Understanding the Dev Effects of Trauma 4.08 - Delaware · Understanding the Developmental Effects...
Transcript of Understanding the Dev Effects of Trauma 4.08 - Delaware · Understanding the Developmental Effects...
Und
erst
andi
ng t
he D
evel
opm
enta
l U
nder
stan
ding
the
Dev
elop
men
tal
Eff
ects
of
Tra
uma
Eff
ects
of
Tra
uma
Vic
ky K
elly
Psy
.D.,
LC
SW, M
HA
, V
icto
ria.
Kel
ly@
stat
e.de
.us
MY
TH
S
•A
ll it
take
s is
love
.
•T
ime
heal
s a
ll w
ound
s.
•Li
ttle
child
ren
don’
t rem
em
ber
wh
at
happ
ens,
so
we
can
mov
e th
em
with
im
puni
ty.
•O
ur tr
aditi
onal
ther
apeu
tic “
tool
boxe
s”ar
e
suffi
cien
t.
Com
plex
Tra
uma
(NC
TS
N)
•E
xpos
ure
to m
ultip
le tr
aum
atic
eve
nts
that
oc
cur
with
in th
e ca
reg
ivin
gre
latio
nshi
p –
the
syst
em
that
is s
uppo
sed
to b
e th
e s
ourc
e of
sa
fety
and
sta
bilit
y in
a c
hild
’s li
fe.
•M
altr
eatm
ent �
emot
iona
l dys
regu
latio
n�lo
ss o
f se
cure
ba
se
�lo
ss o
f dire
ctio
n �in
abili
ty to
det
ect
or r
esp
ond
to d
ange
r �
revi
ctim
izat
ion
Rel
atio
nal T
raum
a:R
elat
iona
l Tra
uma:
A C
ompl
ex T
raum
a P
ersp
ecti
veA
Com
plex
Tra
uma
Per
spec
tive
Tra
uma
of th
e m
altr
eatm
ent i
tsel
f.
+ L
oss
of th
e pa
rent
as
a so
urce
of s
ecu
rity
and
com
fort
.
+ O
verw
helm
ing
inte
rna
l dis
tre
ss w
ith n
o a
ssis
tanc
e in
reg
ulat
ing.
Impa
ct o
f N
egle
ct
NC
TSN
Dat
a
9,33
6 ch
ildre
n an
d yo
uth
serv
ed n
atio
nally
:
�70
% m
ultip
le fo
rms
of tr
aum
a
�48
% s
igni
fican
t beh
avio
ral p
robl
ems
�41
% s
igni
fican
t aca
dem
ic p
robl
ems
�31
% s
igni
fican
t atta
chm
ent
�11
% s
uici
dalit
y
Pyn
oos
, et a
l, 20
08
Dia
gnos
tic
Pro
blem
s
•P
ost-
Tra
umat
ic S
tres
s D
isor
der
(PT
SD)
CA
NS
Stu
dy 7
668
abus
ed c
hild
ren
in fo
ster
car
e: 6
3%
had
trau
ma
sym
ptom
s, b
ut n
early
95%
did
not
mee
t cr
iteria
fo
r P
TS
D
•D
evel
opm
enta
l Tra
uma
Dis
orde
r (p
ropo
sed)
Dev
elop
men
tal T
raum
a D
isor
der
Dom
ains
of
Impa
irm
ent
Pro
pose
d
Be
ssel
va
n de
rK
olk
MD
ww
w.tr
aum
acen
ter.
org
Dev
elop
men
tal T
raum
a D
isor
der
Dom
ains
of
Impa
irm
ent
•A
ttach
men
t
•B
iolo
gy/P
hysi
olog
y
•A
ffect
Reg
ulat
ion
•D
isso
cia
tion
•B
ehav
iora
l Con
trol
•C
ogni
tions
•S
elf C
once
pt
Dev
elop
men
tal E
ffec
ts
Inte
rper
sona
l
Sen
se o
f Sel
f
Abi
lity
to T
hink
Em
otio
nal
Reg
ulat
ion
Bra
in D
evel
opm
ent &
Phy
siol
ogy
Dis
tres
s-R
elie
f Cyc
le
Dis
tre
ss
Em
path
ic
Atta
chm
ent
Car
egi
ving
Rel
ief
Ben
efits
•R
ecip
roci
ty (
giv
e &
take
)
•E
ffect
ance
( I c
an
effe
ct b
ehav
ior
in o
ther
s�
ther
efor
e, “
I mat
ter”
)
•T
rust
•In
tere
st �
Atte
ntio
n
•R
ewar
d �Jo
y
•E
arly
tem
plat
es
of a
ffect
reg
ulat
ion
Att
unem
ent
�In
crea
ses
regu
latio
n (“
feel
ing
felt
by”)
•S
ympa
thy
vs. E
mpa
thy
Dis
tres
s �N
o R
elie
f
Dis
tre
ss
Fai
lure
of
Atta
chm
ent
Em
path
ic
Car
e
Pro
long
ed D
istr
ess
Lia
bilit
ies
•Im
paire
d re
cipr
ocity
;
•Im
paire
d se
nse
that
“I m
atte
r”
•Im
paire
d tr
ust;
•Im
paire
d in
tere
st �
atte
ntio
n;
•Im
paire
d re
war
d �jo
y;
•Im
paire
d af
fect
reg
ulat
ion.
