Pediatric Trauma-Ryst Flashcards
What is this:
Not any stress, but a serious threat or assault on bodily integrity, one that may involve the threat of death.
Trauma
Does trauma incude sexual assault?
yes EVEN without the risk of death
Does a threat have to be aimed at the child for it to be traumatic?
no, it can be towards a loved on (parent or sibling) as well
(blank) can involve either witnessing or learning about it.
Trauma
The degree of trauma is determined by how the individual interprets the (blank)
trauma
What are some examples of childhood trauma?
Physical abuse Sexual abuse Natural disasters Building collapse Transportation accidents Invasive medical procedures Community violence Domestic Violence Physical assault Bullying Terrorism War
Almosts (blank) chidren die every day as a result of child abuse. More than (blank) out of four are under the age of 4.
five
It is estimated that between (blank) percent of child fatalities due to maltreatment are not recorded as such on death certificates
50-60%
A report of child abuse is made every (blank) seconds
10
(blank) percent of child sexual abuse victims know the perpetrator in some way; 68% are abused by family members
90
Child abuse occurs at every (blank), across ethnic and cultural lines, within all religions and at al levels of education
socio-economic level
(blank) of all men in prison and (blank) of women in prison in the USA were abused as children, about twice the frequency seen in the general population.
14%
36%
–Over(blank) of people in drug rehabilitation centers report being abused or neglected as a child.
60%
-About 30% of abused and neglected children will later do what?
.-About 80% of 21 year old that were abused as children met criteria for what?
- abuse their own children
- at least one psychological disorder
CHildren of child abuse are more likely to….?
-teen pregnancy
-get an STD
-arrested
-alcoholics
-substance abuse
-
Neuroendocrin studies indicate an association between early adversity and atypical development of (blank)
HPA axis stress response, which can predispose to psychiatric illness
Neuroimaging studies show structural and functional brain differences in children and adults who have experienced maltreatment. Specific findings implicate structural differences in the (blank) and (blank), and decreased activity of the (blank)
hippocampus and corpus callosum, and decreased activity of the prefrontal cortex.
Very interesting research indicates potential interactions between environmental adversity and (blank). What is an example of this?
genotype
-individuals who carry that MAO-A gene are at increased risk for anti-social behavioral disorders after maltreatment
Having the MAO-A gene and abuse will lead to (Blank) of the brains threat detection system and reduced activity of (blank)
hyper-responsivity
emotion regulation circuits
what did the ACE study show?
that abused individuals will be degenerates, shitty parents and have COPD and liver disease
(blank) is the ability to thrive, mature, and increase competence in the face of adverse circumstances or obstacles
Resilience Factors
What are these: 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).
resilience factors
What is cultural resilience?
cultural background contributes to resilience
Despite high rates of psychopathology in (blank) children and the availability of evidence-based treatments, THE MAJORITY OF these CHILDREN ARE NOT RECEIVING MENTAL HEALTH TREATMENT OF ANY TYPE
foster care
WHat are barriers to mental health care for foster children?
- funding, time, and training
- lack of guidance for screening
- racial biases (AAs dont get good tx)
- stigma and ignorance
Once foster care children are identified with a mental health problem, what are some barriers for them to get tx?
- lack of trained providers
- difficulties w/ continuity of care
- lack of integrated care
What are risk factors that increase likelihood of trauma?
- Intensity of trauma exposure and proximity
- high media exposure
- hx of previous trauma, abandonment or attachment problems
- history of anxiety, depression, low resilience, high reactivity
- parents level of stress
What are the possible sequelae of trauma?
PTSD Depression Anxiety Substance abuse Subsyndromal PTSD
What is criterion A for PTSD?
Exposure to actual or threatened death, serious injury, or sexual violence BY:
-directly experiencing it
-Witnessing it
-learning about it (happening to close friend or family; if death must be violent or accidental)
OR
-experience repeated or extreme exposure to aversive details of the traumatic event
DOES NOT APPLY TO EXPOSURE THROUGH MEDIA
What is criterion B for PTSD?
Presence of one (or more) intrusion symptoms associated with traumatic event
What is Criterion C for PTSD?
Persistent avoidance of stimuli associated with the traumatic event
What is criterion D for PTSD?
Negative alterations in cognitions and mood associated with the event (inability to remember, persistent negative beliefs about the world or others, distorted self-blame, fear/horror/anger/guilt/shame, diminished interests, detachment/estrangement, inability to experience positive emotions.
Ie Being hella sad!
What is criterion E for PTSD?
Marked alterations in arousal and reactivity (irritability, outbursts, recklessness/self-destruction, hypervigilance, exaggerated startle, problems with concentration, sleep disturbance).
T
hink military guys :(
What is the criteria for PTSD occuring in preschool-age children (i.e 6 years and younger)?
- Intrusion symptoms “post-traumatic play re-enactment”
- Neg alterations in cognition (socially withdrawn, lack of interest, negative emotional state)
What are some developmental aspects to consider in trauma?
- Ability to regulate affect and behavior
- effect on core identity
- social skills
What are some reasons why children exposed to trauma have difficulty regulating affect and behavior?
- deterioration of ability to inhibit aggression
- conversly, fear of agression may promote excessive inhibition and lack of assertion
- substance abuse to manage painful emotions
What are the effects trauma may have on core identity?
- powerlessness damages self-efficacy
- magical thinking and tendency to self-blame leads to guilt
- problems with empathy and prosocial behavior
- re-activation of conflicts from earlier periods
- efforts to master fear and vulnerability can lead to long-term identifications (eg with rescuer or the aggressor)
How can social skills be messed up due to trauma?
- anxiey induced withdrawal from social activities
- can lead to ODD
- association with deviant peer groups and involvement in anti-social behavior
What are the developmental stages that can be effected due to trauma in preschoolers?
- attachment
- magical thinking
- Oedipal complex
- fantasy play
What are the developmental stages that can be effected due to trauma in the Latency age?
- mastery
- peer relationships
- self-esteem
- organized play
What are the developmental stages that can be effected due to trauma in Adolescents?
- experimentation/risk-taking
- individuation
- identity
- intimacy
When doing trauma assessment, parent child reports have (low/high) concordance. You may need to use (blank) assessments.
low
non-verbal
What is the mainstay of treatment for PTSD?
What meds would you use as adjuncts?
- psychotherapy
- antidepressants (SSRIs) such as Sertraline and Paroxetine THIS IS MED OF CHOICE
- alpha-adrenergic agents (clonidine/guanfacine)
- benzos and busiprone
What are the 2 SSRIs used to treat PTSD?
paroxitine, setraline
What are the 2 alpha-adrenergic agents used to treat PTSD?
clonidine and guanfacine
What are the four evidence based treatments for PTSD?
- play therapy
- trauma focused CBT
- CBITS (cognitive behavioral intervention for trauma in schools)
- EMDR (eye movement desensitization and reprocessing)
What are these components of: Psychoeducation Symptom monitoring Relaxation techniques Exposure Cognitive re-structuring Parent training
Trauma focused CBT
What is this for:
Only for single-event traumas.
Not sure how/why it works.
EMDR
T or F
There are high rates of trauma in our pediatric population.
T
T or F
Exposure to a traumatic event does not in and of itself predict a PTSD reaction.
T
T or F
The developmental effects of trauma on children is profound, and affects their ability to learn and participate in school.
T
