ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 1

The Neuroscience of Traumatic Stress in Early Childhood: implications for 

intervention and systems

Joshua Arvidson, MSS., LCSWDirector, Alaska Child Trauma Center at ACMHS

Director, Child and Family Services at ACMHS

Regional Site Director, Complex Trauma Treatment Network

Steering Committee, National Child Traumatic Stress Network

Editorial Review Board, Journal of Child and Adolescent Trauma

7/31/2018

LOS ANGELES

Category I - National Center

MA

CT

NY

PA

NM

UT CO MO

OH

VA

Category II – Intervention, Development, and Evaluation CentersCategory III – Community Treatment and Service Centers

ME

FL

AL

CA

OR

WA

ILDC

NCDURHAMOK

MT

ID WIMI

SC

NJMD

TX

TN

GA

LA

MS

NYC

FY01-02 – Member Centers

SAN DIEGO

SAN FRANCISCO

AZ

SD

AK

WV

PORTLAND

EUGENE

JERSEY CITY

DE

MN

NH

2

National Child Traumatic Stress Network (NCTSN) Sites

Arvidson, 2017

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 2

National Coordination & Training Center, The Trauma Center at Justice Resource Institute (CTTN Director:  Joseph Spinazzola; Co‐Director:  Bessel van der Kolk;  Project Coordinator, Hillary Hogden.Lead Trainers: Margaret Blaustein & Kristine Kinniburgh

Midwest Regional Training & Technical Assistance Center, La Rabida Children’s Hospital (Co‐Director: Bradley Stolbach)

Southern Regional Training & Technical Assistance Center, DePelchin Children’s Center (Co‐Director: Robert Hartman)

Northeast Regional Training & Technical Assistance Center, University of Connecticut (Co‐Director: Julian Ford)

Evaluation Center, Washington State University at Spokane (Evaluation PI: Christopher Blodgett, Natalie Turner.)

Training Faculty: Mandy Habib, Robert Abramovitz, Monique Marrow, Ibis Carrion Gonzales, Rocio Chang, Laurel Kiser, Danielle Ferrier.

Pacific Northwest Regional Training & Technical Assistance Center, Alaska Child Trauma Center(Co‐Director: Joshua Arvidson)

Complex Trauma‐Informed (CTI)  Systems of Care Initiatives•Core Concepts•Trainer Training

•CTI Strategic Planning•CTI Organizational Evaluation

•Screening &  Detection•EBP Adoption & Dissemination (TARGET, ARC and 

SPARCS)•Contextual Adaptation of Assessment & Treatment Materials 

& Resources•Sustainability Planning

Complex Trauma Treatment Network (CTTN)

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 3

Physiology of Trauma

Arvidson, 2011

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 4

Arvidson, 2011

Arvidson, 2011

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 5

Area of Scientific Advancement Physiology of the Human Stress Response

THREAT

• Activation of Threat Appraisal and Response System

• Increased Limbic System Activity

• Alarm system “flood”

• Activation of Threat Appraisal and Response System

• Increased Limbic System Activity

• Alarm system “flood”

SURVIVAL 

RESPONSE

• Fight, Flight or Freeze

• Survival Oriented Behavior

• Fight, Flight or Freeze

• Survival Oriented Behavior

POST‐STRESSOR

• Continued Arousal

• Difficulty Modulating 

• Continued Arousal

• Difficulty Modulating 

• Physiological Changes in Brain Structure and Function, Decreased Volume of Amygdala and Hippocampus, Prioritization of Stress Pathways

Adaptation of Brain Processes and Structure

• Significant challenges to Regulatory Capacity, Dysregulation, State and Trait Characteristics.

Chronic Exposure to 

Stress Hormones

• Hypervigilance, Hyper and Hypo Arousal, Survival (as opposed to developmental) based orientation.  Trauma turns a learning brain into a surviving brain.

Physiological Adaptations

Arvidson, 2013

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 6

Attachment allows children to safely explore the world and provides a healthy model for self and others. 

Attachment is the dance of the limbic systems of the child and parent.

‐ Allan Schore

Contextualizing Trauma within the Attachment System

Internal Representational Models

Bowlby model delineates formation of Internal Representational Models:

– Model of SELF• e.g., “I am worthy or competent”; “I am unworthy or incompetent”

– Model of OTHER• e.g., “Others are reliable or trustworthy”; “Others are unreliable or untrustworthy”

– Model of SELF IN RELATION TO OTHER• e.g., “Others will respond to my needs”; “Others will not respond to my needs”

These models form the basis (“working models”)for future relationships.

