Trauma Related Disorders and ACEs

Stressor

Experiences or circumstances that place demands on a person’s ability to adapt or cope

Adversity

P\A broad concept that includes potentially harmful or difficult childhood experiences such as abuse, neglect, family disruption, economic hardship, violence, discrimination, or caregiver difficulties

Trauma

Experiences involving significant threat, harm, or disruption

Definitions vary across contexts

A child who experiences trauma may or may not have a traumatic response or traumatic disorder

PTSD criterion A

Exposure to actual or threatened death, serious injury, or sexual violence

• Direct experience, witnessing in person, learning about certain events involving a loved one, repeated/extreme occupational exposure to aversive details of traumatic events

PTSD symptoms

Intrusion, avoidance, negative alterations in cognition and mood, alterations in arousal/reactivity

Children’s symptoms of PTSD may be more visible through ____, ____, ____, and ____

Behavior, play, relationships, and functioning

Trauma-related play reenactment, frightening dreams, social withdrawl, reduced positive emotion, irritability, concentration difficulties, and sleep problems

The ace study measures…

Abuse - psychological, physical, sexual

Household dysfunction - substance abuse, mental illness, violence against mother, criminal behavior

Not measured for duration or frequency

ACE study findings

Categories were strongly interrelated (multiple commonly co-ocurred)

Positive relationship between ACEs experienced and health-risk behaviors and diseases

Substantially higher risk after 4+

Dose-response pattern

A graded relationship between cumulative exposure and risk

High population-level risk does NOT predict inevitable outcomes for an individual

Felitti et al.’s lens and question

Adult retrospective epidemiological

How is childhood adversity associated with health and functioning later in adulthood?

Porche et al’s lens and question

Child/adolescent population-based + educational

How are adverse family experiences associated with children’s metal health and educational functioning during childhood and adolescence

Porche et al findings

The most common experiences were family financial hardship and parental divorce

Greater number of adverse family experiences (AFE) were associated with more current child mental health diagnoses

Greater # of mental health diagnoses associated with lower school engagement and greater likelihood of grade retention and IEP status

AFEs are associated with educational outcomes, but are ____

Partially mediated by mental health

Students may show changes in ____, ____, ____, ____, ____, ____, which may be misinterpreted as ____, _____, ____

Engagement, attention, behavior, relationships, attendance, or academic performance

Disinterest, avoidance, or rejection of academics

DSM 5 lens and question

Clinical/diagnostic

Does the individual’s response meet criteria for a trauma or stressor related disorder

Be careful with ACE score

They do not measure severity, frequency, duration, timing, meaning, or protective factors

It is not a “score” of how damaged a child is

Framework for thinking about trauma

Exposure → response → functioning → context → support

Exposure

What happened or is happening?

Response

How is the child responding emotionally, cognitively, behaviorally, physiologically, and relationally

Functioning

How is the child functioning at home, school, with peers, and in daily life

Context

What developmental, family, cultural, environmental, and systemic factors shape the experience

Support

What protective relationships, strengths, resources, interventions, or environmental changes may help