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

2. 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

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

4. 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

5. 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)

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

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

8. Adverse Childhood Experiences (ACE) studies

10. 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

11. 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

12. 2
Self esteem
Emotion regulation
Relational capacity

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

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

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

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

17. 3 year old children – ‘normal’ & ‘extreme neglect’

18. 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

19. 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

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

21. 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

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

24. 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

26. Forthcoming book…
London: Jessica Kingsley Publishers.

28. Thank you! Rosaleen.mcelvaney@dcu.ie