Lecture 10 Flashcards
Stressful Events
Events that involve undesirable, unplanned, abnormal, or uncontrollable experiences that threaten our day-to-day functioning
Can be single or multiple ongoing events
Common
Single- divorce
Ongoing- neglect
Stress
Our body’s response to pressure
3 forms of stress:
Positive stress
Tolerable stress
Toxic stress
1 of 3 forms
Positive- normative, essential to development
Tolerable- noon normative, could be source of great adverszity- family member death, natural disaster, limited timing, combined w other supportive factors
Toxic- least ideal , prolonged chronic food
Sexual abuse, neglect
How Stress Affects Children
Stressful experiences are usually manageable and can enhance a child’s competence when they are:
Mild, predictable and brief
Children who are chronically impacted by a stressful environment mobilize their stress responses repeatedly
Stressful events affect each child in different and unique ways:
Hyperresponsive reactions
Hyporesponsive reactions
Over time affects child’s stress response system
1- excessive great vigilance, mistrust, poor relationships, unhelakthy choices
2- under reacting to danger. Threat- more likely to occur after frequent stress experiences, stress system is warn down
Allostatic Load
“wear and tear” on biological systems due to chronic stress
Worn tress system because of chronic stres
Stresso return o homeostasis- high chronic stress takes more to return to homeostasis- in constant stress state
Traumatic events
Exposure to actual or threatened harm or fear of death or injury
Physical and sexual abuse
Accidents
Maltreatments
Natural disasters Trauma- leads to death, injury or sexual assault, serious harm that can cause death
Directly experience, witness it- first aid responder, on tv
Autobiographical Memory and Trauma
Link between reduced autobiographical memory specificity (i.e., overgeneral memory) and trauma exposure
Autobiographical memory- past experienced even st, subjective experience leading to self development, internal working model of self ad other
Over general memory- depression, ealry trauma- cant recall past events, cant specify- respond in general
Specific memory when sad- cant do this- I’m sad when I drop my pizza- no specific event not linked to past
Could be de o avoidance- could trigger trauma- stop searching memory
Traumatic events
Often have immediate and long-term mental health consequences
1 in 4 report some form of major trauma before age 16
The “hidden epidemic”
Some experience trauama and recover
Linked to conduct problems, anxiety
Trauma is common- 25%
Hidden epidemic- so harmful and prevelant
Adverse childhood experiences
Potentially traumatic events that occur in childhood (0-17 years)
Also include aspects of the child’s environment that can undermine their sense of safety, stability, and bonding:
Growing up in a household with:
Substance use problems
Mental health problems
Instability due to parental separation or household members being in jail or prison
Here factors may not be trauma but adverse experience- negative impact on child
Abuse, neglect and household dysfunction
Ace pyramid
Before birth have generation al trauma- inc risk of early adversity
Adverse experiences- disrupt neurodevelopement, social development, over general memory
Leading to choosing risky behaviour, resulting in disease nd death
Very common
Many lasting impacts
Inc likelihood of substance abuse, mental health
More aces- more likely negative outcome
Maltreatment
“Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm.”
Falls under aces and trauma
Many go unreported and undiagnosed
The prevalence is unknown
4 types
Neglect sexual abuse physical abuse and emotional abuse
Child maltreatment
Failure to provide care
Physical sexual emotional abuse
Types of Child Maltreatment by Percentage
Child neglect accounts for ~75% of documented cases
Physical abuse: 17%
Sexual abuse: 8%
Emotional maltreatment: 6%
Neglect= most prevelant
Polyvictimization
The experience of victimization across multiple domains
Almost 1 in 5 (18%) children experience more than one trauma experience at home, school, and community
Polyvictims tend to:
Suffer more serious forms of trauma
Show the highest trauma symptom scores
More aces= more serious forms o trauama and show most symptoms
3 forms of child neglect
Physical neglect: failure to provide for a child’s basic physical needs
Educational neglect: failure to provide for a child’s basic educational needs
Emotional neglect: failure to provide for a child’s basic emotional needs
Physical A 2-year-old who was found wandering in the street late at night, naked and alone
An infant who had to be hospitalized for near-drowning after being left alone in a bathtub
Children who were living in a home contaminated with animal feces and rotting food
Educational
An 11-year-old and a 13-year-old who were chronically truant
A 12-year-old whose parents permitted him to decide whether to go to school, how long to stay there, and in which activities to participate
A special education student whose mother refused to believe he needed help in school
Emotional Siblings who were subjected to repeated incidents of family violence between their mother and father
