Wednesday, December 2, 2009

Traumaversary

I used to believe that kids didn't remember stuff in the pre-verbal stage. But they do. Younger children remember it and it comes out in behaviors. Memories will return even if the children were very young. I've had several therapists tell me of children straight out of the womb having body memories of being placed with another mom, being moved, adopted, abuse, etc. Babies that have no concept of time will have body memories and then have behavioral issues around the same time every year. Their body will instinctively know and remember a trauma that occurred. How???? I have no idea. I do know it's another stellar reason to wear your baby if at all possible.

There's little bit about it here.

Adopt US Kids has some helpful info here.

Honestly, with 3 plus years of living and breathing PTSD and trauma anniversaries it's hard to explain all of it here. Articulating this subject is very difficult because it's so complex.

Yesterday in therapy we found out that J was sent to the cellar (her words) a lot. Today she stated that she was made to sleep in the cellar quite a bit and sent there for behaviors to sit in the dark. She was with this foster family on and off from the time she was 9 months old until she was 5. Explains why she is off the charts terrified of dark areas. We're not talking typical scared of the dark stuff. You can see the PTSD in her eyes. Total fight or flight response to dark areas, (closets, when it's becoming dusk before we turn the lights on....). It has become much better over time but you can see it as soon as it is triggered.

I found a pretty good explanation online by Kelley Gallagher but blogger wouldn't let me do the link so I've copied and pasted here:

I don't agree with all of the helpful information but it does give you a general overview and what works for one child might not work for another so take what works as you know your child better than anyone.

Children & Trauma

Children who are old enough to laugh and experience pleasure, can and do experience trauma.

Trauma is a sudden, unexpected, dramatic, forceful or violent event which involves emotional shock and mental confusion. It may involve bodily harm such as physical/sexual abuse or domestic violence. However, trauma also refers to the overwhelming, uncontrollable experiences that psychologically impact victims by creating feelings of helplessness, vulnerability, loss of safety, and loss of control (James, Bevery, 1989). Traumatic events may be violent or non-violent.

Traumatic experiences shake the foundation of a child’s belief system—destroying their sense of safety and security, shattering their assumptions of trust, and challenging their faith in the future.

Trauma has a profound impact on the emotional, cognitive, behavioral, social and physical functioning of children. Experiencing a traumatic event/ or series of events overwhelms the coping skills commonly used to handle expected problems in life, and strips children of their sense of safety and security

According to the National Institute for Trauma & Loss in Children, the number of children in the United States exposed to a traumatic event in a one year period exceeds 4 million. Children are exposed to trauma as surviving victims, as witnesses to violent or non-violent incidents, by being related to the victim as a family member, friend, peer, or simply because they live in the same community or go to the same school, and/or by simply listening to the details of the traumatic incident.

Trauma or Grief?
Trauma reactions are different from grief reactions. Trauma reactions overpower grief reactions.
This information taken from What Parents Need to Know, by William Steele, TLC Institute, 1997


Grief
Generalized reaction is SADNESS

Grief reaction stand alone

Grief reactions are generally known to the public and the professional

In grief, most can generally talk about what happened

In grief, pain is the acknowledgement of the loss


In grief, anger is generally non-destructive and non-assaultive


In grief, child says “I wish I would/would not have…”

Grief generally does not attack nor “disfigure” our self image


In grief, dreams tend to be of the deceased

Grief generally does not involve trauma reactions like flashbacks, startle reactions, hypervigilance, numbing, etc.


Trauma
Generalized reaction is TERROR

Trauma reactions generally include grief reactions

Trauma reactions, especially in children, are largely unknown to the public and professionals

In trauma, most do not want to talk about what happened

In trauma, pain triggers tremendous terror and an overwhelming sense of powerlessness and loss of safety

In trauma, anger often becomes assaultive even after non-violent trauma

Trauma guilt says, “It was my fault. I could have prevented it.”

Trauma generally attacks, distorts and “disfigures” our self image

In trauma, dreams are about self and potential victim

Trauma involves grief reactions in addition to trauma specific reactions

Responses to Trauma

Traumatic events may cause both physical and psychological reactions in children. A child’s reaction will depend upon the severity of the trauma, prior exposure to trauma, developmental phase, personality makeup, characteristic coping style, and the availability of support to assist the child in understanding and working through the traumatic event.

