EFFECTS OF TRAUMA ON CHILDREN

1. EFFECTS OF TRAUMA ON CHILDREN Armen Sarkissian, EdD HSPP Cummins Behavioral Health Systems, Inc October 15, 2011

2. DEFINITIONS TRAUMATIC EVENT • ACTUAL OR THREATENED DEATH OR SERIOUS INJURY OR THREAT TO PHYSICAL INTEGRITY • RESPONDED WITH INTENSE FEAR, HELPLESSNESS OR HORROR

3. DEFINITIONS… TRAUMATIC EVENT • Events over which we have no control • Public or Private Events

4. DEFINITIONS… TRAUMATIC EVENT • PUBLIC • Natural Disasters • Wars • Terrorism • Hostage situations

5. DEFINITIONS… TRAUMATIC EVENT: PRIVATE • Sexual Assault/Rape • Childhood Physical Abuse • Childhood Sexual Abuse • Childhood Neglect • Bullying • Victim of, or Witness to Violence • Domestic Violence

6. IMPACT OF TRAUMA THE IMPACT OF TRAUMAS ARE CUMULATIVE. IF LEFT UNADDRESSED, TRAUMA UNDERLIES A WIDE RANGE OF SOCIAL, PHYSICAL AND BEHAVIORAL HEALTH PROBLEMS

7. IMPACT OF TRAUMA… • Trauma resulting from prolonged, repeated exposures to violent events can be the most severe • Trauma, especially when untreated, can have severe negative impacts on a person’s physical and emotional well-being

8. IMPACT OF TRAUMA… Persistent stress leads to: • Elevations in heart rate, blood pressure, and stress hormones, which in turn impair: • Brain architecture, immune status, metabolic systems, and cardiovascular systems

9. IMPACT OF TRAUMA… • Exposure to traumatic events seems to change the way infants react to future stressors • Animal and human studies show changes in hormones and brain chemicals after trauma • These brain changes can be long lasting, leading the child to feel numb or anxious

10. IMPACT OF TRAUMA… SOCIAL • SCHOOL PROBLEMS • HOMELESSNESS • PROSTITUTION • DELINQUINCY • CRIMINAL BEHAVIOR • INABILITY TO HOLD A JOB

11. IMPACT OF TRAUMA… PHYSICAL HEALTH • HEART DISEASE • CHRONIC LUNG DISEASE • LIVER DISEASE • HIV-AIDS • SKELETAL FRACTURES • FIBROMYALGIA

12. IMPACT OF TRAUMA… BEHAVIORAL HEALTH • 51 to 98 PERCENT OF CONSUMERS OF PUBLIC BEHAVIORAL HEALTH SERVICES HAVE TRAUMA HISTORIES SAME PREVELANCE RATES AS SUBSTANCE ABUSE DISORDERS

13. IMPACT OF TRAUMA… IN CHILDREN AND YOUTH TRAUMA RELATED DISORDERS ARE OFTEN INACCURATELY DIAGNOSED AS: • DEPRESSION • BIPOLAR DISORDER • ADHD/ADD • ODD

14. IMPACT OF TRAUMA… IN CHILDREN AND YOUTH TRAUMA RELATED DISORDERS ARE OFTEN INACCURATELY DIAGNOSED AS… • SEPARATION ANXIETY DISORDER • REACTIVE ATTACHMENT DISORDER • CONDUCT DISORDER • GENERALIZED ANXIETY DISORDER • ADJUSTMENT DISORDERS

15. IMPACT OF TRAUMA… Life areas affected by trauma: • Safety • Trust • Power and Sense of Competence • Self sufficiency, esteem, ability to self-soothe • Intimacy

16. IMPACT OF TRAUMA… Trauma perpetrated by humans seems to have a more severe and longer lasting impact on victims than natural disasters

17. IMPACT OF TRAUMA… Trauma victims are at a much higher risk for co-occurring mental health and substance related disorders

18. TRAUMA VICTIMS… • Violence victimization • Violence perpetration • Self-injury • Host of other coping mechanisms which themselves have devastating human, social, and economic costs

19. TRAUMA VICTIMS… Trauma has been linked to: • Hallucinations and delusions • Depression • Suicidal tendencies • Chronic anxiety • Irritability • Hostility and chronic anger

