SAOL March 2016 The impact of trauma on

SAOL, March, 2016 The impact of trauma on children Rosaleen Mc. Elvaney

What do we mean by ‘trauma’? • Introduced to DSM in 3 rd edition (APA, 1980) Post Traumatic Stress Disorder (PTSD) • Normal reaction to an abnormal event

Post Traumatic Stress Disorder • Experience that is emotionally overwhelming • Research following 2 nd World War • Work with Vietnam Veterans

Complex trauma • chronic, prolonged exposure; entrapment; developmental (Herman, 1992) • “Children’s experiences of multiple traumatic events that occur within the caregiving system” (p. 5) • “Simultaneous or sequential occurrences of child maltreatment – including emotional abuse and neglect, sexual abuse, physical abuse, and witnessing domestic violence-that are chronic and begin in early childhood” (p. 5) • Cook et al. (eds) (2003). Complex trauma in children and adolescents. National child traumatic stress network www. nctsn. org •

Complex trauma - outcomes • extend beyond PTSD; “span multiple domains of impairment and include: • (a) self-regulatory, attachment, anxiety, and affective disorders in infancy and chidhood; • (b) addictions, aggression, social helplessness and eating disorders; • (c)dissociative, somataform, cardiovascular, metabolic, and immunological disorders; • (d) sexual disorders in adolescence and adulthood; and • (e) revictimization” (p. 5)

Domains of impairment • Attachment • Biology • Affect regulation • Dissociation • Behavioural control • Cognition • Self-concept

Developmental Trauma • Emphasis on impact as child develops • Development as cumulative • Impact as cumulative

Adverse Childhood Experiences (ACE) studies

Psychological impact – what influences it? • Developmental context: pre-trauma • Intrapersonal: self esteem; emotional regulation capacity; general coping capacity • Interpersonal: attachment; family & peer relationships • Community: school; sports; engagement • Society: attitudes; policy; legislation

Psychological impact • Nature of the trauma • Exposure to or experience of physical, sexual, emotional assault, abuse or neglect; acute or chronic • Individual response to the trauma • Meaning/making sense of; emotional reaction • Developmental context: post-trauma • Intrapersonal: feelings, thoughts, meaning • Interpersonal: responses of others and supports: • Community: involvement in co-curricular activities; how society responds

2 • Self esteem • Emotion regulation • Relational capacity

Self Esteem • Egocentricism: the world revolves around me • Bad things happening makes children feel bad about themselves • Vulnerable children are more at risk

Self Esteem • Egocentricism: It’s not your fault • Support child in developing competence • Positive messages: Reward child for achievements

Emotion regulation • Developmental tasks • Left brain/Right brain Thinking before action • Child overwhelmed with intense emotions • Stress hormones

Stan and Ute Lawrence, Canada, 1999 (cited in van der Kolk, 2013)

3 year old children – ‘normal’ & ‘extreme neglect’

Emotion regulation • Regulating FOR the child • Helping child to identify /recognise and express emotions in a safe way • Helping child to talk… • Distraction techniques • Right brian to right brain communication (Allan Schore) Attunement

Relational capacity • Impact on cognitive, social and emotional functioning • Reading social cues in relationships Reflective functioning: capacity to reflect on own emotional experience and experience in relation to others (Fonagy et al. , 1997)

Relational capacity • Learning to trust; taking risks • Separating out this person from that person Teaching reflective functioning

Research on how children overcome adversity • Problem-focused coping strategies (Everall et al. , 2006) • Relationships: supportive peer, parent and other relationships • Face up to the problem • Reflect on the problem • Creatively generate & plan possible solutions • Reach out for help • Future oriented behaviour: experimenting, taking charge

Post-traumatic growth • Kintsukuroi – more beautiful for having been broken • Stephen Joseph’s work: development of new capacities • Research findings: Compassion & empathy

What gets in the way of helping children? • Being open to the possibility… • Our own history…. • Not noticing, seeing, hearing… • Not being able to tolerate their distress… • Our beliefs about what is best…. • Each child is unique…in order to help them we must listen to them • We all have the capacity to know what’s right for us; trauma gets in the way; the challenge is finding the best way for this child

Forthcoming book… • London: Jessica Kingsley Publishers.

Thank you! Rosaleen. mcelvaney@dcu. ie