Childhood Trauma & Health-Ryst

Question 1

T/F Children do not get PTSD.

Answer 1

False. We find out in the 1970s that they do.

Question 2

what is the definition of a trauma?

Answer 2

a serious threat or assault on bodily integrity -may involve the threat of death
or sexual assault
can be towards a loved one or the person

Question 3

Is there a link b/w prison or drug rehab & childhood trauma?

Answer 3

YES
14% of men in prison abused as children
36% of women in prison abused as children
60% of people in drug rehab had a hx of abuse
**also there is a link to these victims going on to abuse their own children & victims developing psychological disorders

Question 4

How can trauma relate to the HPA axis?

Answer 4

early adversity–associated w/ atypical development of the HPA axis stress response

Question 5

T/F The degree of trauma is related to how the child interprets the trauma.

Answer 5

True.

Question 6

How are brain structures different in people who have experienced maltreatment?

Answer 6

structural differences in hippocampus (memory & learning) & corpus callosum (helps coordinate messages from prefrontal cortex–>amygdala)
decreased activity of prefrontal cortex
**also basal ganglia, amygdala, cerebellum

Question 7

Which genotype puts you at risk for anti-social behavioral disorders?

Answer 7

carriers of the low activity allele of MAO-A gene–hyperresponsivity of brain to threats

Question 8

What is the ACE study?

Answer 8

shows health, social, & economic risks that result from childhood trauma–>long term following of patients at Kaiser

Question 9

What is the progression shown with the ACE study?

Answer 9

Adverse Childhood Experiences
Social, Emotional, & Cognitive Impairment
Adoption of Health-risk Behaviors
Disease, disability, & social problems
early death

Question 10

What are those w/ ACEs more likely to do, according to a study published in the Journal of Pediatrics?

Answer 10

More likely to initiate drinking alcohol at a younger age.
More likely to use alcohol as a means of coping with stress.
More likely to smoke, use drugs, become obese and engage in promiscuity.
Higher risk of school failure, gang membership, unemployment, homelessness, violent crime, incarceration and becoming single parents.
High risk adults who become parents are unlikely to provide stable, supportive parenting (intergenerational cycle).
Poor health-related quality of life and increased risk for diseases such as COPD and liver disease.

Question 11

What is resilience? How does it relate to trauma?

Answer 11

resilience: ability to thrive, mature, & increase competence in the face of adverse circumstances or obstacles
* **better adapt to the difficulties of trauma

Question 12

What are some resilience factors?

Answer 12

easy temperament,
secure attachment, 
basic trust, 
problem solving abilities, 
an internal locus of control, 
an active coping style, 
enlisting people to help, 
making friends, 
acquiring language and reading well, 
realistic self-esteem, 
a sense of harmony, 
a desire to contribute to others, and 
faith that one's life matters (Davis, 2001).

Question 13

T/F Majority of foster care children are not receiving mental health treatment of any type.

Answer 13

True.

Question 14

What are the risk factors that increase the likelihood of trauma?

Answer 14

Intensity of trauma exposure and proximity
High media exposure
History of previous trauma, abandonment or attachment problems
History of anxiety, depression, low resilience,high reactivity
Parents’ level of stress

Question 15

PTSD is a possible post-trauma diagnosis…what are others?

Answer 15

Depression
Anxiety
Substance abuse
Subsyndromal PTSD

Question 16

What is the exposure criteria for the diagnosis of PTSD.

Answer 16

Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event
2. Witnessing, in person, the event (s) as it occurred to others.
3. Learning that the traumatic events(s) occurred to a close family member of close friend. If a death, it must be violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic events.

Question 17

T/F Pt is a 15 yo male who is disturbed by images of war on TV. He is having nightmares and is diagnosed with PTSD.

Answer 17

False. The criteria for the diagnosis of PTSD doesn’t apply to exposure to trauma through the media.

Question 18

What other criteria must be met for a diagnosis of PTSD.

Answer 18

1. Exposure
2. Intrusive Symptoms
3. Persistent avoidance of stimuli associated w/ the traumatic event.
4. Neg. alterations in cognitions
5. marked alterations in arousal & reactivity

Question 19

How have they altered the requirements for a diagnosis of PTSD in children?

Answer 19

children may have a harder time describing their cognitions & internal experiences…may prevent them from receiving treatment for PTSD

Question 20

How can you observe negative alterations in cognition in children suffering from PTSD?

Answer 20

Increased frequency of negative emotional states
Diminished interests including constriction of play.
Socially withdrawn behavior
Persistent reduction in expression of positive emotions.

Question 21

In a trauma assessment…looking at regulation of affect & behavior…what might we see?

Answer 21

Deterioration of ability to inhibit aggression
Conversely, fear of agression may promote excessive inhibition and lack of assertion.
Substance abuse to manage painful emotions

Question 22

How might trauma affect core identity?

Answer 22

Powerlessness damages self-efficacy
Magical thinking and tendency to blame themselves leads to guilt
Can interfere with development of empathy and prosocial behavior.
Re-activation of conflicts from earlier periods: disruption of narcisstic fantasies can lead to perpetual search for merger with more powerful
Efforts to master fear and vulnerability can lead to long-term identifications (eg with rescuer, or the aggressor).

Question 23

How might trauma affect social skills?

Answer 23

Trauma induced anxiety can cause withdrawal from normal social activities.
In some children, trauma leads to oppositional defiant behavior (seeing benign actions or hostile or seeing aggression as the only possible response); this further leads to association with deviant peer group and involvement in anti-social activities.

Question 24

How might trauma present at the preschool age?

Answer 24

Attachment, Magical Thinking, Oedipal Complex, Fantasy Play

Question 25

How might trauma present at the latency age?

Answer 25

Mastery, peer relationships, self-esteem, organized play

Question 26

How might trauma present during adolescence?

Answer 26

Experimentation/risk-taking, individuation, identity, intimacy

Question 27

T/F In a trauma assessment, parent-child reports have high concordance.

Answer 27

False. Low concordance.
**might need to use non-verbal assessments
Use PTSD Assessment Tools

Question 28

Is pharmacology helpful in treating PTSD?

Answer 28

Antidepressants–SSRI’s
Sertraline and Paroxetine-treat PTSD in adults
Alpha-adrenergic agents (clonidine/guanfacine) can reduce autonomic nervous system arousal.
Mixed results for benzodiazepines and buspirone.

Question 29

Aside from pharmacology…what are other forms of treatment for PTSD?

Answer 29

Play Therapy
Trauma Focused CBT
Cognitive Behavioral Intervention for Trauma in Schools
Eye MOvement Desensitization and Reprocessing