childhood trauma & stressor related disorders (329 E3) Flashcards
what is the most prevalent form of child abuse in the US
neglect
phase model of treatment for children who have been abused, neglected or witnessed some type of trauma
plan includes psycho, biological, psychological & family goals w/n a staged treatment protocol
stage 1: provide safety and stabilization
stage 2: reduce arousal and regulate emotion through symptom reduction & memory work
stage 3: catch up on developmental and social skills; develop a value system
stage 1
creates a safe and predictable environment for the child, stopping any self harm or self destructive behaviors they may have and providing general education about trauma and its effects
stage 2
help individuals find comfort from other people, integrate suppressed emotions and help expect ambivalence, help them overcome avoidance and work on improving their attention and decreasing disassociation if that occurs
stage 3
enhance their problem solving skills, nurturing self awareness, social skills training, helping develop a value system
interventions include teaching coping skills to help them deal w/ trauma, give socially appropriate goals, and try to find healthy support system
window of tolerance
when a child is subjected to trauma, they’re sympathetic and parasympathetic arousal is kind of at odds -> the child has a hard time shifting emotional and physiological states to adapt to the different environments that they find themselves in
go between hyper arousal and hypo arousal
we try to help them self regulate by using different interventions to keep them balanced aka in the window period
hyper arousal
intense fear, aggression, & anxiety
hypo arousal
withdrawal, numbness and insolation
attachment
a profound reciprocal, physical and emotional relationship between a child and a caregiver
this sets the stage for all future intimate and trusting relationships
risk factors for an attachment disorder
parental factors: can be anything that prevents the parents from meeting the needs of the child in a sensitive, responsive way -> not meeting child’s social, emotional or physical needs, possibly d/t parent’s mental illness or substance abuse problem
child factors: difficult temperament or they aren’t able to communicate their needs clearly, or if they are hard to sooth, if they don’t have a regular sleep wake cycle, if they are slow to warm/shy
common attachment disorders
reactive attachment disorder
disinhibited social engagement disorder
DSM criteria for reactive attachment disorder
Consistent pattern of inhibited, emotionally withdrawn behavior to adult caregivers, manifested by child rarely or minimally seeks or responds to comfort when distressed
Persistent social or emotional disturbance characterized by at least two of following:
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Episodes of unexplained irritability, sadness, or fearfulness evident even during nonthreatening interactions with adult caregivers.
Experienced a pattern of extremes of insufficient care aeb at least one of the following:
- Social neglect or deprivation: persistent lack of basic emotional needs for comfort, stimulation, and affection met by caring adults
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.G., Frequent changes in foster care)
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.G., Institutions)
reactive attachment disorder behaviors may include
-Withdrawal, fear, sadness or irritability that is not readily explained
-Sad and listless appearance
-Not seeking comfort or showing no response when comfort is given
-Failure to smile
-Watching others closely but not engaging in social interaction
-Failing to ask for support or assistance
-Failure to reach out when picked up
-No interest in playing peekaboo or other interactive games
disinhibited social engagement disorder
Occurs in the first 2 years of life
Child approaches and interacts with unfamiliar adults, with two of the following:
-Reduced reservation about approaching unfamiliar adult
-Overly familiar and violates social/cultural boundaries
-Doesn’t check back with caregiver
-Willing to go with unfamiliar person without reservation
Evidence of persistent pathogenic care (severe social neglect) is shown by one or more of:
-Caregiver neglects the child’s basic physical & emotional needs
-Repeated changes of caregiver (frequent changes of foster or institutional care) – stable attachments cannot occur
major difference between reactive attachment and disinhibited social attachment
RA they do not form attachments & are withdrawn
DSA they look for interaction with any adult and the behavior cannot be explained by having a developmental delay
RAD and DSED
Ensure that the child:
- Experiences positive interactions with caregivers and staff.
- Experiences attachment through the five senses.
- Has a safe and stable living situation after discharge.
- Encouraging child’s development by being nurturing, responsive & caring
- Providing consistent caregivers to encourage stable attachment.
- Providing a positive, stimulating and interactive environment
- Addressing the child’s medical, safety and housing needs.
Increasing touch, talk and socialization:
- Hold, hug, touch, feed, and talk to the child.
- Use story-telling.
- Encourage meals with other children and familial caregivers.
-Educate caregivers about the condition.
adjustment disorder
Emotional or behavioral reaction within 3 months of exposure to stressor (For example Loss/death of loved one)
Distress affects ability to function
Reaction is out of proportion to stressor severity
Symptoms end by 6 months
Requires support, understanding and encouragement:
- Active listening, therapeutic communication skills
Assist in increasing coping skills
symptoms experienced in adjustment disorder
anxiety
depression
mixes
regressive behavior in children
fearful or acting out behavior
