1. A Developmental Model of Childhood Traumatic Stress

2. Traumatic Stress PROXIMAL TRAUMATIC REMINDERS PROXIMAL SECONDARY STRESSES APPRAISAL & RESPONSE TO DANGER RESISTANCE & VULNERABILITY ACUTE DISTRESS RESILIENCE ADJUSTMENT PROXIMAL DEVELOPMENT PROXIMAL PSYCHOPATHOLOGY ONGOING ADJUSTMENT DISTAL TRAUMA REMINDERS DISTAL SECONDARY STRESSES REPEATED OR SEQUENTIAL TRAUMATIZATION DISTAL DEVELOPMENTDISTAL PATHOLOGY ECOLOGY OF THE CHILD CHILD INTRINSIC FACTORS

3. Traumatic Stress Alarm Reactions Context Complexity Objective features Subjective experience Coping strategies Loss Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

4. The Complexity of Traumatic Experiences Context Multiple traumatic moments, even within a relatively circumscribed situation. Changes in foci of attention or concern Radical shift in attention or concern when physical integrity is violated Additional traumatic moments after cessation of violence or threat Additional dimensions to traumatic experiences Disturbances in evolving developmental expectations regarding danger Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

5. Proximal Trauma Reminders External and Internal Cues Constellation Pattern of Occurrence Pattern of Reactivity Challenge to Regulation of Aggression Trauma and Loss Reminders Reminders of Prior Trauma Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

6. Proximal Secondary Stresses Changes in Family Living Circumstances, Resources Change in Community Resources Change in Family Constellation and Function Change in Availability and Utilization of Social Support Need to Assume New Responsibilities Medical / Surgical Care, Rehabilitation Altered Role Performance Issues of Accountability Acquisition of New Social Skills Intercurrent Trauma, Loss, Life Adversity Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

7. APPRAISAL AND RESPONSE TO DANGER RESISTANCE AND VULNERABILITY ACUTE DISTRESS RESILIENCE ADJUSTMENT

8. Proximal Development Selective Attention / Cognition / Learning Mechanisms of Emotional Regulation Self-Attributions Autonomous Strivings Perceptions of Self-Efficacy Specific Psychodynamic Concerns Impulse Control Moral Development Sense of Historical Continuity Skills of Social Competency Interpersonal and Intrafamilial Transitions Biological Maturation, including brain structures and physiological and hormonal changes Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

9. Proximal Psychopathology PTSD Depression Complicated Bereavement Phobic Disorder Separation Anxiety Disorder Other Anxiety Disorders Sleep Disorder Attachment Disorder Dissociative Disorder Somatization Disorder Substance Abuse Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

10. Ecology of the Child Family / Parental Factors – Similar grouping as Child Intrinsic Factors – Parental physical illness – Parent past exposure to trauma and loss – Reactivity to reminders – Loss and secondary stresses – Current responsiveness – Current trauma and loss-generated psychopathology Developmental Cycle of the Family – Family Structure and Function School Milieu and Responsiveness Peer Milieu and Responsiveness Social Ecology and Responsiveness Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

11. Child Intrinsic Factors Genetic Temperament Alarm Propensity Anxiety Sensitivity Organization of Stress Response Systems Acquired Developmental Competencies Phase-Specific Concerns Pre-existing Psychopathology Prior Experience – Threats to Attachment – Trauma and Loss – Coping with Prior Danger Modes of Attachment Coping Repertoire Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

12. Distal Trauma Reminders Context in Everyday Life Recognition Difficulty Reactivity and Negative Self-Attributions Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

13. Repeated or Sequential Traumatization Complex impact on development Various exposures at different points Changing nature of similar traumatic stress Incomplete recovery Chronic anticipatory strategies Debilitating conflict over accountability Capitulatory emotional regulation, avoidance, and control of physical or psychological pain Latent negative self-images Harmful tension reduction behaviors Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

14. Distal Secondary Stresses Chronicity of Proximal Stresses Adverse Life Circumstances Accommodation to Physical Disability Judicial / Reparation Proceedings Disclosure and Communication about Previous Trauma Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

15. Distal Development Emerging Personality – Fear, courage, and fearlessness – Trauma, loss, and danger expectancies – Embedded attributions to self, other, and social agencies – Enduring intervention themes – Adult self-care and protective behavior Interaction of proximal disturbances on specific future developmental tasks Interpersonal academic and occupational functioning Parental functioning Decision-making, aspirations, and motivations Political ideology and social contact Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

16. Distal Pathology PTSD and other psychiatric disorders Physical health problems Chronic developmental disturbances Adverse life trajectory outcomes Increased vulnerability to future life stresses Difficulties in treatment situation Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.

17. Proximal Psychopathology Acute Stress Disorder PTSD Depression Complicated Bereavement New Onset Attention Deficit Disorder Separation Anxiety Disorder Other Anxiety Disorders Sleep Disorder Attachment Disorder Conduct Disorder Eating Disorder Phobic Disorder Dissociative Disorder Somatization Disorder Substance Abuse Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds.), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72-93.