A 12-year-old whose parents permitted him to drink and use drugs
A child whose mother helped him shoot out the windows of a neighbor’s house
3-forms abuse
Physical Abuse: Infliction or risk of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise intentionally harming a child
Emotional Abuse: Abusive behavior that involves acts by caregivers that cause, or could cause, serious behavioral, cognitive, emotional, or mental disorders (also called psychological abuse)
Sexual abuse: Abusive acts that are sexual in nature, including touching a child’s genitals, intercourse, incest, rape, and commercial exploitation through prostitution or the production of pornographic materials
Physical abuse
Injuries are often the result of overdiscipline or severe physical punishment
Children who experience physical abuse are often described as more disruptive
and aggressive
Individuals model what they know
Emotional abuse
Extreme forms of punishment (e.g., confinement in a dark closet, verbal threats, put-downs, habitual scapegoating, belittling, name-calling)
Child witnessing domestic violence
Psychological abuse exists, to some degree, in all forms of maltreatment
Emotional- can be in any- all affect emotion and cause emotional abuse
Sexual abuse
Rarely connected to child-rearing, discipline, or inattention to developmental needs
Represents a severe breach of trust, deception, intrusion, and exploitation of a child
Includes commercial or sexual exploitation
Children’s reactions and recovery vary depending on the nature of the sexual assault and the response of their important others, especially the mother
2/3 of those who show symptoms recover significantly during the first 12–18 months
Delayed emergence of symptoms (e.g., PTSD) is becoming more recognized
“Pathogenic” Caregiver-Child Relationship
Maltreatment often occurs within ongoing relationships that are expected to be protective, supportive, and nurturing
Many children do recover or manage to cope effectively
About 1 in 3 go on to develop symptoms of post-traumatic stress disorder (PTSD) or other mental disorders
Maltreatment- often not one time, ongoing dynamic between child and parent
Paradoxical dilemma of child maltreatment
Children are often dependent on those who harm or neglect them
Conflict between sense of belonging and a sense of fear and apprehension:
The victim wants to stop the violence but also wants to belong to the family in which they are being abused
Affection and attention may coexist with violence and abuse
Violence intensity tends to increase over time, but in some cases, physical violence may decrease or stop
Characteristic of child that experience maltreatment
Child age child sex children w disability racial characteristics Younger children- neglect and physical older age 12- physical
Girls more likely for sexual abuse- and more likely t be family member
Disability- physical and sexual
Black, indigenous- minority child and poverty, situatoional factors and race impacts who gets reported
Relational disorders
Disorders that occur in the context of relationships and links between children’s behavior and the availability of a suitable child-rearing environment
Child physical abuse and neglect are relational disorders
These forms of maltreatment often occur during periods of stressful role transitions for parents:
Postnatal attachment period
Early childhood and adolescence; “oppositional” periods of testing limits
Times of family instability and disruption
Perpetrators of Child Maltreatment
80% of maltreatment cases are perpetrated by one or both parents
Exception: Nearly 50% of sexually abused children are abused by persons other than parents
Sexual abuse is committed more often by males (about 90% of the time); about 50% of these abusers are the child’s father or father figure.
Child neglect is committed predominantly by mothers (about 90% of the time)
Most common perpetrator pattern: female parent acting alone, typically younger than 30 years of age
Neglect- may be experiencing othe forms of maltreatment
More likely to have:
A history of learning and intellectual deficits and/or personality disorders
Self-regulation difficulties
Environmental characteristics:
Lower income families
Single parent household or living with a live-in partner
Larger families
Self regulation difficulties- inc risk of over reaching and punishment
Healthy families
Family relations are the earliest and most enduring social relationships that significantly affect a child’s competence, resilience, and sense of well-being
For healthy development children have 2 core developmental needs for their caregiving environment:
An environment supports children’s need for control and direction, or “demandingness”
An environment that supports children’s need for stimulation and sensitivity, or “responsiveness”
meet these 2 developmental needs, healthy parenting includes:
Knowledge of child development and expectations
Adequate skill in coping with the stress related to caring for small children
6. Opportunities and willingness to share the duties of child care between multiple caregivers
What Makes a Fundamental and Expectable Environment?
