midterm Flashcards
normal anxiety in young children
- fear of dark
- separation
- fear of being alone
normal anxiety in teens
- school performance
- social acceptance
- physical appearance
- future success
warming signs of problematic anxiety
- sleep disturbances
- excessive physical complaints
- constant need for reassurance
- avoidant or oppositional behaviour
- behavioural change or emotional dysregulation
- school refusal
anxiety demands 2 things
- certainty “I have to know what’s going to happen next and i want to control it
- comfort “I want to feel safe and comfortable”
anxiety leads to avoidance
child worries –> feels uncomfortable with uncertainty –> seeks comfort through avoidance –> avoids fearful event –> feels relief
what causes anxiety disorders
- genes
- role modeling
- trauma
- temperament
- lack of self efficacy (don’t believe they can do it)
temperament
personality you’re born with
stress response in kids
- fight
- flight
- freeze
common thinking errors
- catastrophic thinking
- black and white thinking
- mind reading
- jumping to conclusions
- discounting the positive
catastrophic thinking
when you think something, someone, or a situation is way worse than what the reality actually is
black and white thinking
think in extremes
mind reading
assuming what someone else is thinking without having much to go on
jumping to conclusion
aking unwarranted assumptions based on limited information.
discounting the positive
you don’t take credit for the good things you’ve earned or achieved in your life
unhelpful way of coping with anxiety
AVOIDANCE
types of anxiety disorder
- separation anxiety
- GAD
- social anxiety
- panic disorder
- OCD
- specific phobias
- PTSD
sx of separation anxiety
- intense fear of being separated from parents
- stomach aches, headaches, dizziness
- an willingness to leave parents sides, even at home
- nightmares about separation
- defiant behaviour when faced with separation
- can lead to extreme avoidant bx
GAD
- “master worriers”
- degree of worry is extreme and not usually developmentally appropriate
- tends to impact females
- may be easily annoyed or restless
- subject of their worry can change and is not relevant
- physical sx = exhaustion, stomach aches, headaches
social anxiety
- start to show 8-15
- hate drawing attention to themselves
- experience physical sx “shaking, sweating, SOB”
- fear of new social situations
- tantrums and crying
panic disorder
- occur suddenly and often unpredictable with no trigger
- palpitation, acute SOB, dizziness, nausea
- sudden and overwhelming fear of death or losing control, a feeling taht the world is unreal, and an intesne desire to flee
- leads to avoidance of places or situations that could trigger an attack
specific phobia
- presents as an irrational fear when faced with particular object, situation or even the thought of encountering something not normally thoughts of as dangerous
- experiences anticipatory dread or full blown panic attacks
- present for at least 6 months and cause significant distress or impairment in functioning
- occur in females at a 2:1
obsessions
unwanted, distressing and intrustive thoughts or images
compulsions
actions or repetitive rituals used to relieve the anxiety associated with obsessions
common obsessive thoughts
- fear of germs or illness
- fear of harm coming to self or others
- need for things to be 100% perfect or they are not satisfied
- need to have symmetry or things to be ordered a certain way
- repeated thoughts of violent, religious, or sexual act
common compulsions
- washing, cleaning rituals
- repeated compulsive checking that people are ok, doors locked
- counting, tapping, touching
- arranging items in specific way
- frequently seeking out reassurance from others
tx for OCD
- exposure response prevention
- learn to tolerate distress without using compulsions
- rate their fears on scale and challenge themselves with easy truggers
exposure response prevention
form of CBT that involves helping children face their fears in slow incremental steps in a safe space
SCARED tool
- child & parent self report instrument used to screen for childhood anxiety disorders
- assess sx related to school phobias
- 10 mins to complete
- suitable for children ages 8-18yrs
how do we manage anxious children
- accurate diagnosis
- educate child & parents about anixety
- begin CBT/DBT with supported, gradual exposure
- young kids respond well to externalizing anxiety
- support parents to manage their own anxiety
- medications?
educating parents about anxiety
- parents often don’t realize that they may be fueling their anxiety
- reassuring, accommodating, and projecting your own fears don’t work
emotional regulation skills with anxiety
- learning to manage intense negative and positive emotions as they arise
- learning to identify, label, and understand their emotions
- learning to tolerate distress
- learning to communicate more effectively in relationships with others
first choice medications for anixety
SSRIs (sertraline, fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram)
concerns with SSRIs
- increase suicidal behaviour
- side effects: nausea, headaches, sleep problems
- results = 4-6 weeks
- behavioural activation
- trigger manic episode
- drinking alcohol can worsen
- not stopped abruptly
causes of mood disorders..
