Natasha Harmon, MS Children’s Home + Aid Childhood Trauma Natasha Harmon, MS Children’s Home + Aid

Today Goals Realize that you may be seeing the impact of trauma in children you serve Recognize how trauma affects all individuals involved Respond by asking the important questions and by trying to do what you can

The human brain & how it is affected by trauma

Complexity and Plasticity Brain Development (Perry) Cortex Limbic Midbrain Brainstem Abstract Thought Concrete Thought Affiliation "Attachment" Sexual Behavior Emotional Reactivity "Arousal" Appetite/Satiety Blood Pressure Heart Rate Body Temperature Sleep Motor Regulation Complexity and Plasticity Brain develops from the bottom up and inside out Physical (breathing, heart, blood pressure)—lower brain I may refer to as the primal brain because we don’t have logical thinking when acting out of this brain Emotional (happiness, aggression, attachment) Thinking (planning, consequences, impulse control)- This is the portion of the brain that is first to go when dysregulated Dr. Dan Siegel-Flipping you lid-when a child becomes dysregulated they immediately loose their sense of thought, emotional regulation, impulse control, attachment and react from their primal brain –we will talk more about what to do when this happens later 4

Brain Development Neurons are chemical messages -Message comes in and the neurons fire -More times the same message is repeated the thicker the neuron connection -The experience children have with their environment determines which neurons and synapses survive and which do not Don’t lose it you may lose it as a young child

Brain Development Critical Periods- for some aspects of brain development, timing is critical. Important abilities will be lost or diminished if they don’t develop at the right time (e.g. vision, attachment, language) Childhood experiences impact how the brain develops Traumatic experiences interfere with normal brain development when they occur during a period when the brain is developing Adolescence is a critical period as well. Don’t just assume that all critical periods occur in infancy or at younger ages. With early, persistent or chronic trauma, the brain gets bathed in stress hormones and the child then is on constant alert

Brain Development Events can cause changes in the brain. A single, powerful experience can affect our brain for life. Repeated smaller experiences can also change our brain. Practice (sports, art, studies, etc.)- the more we repeat things the stronger the brain connections become This is why there is always hope that youth can get better with new, positive experiences So when something is repeated time and time again- it sticks. This is how babies learn and I am sure that you have repeated things like the numbers1-10 or the ABCs more times than you can count to your children to help them learn. It’s important to remember that just like the “good stuff” that is repeated, the “bad stuff” that is repeated sticks too! So try to remember this when working with children who have been traumatized. As we talk about practice/repetition I think about memory…Some would argue that babies don’t make memories. I would challenge that because although they may not have words it doesn’t mean that the baby doesn’t have feelings and events can leave lasting impressions with them. We often talk about body memories and how children may be triggered by something and not be able to identify the connection to the trauma. EXAMPLE!! A former client would scream and cry when she was taken to visitations with her biological mother when she was very young. No physical abuse or neglect was occurring during these supervised visits so many were confused as to why she had such extreme behaviors. She didn’t have language to identify what she was scared of or what she remembered from her past but it was evident that her biological mother had made a lasting, negative impression on her by her behaviors.

Brain Development Let’s look at the effects of trauma on the brain—how much trauma and how long the child is exposed affects brain development. Trauma impacts brain size and the brain’s connections. See how the child with extreme neglect has more holes/gaps-suggesting less connections

Teenage Development Physical Appearance Emotional rollercoaster Cognitive-Always the last to develop When teens hit puberty we see a burst of new brain cells and more development occurs. Physical appearance is first this is how we know a teen is in puberty-we see the hair on boy’s faces, breast development in girls Then comes the emotional development-this is tied up with forming their identity and dealing with pressures like leaving the nest—Some may feel like emotional rollercoaster is too kind!! It is a very challenging time for the teen and parents Cognitive development takes a long time and this isn’t completed until 25 years old—Think of car insurance-when your child turns 16 and you put them on your insurance it is very expensive—what happens when they are 25?? It goes down. Also, you can’t rent a car in most places until 25….it seems these organizations knew about this… --Cognitive development is when impulse control gets developed.

