic pain, asthma, skin problems, span, e.g., pelvic pain, asthma, skin problems, autoimmune disorders, pseudo seizuresautoimmune disorders, pseudo seizures


TraumaTrauma3. AFFECT REGULATION:3. AFFECT REGULATION: Difficulty with emotional self-regulationDifficulty with emotional self-regulation Difficulty describing feelings and internal experienceDifficulty describing feelings and internal experience Problems knowing and describing internal statesProblems knowing and describing internal states Difficulty communicating wishes and desiresDifficulty communicating wishes and desires

4. DISSOCIATION:4. DISSOCIATION: Distinct alterations in states of consciousnessDistinct alterations in states of consciousness AmnesiaAmnesia Depersonalization and derealizationDepersonalization and derealization Two or more distinct states of consciousness, with impaired Two or more distinct states of consciousness, with impaired

memory for state-based eventsmemory for state-based events


TraumaTrauma5. BEHAVIORAL CONTROL:5. BEHAVIORAL CONTROL: Poor modulation of impulsesPoor modulation of impulses Self-destructive behaviorSelf-destructive behavior Aggression against othersAggression against others Pathological self-soothing behaviorsPathological self-soothing behaviors Sleep disturbancesSleep disturbances Eating disordersEating disorders Substance abuseSubstance abuse Excessive complianceExcessive compliance Oppositional behaviorOppositional behavior Difficulty understanding and complying with rulesDifficulty understanding and complying with rules Communication of traumatic past by reenactment in day-to-day Communication of traumatic past by reenactment in day-to-day

behavior or play (sexual, aggressive, etc.)behavior or play (sexual, aggressive, etc.)


TraumaTrauma6. COGNITION:6. COGNITION: Difficulties in attention, regulation and executive functioningDifficulties in attention, regulation and executive functioning Lack of sustained curiosityLack of sustained curiosity Problems with processing novel informationProblems with processing novel information Problems focusing on and completing tasksProblems focusing on and completing tasks Problems with object constancyProblems with object constancy Difficulty planning and anticipatingDifficulty planning and anticipating Problems understanding own contribution to what happens to Problems understanding own contribution to what happens to

themthem Learning difficultiesLearning difficulties Problems with language developmentProblems with language development Problems with orientation in time and spaceProblems with orientation in time and space Acoustic and visual perceptual problemsAcoustic and visual perceptual problems Impaired comprehension of complex visual-spatial patternsImpaired comprehension of complex visual-spatial patterns


TraumaTrauma

7. SELF-CONCEPT:7. SELF-CONCEPT: Lack of a continuous, predictable sense of selfLack of a continuous, predictable sense of self Poor sense of separatenessPoor sense of separateness Disturbances of body imageDisturbances of body image Low self-esteemLow self-esteem Shame and guiltShame and guilt

Impact of Childhood Trauma

Trauma effects every domain of functioningTrauma effects every domain of functioning:: Developmental milestonesDevelopmental milestones AttachmentAttachment Intellectual capacityIntellectual capacity Cognitive ability Cognitive ability Affect regulationAffect regulation Interpersonal functioningInterpersonal functioning Mental healthMental health Immune/Autoimmune systemImmune/Autoimmune system

Impact of Child AbuseImpact of Child Abuse

Childhood trauma is associated with increased rates of:

■ Imprisonment■ Substance Abuse■ HIV Status■ Unemployment Status■ Use of Psychiatric Services■ Impaired Health Status

(Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss & Marks, 1998).

Impact of Child Abuse

Children who have experienced a traumatic event show an increased incidence of:

■ Ischemic heart disease■ Cancer■ Chronic Lung disease■ Skeletal fractures

■ Liver disease


■Temporal Lobe Epilepsy

■Developmental Disabilities; 10-25%■3-6% of abused children will have a permanent disability as a result of the abuse

■Between 20-50% of abused children suffer mild to severe brain damage.

(Office of Trauma Services, Department of Mental Health, Mental Retardation and Substance Abuse Services, Augusta, Maine)


■ Early abuse and neglect negatively effect the maturation of the developing brain.

■ 80% of traumatized children have disorganized attachment patterns

■ During adolescence traumatized children have a 300% greater chance to engage in substance abuse, self-mutilation and aggressive behavior

The Neurobiology of Childhood Trauma and Abuse, Bessel van der Kolk, M.D. The Neurobiology of Childhood Trauma and Abuse, Bessel van der Kolk, M.D.

A Biodevelopmental A Biodevelopmental Framework Framework

Early experiences leave a chemical Early experiences leave a chemical “signature” on our genes that determines “signature” on our genes that determines whether and how the genes are turned on whether and how the genes are turned on or off.or off.

