1. The Resilient Child How Trauma Impacts a Child Nicole Havis, LCSW Family Therapist Cook Children’s Medical Center

2. Do you know this child?  Parents divorced last year  In a car accident over the summer  Gets bullied due to size  Difficulty concentrating  Seems fatigued  Often complains they are sick or don’t feel well – frequent visits to the nurse  Low self esteem  Grades continue to drop

3. How about this child?  Grandfather died last year  Diagnosed with cancer last month and going through chemo  New baby in the home  Keeping up with homework & excelling in school  Good attention span  Does not let negative comments from peers bring them down

4. What is the difference in the two? RESILIENCY!!

5. What is resilience?  The ability to overcome challenges and bounce back  The capability to persevere  The skill of being able to have minimal impact from the damages of adversity  Being able to prevent or minimalize the impact of difficulties in life

6. A resilient child has…  Someone that loves them unconditionally  A positive role model that they want to be like  Someone who praises them for being independent  An older friend or family member outside of their home to talk to about important things, feelings, or problem solving  A reliable family  A belief and confidence that things will be okay  A belief in a higher power  A desire to try new and different things  A willingness to achieve goals and to do well in life  A belief that what they do and who they are makes a difference in how things will turn out  Good self esteem  The ability to focus and stay on task  A good sense of humor  A desire to make plans and follow through  The ability to do nice things that make others think fondly of them

7. When do we notice that a child is resilient?  When something bad happens in a child’s family or personal life  When a tragedy strikes the school  When a child keeps trying despite setbacks

8. Why is resilience important?  Challenges and trauma occur in life – we encounter some sort of minor obstacle almost on a daily basis – no one is exempt from facing some adversity  We need to be able to face and overcome struggles in life  It is important that children and adults are able to rise above crises in life  Resilience is the ability to overcome and triumph

9. What is traumatic to a child?  The response to trauma is different for every child – some are naturally more resilient than others  What is traumatic to one child may not seem to phase another child  Trauma is personal to each individual  A child may find an event to be traumatic even if an adult doesn’t

10. Childhood Trauma  Car Accident  Death of a Family Member  Failing a test  Death of a Pet  Personal Illness or Surgery  Family Illness  Witnessing Family Violence  Being Physically Abused or Neglected  Emotional Abuse  Sexual Abuse  Poverty  Fire  Moving  Family Member in Military  Divorce  Drug Use in the Home  Family Member in Jail  Surgery  Bullying  CPS Removal  Natural Disasters  Mental Illness within the Family  Fleeing home as a refugee or immigrant  Witnessing Community Violence  Being Held Back in School  Repeated Doctor Appointments  Loss of Family Income

11. Repeated Trauma  Some children never experience a true trauma in their lives, some have one instance, and some experience trauma on a very regular basis  Some children build resiliency to situations and seem invincible – some seem to fall under the stress

12. Symptoms of Trauma in a Child  Symptoms vary by age, but some are constant through children and adults: Change in sleep or eating habits Dreams about the event Easily startled or jumpy Feeling angry Having a sense of fear that is irrational  Symptoms may appear that resemble those related to trauma, but may be a response to something else or just a normal part of aging  Symptoms generally interfere with the child and/or family’s life

13. Symptoms of Trauma Birth – Age 2  Tantrums/crying fits that are not easily soothed that last more than a few minutes  Overall sense of agitation, irritability, or aggression  Pulls away from adults that they used to show trust toward  Avoids touch or eye contact  Regression or loss of skills that were previously attained  Scared of things that were okay before and more easily startled  Difficulty separating from their caregiver  Decreased appetite, weight loss, and/or upset stomach  Nightmares and/or sleeplessness  Lethargic or listless

14. Symptoms of Trauma Age 3-5  Nightmares and/or difficulty sleeping  Regression – “baby talk” may return or may begin to wet their pants or bed  Poor development of social skills and acting out in public  Very disruptive behaviors (may be expelled from Preschool or Kindergarten)  Tantrums and/or crying fits that are not easily soothed or calmed  Overly bossy with a need for control – may be verbally abusive to adults or peers  Struggles with focus or learning – may begin to be diagnosed with learning disabilities  Low self esteem or confidence in themselves and their abilities  Frequent headaches, stomachaches, etc – frequently sees the nurse or doctor  Overly angry, aggressive, and/or agitated – easily set off  Fearful of being away from their caregiver – very clingy  Often lonely – withdraws from friends and family members  Difficulty trusting others and making friends  Seems to be confused – may have “wild eyes” when stressed  Reenacting the trauma through their play  Follows rules closely – has a fear of punishment  Decreased appetite, weight loss, and/or upset stomach  Fearful of things that remind them of the trauma – places, sounds, people, etc  Avoids touch and/or eye contact  Easily scared