- genetic vs role modeling
- chemical imbalance (low serotonin)
- environment (chronic stress, unexpected life events, trauma)
- teens coping with loss/grief
- lack of coping skills
major depressive disorder
- less interest in normal activities, feeling sad or hopeless for most of day, everyday, and symptoms for at least 2 weeks
persistent depressive disorder (dysthymia)
- ongoing (chronic)
- low grade, depressed, irritable mood
- at least a year
bipolar disorder
- extreme lows & highs of mood
- can experience psychosis
premenstrual dysphoric disorder
- depressive sx
- irritability
- tension before menstruation
disruptive mood dysregulation disorder (DMDD)
children up to 18 years who exhibit chronic irritability & frequent episodes of extreme behaviouraly dusregulation
girls are at least twice as likely to develop depression t/f
true
Common signs and symptoms of depression in children and
teenagers are similar to those of adults, but there can be some
differences. (t/f)
- true
younger children sx of depression include
- irritability
- no longer interested in playing with friends, isolating
- somatic complaints (tummy aches/headaches)
- withdrawn
- rejection sensitivity
depressive sx in adolescents
- very irritability and sensitive
- anhedonia (loss of interest)
- avoiding social interactions
- lack of motivation
red flags for depression in kids
- poor performance in school
- constant anger/irritability
- rebellious bx
- trouble with family
- trouble with friends
assessment for depression
- MSE
- patient health questionnaire
- anhedonia
- neurovegetative signs
- feelings of guilt or worthlessness
- manic sx
substances in short use can reduce..
anxiety, irritability, negative thoughts in depressed youth
tx for mood disorders
- strong TR
- highlight their strengths
without trust & feeling comfortable, there low chance of obtaining or building collaboration for addressing identified risks
true
Families (and other close informal supports, e.g., friends) can provide
extremely helpful collateral on the situation, triggers, risk/protective factors,
and recent mental health issues. (t/f)
true
Confidentiality: It is often necessary to share information about suicide
risk/plans with family/caregivers in order to keep the youth safe (t/f)
true
teaching emotional coping skills
- interpersonal therapy & supported by parents
- CBT skills & challenge negative thinking errors
- realistic thinking
- problem solving skills & goal setting
- mindfulness techniques and distress tolerance
- encourage to communicate openly
- harm reduction approaches
behavioural activation involves..
working with a depressed person to increase activities that can reduce their depression
behavioural activation looks at
setting goals to do things that will make them feel better
best evidence based practices is..
CBT in combo with SSRI for moderate to severe depression
SSRIs most common class of antidepressants used in adolescents
truw
which med is currently the only drug approved for treatment of depression in children & adolescents
prozac (fluoxetine)
patient education for depression
- watch for changes that may signal worsening sx
- tend to see improvement in neuroveg sx first then mood
- meds begin to work, becomes more motivated and may have ,ore energy to act on SI
manic episode
elevated, expansive, irritable mood for at least 1 week + 3 sx (decreased, flight of ideas, grandosity)
bipolar 1
mood swings b/w mania & depression, sometimes with periods of normal mood b/w extremes
can have mania with no depression
bipolar 2
depression more prominent than mania & may be less common & less severe
mixed episode
manic episode with major depressive ep for 1 week
children and young with bipolar tend to have….
rapid cycling = labile mood swings throughout the day
looks like excessive agitation or anger
One way to distinguish bipolar mood cycles from
normal mood swings is to ask:
- Are your child’s mood shifts accompanied by
extreme changes in thinking, energy, or activity
levels?
If your child’s mood shift lasts only an hour or two,
can it be explained by other factors? - Do other people notice when your child’s mood
shifts? - Do your child’s mood shifts cause problems with
his or her social and family life? - Do they describe feeling an inner rage or anger
all the time?
