V A N E S S A D U R R A N T , M S W , L C S W - C , R M T , R Y TK I N D R E D T R E E H E A L I N G C E N T E R

O W N E R , P S Y C H O T H E R A P I S T

The Impact of Violenceon Children:

Trauma, The Brain, and Resilience

Dr. Seuss said ….

“Unless someone like you cares a whole awful lot,

nothing is going to get better. It’s not.”

“Atrocities refuse to be buried…Remembering and telling the

truth about terrible events are prerequisites both for restoration of the

social order and for the healing of individual victims.”

-Judith HermanTrauma & Recovery: The Aftermath of Violence-from domestic abuse to

political terror

Children Experience Trauma When:

They witness or experience domestic abuse They witness or experience sexual violence They witness or experience emotional, verbal, and/or

physical abuse They lose an important attachment figure

ETC….

OPEN QUESTION: What is Trauma?

Trauma Defined

A physical or psychological threat or assault to a child’s physical integrity, sense of self, safety or survival or to the physical safety of another person significant to the

child

Poll

Yes or No?

Is a child that is too young to understand their environment, impacted by violence?

Children see and hear

Sometimes adults say, “They’re too young to understand”.

However, young children are affected by traumatic events, including violence, and even chronic stress. Even if they may not understand what happened.

Many studies demonstrate the effect of stress ona child, starting in utero.

Toxic Stress Video

http://toxic stress/

How Children May Cope

Difficulty sleeping, eating, digesting, eliminating, breathing, or focusing

A heightened startle response and hyper alertness Agitation and over-arousal, or under-arousal, withdrawal or

dissociation Avoidance of eye contact and/or physical contact Terrified responses to sights, sounds, or other sensory input

that remind the child of the traumatic experience(s), (for example, a dog, police siren, or the smell of alcohol on a person’s breath

Preoccupation with or re-enactment of the traumatic experience (for example, a child’s play may take on an urgent, ridid quality and be dominated by people shooting, each other with police cars and ambulances arriving at the scene).

How the brain develops

Brain Stem Responses

May act out in panic; behavior may not make sense Reflexive in actions, no forethought or planning Time has no relevance May be wildly combative when approached; hit, kick,

or bite May not even be approachable at first May require restrains to protect from hurting self or

others

Amygdala

The emotional hijacker of post traumatic events PTSD is a disorder of the amygdala Amygdala gets stuck in high gear, and identifies

everything as a threat

Trauma and Memory

Normally the brain stores memories in a timeline In a traumatized brain, memory (hippocampus) is

not anchored in the past and instead floats in time Re-experiencing aspects of prior trauma can occur in

the present, causing the child to relive painful feelings, without actual threat

Interpersonal Neurobiology & Interpersonal Violence

Dr. Bruce Perry says:

“The most dangerous children are created by a malignant combination of experiences. Developmental neglect and traumatic stress during childhood create violence, remorseless children”

….BUT…The brain is malleable, and we can use interpersonal neurobiology to promote healing and positive and secure influences. This leads to brain growth and repair.

What is Trauma Informed Practice?

Trauma-Informed Professional

Trauma is a part of many disorders and challenges in people of all ages

Both mind and body respond to traumatic events and the body in particular informs intervention (safety first) is essential to trauma-informed care

“Symptoms” are reframed as adaptive coping necessary to survive, not a pathology

The individual is recognized as “survivor” who is moving to “thriver” (skill and resilience building, among other approaches)

Change in paradigm from “control” to “empowerment”, “collaboration”, and “culturally-sensitive”

Trauma Informed Intervention for the Advocate

For assessing trauma (domestic or sexual violence)Structured Interviews:-Child Exposure to Domestic Violence scale (CEDV)-Child Forensic Interview (Child Advocacy Centers)-Licensed Child Therapists and Psychologists(They can also administer many more assessments to identify impact of trauma and)

What it looks like

Conversation techniques with kids Drawing pictures and story telling

Can help decrease anxiety Useful for younger children

Space Confidential and safe Child friendly with child sized furniture and toys Out of hearing range of parents Removed from the context of the violence

Basic Guidelines for Age Appropriate Language

Short and simple sentences 3-5 words One concept at a time Remove unnecessary clauses- “Can you tell me

about, do you remember” Test knowledge and understanding of certain words

or phrases Avoid why questions Age 7-10 may be able to answer about themselves Age 10-13 may be able to answer about others

