Transcript ADHD - NAMI North Carolina

RESPONDING TO TRAUMATIZED
CHILDREN AND YOUTH:
Signs and Symptoms of Post Traumatic
Stress Disorder
Lindsay Caldwell, MSW, LCSW
Hope Services, LLC
Clinical Director
DJJ and Mental Health Facts
• A high percentage of youth (65 to 70 percent) involved
with the juvenile justice system have a diagnosable
mental health disorder and nearly 30 percent of those
experience severe mental health disorders.
• A large number of youth in the juvenile justice system
have a history of trauma, emotional, and behavioral
problems.
• Youth in contact with the juvenile justice system
experience higher prevalence rates across various types
of mental health disorders.
• Most youth in the system meet the criteria for or are
diagnosed with more than one mental health disorder.
DJJ and Child Welfare: overlapping risk
factors that stem from trauma
• The factors that lead to involvement with the child welfare system often contribute and
coincide with those that bring youth to the attention of the juvenile justice system.
• Trauma: Trauma experienced prior to and during system involvement can negatively
affect development for youth involved in both the juvenile justice and child welfare
system.
• Family: Compromised social and family networks can make it difficult for youth to
establish prosocial coping mechanisms as they mature emotionally and cognitively.
Family tensions, which may result from abuse and neglect or out-of-home placement,
can make it difficult for youth to establish a support network to help them overcome
personal barriers to life success.
• Abuse and Neglect: Child abuse and neglect increase the risk of any arrest of a
juvenile by 55 percent, and the risk of committing a violent crime by 96 percent.
Persistent maltreatment and neglect extending from infancy to adulthood are
significantly correlated with an increased risk of juvenile delinquency and criminality.
.Findyouthinfo.gov
What is Trauma?
• Something terrible or scary that you experience, see or hear
about, it could be something that happens to you or someone
close to you.
• You are afraid that your life or someone else’s life is in danger
or there could be serious injury.
• Examples:
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Physical abuse (hitting, smacking etc.)
Sexual abuse (forcing to engage in or witness sexual acts)
Serious accidents (Car, animal attack etc.)
Natural disasters (fire, tornado, hurricane, flood or earthquake)
Witnessing abuse or a traumatic death
Witnessing war or terrorism
QUESTION: Around how many people experience a traumatic event in
their lives?
70%
Normal Responses to Trauma
• Our brain wants to keep us safe, so, usually, we have a
natural reaction to danger—Fight, Flight or Freeze.
• Some symptoms right after trauma are normal, it is when
they persist for several weeks (or longer) when it
become serious enough to seek help.
What is PTSD?
• Post Traumatic Stress Disorder develops in some people when
they experience a traumatic event (or more than one) and they
are not able to control their stress/anxiety responses.
• PTSD was typically associated with veterans who have been in
combat, but it can happen to anyone—including children and
adolescents.
• 1 out of every 3 girls is sexually abused by the time they are 18
and 1 out of every 6 boys (based on reported statistics).
QUESTION: About what percent of people who experience a
traumatic event develop PTSD?
15%
Trauma’s Affect on a Child’s Brain
• Trauma in early childhood affects how
the brain develops and can lead to
symptoms. The brain is overreacting to
triggers because it thinks they are
dangerous based on previous trauma
experience.
• Trauma over stimulates the “protective”
part of the brain and it gets stuck in
“flight, fight, freeze” mode. The other
areas of the brain don’t have the
opportunity to develop, leading to
learning, social, and behavioral
problems.
