THIRTEEN TO 18Trauma in the Teen Years

TEEN TRAUMA THE STORY OF JANE

Jane is a bright 15 year old girl. You are excited that she is coming to your class. Over the summer Jane was out with her family and was in a terrible car crash.

When Jane comes into your class at first she is respectful, motivated, and participates in class.

TEEN TRAUMA THE STORY OF JANEOver the next three months Jane starts being more irritable in class.Her test scores are low. In class she fidgets a lot and sometimes appears to be staring off into space at nothing. When doors slam Jane jumps out of her chair. Once in class another student raises his voice during an assignment and Jane yells back and nearly hits the boy. When asked about why she did that she stated that she did not know. She said he made me mad and he is stupid.

TEEN TRAUMA THE STORY OF JANE

Jane’s parents call a conference and try to help Jane. Jane becomes embarrassed about this meeting and starts becoming more withdrawn at school.As the year progresses she appears to be less able to concentrate and starts to cut class.You as a teacher try to reach out to Jane and she is irritated and says things push you away. (make you feel stupid)

TEEN TRAUMA THE STORY OF JANE

Parents report that Jane is withdrawn, irritable, yells at her siblings for the smallest things, and no longer listens.

Jane starts to spend time with kids who are getting into trouble.

Some one states that they think Jane is drinking.

Why Trauma Matters: ACES

Trauma in the Teen Years…Teen who have

Face Trauma Often experience

Fear, Worry, Sadness, Feeling alone and apart from others, Anger, Feeling as if people are looking down on them, Low self-worth, and Unable to trust others.

Teen who have Face Trauma Often Display

Dysfunctional BehaviorsIncreased aggression. Out-of-place sexual behavior. Self-harm. Attempt suicide.Abuse of drugs or alcohol.Dropping out of school, Risk of pregnancy at a young age.

Externalizing BehaviorsThe Hyperarousal TypeIncreased Externalizing Behaviors (e.g. acting out)Their anxiety and unregulated protective anger leads to many difficult behaviors. They can ruin their relationships with authority figures and at times have difficulty tolerating friendship.The ability to regulate their emotions is low. Due to this they display more emotions. They can elicit more negative emotions from teachers, parents and friends.

Externalizing BehaviorsThe Hyperarousal TypeThe child acts out their hurt on the externalworld. Such as:

Disruptive behaviorHyperactivityAggressive behaviorsDelinquency

Impulsivity. These Children are often referred to as having conduct problemsDisplay antisocial behaviors Appear under-controlled

Poly-Vagal TheoryThe way it works… V.V.C. Brake Disengages

Sympathetic Nervous system Engages

V.V.C Brake Engaged at rest and Socially Engaged.

DMNX EngagesShutting Down Consciousness

Hyperactivation

The hyperactivated individual floods with information from the body and has less capacity to regulate the intense sensation.Ruth Lanius Found in an fMRI Study…

Over activation in the insula (bringing extreme amounts of information from the body’s interoceptive cues)

Under-activation of the anterior cingulate cortex (ACC) (area needed to regulate the body sensations brought up from the insula)

Under-activation medial prefrontal cortex (mPFC) (area needed to regulate the body sensations brought up from the insula)

Internalizing BehaviorsThe Dissociative Type

Some teens implode and don’t explode.

Teens who are the most overwhelmed sometimes appear quiet, withdrawn and isolated.In trauma we discuss this as “acting-in” vs. “acting-out.”These children can be ignored because they appear to be doing well. They are not. They are highly shame sensitive and need support.They may never ask for it!

Internalizing BehaviorsThe Dissociative Type

Increased Internalizing Behaviors: With-drawing into their own world; Acting and feeling anxious; Being inhibited in normal exploration; Feeling unsafe; Depressed mood and behaviors. Negative Emotions and beliefs. Can appear “over controlled."

Poly-Vagal TheoryThe way it works… V.V.C. Brake Disengages

Sympathetic Nervous system Engages

V.V.C Brake Engaged at rest and Socially Engaged.

DMNX EngagesShutting Down Consciousness

Hypoactivation

For the hypoarousal type, only a small amount of interceptive cues get into the limbic cortex and are quickly squelched by cortical structures, leaving the individual feeling disconnected, emotionally flat, and dissociated.