1. Re-experiencing
a. Intrusive or involuntary thoughts and/or images
b. Recurring nightmares or bad dreams
c. Reenactments of the traumatic event in play
d. Physical reactions/ Somatic complaints when exposed to events that are similar to or symbolize the traumatic event (headaches, stomach aches, etc.)
2. Avoidance
a. Cognitive – unwilling to talk about it
b. Emotional—dissociative reaction
c. Physical – avoids reminders or displaces fear into other situations
3. Hyperarousal
a. Sleep disturbance
b. Irritability or outbursts of anger
c. Difficulty concentrating
d. Hypervigilance or overprotectiveness—extreme concern with self or other’s safety, anxious in crowds, seeking out “safe places”…
e. Exaggerated startle response
f. Attachment reactions—wanting to sleep with parent, not wanting to be alone, clinging…

Trauma reactions can be mistaken for depression, oppositional behaviors, anger and aggression (behavior disorders), attention deficits and attachment problems.
-TLC Institute
Traumatized Children Need:

1. To know they are not alone with their terror and grief
2. To hear the stories and see the reactions of peers also traumatized by similar events
3. The opportunity to express their feelings of sadness, fear, terror, guilt, etc.
4. Tools to allow them to express and experience their feelings in a safe place
5. To learn that their reactions are normal
6. The opportunity to re-attach emotionally to the adult world which they often perceive to have betrayed them by letting this traumatic event happen
7. To have time and trauma-specific attention needed to help them find relief from their terror and develop a sense of power
8. To replace the terror and the sadness with happy memories
-What Color is Your Hurt, TLC, William Steele


Post Traumatic Stress Disorder
(PTSD)


Although most research on Post Traumatic Stress Disorder (PTSD) has been done with combat veterans, research and interest in childhood PTSD has been growing over the past 5-10 years. Children exposed to traumatic events may have a range of PTSD symptoms, behavior disorders, anxieties, phobias, and depressive disorders (Schwarz and Perry, 1994).

Many children exhibit signs and symptoms of PTSD following a traumatic event. However, when the symptoms persist for over one month or when the symptoms greatly interfere with the child’s ability to participate in daily activities, close attention should be given to that child and his/ her needs. Some traumatic events continue to be overwhelming to both children and adults long after the trauma has ended. Trauma is especially challenging to children because they are still developing their sense of self, have a limited perspective on life due to their age, and have a limited repertoire of coping mechanisms.

It is important that the child receive a comprehensive assessment by a licensed mental health professional to make an accurate diagnosis and effective treatment plan. However, it is helpful to understand the basis symptoms of PTSD in order to make accurate referrals and suggestions to families:

Re-experiencing the traumatic event (thoughts, dreams, and play themes).
For example, you may observe children:
• Repeatedly acting out traumatic events/ themes in play.
• Reporting distressing dreams about the trauma or sleep disturbance.
• Feeling distressed when exposed to events that resemble the trauma or at the time of the anniversary of the trauma.
• Acting or feeling as if the trauma is happening again.

Avoidance anything that may remind the individual of the trauma and
A general numbness to all emotional topics.
For example, you may observe children:
• Avoiding all activities that remind the child of the traumatic event.
• Withdrawing from other people/ changing friendships, etc.
• Having difficulty feeling positive/ happy emotions.

Increased “arousal” symptoms/ Increased anxiety.
• Having difficulty falling or staying asleep.
• Appearing irritably or quick to anger
• Having difficulty concentrating.
• Heightened startle response.

The symptoms that the child is dealing with must be interfering with the ability to participate in daily activities: school, family interactions, etc.


A Developmental Look at Trauma
Information adapted from The Scared Child, by B. Brooks, PhD, & P. Siegel.

Infants & Toddlers (Birth to One Year)
It can be very difficult to determine a very young child’s response to traumatic events due to the limited ability of these children to communicate verbally. However, it is important to look for changes in a young child’s behaviors. Children who have been trough a traumatic experience may exhibit the following signs of distress:
• Increased fussing/ irritability.
• Loss of developmental steps already achieved.
• Inability to progress developmentally.
An infant will not be diagnosed with PTSD—However, infants do experience trauma and need assistance in reclaiming a sense of safety, security, and trust. Problems will persist and increase if a sense of safety and security is not reestablished for the infant.

Preschoolers (Two to Five Years)
Preschoolers live in a world that combines their understanding of reality with magical thinking. Events that happen in sequence are believed to have a cause-effect relationship. For example, if a preschooler yells at his/her mother and later that day his/ her mother and father get into a physical altercation—the preschooler will often feel that they caused the altercation. In addition, preschoolers are egocentric. They believe that the world revolves around their needs. Finally, preschoolers often do not tell their parents/ caregivers about their fears/ feelings. They don’t have the words to express what is going on inside of them. Look for these signs of distress:
• Increased anxiety, clinging behaviors, fear of separation.
• Developmental regression.
• Aggressive play with peers.
• Playing the same game over and over again.
• Expression of magical thinking… “Daddy left because I was bad”.
• Expression of having positive feelings about an activity without the physical expressions to validate this feeling. For example, some children will report enjoying an activity while appearing sad, sullen, withdrawn, and fearful.