Suspect bipolar disorder instead of ADHD if:
- Disruptive behaviors appear later in life
(after 10 years of age) - Disruptive behaviors come and go and tend to occur with mood changes
- The child has periods of exaggerated elation, depression, no need for sleep, and inappropriate sexual behaviors
- The child has severe mood swings, temper outbursts, or rages
- The child has hallucinations or delusions
- There is a strong family history of bipolar disorder
common symptoms of bipolar disorder in
children and adolescents
- Severe changes in mood (lability) from being extremely irritable or sad to grandiose all in one day.
- Too much energy, such as the ability to keep going without tiring while the child’s peers are tiring
- In teens decreased need for sleep, such as going for days with very little or no sleep and not being tired
- In children, they still sleep but it may be disrupted
- Talking too much or too fast, changing topics too quickly, and not allowing interruptions
- More anger, violence and physical aggression during mania
lithium (approved pt 12+) doses
- children 15-60mg/kg/day in 3-4 doses/24hrs
- adolescents 600-1800 mg/day in 3-4 doses/24hrs
blood levels for lithium
0.5-1mEq/L (low toxicity threshold)
for bipolar, first choice tx is
mood stabilizers
divalproex
Children ≥ 7 years of age and adolescents
- Can also use Carbemazepine or Oxcarbemazepine (anticonvulsant) = Be aware of Stevens Johnson’s Syndrome (life threatening skin rash)
36
mild to moderate lithium s/e
- tremors
- nausea
- increased urine output
- blurred vision
- some loss of coordination
- slurred speech
- acne
- hair loss
- weight gain
rare but serious s/e of lithium
- vomiting
- convulsions
- uncontrolled jerky movements in arms and legs (TD)
- stupor
- seizures
- coma
antipsychotic meds with bipolar
- newer antipsychotcs being used as adjunctive meds & help with mania, mood stabilizers, to prevent impulsivity
(aripiprazole, clozapine, olanzapine, quetiapine, risperidone)
nursing role for bipolar
- Educate both youth and family about the illness
- Teach parents how to recognize symptoms
- Educate family around side effects of Lithium (e.g. can’t take NSAIDS as they increase lithium levels)
- Monitor for medication side effects
- Encourage teen to avoid triggers such as caffeine, alcohol and drug use, and stress to help prevent manic episodes
- Encourage adequate hydration to prevent toxicity
- Assess for substance use, psychosis and suicide
- Ensure patient is safe on unit
- Offer CBT/ DBT groups
- Have a plan of action in place and a support system to help follow the plan when symptoms of a manic episode start
BPD in teens
- not diagnosed under 18 bc personality hasn’t formed
- complex disorder that carries stigma as presentation involves interpersonal difficulties and can trigger clinicians
risk factors for BPD
- brain differences (regulation of emotions and impulses)
- environmental factors (abuse)
- family history
- genetic influences
BPD sx in teens
- An intense fear of abandonment
- Unstable relationships with family members and
friends - An unclear or constantly shifting self-image
- Impulsive or self-destructive (high risk) behaviors
- A pattern of self-harm
- Extreme emotional swings, particularly in response to seemingly minor issues
- Chronic feelings of emptiness or loneliness
- Explosive periods of anger
- A feeling of being out of touch with reality
managing BPD in teens
- Target suicidality, self harm and substance use with DBT
- Look for interpersonal triggers (break ups, parental divorce)
- Medications can be useful to treat symptoms such as anxiety/ depression
- Clinician can be a container to model healthy relationships with healthy boundaries
- Prognosis is that symptoms gradually decrease with age
examples of counter-aces (protective factors)
- liking school
- teachers who care
- opportunities to have fun
- feeling comfortable with yourself
- establishing a nurturing and protective relationship with primary caregiver
- having predictable home routine
in erikson’s theory, each stage involves..