For infants:
Protective and nurturing adults
Opportunities for socialization within a culture
For older children:
A supportive family
Contact with peers
Opportunities to explore and master their environment
Gradual shift of control from the parent to the child
Continuum of care
Uses emotional delivery and tone that are firm but not frightening
- Uses verbal and nonverbal pressure, often to achieve unrealistic expectations Frightening, threatening, denigrating, insulting
Learning History
Many abusive and neglectful parents had little past or present exposure to positive parental models and supports
Intergenerational transmission of child maltreatment
Ill prepared to be parent- rely on what they know to parent- abused children become abusive parents
Lack of Child-Rearing Knowledge
Unfamiliarity with roles as parents
Unfamiliarity with developmentally appropriate behavior for a child at a given age
Low self-efficacy in parenting skills and knowledge
Temper tantrums- normal for toddlers but don’t bhave knowledge= overreact and maltreat child because don’t know
Stress of child rearing demand
Maltreating parents interact with their children less often than other parents during everyday activities
Neglectful parents tend to avoid interacting with their children
Physically abusive parents tend to deliver threats or angry commands that exceed the demands of the situation
Too stressed- overreact because cant deal with demands
Information-Processing Disturbances
Cognitive misperceptions and distortions of events
Maltreating parents misperceive or mislabel typical child behavior in a manner that leads to inappropriate responses and increased aggression
Mspercieve child behaviour
Child and Family Influences
Coercive interactions:
physically abused or neglected children may learn from an early age that misbehaving often elicits a predictable parental reaction—even though it’s negative—which gives the child a sense of control
Family circumstances:
Conflict and marital violence
About 1/2 of families where adult partners are violent toward one another, 1 or both parents also have been violent toward a child at some point during the previous year
Child learn to get attention by acting out- reinforce behaviour in child and abuse
An Integrated Model of Physical Child Abuse
Stage 1: Reduced tolerance for stress and disinhibition of aggression
Destabilizing Poor child-rearing preparation
Low sense of control and predictability
Stressful life events
Compensatory factors
Supportive spouse
Socioeconomic stability
Success at work and school
Social supports and healthy models
Stage 2: Poor management of acute crises and provocation
Destabilizing
Conditioned emotional arousal to child behavior
Multiple sources of anger and aggression
Belief that child’s behavior is threatening or harmful to parent
Compensatory
Improvement in child behavior
Community programs for parents
Coping resources Stage 3: Habitual patterns of arousal and aggression with family members
Destabilizing
Child habituates to physical punishment
Parent’s use of strict control techniques is reinforced
Child increases problem behavior
Compensatory Parental dissatisfaction with physical punishment
Child responds favorably to noncoercive methods
Community services
Trauma, Stress, and Maltreatment: Defining Features
DSM-5 considers some forms of child stress and maltreatment under the category “Other conditions that may be a focus of clinical attention”
e.g., a child who was abused and is also suffering from a clinical disorder such as depression
Trauma- and Stressor-Related Disorders
Trauma- and stressor-related disorders is new category in DSM-5
Disorders involving direct or indirect exposure to acute or chronic stressors or catastrophic events, which may consist of multiple events over time (e.g., child maltreatment):
Reactive Attachment Disorder
Disinhibited Social Engagement Disorder
Acute Stress Disorder
Adjustment Disorder
Posttraumatic Stress Disorder (PTSD)
Reactive attachment disorder (RAD)
Disinhibited social engagement disorder (DSED)
Related to neglect
RAD and DSED stem from very inadequate care
Reactive attachment vs disinhibited social engagement disorder
Reactive
Symptoms include:
Avoids caretakers
Withdraws from
social situations
Resistant to signs of comfort (hugging)
Outcomes tend to include:
Internalizing disorders
Disinherited
Symptoms include:
Not understanding social boundaries
Behavior not appropriate for age
Overly friendly, attention seeking to strangers
Outcomes tend to include:
Externalizing disorders
DSM-5 Criteria for Reactive Attachment Disorder
A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
The child rarely or minimally seeks comfort when distressed.
The child rarely or minimally responds to comfort when distressed.
A persistent social and emotional disturbance characterized by at least 2 of the following:
Minimal social and emotional responsiveness to others.
Limited positive affect.
Episodes of unexplained irritability, sadness or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
The child has experienced a pattern in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by at least 1 of the following:
Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving 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 with high child-to-caregiver ratios).
The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
The criteria are not met for autism spectrum disorder
The disturbance is evident before 5 years of age
The child has a developmental age of at least 9 months
Specify if: Persistent: The disorder has been present for > 12 months.
Specify if: Severe: When a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
DSM-5 Criteria for Disinhibited Social Engagement Disorder
A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
Reduced or absent reticence approaching/interacting with unfamiliar adults.
Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
Willingness to go off with an unfamiliar adult with minimal or no hesitation.
The behaviors in Criterion A are not limited to impulsivity (as in ADHD) but
include socially disinhibited behavior.
The child has experienced a pattern of extremes of insufficient care as evidenced by at least 1 of the following:
Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving 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 with high child-to-caregiver ratios).
The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
The child has a developmental age of at least 9 months.
Specify if: Persistent: The disorder has been present for > 12 months.
Specify if: Severe: When a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Causes and treatments
Little is known about the long-term consequences of the two disorders
Interventions that focus on improving caregiving quality (e.g., stability, positive affection, and safety) are often the primary form of treatment
No standard treatment for either disorder
Treatment should involve the child and parent(s) or primary caregivers. Goals of treatment are to help ensure that the child:
Has a safe and stable living situation
Develops positive interactions and strengthens the attachment with parents and caregivers
Attachment and Biobehavioural Catch-Up (ABC) Intervention
This intervention aims to help carers increase their infant’s emotional regulatory capacities by:
Encouraging child-led play
Use of nurturing touch
Adult recognition and labelling of emotions
Behavioral Management Techniques
Help parents or caregivers focus on the quality of their interactions with their child
Behavior modification strategies for parents can help parents communicate appropriate behavioral expectations and consequences and provide adequate support to their children.
Play Therapy and Art Therapy
Build a nurturing and safe environment where the child can take the lead in playing with different toys and materials
Allows a therapist or a caregiver to come to the level of the child and better understand problem areas the child is struggling with through play
