Trauma Exam One

History of the NCTSN

• Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA)

• Coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS)

NCTSN

unique network of frontline providers, family members, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S.

Their mission is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States

Year NCTSN was founded

Created by Congress in 2000

Why was NCTSN founded?

raise the standard of care and increase access to services for children and families who experience or witness traumatic events

Chronological age is not

developmental age

Key elements of the attachment bond

• special enduring form of an “emotional” relationship with a specific person

• relationship brings safety, comfort, soothing, and pleasure

• loss or threat of loss of the person evokes intense distress

• child finds security and safety in the context of the relationship

1st core concept

Traumatic experiences are inherently complex

2nd core concept

Trauma occurs within a broad context that includes children’s personal characteristics, life experiences, and current circumstances

3rd core concept

Traumatic events often generate secondary adversities, life changes, and distressing reminders in a child’s daily life

4th core concept

Children can exhibit a wide range of reactions to trauma loss

5th core concept

Danger and safety are core concerns in the lives of traumatized children

6th core concept

Traumatic experiences affect the family and broader caregiving systems

7th core concept

Protective and promotive factors can reduce the adverse impact of trauma

8th core concept

Trauma and post-traumatic adversities can strongly influence development

9th core concept

Developmental neurobiology underlies children’s reactions to traumatic experiences

10th core concept

Culture is closely interwoven with traumatic experiences, responses, and recovery

11th core concept

Challenges to the social contract, including legal and ethical issues, affect trauma response and recovery

12th core concept

Working with trauma-exposed children can evoke distress in providers that makes it more difficult for them to provide good care

How many neural connections per second between birth and age 3

1 million

What shapes the developing brain/construct brain architecture

Interaction of genes and experiences

what is the adult protective shield?

a government social services program that investigates abuse, neglect, and financial exploitation of vulnerable older adults and adults with disabilities

why is the adult protective shield important for children

buffering children from environmental dangers, chronic stress, and community trauma.

What is the danger apparatus

works to keep us safe at all times

Highly developed and poised for action; takes priority over normal activities of daily functioning

Acute Trauma

A single traumatic event, limited in time

Example of Acute Trauma

Car crash, natural disaster, physical/sexual assault

Chronic trauma

Particular type of trauma that goes beyond a one-time incident

Domains of impairment

• Thinking and learning

• Brain and body

• Dissociation

• Emotional regulation

• Attachment

• Self-concept

• Behavior Regulation

Thinking and learning impairment

Delays in learning, memory, reasoning, and attention

Brain and body impairment

Cannot access rational thought in the face of overwhelming emotion

Emotional regulation impairment

Withholding their emotions from others word

Dissociation

Having thoughts, emotions, and sensations that are disconnected from awareness

Attachment

a strong emotional bond that an infant forms with a primary caregiver

Self-concept

Sense of oneself as valued, worthy, and competent

Behavior regulation impairment

Ranges from being overly confrontational to overly compliant

ACEs Major finding

Childhood maltreatment and household dysfunction contribute to the development – decades later – of the chronic diseases that are the most common causes of death and disability in the United States

What is a trauma reminder?

Linked to the details of the experience, the type of dangerous situation, and what happened.

Simple cues or triggers that remind the child of a whole set of circumstances

Cause distress, physical reactions, and changes in behavior

What is a loss reminder?

Brings to mind the continued absence of someone who has died

Causes intense physical and emotional reactions, loss-related behaviors, insecurities, and changes in how children see themselves in the world around them

Three reactions to trauma reminders

Physical, psychological, behavioral

Example of secondary traumatic stress

a therapist, counselor, or healthcare professional experiencing anxiety, nightmares, or emotional exhaustion after repeatedly hearing clients describe their traumatic experiences

What problems can be attributed to developmental cost?

unachieved developmental tasks + missed or delayed developmental milestones + unexploited developmental opportunities

developmental insult

Adverse life event, circumstance, or major hardship that significantly interferes with a child’s ability to achieve important developmental tasks, take advantage of enriching developmental opportunities, and acquire developmental competencies as a result

developmental injury

significant impairment in a child’s ability to work on age-appropriate developmental tasks and acquire developmental competencies as a result.

Causal effects of developmental insults

• Significant disruptions in one or more developmental tasks that are appropriate to one’s age, culture, and life circumstances.

• Difficulties regulating emotions, changes in attention and concentration, or a reduction in precision learning, such as fine-motor skills. Children must acquire these skills in order to developmentally progress

developmental competencies

equip children to successfully transition to the next developmental period and work on the developmental tasks associated with that developmental stage

developmental disturbance/disruption

significant disturbance in any developmental task or competency resulting from a developmental injury

• The more intense and persistent the functional impairment caused by distress symptoms, the greater the risk for developmental disruption.

• Developmental interruptions

• Developmental regressions

• Developmental delays

• Precocious developmental accelerations

developmental cascades

The cumulative, snowballing consequences across development that precipitate developmental insults set in motion.