More…

Establish Meeting focus Describe your role with the child Address confidentiality and it’s limit Communicate concern in an age appropriate way Provide a brief and general overview

Respect child’s boundaries Honor the child’s loyal to the abusive parent/person Respect right not to talk or hesitance to share-forcing the issue will escalate

trauma response and lead to shut down Don’t force child to leave their parent Don’t make promises you can’t keep

Questioning Open ended questions (Allow a free running narrative) Start with general questions and move to more specific Be conscious about leading Avoid why questions and lean towards what and how questions

16 Trauma-Informed, Evidence-Based Recommendations for Advocates

A full document on this can be accessed at:http://www.futureswithoutviolence.org/userfiles/file/Children_and_Families/16%20Evidence%20Based%20Strategies%20for%20Advocates.pdf

*A great resource

Interventions Continued…

1. Understand that children of all ages, from infancy through adolescence, are vulnerable to the adverse impact of IPV exposure

2. Establish a respectful and trusting relationship with the child’s parent

3. Let mothers and children know that it is ok to talk about what has happened, if the child would like to engage in this type of discussion

4. Tell children that violence is not their fault; if children say that the violence is their fault or that they should have stopped it, tell them directly that they are not responsible for the violence and that it is not their job to intervene (and/or coach parent to do so as well)

5. Foster children’s self-esteem by showing and telling them that they are lovable, competent, and important

6. Help children know what to expect

Interventions continued…

7. Model and encourage good friendship skills

8. Use emotion words to help children understand how others might feel during disagreements

9. Recognize that when children are disruptive, they are generally feeling out of control and may not have the ability to use other strategies to express themselves

10. Incorporate the family’s culture into interventions, and support the parent and children to explore the values, norms, and cultural meanings that impact their choices and give them strength

11. Actively teach and model alternatives to violence

12. Involve parent in conversations with their children about the children’s views of the abuse

13. Discuss child development with parent

14. Help the parent teach their children how to label their emotions

15. Address parenting stress

16. Work with the parent to help them extend both their own and their child’s social support network

Resiliency

How would you define resiliency?

Resiliency =

Interpersonal Neurobiology & Interpersonal Violence

Dr. Bruce Perry says:

“The most dangerous children are created by a malignant combination of experiences. Developmental neglect and traumatic stress during childhood create violence, remorseless children”

….BUT…The brain is malleable, and we can use interpersonal neurobiology to promote healing and positive and secure influences. This leads to brain growth and repair. =RESILIENCY !!

Questions

What has stuck out for you?

Is there anything you’d like to discuss further?

ETC…..

References

Bolger, K.E., Patterson, C.J., & Kupersmidt, J.B. (1998). Peer relationships and self-esteem among children who have been maltreated. Child Development, 69, 1171-1197. Crick, N.R., & Dodge, K.A. (1994). A review and reformulation of social information- processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74-101. Criss, M.M., Pettit, G.S., Bates, J.E., Dodge, K.A., & Lapp, A.L. (2002). Family adversity, positive peer relationships, and children’s externalizing behavior: A longitudinal perspective on risk and resilience. Child Development, 73, 1220-1237.DuBois, D.L., Felner, R.D., Brand, S., Adan, A.M., & Evans, E.G. (1992). A prospective study of life stress, social support, and adaptation in early adolescence. Child Development, 63, 542-557.

DuBois, D.L., Felner, R.D., Meares, H., & Krier, M. (1994). Prospective investigation of the effects of socioeconomic disadvantage, life stress, & social support on early adolescent adjustment. Journal of Abnormal Psychology, 103, 511-522.Fosco, G.M., DeBoard, R.L., & Grych, J.H. (2007). Making sense of family violence: Implications of children’s appraisals of interparental aggression for their short- and long-term functioning. European Psychologist,

