1. Trauma Informed Care for Children –
Best Practices for Supporting
Emotional and Intellectual Development
Introduce LDA

2. Objectives What is trauma
How does it impact brain and social emotional development
How it impacts the life of a child and the ability to learn
Understanding behavior
Strategies
Self Care
What we will be looking at today

3. What is Trauma
Defined as an experience that threatens life or may cause physical injury and is so powerful and dangerous that it overwhelms the child’s capacity to regulate emotions
Generally, traumatic events evoke feelings of extreme fear and helplessness
Reactions to traumatic events are determined by the subjective experience of the child, which could be impacted by developmental and cultural factors
What is extremely traumatic for one child may be less so for another

4. Childhood trauma…
…can be any negative experience that causes major stress for an infant or child, interfering with a child’s social emotional and cognitive development

5. Quick Overview of Brain Development
Infant- Child
synapses organize the brain
by age 3 the brain has reached almost 90% of it adult size
Pre puberty – Adolescent
frontal lobe growth spurt – governs planning, impulse control and reasoning
goes through a process of pruning synapses – somewhat like the infant and toddlers brain
still the age of impulsivity until their frontal lobes are matured.
Young Adult -Adult
brain tissue continues to develop sometimes until the age of 32 – typically though mid-twenties
the brain develops more myelin to insulate the nerve fibers and speed neural processing – occurs in the frontal lobe
Adult – Older Adult
neurons continue to grow and change well into adulthood,, which challenges the traditional belief that adult brain cells, or neurons, are largely static and unable to change their structures in response to new experiences ]‬

6. The concept of resilience
It is the processes by which children develop into well-adjusted adults despite adverse circumstances
Brain plasticity – the ability of the brain to respond to experience by modifying its structure and function

7. Impact on Social and Emotional Development Surviving or Thriving?

9. Social Emotional Development: Attunement and Attachment
Attunement impacts emotions – development and regulation – it is how attachment happens
Attachment develops over time and impacts the ability to form relationships and interact with others

10. Attunement and Attachment How do these develop
Young children are developing communication, empathy, relationships, self- awareness, self-regulation and a basic sense of self
Inconsistency in young years can undermine healthy development – inconsistent caregivers
This makes young children especially vulnerable to the impact of trauma

11. Conditions that support human development
Protection and nurturance from adults
Opportunities to explore and learn from the environment
Remember that….
Experiences are encoded in the brain through learning and memory – pleasant and unpleasant

12. Stress: Positive stress – Tolerable stress – Toxic stress –
Moderate, brief and generally a normal part of life. Such as entering a new child care or school setting
Learning to adjust to this type of stress is an essential component of healthy development.
Tolerable stress –
Events that have the potential to alter the developing brain negatively
Occur infrequently and give the brain time to recover – death of a love one
Toxic stress –
Strong, frequent and prolonged activation of the body’s stress response system – chronic neglect or traumatic event -

13. Situations that can be stressful or traumatic:
Physical or sexual abuse
Caregiver’s substance abuse
Abandonment
Neglect
The death or loss of a loved one
Life-threatening illness in a caregiver
Witnessing domestic violence
Automobile accidents or other serious accidents
Bullying
Life-threatening health situations and/or painful medical procedures
Witnessing or experiencing community violence (e.g., shootings, stabbings, robbery, or fighting at home, in the neighborhood, or at school)
Witnessing police activity or having a close relative incarcerated
Life-threatening natural disasters
Acts or threats of terrorism (viewed in person or on television)
Living in chronically chaotic environments in which housing and financial resources are not consistently available

14. PTSD and the brain
When posttraumatic stress disorder (PTSD) occurs, the brain gets stuck in the trauma and relives it over and over again.
Reminders of the trauma can trigger a flood of stress hormones before a child even knows what is happening.
Symptoms of childhood PTSD include:
zoning out,
withdrawing
sleep problems such as night terrors or repeated night waking
loss of developmental skills such as a child who is learning to speak suddenly stops talking,
violent play such as acting out threats and physical attacks with toys over and over again

15. Risk Factors for Post-Trauma Adjustment Problems
Previous trauma exposure
Severity of trauma
Extent of exposure
Proximity of trauma
Understanding and personal significance
Parent distress
Separation from caregiver
General predisposition - temperament
Lack of material/social resources

16. What you might observe in young children:
Remember, young children do not always have the words to tell you what has happened to them or how they feel.
Behavior is a better gauge and sudden changes in behavior can be a sign of trauma exposure.
Separation anxiety or clinginess towards teachers or primary caregivers
Regression in previously mastered stages of development (e.g., baby talk or bedwetting/toileting accidents)
Lack of developmental progress (e.g., not progressing at same level as peers)
Re-creating the traumatic event (e.g., repeatedly talking about, “playing” out, or drawing the event)
Difficulty at naptime or bedtime (e.g., avoiding sleep, waking up, or nightmares)
Increased somatic complaints (e.g., headaches, stomachaches, overreacting to minor bumps and bruises)
Changes in behavior (e.g., appetite, unexplained absences, angry outbursts, decreased attention, withdrawal)
Over- or under-reacting to physical contact, bright lighting, sudden movements, or loud sounds (e.g., bells, slamming doors, or sirens)
Increased distress (unusually whiny, irritable, moody)
Anxiety, fear, and worry about safety of self and others
Worry about recurrence of the traumatic event
New fears (e.g., fear of the dark, animals, or monsters)
Statements and questions about death and dying