new developmental tasks and a struggle or crisis to overcome
& if we don’t master these tasks, we still move onto the next stage, but with feelings of inadequacy and insecurity
psycho-social crisis for:
- infant to 18mon
- 18mon to 3
- 3 to 5
- 5 to 13
- 13 to 21
- 21 to 39
- 40 to 65
- 65+
- trust vs mistrust
- autonomy vs shame/doubt
- initiative vs guilt
- industry vs inferiority
- identity vs role confusion
- intimacy vs isolation
- generativity vs stagnation
- ego integrity vs despair
piaget’s cognitive developmental theory
- sensorimotor (birth - 2yrs = understands worth through senses and actions)
- preoperational (2-7 = understands world through language & mental images)
- concrete operational (7-12 = understands world through logical thinking and categories)
- formal operational (12+ = understands world through hypothetical thinking and scientific reasoning)
kohlberg’s theory of moral development 3 levels
level one preconventional (younger than 6)
level 2 conventional level (7-11)
level 3 postconventional (11+)
level 1 kohlberg’s
step 1 = punishment & obedience orientation, obey rules to avoid punishment
step 2 = naive hedonism, conforms to get rewards and to have favors returned
level 2 kohlbergs
step 3 = good boy morality, conforms to avoid disapproval or dislike by others
step 4 = conforms to avoid censure by authorities
level 3 kohlberg
step 5 = conforms to maintain communities. emphasis on individual rights
step 6 = individual principles of conscience
family systems theory
- sx viewed as expression of dysfunction within family
- most vulnerable person (least differentiated person) becoems sx bearer
- children best understood within context of fam
- bx often result of anxiety/tension within family (triangulation)
parenting styles
- authoritarian
- authoritative
- uninvolved
- permissive
ideal parenting style
- authoritative
authoritative style characteristics
- encourage independence & problem solving
- place limits, consequences and expectations on their bx
- express warmth and nurturance
- listen and make time when they want to talk
- allow children to express opinions
bowlby attachment theory
- viewed caregiver responsiveness to infant’s expression of attachment needs as critical to the development of secure attachment b/w an infant & caregiver
- consistently respond to their infants expression of distress in nurturing ways, they learn that their expression of negative emtions will elicit comforting from caregiver
4 patterns of attachment styles
- secure, anxious, avoidant, disorganzed
emotional regulation
- complex skill that evolves
- parents struggle with their own emotional regulation when caring for their dysregulated child
- dysregulation may reduce their ability to respond to their child’s emotional needs and model maladaptive responses to emotional distress
mirroring and mindfulness are skills to help teach children emotional regulation (t/f)
true
anxious attachment
child is anxious in new situations and are reluctant to get close to others
disorganized attachment
- inconsistent bx
- lack of clear attachment bx
- simutaneously reach for & then turns away from xaregiver often the caregiver is both cause of distress yet only source of comfort
RAD presentation
- emotionally withdrawn
- emotionally dysregualted
- rarely seek comfort when distressed
- demonstrates extreme behavioural problems
- disinhibited
consent is an ongoing proces and should be addressed reg (t/f)
true
what is said b/w youth & nurse is protected by confiendentially unless its:
- abuse
- court order
- police investigation
- coroner investigation
- clear and immediate danger to harm themselves or others
must disclose with or without consent
Anyone with reason to believe a child is being abused or neglected—or is at risk for
abuse or neglect—where the parent is unwilling or unable to protect them, has a legal duty to report that concern to a child welfare worker in MCFD or to a Delegated Aboriginal Agency child welfare worker
may disclose with or without consent
Information that other’s ‘need to know’ and/or for the purpose of providing safe and
effective care. For example, you may disclose personal information so that the next of kin or a friend of an injured, ill or deceased individual may be contacted
may not disclose without consent
You are disclosing more information than the person you’re disclosing information to (such as the clinician, carer or other agency) needs to know and the information is not required to provide care or services
infants act
- address legal rights of children under 19 to consent to tx against parent’s wishes
The Infants Act states that children may consent to a
medical treatment on their own as long as the health care provider is sure that the treatment is in the child’s best interest, and that the child understands the details of the treatment, including risks and benefits (T/F)
true
criteria for infant act
- why they need medical tx
- what the tx involves
- benefits and risks of getting tx
- benefits and tisks of not getting the tx
mature minors
make own health care decisions independent of their parents wishes (birth control, abortion, immunizations)
in bc there is no set age when a child is considered capable of giving consent (t/f)
true
youth criminal justice act
federal law designed to protect public by holding youth and parents accountable for their criminal bx