Ruth Lanius Found in an fMRI Study…Down regulation of physical sensations from the insula cortex.Hyperactivation activation in the anterior cigulet cortex (ACC). Hyperactivation in the medial prefrontal cortex mPFC.

Working with the Traumatized Teen

Trauma can be a shattering life event. Teens are prone to feel disconnected from society, adults and each other.Traumatic events can lead to increased feelings of isolation. This combination can be very detrimental to a teen.Traumatic events are often caused by people who are trusted by the teenager. That rupture and trust can make it more difficult to the teen to move out of isolation and back into a trusting relationship with authority figures.

Working With the Traumatized Teen

Affect instability, externalizing behaviors, lack of trust and avoidance behaviors can lead a teenager to act in ways that damages important relationships. Working with an adolescent who has experienced trauma requires building trust, tolerated acting out but supporting the teen to make safe choices and their life.Adults working with traumatized teenagers need to be very aware of the subtle attachment behaviors that can alert the teen at the adult they are with his safe.It is also important for adults to know that subtle facial expressions, body positions, behaviors, tones of voice, and interaction styles can trigger a fight flight response.

Working With the Traumatized TeenIf a teenager has a fight flight response it’s important to assess if there were triggers in the way a care provider was talking, behaving, or displaying emotion and.Trauma triggers are classically conditioned. This means they’re often not logical, connected to things that we would expect, and in response to the trigger is highly disproportionate to the event.The disproportionate nature of the traumatic response to the event trigger in response can be highly frustrating and confusing to the adult care providers working with the traumatized teenager.

Working With the Traumatized Teen

Because the adult responses to a child’s externalizing behavior can also be trauma triggers it imperative for care providers to be able to tolerate, regulate, and redirect highly emotional behavior.Remember emotions are contagious! And the emotions of trauma are extremely intense. Therefore it’s important to learn some skills at regulating your own responses to intense emotions.

Emotion Regulation ToolsOrienting: Is paying attention to the here and now through the five senses.Resourcing: Is accessing a previous memory or a current felt experience of mastery, positive emotion, safety, or pleasurable sensation.Distress Tolerance: Is recognizing that life is often difficult, and sometimes all you can do is tolerate a difficult. With more practice it becomes easier to remain present even in the face of a highly uncomfortable and stressful emotional event.

Emotion Regulation ToolsBreath: Breathing into your belly can be a powerful way to stabilize your consciousness when you’re feeling of intense emotion.

Self soothing: This is the skill that can help increase your tolerance of difficult emotions.

You can soothe with in the five senses: touch, sight, smell, taste, hearing. You can soothe with your thoughts: positive self talk can help soothe a difficult emotion. You can soothe your imagination. Imagining a time when you felt good, safe, loved or tolerated a difficult situation can help you learn to be with the most difficult emotions.

Emotion Regulation ToolsHumor: Finding ways to be irreverent, take a difficult situation lightly, and seeing the humor in challenge can be a profound way to learn to tolerate emotions.Half smile: Your face is connected into the parasympathetic nervous system. When you put a half smile on your face, you tell your body to your safe. This can reduce stress, increase pleasure, and help you tolerate challenging emotions.

Emotion Regulation ToolsNaming a Pattern: All people have patterns of behaviors. Children do too. When you in a non-judgmental way name a pattern it allows the other person to grow in awareness and have a chance to reflect if that action matches their own goals.Decoding Thoughts and Feelings: ToM or Theory of mind is one of the core skills in emotional relatedness. All people have a guess about the internal state of other people. Children who have faced trauma often make guesses that are threatening and inaccurate. In this skill you make a guess about the inner experience of a child and how that is effecting their behavior but then give them room to correct you.

Emotion Regulation ToolsTeflon mind: Is a practice of letting emotions and events roll off your back. It’s like the thought can come and and the feeling can be there but you let it go very quickly. This takes practice. In the skill is one of the most vital in working with children who have experienced trauma. Mindfulness: Children and in particular children with trauma have a feeling or a thought and react. This is the skills of noticing the sensation in the body and building time in between the feeling and the action.Non-judgementalness: This is the skill of accurate, simple and direct description of behaviors. It sounds easy but takes a lot of skill.

The “Attitude”The “Attitude” creates safety and lays the ground work for effective teaching.Calm:  Stay  calm  ware  the  poker  face and remain warm.

