Ch.12 Trauma

Psychological abuse

(also known as emotional abuse) includes repeated acts or omissions by the parents or caregivers that have caused, or could cause, serious behavioral, cognitive, emotional, or mental disorders.

DSM-5 diagnosis of PTSD for children (over age 6) as well as adults involves four core features that persist longer than one month:

1) Symptoms of intrusion, such as distressing memories, dreams, or flashbacks that is often described as a feeling of reliving the traumatic event(s). 2) Avoidance of distressing memories, thoughts, or feelings, as well as avoidance of any reminders that arouse such thoughts or feelings. 3) Distortions in thoughts or feelings (i.e., alterations in cognitions and mood) associated with the traumatic event(s), such as elevated fear, inability to feel positive emotions, self-blame, and guilt. 4) Symptoms of extreme arousal and reactivity, such as angry outbursts, self-destructive behavior, sleep problems, or hypervigilance (i.e., watchfulness

1/3

About ________ of the childhood victims of sexual abuse, physical abuse, or neglect meet criteria for lifetime PTSD

Treatment dilemma

Access to treatment and prevention depends on admitting to or recognizing one's own culpability

adjustment disorder

Children or adults who react to more common (and less severe) forms of stress in an unusual or disproportionate manner (a short-term diagnosis (i.e., symptoms last no longer than 6 months after the stressor)

post-traumatic stress disorder (PTSD)

Persistent anxiety following an over-whelming traumatic event that occurs outside the range of usual human experience

depression, ADHD

RAD in early childhood has been linked to subsequent internalizing disorders such as ________ DSED has been linked to disruptive behavior disorders such as ______

Expectable environment for younger children

Requires protective and nurturing adults, as well as opportunities for socialization within a culture

1) Adequate knowledge of child development and expectations, including knowledge of children's normal sexual development and experimentation 2) Adequate skill in coping with the stress related to caring for small children, and knowledge of ways to enhance child development through proper stimulation and attention 3) Opportunities to develop normal parent-child attachment and early patterns of communication 4) Adequate parental knowledge of home management, including basic financial planning, proper shelter, and meal planning 5) Opportunities and willingness to share the duties of child care between two parents, when applicable 6) Provision of necessary social and health services

Determinants of healthy parent-child relationships and family roles derived from these two primary developmental needs include:

relational disorders

Disorders that occur in the context of relationships, such as child abuse and neglect. Relational disorders signify the connection between children's behavior patterns and the availability of a suitable child-rearing environment.

hippocampus, prefrontal cortex, amygdala

The brain areas implicated in the stress response that can lead to long-term mental health problems include the _______________ (learning and memory), _________________ (planning and decision-making), and the _____________

Disinhibited social engagement disorder (DSED)

The child shows a pattern of overly familiar and culturally inappropriate behavior with relative strangers (Social neglect)

dissociation

The process allows the victim to feel detached from the body or self, as if what is happening is not happening to him or her

- Exposure therapy - CBT - Trauma-focused CBT* - Psychological first aid - Grief and Trauma Intervention - Narrative therapy - Modeling (Family therapy) - Education - Coping - Prevention-skills training

Treatment and Prevention techniques:

child neglect

Treatment for _____________ focuses on parenting skills and expectations, coupled with training in social competence and household management.

physical abuse

Treatment of _____________ involves training parents in more positive child-rearing skills, accompanied by cognitive-behavioral methods to target specific anger patterns or distorted beliefs

1) absolute authority over the family by the husband 2) the right to family privacy.

Two major cultural traditions have influenced the condoning of family abuse until recently:

Information-processing disturbances

cause maltreating parents to misperceive or mislabel typical child behavior in ways that lead to inappropriate responses and increased aggression

Reactive attachment disorder (RAD)

characterized by a pattern of disturbed and developmentally inappropriate attachment behaviors (Social neglect)

limbic irritability

coined to account for symptoms of internalizing psychopathology after maltreatment because of its impact on the limbic system. Symptoms of limbic irritability include somatic, sensory, and behavioral phenomena believed to be due to increased excitatory neurotransmission after maltreatment in early childhood

Stressful events

events that are less extreme than traumatic events and stem from single events or multiple or ongoing stressful situations or events

hyperresponsive to stress

excessive threat vigilance, mistrust, poor social relationships, impaired self-regulation, and unhealthy lifestyle choices

Traumatic Events

exposure to actual or threatened harm or fear of death or injury and are considered uncommon or extreme stressors

For older children, an Expectable environment

includes a supportive family, contact with peers, and ample opportunities to explore and master their environment

Sexual abuse

includes fondling a child's genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic mate-rials.

