1
Q
Preventing Relational Trauma
A
- focus on fostering caregiver responsiveness & attentiveness
- Address both historical & current conditions that may affect caregiving.
- Emphasize the significance of forming strong attachment bonds early.
2
Q
MODERATORS for Relational Trauma
A
- Family environment
- Genetic Predispositions
- Child’s Gender
(boys: disorganized and insecure behavior)
(girls: secure and avoidant behavior)
3
Q
Attachment Theory
A
- Assumes there is a BIOLOGICALLY BASED BONDING process that DRIVES children toward caregivers
- To maintain caregiver connections, the child monitors the caregiver’s whereabouts and develops strategies to avoid feeling separated.
- These strategies for maintaining connections are the basis of for the categorization of attachment behaviors
4
Q
Relational Trauma
A
what is most dangerous to a child is not necessarily an event; rather it is the threat directly associated w. caregiver relationships
5
Q
Relational Trauma long-term effects
A
long-term effects are pervasive and severe, they encompass:
- physiology
- brain development
- cognition
- affect
- behavior
6
Q
Relational Trauma & Neuroscience
A
- relational trauma has serious adverse effects on BRAIN DEVELOPMENT, and the child’s subsequent ability to COPE w/ STRESS,
- Effects of relational trauma not only PERSIST INTO ADULTHOOD, but also INTERGENRATIONALLY THROUGH EPIGENESIS
7
Q
Parental Risk Factors of Relational Trauma
A
- Parental history of UNRESOLVED TRAUMA OR LOSS
- Tendency toward HOSTILE/HOPELESS parenting
- Parents’ CURRENT RISK ENVIRONMENT
8
Q
Child Implications of Relational Trauma
A
- Internaling behaviors (withdrawn, anxious, self-doubt)
- Externalizing behaviors (confrontational, combative, threatening)
- Abrupt changes in mood
- Mental delays and low levels of metacognition
9
Q
Fetal Development WEEK 2 FERTILIZATION
A
- @ the start of this week, ovulaton occurs and egg is fertilized (12-24 hrs later —-if sperm penetrates)
- Over the next several days, the fertilized egg will start dividing into multiple cells as it travels down the fallopian tube and enters the uterus, starts to burrow into the uterine lining.
10
Q
Fetal Dev. WEEK 3: IMPLANTATION
A
- A microscopic ball of hundreds of rapidly multiplying cells called a BLASTOCYST, is now nestled in the uterine lining.
- The pregnancy hormone hCG is now being produced & notified the ovaries to STOP RELEASING EGGS.
11
Q
*** WEEK 4; EMBRYONIC PERIOD
A
- The ball of cells (previously known as the bloastocyst) is now an EMBRYO
- From now until 10 wks, ALL VITAL ORGANS DEV. & FUNCTION
- As such, this period marks a HIGH VULNERABILITY TO INTERFERENCES W/ DEVELOPMENT
12
Q
5-9 wks. THE PERIOD OF THE EMBRYO
A
- Wk 5: Embryonic disks folds into 3 layers:
Ectoderm–neural tube, from which the brain, spinal cord, nerves and backbone will sprout, forming the top later.
Mesoderm (middle)—–the heart & circulatory system begin to form in this middle layer, which will also form muscles, cartilage, & bone.
Endoderm—- this layer will house lungs, intestines, & rudimentary urinary system, thyroid, liver, & pancreas. - Wk 5: Nose, mouth, & ears form.
- Wk 7: Hands & feet emerge from arms & legs.
- Wk 8: Primitive neural pathways are developing.
- Wk 9: Basic physiology in place; ready for rapid lb. gain
13
Q
10-12 wk. The period of the FETUS
A
- Known as the INITIAL FETAL ACTIVITY
- The fetus’ movements are more frequent as the body grows & becomes more developed & functional.
- As nerve cells rapidly multiply in the brain, SYNAPSES FORM.
- Tissues & organs also rapidly grow & mature.
- EXTERNAL GENITALS become visible w/ an ultrasound
- marks the END OF 1ST TRIMESTER
14
Q
13-27 wks. Period of the FETUS
A
-AGE OF VIABILITY is typically b/w 22 & 26 wks.
