Ryst: Childhood Trauma and Health

Question 1

Not any stress, but a serious threat or assault on bodily integrity, one that may involve the threat of death.
Includes sexual assault even without the risk of death (assault on body integrity)
The threat can be towards a loved one (parent or sibling) rather than the child himself/herself.
Can involve either witnessing or learning about it.

Answer 1

trauma

Question 2

What determines the degree of trauma an individual experiences?

Answer 2

how the individual interprets the trauma

Question 3

Explain why pediatric post-traumatic stress disorder “did not exist” until the 1970’s.

Answer 3

The Chowchilla incident occurred in the 70’s after which Dr. Terr initiated a multi-year study on childhood trauma

Question 4

T/F: There are over 3 mil reports of child abuse made every year in the US.

Answer 4

True

**more common that you think

Question 5

What is happening to the epidemiology of child abuse?

Answer 5

it’s becoming more common

Question 6

Neuroendocrine studies indicate an association between early adversity and atypical development of the (blank), which can predispose to psychiatric illness.

Answer 6

HPA axis stress response

Question 7

There are some structural brain changes in people who have experienced maltreatment. What areas of the brain might be different?

Answer 7

hippocampus
corpus callosum
decreased activity of prefrontal cortex

Question 8

This can also play a role in whether or not an individual develops anti-behavioral disorders after maltreatment…

Answer 8

genetics

*ex: individuals who are carriers of low activity allele of MAO-A gene may be at increased risk of anti-social behavioral disorders following maltreatment

Question 9

ongoing collaborative research between the Centers for Disease Control and Prevention in Atlanta, GA, and Kaiser Permanente in San Diego, CA;
reveals staggering proof of the health, social, and economic risks that result from childhood trauma

Answer 9

ACE study

**shows that childhood trauma leads to bigger problems later in life

Question 10

Childhood adversity has a life-long effect on (blank)

Answer 10

toxic stress

Question 11

“the ability to thrive, mature, and increase competence in the face of adverse circumstances or obstacles”

Answer 11

resilience factors

Question 12

a term that considers those aspects of one’s cultural background such as cultural values, norms, supports, language, and customs that promote resilience for individuals and communities

Answer 12

cultural resilience

Question 13

T/F: The majority of foster care children have some psychopathology and are receiving mental health treatment for their issues.

Answer 13

false; most foster care children are not receiving mental health treatment of any type

Question 14

What are some barriers to mental health care for foster children?

Answer 14

National guidelines endorse universal screening for all children entering out-of-home placement—but lack guidance regarding the details of what, when or who should do the screening.
Racial biases as well as less effective engagement and retention of African American children may explain lower rate of mental health care in these children.
Stigma and lack of understanding about mental illness impedes successful identification and treatment.

Question 15

What are these?
Lack of trained providers in the community
Difficulties in ensuring continuity of care across settings as children transition.
Lack of integrated care (eg, care being provided in “silos”)

Answer 15

barriers to mental health care for foster children even if mental health needs are identified…

Question 16

Some risk factors that increase likelihood of trauma…

Answer 16

intensity/proximity of trauma
high media exposure
history of previous trauma
history of anxiety, depression
low resilience
parents' level of stress

Question 17

Diagnosis that might be made post trauma…

Answer 17

PTSD
depression
anxiety
substance abuse

Question 18

Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event
2. Witnessing, in person, the event (s) as it occurred to others.
3. Learning that the traumatic events(s) occurred to a close family member of close friend. If a death, it must be violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic events.
DOES NOT APPLY TO EXPOSURE THROUGH MEDIA
Criterion B: Presence of one (or more) intrusion symptoms associated with the traumatic event
Criterion C: Persistent avoidance of stimuli associated with the traumatic event
Criterion D: 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.
Criterion E: Marked alterations in arousal and reactivity (irritability, outbursts, recklessness/self-destruction, hypervigilance, exaggerated startle, problems with concentration, sleep disturbance).

Answer 18

PTSD

Question 19

How can PTSD be different in young children?

Answer 19

“intrustion” symptoms can include post-traumatic play

Question 20

What are some signs of PTSD in young children?

Answer 20

observable behavior:
increased frequency of negative emotional state
diminished interest *ex: constriction of play
socially withdrawn behavior
persistent reduction in expression of positive emotions

Question 21

Trama can effect (blank) in the following ways:

Powerlessness damages self-efficacy
Magical thinking and tendency to blame themselves leads to guilt
Can interfere with development of empathy and prosocial behavior.
Re-activation of conflicts from earlier periods: disruption of narcisstic fantasies can lead to perpetual search for merger with more powerful
Efforts to master fear and vulnerability can lead to long-term identifications (eg with rescuer, or the aggressor).

Answer 21

core identity

Question 22

Trauma can also affect (blank) in the following ways:

Trauma induced anxiety can cause withdrawal from normal social activities.
In some children, trauma leads to oppositional defiant behavior (seeing benign actions or hostile or seeing aggression as the only possible response); this further leads to association with deviant peer group and involvement in anti-social activities.

Answer 22

social skills

Question 23

What tools can you use to assess childhood trauma? Are parent-child reports useful?

Answer 23

non-verbal assessment, like pictures and play may be useful; parent-child reports are not always useful

Question 24

Mainstay of treatment for trauma? Other evidence-based treatment modalities?

Answer 24

psychotherapy;
play therapy, trauma-focused CBT, cognitive behavioral intervention for trauma in schools, eye movement desensitization and reprocessing (for single-event traumas)

Question 25

Medical treatment of choice (if necessary) for trauma?

Answer 25

antidepressants (particularly SSRI’s)

Question 26

These two SSRIs are FDA approved for PTSD in adults

Answer 26

Sertraline

Paroxetine

Question 27

T/F: Exposure to a traumatic event predicts a PTSD reaction.

Answer 27

False

Question 28

T/F: Most children w trauma reactions do not get help

Answer 28

True