4991 The Effects of Trauma on Children

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4991The Effects of Trauma on Children

• A Videoconference
• Presented By
• Oklahoma State Department of Education
• Tuesday, September 08, 2009

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Presenters

• Gayle Jones
• Director, Title IV, Safe and Drug-Free Schools,
  OSDE
• G. Denise Pace
• LADC, LPC, B.C.E.T.S. Diplomate, American Academy
  of Experts in Traumatic Stress, and
• EMDR Trained Clinician

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Purpose

• This presentation will provide participants
  with an understanding of the enduring negative
  impact of attachment trauma on the developing
  brain.  Participants will learn how many
  behaviors displayed by the traumatized child are
  the results of a disorganized brain and an
  attempt to survive psychic pain.

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Professional Development Credit

• This PDA is approved for 2 contact hours.
• To receive credit you must register and complete
  the survey at the end of the presentation.
• This is a linear conference.
• You cannot start and stop at will.
• Length of Conference
• 1 Hour and 50 Minutes

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Conference Notes

• Slides 6-24 are the notes for the conference.
• You may wish to print these slides for reference
  during the conference.
• Precede to slide 25 to begin the conference.

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AFTEREFFECTS OF TRAUMAOKLAHOMA DEPARTMENT OF
EDUCATIONSEPTEMBER 8, 2009

• G. Pace, LADC, LPC, B.C.E.T.S.
• Diplomate American Academy of Experts in
  Traumatic Stress
• EMDR Clinician
• Children are not resilient, children are
  malleable. Bruce Perry

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Trauma DefinedThe Diagnostic and Statistical
Manual of Mental Disorders, 4th edition, Text
Revision (DSM-IV-R) American Psychiatric
Association (APA), 2000

• Direct personal experience of an event that
  involves actual or threatened
• death or serious injury, or other threat to ones
  physical integrity or
• witnessing an event that involves death, injury,
  or a threat to the physical
• integrity of another person or learning about
  unexpected or violent death,
• serious harm, or threat of death or injury
  experienced by a family member or
• other close associate. The persons response to
  the event must involve
• intense fear, helplessness, or horror (or in
  children, the response must involve
• disorganized or agitated behavior).
• Children are not resilient, children are
  malleable.

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Categories of Trauma

• Impersonal Trauma the cause is impersonal, for
• example natural disasters
• Interpersonal Trauma the deliberate threat or
  injury
• in the context of an interpersonal interaction.
  ..
• ex. stranger rape, criminal assaults, sexual
• harassment, combatalthough this type of
• trauma occurs outside close or intimate
  relation-
• ships they can be profoundly damaging.
• Attachment Trauma the deliberate threat or
  injury
• in the context of a relationship where the
  victim
• has some level of emotional involvement.
• Allen, Jon G. Traumatic Relationships and Serious
  Mental Disorders, 2001

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Types of Trauma

• TYPE I experienced a single event
• TYPE II repeated victimization
• Type IIA multiple trauma w/stable backgrounds
  and
• healthy resourcescan separate traumas
• Type IIB overwhelmed w/multiple
  traumasunable to
• separate one from the other
• Type IIB(R) stable background but so over-
• whelmed can no longer maintain
  resilience
• Type IIB(nR) victim never developed
  resources
• for resilience
• Type III extreme trauma characterized by
  multiple traumatic
• experiences that typically
  begin in early childhood

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Childhood Trauma, the Neurobiology of Adaptation
and Use-dependent Development of the Brain How
States become TraitsTrauma Information Pages,
Articles Perry, et al. 1996

• Trauma is an experienceUltimately, it is the
  human brain that processes
• and internalizes traumaticexperiences. It is
  the brain that mediates all
• emotional, cognitive, behavioral, social and
  physiological functioning. It
• is the brain from which the human mind arises and
  within that mind resides
• our humanity . Understanding the organization,
  function and development
• of the human brain, and brain-mediated responses
  to threat are the keys to
• understanding the traumatized child.

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Use-dependent Development of the Brain

• We now know that no single gene is responsible
  for anything
• as complex as human behavior. Personality traits
  and patterns of
• behavior probably involve many genes, most of
  which are
• Influenced by environmentEven when genes
  predispose an
• Individual to a disease, say type II diabetes,
  changes in lifestyle
• (e.g., diet and exercise) can be the determining
  factor. Stien, P.
• and Kendall, J.
• Approximately one-third to one-half of our
  approximately
• 30,000 genes (Claverie, 2001) affect the
  development and regulation
• of the nervous systemat least half of these
  genes depend on
• environmental stimulation to be activated (Mack,
  1996).