Firm:  Stick  to  the  rules  while  remaining   kind  and  supportive.

Accepting:  Accept  the  child  fully not  the  actions.

Empathic:  Your  empathy  helps  the  child   grow  empathy  for  others

Playful  and  Curious:  Enjoyment  is  key  for  a  child or teen with  trauma.  Curiosity  is  the   Hallmark  of  safety.

Attachment Behaviorso Creating Social Bonds: Social bonds increase the impact of

the educational relationship.

STEPS:

1. Create Safety (eye contact – upper face working), 2. Approach Proximity (physical/ emotional closeness), 3. Establish Contact (physical/ emotional contact).

o Self-Empowerment: Uses positive emotions to build on existing strengths.

Attachment Behaviors• Your body talks: Your whole presence communicates safety.

• High Vocal Prosody: Reduces stress through increased social engagement via changing tuning of inner ear.

• Eye Contact: Reduces stress response 1. Make sure type of eye contact with in cultural norms, 2. Follow patient’s lead (trauma).

• Heart Face Connection: Core social engagement system. Seen in contact between mother and child. Can be evoked through face to face caring contact.

• Environment Matters: Small amounts of physical beauty impacts stress.

Cognitive Behavioral – TriadThoughts, Feelings and Behaviors.

Thoughts

Cognitions, Ideas, Beliefs, Values

Feelings, Emotions(Happy, Sad, Fear, Anger,

Disgust, Surprise)

BehaviorsActions or anything observable from

the outside

Development of Emotional Regulation

Overview: The rupture repair cycle is one of the key tools that grows emotional regulation. It also grows the emotional regulation centers in the brain. If there are small ruptures in the relationship that are followed by repairs the relationship gets stronger. If there are difficult emotions followed by positive emotions and social engagement the ability to regulate the emotions get stronger.

Development of Emotional RegulationValidation – Validation is giving some one the experience of being understood. Listening to some one and appreciating their emotions as real is one of the key tools for validation. Validation is not agreeing!Decoding – This is a three step process.

1. The first is noticing the other’s reaction.

2. The second is making a guess about what the reaction is to the person.

3. The third gives the teen a chance to agree or disagree with your interpretation.

Development of Emotional Regulation

Modeling acceptance – Difficult things happen to all of us. At times it is important to be able to model the ability to accept situations.

Resourcing – Helping the teen find a positive coping skill, personal strength or identify something that makes them feel good.

Balance of Love and Respect

For all of us we need to balance these factors. For teens it is very important.Their life stage is asking them to be independent. This means they will push against authority figures. They need to learn both from authority that this is simply time to respect the adults and that adults care.One of the most important lesson for teens to understand is to connect love and caring with discipline. For this to be the case discipline must happen in a context of respect and support.

Threat and Arousal in Class Room Management

When a child becomes too angry the front brain shuts down.Their limbic system (mammal and lizard brain) kicks in. The child or teen does not see the person but sees people as a threat. Teens are more susceptible to this then adults. When adults see a face that is angry they use their front brain to interoperate the emotions when teens do the same thing they use the amygdale (fight-flight center).

Threat and Arousal in Class Room Management

There is a fast acting circuit in the brain that communicates threat. There is a slow acting circuit that appraises threat but uses the front brain. There is a way to speak to the fast acting circuit that makes it feel safe. Learning these tools can make you extremely effective at defusing difficult situations.

Threat and Arousal in Curriculum

Threat shuts down the front brain. Lowers Ach a neural chemical associated with learning and concentration. Hyperaroused teens also often have significant numbers of negative thoughts that distract them from focusing. Curriculum can trigger threat itself. Learning is difficult. In order to be able to learn one must be able to tolerate the negative feelings and thoughts one has during the learning process.

Threat and Arousal in Curriculum

Movies manage our threat arousal cycle very well. They scare us and then make it ok. They use the “rupture repair cycle.” This is important for children with PTSD as well as helping all kids learn.Build learning around the four zones:

1. Safety Zone (easy work)2. Stretch zone (slightly difficult work) 3. Growth Zone (difficult work) 4. Danger Zone (Overwhelm no learning possible) If there has been too much stretch for too long it can be overwhelming there needs to balance and a movement.