15. Symptoms of Trauma Age 6-12  Has suicidal thoughts, plans, and/or attempts  Experiments with drugs and/or alcohol  Has sexual knowledge beyond that is normal for their age  Hoards food  Overreacts  Nightmares and/or difficulty sleeping  Acts out in public  Disruptive at school (may be expelled or suspended)  Overly bossy with a need for control – may be verbally abusive to adults or peers  Low self esteem or confidence in themselves and their abilities  Frequent headaches, stomachaches, etc – frequently sees the nurse or doctor  Overly angry, aggressive, and/or agitated – easily set off  Fearful of being away from their caregiver – very clingy  Often lonely – withdraws from friends and family members  Difficulty trusting others and making friends  Seems to be confused and has trouble focusing  Reenacting the trauma through their play  Decreased appetite, weight loss, and/or upset stomach  Fearful of things that remind them of the trauma – places, sounds, people, etc

16. Symptoms of Trauma Age 13-18  Has suicidal thoughts, plans, and/or attempts  Harms self (cutting, etc)  Uses drugs and/or alcohol  Hoards food  Nightmares and/or difficulty sleeping  Acts out in public  Disruptive at school (may be expelled or suspended)  Overly bossy with a need for control – may be verbally abusive to adults or peers  Low self esteem or confidence in themselves and their abilities  Frequent headaches, stomachaches, etc – frequently sees the nurse or doctor  Overly angry, aggressive, and/or agitated – easily set off  Often lonely – withdraws from friends and family members  Difficulty trusting others and making friends  Seems to be confused and has trouble focusing  Decreased appetite, weight loss, and/or upset stomach – or overeats  Fearful of things that remind them of the trauma – places, sounds, people, etc

17. Symptoms of Trauma Age 13-18  Romantic relationships that are inappropriate or unhealthy  Engaging in risky behaviors  Sexual promiscuity  Hanging out with people who are not good for them  Overly reliant on themselves  Runaways  Hostile behaviors  Panic attacks or flashbacks  Shame about the trauma  Defiant and starts fights  Alienated and difficulty relating to others  Does not see a future for themselves  Lack of ambition

18. Learning a Child’s Story  Sometimes an event happens to the whole school and everyone is aware that a trauma has occurred – an act of violence, natural disaster, death of a student and/or staff member  Sometimes a child’s family member may update you on what is occurring in the child’s life  Sometimes a child may confide in you about a trauma that is happening or that has happened in the past  In other instances you may notices the symptoms of trauma present in the child and not learn about the actual incident until much later  You may also never be aware of trauma that has occurred to a child

19. Responding to Trauma  Listen patiently and let the child know that you believe what they are telling you  Ensure the child knows that you don’t think poorly of them because of what has occurred  Don’t minimize their response  Validate the child’s feelings  Let the child know you support them and that they are safe  Refer the child for additional counseling if you feel it is warranted

20. Why are some children more resilient than others?  Genetics  Family dynamics  Life experiences  Education about resilience in past

21. Why wait until something bad happens to teach resiliency?  Would you accept a job as a teacher or a nurse with no education or experience and simply learn the skills after the fact?  Would you go to a surgeon who had never been to medical school and was planning to figure things out along the way?  Resilience should be promoted in children before a traumatic or challenging situation occurs so that they have necessary skills in place to handle things

22. Sources of Resiliency  Resiliency can be innate, but it can also be taught or promoted  Some skills may seem obvious or easy, but not be a given for every child  According to The International Resilience Project, resilience comes from features in a child labeled as “I Have,” “I Am,” and “I Can.”

23. I Have  These are external supports and resources in the child’s life  Before a child can develop internal means of resilience, they relay on outside sources

24. I Have  The resilient child has: People in their life whom they trust – they love the child unconditionally People who set limits and boundaries so they will know how to avoid danger People who will assist them if they are in trouble, sick, or in need of help/guidance People who want them to learn to be independent and self-sufficient as able People who will guide them and lead by a positive example

25. I Am  These are a child’s personal strengths that are internal  Incorporates beliefs, attitudes, and feelings

26. I Am  The resilient child: Is likeable and loveable One who likes to do good and nice things for others to show that they care Take responsibility for their actions Is sure that everything will be okay Has respect for both themselves and others

27. I Can  These factors incorporate social and interpersonal skills  These skills are learned by interacting with others and from those who teach them

28. I Can  The resilient child: Talks to others when they feel scared or bothered by something Problem solves on their own Finds help when needed Determines when it is a good time to stop and talk with someone or to take action Has self control when they feel like doing something that isn’t right or that could be harmful

29. Sources of Resiliency  A child may not have all three sources – I have, I am, and I can, but they need more than one – resiliency comes from a combination of these traits.  A child with good self-esteem (I am) who is unable to solve problems (I can) and has no one to turn to (I have) will not be resilient.  A loved child (I have) who lacks self confidence (I am) or the ability to trust others (I can) will lack resiliency.