12, 6-16. Garner, A., Shonkoff J. (2012) Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129:224-231 Graham-Bermann, S., Gruber, G., Howell, K., & Girz, L. (2009). Factors discriminating against resilience and psychopathology in children exposed to intimate partner violence. Child Abuse and Neglect, 33(9), 648-660. Graham-Bermann, S.A., & Brescoll, V. (2000). Gender, power, and violence: Assessing the family stereotypes of the children of batterers. Journal of Family Psychology, 14, 600-612. Graham-Bermann, S.A., & Hughes, H.M. (2003). Intervention for Children Exposed to Interparental Violence (IPV): Assessment of Needs and Research Priorities. Clinical Child and Family Psychology Review, 6, 189-204.Graham-Bermann, S. A., Lynch, S., Banyard, V., DeVoe, E., & Halabu, H. (2007). Community-based intervention for children exposed to intimate partner violence: An efficacy trial, Journal of Consulting and Clinical Psychology, 75, 199-209. Grych, J.H., & Fincham, F.D. (1993). Children’s appraisals of marital conflict: Initial investigations of the cognitive-contextual framework. Child Development, 64, 215-230.Grych, J.H., Jouriles, E.N., Swank, P.R., McDonald, R., & Norwood, W.D. (2000). Patterns of adjustment among children of battered women. Journal of Consulting & Clinical Psychology, 68, 84-94. Hodas, G. (2006) Responding to childhood trauma: the promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Services. 11 16 Trauma-Informed Evidence-Based Recommendations for Advocates www.promisingfutureswithoutviolence.org ©2013 Futures Without Violence Huesmann, L.R., & Guerra, N.G. (1997). Children’s normative beliefs about aggression and aggressive behavior. Journal of Personality and Social Psychology, 72, 408-419. Jouriles, E. N., McDonald, R., Spiller, L., Norwood, W. D., Swank, P. R., Stephens, N., Ware, H., & Buzy, W. (2001). Reducing conduct problems among children of battered women. Journal of Consulting and Clinical Psychology, 69, 774–785.Katz, L. F., & Windecker-Nelson, B. (2006). Domestic violence, emotion coaching, and child adjustment. Journal of Family Psychology, 20, 56-67. Lieberman, A.F., Van Horn, P., & Ippen, C.G., (2005). Toward

evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1241-1248.Lieberman AF & Van Horn P. (2003). Don’t Hit My Mommy: A Manual for Child Parent Psychotherapy for Young Witnesses of Family Violence. Washington DC: Zero to Three Press. Luthar, S.S., Cicchetti, D., &

Becker, B. (2000). Research on resilience: Response to commentaries. Child Development, 71, 573-575. Masten, A.S. & Coatsworth, J.D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53, 205-220.Masten, A.S., Hubbard, J.J., Gest, S.D., Tellegen, A., Garmezy, N., & Ramirez, M. (1999). Competence in the context of adversity: Pathways to resilience and maladaptation from childhood to late adolescence. Development and Psychopathology, 11, 143-169.McAlister Groves, B. (2002). Children who see too much: Lessons from the child witness to violence project. Boston, MA: Beacon Press.McGee, C. (2000). Children’s and mothers experiences of support and protection following domestic violence. In J. Hanmer & C. Itzin (Eds.), Home truths about domestic violence: Feminist influences on policy and

practice (pp. 77-95). New York: Routledge. Runyon, M.K., Deblinger, E., & Steer, R.A. (2010). Group cognitive behavioral treatment for parents and children at-risk for physical abuse: An initial study. Child & Family Behavior Therapy, 32, 196-218. Sytsma, S.E., Kelley, M.L., Wymer, J.H. (2001). Development and initial validation of the Child Routines Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 241-251.

Brain Development References

Perry, B.D. and Hambrick, E. (2008), “The Neurosequential Model of Therapeutics (NMT),” in Reclaiming Children and Youth, 17 (3) 38-43; and Dobson, C. & Perry, B.D. (2010), “The role of healthy relational interactions in buffering the impact of childhood trauma in “Working with Children to Heal Interpersonal Trauma: The Power of Play,” (E. Gil, Ed.) The Guilford Press, New York, pp. 26-43. Both at: http://childtrauma.org/nmt-model/references/

Bruce Perry MD, Daniel Siegel MD, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” www.youtube.com/watch?v=jYyEEMlMMb0 – introductory video on Attachment Disorder and development trauma. Copies at www.postinstitute.com/dvds.

Perry, Bruce D., MD, “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished). Library of articles on interventions, trauma, brain development:https://childtrauma.org/cta-library/. Training in NMT Method and Somatosensory Regulation, Power of Rhythm —Individual and Site Training Certification Programs, DVD/streaming training, and online training: http://www.ctaproducts.org. Dr. Perry’s latest research and key slides: “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, Sept. 5, 2013 at www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/ (scroll down to Sept. 2013.) Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch

Herman, Judith, “Trauma and Recovery,” Basic Books, New York, 1992

Thank you!!

I love doing this! It’s my honor to be a part of your learning journey.

Now, go practice some positiveinterpersonal neurobiology!!