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

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

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

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

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

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’

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

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

A Little Bit of Neuroscience

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

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

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

Maslow’s Model

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

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

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

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

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

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

Thank You Dr Larry Cashion