2. 1 Trauma’s impact on children a potential legacy of pain Marjorie Withers, LCPC

3. 2 Workshop dedicated  To children and families who have shared their stories:  Who have reached for their core of resilience and coped with feelings and memories:  And To those that have been their heroes whether it was an auntie, a teacher, a therapist, a fireman or another child.  NO ONE IS EXEMPT FROM THE AFTERMATH OF TRAUMA

4. 3 Definition of Trauma  Horrific event beyond the scope of normal human experience. ( American Psychiatric Assoc., 1980)  Includes events that are perceived as life threatening.  Engenders: Fear, hopelessness, horror, helplessness.  Witnessing violence, and or being a victim of violence.  Being diagnosed with a life threatening disease.  Natural disasters, accidents, House fires loss caused by violence.  War, gang war.

5. 4 Kinds of Trauma  Complex trauma (repeated abuse)  Early childhood trauma (before age 6)  Domestic Violence  Death of a parent or family  Community /school violence  Natural Disasters  Wars  Medical Trauma  Abuse, physical, sexual, neglect

6. 5 Effects of Trauma on Children  Effects cognition  Effects affect/feelings  Effects behavior  Effects neurophysiology  Effects physiology  Responses are coping adaptations

7. 6 Impact on Physiology Traumatic event Prolonged Alarm Reaction Altered Neural System

8. 7 Prevalence of Trauma in Children in United States  Over 5 million children a year experience trauma.  Estimated 2 million from sexual or physical abuse.  Unknown number more terrorized by Domestic Violence in their home  Natural disasters, car accidents, life threatening illnesses, community violence.  By age 18, one out of four will have been effected by family or community violence.

9. 8 Recent studies indicate increase in the numbers of children effected by trauma  84% of second year college students have experienced at least one major trauma.  Poverty and substance abuse and social turmoil increase exposure rates of trauma.  Multi layers of trauma  Concept of Historical Trauma  Impacts on future generations

10. 9 Trauma knows no age limits  In- Utero effects of trauma (increase cortisol levels). Anxious babies  Infant and toddlers exposed to violence towards a parent have changes in behavior.  Exposure to violence impacts child as much as violence to a child.  Pre-verbal children show signs and symptoms of trauma similar to those of older children.

11. 10 Break  Think of children you have known and what trauma may have effected them.  What would you do for them if you knew they were trauma effected? ********************************** BRETHING BREAK:

12. 11 Impact of Trauma and its ramifications  Trauma can change behavior in multitudes of ways that may be confused with other diagnoses.  Frequently misdiagnosed as: ADHD Oppositional Defiant Disorder Learning Disability ADD

13. 12 Partial list of potential related symptoms:  Disruptive Behaviors  Fighting  Anger  “Don’t Care” attitude  Criminal behaviors  Non compliance with teachers, medical providers.  Poor frustration tolerance  Substance Abuse  Revert to behaviors of earlier stages/ages  Depression  Anxiety  Loss of interest  Poor Concentration  Distracted  Hyper vigilance  Startle response  Absences  Suicidal thoughts/behaviors  Hopeless & Helpless

14. 13 Post Traumatic Stress Symptoms  Numbness  Avoidance  Hyper arousal  Intrusive thoughts  Flashback  Hyperventilation  Anxiety  Crying  Inability to focus  Fear  Helpless/hopeless  Memory disruptions  Negative feelings  Loss of safety  Feeling out of control  Time (slowed down or sped up)  Physical symptoms

15. 14 Differential Response to trauma  Dissociation  Detached  Numb  Compliant  Decrease Heart Rate  Suspension of time  De-realization  “crazy like behavior”  Fainting/light headed  Hyperarousal  Hypervigilance  Anxious  Reactive  Alarm response  Increase Heart Rate  Freeze: Fear  Flight: Panic  Flight: Terror (Bruce Perry, PhD)

16. 15 Role of attachment on the impact of trauma.  Foundation of childhood trust and resilience.  Attached child has more skills for seeking safety and comfort.  Attachment can be effected by trauma and need repair such as when a toddler or young child looses their mother or attached figure.  Child feels betrayed by parent inability to keep them safe.

17. 16 Small Groups:  What are the major traumas you see in the children you work with?  What the most common symptoms you see?  What interventions or supports seem to help the child?  Share with large group:

18. 17 Lunch  Acute Post Traumatic Period  Trauma and memory at cellular level  Repeated replaying  Hypervigilant  Increased startle response  May have increased breathing rate  Fear, Panic, flashbacks, intrusive thoughts *******************************

19. 18 Self Protection in children  Avoidance  Dissociation as protection  Longer symptoms go on the more chance of having PTSD

20. 19 Annie  Annie was 5 when her mother was killed in a car accident.  Annie was in the car and kept calling her mother.  It took the rescue people 3 hours to get Annie out.

21. 20 Annie’s responses  Would not let go of her father  Screamed at night for her mother and would be unable to go to sleep again.  Annie would not interact with others when she returned to school.  She would get scared and start running around the class.

22. 21 Intervention  Calming skills  Reassurance  Safe place  One adult talking with her  Access to things that she enjoyed…coloring  Inclusion of Annie’s best friend when she wanted to rejoin an activity

23. 22 Therapy with father  Help family deal with the loss of mother separate from the accident  Information about the accident as Annie needs or wants it.  Place where she can remember it in playroom  Teaching father and significant others calming skills that work for Annie.  Breathing  Routine development and plan for nights.

24. 23 Role of a caring significant other  Children report difference a caring adult makes:  “My aunt was always there after my mom died”  She made me feel safe and special

25. 24 Children taking the blame  Fear that they should have or could have Protected Saved Avoided Prevented Kept trauma from occurring (wish for control) Need for correction of untrue thoughts or assumption

26. 25 Child needs  Stress management skills  Coherent narrative of what happened  Changing misassumptions that the experience caused…it happened because I was bad…changed to bad things can happen even to good kids.  Involvement of parents or safe loving involved adult  Normalcy restoration

27. 26 Summary  You can make a difference  Children are resilient when given tools  Mastery of soothing skills  Mastery of stress management skills  Time, love, reassurance, dependable environment that encourages safety planning.  Trauma reactions are not pathological.  Healing from wound to scar  I am a survivor…..I am Loved, loveable and I can soothe myself.