Cognitive Development Science has taught us that the part of the brain that develops last during adolescence is the prefrontal lobe, which controls: Complicated Decision-Making Thinking Ahead Planning Comparing Risks and Rewards Something dumb after high school – forgive yourself—blame your undeveloped brain  I find this interesting because often adolescence is the time when we make teen decide major life decisions such as whether or not to attend college/ enter employment field/choose major…when really they are still developing in these areas. I guess if you figured it out the first time you were LUCKY!!!

Teen’s Cognition Teens make decisions differently than adults. They rely more on their “emotional” centers than their “thinking” centers They often think before they act but they are using a different set of “values” to make these decisions They often choose actions that are much riskier than adults would choose You may be thinking tell me something I didn’t know…. Given it’s lack of development, the teen brain will default to the emotional center, rather than the frontal lobe when making a decision. So when we say “why didn’t you think about this” when the teen has done something—truth is they may have thought about it but just used different logic!

The Brain is complex..did you get all that??? REMEMBER: BOTTOM –up development Physical processes, emotional processes then cognitive

So..what is childhood trauma?

Childhood Trauma The experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects. National Institute of Mental Health Overwhelming, uncontrollable experiences that psychologically impact victims by creating in them feelings of helplessness, vulnerability, loss of safety and loss of control—Beverly James We will discuss event, experience and effects in greater detail soon. I have found that when a child feels a loss of safety and control they are greatly impacted by this experience and dysregulated behavior often is the result

Childhood Trauma Event – One time or chronic Experience – whether the event is experienced as scary or threatening Effect - long-lasting and life altering The three e’s Event- can be single event such as accident, illness, natural disaster OR could be repeated event or repeated exposure EXAMPLE?? World Trade Center attacks is an example of a 1x event that was scary and had life-altering effects for some.

Adverse Childhood Experiences(ACEs) Growing up (prior to age 18) in a household with: Recurrent physical abuse Recurrent emotional abuse Sexual abuse Emotional or physical neglect  Felitti, 2009 ACEs are experiences which most agree would be considered traumatic and thus have an impact on the child

Adverse Childhood Experiences Growing up (prior to age 18) in a household with: An alcohol or drug abuser An incarcerated household member Someone who is chronically depressed, suicidal, institutionalized or mentally ill Mother being treated violently One or no biological parents Felitti, 2009 Presence of stress in child’s environment – American Academy of Pediatricians

Beyond ACEs Being a victim of crime Community violence Traumatic loss Beyond ACEs other experiences that can be traumatic-- Traumatic loss-being an adoption preservation counselor I have seen the effects of traumatic loss and reoccurrences of loss and how deeply these can impact children. Dr. Purvis and Cross from Texas Christian University who are leaders in trauma work have stated that Relationship trauma can only be healed relationally—I found this to be very powerful and motivating reminding us that a child who has gone through relationship trauma will need extensive repair done in this area.

Experience Definition says “emotionally painful or distressful Scary or threatening Age matters – What is threatening for a 3 year old may not be threatening to a 15 year old Bottom line – feels scary, threatening your safety-it can be traumatic-THIS can be DIFFERENT For everyone Now what about that memory/impression thing? Here’s where it really comes in to play. Example: 15 year old who I work with: when the parents start yelling and she feels confronted she immediately starts crying, saying “I don’t know” to anything she is asked and she starts to wring her hands—she is reacting from a place of fear-Does she remember doing this as child in her abusive home? No but she has done this for as long as we know. I feel it is because she has similar memories of getting yelled at and this may have been her response as a younger child.

Prenatal Experience (Henry, Sloane & Black-Pond) Children exposed to prenatal alcohol combined with childhood trauma have significantly greater severe neurodevelopmental deficits in : Attention Language Memory These children have also been shown to have greater Oppositional/Defiant Behavior Inattention Hyperactivity Impulsivity Social problems This study by Henry, Sloane & Black-Pond in 2007 looked at the effects of prenatal alcohol exposure combined with other childhood trauma. They compared children with prenatal alcohol exposure to children who experienced other childhood trauma and they found children with both types of trauma experienced more sever neurodevlopmental deficits and had greater behavioral problems.

