E-Book: Trauma Safe Schools - Developing Trauma Safe Programs for Toddlers

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1 Creating Trauma Safe Schools Image by Vlado Section Two Zero to 5 Trauma In Toddlers

Transcript of E-Book: Trauma Safe Schools - Developing Trauma Safe Programs for Toddlers

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Creating  Trauma  Safe  Schools  

 

 

 

   

   

   

   

   

   

Image  by  Vlado  

 

Section  Two  

Zero  to  5  Trauma  In  Toddlers  

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Notice of Copyright

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Disclaimer of Warranty

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efforts in preparing this book, they make no representations or warranties with respect to

the accuracy or completeness of the contents and specifically disclaim any implied

warranties.

You should consult a professional where appropriate. The author, advisors, and publisher

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Table of Contents

1. The story of Billy

2. Trauma in the Toddler Years

3. PTSD Symptoms Yong Children (0 to 3)

4. Hyperarousal in Toddlers

5. Acting In vs. Acting Out

6. Seven Domains Effected by Trauma

7. Building Resiliency: Creating Islands of Safety

8. Moving With Building, “I Can!”

Creating Safety Building Mastery

9. Exercise: Seven Domain Assessment

10. Key Points: Trauma in Young Children

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Zero to 5: Trauma in Toddlers Section Two

They Story of Billy..

When Billy was two years old and just learning to potty train he had a

terrible fall. His parents were grateful he survived. At that time Billy’s

parents said that he became more clingy and angry but that was

understandable. Since then Billy has been slow to hit his developmental

markers. At the age of five he could talk but became frustrated when people

did not understand him.

When a teacher or parent asked him to do something he often would become

angry, or just sit and refuse. He had a difficult time solving problems with

peers. If there was a conflict over a toy Billy quickly pushed the kid or bit

the kid he was fighting with.

A very astute teacher noticed that Billy did not always understand what he

was told. The teacher noticed that using certain tones of voice, and speaking

slowly helped.

Billy was popular but also socially awkward. He was strong an tuff so the

other boys liked him but he often blurted things out in class, interrupted

people, and seemed not to notice when other kids were getting angry. Billy

has a very hard time when his parents leave in the morning.

When the teacher is absent and there is a substitute teacher, Billy will be

more hyper, aggressive and brake toys. When ever there is a loud noise Billy

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jumps. Billy will often play in dangerous ways nearly falling or getting other

kids to fall off of the top of the play structures at school.

Billy’s teacher notices that when things are stressful, chaotic or there are

changes Billy’s attention span goes down and it is hard for him to learn.

When it is difficult for Billy to learn he sometimes gets in trouble so that the

other kids do not notice. Billy’s parents report that he does not sleep well

and that he often has night terrors.

Trauma in the Toddler Years

Yong Children (0 to 5) display more intense symptoms of trauma then

adults. Because PTSD is fundamentally a disorder of emotional regulation

and children have less ability to regulate their emotions they display highly

intense symptoms of PTSD. Another factor that make young children more

likely to display intense symptoms of PTSD is that children are highly

dependent on their parents. They have less ability to stand up for themselves.

Being able to stand up and protect one self or others is has been associated

with less intense symptoms of trauma and less chance of developing PTSD.

Toddlers, preschoolers and kindergartners also have a grater chance of

developing symptoms of trauma then adults or even older children. To add

to this difficulty Young children often have more symptoms of hyperactivity

and depression after traumatic events.

Yong Children (0 to 3) display higher differences in cognitive development,

emotional development due to it being a time of large scale Neuroplasticity,

and younger children having less language abilities. Often young children

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display their anger, fear and anxiety and they cannot make sense of it. They

don’t have the verbal skills to say, “Mommy I am scared or mad now.” They

tend to just express these feelings. When they express the feelings it is often

in behaviors that make it difficult for parents, teachers and peers. They can

isolate, fly off the handle quickly, throw or brake toys, have difficulty

managing conflict with peers and poor ability to tolerate frustration. All of

these factors can be frustrating or parents and teachers and leave the child

socially isolated.