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Four Periods of Major Structural Change in Brain
Development (Dr. Ornitz, 1996, UCLA Medical
School) Stien, P. and Kendall, J. (2004)
Psychological Trauma and The Developing Brain The
Hawthorn Press, Inc., Binghamton, NY

• First Period of Remolding15 months to 4 years
• Second Period of Remolding6 years to 10 years
• Third Period of Remoldingprepuberty
• Fourth Period of Remoldingmidadolescence
  (dramatic overproduction in early adolescence
  rivals growth observed in first years of life
  (Thompson, et al., 2000). Around 11 for girls
  and 12 for boys. Building and stabilizing
  connections between several key systems.
• The single most significant distinguishing
  feature of all nervous tissue of neurons
• is that they are designed to change in response
  to EXTERNAL signals. Bruce Perry

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Biological Effects of Childhood TraumaHeide, K.
M. and Solomon, E. P. (2006) Biology, childhood
trauma, and murder Rethinking justice.
International Journal of Law and Psychiatry 29,
220-233

• The brain does not complete development until
  adulthood
• Childhood trauma interferes with normal brain
  development
• Childhood trauma can cause long-term changes in
  the brain
• EEG (electroencephalogram) abnormalities
• Effects on the corpus callosum
• Effects on the limbic system
• Effects on neurotransmitters
• Traumatic memories get stuck in the limbic
  system
• The limbic system remains on red alert
• Remembering traumatic experiences can cause
  speechless terror
• 4. Childhood trauma causes long-term changes in
  the endocrine system
• A positive feedback loop intensifies aggressive
  behavior
• Trauma causes a disconnect between the mind and
  body
• Genetics plays a role

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Functions and Characteristics Associated with the
Right and Left Cerebral HemispheresCorpus
callosum is a neural band of tissue that connects
two hemispheres

• Left Hemisphere
• Positive, optimistic emotions
• Motivational tendency to approach, explore and
  take action
• Involved in the processing of verbal
  communication, words numbers
• Has the capacity to analyze, problem solve
  process information sequentially
• Allows for elaboration provides detailed
  perspective
• Right Hemisphere
• Negative, pessimistic emotions
• Motivational tendency to withdraw and avoid
• Involved in the processing of nonverbal,
  emotional communication, imagery visual-spatial
  information
• Limited capacity to think analytically
• Provides global perspective

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Triune BrainEvolutionary perspective of brain
development, by Paul MacLean, which emphasizes
that the human brain evolved from the bottom up.
Each new layer added new functions, that helped
in the struggle to survive and dominate.

• Brainstem Cerebellum
• Reptilian brain (resembles the brain of modern
  reptiles)
• Regulates cardiovascular respiratory functions
• Contains some of the nuclei that regulate arousal
• Limbic System
• Emotional brain source of our urges, needs
  emotions
• Primary role in the functions necessary for
  self-preservation (fleeing, fighting, freeze,
  submit food reproduction)
• Evaluates experience for emotional significance
• Hub for memory system

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Schole, Allan (2001). The Effects of a Secure
Attachment relationship on Right Brain
Development, Affect Regulating, Infant Mental
Health. Infant Mental health Journal, 22, 7-66

• Limbic System

Cingulate
Thalamus
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THE LIMBIC SYSTEM (gut brain)Bremner, J.
Dounglas (2002) Does Stress Damage the Brain? W.
W. Norton Company, Inc., New York, N. Y.

• Amygdala alarm system which matures very
  quickly in the infants brain and is much closer
  to full formation than other structures at birth.
  One of the important appraisal centers
  assigning emotional meaning to incoming data and
  can take control over the thinking brain.
• Hippocampus does not develop until 16-18 months
  and its main purpose is learning and short term
  explicit or declarative memory. Elevated
  cortisol can damage this areas ability to learn
  new information. The role of this structure is
  not only to store new facts but to provide
  context of space and time to a memory and to help
  integrate experiences by relating prior
  information with present information.
• Hyplothalamus gateway from the brain to the
  body. The amygdala relays an emotional message
  to the hypothalamus and the motor centers of the
  brain, where it gets transformed into a bodily
  response. The hypothalamus sends neural signals
  to the body (via ANA) and releases hormones into
  the blood. The hypothalamus activates CRH which
  actives the pituitary gland to release ACTH which
  activates the adrenal glands to release cortisol.
  The cortisol will halt the alarm reaction once
  the event is over bringing the body back into
  balance.
• Thalamus (back ally to amygdala)screens what is
  and is not necessary a central relay point where
  information from the senses come in and is
  distributed to different parts of the brain.
• Cingulate (COO of limbic system) Anterior
  cingulate is involved in concentration, empathy,
• inhibition of responses, normal emotion and
  planning and executing of behavior. The
  posterior cingulate is involved in processing
  information in space and time., which may be
  important for rapid response to life-threatening
  situations.
• Orbitofrontal and Medial Prefrontal Cortexes
  Regulates emotions, social behavior and a sense
  of right and wrong.