Effects A child’s brain development responds to the child’s experiences Stress Alarm System as a Survival Mechanism After Trauma Child overreacts to normal situations Child is on constant alert Child may over-interpret signs of danger What do you do when you are worried? How does it feel? Imagine feeling that way 24/7 Can change the shape of the part of the brain that triggers danger ** 2 children exposed to the same trauma may demonstrate very different symptoms and behaviors

Perry’s Dominant Response Types Hyper arousal Flight or Fight Hyper-vigilant Easily Offended Over-reactive Avoidant Dissociation Freeze/Numb Overwhelmed Nonresponsive Self-Mutilation Passing Out Boys: thought to use this more than girls flight or fight –however many girls I know identify with the fight response Girls: dissociation-The little girl who I told you about earlier who used to scream when on visits with bio mom eventually stopped screaming and she would appear non responsive or dissociative after the visits for about 3 days back with her foster mom Babies: somatic – appetite, sleep, startle, FAILURE TO THRIVE Adolescents with both response types – huge risk-takers

More Effects Emotions Cognition Trouble calming down Trouble understanding others’ emotional expressions Poor emotional awareness-less “feeling” words Cognition Learning problems Early delays in language development Information processing problems

Graphic by: Seth Pollak, courtesy PNAS Physically Abused Children See Anger Where Others See Fear Graphic by: Seth Pollak, courtesy PNAS Study was done that showed how much difficulty children who have experienced trauma have reading facial expressions. They default to anger. Abigail Baird did another study on teens reading facial expressions. She found that teens can read their parent’s facial expressions but with models they couldn’t read them correctly. So if your child misinterprets your facial expression it may truly be their lack of development in this area.

More Effects Physiological (Body System) Behavior Control Trouble regulating body (eating, sleep) Physical complaints Self mutilation Behavior Control High risk behaviors (sexualized, aggressive) Impulsive Behaviors Social Relationships Boundary problems with others Trouble forming and keeping relationships

More Effects Major Mental Illness Substance Abuse Exposure to Trauma Increases the Risk for: Major Mental Illness Substance Abuse AIDS and Sexually Transmitted Diseases Academic Difficulties Impaired Physical Health Trauma increases the odds for Major Depression nearly 2fold Trauma significantly increases risk for alcohol and drug abuse in adolescents Trauma impacts school readiness, school performance and increases the likelihood of dropping out of high school National Child Traumatic Stress Network states that about 75% of youth in the juvenile justice system have trauma symptoms

This is intense! How can I help?

Perry’s key concepts Resilience: Not everyone exposed to adverse experiences is traumatized Recovery-Brains respond to repeated stimuli (practice more of the “good stuff”) Even as adults, brains are capable of learning and changing So FINALLY some positive news!!! 2) So we can help children heal by rehearsing some positive coping strategies and techniques

Create a safe environment Be consistent-rewards & consequences Be predictable- have a routine and structure Reassure them that you a safe person “Felt safety” Be consistent with these children. They can be very impulsive and safety can be a risk factor for these children thus if you are consistent that can provide a feeling of safety. Be predictable-most of these children do not do well with change and can become very emotional when unexpected things occur. EXAMPLE: (A.L.) Client we had in our program-would be upset if his mom would not sit in on his session because I needed her to sign paperwork for her sister who I was working with. He would hyper focus on her absence, he would get aggressive and very agitated. He often would be able to stand the change for maybe 5 minutes then he would be so anxious and dysregulated that he would come get her. He needed the safety of the routine in the office environment. **EQUAL BALANCE OF NURTURE AND STRUCTURE are important for these children-1 cup nurture for every 1 cup structure Reassure them that you are a safe person- You have to do this by words and behaviors. We often talk about “felt safety” This is how safe the child feels-it does not matter how safe you tell a child a situation is! If he doesn’t feel safe he will not be able to regulate. It’s all about his felt safety Create Felt Safety by attending to the child’s physical and emotional needs, respond appropriately and interact with child appropriately.

Support Every child needs 3 supportive adults in their lives as they grow up Mentors should stay in the child’s life at least 6 months to be effective Often very helpful for parents to be in a group setting to have others recognize the complexities of their children’s behaviors SEARCH institutue-3 supportive adults Mentors- Be careful about coming into the kids life and leaving as this could be considered a great loss to a fragile child.

