1. September 2013

2. Module 4 Understanding the impact of maltreatment, stress and separation on development

3. Module 4 Learning Objectives Participants will: Identify the impacts of maltreatment, neglect and abuse on the physical, motor, language and communication, cognitive and social-emotional domains Understand how these negative impacts early in life can lead to lifelong challenges Understand the importance of making careful decisions when “transitioning” a child away from his or her caregiver

4. Overview of this module There are often significant differences across all the developmental domains when we compare children who have been abused or neglected with children who have not The impacts of these early years will carry on long into adulthood, as we have learned from the ACE study What does this all mean for child welfare professionals?

5. Developmental comparison between a typical and maltreated child Physical Motor Language Cognitive Social emotional

6. Billy and Lucian

7. Video: First Person, Impressions of Being a Baby Clip #1 Lucian: minutes 13:55-18:35

8. Video: Broken Child, Case Studies of Child Abuse Clip #2: Billy (5:34-7:56)

9. Mom’s healthy prenatal care put Lucian on a trajectory of optimal physical and emotional health

10. Mom’s poor prenatal care put Billy on a lifelong trajectory for health and emotional problems

11. Transgenerational Transmission “… the handing down of a susceptibility from parent to child.” Mothers who report experiencing stress during pregnancy are more likely to have babies who are hyperactive and developmentally delayed Newborns of depressed mothers are more irritable and harder to soothe, have more problems sleeping and have higher levels of the stress hormone cortisol in their blood

12. Physical Development Height and Weight Nutrition Physical Activity Dental, Vision and Hearing

13. Physical Development Lucian On target for height and weight Regular checkups Immunizations up-to-date Good teeth Excellent health Breastfed, so good immunities Billy Malnourished and anemic Bottle mouth and rotten teeth Chronic untreated ear infections with possible hearing loss Compromised lung function from second- hand smoke No immunizations Bleeding diaper rash

14. Motor Development Gross motor development Fine motor development Development of self-help skills

15. Motor Development Lucian Drinks unassisted from a cup Feeds self with spoon and fork Can undress self Sits on potty but still wears pull-ups at night Can work puzzles and stack blocks Can turn on dad’s iPhone and play Billy Prefers crawling but can run Drinks from bottle, not cup Eats with fingers Has never used spoon or fork Uses pincher grasp to pick up cigarette butts and food from floor Still in diapers

16. Language and Communication Receptive communication Expressive communication

17. Speech and Language Development Lucian Vocabulary of 300 words Can point and name correct animal in book “show me the dog” Carries out directions Initiates five-word sentences Asks for what he needs Knows songs, rhymes and fingerplays Billy Points to get what he needs Ear infections make it hard to hear words No words No books in the house Watches TV Never been read to or sung to

18. Left behind by kindergarten By age 4, the average child in a poor family might have been exposed to 13 million fewer words than a child in a working class family and 30 million fewer words than a child in a professional family. Source: http://www2.ed.gov/programs/readingfirst/2008conferences/language.pdfhttp://www2.ed.gov/programs/readingfirst/2008conferences/language.pdf

19. Cognitive Development Eagerness and curiosity Persistence Creativity and problem-solving Vocabulary

20. Cognitive Development Lucian Creativity and problem- solving Plays make believe with stuffed animals Can name all his body parts Can count to 10 Can work mechanical toy Vocabulary Billy Creativity and problem- solving Curiosity Persistence-finds hidden food Imitates mom smoking with stick Minimum receptive language

21. Children learn through experiences Eagerness and curiosity Persistence Creativity and problem-solving

22. Social and Emotional Development Trust and emotional security Self-regulation Self-concept

23. Social-Emotional Development Lucian Range of emotions Happy, emotionally calm, balanced Expresses affection warmly Comforts other kids when hurt Uses Dad as secure base from which to explore world Reciprocity in relationship Billy Plays with baby brother Flat affect Runs to mother Stays near mother

24. What has Billy learned about relationships?

25. What was Billy’s level of stress? How does it affect his development?

26. Who was their secure base? How did the adults in their life help them regulate?

27. Trauma and Young Children

28. Consequences of Trauma Depression Anxiety Aggression Conduct disorders Sexualized behaviors Eating problems Substance abuse Source: Harris, W.W., Putnam, F. W., and Fairbank, J.A. Mobilizing Trauma Resources for Children. January 8, 2004.

29. Child Welfare and Trauma “Trauma can be a single event, connected series of traumatic events or chronic lasting stress.” Diagnostic Classification: 0-3R Children in the child welfare system almost by definition have suffered trauma, often multiple traumatic events, and 50-75% exhibit behaviors or symptoms that need mental health treatment. Source: Landsverk, Burns, Stambaugh, & Rolls Reutz (2009). Psychosocial Interventions for Children and Adolescents in Foster Care: Review of Research Literature. Child Welfare, 88 (1), 49-69.

30. Did Billy have any signs of trauma? Signs of trauma in toddlers: Lack of verbal skills to express emotions Biting, kicking, tantrums, unprovoked aggression Disengagement with others Disinterested in toys Indiscriminate preferences of caregivers Skill regression Vigilance Lack of exploration

31. How will Billy react when separated from his mother?

32. What could have helped? What can help Billy now? What were the early signs of stress and indications that Billy was not doing well? What could have helped his mom to parent? What does Billy need now? What could be done to repair his relationship with his mother?

33. Summary: Understanding the Impacts of Maltreatment Children who have been abused, neglected and/or maltreated are more likely to experience toxic stress The impacts of abuse, neglect and/or maltreatment, even in the prenatal period, can negatively influence all developmental domains These delays persist through a child’s life, making it harder for them to do well in school and adulthood The “buffering” relationship with a loving, stable caregiver remains key to alleviating these negative impacts. It’s never too late!

34. Activity In your small group or with your partner, using the “Carly” case study, discuss the following questions: 1)Even though Carly is still a baby, what kinds of concerns do you have about her development (physical, motor, language, cognitive, social- emotional) into her toddler years, preschool years and eventually school years? 2)What does Carly need right now in order to get her on a positive trajectory of healthy development in all the domains? 3)What kind of recommendations do you have for Carly’s transition to a new foster family? How will her birth mom be involved?