On of the key differences in between young children with PTSD and older

children or adults is that young children often do not display symptoms of

numbing. Numbing are the symptoms of feeling emotionally disconnected,

flat or disinterested. This can be a good thing because these children are

more likely to seek social support from parents, teachers and peers when

they are not in a “trigger” or highly activated states. Highly activated states

are emotional and biological states where the child feels scared, angry or

defensive. This can also be challenging. Adults can sometimes get by in

everyday conflicts despite extreme levels of activation due to the ability to

numb their feelings. So this can leave children more raw and susceptible to

acting out on their impulses.

Children 0-5 are often misdiagnosed as having oppositional defiant disorder

and separation anxiety disorder in children with trauma. Children often use

their primary support group or family to help them regulate emotions. This

makes good sense because their brains are not ready to regulate their

emotions on their own. But this also means that since their emotions are

highly intense they may feel more worried about leaving a safe parent. Thus

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increasing separation anxiety. Also, children with PTSD have experienced

the fact that this world can be a dangerous place. Because of this fact they

often worry about the safety of loved ones. They can wonder if they will see

their parents when they leave. Many children who have family members

with cancer or who work in dangerous jobs get highly anxious that they

might not see their parents again. Anxious children can be highly defiant

refusing to leave, get in the car or follow the directions of an adult. It is an

important skill to be able to differentiate between these factors. Due to

defiance, poor ability to tolerate anger, and acting out behaviors it is no

surprise that children who have experienced trauma are often given

diagnosis of oppositional defiant disorder.

Yong Children (0 to 3) Often Display These Symptoms:

Re-enactment play – Re-enactment play is play that incorporates aspects of

the trauma. Children who have had falls may pretend that they are falling.

Children who have seen violence may incorporate it into their play.

Toy destruction – Children often are not carful with their toys. Children with

PTSD however have two difficulties that make it more difficult for them.

The first is frustration tolerance. Sometimes toys are broken because the

child is frustrated. They may throw the toy or smash it when angry. The

other factor is poor attention and concentration. This is the child that seems

to not know their own strength or that seems careless in how they treat the

toy. This can be a difficulty in focus and attention due to feeling anxious,

triggered or having lots of negative feelings inside.

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Aggression towards peers – As discussed above children with PTSD in

general have difficulty regulating their aggression in an appropriate manor.

Children 0 – 5 have particular problems due to their underdeveloped

emotional regulation systems in their brains and less social skills to manage

conflict. Children learn social skills through solving problems. Children with

PTSD struggle to learn when they are angry or anxious more then most

children. This can make it more difficult for them to learn the complicated

skills of conflict resolution.

Defiance toward parents and adults – Poor emotion regulation, feelings of

anxiety or anger that appear without a clear reason can all increase the

defiance that a child displays. These children may also have times when they

are very sweet but when they get angry they “turn on a dime” and talk back

with a high level of intensity. Learning to speak the language of fight flight

and how to help the relaxation response to come back on after a triggering

event, can help a child learn to shift from defiant and angry to engaged and

thoughtful.

Living with domestic violence is related to more aggressive and acting- out

behavior, possibly due to modeling. Many children with PTSD have poor

modeling for how to manage conflict. There is no life without conflict. But

we can manage it well or poorly. Children who have seen violence are more

likely to act violent towards others. We learn many of our emotional and

social habits by watching not by being told. The good news is that educators

can be a powerful force for a more effective model for how to tolerate

emotions.

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Difficulty sleeping – We all know how much fun it is to not sleep well. It can

make us more defensive, less effective in learning and as adults our work

can suffer. Children are no different. Trauma can overwhelm the attention

system in the brain such that it is no longer effective at doing its job. This

same hyperactive attention system has been found to not allow an individual

with PTSD to rest fully. This attention system wakes up the child at small

sounds. Nighttime is also a key time for learning. It is the time when the

brain has the most acetylcholine. This is the neurochemical that produces

attention states and is involved in rates of Neuroplasticity (how the brain

changes with learning). This means if a child does not sleep well they don’t

learn well.

Night terrors – These are events where a child wakes up screaming in the

middle of the night with intense emotions of anger or fear. They typically

don’t know why they are afraid. These events can sometimes cause kids to

not want to sleep (understandably). Some kids will avoid sleep through

arguments, talking back, reading or even laying awake in their beds to stop

the intense dreams.

Reduced attention span – Children with PTSD often have difficulty

concentrating. They struggle with the ability to focus. Some of this difficulty

is due to too much fight flight arousal. We have an optimal level of arousal.

