The following lecture has been approved for University

The following lecture has been approved for University Undergraduate Students This lecture may contain information, ideas, concepts and discursive anecdotes that may be thought provoking and challenging It is not intended for the content or delivery to cause offence Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation

Childhood Trauma Prof. Craig Jackson Head of Psychology BCU craig. jackson@bcu. ac. uk Childhood trauma Craig Jackson

Preamble They fuck you up, your mum and dad They may not mean to, but they do They fill you with the faults they had And add some extra, just for you. This be the verse A childhood where nothing ever happened – Philip Larkin Childhood trauma Craig Jackson

Trauma Most experience some trauma in course of life Minor trauma is a part of everyday life For most people these setbacks are only transient Some will have psychiatric and social complications Childhood trauma Craig Jackson

Traumatic events are common Lifetime prevalence of specific traumatic events Type of trauma Prevalence Assault Serious car or motor vehicle crash Other serious accident or injury Natural disaster Other shocking experience Diagnosed with a life threatening illness Learning about traumas to others Unexpected death of close friend or relative Any trauma Childhood trauma Craig Jackson 38% 28% 14% 17% 43% 5% 62% 60% 90%

What children think of stress Stress Looks like a flaming deamon Sounds like an eagle squaking Tastes like a burnt sausage Smells like sour milk Feels like stroking a hedgchog Stress is when mum says NO!!!!! by Andrew (aged 10) Year 5 Potley Hill Primary School Childhood trauma Craig Jackson

Acute Stress VS Chronic Stress A response Not a disease Common After-effects Leave behind Life threatening One-off Ever-present By proxy Childhood trauma Craig Jackson

Introduction Different types of trauma: Childhood abuse physical emotional sexual Neglect Traumatic incidents first-hand witness War and Displacement refugees Child-to-child bullying (Natural) Disasters first-hand witness / proxy Childhood trauma Craig Jackson

Epidemiology – NSPCC statistics • 1 child dies per week as the result of adult cruelty • 25% of all rape victims are children • Most abuse is committed by someone the child knows and trusts • Abuse is often known about or suspected by an another adult • 75% sexually abused children do not tell anyone at the time • 30% are not able to tell anyone about the experience later • 80 children killed per year by parents carers in England & Wales • Number of babies being killed has risen steadily since 1997 • Babies 5 times more likely to be killed than any other age group • 30, 000+ children are on child protection registers • 600+ added to the child protection registers per week • 1 in 10 adults seriously abuse or neglect during childhood Childhood trauma Craig Jackson

Epidemiology - perspective Traumatic Brain Injury TBI Leading cause of death of children >1 yr Brain injury - leading cause of death and disability in trauma victims 1994 - USA data 9000 deaths in 0 - 19 age group 68, 000 hospitalized Mortality rate of 35% Childhood trauma Craig Jackson

Facts and figures Child abuse 15 times more likely to occur in homes where there is domestic violence American Humane Association Childhood trauma Craig Jackson

Facts and figures 45 - 63 % of mothers of abused children were also abused concurrently Pagelow 1989 Childhood trauma Craig Jackson

Facts and figures As violence towards mother becomes more extreme and frequent, children in the home experience a 300% increase in frequency of physical violence from the batterer Strauss and Gelles 1990 Childhood trauma Craig Jackson

Victimized parents abusing their children Rate of child abuse by mothers who were victimized by partner was twice as high as that of women whose partners did not assault them Strauss and Gelles 1990 Childhood trauma Craig Jackson

Generation link “Cycle of abuse” theory Domestic violence Elder abuse Childhood trauma Craig Jackson

Facts and figures 62% of women reporting childhood abuse have experienced domestic violence Commonwealth Fund Childhood trauma Craig Jackson

“Childhood trauma a cause of ADHD? ” “Disease” camp vs. “Environmental” camp Can certain circumstances increase chances of ADHD? 522 children aged 6 - 17 280 ADHD 242 Comparisons Early childhood trauma was a cause Boys more functionally impaired than girls Low social class made ADHD more likely Maternal smoking made ADHD more likely Greatest risk factor was family conflict Bierderman et al. 2002 Childhood trauma Mumme - 1 yr olds! Craig Jackson

“Spanking makes children violent? ” Gershoff 2002, reviewed 88 studies on spanking Strongly linked with immediate compliance! But also. . . Aggression Antisocial behaviour Abuse of children and spouses Corporal punishment escalates into maltreatment? No - Punishment is not causative of hostile adults Frequency Method Administration Emotional context Combination Likelihood of developing aggression Childhood trauma Craig Jackson

“Abuse survivors see emotions differently” Experience can alter perceptions of emotion Pollak et al. 2002 Studied abuse survivors (8 -10 yrs) Faces with morphed photos - combination of emotions happy fearful sad angry Abused and Non-abused reacted similarly to happy faces Abused children more sensitive to angry faces Childhood trauma Craig Jackson

“Abused boys have more health problems” “Male victims of sexual abuse 3 times more likely to suffer health problems” 93 boys abused by same teacher 6 yrs after abuse survivors aged 14 -16 Health problems between abused and non-abused NOT different Abused boys significantly more time at GP than controls for unexplained symptoms Price et al. 2002 Interpretative differences of abuse studies Childhood trauma Craig Jackson