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Norepinephrine and Epinephrine

• Functions
• Sharpens focus
• Raises fear level
• Quickens heart rate
• Raises blood pressure
• Stimulates verbal emotional
• memory
• Blood sugar for energy
• Helps to form descending path-
• ways to lower brain centers
• Dysregulation
• Learned helplessness
• Flashbacks

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Cortisol

• Function
• Increases blood pressure
• Increases heart rate cholesterol
• Raises blood levels of norepinephrine
• and epinephrine
• Redistributes energy of the body
• Exaggerated Levels of Cortisol
• Thin lining of stomach (gastric ulcers)
• Thinning of bones (osteoporosis)
• Impairment in reproduction
• Heart disease
• Stroke

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Neurotransmitters and HormonesChemical
Changes Linked to TraumaStien, Phyllis and
Kendall, Joshua (2004) Psychological Trauma and
The Developing Brain The Haworth Press, Inc.
Binghamton, NY

• Elevated levels of norepinephrine/epinephrine,
  which contributes to core PTSD systems such as
  hyperarousal, flashbacks, intrusive memories, and
  nightmares
• Changes in the hormones of the hypothalamic-pituit
  ary-adrenal (HPA) axis, which impairs the
  adaptability of the stress response, including
  the bodys ability to return to a calm state.
• Altered concentrations of neuropeptides (e.g.,
  endogenous opioids) which contribute to bodily
  and emotional anesthesia.
• Changes in related neurotransmitter systems
  (e.g., dopamine, serotonin, and central amino
  acids) and in the receptors for stress-related
  neurotransmitters and hormones, which further
  intensifies the dysregulation of the stress
  response.

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Brain Impairments Associated with Complex
PTSDStien, Phyllis and Kendall, Joshua (2004)
Psychological Trauma and The Developing Brain
The Haworth Press, Inc. Binghamton, NY

• Dysregulation of the Stress Response System and
  Limbic Irritability
• Amygdala
• Neurotransmitters (serotonin, dopamine,
  epinephrine and norepinephrine)
• Hormones (CRF, ACTH and coritsol)
• Prefrontal Cortex
• Hippocampus
• Anterior Cingulate
• Sympathetic and parasympathetic arousal
  (freezing and dissociation)
• Decrease in Hippocampal Volume and Abnormal
  Activity in the Cerebellar Vermis
• Hippocampus
• Cortisol
• Cerebellar Vermis
• Underdevelopment of the Left Hemispheres and
  Communication Problems Between Brain Hemispheres
• Myelinization
• Corpus Callosum
• Lateralization
• metacognition
• Neuroendocrine and Immune System Dysfunction
• Growth related hormones

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The Effects of Maltreatment on a Childs
PsycheStien, P. and Kendall, J. (2004) The
Haworth Press, Inc. Binghamton, NY

• Problems Regulating Emotions and Arousal
• Alterations in Consciousness and Memory
• Damage to Self-Concept and Identity
• Disruption of Cognitive Capacities
• Hyperactivity and Attention Problems
• Relationship Problems
• Alteration in the System of Beliefs

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Complex PTSDJudith Herman

• Alteration in regulation of affect and
• impulses
• Chronic affect dysregulation
• Difficulty modulating anger
• Self-destructive or suicidal behaviors
• Difficulty modulating sexual involvement
• Impulsive and risk-taking behaviors
• 2. Alterations in attention or consciousness
• Amnesia
• Transient dissociative episodes
• Depersonalization
• 3. Somatization
• Digestive system problems
• Chronic pain
• Cardiopulmonary symptoms
• Conversion symptoms
• Sexual symptoms
• Panic

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Stress Warning Signs and Symptoms

• Cognitive Symptoms
• Memory Problems
• Inability to Concentrate
• Poor Judgment
• Seeing only the Negative
• Anxious or Rolling Thoughts
• Constant Worrying
• Physical Symptoms
• Aches and Pains
• Diarrhea or Constipation
• Nausea, Dizziness
• Chest Pains, Rapid Heartbeat
• Loss of Sex Drive
• Frequent Colds

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Begin Conference

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Link to PDA Survey

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• The Effects of Trauma on Children.
• If you have questions about the conference,
  please contact Lois Howard.
• E-mail howardl_at_bps-ok.org
• Phone [phone]

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