If we are not aroused enough we are board and cannot learn. If we are too

aroused our learning mind shuts off and the defensive mind takes over and

no learning is possible. To learn a child needs to be in the optimal zone.

Children with trauma have difficulty-shifting gears from stress to rest or out

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of fight (anger) or flight

(fear) and back into a good

range of arousal. We can help

children stay in the optimal

zone through providing ways

for them to calm down,

offering tools in lessons,

regulating our own emotions

and structuring curriculum to keep kids in the optimal arousal zone.

Interpersonal/Social Difficulties - Relationally, survivors of interpersonal

trauma suffer from a loss of trust and a sense of betrayal from a person who

is loved. This can be difficult for teachers. Many teachers and even parents

of children who have symptoms of PTSD feel like they are doing what they

do with other kids and that what they are doing is not working. They feel

like the child is not letting them “in.” Or that the child is acting in ways that

“push them away.” This is likely true. The child does not trust and their trust

at times has been damaged by people who were supposed to protect them.

Similarly, many children have been hurt by parents or other loved ones. This

can make it difficult for them to reach out.

Attachement behaviors help the child know you are a safe adult. Learning

the attachment behaviors which, help show the child with your body

language that you are safe, can be a valuable tool in beginning to build the

ability to trust again. Long before our thinking self knows some one is safe

our limbic brain or our emotional mind as already assessed them. This

happens at about 500 milliseconds. Our thinking mind (the front brain or

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prefrontal cortex) gets the message at about 700 - 1200 milliseconds. There

is a system in the brain that functions when we are safe. It is called the

“social engagement system.” The hallmark of the social engagement system

is curiosity, learning, focus and flexibility. The social engagement system is

off when we are afraid and on when we trust the people we are with. There

are ways to help the child move from fear to trust by showing the “body

language of safety.” How to trigger safety with body language and vocal

tone will be explored further. One researcher coined the term

“neruoception.” This is the term he uses to explain how before a child event

is consciously aware of your behaviors they are assessing how safe you are.

Personality changes - A common theme for children with PTSD is that after

the event, “they were different” or they “changed.” The child who was

relaxed and playful can become anxious and angry. This can be difficult for

parents as they struggle to make sense of the changes and feel at times like

they lost their child. It can also impact parent teacher relationships. A parent

may wish that the teacher knew the child before the event or may see a

different child at home because the child feels safe at home and does not get

triggered as easily.

Increased separation anxiety – This is very common and often relates to two

factors these are worry that about their loved ones and the need for emotion

regulation. Children more then teens and much more then adults rely on

others to help them regulate their emotions. Children with intense emotions

may feel terrified going to school with all the peer and performance stress

and also not feel like they can find a safe adult to help them tolerate the

intensity of their emotions.

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Hyperarousal in Toddlers

Hyper arousal symptoms in preschool children were associated with

increased threats of violence, mild violence, and sexual violence. Lets look a

little deeper. What is hyperarousal? Hyperarousal is the intense feelings of

fear or anger that often occur in people who have symptoms of trauma.

Our brains can be thought of as having three systems. The first is the cortex.

The cortex is where we have the higher system or the front brain that does

thinking, planning, higher levels of emotional processing and social

cognition. The second is the limbic system. This is the raw feelings of anger,

sadness, anxiety or worry. The third is the brain stem. The brainstem mostly

deals with automatic functions. All animals including reptiles have a

brainstem. The brainstem also deals with protective responses and helping

the body mobilize the tremendous levels of fight flight necessary to defend

itself from a traumatic event.

When we get very upset our front brains shutdown and our emotional brains

along with the lizard brain start to act. The truth is that between ages 0 and 5

the front brain only has a very limited ability to regulate emotions. So, when

children are hyperaroused instead of discussing it they often make threats.