applies to 12-17 y/o
the youth criminal justice act is intended to
prevent crime, rehabilitate, and reintegrate and ensure they face meaningful consequences
meaningful consequences should
- address the offending behaviour of the youth,
- be meaningful to the youth,
- reinforce respect for societal values,
- encourage repair of the harm done to victims and the community,
- respect gender, ethnic, cultural and linguistic differences
- be responsive to the needs and circumstances of Aboriginal youth and youth with special requirement
children under 16 can be admitted by parent as voluntary under MHA and can not request second medical opinion (t/f)
true
for a voluntary admission, 16+ as considered adults and can give consent for tx and be discharged at request
true
what form is filled out by parents for ppl under 16 y/o for voluntary admission
form 2
form 1 is
request for admission
children under 16 need to be informed of their rights using what form
form 14
4 required criteria for involuntary
- suffering from mental disorder that srsly impairs ability to react appropriately to environment
- requires psyc tx in designated facility
- requires care, supervision, control to prevent deterioration or protection
- not suitable as voluntary
voluntary admissions forms
- form 1 (request admit)
- form 2 (consent)
- form 3 (renewal)
- form 14 (rights)
- form 16 (notification)
involuntary admission forms
- form 4.1 (invol admit) & 4.2 (within 48 hrs)
- form 5 (consent)
- form 7 (apply for review)
- form 13 (rights)
- form 15 (nomination of relative)
- form 17 (discharge)
form 18 (notification of renewal)
steps to invol admission
- Child is brought to Emergency Dept. via police,
ambulance or parents. - Child is assessed by ER doc, who may call psychiatrist on call to assess and determine level of risk to child.
- If child is certifiable, doc completes first Form 4.1
(hold X 48 hrs), second doc completes Form 4.2 (hold X 30 days) - Consent form needs to be signed (done by physician if child is not capable)
- Child should be informed of their rights and reasons for certification (Form 14)
- Designated director should inform a near relative immediately after the patient’s admission, discharge
or an application to the Mental Health Review Board. - The youth can also nominate a near relative (Form 15)
Can children under 16 yrs. old apply for a Review Panel hearing
yes
restraints
any method of restricting freedom of movement, physical activity, or normal access to their body
seclusion
method of restraint involving invol confinement in a locked room
chemical restraint
medication used to restrain in emergencies and not in tx for condition (promote sedation)
reasons not to use restraint/seclusion
- sub for less restrictive alternatives
- disciplinary
- means of addressing disruptive bx
- convenience
- sub for inadequate staffing
- prevent damage of property
- prevent pt from leaving
- obtain submission or compliance
hierarchy of safety
- offer prn
- offer solutions to meet needs (core pains)
- suggest they take some space and go to their room
- seclusion
what is arc framework
- designed to prevent retraumatization by prioritizing engagement and helping rebuild parent-child (relationships)
- attachment: caregivers supported to connect in secure ways with child
- regulation: youth taught emotional regulation skills, distress tolerance, and identification of feelings
- competency: goal is to build on resilience and empowerment
specific learning disorder
- deficits in reading, writing, math
- not identified until preschool / elementary
- often co-exist with social/emotional/behavioural problems
dyslexia is
trouble with reading, writing, language skills
signs of dyslexia
- trouble with rhyming
- match sounds with letters
- talking later than others
- having hard time following directions
dyscalculia
struggles with math
(difficulty understanding logic behind math probems, confusing math symbols)
how do children with learning disorder present
- trouble understainding whats expected
- talk out of turn
- miss social cues
- not get others humor
- trouble finding words to express themselves
- poor self regulation skills
- lack of self confidence
self regulation is
ability to manage your emotions and bx in accordance with demands of situation (calm self down, emotional reactions)
executive functioning skills
help us plan, organize, make decisions, shift b/w situations or thoughts, control our emotions and impulsivity, learn form past mistakes
working memory
governs ability to retain and manipulate distinct pieces of info over short period time
mental flexibility
help us sustain or shift attention in response to different demands or to apply different rules in different settings
self control
enables us to set priorities and resist impulsive actions and responses
common tests for learning disorders
- intelligence tests
- achievement tests
- visual motor integration tests
- language tests
supporting parents with children with learning disabilities
- Listen without judgment
- Validate their feelings
- Provide education on their child’s specific LD
- Help them come to terms with what their child is capable of and moderate their expectations
- Provide resources and information about support groups
- Promote self-care as a priority for parents of children with learning disabilities.