30. Talking about Resiliency  Teach a vocabulary or resiliency – talk about the traits you see in them that are part of the I have, I am, and I can.  Some children simply don’t realize they have these things in place and need them to be identified.  Use “feeling” words and use yourself as an example - It’s okay to say that you feel sad or scared, but include how you overcome this

31. How can you promote resiliency at home or in the classroom?  Skills can be taught to all ages  Younger children rely more on the “I have” and later switch to “I can” – it is a continually process of learning the “I am”  Actively refer to resilient skills  Build up the child  Talk through situations as they occur

32. Children - Age 0-3  At this age, children are learning about trust and autonomy  They rely on others to provide for their basic physical and emotional needs  They learn to self-soothe and to have control over their body

33. Children - Age 0-3  When a child at this age makes a mistake, they either learn from it or feel shame  Through mistakes the child learns to trust themselves and also others  If the child is not allowed to make mistakes or is overly criticized, they will begin to doubt themselves and/or their abilities – they also might feel shameful

34. Teaching Resilience, Age 0-3  Provide unconditional love and support  Enforce age appropriate rules and limits  Model good behavior that is optimistic and confident  Give praise for accomplishments  Offer encouragement when the child attempts things on their own  Help the child to identify and label their feelings  Begin education about trying situations

35. Teaching Resilience, Age 0-3  Give them safe areas to explore their freedom  Offer an explanation with rules and discipline  Give comfort and encouragement when you see that the child is stressed  Provide stability and a routine, but also expose the child to new and different things

36. Age 0-3 -- Example  An infant is laying on their back crying loudly and flailing. There is no indication of what is wrong, but the baby will not calm down.  Resilience is promoted when: You pick the baby up and soothe while checking for a cause of distress.  Resilience is not promoted when: You tell the baby to stop crying, change the diaper, and walk away

37. Age 0-3 -- Example  You are at the store with a two-year-old. She grabs a candy bar, opens it, and takes a bite. You try to take it away and she yells, “No!”  Resilience is promoted when: You quietly remove her from the situation and explain the rules. Offer a positive alternative behavior.  Resilience is not promoted when: She is allowed to finish the candy, if you hit her, or loudly scold her in public.

38. The Resilient Child - Age 3  Feels safe and secure with their parents  Feels loved and is proud of themselves  Knows their needs will be met  Feels safe exploring and trying new things  Knows about rules and consequences  Has a day-to-day routine  Likes to learn new things  Uses words to express their feelings  Has self-control

39. Children - Age 4-7  At this age, children are learning about initiative and usually stay very active  Imaginative play is big and the child sometimes cannot separate fantasy from reality  The child wants to be helpful, but might have difficulty staying on task

40. Children - Age 4-7  Children at this age ask and endless amount of questions and are very inquisitive  While the questions are sometimes tiring, it is important to be respectful  If their thoughts and questions are dismissed or ignored, they may feel unable to take initiative or guilty/unworthy.

41. Teaching Resilience, Age 4-7  Provide unconditional love and support  Verbally express love and praise  Use a hug or calm voice to soothe a child  Teach a child how to calm themself down  Be a good role model  Have set rules and consequences  Encourage independence and autonomy

42. Teaching Resilience, Age 4-7  Continue to teach about feelings in themselves and in others  Gradually teach the child to adverse situations  Encourage empathy and kindness  Teach communication skills  Model and teach how to problem solve  Teach about taking responsibility for their actions and what this means  Give encouragement in stressful situations

43. Age 4-7 -- Example  A single mother has to move to another city for her job. She has to leave her daughter with a family member temporarily while she saves up for daycare.  Resilience is promoted when: The mother explains to her daughter why she is moving and what the job can provide. She tells the child she loves her and that she will be safe with the family member. A plan is made to communicate and visit.  Resilience is not promoted when: You shame the child for crying when you leave and do not explain things or offer any details about where she will be and for how long.

44. Age 4-7 -- Example  A seven year old boy is in the yard with his father. His father gets into an argument with the neighbor who stabs him.  Resilience is promoted when: If the boy feels he can help his father and tries to comfort him. When the boy knows how to seek help and does so.  Resilience is not promoted when: If the boy cries and takes no action to assist and is later scolded for doing so.

