Presented by C. Lynne Edwards, LCSW Home Visiting Consortium October, 2013 Impact of Trauma on Children and Families Part One 1 HANDOUT: MY NOTES Presented by C. Lynne Edwards, LCSW

#1: The effects of abuse/neglect, removal and other traumas that occur when children are young have fewer consequences than for older children. #2: There is nothing that parents or caregivers can do to change the impact of their child’s early traumatic experiences. #3: Children’s behaviors can best be managed by rules and consequences. #4: Parent education classes are the most effective way to teach parents how to keep their children safe and meet their needs 2Presented by C. Lynne Edwards, LCSW

Feeling safe positively affects the nervous system and provides stimulation for healthy development. 3Presented by C. Lynne Edwards, LCSW

ACUTE CHRONIC COMPLEX 4Presented by C. Lynne Edwards, LCSW

5 Complex Trauma Multiple, chronic and prolonged, developmentally adverse events Often of an interpersonal nature with early life onset Effects are cumulative Toxic stress Presented by C. Lynne Edwards, LCSW

◦ Child’s chronological age and developmental stage ◦ Child’s perception of the danger ◦ Whether the child was a victim or witness ◦ Child’s past experience with trauma ◦ Child’s relationship to the perpetrator ◦ Presence/availability of adults to help 6Presented by C. Lynne Edwards, LCSW

 The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone important to the child.  Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, helplessness, powerlessness, and out of control physiological arousal. 7Presented by C. Lynne Edwards, LCSW

Trauma is experienced through the body, mind and spirit and has a long term impact. 8Presented by C. Lynne Edwards, LCSW

Adverse Childhood Experiences Study Adverse childhood experiences : ◦ are a major health issue ◦ result in social, emotional and cognitive impairment ◦ linked to higher risks for medical conditions (heart disease, severe obesity, COPD) ◦ linked to higher risk for substance abuse, depression and suicide attempts 9Presented by C. Lynne Edwards, LCSW

 Studies with antisocial youth have found self-reported trauma exposure ranging from 70% to 92% (Greenwald, 2002)  Antisocial youth have a high rates of Post Traumatic Stress Disorder (Greenwald, 2002)  Research suggests that anger and violent acting out often are symptoms of PTSD (Chemtob, Novaco, Hamada, Gross, & Smith, 1997)  Study of Foster Care Alumni revealed higher levels of PTSD in the alumni than in war veterans. (NC Children’s Practice Notes, Vol.10, No 3, June 2005) 10Presented by C. Lynne Edwards, LCSW

BRAIN DEVELOPMENT BIOLOGY MOOD REGULATION COGNITION AND LEARNING BEHAVIORAL CONTROL DISSOCIATION MEMORY ATTACHMENT SELF CONCEPT AND WORLD VIEW Presented by C. Lynne Edwards, LCSW11

Neurological pathways or patterns that begin to form are based on what infants SEE, HEAR, TOUCH, SMELL and FEEL Your first set of associations becomes your template 12Presented by C. Lynne Edwards, LCSW

 Physical sensations such a rapid heart rate, trembling, dizziness or loss of bladder or bowel control  Movement and sensation  Hypersensitivity/insensitivity  Coordination, balance and body tone  Unexplained physical symptom  Increased medical problems 13Presented by C. Lynne Edwards, LCSW

 Difficulty knowing and describing their feelings  Brain can’t shift from feeling to thinking  State dependent responses to experiences  Communication impaired 14Presented by C. Lynne Edwards, LCSW

 Focusing on and completing tasks  Anticipating and planning for future events  Absence of cause and effect thinking  Range of learning difficulties  Adaptive develop- ment impaired 15Presented by C. Lynne Edwards, LCSW

 Children’s behavior is state dependent-fear driven  It’s a message-an indication of an unmet, underlying emotional need  Interventions require the use of relational rather than confrontational approaches  Behavior problem is a relationship problem 16Presented by C. Lynne Edwards, LCSW

 The younger the trauma, the more likely to use dissociation, rather than the flight or flee response  Babies can’t do either 17Presented by C. Lynne Edwards, LCSW

 Lack cognitive memory of events  Memory of trauma stored in the senses, the body  State dependent memory 18Presented by C. Lynne Edwards, LCSW

 Rooted in biology  Mutual psychological process  Learned after birth 19Presented by C. Lynne Edwards, LCSW