• Family system

• Social system

• School system

Center on the Developing Child Harvard University presentation

Brains are built over time, from the bottom up, through an ongoing process that begins before birth. Simple neural connections form first, followed by more complex circuits.

The connections that form early provide either a strong or weak foundation for the connections that form later.

Our early experiences shape our brain architecture, which provides the foundation for all future learning, behavior, and health

How does toxic stress derail healthy development

• When we are threatened, our bodies prepare us to respond by increasing our heart rate, blood pressure, and stress hormones, such as cortisol.

• When a young child’s stress response systems are activated within an environment of supportive relationships with adults, these physiological effects are buffered and brought back down to baseline

What are 3 kinds of responses to stress

Positive

Tolerable

Toxic

Positive response

Brief increases in heart rate, mild elevations in stress horomone levels

Tolerable response

Serious, temporary stress responses, buffered by supportive relationships

Toxic response

Prolonged activation of stress response systems in the absence of protective relationships

What is the negative impact(s) of toxic stress?

it weakens the architecture of the developing brain, which can lead to lifelong problems in learning, behavior, and physical and mental health

How are brains built over time?

from the bottom up.

What does pruning mean?

Synapse elimination

What is serve and return?

responsive, back-and-forth exchanges between a young child and a caring adult

affect the formation of neural connections and the circuitry of the developing brain

How do early experiences affect brain architecture?

Provides the foundation for all future learning, behavior, and health.

Provides either a strong or weak foundation for the connections that form later.

Know the major findings of what happens to the individual in The Brain Keeps Score presentation

a mother’s emotional withdrawal had the most profound and long-lasting impact

How does complex trauma effect cognition?

❑ May have problems thinking clearly, reasoning, or problem solving

❑ All their internal resources go toward survival

❑ Cannot think a problem through, plan ahead, anticipate the future, act accordingly

❑ Hard to acquire new skills or take in information

❑ May struggle with sustained attention or curiosity

❑ Distracted by reactions to trauma reminders

❑ May show deficits in language development and abstract reasoning skills

❑ Learning difficulties that may require support

emotional responses of children to complex trauma

• May tune out threats, making them more vulnerable to revictimization

• Become easily overwhelmed

• Never learned how to calm themselves down

Categories of adverse experiences (ACEs)

Personal abuse

Exposed in environment

Domestic violence

Loss/seperation from caregiver

Personal abuse

• Physical abuse

• Emotional abuse

• Sexual abuse

Exposed through environment

Lived in a household with:

• Alcoholic or drug user in home

• Family member in prison

• Mentally ill caregiver

impact of ACES on life expectancy

premature mortality (up to 20 years lost)

risk of increased ACES on health and wellbeing

More likely to have heart disease, cancer, stroke, diabetes, skeletal fractures, liver disease, and poor health as an adult

findings of the YRBS 2023 study regarding top ACES

preventing ACEs earlier in childhood helps to prevent negative impacts in adolescence and beyond

four aspects of Finkelhor and Brown’s model of trauma for children who have been sexually abused

Traumatic Sexualization

Betrayal

Stigmatization

Powerlessness

Traumatic Sexualization

process by which a child’s sexuality (sexual feelings and attitudes) is shaped in a developmentally inappropriate and interpersonally dysfunctional fashion as a result of the sexual abuse.

Betrayal

Someone on whom the child is vitally dependent has caused them harm

mislead + manipulated

Powerlessness

The victim is left disempowered against their will, increasing fear and a feeling of being trapped

Stigmatization

negative connotations, badness, shame, guilt, communicated to the child about the experiences and then become incorporated into the child’s self

continuum of sexually abusive behaviors

why children do and do not disclose

Fear, lack of support/belief, relationship with perpetrator, shame, guilt, self-blame, emotional awareness, gender stigma, cultural factors, racism.

religious duress

unique kind of threat and constraint involuntarily experienced by some members of the Roman Catholic Church as a result of religious indoctrination and training

Fear, awe, and respect for the clergy

the name of the largest clergy sex abuse report to date, commissioned by the Catholic Church

John Jay

4,392 clerics were accused of childhood sexual abuse (4% active clerics)

10,667 total allegations

which gender is most at risk for clergy abuse

Male

fiduciary responsibility

a broad obligation to act in a client’s “best interests” and refrain from exploitation and harm

applies to any relationship that necessitates a “blind” trust of a professional’s special knowledge or skills, such as those of an attorney, doctor, therapist, or educator

most common forms of intimate partner violence

Physical abuse

Emotional abuse

Sexual abuse

Stalking

a pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one’s own safety or the safety of someone close to the victim

Psychological aggression

use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person

Physical violence

a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force

People exposed…

tend to have more issues than those who experience it

Which child was the most damaged in the class video

The 6-month-old baby who grew up