-Marks beginning of the 2nd trimester
fetal volume and lb. increase proportionally & there is a considerable growth & movement
-give the growth increase the FIRST MOVEMENT is often felt during this period
15
Q
THIRD TRIMESTER
A
- Cerebral cortex enlarges
- Fat layer develops for TEMPERATURE regulation
- Fetus moves to the upside-down position in preparation for birth
- Fetus MOVES LESS
- Wrinkled skin is starting to smooth out as the fetus gains lb.; fingernails & toenails develop
- Final wks. utero are spent GAINING WEIGHT
16
Q
Toddlerhood
A
1 to 3 yrs old.
- Children advance from infancy toward preschool yrs.
- Physical growth & motor development will slow, but there are significant advancements in cognitive, social and emotional development
17
Q
Physical Growth: Toddlerhood
A
Rates of physical growth differ based on heredity & environmental factors.
-Balanced diets and new foods enhance growth.
-Steady sleep schedule promote healthy growth, & include 9-10 hrs at night
1-2 hrs napping.
-Minor illnesses (respiratory infections and gastrointestinal upsets) are common, but don’t have lasting effects on growth.
18
Q
Motor Dev.: Toddlerhood
A
- Toddlers improve the motor skills they develop as infants:
1. Climbing
2. Walking
3. Running
4. Throwing
5. Jumping - Boys & girls are SIMILAR in motor skills during toddlerhood.
19
Q
Cognitive Dev: Toddlerhood
A
@ 2 yrs. old, a toddler’s brain has reached 75% of the lb. of an adult brain.
- B/w 1-2 yrs of age, toddlers can remember certain events, but they rely on cues provided by others to help them retrieve memories
- Frequently sort objects by shape & color
- Engage in make-believe
- Experience rapid development of language skills.
20
Q
Social Dev.-Toddlerhood
A
-Toddlers frequently imitate the behaviors of others.
-Aware of him/herself as separate from others.
-Tend to be ENTHUSIASTIC about company of other children.
-Begin to dev. an understanding of gender roles.
(learn masculinity/femaninity by observing & imitating; Form perceptions & apply it to their behaviors)
21
Q
Emotional Dev-Toddlerhood
A
-Increasing capability of self-regulation, due to brain maturation.
-Sense of self (i.e. who they are and how they feel abt self) develops & grows more complex.
-Begin to acquire a sense of their abilities and an increasing mastery of the environment
-Number of fears peak by age 2.5
Common fears: animals, imaginary creatures, dark and personal dangers
22
Q
Developmental Delays-Toddlerhood
A
- @ certain intervals (9, 18, 30, 48 months.) dev screenings re administered at well-child care visits.
- Formal dev screens are completed when there is a parent or pediatrician concern abt the dev
- Screens examine all areas of dev: language, problem-solving, social, emotional, fine/gross motor skills
- An autism screening is typically completed on all children 18 to 24 months
23
Q
School Age Trauma- EFFECTS
A
-Cognitive Functioning
Worse performance on verbal recall
Impairment in attention
Difficulty w/ working memory
Deficits in prob solving
Lower estimated IQ scores
-Psychiatric Disorders
Higher rates of suicide attempts & drug abuse
More severe bipolar symptoms
24
Q
Re-experience, Release, Reorganize
Navors et al.
A
- Re-experiencing traumatic events on “own terms” through non-directive techniques allows children to review their experiences & feelings.
- RELEASING –helps children reocognize the trauma occurred in the past and is over now
- RE-ORGANIZING—-creates an opportunity for positive connection w/ others through nurturing relationships rather than re-enactment
25
School Age Trauma Implications
- Poor functioning
- Cognitive Deficits
- Psychiatric conditions in adulthood
- Impairment in school performance and verbal ability
26
Family Dynamic Traumas
- School, Violence, Divorce, Separation, Death, Moving
- Any bx that violates a school's educational mission or climate of respect that jeopardizes the intent of the school to be free of aggression against persons/ property/ weapons/ disruptions/ disorder
27
Common traumas in toddlerhood
1. physical abuse
2. sexual abuse
3. neglect
28
Abuse (toddlerhood0
Abuse is any willful act or threatening act that results in physical, mental or sexual injury/harm that causes [or likely to cause] the child's physical mental or emotional health to be significantly impaired.