This is known as “epigenetic adaptation,”This is known as “epigenetic adaptation,” It shapes how our brains and bodies It shapes how our brains and bodies

develop. develop. This is a biological mechanism This is a biological mechanism

The environment of relationships, physical, The environment of relationships, physical, chemical, built environments, and early chemical, built environments, and early nutrition cause the physiological adaptations nutrition cause the physiological adaptations and disruptions that can influence a lifetime of and disruptions that can influence a lifetime of well-being. well-being.

How Early Experiences Get into How Early Experiences Get into the Body: A Biodevelopmental the Body: A Biodevelopmental Framework Framework

Traumatic Reaction

Exposure to Trauma

Reaction

Avoidance/Numbing

Re-Experiencing

Hyperarousal

Brain LobesBrain Lobes

Limbic SystemLimbic System

Effects of Trauma on Effects of Trauma on Brain FunctionBrain Function

Pre-frontal Cortex(Integration and Planning)

Amygdala

(significance)

Thalamusvisual

auditory

olfactory

kinestheticgustator

y

Hippocampus

(cognitive map)

Impact of Neglect on a Developing Brain

Bruce Perry (2004). Maltreated Children: Experience, Brain Development, and the Next Generation

Long-Term Effects of Long-Term Effects of TraumaTrauma

Generalized hyperarousal•Problems with social attachment – excessive dependence or isolation•Aggression against self and others•Inability to modulate sexual impulses

Alterations in Neurobiological processes in stimulus discrimination•Problems with attention and concentration•Dissociation•Somatization

Conditioned fear responses to trauma-related stimuli

Shattered meaning propositions

■ Loss of trust, hope, and sense of agency

■ Loss of “thoughts as experimental action”

Social avoidance

■ Loss of meaningful attachments

■ Lack of participation in preparing for the future

Effects of Trauma

Curriculum - Blaustein

Developmental Stage: Birth-2

NormativeNormative:: TasksTasks: Identity, : Identity,

Connection, Exploration, Connection, Exploration, AgencyAgency

Communication through Communication through physical activityphysical activity

Strong increase in Strong increase in anxiety when immediate anxiety when immediate needs not metneeds not met

Need physical human Need physical human contact for reassurancecontact for reassurance

Growth of sensory Growth of sensory perception/responseperception/response

Trauma impactTrauma impact:: Altered connections; Altered connections;

sacrifice of exploration; sacrifice of exploration; deficits in agencydeficits in agency

Deficits in development of Deficits in development of non-verbal/ dyadic non-verbal/ dyadic communication strategiescommunication strategies

Exposure to significant Exposure to significant arousal in absence of arousal in absence of strategies for soothingstrategies for soothing

Multiple potential Multiple potential “triggers”/ danger cues “triggers”/ danger cues solidified on NON-VERBAL solidified on NON-VERBAL levellevel


Developmental Stage: 2-6

NormativeNormative:: Increased focus on Increased focus on

development of agency, development of agency, independenceindependence

Need for structure and Need for structure and securitysecurity

Cognitively aware of need for Cognitively aware of need for nurturingnurturing

Minimal concept of Minimal concept of time/spacetime/space

Speech available; but feelings Speech available; but feelings still communicated more still communicated more through play and behavior, through play and behavior, needs through wordsneeds through words

Trauma ImpactTrauma Impact:: Continued sacrifice of Continued sacrifice of

independence (or—age-independence (or—age-inappropriate inappropriate independence)independence)

Development of rigid Development of rigid control strategies to control strategies to manage anxietymanage anxiety

Reliance on primitive Reliance on primitive coping/self-soothingcoping/self-soothing

Building of defenses against Building of defenses against affect and/or connectionaffect and/or connection

Continued deficits in self-Continued deficits in self-expressionexpression


Developmental Stage: Elementary

NormativeNormative:: Increase in Increase in

independence and independence and industryindustry

Increased ties to and Increased ties to and investment in school, investment in school, community, peerscommunity, peers

Concrete information Concrete information more important than more important than abstract in meaning-abstract in meaning-makingmaking

Early understanding of Early understanding of time/space, but still time/space, but still focused on the presentfocused on the present

Trauma ImpactTrauma Impact:: Reduced development of Reduced development of

competencies across competencies across domainsdomains

School deficits/impairmentsSchool deficits/impairments Building and internalization Building and internalization

of negative self-concept/ of negative self-concept/ self-blameself-blame

Failure to develop Failure to develop adequate peer adequate peer relationships; vulnerability relationships; vulnerability to harm by othersto harm by others

Early onset depression/ Early onset depression/ hopelessness/ helplessnesshopelessness/ helplessness


Developmental Stage: Adolescence

NormativeNormative:: Striving for independence; Striving for independence;

separation/individuationseparation/individuation Peer group important Peer group important

source of support, source of support, information, and referenceinformation, and reference