Impo
rtan
ce o
f M
isat
tune
men
t
If m
anag
ed e
ffect
ivel
y te
ach
es:
�N
egat
ive
fee
lings
ca
n be
end
ured
;
�C
are
give
r (o
ther
s) a
s re
sour
ce;
�F
rust
ratio
n to
lera
nce
;
�In
crea
ses
resi
lienc
e;
�In
tera
ctiv
e re
pair.
Mis
attu
nem
ent
Mis
attu
nem
ent :
Not
Han
dled
: N
ot H
andl
ed
•F
ailu
res
in in
tera
ctiv
e re
pair;
•D
ysre
gula
ted
sham
e an
d ov
erw
helm
ing
affe
cts�
ove
rwhe
lm c
opin
g;
•Im
paire
d vo
cabu
lary
for
inte
rnal
sta
tes;
•N
ot in
tern
aliz
ing
care
give
r a
s re
sour
ce;
•A
ffect
ive
bia
ses.
Unr
elie
ved
Dis
tres
s
•A
rous
al �
cort
isol
stre
ss r
esp
onse
;
•N
umbi
ng (
endo
geno
us o
piod
s);
•F
ree
zing
;
•C
ompu
lsiv
e s
elf-
relia
nce
;
Con
diti
oned
Fea
r R
espo
nses
(LeD
oux)
Thi
nkin
g B
rain
Sen
sory
Am
ygda
la
Inpu
t
Stim
ulus
Rea
ctio
n
Con
diti
oned
Fea
r R
espo
nses
Con
diti
oned
Fea
r R
espo
nses
(LeD
oux)
Thi
nkin
g B
rain
Tha
lam
usE
mot
iona
l B
rain
Am
ygda
la
Stim
ulus
Rea
ctio
n
Dev
elop
men
t of
the
Hem
isph
eres
•Le
ft H
emis
pher
e
•D
evel
ops
late
r
•R
espo
nsiv
e to
sta
bilit
y
•P
rom
otes
inhi
bitio
n
•R
ight
Hem
isph
ere
•D
evel
ops
earli
er
•R
espo
nsiv
e to
ac
tivat
ion
(cha
nges
in
the
envi
ronm
ent)
•P
rom
otes
act
ivat
ion
Rol
es o
f the
Hem
isph
eres
Lef
t•
Lang
uage
•S
eque
ntia
l, lo
gica
l
•C
onte
nt
•S
ocia
l em
otio
nsG
uilt
& r
emor
se
Prid
e
•In
hibi
tion
Rig
ht•
Non
verb
al
com
mun
icat
ion
•C
onte
xt
•P
rimar
y em
otio
ns
•S
elec
tive
atte
ntio
n
•T
actil
e pe
rcep
tions
•In
tern
al r
epre
sent
atio
n
Mal
trea
tmen
t an
d E
ffec
ts o
n So
cial
Inf
orm
atio
n P
roce
ssin
g
•D
isto
rted
per
cep
tions
•H
ostil
e a
ttrib
utio
nalb
ias
(Ke
n D
odge
)
•Im
paire
d ab
ility
to th
ink
abou
t one
’s
thou
ghts
and
feel
ings
•C
oncl
usio
ns
•Li
mite
d re
call
and
diffi
culty
ass
oci
atin
g cu
rren
t beh
avio
rs w
ith p
ast m
altr
eat
men
t.
Inte
rnal
Wor
king
Mod
elIn
tern
al W
orki
ng M
odel
Secu
reSe
cure
•I a
m lo
vabl
e, w
orth
y,
capa
ble,
goo
d…..
•O
ther
s ar
e ba
sica
lly
good
, hel
pful
, ca
ring…
•T
he w
orld
is a
saf
e &
pr
edic
tabl
e pl
ace.