29
Neglect in Toddlerhood
Neglect occurs when a child is deprived of, or is allowed to be deprived of, necessary food, clothing, shelter, or medical treatment, or a child is permitted to live an environment when such deprivation or environment causes the child's physical, mental or emotional health to be significantly impaired or to be in danger of being significantly impaired.
30
Betrayal in Toddlerhood
- Approx. 6 million children were referred to Child Protective Services.
- An estimated 81% of those cases, the perpetrators were the caregivers,
- Potential risk factors for betrayal trauma:
1. mother's betrayal trauma history
2. unresolved parental trauma history
31
Traumatic responses Toddlerhood
- Changes in sleep and eating
- Difficulty being soothed
- Tantrums
- Extreme passivity
- Failure to develop skills
- Loss of previously trained skills.
- Attachment probs
32
Common bxs following trauma exposure toddlerhood
- increased clinginess, crying, and whining
- Greater fear of separation from parents
- Increase in aggressive bx
- More withdrawn & harder to engage
- Changes in sleeping & eating patterns
- More easily frustrated/harder to comfort
- A return to earlier behaviors (regression, frequent night-wakening, thumb-sucking)
33
Recommendations for treating trauma toddlerhood
- Respond to the need for increased attention and reassurance
- Pay closer attention to feelings
- Offer safe ways to express feelings
- Be patient when child clings and whines
- Answer children's questions according to their level of understanding
34
Mandated Reporting
- Any individual that works w/ children is a mandated reporter required by law to report any SUSPECTED abuse/neglect
- When there is reasonable cause to suspect a child has been abused, abandoned, or neglected.
35
Abuse Reporting
Demographic information ot persons involveed
means to locate the subjects of the report
-Specifics of incident being reported.
36
Themes in Adolescence
- Adolescence is a time of opportunity, not turmoil.
- Norma, healthy development is uneven
- Young ppl dev positive attributes through learning and experience.
- Family, friends, and community all contribute to adolescents' transition into adulthood.
37
Adolescence Growth
-Rapid growth
Puberty: physical growth & emotion & bx regulation
-Importance of understanding interaction of all systems
-Transitions all occur SEQUENTIALLY, but not necessarily @ the same time.
38
Physical Growth in Adol.
```
Gains in height & lb.
girls mature abt 2 yrs earlier
weight gain: muscles for boy; fat for girls
-Secondary sex characteristics:
facial, pubic & underarm hair
voice changes (boys)
menarche (girls)
```
39
Adol. Brain
- Not completely dev until late adolescence
- Emotional, phys., & mental abilites incomplete
- May explain why some have diff. controlling:
1. emotions
2. impulses
3. judgements
40
Dev. Impacts on Teens
- May sleep longer
- Vulnerability to decision-making & risk taking
- More time w/ friends
- More q's abt sexuality & beliefs
- Dev of self-regulation lags behind
41
Parental Support in Adolescence
- Provide opportunities for "safe" risk taking
- Avoid criticizing/comparing to others
- Encourage enough sleep
- Model healthy eating/exercise/self-care
- Provide honest answers abt sex
42
Trauma Responses in Adolescence.
- powerlessness & loss of control
- extreme behaviors
- intense and confusing emotions
- sensitivity to others
- vulnerability and/or lack of protection
43
Adolescence Sources of Stress
- feelings of inadequacy
- excessive worry
- unrealistic feelings of guilt
- exaggerated preoccupation w/ body
- somatic manifestations
behavioral difficulties:
1. unsafe sex
2. criminal activities
3. illegal activities
4. drugs
5. pregnancy
44
Adol. & Trauma Effects
-especially vulnerable to effects
-many active changes during this stage of life
Adol at risk of trauma related to:
bullying and embarrassment in school, vulnerable in the home and community
"level of invicibliity"
-Experimentation w/ drugs and other risky situations
45
Trauma Definition
- overwhelming, unanticipated danger that CANNOT be mediated, thus leading to:
1. fight or flight response
2. neurophysiological dysregulation
3. loss of internal control
46
Childhood Trauma Definition
-Extensive trauma exposure DOES NOT FIT well within one diagnosis.