School Aged (Six to Twelve Years)
School aged children have a more realistic outlook and awareness about traumatic events. This is helpful in creating an understanding of the event. However, this is also challenging because school aged children are aware of the real threats of this world. School aged children also understand the impact of their feelings on others. They may stay isolated following a traumatic event to protect others from their feelings. Look for signs of distress including:
• Reverting to developmentally immature behaviors.
• Self blame for traumatic events.
• Reckless behaviors that may result from the knowledge of not being able to control all events in his/ her world.
• Significant changes in school performance.
• Difficulty concentrating or becoming intensely focused on schoolwork to the exclusion of having fun.
• Increased defiance/ rule testing.
• Changes in friendships.
• Sleep disturbance.
• Increased aggression.
• Magical thinking and increased fears.

Adolescence (Thirteen to Eighteen Years)
Adolescents have a grown-up grasp of reality of the traumatic situation. However, their behaviors will swing from that of a mature adult to that of a very young child. It is important to watch for signs of PTSD in this population.
• Many adolescents believe that only peers can understand what they are going through. However, a marked change in an adolescent’s relationship with parent(s) should be noted.
• Increase in risky behaviors, such as experimenting with drugs, sexual activity, and truancy. Adolescents who experience a traumatic event often feel that the future in limited. They have a belief that whatever they are working for could be taken away without warning.
• Negative self-image.
• Feeling of powerlessness.
• Engaging in revengeful fantasies and feeling guilty about these fantasies.
• Isolation from friends/ others. This may signify depression and increased risk for suicide.


Treatment Options & Types of Community Referrals

Traumatized children have special therapeutic needs. They have a difficult time trusting new adults and building a secure relationship in which to explore the traumatic event. Therapy is aimed at assisting children in reprocessing the trauma in a safe and supportive environment. In addition, children may need to change previous patterns of helplessness and feel more in control of their lives by developing new coping skills, self expression tools, and problem solving methods. There are a variety of treatment options that may work alone or together to assist children experiencing the painful symptoms of PTSD.

Behavior Therapy: Behavior therapy works to address the child’s intrusive thoughts and behavior patterns created by the trauma. Children also learn relaxation techniques, identification of feelings, and connection between feelings and behaviors.

Cognitive Therapy: Cognitive therapy assists the child in identifying their personal values, goals, and the influence of the trauma on the child’s thoughts/ behaviors. Cognitive therapy may also help the child to reinterpret traumatic events and feelings in more positive ways.

Art & Play Therapy: Art and play therapy are particularly useful with young children because play is a comfortable mechanism/ tool for children to express themselves—using toys/ materials as words. Story telling, problem solving, re-experiencing trauma, communicating feelings, and releasing feelings are all part of the therapeutic process.

Family Therapy: Family therapy is also helpful as it offers parents and siblings a supportive environment to share their fears/ feelings/ and reactions. Caregivers are provided with guidance and education on ways to support their child and take care of their own needs following a traumatic event.

Group Therapy: Group therapy can also be helpful in encouraging children to share their experiences and reactions to similar traumatic events. Group members help one another to normalize the feelings, fears, and behaviors that are problematic for children following traumatic events.

Medication: Medication can be helpful in curbing the symptoms of PTSD. The symptom relief that medication provides may assist the child in participating more effectively in supportive therapy options outlined above. Medications may be able to assist with severe anxiety, depression, and sleep disturbances.


Helping Children at Home
Suggestions adapted from the National Association of school Psychologists.
Trauma & Children handout compiled by P. J. Lazarus, Ph.D. Florida International University.
1998 National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814

• Establish a sense of safety and security. Children need to feel protected, safe, and secure. Be sure that all basic emotional needs are met including love, care, and physical closeness. Spend extra time with the child to let them know that you care about them and want to provide comfort and security.

• Listen to the child’s words and behaviors. Adults frequently worry about saying the right thing at the right time—it is perhaps more important to actively listen to the child in a nonjudgmental way. Children are often reluctant and inexperienced at telling their story of the trauma. It can be very helpful to ask the child what they feel other children would think/ feel about the event. In addition, children have an easier time talking about what they saw, smelled, heard, and physically felt during the event. It is more difficult to attach feeling words to these experiences.