Blaustein, 2005

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 7

Areas Impacted by Complex Trauma

Physiology and brain 

development

Tolerate, control and express emotions and sensations

Control impulses and concentrate

Form healthy attachments and social 

relationships

Safely negotiate conflict and differentiate 

safe from unsafe

Learn and engage in goal‐

directed behavior

Form a positive and cohesive sense of self

Arvidson et al, 2011, Cook et al, 2005, Kisiel et all, 2009 and Spinazzola et al, 2005

0 20 40 60 80 100

Kidnap

School Violence

Forced Dispalcement

Natural Disaster

Serious Injury/Accident

Extreme Interpersonal Violence

Illness/Medical

Community Violence

Physical Assault

Other Trauma

Sexual Assault

Sexual Maltreatment/Abuse

Physical Maltreatment/Abuse

Emotional Abuse/Psychological Maltreatment

Domestic Violence

Traumatic Loss/Bereavement

Imparied Caregiver

Neglect

Children Served at the Alaska Child Trauma Center, 2005‐2011Types of Trauma Experienced

Yes

Suspected

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 8

Trauma: 

Alarm system activates

Dysregulation generalizes

Confirmation that world and experience is overwhelming

Internalization of 

overwhelming experience (There is something 

wrong with me)

Behavioral adaptation 

increases risk for re‐exposure

The Reproductive Cycle of Trauma: How Trauma Perpetuates Itself

Arvidson, 2016

The fundamental problem of chronic exposure to traumatic experiences in childhood is that overwhelming stress turns a learning brain into a surviving brain.

But, the brain and the physiological impact of trauma, is only the beginning of the story.  Development is the context in which the impact of childhood trauma is fully realized…

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 9

…The developmental necessities of childhood: formation of healthy attachments and social development, attentional capacity and cognitive development, mastery, competency, and regulation, (the ability to control one’s body, emotions and behaviors) are compromised by chronic exposure to overwhelming stress…

…Childhood trauma can be understood, fundamentally as developmental derailment.  Thus, trauma‐informed care for  children is about  helping the child and parent “put the train of healthy development back on the tracks.”  

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 10

…Trauma‐informed care is about helping children and families chart new developmental trajectories that promote healthy development, build resiliency and restore functioning.

‐ J. Arvidson

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 11

Study Conditions: Complex Trauma Treatment using ARC Framework at a clinic serving  predominantly child welfare involved clients.  

Attachment/

Caregiving System

Self‐Regulation

Competencies

Competency

Regulation

Attachment

Engagement

Trauma Experience Integration

Routines & Rituals

Executive Functions

Self‐Development & Identity

Psychoeducation

Caregiver Affect 

Management

Effective Response

Attunement

Identification

Relational Connection

Modulation

Graphic by Jeremy Karpen; Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

ARC Framework

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 12

86

49

0

10

20

30

40

50

60

70

80

90

100

Baseline CBCL End of Trx (1‐yearaverage)

Alaska Child Trauma Center Child Trauma Clinical Outcomes Study 

CBCL Score Changes with 1 – year Complex Trauma Treatment (Percentile)

Treatment Complete

CBCL (T‐Scores) at Completion of Treatment

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 13

Econometrics of Early Intervention & Prevention• Funding early

interventions provides the largest possible return on investment

Doyle et al. (2009) Investing in Early Human Development. In: Economics and Human Biology v7:pp1-6

From, M. Hirschfeld AAPP

Public Investment in Children by Age

From, M. Hirschfeld, AAPP

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 14

27

Source: 2013-2015 Alaska BRFSS, Section of Chronic Disease Prevention and Health Promotion, Alaska Division of Public Health, Graphic by Alaska Mental Health Board Staff

Population Attributable Fraction

28

Source: Child and Adolescent Health Management Initiative (2012). “2011‐2012 National Survey of Children’s Health (2012), U.S. Department of Health and Human Services, Health Resources and Services Administration.  Graphics and analysis done by the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse Staff

Population Attributable Fraction

ARC: Attachment, Self-Regulation, and Competency Do Not Reproduce Without PermissionKristine Kinniburgh, LICSW, Margaret E. Blaustein, Ph.D. The Trauma Center at JRI 15