Self-conscious; belief in Self-conscious; belief in self as focus of attentionself as focus of attention

Body image, sexual image, Body image, sexual image, self-image all importantself-image all important

Black-and-white view; Black-and-white view; extremes, judgmentsextremes, judgments

Able to see future but less Able to see future but less able to see consequencesable to see consequences

Trauma ImpactTrauma Impact:: Premature separation Premature separation oror

age-inappropriate age-inappropriate dependencedependence

Risk for negative peer Risk for negative peer influence and affiliationinfluence and affiliation

Significant risk for high-risk Significant risk for high-risk behaviorsbehaviors

Over-control/perfectionismOver-control/perfectionism Ongoing reliance on Ongoing reliance on

primitive coping strategies, primitive coping strategies, with failure to develop age-with failure to develop age-appropriate strategiesappropriate strategies

Crystallization of negative Crystallization of negative self-identityself-identity


Developmental Stage: Developmental Stage: AdulthoodAdulthood

NormativeNormative:: Solidification of identity, Solidification of identity,

formation of adult formation of adult relationships, transition into relationships, transition into multiple roles, evaluation of multiple roles, evaluation of life industrylife industry

Able to function Able to function independently, with others as independently, with others as occasional source of occasional source of instrumental or emotional instrumental or emotional supportsupport

Capacity to take perspectiveCapacity to take perspective Capacity to use abstract Capacity to use abstract

thoughtthought Able to link past, present, Able to link past, present,

and future and future

Trauma ImpactTrauma Impact:: Altered self-identity (self-Altered self-identity (self-

blame, guilt, shame, damage, blame, guilt, shame, damage, powerlessness, etc.)powerlessness, etc.)

Impaired capacity to form Impaired capacity to form mature relationships (over-mature relationships (over-dependence or under dependence or under dependence)dependence)

Difficulty regulating emotional Difficulty regulating emotional and physiological states, and and physiological states, and increasingly rigid reliance on increasingly rigid reliance on primitive strategiesprimitive strategies

Breakdown of cognitive Breakdown of cognitive processes in face of danger/ processes in face of danger/ overwhelming stressoverwhelming stress

Splintered identity and Splintered identity and functioning functioning

Trauma Informed System

Trauma-informed services are not designed to treat symptoms or syndromes related to abuse or trauma. Instead, the primary purpose is to deliver mental health, addictions, housing supports, vocational or employment counseling services, etc., in a manner that acknowledges the role that violence and victimization play in the lives of most consumers of mental health and substance abuse services.

Trauma Informed SystemTrauma Informed System

This understanding is used to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation that is appropriate and helpful to the special needs of trauma survivors.

Harris, M., & Fallot, R. EDS. (2001) Using trauma Theory to Design Service Systems, Jossey-Bass, San Francisco.

•42

1.1. SafetySafety:: Ensuring Physical & Emotional Ensuring Physical & Emotional SafetySafety

2.2. TrustworthinessTrustworthiness:: Maximizing Maximizing trustworthiness through Task, Clarity, trustworthiness through Task, Clarity, Consistency, & Interpersonal BoundariesConsistency, & Interpersonal Boundaries

3.3. ChoiceChoice:: Maximizing Consumer Choice & Maximizing Consumer Choice & ControlControl

4.4. CollaborationCollaboration:: Maximizing Collaboration Maximizing Collaboration and Sharing Powerand Sharing Power

5.5. EmpowermentEmpowerment:: Prioritizing Prioritizing empowerment and skill buildingempowerment and skill building

Fallot & Harris (2006)Fallot & Harris (2006)

5 Principles of a Trauma-Informed System

RICH

■ Respect

■ Information

■ Connection

■ Hope■ Empowering and Collaborative Relationships

Risking Connection, Karen Saakvitne

•(

What WorksWhat Works

What WorksWhat Works

PowerPower

ChoiceChoice

ControlControl

Harris, M., & Fallot, R. EDS. (2001) Using trauma Theory to Design Service Systems, Jossey-Bass, San Francisco.

C.L.E.A.R.E.D.C.L.E.A.R.E.D.

CCreate reate something (food, art, photography….)something (food, art, photography….)

LLove ove your family, spouse, and pets and spend your family, spouse, and pets and spend lots of lots of time with them time with them

EExercisexercise at least 3 times per weekat least 3 times per week

AAvoidvoid excess in anything (food, caffeine, alcohol, excess in anything (food, caffeine, alcohol, exercise, work…) exercise, work…)

RRelaxelax with a good book, and schedule “nothing” with a good book, and schedule “nothing” timetime

EEatat healthy foodhealthy food

DDreamream about your goals and envision the future about your goals and envision the future you you want for yourself and your family want for yourself and your family

the impact of psychological trauma on development and learning

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