17. What you might observe in school age students:
• Recreating the event (e.g., repeatedly talking about, “playing” out, or drawing the event)
• Over- or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements
• Statements and questions about death and dying
• Difficulty with authority, redirection, or criticism
• Re-experiencing the trauma (e.g., nightmares or disturbing memories during the day)
• Hyperarousal (e.g., sleep disturbance, tendency to be easily startled)
• Avoidance behaviors (e.g., resisting going to places that remind them of the event)
• Emotional numbing (e.g., seeming to have no feeling about the event)
• Anxiety, fear, and worry about safety of self and others (more clingy with teacher or parent)
• Worry about recurrence of violence
• Increased distress (unusually whiny, irritable, moody)
• Increase in activity level
• Decreased attention and/or concentration
• Withdrawal from others or activities
• Angry outbursts and/or aggression
• Absenteeism
• Distrust of others, affecting how children interact with both adults and peers
• Increased somatic complaints (e.g., headaches, stomachaches, overreaction to minor bumps and bruises)
Changes in school performance
A change in ability to interpret and respond appropriately to social cues

18. Impact in general…
First impressions last a lifetime. A child’s brain will blossom from lots of positive, nurturing experiences
Negative experiences have the opposite effect on brain development— trauma can leave a lasting imprint on the developing brain.
The younger a child is, the more vulnerable their brain is to the effects of trauma

19. Impact in general continued
When children feel calm and safe, they focus their energy on development
Children who are dealing with trauma are often in a chronic state of crisis
They focus on trying to feel “OK” or normal- this compromises their ability to function
Traumatized children have more speech problems and difficulty learning

20. Children who have experienced traumatic events may have behavioral problems, or their suffering may not be apparent at all
It is important to be aware of both the children who act out and the quiet children who don’t appear to have behavioral problems.
Be alert to the possibility of misdiagnosis due to the many presentations of trauma-related anxiety.
For instance, many behaviors seen in children who have experienced trauma are nearly identical to those of children with developmental delays, ADHD and other mental health conditions.
Without recognition of the possibility that a child is experiencing childhood traumatic stress, adults may develop a treatment plan that does not fully address the specific needs of that child with regard to trauma.

21. How Common are Traumatic Experiences?
69% of the general US population report exposure to one or more traumatic events
14% to 43% of children/adolescences report having experienced a traumatic event
Up to 91% of youth living in marginalized settings experience some kind of trauma exposure

22. Statically Speaking…
One out of every 4 school age child has been exposed to a traumatic event that can affect their social development impacting learning and/or behavior.

23. Remember resilience
Some children, if given support, will recover within a few weeks or months from the fear and anxiety caused by a traumatic experience.
However, some children will need more help over a longer period of time in order to heal and may need continuing support from family, teachers, or mental health professionals.
Anniversaries of the events or media reports may act as reminders to the child, causing a recurrence of symptoms, feelings, and behaviors.

24. Let’s review the facts….

25. FACT: Impacts Learning
Single exposure to traumatic events may cause jumpiness, intrusive thoughts, interrupted sleep and nightmares, anger and moodiness, and/or social withdrawal—any of which can interfere with concentration and memory.
Chronic exposure to traumatic events, especially during a child’s early years, can:
• Adversely affect social and emotional development attention, memory, and cognition
• Reduce a child’s ability to focus, organize, and process information – executive functioning
• Interfere with effective problem solving and/or planning
• Result in overwhelming feelings of frustration and anxiety

26. FACT: Impacts School Performance
• Lower GPA
• Higher rate of school absences • Increased drop-out • More suspensions and expulsions
• Decreased reading ability

27. FACT: Impact on Physical/ Social and Emotional Distress
Physical symptoms like headaches and stomachaches
Poor control of emotions
Inconsistent academic performance
Unpredictable and/or impulsive behavior
Over or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements
Social and Emotional reactions
Thinking others are violating their personal space, i.e., “What are you looking at?”
Blowing up when being corrected or told what to do by an authority figure
Fighting when criticized or teased by others
Resisting transition and/or change

28. FACT: You can help a child who has been traumatized…
Think regulation not control
This fosters safe relationships
Maintain routines.
Any “normalcy” will communicate the message that the child is safe and life will go on
Understand that children cope by re-enacting trauma through play or through their interactions with others.
While this is a way for the child to cope, resist their efforts to draw you into a negative repetition of the trauma: for instance, some children will provoke teachers or care giving adults in order to replay abusive situations at home

29. How do we start this shift?
Awareness – understanding the psychobiological impact of trauma on the brain
Creating safe predictable environments
Support children as they develop social and emotional skills
Teach “calming” skills to all children - mindfulness
Lens shift:
From: “What is wrong with you?”
To: “What happened to you?”