Educational neglect

involves actions such as allowing chronic truancy, failing to enroll in school a child who is of mandatory school age, and failing to attend to a child's special educational needs.

insecure-disorganized attachment

maltreated infants and toddlers have considerable difficulty establishing a reciprocal, consistent pattern of interaction with their caregivers. Instead, they show a pattern described as ___________________

Complex trauma

manifests as problems with attachment to others, emotion regulation, dissociation, behavior problems, and distorted self-concept.

Physical abuse

multiple acts of aggression that include punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child.

Emotional neglect

one of the most difficult categories to define, includes actions such as marked inattention to the child's needs for affection, refusal or failure to provide needed psychological care, spousal abuse in the child's presence, and permission for drug or alcohol use by the child.

Physical neglect

refusal or delay in seeking health care, expulsion from the home or refusal to allow a runaway to return home, abandonment, and inadequate supervision.

Cycle-of-violence hypothesis

relationship between being abused as a child and becoming abusive toward others as an adult

emotion regulation

the ability to modulate or control the intensity and expression of feelings and impulses, especially intense ones, in an adaptive manner

polyvicimization

the experience of victimization across multiple domains of the child's life

hyporesponsive to stressful events

underreacting to signs of danger or threat—indicating that their stress system is overtaxed and may be shut-ting down

Trauma-focused cognitive-behavioral therapy (TF-CBT)

Components-based psychosocial treatment model that incorporates elements of cognitive-behavioral, attachment, humanistic, empowerment, and family therapy models. - Involves a combination of exposure therapy and skill building to al-low the individual to practice more effective ways of cop-ing with intrusive memories and emotions. *

(1) Those most in need are least likely to seek help on their own; (2) these children are brought to the attention of professionals as a result of someone else's concern, usually after they have violated expected norms or laws; and (3) parents do not want to admit to problems because they fear losing their children or being charged with a crime (fears that are, of course, realistic).

Obstacles to intervention and prevention services for maltreating families:

1) The victim not only wants to stop the violence but also longs to belong to a family 2) Affection and attention may coexist with violence and abuse. 3) The intensity of the violence tends to increase over time, although in some cases physical violence may decrease or even stop altogether

Because children are dependent on the people who harm or neglect them, they face other paradoxical dilemmas:

Acute stress disorder

Characterized by the development during or within 1 month after exposure to an extreme traumatic stressor of at least nine symptoms associated with intrusion, negative mood, dissociation, avoidance, and arousal (Last for 1 month or less)! Short term

hypothalamic-pituitary-adrenal (HPA) axis and norepinephrine

For example, long-term alterations in the ____________________ and _____________ systems are found among maltreated children and adults with a history of childhood abuse, which have a pronounced effect on their responsiveness to stress

1) control and direction, or "demandingness," with 2) their need for stimulation and sensitivity, or "responsiveness"

For healthy development, children need a caregiving environment that balances their need for:

PTSD Prevalence

In a large national sample of over 4,000 adolescents 12 to 17 years of age in the United States, the six-month prevalence of PTSD was 3.7% for boys and 6.3% for girls

sexually abused

Interventions for children who have been _________________ emphasize the children's needs for safety, understanding, and expression of emotional consequenc

PTSD

________ reflects the longer-lasting, ongoing pattern

Representational models

_______________ of oneself and others are significant because they contain experience, knowledge, and expectations that carry forward to new situations

Traumatic sexualization

a child's sexual knowledge and behavior are shaped in developmentally inappropriate ways.

Allostatic load

a concept used to describe this progressive "wear and tear" on biological systems due to the effects of chronic stress

Child maltreatment

a generic term that refers to four primary acts: physical abuse, neglect, sexual abuse, and psychological abuse

Grief and Trauma Intervention for Children (GTI)

address topics that are common to children who are experiencing grief and trauma, such as dreams (nightmares), questioning, anger, and guilt

Psychological First Aid (PFA)

based on the theory that children need information and support to reintegrate back into their school routine