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Goals
1: Describe children's concepts of trauma and traumatic events
Greater susceptibility to injury and their dependence on others for livelihood, decision making, and emotional support.
Caring for children in the aftermath of a traumatic event involves psychological and social challenges stemming from their level of cognitive ability, emotional vulnerability, and dependence upon the support of family members.
Children
require special attention and procedures after a traumatic event, and they are often identified as a population that should be prioritized during relief efforts.
US Army
The shock of the unimaginable creates memories that are indelible and intrusivemuch like a flashbulb in our brains.
Familiar and favorite objects look different or have disappeared The known becomes the unknown Safety is challenged Change in day to day structure may create more anxiety Life is different The return to normal is replaced with a new normal
Photo Marco Dormino/ The United Nations
Traumatic events are intense and extreme versions of stressful events, they can be life threatening or potentially life threatening. The event causes the child to feel fear, hopelessness and horror and threatens psychological and physical well-being.
The effects that surround a stressful event are alleviated when the stressor is removed while the emotions evoked by a traumatic event last long after the event is over.
Memory of the traumatic event lingers on, physiological arousal continues and the body never fully recovers
A History of Trauma
The symptoms of traumatic stress were noted as early as the Civil war. The condition was called Soldiers Heart.
Photo: NARA
Hysteria
Sigmund Freud was the first to suggest that hysterical behavior was related to a premature sexual encounter.
Anna O
Shell Shock
Trauma was not addressed again until World War I. Soldiers brains were thought to have been shocked by exploding shells during battle.
Battle Fatigue
The effects of trauma were noted in combat soldiers during World War II.
Upon their return from Viet Nam in the mid 1960s veterans complained of flashbacks, hyperarousal and inability to function in day to day life.
Women, spurred by the success of the Viet Nam Vets, started to meet in groups to Break the Silence of Rape in the late 1970s
Children in war addressed by Margaret Mead in 1945 The separation of children from family proved more disruptive than the London blitz.
First identified in 1874 and treated through the Society for the Prevention of Cruelty to Animals Child abuse not recognized as a public health problem until 1975
Research on the long term and immediate effects of trauma began in the in the last 20 years Natural Disasters
Community violence
Activation of a cascade of neurochemicals through the brain and the body Preparing the human for survival
Freezing Flight Flight Tending
Memory Time Distortion Splitting of affective and cognitive elements of the experience
Traumatic events in childrens lives - Any direct or witnessed event that threatened his/her own and/or his/her caregivers physical and/or emotional integrity (Pynoos, 1990)
Children exposed to traumatic events are at high risk for developing post-traumatic distress, maladjustment and PTSD The symptomatic picture is different in children in comparison to adults, especially for young children
Types of Trauma
Need to differentiate between: Familial and non-familial events (attachment figure or friend vs. foe)- identity of the perpetrator Acute trauma which is violent and sudden (plane crash, car accident, bombings, 9/11, natural disasters) and Chronic trauma which is subtle and cumulative (various forms of terror threats, domestic violence) and their combination Collective Trauma (war, persecution, terrorism, genocide) and individually endured (rape, assault, physical and sexual abuse) Human (Intentional and unintentional) and non-human causes occurring in infancy, childhood or adolescence.
In children, traumatic experiences, in addition to increasing the risk for PTSD, depression and anxiety, appear to interfere with the developmental course: Affronting childrens sense of safety, wellbeing, and bodily integrity
A complex interaction:
The significance of the event in the life of the child (Proximal contact, loss) Individual characteristics
Developmental stage Cognitive abilities Age and gender Family loss and injury Displacement of school, community Media and Strangers
The environment
Cognitive Stage
Causal Thinking
Developmental Fears
Traumatic loss
3250 children lost parents from the three attacks on 9/11 Trauma symptoms associated with the circumstances of a parents death can impair the ability to navigate the grieving process.
The traumatic nature of the loss is an obstacle as the child tries to accept the reality and permanence of the death, cope with painful emotions, adjust to life changes resulting from the loss, and make meaning of the death Cohen & Mannarino, 2004
Family members who are also profoundly affected and themselves suffering
Two months after September 11, a predictor of child mental health service utilization was parental PTSD symptoms. Stuber et al. (2002)
The environment
Ongoing disruptions (home, school) Support Education
Rates of PTSD symptoms were higher among the exposed youth at three and nine months following the attack. The exposed youth also evidenced more disaster-related fears unrelated to terrorism than the comparison youth Koplewicz et al.(2002)
After the Pentagon attacks on September 11th Nearly 73% of children reported at least one symptom of PTSD 2-3 months later
10.6% of 8,236 school children reported they experienced re-experiencing, avoidance, and hyperarousal symptoms.
The authors of the study suggested that these children may have a probable diagnosis of post-traumatic stress disorder
Hoven et al. (2005)
The Availability of Human Bonds for Children Coping with Traumatic Events
Margaret Mead, Anna Freud and Dorothy Burlingaham (194143): The disruption of family ties is more traumatic to children than the events of war Coates (2003): Trauma and human relatedness may be understood as inversely related. The greater the strength of the human bonds connecting the individual to others, and the more these bonds are accessible in times of danger, the better the individual can cope with the trauma and recover
Parental emotional reactions mediate child PTSD Parental reactions predict child post-traumatic distress more than the level of exposure and the severity of the event There is a relationship between specific parental and family characteristics and child adaptation post-trauma
Previous trauma Stage of development Cognitive & emotional Cultural/spiritual beliefs The nature & magnitude of the trauma Human inflicted The degree of exposure Directly affected-illness, injury Loss (Parent, home, school) Continued disruption in life Support systems Personality type and coping styles Prior individual and relational factors (related to vulnerability and resilience: attachment,
temperament, individual disorders, family stresses, morality and religion and their interaction).