Symptoms of Traumatic Stress
• Nightmares, flashbacks, re-experiencing
• Repetitive behaviors: safety behaviors, re•
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enacting the trauma in play
Clinging and withdrawal (Can look like
anxiety)
Fear and avoidance of certain places, things
or situations that remind them of the event
Complaints of aches and pains with no
medical explanation
Difficulty concentrating and easily startled
(Can look like ADHD)
Symptoms Continued
• Irritability, impulsiveness, anger and hostility (can look like
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ADHD)
Accident-prone and reckless behavior
Depression and overwhelming sadness or hopelessness
Loss of interest in previously enjoyed activities
Disruption in sleeping and eating
Distorted thoughts about self, others and the world
(Example: “I am bad”, “The world is unsafe”, “It’s all my
fault”)
Disassociation: Depersonalization or Derealization
Triggers
• Anything that reminds a person (or their brain) of a
previous trauma and causes their brain to go into
“protective mode” leading to an anxious reaction in their
brain and body (symptoms).
• Psychological (thoughts, memories)
• Physiological (rapid heart rate, sweaty palms) response
Triggers
• Example: A 15-year old adolescent was the victim of a
rape by a middle aged Caucasian man with a beard in the
park.
• Triggers might be: middle aged Caucasian men, beards, a man’s
voice, parks, children laughing, the sound of swings, being naked,
being restrained.
• Example: A 7- year old child grew up in a home with
domestic violence for the first 5 years of their life and
witnessed several fights between their parents including
lots of yelling.
• Triggers might be: other people fighting, loud noises, the
neighborhood where they used to live, certain smells, certain
colors, physiological and psychological reminders (heart racing),
POLICE INVOLVEMENT
Minimizing police involvement as a trigger
for traumatized youth
• Find out as much information about the youth as you can
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before approaching them.
Start the conversation from a distance.
If possible ask permission to approach or talk with the
youth.
Use anticipatory guidance to explain what is
happening/will happened next.
Tap out with your partner if you become aware that you
may be a trigger for the youth.
Avoid restraints when possible, especially down on the
ground.
Use validation and reassurance – “I know this is hard”
“I’m sorry this is scary.” “I don’t want to hurt you.”
Ariana’s Story
• A first hand experience of a teenager with PTSD’s
involvement with CIT.
• Reflections
• What was helpful?
• What did you learn?
• What is one way this will change the work you do in
the future?
Treatments for PTSD
• Therapy: Developing coping
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skills, social skills, relaxation
techniques
Parent Training
Gradual exposure
Diet/Nutrition and Exercise
Medication evaluation
Treatment Options
• Therapy:
• Trauma Focused-Cognitive Behavioral Therapy: 90% effective at
reducing trauma symptoms
• Cognitive Behavioral Therapy
• Dialectical Behavioral Therapy: teaching coping skills and mindfulness
• Behavioral Interventions: Rewards and consequences system
• Psychodynamic Therapy
• Group therapy: coping skills, social skills
• Parent Training and Education
• Medications for anxiety, depression, sleep problems, attention
issues
• Treatment can be in the home or the office and should always
include parents
• Treatment could help relieve symptoms even if full PTSD is not
diagnosed
Referral Information
• Hope Services, LLC
• 3000 Highwoods Blvd, Raleigh, NC
• 919.714.7500
• Open Access
• Monday – Friday
• 9am-3pm
• Medicaid, Healthchoice, IPRS, BCBS, Tricare, self pay
Resources
• Attention Deficit Information Network: support, information,
community resources
• www.addinfonetwork.org
• 781-455-9895
• Children and Adults with Attention-Deficit/Hyperactivity Disorder
(CHADD): Support, information, resource center
• www.chadd.org
• 301-306-7070, 800-233-4050
• Find Youth Info
http://www.findyouthinfo.gov/youth-topics/juvenile-justice/youth-involved-juvenilejustice-system
• National Child Traumatic Stress Network: www.nctsn.org
• National Center for PTSD: www.ncptsd.org
• Links to interdisciplinary index database, publications, books, research quarterly,
clinical quarterly, assessment instruments.
• National Institute of Mental Health (NIMH): www.nimh.nih.gov
• Free educational materials for professionals and the public.
• NC Child Treatment Program Ncchildtreatmentprogram.org