Trauma U1 Exam

What is attachment?

a close interpersonal bond between child and caregiver serving to protect individuals from harm and obtain security

(threat of) loss of caregiver evokes intense distress

What is bonding?

the process of forming attachment, often through serve-and-return interactions with bids for attention

What does attachment and bonding do for a child’s internal working model?

both CONTAINS and OPENS UP the child’s world (secure base and safe haven)

builds healthy self esteem as a child worthy of love and attention.

What are the four types of unresponsive care?

occasional inattention

chronic understimulation

severe neglect in a family setting

severe neglect in an institution setting

Which type of unresponsive care is most harmful for a child?

severe neglect in an institution

What is attunement?

ability to read and respond to the cues of a child in one’s care

being synchronous and interactive with a child

a skill that can be taught or learned

What does NCTSN stand for?

National Child Traumatic Stress Network

When was the National Child Traumatic Stress Network founded? What organization created it?

2000 (created by Congress)

Why was the National Child Traumatic Stress Network founded?

Children’s Health Act - raise standard of care and increase access to services for children and families who deal with traumatic events

What are the 12 Core Concepts?

1. Complexity

2. Life Experiences

3. Reminders and Adversities

4. Wide-Ranging Reactions

5. Danger and Safety

6. Caregiving Systems

7. Protective and Promotive Factors

8. Development

9. Neurobiology

10. Culture

11. Social Contract

12. Provider Distress

What is the core concept of Complexity (1)

Different parts of a traumatic experience create complex reactions from children. It is important to discover all the details and what was the “worst moment”.

What is the core concept of Life Experiences (2)

Previous experiences, personal characteristics, and more can build on each other, informing reactions to current trauma

What is the core concept of Reminders and Adversities (3)

Internal and external reminders can result in physical, behavioral, and psychological reactions, resulting in secondary adversities and potential life changes.

What is the core concept of Wide-Ranging Reactions (4)

Children can show a wide range of reactions after a traumatic experience

What is the core concept of Danger and Safety (5)

Traumatic events reveal a failure of the protective shield, and makes children uncertain about safety going forward.

What is the core concept of Caregiving Systems (6)

Trauma impacts caregiving systems, causing different reactions from different members, causing different reactions and different needs to arise from each member

What is the core concept of Protective and Promotive Factors (7)

Protective and Promotive factors reduce the harm dealt by traumatic events

What is the core concept of Development (8)

Traumatic stress can pause, stop, rewind, or precociously speed up development, resulting in costs down the line.

What is the core concept of Neurobiology (9)

Traumatic stress rewires the danger apparatus to become more responsive to trauma reminders

What is the core concept of Culture (10)

Culture deeply affects how children respond to trauma and loss

What is the core concept of the Social Contract (11)

Children expect systems such as law enforcement, courts, and protective services to be just and provide protection.

When this social contract is breached, it affects responses and recovery from traumatic events.

What is the core concept of Provider Distress (12)

Providers engaging in heavy emotional work are prone to secondary traumatic stress. Engaging in self-care is vital to longevity in the field.

What is the danger apparatus?

Part of the brain which identifies potential dangers and responds to threats, overtaking regular functions of living.

How can traumatic events affect brain development?

Traumatic stress can divert resources for development toward survival, resulting in delayed or missing developmental task masteries, or even leading to precocious development.

What is the adult protective shield?

The adult protective shield is the loving support that caregivers provide, allowing children to withstand traumatic experiences.

When provided with the buffer of nurturing and safe relationships with adults, children can heal better from trauma. Without it, the negative impacts of trauma are exacerbated.

What is acute trauma?

Acute trauma is a stressful event that is concentrated to a short time period, such as a car accident, sexual assault, or shooting.

What is chronic trauma?

Chronic trauma occurs over a long period of time and without a defined end. This could include bullying, domestic violence, or child abuse.

What is a trauma reminder?

A trauma reminder is a reminder of a traumatic event, which can be either internal or external.

What is a loss reminder?

A loss reminder reminds the child of the absence of someone close to them who has died.

What are the three types of reactions to trauma reminders?

Physical, psychological, and behavioral

What is secondary traumatic stress?

Stress that arises from continued exposure and investment in details of traumatic experiences, such as being reminded of one’s own past trauma of child abuse after working with a client who is currently dealing with it.

What is a developmental insult?

A developmental insult is an adverse life event that can cause harm to a child’s ability to develop at a typical rate.

What is a developmental injury?

A developmental injury is the result of a developmental insult. It is a significant impairment in a child’s ability to work on developmental tasks.

What are developmental competencies?

Developmental competencies are tasks that should be mastered by a certain age. They build on each other as one grows older and give children the resources needed to cope with challenges of the current developmental period.

What is developmental disturbance?

A developmental disturbance occurs when mastery of developmental tasks is delayed due to experiencing trauma or a loss.

What is developmental disruption?

A developmental disruption occurs when severe cessation or regression or even acceleration has occurred, leading to difficult consequences.

What are developmental cascades?

The building consequences of developmental injuries across the lifespan

How does toxic stress derail healthy development?

Toxic stress places strain on the brain by causing resources required for healthy development to be routed toward survival.

What are the three kinds of responses to stress?