45. The Resilient Child – Age 7  Proud of their accomplishments  Takes initiative  Problem solves on their own  Feels confidence when they are faced with a struggle  Understands the relationship of actions and consequences  Takes responsibility for their actions  Able to better communicate  Feels safe and loved  Has good self-esteem

46. Children - Age 8-11  The child is learning to be more productive and is mastering skills  Success and achievements are desired  Friendships and acceptance by peers are important  Able to follow through with things

47. Children - Age 8-11  When the child does not find success, they will feel inferior. They may become sensitive and start to question their abilities.  If a peer, teacher, or caregiver makes the child feel that they are not capable they will buy into this and question their self- worth and be insecure.

48. Teaching Resilience, Age 8-11  Provide unconditional love and support  Verbally express love and praise  Set limits and offer verbal reminders  Model good behavior  Offer explanations about rules and expectations as needed  Praise accomplishments and good behavior  Allow them to solve their own problems  Encourage and model good communication

49. Teaching Resilience, Age 8-11  Balance autonomy with help as needed  Follow a consequence/punishment with love and empathy  Communicate about new expectations as the child grows up  Encourage the child to accept responsibility without making them feel shameful  Model flexibility

50. Age 8-11 -- Example  An eleven-year-old girl was babysitting her three year old brother when the house caught on fire. She tried to put out the fire and couldn’t. She tried to save her brother, but couldn’t reach him and he died. She was able to escape.  Resilience is promoted when: Share grief with the family. Remind the girl that she is loved and that you know she tried to save the house and her brother.  Resilience is not promoted when: The girl is blamed for the fire and not saving her brother.

51. Age 8-11 -- Example  A nine-year-old boy left home even when he was told not to. The father didn’t know the boy left until is was very late and he discovered the boy was not there.  Resilience is promoted when: Have a conversation with the boy when he returns home to ask why he did this. Communicate this was not okay and that consequence. Make a plan for the future.  Resilience is not promoted when: You yell at or spank the boy when he comes home. If you accuse him of being bad and make him feel guilty.

52. The Resilient Child – Age 11  Is flexible  Knows when to do things on their own and when to ask for help  Has confidence  Takes initiative and completes activities  Able to solve problems  Has good self-esteem  Takes responsibility  Recognizes feelings in self and others  Recovers from adversities  Has empathy and is kind

53. Overall Checklist of Resiliency  The child: Has someone that loves and supports them unconditionally Has a trusted adult to talk to Receives praise for being autonomous Can count on family/friends/teachers to be there if they need them Has a good role model Thinks everything will be okay in the end Does kind things for others

54. Overall Checklist of Resiliency  The child: Believes in a higher power Is not afraid to try new things Likes to set goals and do what it takes to accomplish them Feels like they matter Has good self-esteem Can focus on something and follow through Has a sense of humor

55. Teaching Strategies  Talk about adversities that people might face – problem solve what to do when they happen  Ask children to use examples from their life and how they responded

56. Teaching Strategies  Use the word resilience and talk about what it means – identify these traits when you see them in a child or in class  Teach the class the “vocabulary of resilience” – encourage them to identify this when seen in class

57. Teaching Strategies  Discuss the “I have,” “I am,” and “I can.” Make lists of what the child has that falls in each category.  Help children identify who is there to support them. Ensure they know they can come to you. When they do come – listen and be supportive.  Discuss other resources that might be available.

58. Teaching Strategies  Present a possible adverse situation and ask these questions for a single child or group to discuss: What would you do? How would you feel if this happened? What resilience factors could be used? How do you think the situation ends?  Don’t be afraid to use a personal example and how you responded to model good resiliency skills.

59. Teaching Strategies  Be resilient and be a role model. Don’t pretend that you don’t have problems. Model how to deal with adversity and changes.  Don’t try to protect children from problems, changes, or difficulties. Instead, teach them how to cope.  Teach how to problem solve.  Help to identify emotions  Model communication skills and teach how to do this

60. Teaching Strategies  Offer choices and support decisions  Teach and model empathy and kindness  Give opportunities to try new things – be supportive  Believe in children and convey this to them.

61. Overview of Trauma and Resilience  Don’t be afraid to talk about a situation when something bad happens  Use yourself as an example  Don’t feel the need to hide your emotions  Remember that it is okay to talk about feelings  Be supportive  Remember that you might not know a child’s whole story

62. Remind Children… "You have everything you need to be successful – and you can do it.“ --Roger Mills

63. Questions? nicole.havis@cookchildrens.org