Inse
cure
Inse
cure
•I a
m b
ad, d
efec
tive,
un
wor
thy,
un
lova
ble…
•O
ther
s ar
e hu
rtfu
l, co
erci
ve, r
ejec
ting…
•T
he w
orld
is a
da
nger
ous
, cha
otic
pl
ace.
Per
cept
ions
+ B
elie
fs � ���
Beh
avio
r
Impo
rtan
ce o
f a
Impo
rtan
ce o
f a
Coh
eren
t N
arra
tive
Coh
eren
t N
arra
tive
•M
ake
sens
e of
life
exp
erie
nce
s;
•C
halle
nge
ear
ly e
go-c
entr
ic b
elie
fs;
•In
tegr
ate
posi
tive
and
nega
tive
feel
ings
;
•A
cqui
re g
rea
ter
secu
rity
in a
ttach
men
t.
Eff
ects
of
Tra
uma
on t
he S
elf
Eff
ects
of
Tra
uma
on t
he S
elf
Syst
emSy
stem
•“F
alse
sel
f”;
•P
rofo
und
sham
e;
•E
arly
mal
adap
tive
sche
mas
or
life
scrip
ts:
Aba
ndon
men
t, M
istr
ust,
Def
ectiv
enes
s/sh
ame
Eff
ects
of
Tra
uma
on
Eff
ects
of
Tra
uma
on
Inte
rper
sona
l Fun
ctio
ning
Inte
rper
sona
l Fun
ctio
ning
•D
efic
its in
em
path
y
•D
efic
its in
so
cial
em
otio
ns;
•D
efic
its in
pro
-so
cial
beh
avio
rs;
•D
efic
its in
mor
al d
evel
opm
ent.
Em
path
y T
rain
ing
•A
ttune
men
t
•E
mpa
thy
(su
bjec
tive)
•E
mpa
thy
(inte
rpe
rson
al)
�R
ecog
nizi
ng fe
elin
gs (
affe
ctiv
e)
�T
akin
g pe
rsp
ectiv
e of
oth
er
Tou
chst
ones
of
Stra
tegy
Tou
chst
ones
of
Stra
tegy
•S
afet
yfirs
t an
d fo
rem
ost!!
!!
•D
evel
opm
enta
l (no
t chr
onol
ogic
al)
age
•D
ete
rmin
e “W
on’
t”ve
rsus
“C
an’t”
•C
orre
ctiv
e e
xper
ienc
es
of a
ttune
men
t so
the
child
“fe
els
felt
by”
anot
her
•M
akin
g se
nse
of e
xper
ienc
e
•A
pplie
d de
velo
pmen
tal p
sych
olog
y
Adv
ocac
y
•E
sta
blis
hing
per
man
ency
•P
reve
nt m
ultip
le p
lace
me
nts
•E
duca
te p
are
nts
(birt
h, fo
ster
, ado
ptiv
e) to
re
cogn
ize
tra
uma
rea
ctio
ns a
nd
find
wa
ys to
co
pe in
con
stru
ctiv
e w
ays
•A
dvoc
ate
for
the
Dev
elop
men
tal T
raum
a D
isor
der
Dia
gnos
is (
ww
w.d
sm5.
org)
Sele
cted
Ref
eren
ces
•w
ww
.nct
sn.o
rg
•Le
doux
, J (
1998
). T
he
Em
otio
nal B
rain
.
•P
olla
ck, S
D, e
t al
(201
0). E
ffect
s of
ea
rly d
epriv
atio
n.
Chi
ld D
evlo
pmen
t, 81
, 22
4 –
236.
•T
eich
er, M
H, e
t al
(200
3). T
he
neur
obio
logi
cal
cons
eque
nces
of e
arly
st
ress
and
chi
ldho
od
mal
trea
tmen
t. N
euro
scie
nce
and
Bio
beha
vior
Rev
iew
, 27
, 33
–44
.
Ref
eren
ces
Con
t’d
•P
erry
, B.D
. (20
06).
A
pply
ing
prin
cipl
es o
f ne
urod
evel
opm
ent t
o cl
inic
al w
ork
with
m
altr
eate
d ch
ildre
n. In
N
B W
ebb
(Ed.
),
Wor
king
with
tr
aum
atiz
ed y
outh
(27
-5
2). N
Y: G
uilfo
rd.
•P
ynoo
s, R
. (20
08).
R
evie
w o
f NC
TS
N
Cor
e D
ata.
NC
TS
N.
•va
n de
rK
olk,
BA
(2
005)
. D
evel
opm
enta
l T
raum
a D
isor
der.
P
sych
iatr
ic A
nnal
s.