20. TRAUMA VICTIMS… Trauma has been linked to… • Interpersonal sensitivity or poor “social skills” • Somatization such as “fibromyalgia” • Eating disorders • Dissociation

21. TRAUMA VICTIMS… IN CHILDREN AND YOUTH: • Inability to have loving feelings • Developmental regression • New separation anxiety • New onset of aggression • New fears • Disruption of play activities

22. TRAUMA VICTIMS… • Disruption of play activities: • Repetitive actions • Driven quality • Constricted quality • Preoccupation with separation, loss, and reunion • Loss of play activities, in cases of neglect

23. DISASTER TRAUMA • All disaster victims are likely to experience some form of trauma • Many disaster survivors “recover” from grief and shock after a few months • 25 percent to 30 percent of those directly affected may develop PTSD

24. DISASTER TRAUMA… • People are most at risk who have had: • Prior exposure to any trauma; domestic violence, childhood abuse, disaster, etc • History of mental illness or drug abuse

25. Post Traumatic Stress Disorder SYMPTOMS OF PTSD • TRAUMATIC EVENT • REEXPERIENCING THE EVENT • AVOIDANCE • AROUSAL

26. PREVALENCE OF PTSD • 50-60 percent experience a trauma over their lifetime • Lifetime PTSD prevalence rate: • Men 5-8 percent • Women 10-14 percent

27. PREVALENCE OF PTSD… • Lifetime PTSD prevalence rate • 8 percent in US population • PTSD rates increase with type and severity of trauma • 50 percent of those with PTSD experience it chronically

28. PREVALENCE OF PTSD… Most clinicians in the field believe that the prevalence is much higher than what is being reported since most people are reluctant to admit or acknowledge trauma

29. Can PTSD be prevented? • Trauma is a necessary but not sufficient condition for developing PTSD • The “weak link” • Unclear if early intervention is helpful, as was clear post 9-11 and post Katrina • Seems discussion and altruistic activities are helpful for adults • Spiritually oriented adults, cope better

30. Can PTSD be prevented? • Resilience in youth is a protective factor against developing PTSD • Individual and environmental factors play a part • The most important protective factor is a healthy and well functioning parent

31. COMORBID CONDITIONS FOR YOUTH: • DEPRESSION • BIPOLAR DISORDER • ANXIETY / PANIC • OPPOSITIONAL DEFIANT DISORDER • ADDICTIONS • ADD/ADHD

32. COMORBID CONDITIONS FOR YOUTH… • REACTIVE ATTACHMENT DISORDER • DISRUPTIVE BEHAVIOR DISORDERS • ADJUSTMENT DISORDERS • CONDUCT DISORDER • SEPARATION ANXIETY DISORDER • ENURESIS, ENCOPRESIS • PSYCHOTIC DISORDERS

33. Assessing for Trauma… • Take every trauma seriously, even if not taken seriously by the reporter • Allow the youth to postpone discussing the trauma to a later session

34. Assessing for Trauma… • Even if the PTSD criteria are not met, trauma may still cause stress in the individual’s life and ability to cope with life situations

35. Assessing for Trauma… • Trauma causes a change in persons’ view of themselves and of the world around them, as it applies to them

36. Recognizing Trauma Discuss with youth information about trauma in general, the effect it has on people, and the availability of effective treatment when relevant

37. Trauma informed care Trauma may be addressed while working on concurrent issues, such as substance related disorders, depression, anxiety, panic, oppositional disorders, attention deficit disorders, etc

38. FINANCIAL COSTS OF TRAUMA The financial burden of undiagnosed and untreated trauma to society is staggering

39. FINANCIAL COSTS… Alcohol and Drug Abuse treatment costs due to untreated trauma were estimated at $160.7 billion in 2000

40. FINANCIAL COSTS… The estimated cost to society of child abuse and neglect is $94 billion per year, or $258 million per day

41. FINANCIAL COSTS… Long-term psychiatric and medical health care costs are estimated at $100 billion per year for childhood abuse survivors

42. RESOURCES • Indiana Association for Infant and Toddler Mental Health (iaitmh.org) 317/638-3501 EXT 221 • Zero to Three (www.zerotothree.org) • National Child Trauma Stress Network (www.nctsnet.org)

43. RESOURCES mentalhealth.samhsa.gov/nctic www.thriveintiative.org www.chadwickcenter.org