1. Effects of Trauma and Family Violence on the Development of Children Dr Larry Cashion Specialist Consultant Psychologist Presented at the Communities for Children Connections Conference Launceston, 29 June 2011

2. Trauma  A deeply distressing or disturbing experience –Oxford Dictionary  Posttraumatic Stress Disorder –DSM-IV-TR 309.81  The development of characteristic symptoms following exposure to an extreme traumatic experience stressor  Direct personal experience OR  Vicarious experience with close relationship

3. Trauma without PTSD  PTSD requires specific outcomes in response to trauma  Some children experience incidents at being traumatic when others do not  Some children do not develop PTSD  However, that does not mean there is no effect on children simply by the absence of sufficient diagnostic criteria for a diagnosis of PTSD

4. Types of Trauma  This presentation will focus on family-based trauma  What we are considering includes: –Family violence –Deprivation and neglect –Exposure to high risk situations –Sexual abuse

5. Trauma, Deprivation and Neglect  These issues can affect the quality and quantity of social and emotional responses by children  Trauma can be directly or indirectly experienced  Deprivation is a lack of physical care and of social and emotional stimulation and interchange  Neglect is a failure of caregivers to fulfil their caretaker obligations to children

6. Trauma Effects  Children with traumatic experiences will often demonstrate avoidance behaviours  This means they will avoid thinking about their experiences by any means  Some will have affective numbing and will be highly unresponsive  It is often helpful to treat the child as a ‘survivor’ rather than a ‘victim’

7. Deprivation-Type Effects  Inability or dysfunction in forming normal social relationships or connecting with others  May manifest similarly to autism spectrum disorders –Repetitive stereotyped OCD-like behaviours –Poor eye contact –Delayed language  Mood and anxiety problems

8. Neglect-Type Effects  Limitations in the ability to appropriately read nonverbal facial and gestural cues  Language deficits  below age normal  Limited problem-solving skills  IQ deficits  nutritional, interpersonal and environmental factors  Learned helplessness  no matter what I do it won’t make any difference  Fear of caregiver retribution

9. A Little Bit of Neuroscience

10. Ways of Examining Trauma Effects  Psychological –Cognitive –Emotional  Physiological –Stress responses by the body  Neurological –Changes in brain function –Changes in brain structure

11. Theories of Child Development  Erickson’s theory of psychosocial development –Each life stage has a psychological crisis that needs to be met successfully  Maslow’s hierarchy of needs –Certain needs have to be fulfilled to move the to next level of development  Attachment theories –Failure to develop significant and appropriate attachments has lifelong effects

12. Erickson’s Psychosocial Crises  Infancy: Trust vs Mistrust  Early childhood: Autonomy vs Shame  Play age: Initiative vs Guilt  Middle childhood: Industry vs Inferiority  Adolescence: Identity vs Role Confusion

13. Maslow’s Model

14. Physiological Responses  Dizziness  Headaches  Chest pain/tightness  Difficulty breathing  Muscle tremors  Sensitivity to sights, sounds, smells, touches and tastes ‘associated’ with the traumatic event  Fatigue  Elevated blood pressure  Profuse sweating  Vomiting/nausea  Teeth grinding  Somatic disturbance

15. Physiological Effects  Increases in stress hormones –Cortisol –Adrenaline (epinephrine) –Noradrenaline (norepinephrine)  Long term depression of function  Can lead to biological depression due to long term effects on brain chemistry

16. Neurological Effects  Amygdala versus Hippocampus in memory formation  Failure to develop neural networks required for social, academic, and adaptive functioning  Unusual patterns of resource utilisation  Over-excitement of some brain areas with under-excitement in others

17. How to Help?  The world as a safe place (even though adults know it’s not)  Consistent behaviours have consistent outcomes – includes provision of clear boundaries  Positive regard in the face of challenging behaviour  The response to the child is more important that what is said – good behaviour needs to be modelled – good behaviour needs to be explicitly taught

18. How this Helps?  Consistency and safety allows resources to psychologically and neurologically recover resources for development, not just crisis coping  Children who experience trauma in their home environment often don’t know how to behave appropriate because it is not modelled

19. The 3-Phase Approach  STOP –The word ‘stop’ has one meaning – words such as ‘no’ and ‘don’t’ have multiple meanings  DON’T DO THAT –The child needs to know what not to do – carers often say ‘don’t do that’ – vague/confusing  DO THIS –This is the most important part that is very often missed –Children are not little adults – children who have experienced trauma more so – it cannot be assumed they will learn by osmosis

20. Thank You Dr Larry Cashion larry@cashion.net www.drcashion.com.au