-Symptoms often manifest as:
difficulty with emotion regulation
inability to maintain attention
impulse control disorders
-A more appropriate diagnosis = Developmental Trauma Disorder/ Complex Trauma
--> MORE EXTERNALIZING BEHAVIOR
47
Physiological Trauma Responses
- Increased heart rate
- Dilated pupils (take in light) veins in skin tighten and squeeze, pushing blood to major muscles and back to the heart.
- Muscles tense *goosebumps*
- Body in survival mode
- exhaustion
- can have lasting impairments and no equilibrium
48
Complexity of Trauma
-Complex Trauma is a combination of frightening, alienating, and demoralizing experiences in the absence of adequate response or protection (NO safety)
49
Complex Trauma is
1. Adverse childhood Experiences (ACE)
2. Polyvictimization
3. Cumulative Trauma
50
Adverse Childhood Experiences (ACE)
- longitudinal study linking physical and mental health problems in adulthood to the traumatic experiences in childhood.
- First study to simultaneously assess multiple categories of childhood maltreatment
- ACEs are not only common, but also interrelated
- Most categories of ACEs experienced= greated threat of risky health bxs
- Multiple ACEs linked to increased prevalence of psychological symptoms
51
Poly-victimaztion
-Many types of victimization rather than just a single form.
52
4 Factors that contribute to poly-victimization in youth:
1. residing in a dangerous community
2. living in a dangerous family
3. living in a chaotic family environment
4. difficulty regulating emotions
53
Poly-victimization Take-Away
- Youth are poly-victimized if they endorse 4 or more different types of victimization
- Polyvictims 4 times more likely to be re-victimized
- Most significant predictors of persistent poly-victimization = heightened anger and aggression.
- Four events do NOT relate (that's cumulative trauma when they do)
54
Cumulative Trauma
-Interpersonal victimizations (i.e., physical and/or sexual abuse, emotional abuse, and/pr neglect, witnessing domestic violence caregiver abandonment and/or impairment, etc.) that accumulate as one experience leads to another.
55
Implications of Trauma
Different forms of abuse can have specifc effects on targeted brain regions.
- Abuse: cortical thinning in regions of frontal and temporal lobes
- Inadequate input (ex: neglect) + Unwanted Input (ex: sexual abuse) = Development/Clinical Abnormalities
56
Teratogens
-Teratogens are substances or stressors that traumatize the fetus and can cause congenital abnormalities (i.e., birth defects) during pregnancy by affecting the development of major organ systems
57
Influence of Teratogens
- Genetics can help or hinder the effects of teratogens.
- Larger does over time = more negative effects
- Sensitive periods are espeically important
- MOST SUSCEPTIBLE DURING EMBRYONIC PERIOD
- Physical and psychological effects
58
4 Main Classes of Teratogens
1. Alcohol and Drugs
2. Medications
3. Stress
4. Smoking
59
1. Alcohol And Drugs
-Fetus affected by even moderate amount of alchol.
-Children born to heavy drinkers are at risk of problems w/ memory and/or behaviors
-Interferes w/ [neural] cell duplication
-Abnormalities caused by alcohol include:
Deformities of the face, arms, and legs
Heart conditions
Mental retardation
Fetal growth restriction
60
Alcohol and Drugs: Illicit Drugs
1. Cannabis: low birth weight, intracranial bleeding, jitters, low blood sugar, low levels of calcium in the blood, poor feeding, irritability, and rapid breathing
61
Cocaine
miscarriage, problems w/ urinary system, and/or genital tract, microcephaly (small head due to abnormal brain development), neurobehavioral probs, and placental abruption.
62
Meth and Heroin
-premature birth, low birth weight, fetal growth restriciton, addiction, and neonatal abstinence withdrawal syndrome (withdrawals)
63
Medications (prescription meds)
- ACE inhibitors used to treat high blood pressure can cause fetal growth restriction, kidney probs and miscarriage.
- Isotretinoin used in severe acne cases is linked to cleft palate, heart defects, deformation of the outer ears, and underdevelopment of the lower jaw.
