Transcript Interviewing Children in Forensic Settings

Effects of Trauma and
Family Violence on the
Development of Children
Dr Larry Cashion
Specialist Consultant Psychologist
Presented at the
Communities for Children Connections Conference
Launceston, 29 June 2011
Trauma
 A deeply distressing or disturbing experience
– Oxford Dictionary
 Posttraumatic Stress Disorder
– DSM-IV-TR 309.81
 The development of characteristic symptoms
following exposure to an extreme traumatic
experience stressor
 Direct personal experience OR
 Vicarious experience with close relationship
Trauma without PTSD
 PTSD requires specific outcomes in
response to trauma
 Some children experience incidents at being
traumatic when others do not
 Some children do not develop PTSD
 However, that does not mean there is no
effect on children simply by the absence of
sufficient diagnostic criteria for a diagnosis
of PTSD
Types of Trauma
 This presentation will focus on family-based
trauma
 What we are considering includes:
– Family violence
– Deprivation and neglect
– Exposure to high risk situations
– Sexual abuse
Trauma, Deprivation and Neglect
 These issues can affect the quality and quantity
of social and emotional responses by children
 Trauma can be directly or indirectly
experienced
 Deprivation is a lack of physical care and of
social and emotional stimulation and
interchange
 Neglect is a failure of caregivers to fulfil their
caretaker obligations to children
Trauma Effects
 Children with traumatic experiences will
often demonstrate avoidance behaviours
 This means they will avoid thinking about
their experiences by any means
 Some will have affective numbing and will
be highly unresponsive
 It is often helpful to treat the child as a
‘survivor’ rather than a ‘victim’
Deprivation-Type Effects
 Inability or dysfunction in forming normal
social relationships or connecting with
others
 May manifest similarly to autism spectrum
disorders
– Repetitive stereotyped OCD-like behaviours
– Poor eye contact
– Delayed language
 Mood and anxiety problems
Neglect-Type Effects
 Limitations in the ability to appropriately
read nonverbal facial and gestural cues
 Language deficits  below age normal
 Limited problem-solving skills
 IQ deficits  nutritional, interpersonal and
environmental factors
 Learned helplessness  no matter what I do
it won’t make any difference
 Fear of caregiver retribution
A Little Bit of Neuroscience
Ways of Examining Trauma
Effects
 Psychological
– Cognitive
– Emotional
 Physiological
– Stress responses by the body
 Neurological
– Changes in brain function
– Changes in brain structure
Theories of Child Development
 Erickson’s theory of psychosocial
development
– Each life stage has a psychological crisis that
needs to be met successfully
 Maslow’s hierarchy of needs
– Certain needs have to be fulfilled to move the
to next level of development
 Attachment theories
– Failure to develop significant and appropriate
attachments has lifelong effects
Erickson’s Psychosocial Crises
 Infancy: Trust vs Mistrust
 Early childhood: Autonomy vs Shame
 Play age: Initiative vs Guilt
 Middle childhood: Industry vs
Inferiority
 Adolescence: Identity vs Role
Confusion
Maslow’s Model
Physiological Responses
 Dizziness
 Fatigue
 Headaches
 Elevated blood
 Chest pain/tightness
pressure
 Profuse sweating
 Vomiting/nausea
 Teeth grinding
 Somatic disturbance
 Difficulty breathing
 Muscle tremors
 Sensitivity to sights,
sounds, smells,
touches and tastes
‘associated’ with the
traumatic event
Physiological Effects
 Increases in stress hormones
– Cortisol
– Adrenaline (epinephrine)
– Noradrenaline (norepinephrine)
 Long term depression of function
 Can lead to biological depression due to
long term effects on brain chemistry
Neurological Effects
 Amygdala versus Hippocampus in memory
formation
 Failure to develop neural networks required
for social, academic, and adaptive
functioning
 Unusual patterns of resource utilisation
 Over-excitement of some brain areas with
under-excitement in others
How to Help?
 The world as a safe place (even though adults
know it’s not)
 Consistent behaviours have consistent outcomes –
includes provision of clear boundaries
 Positive regard in the face of challenging
behaviour
 The response to the child is more important that
what is said – good behaviour needs to be
modelled – good behaviour needs to be explicitly
taught
How this Helps?
 Consistency and safety allows resources to
psychologically and neurologically recover
resources for development, not just crisis
coping
 Children who experience trauma in their
home environment often don’t know how to
behave appropriate because it is not
modelled
The 3-Phase Approach
 STOP
– The word ‘stop’ has one meaning – words such as ‘no’
and ‘don’t’ have multiple meanings
 DON’T DO THAT
– The child needs to know what not to do – carers often
say ‘don’t do that’ – vague/confusing
 DO THIS
– This is the most important part that is very often missed
– Children are not little adults – children who have
experienced trauma more so – it cannot be assumed
they will learn by osmosis
Thank You
Dr Larry Cashion
[email protected]
www.drcashion.com.au