30. Safe Emotional Environment
Give children choices
Often traumatic events involve loss of control and/or chaos, so you can help children feel safe by providing them with some choices or control when appropriate
Provide a safe place for the child to talk about what happened
Set aside a designated time and place for sharing to help the child know it is okay to talk about what happened
Be aware of other children’s reactions to the traumatized child and to the information they share
Protect the traumatized child from peers’ curiosity and protect peers from the details of a child’s trauma

31. Safe Physical Environment
Be sensitive to the cues in the environment that may cause a reaction in the traumatized child
For example, survivors of natural storm-related disasters might react very badly to threatening weather or storm warnings
Children may increase problem behaviors near an anniversary of a traumatic event
Anticipate difficult times and provide additional support.
Many kinds of situations may be reminders
If you are able to identify reminders, you can help by preparing the child for the situation
Warn children if you will be doing something out of the ordinary, such as turning off the lights or making a sudden loud noise

32. The Learning Environment
While a traumatized child might not meet eligibility criteria for special education, consider making accommodations and modifications to academic work for a short time, even including these in a 504 plan.
You might:
Shorten assignments – avoid long “wait” times
Allow additional time to complete tasks
Give permission to go to a “safe place” in the room if feelings become overwhelming – “soft landing” area
Provide additional support for organizing and remembering tasks

33. The Behavioral Environment
Set clear, firm expectations for inappropriate behavior and develop logical rather than punitive consequences – teach and support the behavior you want to see happen
Remember you are always modeling behavior
Recognize that behavioral problems may be related to trauma and that even the most disruptive behaviors can be driven by trauma-related anxiety – it is not personal

34. Understanding behavior…

36. Patterns of Behavior
Look for patterns and the times that may be triggering behavior problems – try and change the trigger as a short-term solution
Communicate with family more frequently
Maintain a normal routine, but consider adjusting expectations – if possible and necessary

37. Collect data on persistent behavior to track the occurrences
Data Collection for: __________________________
Behavior Observed: __________________________
Time
Mon.
Tues.
Wed.
Thurs.
Fri.
8:00-9:00
9:00-10:00
10:00-11:00
11:00-12:00
12:00-1:00
1:00-2:00
2:00-3:00
3:00-4:00

38. Reframe the Challenging Behavior
Look at the presenting behavior as more than just “bad” behavior
It is a presenting symptom of something deeper
Use the PIC/NIC Analysis

39. PIC/NIC Analysis Antecedents Behavior Consequences Positive/ Negative
Immediate/
Future
Certain/
Uncertain

40. When should a referral be made for additional help for a traumatized child?
When reactions are severe (such as intense hopelessness or fear) or go on for a long time (more than one month) and/or interfere with a child’s functioning
As severity can be difficult to determine—some children becoming avoidant or appearing to be fine, so don’t feel you have to be certain before making a referral
Let a mental health professional evaluate the likelihood that the child could benefit from some additional type of intervention or treatment

41. When to seek self care?
Seek support and consultation routinely for yourself in order to prevent “compassion fatigue,” also referred to as “secondary traumatic stress” or “vicarious traumatization”
Be aware that you can develop compassion fatigue from exposure to trauma through the children with whom you work.

42. Tips for self-care 1. Be aware of the signs. of compassion fatigue
Increased irritability or impatience with students
Difficulty planning classroom activities and lessons
Decreased concentration
Denying that traumatic events impact students or feeling numb or detached
Intense feelings and intrusive thoughts, that don’t lessen over time, about a student’s trauma
Dreams about students’ traumas
2. Don’t go it alone
While respecting the confidentiality of the child get support by working in teams
3. Recognize compassion fatigue as an occupational hazard
Compassion fatigue is not a sign of weakness or incompetence; rather, it is the cost of caring
4. Seek help with your own traumas
Any adult helping children with trauma, who also has his or her own unresolved traumatic experiences, is more at risk for compassion fatigue
5. If you see signs in yourself, talk to a professional
If you are experiencing signs of compassion fatigue for more than two to three weeks, seek counseling with a professional who is knowledgeable about trauma
6. Attend to self care. Guard against your work becoming the only activity that defines who you are
. Take care of yourself by eating well and exercising, engaging in fun activities, taking a break during the workday, finding time to self-reflect, practicing mindfulness, breathing etc.

43. Contact: Karen Thomson Regional Program Planner
Midland Division – Central Territory

44. Sources
2.pdf
Young Exceptional Children. Nov (1) pp “Keys to Being Successful When Confronted with Challenging Behaviors” by Strain, P. & Hemmeter, M.
Teaching Exceptional Children. Spring Special Focus: Functional Assessment.
Technical Assistance Bulletin. Nov Issues in Education. Missouri Dept. of Elementary and Secondary Education Center for Innovation in Special Education.