Help Them Soothe Themselves Recognize these youth can be challenging Try to keep your emotional reactions in check and stay calm When a child has gone to the primal brain-they will need your help to regulate Praise them for any coping strategies they use to calm down—even after a meltdown As you have heard today, these children can have a host of complexities and they can be challenging to work with. Its important for you to keep your emotions in check and not REACT to their behaviors; RESPOND—with care and compassion. Even if the child is having a meltdown at an inopportune time it will not help for you to yell or get worked up. They need you to be calm and help get them calm. This takes practice—but remember the more you do it the easier it will come to you  Again when a child has gone to their primal brain—there is not teaching or correcting that can be done until they are regulated again. So help them to calm down and later come back to the lesson. PRAISE, PRAISE, PRAISE!!! Remember if a child can use any coping strategy to calm down you want to praise this because it is hard to do! Praise and help them practice these strategies often so they also become easier and more natural to implement.

Soothing Suggestions Lollipops, drinking cold drink through the straw Chewing gum Hydration Food every 2 hours Deep Pressure/Weights Exercise Magic Mustache Traumatized children often do not get a lot of sensory exposure during their first years of life so it has been proven beneficial to provide them rich, safe sensory activities. Snacks, activities (such as deep pressure activities, weighted blankets) and other physical exercises provide good sources of sensory input Utilize the sucking reflex-which is very soothing to many children-Have them suck on a lollipop or popsicle or drink something cold through a straw Chewing gum also seems to provide some sensory input and can help soothe a child Also, make sure they are plenty hydrated as some dysregulation has been shown to come from this Drs. Purvis and Cross (Texas Christian University) suggest a child should have something to eat every 2 hours to help regulate blood sugar and keep those bodily systems regulated Magic Mustache –I also learned from Dr. Purvis and Dr. Cross-there is a pressure point about our lip, if we apply some pressure it and hold it for 10 seconds, it can help to soothe us **Find what works for them—some kids really like sour treats to help regulate!

IDEAL Response® (Purvis & Cross) Immediate Direct Efficient Action-based Leveled at the behavior-not at the child Immediate Response-Respond to the behavior in the moment, less than 3 seconds is preferred Direct-NOT Forceful-still have to be nurturing and connecting. To do this you want to use eye contact, ask permission before you touch them(especially if hostile) and try to ensure their “felt safety” Let’s discuss the efficient response on the NEXT SLIDE

Efficient Response Respond using engagement Use the least threatening form of engagement possible Playful engagement Structured engagement-choices/compromise Calming engagement Protective engagement Efficient-you want to respond to them using engagement. Try to use playful engagement as it is the least threatening. You may have to use more strict forms of engagement such as calming or protective engagement if the child is unable to regulate themselves and you need to ensure their safety. You can use more structured engagement if the child is emotionally present utilizing strategies such as choices and compromise Let’s talk more about choices on the next slide

Choices Give choices to help teach cooperation rather than get into a power struggle Choices should be simple Gives child sense of appropriate control Give choices 1 or 2-point to fingers

IDEAL Response® (Purvis & Cross) Immediate Direct Efficient Action-based Leveled at the behavior-not at the child Getting back to the IDEAL response we will discuss the Action-based response

Action-Based Response: Behavior Re-do’s Why don’t you try that again, this time with respect? If at first you don’t succeed try, try again! Behavior Re-do’s are very important for many reasons: give the child the opportunity to learn how to do the appropriate action/give the brain a chance to practice this appropriate action again and hopefully strengthen that brain connection/ allowing yourself a chance to praise the child for trying again and doing it right

IDEAL Response® (Purvis & Cross) Immediate Direct Efficient Action-based Leveled at the behavior-not at the child Finally you want to ensure that your response is leveled at the child’s behavior, not the child. Remember this behavior is not a character flaw—they behave this way because of their trauma so don’t react to the child-RESPOND to the behavior.

We are learning more than we ever have about the brain and trauma We are learning more than we ever have about the brain and trauma. Brains and Behaviors can change—there is hope! Thank you!