- Encourage hope and optimism for the future (many people with LD go on to lead successful lives and
careers).
non-verbal learning disorders
affects child’s ability to read social cues, organize information, planning and they can be physically awkward or clumsy
5 areas of weakness for non-verbal learning disorders
- trouble with visual-spatial awareness
- difficulty with higher order comprehension
- trouble understanding patterns and social cues
- good at rote learning but not advanced problem solving in math
- poor executive functioning skills
intellectual developmental disorder is considered chronic and often co-occurs with
depression, ADHD, ASD
sx of intellectual developmental disorders are divided into 3 categories
- conceptual impairments (academics & learning)
- social impairments (difficulty making and keeping friends, lack of social inhibitions)
- practical impairments (delays in practical skills)
how does intellectual developmental disorder present
trouble with:
- reasoning
- problem solving
- planning
- abstract thinking
- judgement
- academic learning
- experiential learning
what causes intellectual disability
- prenatal (genetics, accidents/exposures in fetus)
- perinatal (maternal prematurity, anorexia, injury during birth)
- postnatal (poor nutrition, trauma, head injury, meningitis)
neurobehavioural disorder associated with prenatal alcohol exposure
- fetal alcohol spectrum disorder
- problems resulting from exposure to alcohol during pregnancy
presentation of FASD problems
- thinking & memory (trouble planning or forget material)
- behaviour problems (severe tantrums, mood issues, difficulty shifting attention)
- trouble with day-to-day living (bathing, dressing, weather, playing with other children)
management of FASD
- meds used to manage aggressive bx & emotional dysregulation
- parents require support, respite, education
- specialized programs may be required with smaller classrooms with 1:1 adis
8 magic keys of success for FASD
- concrete (use concrete language rather than abstract)
- consistency (keeping things consistent with few changes will benefit)
- repetition (learn info and practice skills many times)
- routine (stable routines that don’t change day to day will benefit)
- simplicity (keep it short and simple)
- specific (say exactly what you mean)
- structure (achieve enough structure to support them)
- supervision (supervision to develop habits of appropriate bx)
attunement
recognize the child’s developmental level and adjust your approach accordingly
goals of the assessment
- engage to form trust
- gather accurate, relevant data to guide your tx plan
- gain deeper understanding of youth’s environment & factors influencing their MH
- create family centered goals that can support the child after discharge
admission day, what to do
- prioritize engagement
- ensure child isn’t hungry & communicate how long meeting will be
- ensure they are oriented to unit
- parents should discuss nature & purpose of admission
- if meeting alone w parents, ensure another satff if engaging with child to prevent separation anxiety
HEEADSSS assessment
home
education & employment
eating & exercise
activity & peer relationships
drugs & alcohol
sexuality
self harm, suicide, depression
safety (risk taking)
self harm definition
preoccupation with deliberately hurting oneself without conscious suicidal intent, often resulting in damage to body tissue
why youth self harm
- control
- release of intense emotions
- makes them feel better
- punish themselves
- lack of strong family attachments
- lack of impulse control
cycle of self harm
trigger event increases distress –> self-harming action takes place –> relief from tension is experienced –> guilt/shame at self-harm –> self disgust and tension builds up –>
risk factors for self harm
- female
- 12-14 y/o
- having friends that self harm
- negative life issues
- mental health issues
- family loneliness
neuroveg signs
- sleep changes
- changes in appetite
- changes in energy
- anhedonia
- fatigue
suicidal motivations in child/adol
- family losses / changes
- shifting social pressures
- hopelessness about future
- repeated disappointments
- chronic illness
- feel isolated and disconnected
suicide risk assessment
- risk factors (stressors)
- nature & intensity of suicidal thoughts
- screen for intent (CASE)
- access to lethal means (plan)
- protective factors (supports)
warning signs of possible hidden suicidal ideation, intent, plan include
- psychosis
- unable to develop rapport
- avoids eye contact
- reluctant to answer direct qts about suicide
- responds “IDK” to qts about suicide
- appears despondent or emotionally distant
- angry or agitated
impact of childhood trauma
- cognition problems
- physical health problems (sleep, eating, poor immune)