Trust/Need Needs Arousal Displeasure Relief Relaxatio n Gratification: eye contact touch smile movement feeding 20Presented by C. Lynne Edwards, LCSW

Initiating Positive Interactions Parent Initiates Positive Interaction Gratification Parent Responds Gratification Child Responds 21Presented by C. Lynne Edwards, LCSW

N Nurturing E Engagement C Challenge S Structure 22Presented by C. Lynne Edwards, LCSW

23Presented by C. Lynne Edwards, LCSW

 Lack of a continuous, predictable sense of self  World is not a safe place to be  I’m a bad child; everything bad is my fault  People who love you, hurt you and/or abandon you  My feelings don’t matter  No one listens 24Presented by C. Lynne Edwards, LCSW

FEAR Flight Fight Freeze Alters brain chemistry Shuts off cortex Stops Empathy 25Presented by C. Lynne Edwards, LCSW

FEAR Suppresses the child’s voice high risk behaviors Barriers to intimacy Aggression/ digression 26Presented by C. Lynne Edwards, LCSW

 Pervasive feelings-Fear and anxiety  Core issues-grief, loss, rejection, attachment, control, guilt, identity  Internalized beliefs-I’m a bad kid, I can’t trust adults, people who say they love you, hurt and/or leave you, the world is not a safe place to be, etc.  Control issues-children feel so out of control they try to control everything in whatever way they can 27Presented by C. Lynne Edwards, LCSW

 Sensory issues-sensitive to touch, loud noises,  Delayed adaptive development  Regulation of emotions-their brains can not shift from their emotions to their thought processes  Pull/Push-come close, now go away; afraid of getting close  High risk behaviors 28Presented by C. Lynne Edwards, LCSW

Children’s learned solutions become caregivers problems 29Presented by C. Lynne Edwards, LCSW

 Pervasive feelings-Fear and anxiety  Core issues-grief, loss, rejection, attachment, control, guilt, identity  Internalized beliefs-I’m a bad person/parent, I can’t trust adults, the world is not a safe place to be, etc.  Control issues  Delayed adaptive development  Regulation of emotions  High risk behaviors 30Presented by C. Lynne Edwards, LCSW

PLUS:  Parents’ ability to make appropriate judgments about safety is compromised  Trauma reminders presented in children’s behaviors trigger extreme reactions.  Tendency for parents to personalize their children’s negative behavior which challenge attachment and can lead to ineffective or inappropriate discipline. 31Presented by C. Lynne Edwards, LCSW

 Parents’ capacity to regulate their emotions is impaired.  Parent’s executive functioning is impaired which results in poor decision-making, problem solving or planning.  Parent is more vulnerable to other life stressors. 32Presented by C. Lynne Edwards, LCSW

 It’s hard for them to form and maintain secure, trusting relationships ◦ Disruptions in relationships due to negative feelings about parenting, personalizing children’s negative behaviors ◦ Challenges in relationships with caseworkers, foster parents and services providers 33Presented by C. Lynne Edwards, LCSW

Parents’ learned solutions to their situation are our challenges in working with them 34Presented by C. Lynne Edwards, LCSW

 Manipulation  Triangulation  Aggression  Control  Resistance Presented by C. Lynne Edwards, LCSW35

The brains of children who experience trauma are wired differently and the impact carries into adulthood. 36Presented by C. Lynne Edwards, LCSW

So what? 37 HANDOUT: TRAUMA INFORMED PRACTICE Presented by C. Lynne Edwards, LCSW

 Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth  National Child Traumatic Stress Network-newsletter and developed the Child Welfare Trauma Training Toolkit. nctsn.org/products/child-welfare-trauma-training-toolkit-2008  Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators Guide.pdf Guide.pdf  Child Trauma Academy Presented by C. Lynne Edwards, LCSW

 Adverse Childhood Experiences cds.gov/ace/pyramid.htm  Child Welfare Trauma Referral Tool trauma-training-toolkit-2008#q4 trauma-training-toolkit-2008#q4  Trauma Symptom Checklist for Children  Zero to Three  Brain Connection Presented by C. Lynne Edwards, LCSW

 Resilience Trumps Aces  Trust Based Relational Interventions developed by Dr. Karyn Davis and Dr. David Cross at the TCU Institute of Child Development 40Presented by C. Lynne Edwards, LCSW

C. Lynne Edwards, LSCW Trauma and Attachment Therapist Consultant and Trainer What we do today can help improve others’ tomorrow. 41Presented by C. Lynne Edwards, LCSW