Re-experiencing symptoms in preschool children were associated with

increased violence of all types. In adults who have re-experiencing

symptoms there is increased acting out of aggression. Children have less

capacity then adults to tolerate these feelings. So this finding is hardly

surprising. What is re-experiencing? Let’s look a little deeper. In a traumatic

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event the brain is set on high alert. This makes an intuitive sense because if

the child ever faces this type of threat later, if the brain remembers the threat

the child will have a better way to deal with it. That is the good side of the

traumatic reaction. The down side is extremely challenging form many

children. Because the brain is in a “high-learning state” memories are

encoded in what is called a “flash-bulb” memory. Think of it like taking a

bright snapshot of the whole event, sights smells and feelings. All of the

sensory experience at that time can be coupled or associated with the intense

feelings of arousal in the body. Like Pavlov’s dogs who salivated at the

sound of foot steps of the man who is bringing food, children with trauma

can have intense emotional reactions triggered by sounds, smells, tones of

voice, facial expressions etc. This can be highly confusing to say the least.

Say a child had a very large fall as they were looking at a red play structure.

When they fell, it felt like their stomach was falling out and they became

terrified. Now much later they may have a queasy body feeling and terror

when they see the color red. Red does not trigger these feelings for most of

us. So this does not seem to make sense to adults or the child. It is

confusing. Red is not by its nature scary! So, the child can be confused by

these emotions and act them out blaming the feelings on a friend, a teacher,

a parent or a seemingly not important event.

Many studies find that toddlers do not display symptoms of Numbing and

avoidance as frequently as adults or older children. One group of researchers

found that young children also have three symptom categories but replace

numbing with a category called “new fears and aggression.”

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Acting In vs. Acting Out

There are two main patterns that researchers have discussed in how children

and teens deal with difficult emotions. These are called externalizing and

internalizing. Both of these types of behaviors are difficult and have

negative impact on a child’s life and education. While some children “act

out” their emotional pain on others, some children “act in” inflicting their

emotional pain on themselves. Both of these patterns are difficult or both the

child, their friends and the adults in the their lives.

Acting In: Internalizing Behaviors

Internalizing behaviors are: Problems that tend to affect the child’s “inner

world.” Children who internalize their responses often display these

symptoms:

1. Withdrawing into their own world. Acting and feeling anxious. Being

inhibited in normal exploration. Feeling unsafe.

2. Depressed mood, behaviors, emotions and beliefs. Children can

appear “over controlled."

Internalizing behaviors can lead a child to isolate, not talk about their

feelings, avoid adult support and can make children defensive when people

offer help. Internalizing behaviors can be hard to spot. It is possible for a

child to be quite in class but be “imploding” on the inside unable to speak up

for themselves. In education these symptoms can be insidious. Children can

be easily distracted by their inner feelings and will fail to learn or complete

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tasks. They often can make mistakes on work and may refuse to attempt

difficult assignments.

Acting Out: Externalizing Behaviors

Externalizing behaviors manifest in children's outward behavior. The child

acts out their hurt on the external world. Children who display this pattern of

behaviors often display these symptoms.

1. Disruptive behavior Hyperactivity Impulsivity Aggressive behaviors

Delinquency.

2. Often referred to as having: Conduct problems, Antisocial behaviors

They can appear: Under-controlled

Seven Domains of a Child’s Life Effected by Trauma

Trauma is not just a psychological event. It effects the whole child, their

family and their ability to learn. The symptoms of PTSD are only one aspect

of the impact of trauma on a child. Trauma affects a child’s thoughts; the

meaning they try to create about their life and it can disrupt cognitive and

emotional development through out a lifetime.

As the brain develops more complex skills often rely on skills developed in

previous years. Because trauma effects learning, attention and a fundamental

since of safety it can dramatically alter how well a child performs in school

and even the development of brain structures. In adults PTSD has been

shown to be correlated with shrinking the hippocampus. The hippocampus is

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the main part of the brain that stores

long-term declarative (information based)

memory. This has profound effects on the

life trajectory of a child. But if these

difficulties are attended to there are

implications that these difficulties can be

reduced.

Resiliency studies show it does not take many positive relationships to help

the child reach a good adult life. In brain research reducing cortisol (a

chemical indicator of fight/flight activation) has been associated with re-

growth of the hippocampus. In other words better learning. The good news

is that reducing cortisol is very, very possible and with tools you already

know.

These are the seven key areas that are

effected by PTSD for children and teens.

1. Symptoms of PTSD: Re-experiencing, avoidance/numbing,

hyperarousal, and in young children: new fears and angers.

2. Psychological Meaning Created: Traumatic guilt, responsibility,

shame, life is dangerous, mom hates me, daddy left because I am

bad, strangers hurt people, I can’t trust any one.

