1. Trauma and Child Brain Development: the physiological impact of traumatic stress and implications service systems Joshua Arvidson, MSS., LCSW Alaska Child Trauma Center at Anchorage Community Mental Health Services Associate Director Complex Trauma Treatment Network National Child Traumatic Stress Network

2. National Child Traumatic Stress Network Sites LOS ANGELES Category I - National Center MA CT NY PA NM UT CO MO OH VA Category II – Intervention, Development, and Evaluation Centers Category III – Community Treatment and Service Centers ME FL AL CA OR WA IL DC NC DURHAM OK MT ID WI MI SC NJ MD TX TN GA LA MS NYC FY01-02 – Member Centers SAN DIEGO SAN FRANCISCO AZ SD AK WV PORTLAND EUGENE JERSEY CITY DE MN NH Blaustein and Kinniburgh, 2010

3. What is “trauma”?

4. Definition of Trauma: DSM-IV [An] event involving actual or threatened death, serious injury, or threat to physical integrity. The individual’s response includes intense fear, horror, or helplessness.

5. Trauma Exposure, Adverse Experiences, and Diverse Symptom Profiles in a National Sample of Traumatized Children Robert S. Pynoos, MD, John A. Fairbank, PhD, Ernestine C. Briggs-King, PhD, Alan Steinberg, PhD, Christopher Layne, PhD, Bradley Stolbach, PhD and Sarah Ostrowski Sarah Ostrowski National Center for Child Traumatic Stress

6. Prevalence of Multiple Traumas NCTSN Core Data Set

7. Met Full Criteria for PTSD Percent NCTSN Core Data Set

8. What is “Trauma”?: “Overwhelming demands placed upon the physiological system that result in a profound felt sense of vulnerability and/or loss of control.” R.D. Macy R.D. Macy

9. The Human Brain:

10. 10 Joshua Arvidson, 2011

11. 11 Joshua Arvidson, 2011

12. 12 Joshua Arvidson, 2011

13. Blodgett, 2011

14. 14 Estimates of the Population Attributable Risk* (PAR) of Adverse Childhood Experiences for Selected Outcomes in Women Mental Health: PAR Current depression54% Depressed affect41% Suicide attempt58% Drug Abuse: Alcoholism65% Drug abuse50% IV drug abuse78% Promiscuity48% Crime Victim: Sexual assault62% Domestic violence52% *Based upon the prevalence of one or more ACEs (62%) and the adjusted odds ratio >1 ACE.

15. Arvidson et al 2011

17. Number of Traumas X Total Co-morbid Conditions NCTSN Core Data Set (N=8,120) NCTSN Core Data Set 2010

18. Atkinson and Lamar, 2010 Arvidson et all 2011 Children who receive comprehensive intervention focused on the caregiving system experience dramatic improvements in behavioral outcomes.

19. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005