SAOL, March, 2016 The impact of trauma on children Rosaleen McElvaney

What do we mean by ‘trauma’? Introduced to DSM in 3rd edition (APA, 1980) Post Traumatic Stress Disorder (PTSD) Normal reaction to an abnormal event

Post Traumatic Stress Disorder Experience that is emotionally overwhelming Research following 2nd World War Work with Vietnam Veterans

Complex trauma chronic, prolonged exposure; entrapment; developmental (Herman,1992) “Children’s experiences of multiple traumatic events that occur within the caregiving system” (p.5) “Simultaneous or sequential occurrences of child maltreatment – including emotional abuse and neglect, sexual abuse, physical abuse, and witnessing domestic violence-that are chronic and begin in early childhood” (p.5) Cook et al. (eds) (2003). Complex trauma in children and adolescents. National child traumatic stress network www.nctsn.org

Complex trauma - outcomes extend beyond PTSD; “span multiple domains of impairment and include: (a) self-regulatory, attachment, anxiety, and affective disorders in infancy and chidhood; (b) addictions, aggression, social helplessness and eating disorders; (c)dissociative, somataform, cardiovascular, metabolic, and immunological disorders; (d) sexual disorders in adolescence and adulthood; and (e) revictimization” (p.5)

Domains of impairment Attachment Biology Affect regulation Dissociation Behavioural control Cognition Self-concept

Developmental Trauma Emphasis on impact as child develops Development as cumulative Impact as cumulative

Adverse Childhood Experiences (ACE) studies

Psychological impact – what influences it? Developmental context: pre-trauma Intrapersonal: self esteem; emotional regulation capacity; general coping capacity Interpersonal: attachment; family & peer relationships Community: school; sports; engagement Society: attitudes; policy; legislation

Psychological impact Nature of the trauma Exposure to or experience of physical, sexual, emotional assault, abuse or neglect; acute or chronic Individual response to the trauma Meaning/making sense of; emotional reaction Developmental context: post-trauma Intrapersonal: feelings, thoughts, meaning Interpersonal: responses of others and supports: Community: involvement in co-curricular activities; how society responds

2 Self esteem Emotion regulation Relational capacity

Self Esteem Egocentricism: the world revolves around me Bad things happening makes children feel bad about themselves Vulnerable children are more at risk

Self Esteem Egocentricism: It’s not your fault Support child in developing competence Positive messages: Reward child for achievements

Emotion regulation Developmental tasks Left brain/Right brain - Thinking before action Child overwhelmed with intense emotions Stress hormones

Stan and Ute Lawrence, Canada, 1999 (cited in van der Kolk, 2013)

3 year old children – ‘normal’ & ‘extreme neglect’

Emotion regulation Regulating FOR the child Helping child to identify /recognise and express emotions in a safe way Helping child to talk… Distraction techniques Right brian to right brain communication (Allan Schore) - Attunement

Relational capacity Reflective functioning: capacity to reflect on own emotional experience and experience in relation to others (Fonagy et al., 1997) Impact on cognitive, social and emotional functioning Reading social cues in relationships

Relational capacity Teaching reflective functioning Learning to trust; taking risks Separating out this person from that person Teaching reflective functioning

Research on how children overcome adversity Problem-focused coping strategies (Everall et al., 2006) Face up to the problem Reflect on the problem Creatively generate & plan possible solutions Reach out for help Relationships: supportive peer, parent and other relationships Future oriented behaviour: experimenting, taking charge

Post-traumatic growth Kintsukuroi – more beautiful for having been broken Stephen Joseph’s work: development of new capacities Research findings: Compassion & empathy

What gets in the way of helping children? Being open to the possibility… Our own history…. Not noticing, seeing, hearing… Not being able to tolerate their distress… Our beliefs about what is best…. Each child is unique…in order to help them we must listen to them We all have the capacity to know what’s right for us; trauma gets in the way; the challenge is finding the best way for this child

Forthcoming book… London: Jessica Kingsley Publishers.

Thank you! Rosaleen.mcelvaney@dcu.ie