A Developmental Model of Childhood Traumatic Stress Traumatic

A Developmental Model of Childhood Traumatic Stress

Traumatic Stress PROXIMAL SECONDAR Y STRESSES APPRAISAL & RESPONSE TO DANGER PROXIMAL TRAUMATIC REMINDERS ECOLOGY OF THE CHILD RESISTANCE & VULNERABILITY ACUTE DISTRESS RESILIENCE CHILD INTRINSIC FACTORS ADJUSTMENT PROXIMAL PSYCHOPATHOLOGY PROXIMAL DEVELOPMENT DISTAL TRAUMA REMINDERS DISTAL DEVELOPMENT ONGOING ADJUSTMENT REPEATED OR SEQUENTIAL TRAUMATIZATIO N DISTAL SECONDARY STRESSES DISTAL PATHOLOGY

Traumatic Stress • Alarm Reactions • Context • Complexity • Objective features • Subjective experience • Coping strategies • Loss Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

The Complexity of Traumatic Experiences • Context • Multiple traumatic moments, even within a relatively circumscribed situation. • Changes in foci of attention or concern • Radical shift in attention or concern when physical integrity is violated • Additional traumatic moments after cessation of violence or threat • Additional dimensions to traumatic experiences • Disturbances in evolving developmental expectations regarding danger Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Proximal Trauma Reminders • External and Internal Cues • Constellation • Pattern of Occurrence • Pattern of Reactivity • Challenge to Regulation of Aggression • Trauma and Loss Reminders • Reminders of Prior Trauma Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Proximal Secondary Stresses • Changes in Family Living Circumstances, Resources • Medical / Surgical Care, Rehabilitation • Change in Community Resources • Altered Role Performance • Change in Family Constellation and Function • Change in Availability and Utilization of Social Support • Issues of Accountability • Acquisition of New Social Skills • Intercurrent Trauma, Loss, Life Adversity • Need to Assume New Responsibilities Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

APPRAISAL AND RESPONSE TO DANGER RESISTANCE AND VULNERABILITY ACUTE DISTRESS RESILIENCE ADJUSTMENT

Proximal Development • Selective Attention / Cognition / Learning • Mechanisms of Emotional Regulation • Self-Attributions • Autonomous Strivings • Perceptions of Self-Efficacy • Specific Psychodynamic Concerns • Impulse Control • Moral Development • Sense of Historical Continuity • Skills of Social Competency • Interpersonal and Intrafamilial Transitions • Biological Maturation, including brain structures and physiological and hormonal changes Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Proximal Psychopathology • • • PTSD Depression Complicated Bereavement Phobic Disorder Separation Anxiety Disorder • Other Anxiety Disorders • • • Sleep Disorder Attachment Disorder Dissociative Disorder Somatization Disorder Substance Abuse Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Ecology of the Child • Family / Parental Factors – Similar grouping as Child Intrinsic Factors – Parental physical illness – Parent past exposure to trauma and loss – Reactivity to reminders – Loss and secondary stresses – Current responsiveness – Current trauma and loss-generated psychopathology • Developmental Cycle of the Family – Family Structure and Function • School Milieu and Responsiveness • Peer Milieu and Responsiveness • Social Ecology and Responsiveness Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Child Intrinsic Factors • • • Genetic Temperament Alarm Propensity Anxiety Sensitivity Organization of Stress Response Systems Acquired Developmental Competencies • • • Phase-Specific Concerns Pre-existing Psychopathology Prior Experience – Threats to Attachment – – • • Trauma and Loss Coping with Prior Danger Modes of Attachment Coping Repertoire Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Distal Trauma Reminders • Context in Everyday Life • Recognition Difficulty • Reactivity and Negative Self-Attributions Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Repeated or Sequential Traumatization • Complex impact on development • Various exposures at different points • Changing nature of similar traumatic stress • Incomplete recovery • Chronic anticipatory strategies • Debilitating conflict over accountability • Capitulatory emotional regulation, avoidance, and control of physical or psychological pain • Latent negative self-images • Harmful tension reduction behaviors Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Distal Secondary Stresses • Chronicity of Proximal Stresses • Adverse Life Circumstances • Accommodation to Physical Disability • Judicial / Reparation Proceedings • Disclosure and Communication about Previous Trauma Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Distal Development • Emerging Personality – Fear, courage, and fearlessness – Trauma, loss, and danger expectancies – Embedded attributions to self, other, and social agencies – Enduring intervention themes – Adult self-care and protective behavior • Interaction of proximal disturbances on specific future developmental tasks • Interpersonal academic and occupational functioning • Parental functioning • Decision-making, aspirations, and motivations • Political ideology and social contact Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Distal Pathology • PTSD and other psychiatric disorders • Physical health problems • Chronic developmental disturbances • Adverse life trajectory outcomes • Increased vulnerability to future life stresses • Difficulties in treatment situation Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.

Proximal Psychopathology • Acute Stress Disorder • PTSD • Depression • Complicated Bereavement • New Onset Attention Deficit Disorder • Separation Anxiety Disorder • Other Anxiety Disorders • Sleep Disorder • Attachment Disorder • Conduct Disorder • Eating Disorder • Phobic Disorder • Dissociative Disorder • Somatization Disorder • Substance Abuse Adapted from: Pynoos RS, Steinberg AM, Wraith R: (1995) A developmental model of childhood traumatic stress. In: D. Cicchetti and DJ Cohen (Eds. ), Manual of Developmental Psychopathology New York: John Wiley & Sons, 72 -93.