Threat and Arousal in Student Behaviors

Recognizing threat is important.Physical signs of fight/flight arousal:Fidgeting, tense jaw, tight shoulders or fists, flush or pale skin, pupils dilated, sweating, breathing changes, defensive postures.Vocal signs of fight/flight arousal:Lack of musicality (vocal prosody), short clipped sentences, angry tone or silence.

Key Points: Trauma in Teen Years

Teens with trauma often: Display: Increased aggression, hyper-sexuality, self-harm/suicide, drug and alcohol addiction, drop out of school, pregnancy.

Feel: Fear, worry, sadness, feeling alone/isolated, anger, feeling judged, low self-worth, and mistrustful of others.

Key Points: Trauma in Teen Years

Externalizing: Impulsivity, These Children are often referred to as having conduct problems, Display antisocial behaviors, Disruptive behavior, Hyperactivity, Aggressive behaviors, Delinquency.Hyperactivation: The hyperactivated individual floods with information from the body and has less capacity to regulate the intense sensation.

Key Points: Trauma in Teen Years Internalizing: Some teens implode and don’t explode. With-drawing into their own world; Acting and feeling anxious; Being inhibited in normal exploration; Feeling unsafe; Depressed mood and behaviors. Negative Emotions and beliefs. Can appear “over controlled.” These teens are highly shame sensitive and they may never ask for help.Hypoactivation: For the hypoarousal type, only a small amount of interceptive cues get into the limbic cortex and are quickly squelched by cortical structures, leaving the individual feeling disconnected, emotionally flat, and dissociated.

Key Points: Trauma in Teen Years Working with a Traumatized Teen:

The work can be frustrating. Before you confront regulate yourself. Put on your own oxygen mask first.Trauma triggers are classically conditioned. This means they’re often not logical. The disproportionate nature of the traumatic response to the event trigger in response can be highly frustrating and confusing.Building trust, tolerated acting out but supporting the teen to make safe choices and their life.Adults working with traumatized teenagers need to be very aware of the subtle attachment behaviors that can alert the teen at the adult they are with his safe.

Key Points: Trauma in Teen Years Skills to teach:Orienting: Is paying attention to the here and now through the five senses.Resourcing: Is accessing a previous memory or a current felt experience of mastery, positive emotion, safety, or pleasurable sensation. Distress Tolerance: The ability to tolerate difficult emotions.Breath: Breathing into your belly can be a powerful way to stabilize your consciousness when you’re feeling of intense emotion.

Key Points: Trauma in Teen Years Skills to teach (cont.):Self soothing: Soothing in the five senses, soothing with thoughts, soothing with imagination. Humor: Be irreverent, find humor in difficulty.Half smile: Your face is wired to your emotions. You can change your feelings by changing your face.Naming a Pattern: Be clear describe with out judgment. Name the outcome and see if the teen would prefer another outcome.

Key Points: Trauma in Teen Years

Skills to teach (cont.):Decoding Thoughts and Feelings: Guess the feeling, express non-judgmentally and check with the child to see if you are right.Teflon mind: Is a practice of letting emotions and events roll off your back. Mindfulness: Being aware of this current context builds the ability to see through the trauma.

Key Points: Trauma in Teen Years

The “Attitude”: creates safety and lays the ground work for effective teaching. Five parts: Calm, Firm, Accepting, Empathic, Playful  and  Curious.

Building Emotion Regulation: Rupture repair cycle (Good, Tuff, Good – Sandwich).Five skills to build Emotion Regulation: Validation, Decoding, Modeling Acceptance, Resourcing, “The Attitude.”

Key Points: Trauma in Teen Years Threat in Curriculum: Learning can trigger threat itself. Learning is difficult. Threat shuts down the front brain making learning even more difficult. Choose your zone (Safety, Stretch, Growth and Danger) and watch the physical signs of “stress.”Threat in Classroom Management When a child becomes too angry the front brain shuts down.Their limbic system (mammal and lizard brain) kicks in. The child or teen does not see the person but sees people as a threat. There is a way to speak the language of the limbic system to help a teen move from threat to safety.

Key Points: Trauma in Teen Years Creating Social Bonds: Social bonds increase the impact of the educational relationship. Five behaviors: Your body talks, High Vocal Prosody, Eye Contact, (make sure type of eye contact with in cultural norms), Heart Face Connection, Environment Matters.

School attachment predicts educational success. You are the key to school attachment!Remember to balance love and respect both are needed to help teens with trauma.