3. Developmental disruptions: Each age holds a developmental

task and there are key social, emotional, neurological, cognitive

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and intellectual tasks to achieve. Trauma can create disruptions in

these tasks.

4. Effects on later development: Some developmental stages build

on capacities from previous stages thus disrupting the

development of later capacities.

5. Impact on support systems: Often times traumatic events

happen to the whole family or other important figures in the

child’s life. These traumas can effect the parent’ ability to engage

with the child. Many negative interaction patterns can develop.

6. Impact of child’s symptoms on others: The child’s symptoms

often impact others and make peer, teaching, care providing,

siblings and parenting relationships difficult.

7. Cumulative Trauma:

a. Higher exposure to trauma increases severity of symptoms and

number of symptoms.

b. One traumatic event if similar can trigger other events (trauma

stacking).

Building Resiliency: Creating Islands of Safety

Resiliency is the ability to bounce back after a stressor. Each child has their

own innate resiliency. As an educator helping a child access their resiliency

can be transformative. Because educators do this naturally there are many

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stories of teachers who changed the entire direction of a child’s life.

Teachers can give their students tools and help the child access her own

innate ability to bounce back from stress.

While all children can “bounce back.” Some children appear better at this

then others. However, social relationships, feeling competent (aka Matery

Experiences), positive adult relationships and setting goals have all been

found to help children bounce back more effectively.

There are many things that a teacher can do to help promote mastery.

Mastery is the experience of being able to accomplish what one sets out to

accomplish. This can be difficult for all kids, even adults. Children and

adults with trauma struggle with mastery due to feeling overwhelmed and

like their emotions are out of control. At times individuals with PTSD can

even feel that their whole life is out of their control.

Children with PTSD often have lost their innate ability to find safety.

Finding safety is a powerful way for a child with trauma to return to a

strong, positive and healthy life. One of the key ways for them to find this is

to build islands of safety. These are places where the child feels understood

cared for and like the adults will stick up for their needs.

In the PTSD overview section the impact of positive emotions on reduction

of the stress response was discussed. We also discussed how individuals

who had more positive emotions were less likely to develop PTSD after 911.

This is good news. Increased positive emotions and ability to calm down or

sooth after a trigger creates a feeling of safety and helps the child learn

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better. This means that teachers have a number of powerful tools in their tool

belt that can help a child who is struggling become more successful.

Children’s bodies and nervous systems have a drive to develop. This is good

news because while trauma can be a boulder in the stream of their life

children will find a way to heal or to get around the boulder. However,

trauma can make it more difficult for their brains and bodies to develop.

Reducing the trauma can help and teachers can provide many experiences

that help support increased emotion regulation, safety and foster the

development of a healthy brain and body. With young children the

relationship of safety, containment, consistency and understanding helps

them develop.

Psychologically Young Children are Establishing: Basic trust in themselves

and others; the ability to act independently; the ability to self-regulate

emotions; the trust in their ability to master their environment. For children

who have been traumatized they can be very sensitive to small changes in

the relationship. Reassurance of the fact that the relationship is still there

after a conflict or feedback can go a long to helping these children be more

effective in the classroom.

Children who have been traumatized also often feel powerless over the

events in their lives. Children who have been traumatized often feel an “I

can’t...” where other children feel an “I can!” A classroom can be an island

of safety where the child can build mastery experiences and learn to trust

again.

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Moving With Building, “I Can!” Creating Safety Building Mastery

Overview: Children with PTSD often feel a deep inner feeling of “I can’t.”

Hypervigilence can interrupt the learning process. Children with trauma

have experienced “overwhelming events.” They often feel as if life events

are unsafe, unpredictable and they cannot affect them positively. In the life

of a child with trauma it is important to build “Islands of Safety.” These are

place and times when then the child feels safe.

One of the big ways to create safety is to build mastery. Mastery is the

experience we all have when we feel capable strong and effective.

Exercise Creating Safety Building Mastery

Steps to Build Mastery…

1. Identify an aspect of the class that you teach which a child is likely to

be successful but may at times struggle.

2. Prior to the attempt give clear supportive instruction on the skill.

3. Ask the child to set their goal for what success looks like.

4. Use your verbal support and validation to help the child stay focused

and tolerate the negative emotions that often impede a child with

trauma from being successful.

