Section Two

Zero to 5:

Trauma in Toddlers

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.

They Story of Billy…(cont.)

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.

They Story of Billy… (cont.)

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.

They Story of Billy… (cont.)

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 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.

They Story of Billy… (cont.)

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 YearsYong Children (0 to 5) Display…

More intense symptoms of trauma

Have a chance of developing symptoms of trauma More incidence of hyperactivity and depression after a traumatic events.

Trauma in the Toddler Years

Yong Children (0 to 3) Display… Higher differences in cognitive development, emotional development due to it being a time of large scale neuroplasticity, and less language abilities. Young children often do not display symptoms of numbing.

There is a higher amount of diagnosis of oppositional defiant disorder and separation anxiety disorder. Toddler’s with PTSD are often misdiagnosed as ADHD, and behavioral disorders.

Trauma in the Toddler Years

Yong Children (0 to 3) Display…Re-enactment playToy destructionAggression towards peersDefiance toward parents and adultsLiving with domestic violence is related to more aggressive and acting- out behavior, possibly due to modeling.

Trauma in the Toddler Years

Yong Children (0 to 3) Display…Difficulty sleepingNight-terrorsReduced attention spanRelationally, survivors of interpersonal trauma suffer from a loss of trust and a sense of betrayal from a person who is loved.Personality changesIncreased separation anxiety

Trauma in the

Toddler YearsHyperarousal symptoms in preschool children were associated with increased threats of violence, mild violence, and sexual violence.Re-experiencing symptoms in preschool children were associated with increased violence of all types.Many studies find that toddlers do not display symptoms of Numbing and avoidance as frequently as adults or older childrenScheeringa et al. (1995) in a comprehensive study found that for toddlers the main three symptom groups the same but added a category called: “new fears and aggression.”

Acting In vs. Acting OutSome children “act out” their emotional pain on others.Some children “act in” inflicting their emotional pain on themselves.These are called: Externalizing and Internalizing behaviors.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”

With-drawing into their own world.Acting and feeling anxious. Being inhibited in normal exploration.Feeling unsafe. Depressed mood, behaviors, emotions and beliefs. Children can appear “overcontrolled."

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Acting Out: Externalizing Behaviors

Externalizing behaviors manifest in children's outward behavior. The child acts out their hurt on the external world.

Disruptive behavior, Hyperactivity, Impulsivity.Aggressive behaviors.Often referred to as: Conduct problems,Antisocial behaviors, Under-controlled.Sometimes externalizing behaviors can be triggered by anxiety.

Trauma effects the Whole Child

Trauma is not just a psychological symptom.Trauma effects a child’s brain development and ability to learn.Trauma impacts a child’s relationships with friends and adults.One way to understand these impacts is by understanding the seven domains effected by PTSD.

Seven Domains Effected by Trauma

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 and intellectual tasks to achieve. Trauma can create disruptions in these tasks.

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Seven Domains Effected by Trauma4. 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.

Seven Domains Effected by Trauma6. 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…Higher exposure to trauma increases severity of symptoms and number of symptoms. One traumatic event if similar can trigger other events (trauma stacking).

Building Resiliency: Creating Islands of Safety

Each child has their own innate resiliency.Their bodies and nervous systems have a drive to develop. With young children creating a “relationship of safety” that provides: containment, consistency and understanding helps them develop skills and heal from the trauma.

Building Resiliency: Creating Islands of Safety

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.

Building Resiliency: Creating Islands of Safety

For children who have been traumatized they can be very sensitive to small changes in the relationship. 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!”. This can make it more likely that they give up before trying.A class room can be an island of safety where the child can build mastery experiences and learn to trust again.

Creating SafetyBuilding Mastery

Overview: Children with trauma have experienced “overwhelming events.” They often feel as if the events of life are unsafe, unpredictable and they can not effect them.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.

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Creating SafetyBuilding MasterySteps 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 supporting mastery give clear supportive instruction on the skill.

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

Creating SafetyBuilding Mastery 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 support the child to reflect on what made them successful. Asking them to see the behaviors and action that helped them reach their goals.

Exercise: Seven Domain Assessment

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

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Seven Domain Assessment1. 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?

Seven Domain Assessment

2. Psychological Meaning: • Are they highly sensitive to shame? Embarrassment• Do they feel guilty and responsible for things they

did not do. • Do they make comments that seems like the think

that life is dangerous, (e.g. mom hates me, strangers hurt people, I can’t trust any one.)

• Do they seem to think that the difficulty is their fault (e.g. daddy left because I am bad)

Seven Domain Assessment3 Developmental disruptions: • Are they meeting the developmental tasks for their

age?

• Assess their social skills, emotional skills, cognitive skills. Are they age appropriate? If not was there a recent stressor?

• When do their developmental abilities fluctuate wildly when they are under stress, angry, embarrassed?

Seven Domain Assessment4. Effects of developmental delay on later

development: • When did they last meet their developmental

abilities in cognitive, emotional or social domains?• Is there a current cognitive, emotional or social

ability that seems to be effected 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).

Seven Domain Assessment

5 Impact on support systems: • 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? • Is the trauma impacting the ability of the adults

in a child’s life to effectively support the child?• Are their many negative parent child, teacher

parent interactions or teacher child interactions?

Seven Domain Assessment6. Impact of child’s symptoms on others: • Are the child’s symptoms often impacting others? • Are they impacting peer, teaching, care providing,

siblings or parenting relationships?• If so how?

7. Cumulative Trauma: Is there cumulative trauma (e.g. leaving a war zone, alcoholism or addiction, ongoing abuse)? Identify the triggers related to the events.

Key Points Trauma in Young Children

Young Children Display: More intense symptoms of trauma;Increased risk of developing PTSD; More incidence of hyperactivity and depression then older children.

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.

Key Points Trauma in Young Children

Young children often do not display “numbing/ avoidance symptoms.”They often display what one researcher called, “New fears and aggressions.”Young children display an increase of externalizing (acting out) and internalizing (acting in) behaviors.

Key Points Trauma in Young Children

Trauma effects Seven Domains of a Child’s Functioning…

1. Symptoms of PTSD2. Psychological meaning3. Developmental disruptions4. The effects of developmental disruptions on later

development5. Direct Impact of the traumatic event on social support

systems. (Other’s symptoms of trauma).6. Impact of child’s symptoms on others.7. Cumulative Effects of Trauma. (Trauma Stacking).

Key Points Trauma in Young Children

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.