The Effects of Trauma on Young Children

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The Effects of Trauma on Young Children

• Stacey Ryan, LCSW
• Angela M. Tomlin, Ph.D.
• IAITMH
• 2006

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Types of Trauma

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

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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

4
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

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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

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Assessing severity of trauma

• Closeness of people involved to the child
• What the child saw
• Childs developmental level
• Reactions of important adults

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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

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Clinical Patterns in Abused/Neglected Infants

• Gaensbauer 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)

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Effects of Trauma

• Can appear immediately or after days, weeks
• May remind young child of previous traumas,
  making reaction more severe

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Effects of Trauma

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

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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

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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

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Traumatic reminders

• Can be difficult to identify in nonverbal child
• Sensory (siren, smell)
• Dreams
• Re-experiencing the event
• Irrational fear of benign objects

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Developmental Effects of Trauma

• Developmental delays are expecteddevelopmental
  assessment is advised
• Problems may occur in development of attachments
  and other social emotional skills
• Regression is possible

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Effects on Play Skills

• Repetitive actions
• Driven quality
• Constricted quality
• Preoccupation with separation, loss, and reunion

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Effects on Behaviorinfants and toddlers

• Increased irritability/inability to soothe
• Sleep disturbance
• Emotional distress sadness
• Fears of being alone clinging refusal to
  separate
• Motor agitation
• Temper tantrums

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Effects on Behaviortoddlers 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

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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

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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

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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 ones own child

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Abused children as parents

• Harsh discipline
• Failure to respond to childs needs
• Inconsistent limit setting
• Inability to express affection
• Inability to enjoy interactions with child
• Minimize or deny childs painful experiences

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Young children and neglect

• Failure to provide for childs 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

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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

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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

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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

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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

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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

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Arousal-Relaxation Cycle
Child experiences a need
Child feels content

• Child feels upset

Adult satisfies need
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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

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Why do children form attachments to abusive
parents?

• Childrens 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

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Insecure Attachments

• Avoidant patterns (turning away from the
  caregiver when distressed) develop when
  caregivers reject babys request for nurturance.
  
• Resistant patterns (fussy, resistant behavior)
  develops when caregivers inconsistently respond
  to the baby

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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

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Long term Effects of Disorganized Attachments

• Aggression with peers
• Dissociative behaviors

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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

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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

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How Foster Parents Can Help

• Responding to parent anger
• Listen
• Be non-reactive
• Acknowledge how difficult it is to be away from
  child

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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

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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

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Question and Answer
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Factors in Determining Types of Interventions,
(Osofsky Fenichel, 1994)

• Safety and Stability of Current Living Situation
• Childs 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

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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

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Common Intervention Needs (Osofsky Fenichel,
1994)

• Improving the caregivers ability to attend to and
  provide for the childs needs
• Further develop caregivers ability to interpret
  childs 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

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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

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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

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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

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Play

• Encouragement of Play with Dyad
• Help the Parent Understand and Support Use of
  Play
• Allow the Parent to Be Main Supporter to Child

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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

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Child Fears

• Support Parent Understanding of Fears
• Bring Attention to Cues Child Gives Regarding
  Fears
• Develop with Parents Strategies for Containing
  Fears

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Aggression Toward Parent

• Give Parents Meaning for This Behavior
• Assist Parents In Containing Feelings Regarding
  this Behavior
• Develop Strategies for Controlling
  Anger/Aggression

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Aggression Toward Peers

• Build Understanding of Reasons for Behavior
• Clinician Gives Resources for Deescalating
  Behavior
• Empower Parents to Take Action and Assist Child

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Parental Use of Physical Punishment

• Explore with Parent Feelings and Concerns
• Contain Own Emotions and Reactions
• Educate on Reasons Physical Punishment May Worsen
  Symptoms

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Parental Criticism

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

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Relationship with Perpetrator

• Educate on Child Needs/Experiences
• Support/Listen to Parent Concerns/Feelings
• Mutually Develop Strategies

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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

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Treatment Videos

• Discussion
• Questions/Comments

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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

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Another Way to Help

• Speak for the babies..

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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)

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Contact us.

• Stacey (yphsdir_at_cmhcinc.org)
• Angie (atomlin_at_iupui.edu)

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The Effects of Trauma on Young Children

• Stacey Ryan, LCSW
• Angela M. Tomlin, Ph.D.
• IAITMH
• 2006