- Tranquilizers and anti-anxiety are linked w/ congenital abnoralities such as cleft lip or palate.
- SSRIs used to treat depression are capable of crossing the placenta affecting the baby. Effects like irritability, agitation, tremor, and increased respiratory rate.
64
Smoking: tobacco use
- low birth weight and premature births
- impaired breathing
- miscarriage and infant death
- probs w/ dev of the brain, cardiovascular system and respiratory system
- born w/ an increased startle reflect and/or tremor
65
Stress: Violence and Stress
- At least 4 to 8% of women report violence during pregnancy
- As many as 324, 000 women who gave birth in the last year experienced violence
- Violence During pregnancy can result in:
1. spontaneous abortion
2. fetal injury
3. death from trauma
Domestic Violence Homicide= the leading cause of death for pregnant women
66
Stress: Possible Demographic Features
- Young maternal age/adolescence
- Unintended pregnancy
- Delayed prenatal care
- Smoking
- Alcohol and drug use
- Lack of social supports
- STD/HIV/AIDS
67
Maternal Anxiety and Depression
Shown to impact infants long term:
1. behavior problems
2. Anxiety
3. Lower IQ
68
Development Psychology (overview)
- Developmental psychology studies the physical, cognitive, emotional, and social aspects of human development.
- Life span perspective: belief that human development occurs throughout the lifetime.
69
Maturation/Nature
- Arnold Geseil
- Mature is the main developmental PRINCIPLE
- Heredity is the DRIVING force behind child growth and development
70
Behaviorism/Nurture
- Watson
- Development best viewed in terms of the learning theory
- Children's ideas and skills are shaped by EXPERIENCES
- Importance of physical/social environments
71
Freud Psychoanalytical view
- Stressed the importance of conflicts b/w the opposing inner forces
- psychosexual development (id, ego, superego)
72
Erikson's Psychoanalytical
```
-focused on development
psychological traits
emotional life
social relationships
-Placed emphasis on EGO
-Believed EARLY EXPERIENCES affect future dev
```
73
Behaviorism (Learning Perspectives)
-Skinner--classical conditioning
Learning in which an original neutral stimulus elicits a response
-Operant conditioning -----form a learning in which behaviors are reinforced
-Reinforcement----providing stimuli following responses that increase frequency
74
Social Cognitive Theory (Learning, Bandura)
-Emphasizes OBSERVATIONAL LEARNING
-Occurs by modelling the behavior of another person
- There is an added social component to this theory (we learn based off what we see)
___modeling and imitation is important and eventually the child is more selective in imitation
75
Cognitive Developmental Theory
-Scheme, Adaptation, Assimilation, Accommodation & Equilibrium
Child's abilities to mentally represent the world & solve problems are a result of:
Interpretation to explore, Manipulation of neuorological structures, (Piaget's stages, children active learners)
76
Information Processing Theory
- Cognitive process ENCODING information
- Storing information in the Long-term memory
- Retrieving information or placing it in the Short Term Memory
- Manipulating information to solve problems
- DOES NOT USE STAGES
- --> Development = CONTINUOUS
77
Biological Perspective
-Directly relates to PHYSICAL DEVELOPMENT
-Gain in height and weight
-Development of the brain
-Development connected w/hormones, reproduction and heredity
-Two primary theories:
Evolutionary Perspective => humans' historical adaptations to the environment influence behavior
Ethology => behaviors specific to a species that are inborn
_NO EMOTIONAL, NO COGNITIVE ASPECTS
78
Ecological Perspective
views person as developing within a complex system of relations affected by multiple levels of surrounding environment.
ECOLOGY: branch of biology that deals with the relationships between living organisms and their environment.
ECOLOGICAL SYSTEMS THEORY: explains the child development through reciprocal influences; explains development exist between people and the settings in which they live.
79
Sociocultural Perspective
-Developed by Vygotsky
-Humans are social beings affected by their cultural environment
Focuses on transmission of information and cognitive skills from generation to generation.
Views the child's functioning as adaptive to social or cultural interactions.
-culture, social interactions, importance of adults
Social Dev. & Trauma
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