ICL 3.3: Developmental Trauma & Adverse Childhood Experiences Flashcards
why do we care about developmental trauma and adverse childhood experiences?
maltreatment and adverse childhood experiences can harm the physical, psychological, cognitive, and behavioral development of children
the impact can be long-term, affecting functioning throughout life
maltreatment = exposure to violence, physical abuse, emotional/psychological abuse, sexual abuse
what is the prevalence of childhood abuse or neglect?
12.5% of children have experienced at least one episode of abuse or neglect by age 18
most were neglect cases (almost 80%) = most common child maltreatment
in which populations is childhood abuse/neglect more common?
minority children
21% of African-American children
14.5% Native Americans
13% Hispanic
what is the definition of physical abuse?
acts that any non-accidental physical injury to the child and can include striking, kicking, burning, or biting the child, or any action that results in a physical impairment of the child
in most US states and territories the definition of abuse also includes acts or circumstances that threaten the child with harm or create a substantial risk of harm to the child’s health or welfare
what is the definition of emotional maltreatment/psychologcal abuse?
acts that cause injury to the psychological capacity or emotional stability of the child as evidenced by an observable or substantial change in behavior, emotional response, or cognition, or injury as evidenced by anxiety, depression, withdrawal, or aggressive behavior
is child physical abuse well reported in the US?
no, it’s substantially underestimated
for every child officially listed as a confirmed victim of physical abuse, more than forty others went undetected
how many kids are exposed to violence?
1/6 children worldwide lives in a conflict zone –> research on the long-term effects of war and occupation on the Palestinian children in the Gaza Strip and 41% of children had PTSD
in the US, exposure to violence was highest among inner city children
exposure to violence relates to the development of what other conditions?
- trauma symptoms/PTSD
- depression
- anxiety
- behavior problems
these often persist into adulthood….
what is the worst type of exposure to violence?
being a witness to or victim of violence at home
children who witness violence in the home are at high risk for perpetrating violence as adolescents and adults
this is a form of maltreatment! the caregiver is failing to take available measure to protect the child from violence exposure
how prevalent is sexual abuse?
1 in 3 to 4 girls will be sexually assaulted by 18
1 in 6 to 7 boys by 18
perpetrators usually male: 95% when victim is female, 80% when victim is male
perpetrators are usually known to the victim and aren’t strangers
what problems are related to someone who has been sexually abused?
- hypersexual behavior
- nightmares
- enuresis
- encopresis
- irritability
- school problems
- feelings of guilt
- depression
- anger
what is vulnerable child syndrome?
children in families who overuse health care resources with frequent visits to doctors’ offices for perceived child problems
these children are seen as vulnerable and thought to be at risk for behavioral, developmental, or medical problems
VCS relates to parental perception of child vulnerability!! the perception itself predicts increased ED visits and hospital admissions
parents with PPCV report more pregnancy problems, delivery problems, parent mental health problems
it’s not in an of itself a type of maltreatment unless it crosses over into factitious disorder imposed on another
what is factitious disorder imposed on another?
an individual, usually a parent or caregiver, present another person, often a child, as ill, impaired or injured
there’s falsification os signs and symptoms so it’s identified as deception
they do this even in the absence of external reward/gain so it’s the PERPETRATOR that receives this diagnosis!!
it’s thought to be due to a desire or psychological need to be associated with a chronically or seriously ill child, to gain medical attention
whether the caregiver qualifies for a diagnosis or not, the act itself can be labeled as medical child abuse or physical assault/abuse
what is medical child abuse?
child receives unnecessary and harmful or possibly harmful medical care (injured or put at risk by medical procedures, medication, etc.) because of caregivers’ fabricated or grossly exaggerated reports
what is physical assault/abuse in reference to factitious disorder imposed on another?
direct injury to a child by a parent to cause illness
e.g., inducing seizures, causing vomiting, suffocation, poisoning
what is the definition of child neglect?
the failure of a parent to provide for the development of the child – where the parent is in a position to do so – in one or more of the following areas: health, education, emotional well-being, development, nutrition, shelter/safe living conditions
neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver
this is the most common type of child maltreatment
what is failure to thrive?
undernutrition due to inadequate caloric intake/caloric absorption, or excessive caloric expenditure
majority involve inadequate caloric intake caused by behavioral or psychosocial issues
how do you treat failure to thrive?
treatment depends on cause and presentation:
- obtain an accurate account of a child’s eating habits and caloric intake
- refer/address parental mental illness/substance abuse if present
- report/address neglect/abuse if present
- home nursing visits
- nutritional counseling
hospitalize if failure of outpatient management, abuse or neglect, or severe parental impairment
how does early trauma effect the limbic system?
limbic system abnormalities like reduced volume in the hippocampus, overactivity in the amygdala
the brain grows in a use-dependent fashion but the child is having traumatic experiences that they don’t want to remember so there’s reduced volume in the hippocampus and overactive amygdala
how does early trauma effect the hypothalamic-pituitary-adrenal axis?