“Future criminals can be spotted early” Association between behaviour at 3 yrs and adult criminality Spec. behaviour problems in pre-school place child at risk of conviction of adult offence Social circumstances not relevant - Therefore, poverty doesn’t lead to crime! 828 adult offenders retrospectively compared with nonoffenders. Offender group had history of: Temper tantrums Inability to socialise ADD actions Soiling Discipline difficulties Stevenson 2001 Childhood trauma Craig Jackson

“Daycare leads to aggression” Increased daycare hours = increased aggression Belsky 2002 2000 children in US - mean time was 26 hours per week Quality of care not important Parenting style not important Linear relationship between aggression and hours spent in daycare Childhood trauma Craig Jackson

“Broken homes lead to psychiatric problems” Longitudinal study of 1 million children over 20 years Children with 1 parent were twice as likely to: develop psychiatric problems attempt suicide develop alcohol-related disease develop drug-related ill-health (X 3 girls) (X 4 boys) Financial hardship linked to emotional problems Parental quality linked to emotional problems Childhood trauma Craig Jackson

Outrageous claims? Childhood trauma a cause of ADHD Spanking makes children violent Abuse survivors see emotions differently Abused boys have more health problems Future criminals can be spotted early Daycare leads to aggression Broken homes lead to psychiatric problems Childhood trauma Craig Jackson

Post Traumatic Stress Disorder - PTSD Response to specific traumatic / extreme event DSM IV & ICD-10 1. Experience intense fear 2. Persistent re-experience 3. Avoidance of associations 4. Persistent increased arousal since event 5. Flashbacks 6. Hyper-arousal – sleep, irritability, concentration, hypervigilance, startle Childhood trauma Craig Jackson

Post Traumatic Stress Disorder - PTSD Psychiatric diagnosis is not a disease Distress and suffering is not psychopathology PTSD constructed from political ideas PTSD linked to changes in society and individual lifestyle Diagnoses must be objective PTSD lacks precision What is subjective distress or objective disorder Psuedocondition – transforms social ills into medical ones Childhood trauma Craig Jackson

Psychiatric diagnoses in juvenile offenders 93% Conduct Disorder 82% Substance Abuse Disorder 18% ADHD 26% Learning Disabilities 32% Anxiety Disorders 22% Mood Disorders 15% Associative Disorders Stanford University, Division of Child Psychiatry Childhood trauma Craig Jackson

Psychopathology of disruptive behaviour disorders Trauma Related Disorders Personality Disorders DISRUPTIVE BEHAVIOUR DISORDERS Mood & Affective Disorders Substance misuse Stanford University, Division of Child Psychiatry Childhood trauma Craig Jackson

Connecting family violence with childhood abuse Domestic violence present in 41% of families where child abuse was present - Oregon DHR 43% of child fatalities occured in families where mother was being abused - Massachusetts DHR If mother is not safe, neither is the child Childhood trauma Craig Jackson

Witnessing domestic violence Children who witness abuse often display same emotional responses / behaviours as the physically and emotionally abused victim Childhood trauma Craig Jackson

Psychological markers of childhood trauma Isolation Guilt Depression Fear Isolation Loss Common “legacies” of childhood sexual, physical or emotional abuse Childhood trauma Craig Jackson

Behavioural markers of childhood trauma Forgetting False memory syndrome - statute of limits Denial Avoidance Control Eating disorders OCD Self harm Rationalisation Acceptance Negative self Distraction Self harm Childhood trauma Sexualisation Craig Jackson

Behavioural markers of childhood trauma Immediate consequences of abuse or neglect may involve physical or psychological trauma Residual effects - emotional and developmental scars Often before problem behaviours in adolescence / adulthood Research shown abused or neglected children are likely candidates for delinquency and adult criminality The relationship of maltreatment to subsequent drug or alcohol misuse is less clear Ireland & Widom 1994 Childhood trauma Craig Jackson

Deliberate Self Harm: behavioural markers DSH (Parasuicide) intentional, non-suicide, non-life threatening act Female: Male At risk: 2: 1 15 -24 biggest group Female Isolation Negative life events bereavement abuse Pre-existing psychiatric conditions Family history of DSH Intolerable stress Impulsive, Immature, Aggressive personality Childhood trauma Craig Jackson

Deliberate Self Harm: methods • Cutting Forearms and wrists Legs and feet Laterality Genitalia (abuse survivors) • Burning • Pills and Toxins (detection) 5 th biggest cause of hospital admissions in UK Childhood trauma Craig Jackson

Deliberate Self Harm: pre-meditation Premeditation can be biggest sympathy inhibitor • Saving up pills / blades • Avoiding discovery • Long sleeves • Prepared excuse stories • Bandage stockpiles Childhood trauma Craig Jackson

Deliberate Self Harm: motivation • Cry for help have they talked to anyone prior to DSH? • Escape from situation control & mastery • Punishment and Manipulation of others loved ones failing relationships inferiority Childhood trauma Craig Jackson

Factitious injury Feigned physical / psychological symptoms or signs Aim is to receive medical care Most are female, “stable” networks, many working in healthcare Only confront if evidence of factitious harm is established Supportive confrontation: aware of role of behaviour in their illness offer psychological help with this Patients usually stop behaviour but leave clinic Offer of psychiatric care rarely taken up Childhood trauma Craig Jackson

What conclusions can we really make? ? Childhood trauma Craig Jackson