2.  40 years ago more focus on how children develop and nature versus nurture  Attachment literature started with animals (imprinting) and moved to babies  Mary Ainsworth and the strange situation  Harlow’s monkeys  More recent studies on orphanage reared children  Capacity to measure stress (cortisol) and look at brains- functional MRI”S

4.  Brain development begins before babies are born.  Nerve cells are ready to make connections  These connections are what we are talking about when we say ‘brain development’  700 hundred new connections are formed every second in the first few years of life

8.  Stress hormones released at high and sustained levels (cortisol, adrenaline)  Neural circuits damaged  Troubling circuits established  Brain function impaired especially affect and memory

9.  Exposure to violence  Neglect  Abuse  Permanent changes caused by alcohol etc. in-utero  Maternal mental illness including post partum depression

10.  1. Recurrent physical abuse 2. Recurrent emotional abuse 3. Contact sexual abuse 4. An alcohol and/or drug abuser in the household 5. An incarcerated household member 6. Someone who is chronically depressed, mentally ill, institutionalized, or suicidal 7. Mother is treated violently 8. One or no parents 9. Emotional or physical neglect

11.  Regulation of affect and impulses  Behavioral control  Attention or consciousness  Self-perception  Attachment/Interpersonal relationships  Biology  Cognition  Systems of Meaning

12.  Emotional self-regulation  Labeling and expressing feelings  Over reaction to stress, easily overwhelmed  Limited self-calming skills  Relationship challenges  Excessive risk taking in many areas

13.  Impulse control  Oppositional behavior  Aggression  Substance abuse  Eating disorders  Social isolation  Excessive compliance  Sleep disorders  Reenactment of trauma in behavior

14.  Dissociation – “spaces out”, forgetful, no memories  De realization- feel like you are walking in a dream  Depersonalization- may not know what it feels like to be in one’s body  Difficulties in attention, focusing and completing tasks  Difficulty planning and anticipating  Difficulty processing new information

15.  Feel their lives do not make sense or have purpose  View the world through a dark lens  Despair and hopelessness  Lack hope and confidence around positive changes  Develop a negative self- view  Apply self-blame

16.  Problems with coordination and balance  Physical symptoms replace their inability to put words and feelings to their traumatic experience  ACES- increased medical problems

17.  Inability to trust others  Interpersonal problems  Social isolation  Boundary Problems  Re victimization  Victimizing others

18.  Sleep problems  Attachment problems, separation issues  Eating difficulties  Hyper vigilance  Excessive crying or little crying  Staring/disengagement

19.  Trouble concentrating, short attention span  Trouble following directions and remembering routines  Peer related problems  Social and emotional challenges  Poor executive functioning

20.  Research has shown that the presence of a sensitive and responsive caregiver can prevent elevations in cortisol among toddlers even in children who tend to be temperamentally fearful or anxious. (1996)  Child Development, (67).

21.  Keep the relationship in mind.  Establish routines and be predictable.  Safety is a priority and includes emotional as well as physical safety.  Think out loud  Be organized  Listen to people’s stories  Normalize behaviors  Mourning losses  Learn about trauma informed care