Photo: Gannett
Younger children show more circumscribed or vague symptoms than older ones
more somatic complaints and somatic rare phenomena (bruxism, alopecia) more regressive behaviors and more regulatory difficulties in sleep, mood, attention and behavior They report less symptoms of re-experiencing or of numbing and avoidance. Thus their problems may not be identified as trauma related.
If children can be identified immediately after experiencing a traumatic event and given strategies to cope with that event they will be less vulnerable to the use of destructive behaviors.
Modeling of coping behavior, efficacy and inspiring optimism and hope. Organizing and safely structuring the childs environment Building a sense of connection with meaningful others and of agency Helping the child regulate emotions by being attentive and physically and emotionally available to protect and sooth
Communicating about confusing, fearful things, anxieties and problem-solving Creating a coherent, sensible, emotionallybalanced and empowering trauma narrative.
Turning traumatic memories which are disjointed, confusing, uncontrollable and emotionally unregulated, into normal memories which are embedded in a narrative that can be processed and controlled.
Talking to Children
About Traumatic Events
Photo by Wendy Ewald with students at Central Intermediate School, the African American Alphabet in I Wanna Take Me A
Developmental Considerations
Key Points
The Setting
Introductions
Getting Started
Children do not have the capacity to process information in the same way as adults Yet they are keen observers of the world No matter how much we shield them, they notice things and form their own conclusions
Talking. . .
Cognitive stage is the most crucial determinant of how grief, loss and trauma are processed AND how we talk to children
Talking. . .
A time for observation Talk to others who can respectfully comment on their experience Revealing pain and vulnerability can complicate resolution of trauma Give parents, schools information
When to stop. . .
Childrens Needs
When to end. . .
Building Community
Sharing the experience with others creates a sense of community. Providing social support
Beyond Talking
Doing Good
. . . a Way To Be Helpful!
Allow children to express their feelings in their own words and images
their feelings their understanding of a traumatic event Allowing for dialogue on two levels- emotional and cognitive
Photo therapy
Children learn how to use a camera Work together in groups Visualize & photograph how they will represent a letter Write about their picture I Feel Better When
Carrying our Baggage Children must carry their suitcase full of experiences with them through the rest of their lives
Taking short cuts, Pushing things away without thought results in . Everything spilling out when we are least prepared.
Grounding experiences . . .
Reconnect us to what is familiar and stable.
A sense of accomplishment
A Beginning A Middle An End
A Grounding experience
Journaling
Allows the child or teen to tell their own story Another way to express emotions, ask questions Provides and opportunity to revisit earlier times
Infusing life into inanimate objects Telling their story Safety Retelling the trauma Working through different endings
Finding sanctuary?
A physical and emotional place of safety and security.
Respite from outside threats. Offers comfort and familiarity. Facilitates healing and growth.
Sanctuary
Children find sanctuary through Play Learning Social supports
Children can find sanctuary in the world around them through experiences that are grounding.
Growth and resilience in nature Sights and sounds of nature The wonders of learning Literature that is comforting and/or therapeutic Interaction with others Play, drama and art
We are all vulnerable in the beginning, when we are young, and growing up in the world.
Photo: Audrius Meskauskas
When confronted with painful events we keep ourselves in a safe and warm cocoon. We know that we need time to grow and protect ourselves . . . until we are ready to emerge. . .
Photo: Captain Tucker
The ability to thrive, mature and succeed in spite of challenges and obstacles. Not absolute protection against the effects of trauma, It does help children move towards growth and positive physical and mental health.
Resilient Children
Memory of images of helpful, sustaining people Awareness of feelings A desire and ability to help others Altruism A feeling of competence
Photo: Gannett
Resourcefulness Recognition and use of support systems Curiosity and intellectual mastery Compassion and caring for others
Photo: Gannett
Safety and security (home & community) Reassurance Familiar and regular activities Factual information Active listeners Available parents and caregivers Limited exposure to the media Extra time, attention, affection Play and school And . . .
Helping Young People Understand Trauma and How it Affects our Bodies and Brains
One
goal:
Freezing we instantly check where the danger is and if we can get away.
Body
Time is distorted
Our Thinking
these
responses do not mean a person is mentally ill this is how all human beings react to a traumatic event!
The
Research studies show that suppressing memories of any type result in a rebound effect Although not thinking about painful thoughts seems to be a reasonable way to copetrying to forget actually makes it worse.
Wegner, 1994
What to do..
The physically ill and more vulnerable chicks are herded towards the center.
Resources
The National Child Traumatic Stress Network. http://www.nctsnet.org/nccts/nav.do?pid=hom_main David Baldwin Trauma Pages http://www.trauma-pages.com/disaster.php Center for Traumatic Stress in Children and Adolescents http://www.pittsburghchildtrauma.org Cohen, E. (2008). Parenting in the throes of traumatic events: Relational risks and protection processes. In: J. Ford, R. Pat-Horenczyk & D. Brom (Eds.) Treating traumatized children: Risk, resilience and recovery. Routledge. The Dart Center- Children and Trauma http://dartcenter.org/topic/childrentrauma Fendya, D. (2006) When Disaster Strikes Care Considerations for Pediatric Patients, 13 J. TRAUMA NURSING 161, 161. INST. OF MED., EMERGENCY CARE FOR CHILDREN: GROWING PAINS 234 (2007). Psychological First Aid, Field Operations Guide. http://www.nctsnet.org/nctsn_assets/pdfs/PFA_InfoBrief_FINAL.pdf