Positive, Tolerable, and Toxic

What is a positive response to stress?

A brief increase in heart rate, mild elevation of cortisol levels

What is a tolerable response to stress?

serious, temporary stress responses buffered by supportive relationshipsWh

What is a toxic stress response?

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

From ages 0 to 3, how many neural connections are made per second?

1 million

What is synaptic pruning?

Synapses, or connections between neurons, are removed when they are unused

What is bottom-up development in relation to neurons?

Neurons begin unspecified but then specialize in specific regions of the brain.

What is serve and return?

Serve and return is the process by which a child and caregiver connect. When a child serves (shows they are in need of help) and the caregiver returns (by responding appropriately), the bond between them grows stronger.

By adolescence, how many of their synapses from age 2 will be gone?

Half

How do early experiences affect brain architecture?

If the caregiver does not provide proper stimulation or response to a child, their developing brain circuits could be disrupted.

What did Lyons-Ruth in The Body Keeps the Score find about maternal behavior and its effect on mental stability in adult children?

A mother’s emotional withdrawal had the most profound and long-lasting impact (NOT aggression or intrustion!)

According to Van Der Kolk in The Body Keeps the Score, where does trauma “appear” in the brain and in what manner?

Trauma appears in the insula, which processes sensory information. It is described as a splinter. Reminders of the trauma activate the insula, forcing someone to relive it.

What did Dr. Van Der Kolk in The Body Keeps the Score find about a common response to trauma?

Trauma survivors learned to shut down the brain areas that transmit feelings of terror, which makes them feel less alive.

What is dissociation?

A state of being out of one’s mind or body, or a discontinuation of the self.W

What is complex trauma?

It goes beyond a one-time event.

-Repeated/ongoing

-difficult/impossible to escape from

-occurs within a personal relationship

-begins in childhood (affecting development)

-often covered up, kept secret, or denied

What effect can complex trauma have on cognition?

Problems with thinking/concentration, difficulty feeling present, lack of attention, dissociation, problems with memory

What are the seven domains of disruption?

Brain and Body, Thinking and Learning, Emotion Regulation, Dissociation, Attachment, Self Concept, Behavior Regulation

What might children struggle with emotionally when faced with trauma?

May have trouble identifying, expressing, or managing emotions

What are the three categories of adverse childhood experiences?

Abuse, Family Dysfunction, Neglect

What are the types of abuse (3) outlined in ACEs

physical, emotional, sexual

What are the two types of neglect in ACEs?

physical, emotional

What are the types of household challenges in ACEs (5)

mental illness, substance use in the household, parental separation, household member incarcerated, domestic violence

What is the impact of ACES on life expectancy?

Up to 20 years of life can be lost when looking at higher ACE numbers.

What is the risk of increased ACEs on health and wellbeing? (triangle)

Childhood maltreatment and household dysfunction contribute to disability and death.

historical trauma → social conditions → ACEs → disrupted neurodevelopment → social, cognitive, and emotional impairment → adoption of health risk behavior → disease, disability, and social problems → early death

What are the different negative health domains associated with early adversity? (web)

injury, mental health, maternal health, infectious disease, chronic disease, risky behaviors, opportunities

According to the YRBS 2023 study, what are the most common ACEs being experienced by high school students?

emotional abuse (61%), physical abuse (31%), household mental health or substance use problem (28% and 25%)

What are Finkelhor and Brown’s four model of trauma for CSA victims?

Traumatic sexualization, betrayal, powerlessness, stigmatization

What is traumatic sexualization?

The child’s sexuality is shaped in a developmentally inappropriate and interpersonally dysfunctional fashion.

What is betrayal?

The child grapples with the idea that a person they relied on has caused them harm.

What is powerlessness?

Child’s will, desires, and body space are invaded.

What is stigmatization?

Child is blamed and denigrated.

Why do children disclose sexual abuse?

Instrumentally, or because they are found out.

Why don’t children disclose sexual abuse?

Fear, lack of caregiver support/belief, relationship with perpetrator, self-blame/shame/guilt, age, gender, cultural factors, racism

What is the continuum of sexually abusive behaviors?

Nudity (disrobing)

Exposure

Observing

Kissing/Fondling

Masturbation

Oral Genital Contact

Penetration

Sexualized Environment

Three children who witnessed domestic violence and abuse — how did they react?

boy dissociates, girl blames herself, baby is violent four years later.

In what direction does the brain develop?

The brain grows from the bottom to the top and from the inside out

What do children need in order to heal and thrive?

Being able to talk about feelings and be affirmed

What was the “Never Give Up” film by Youth for Youth about?

How complex trauma has affected their coping mechanisms and what has helped them to heal

What were the main findings about number of ACEs of the PBS “Invisible Scars” video?

4+ ACES is associated with at least 5 of the leading causes of death in the US

What is religious duress?

Unique threat held over a member of the laity by a member of the clergy as a result of religious training and indoctrination.

What was the largest clergy sex abuse report?

It was done by the John Jay College or Criminal Justice

Which gender is most at risk for clergy abuse?

Boys - due to “sin” of homosexuality

What is fiduciary responsibility?

obligation to act in a client’s best interests and reduce harm and exploitation