early trauma leads to a hyperactive hypothalamic-pituitary-adrenal (HPA) axis
HPA is a major stress-regulating system so this leads to prolonged “fight or flight” responses, increased responsiveness to stress, and symptoms of PTSD
how does early trauma effect self regulation?
loss of self-regulation
patients can’t inhibit fight or flight responses and can’t think clearly about present threat
this causes new, more minor stressors to be experienced with intense distress, attentional problems, impulse control problems
how does early trauma effect fear response?
it causes a persistent fear response
victimes will have a reduced ability to differentiate between safe and dangerous situations/people
they also too often/too readily perceive threat
how does early trauma effect arousal?
it leads to hyperarousal
repeated danger/stress causes the child’s brain to sensitize the pathway for the fear response so it is automatically triggered even w/o conscious thought
so the brain is always “on alert” for danger and seldom/never achieves the calm state necessary for learning
sometimes they can also dissociate
how does early trauma effect internalizing symptoms?
there is increased internalizing symptoms
changes in the areas of the brain involved in emotion and stress regulation (e.g., amygdala, hippocampus and the connectivity between them) > anxiety, emotion dysregulation
how does early trauma effect executive functioning?
there is impaired executive functioning involving:
- working memory
- inhibitory control, inhibiting impulses, filtering thoughts
- cognitive flexibility, adjusting to change, seeing things in a different way
impaired executive function can lead to lower academic achievement, decreased IQ and problems with attention
how does early trauma effect developmental milestones?
it leads to delayed developmental milestones
to achieve key developmental tasks, children need parents/caregivers’ engagement, encouragement, and guidance
for example, in order to develop brain circuitry for language, infants need to have repeated face to face, reciprocal communication with caregivers and hear words and sounds repeatedly
what are the selected outcomes of child maltreatment?
- higher risk for PTSD, Reactive Attachment Disorder
- 2X greater risk of arrest for violent crime
- earlier and more chronic involvement in criminal behavior
- about 1/3 of abused children grow up to be abusive or neglectful parents
- negative health outcomes
- negative mental health outcomes
- decreased academic functioning
what are some of the clinical symptoms you’d see with a toddler who was experiencing PTSD?
- sleep was disturbed
- wakes up screaming for her mother
- would fall asleep without protest but cried out 3 - 4 times per night , unresponsive and inconsolable
- wake up screaming at her mothers’ assailant to leave her alone, consolable but took some time
- newly aggressive behavior with children
- more stubborn and defiant with mom
- cried more readily
- avoided contact with men
- staring spells lasting 2 – 3 minutes and occurring 2 – 3 time a week
- when playing repetitively threw dolls on floor and hitting them
what are the characteristics of a child that puts them at risk for child maltreatment?
- emotional/behavioral difficulties
- chronic illness
- physical disabilities
- developmental disabilities
- preterm birth
- unwanted
- unplanned
what are the characteristics of a parent that would put their child at risk for child maltreatment?
- low self-esteem
- poor impulse control
- substance/alcohol abuse
- young maternal or paternal age
- abused as a child
- depression or other mental illness
- poor knowledge of child development or unrealistic expectations for child
- negative perception of normal child behavior
what are the environmental factors that would put their child at risk for child maltreatment?
- social isolation
- poverty
- unemployment
- low educational achievement
- single-parent home
- non-biologically related male living in home
- family or intimate partner violence
what are the protective factors against child maltreatment?
- supportive family environment and social networks
- nurturing parenting skills
- stable family relationships
- household rules and child monitoring
- parental employment
- adequate housing
- access to health care, child care and social services
- caring adults outside the family who can serve as role models or mentors
- communities that support parents
- parenting/abuse prevention programs
how do you treat child maltreatment?
trauma-focused cognitive behavioral therapy (TF-CBT)
- overcome denial.avoidance of event(s)
- encourage processing trauma in safe environment / exposure techniques
- teach anxiety reduction / relaxation techniques
- teach coping skills
- pharmacotherapy: if indicated, medications designed to address emotional regulation, depression and anxiety
- psychological intervention addressing parent/child interactional/relational factors
- treatment for parent(s)
what are some of the screening questions you’d ask to a child that you suspected maltreatment?
How did your nose/finger/arm, etc get broken?
What happens when you get in trouble at home?
Has someone hurt you?
Has someone been mean to you or called you names?
Have you seen or heard people fighting?
Has someone made you feel scared?
Have you been told to keep secrets?
Are there times when you are home alone? Has there been a time when you didn’t have something to eat? Place to sleep? Who makes your meals?
Do you know what I mean when I say “privates?” Has someone touched your privates? Has someone shown you their privates? Has someone made you touch their privates? Has someone shown you pictures of naked people?
what is Ohio’s law regarding mandatory reporting of child abuse and neglect?
you gotta do it because you’re a health care professional!!
for any kid under 18 or anyone under 21 with a developmental disability/physical impairment
tell the public children services agency or a peace officer in the county
how do you calculate an ACE score?
adverse childhood experience score