• Help the child retell or reexperience his/ her story. Children need to retell their version of the traumatic event or reenact this experience in play. This is a big step in the healing process. Once the child has put words to their perception of events, they may repeat the story over and over again. Adults should listen supportively to the retelling of this story. Reenacting the trauma in play may also occur repeatedly. This experience offers the child the opportunity to make sense of the trauma and perhaps to gain mastery or a sense of control over the trauma.

• Validate the child’s feelings. Help children to understand that all their feelings are acceptable. Children will most likely express a multitude of difficult and contradicting feelings that may include guilt, shame, rage, anger, sadness, pain, isolation, loneliness, and fear. Children need to understand that all of their feelings are “normal”.

• Allow children the opportunity to regress as necessary. Regression is one way that many children “emotionally regroup”. Try very hard to be patient and not to ridicule—regression is usually a temporary coping strategy.

• Clear up misconceptions. Help the child to understand important details of the traumatic event. Include detailed information about safety plans, prevention, and security issues.

• Educate yourself about trauma and crisis. The more you understand about the traumatic events that the child experienced, the more confident you will be in assisting the child to achieve a positive resolution.

• Affirm that your children are capable of coping and healing after the trauma. Reinforce that children can heal from traumatic events. Outline the people who are available to the child for love, support, and security.

• Seek professional consultation and encourage mental health treatment if necessary. Find mental health professional who has experience working with traumatized children. Keep in mind that asking for help can be very difficult for the parent(s) due to their own challenging feelings and beliefs about the traumatic event(s). Much support may be needed to identify the need for and to facilitate this community referral.

Tips for Teachers

Your students may be tired – you might want to provide some extra quiet time with soft music. Stress to the children to go to bed early.

Your students may startle easily – they are on the look out for danger – keep distractions to a minimum and keep your regular routine.

Your students may become more irritable, aggressive and acting tough – keep firm expectations in place. They are feeling powerless.

Your students may forget what they have just learned – instruct in short chunks of time with lots of psychomotor activity – drawing, cutting, creating, etc.

Your students may regress in their behaviors – remind them they are to talk like, act like “big girls, big boys,” etc. in a gentle way.

Your students might withdraw and want less to do with their friends – encourage them to participate in activities.

Your students might develop school problems you haven’t seen before – stay firm but loving, chances are when things are calm, the problems will go away.

Your students might have more stomach aches, head aches, etc. – push them gently to stay in school.

Your students might fixate on one issue that is happening in his life – allow him to talk through it – he is trying to gain power over it.

Your students will need more nurturing. They may want to be physically closer to you. We need to do all we can to let our students know they are safe with us at school, and we are there for them. Abandonment is a major fear for children.

Minimize homework – they may not have help at home.

This is a good time for writing about different feelings in journals. This is a good time to draw pictures of them also.

Take extra breaks during the day. Physical exercise is very important to release stress.

Give honest brief answers to children’s questions. You may be the best source of information they have.

Create opportunities for children to talk with each other.

If a child keeps asking the same question over and over again, it’s because they are trying to make sense out of their confusion.

Keep your sense of humor and bright outlook on life – you may be the only stable person in your student’s life.

8 comments:

MomInTheTrench said...

That may be the longest post I've ever read. And yes, traumaversary is right on the mark. Living. It. This is our time of the year. That combined with the holidays is, um, eventful. It is amazing. . .I forget some trauma dates, but the behaviors remind me. I'm so glad someone else understands this, and sorry at the same time that you do.

Linda B said...

I learned alot from this post. Much of it I can relate to and didn't know it was a part of ptsd. Thank you!

Tracey said...

Please don't apologize for rocking my world with such an informative and timely post! We will be going over this as a family tomorrow!

Essie the Accidental Mommy said...

What is scary is how much all this stuff overlaps. Like, RAD and PTSD look very similar diagnostically but if you try to treat RAD with play therapy you will get a Borderline Personality Disorder for an adult. You have to have someone who is crystal clear on all the different aspects to make a decision.
But, I think that the vets coming out of this war are going to get a lot of analysis and medical testing and those results are going to show us with kids a lot of connections.

SocialWrkr24/7 said...

Awesome, awesome, awesomeness!

Thandi said...

Thank you. Sad about J,poor girl.She's gone through a lot in her short life.this infpo is very relevant to someone very close to me.

Tricia said...

thank you so much for this post!!!!

waldenbunch said...

Amazing amount of information. I'm hoping to continue to figure out my two and gain more insight. It's hard because they were so little when we got them. You're awesome, Lisa!