- emotion problems (dysregulation, coping skills)
- relationships (attachment problems)
- mental health (depression, anxiety)
- behaviour (aggression)
- brain development
regressive behaviour
difficulty meeting their developmental milestones
understanding traumatic stress responses in childhood
- behaviour reactions (bed wetting, headaches, clingy, night terrors, regression in tolieting & speech)
- emotional reactions (anxiety, fear, panic, depression, helplessness, dysregulation)
what does trauma response look like children
- affect = guarded, anxious
- emotionally reactive (hairpin trigger)
- difficulty self regulating
- power struggle and fear re: rule enforcement
- display fears & avoidance bx
- difficulty taking responsibility for bx
- difficulty functioning at school
PTSD & SUD
self medicate or manage emotional distress associated with early trauma
numb your feelings & not experience intense emotions
acute stress response
2-3 days after event
reaction to acute stress
not lasting effects & can return to normal functioning over time
risk factors for PTSD
- severity of event
- parental reaction to event
- physical proximity to actual traumatic event
- previous traumatic experiences or deaths increase risk
- how child hears news
PTSD
- sx keep happening for more than 1 month & negatively affecting child’s life & how they function
may be accompanied by depression, substances, anxiety
common sx of PTSD
- avoiding situations that make them recall event
- experiencing nightmares or flashbacks
- playing in a way that repeats event
- acting impulsvely or aggressively
- nervous or anxious
- emotional numbness
- trouble focusing at school
- heightened arousal
PTSD in young children
- don’t have language skills to verbalize feelings
- concrete thinkers, often makes connections (trauma in car, won’t get in a car)
- increase in generalized fears, separation anxiety, nightmares, regressive bx
PTSD in school-aged
- time skew = mis-sequences trauma related events
- omen formation = belief that there were warning signs that could have predicted the traumatic event
- re-enact trauma through play
PTSD in teens
- engage in trauma re-enactment where they incorporate aspects of trauma into their daily lives
- show impulsive and aggressive bx
- unable to escape impact of trauma
- lead to increased risk for substance use & self-harming bx
complex trauma
- chronic, interpersonal negative experiences, often perpetrated by parents
- extended period of time
- affects childs ability to relate to others and build trusting relationships with caregivers and other authority figures
- prevents child from learning to trust adults
- mimic PTSD & more pervasive
- dysregulated
sx of complex trauma
- challenges with attachment & relationships
- difficulty regulating emotions & bx
- challenges related to attention
- low self-esteem
- negative outlook of world
- major impact on ability to learn, regulate bx, and focus in school
being trauma informed
- understand what trauma is & what causes
- understnad how it impact the brain and ability to learn
- view resistance as means of communication & coping
- don’t take their actions/words personally
- practice self care regularly & deal with own triggers
- work on TR skills
supporting parents with PTSD
- Let their child know that it’s normal to have lots of different feelings and
emotions after something bad happens. - Encourage them to control their own reactions
- Be an active listener
- Don’t minimize feelings “it’s not that bad” “you’ll be fine”
- Encourage the child to return to normal activities (sports) as soon as they are
able. - Don’t protect them by letting them avoid what they fear
- Be aware of anniversary dates as a potential trigger
- Find a TF-CBT therapist
treatment modalities for PTSD
- Trauma Focused CBT- child directly discusses the
traumatic event (exposure), anxiety management techniques such as relaxation and assertiveness training, and correction of inaccurate or distorted trauma related thoughts eg. The world is unsafe. - Play Therapy
- EMDR (Eye moment desensitization and reprocessing) - child recalls traumatic event while working through guided
eye movement exercises, reduces the physiological reaction to traumatic memories. - Medications (antidepressants & Anti anxiety meds) - not a
lot of evidence of their efficacy in children.
supporting kids with trauma
- Remember these kids are generally more reactive so
approach them with care - Project a calm presence
- Avoid sudden movements
- Avoid getting too close to their personal space,
- Avoid using a loud tone of voice and yelling
- Be very aware of your facial expressions as angry facial
expressions can be triggering - Provide structure and predictability to their environment
- Teach grounding exercises for self regulation
- Practice ARC