5. Allow for pride (pronking – the animal reaction to success) and

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support the child to reflect on what made them successful. Asking

them to see the behaviors and action that helped them reach their goals.

6. Help the child notice that they struggled with the learning but was

successful. A good question is, “when you were first learning it looked

hard. What helped you figure the problem out?”

Exercise: Seven Domain Assessment

Overview: This skill looks to identify which areas of a child’s life is affected

by the PTSD. Through that assessment it is possible to create educational

interventions that will make them more successful. It will also help teachers

identify what referrals would best help the families.

Identify which symptoms of PTSD you see:

1. Re-experiencing: Do they have thoughts that keep playing in their

minds? Do they worry about their parents? Have separation issues, or

seemed “spaced out” like they are not listening to you?

2. Avoidance/numbing, hyperarousal: Do they have trouble staying in

their seats? Difficulty concentrating? If there are load noises do they

jump?

3. Young children: new fears and angers: Are they set off easily and get

angry quickly? Are the afraid of things thy used to enjoy?

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Psychological Meaning:

1. Are they highly sensitive to shame? Embarrassment? Do they feel

guilty and responsible for things they did not do?

2. Do they make comments that seem like the think that life is

dangerous, (e.g. mom hates me, strangers hurt people, I can’t trust any

one)?

3. Do they seem to think that the difficulty is their fault (e.g. daddy left

because I am bad)?

Developmental disruptions:

1. Are they meeting the developmental tasks for their age?

2. Assess their social skills, emotional skills, and cognitive skills. Are

they age appropriate? If not was there a recent stressor?

3. When do their developmental abilities fluctuate wildly when they are

under stress, angry, embarrassed?

Effects of developmental delay on later development:

1. When did they last meet their developmental abilities in cognitive,

emotional or social domains?

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2. Is there a current cognitive, emotional or social ability that seems to

be affected by previous disruptions in development? (E.g. In order to

develop complex moral reasoning they would need the ability to

understand their own experience and anticipate the experience of

others).

Impact on support systems:

1. Were family members also traumatized by the event? If so how

many? Did the event or events effect other important people in the

child’s life?

2. Is the trauma impacting the ability of the adults in a child’s life to

effectively support the child?

3. Are their many negative parent child, teacher parent interactions or

teacher child interactions?

Impact of child’s symptoms on others:

1. Are the child’s symptoms impacting others? How? How often?

2. Are their symptoms impacting peer, teaching, care providing, siblings

or parenting relationships? If so how?

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Cumulative Trauma:

1. Is there cumulative trauma (e.g. leaving a war zone, alcoholism or

addiction, ongoing abuse)?

2. Identify the triggers related to the events.

Key Points Trauma in Young Children

1. Young Children Display: More intense symptoms of trauma,

Increased risk of developing PTSD, More incidence of hyperactivity

and depression then older children.

2. Young Children: Act out the trauma in play more often the older

children, Tend to have a higher incidence of destructive behavior and

violence, Can display higher levels of oppositional behaviors then

older children.

3. Young children often do not display “numbing/ avoidance

symptoms.” They often display what one researcher called, “New

fears and aggressions.”

4. Young children display an increase of externalizing (acting out) and

internalizing (acting in) behaviors.

5. Trauma effects Seven Domains of a Child’s Functioning...

a. Symptoms of PTSD, b. Psychological meaning c. Developmental

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disruptions d. The effects of developmental disruptions on later

development e. Direct Impact of the traumatic event on social support

systems. (Other’s symptoms of trauma). f. Impact of child’s

symptoms on others. g. Cumulative Effects of Trauma. (Trauma

Stacking).

6. Educators can create islands of safety. Children who have been

traumatized often feel an “I can’t...” where other children feel an “I

can!” A class room can be an island of safety where the child can

build mastery experiences and learn to trust again.

A word of caution!

Learning anything new takes work! Some people may try these skills once,

feel frustrated that they did not work and give up. As you practice you get

stronger! As always if practicing this skill brings up a lot of emotion, contact

your therapist or seek out a therapist who can work with you!

Well, that about covers it for the Ebook “Trauma Safe Schools Series:

Trauma in young children (Ages 0 – 5)” I hope you enjoyed it.

We always love to hear people’s thoughts about how this has helped you in

your life. Please feel free to send us questions, feed back and thoughts!