Trauma and children’s development

Abi Gewirtz, Ph.D., Associate Professor, Dept. of Family Social Science &Institute of Child Development,University of Minnesota

OverviewDomestic violence, homelessness, and maltreatment – what do we know?How does exposure to traumatic stress affect children’s development?Short-term and longer-term reactions and challengesTrauma, risk, and resilienceParents and children

Effects of parents’ own trauma history on parentingImpact of parenting on children

The cycle of violence

Both follow-up and follow-back studies have consistently shown a direct link between exposure to violence and subsequent perpetration of violence.For example, Widom (2001) reported that child victims of violence and neglect were 59% more likely to be arrested as juvenile, 28% more likely to be arrested in adulthood, and 30% more likely to be arrested for a violent crime.

Defining traumaIn its definition of posttraumatic stress disorder, the Diagnostic and Statistical Manual uses this definition of trauma: an event or events the person experienced, witnessed, or was confronted with that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

Homelessness and maltreatment: threats to children’s development

HomelessnessChild’s basic needs for shelter not metExtreme poverty, food insecurityParent’s own challenges – history of foster care is strongly associated with homelessness as an adultLikely associated challenges (examples):

Stability, security, routine, structureParenting challenges (parents who don’t have their own positive parenting role models)Families who are homeless live within a broader context of prejudice and disempowerment

Impact of traumatic events on children’s development

Children’s responses to violence are determined by an interplay of

factors:Details of the event, including nature of injuries, child’s relationship to victim and perpetrator, child’s proximity to eventChild’s developmental status, including cognitive and emotional capacities, phase-specific concernsFamily and community context of event, e.g., isolated event or chronic exposureAvailability of supportive response from family and other community institutions

Infants and young children – expected development

-need protection and nurturing-need reliability and consistency in care-

taking to respond to situations of uncertainty-caregiving is basis for secure attachment

Infants under stress

disturbances of sleep and eatinginability to be soothedconstant cryingmore generalized fears such as stranger or separation anxietyavoidance of situations that may or may not be related to the trauma

Preschoolers (18mths-3) – expected development

Want to explore but seek attachment figures to diminish apprehension.Increased capacities: physical, cognitive, language developmentnormal struggles around separation

Preschoolers – impact of violence

disruption of expectations of protective figures (attachment difficulties)agitated motor behavior or extreme passivity.eating and/or sleeping disturbancesinconsolable crying

Transition to school (ages 4-6) – expected development

play: to express feelings and ideasincreased cognitive capacitiesincreased sophistication of languageless actionreality and fantasy

Impact of violence on 4 – 6 year olds

regression: loss of previously attained milestones (e.g. toilet training)preoccupation with words or symbols that may or may not be related to the trauma. posttraumatic play in which themes of the trauma are repeatednightmarestemper tantrums

School age – expected development

rely less on cues from caretakers and understand situations of potential threat . They invoke fantasies of superhuman powers to protect themselvesmastery and control, separation - individuation, self awareness - self esteem, energy directed to school and learning (mastery motivation system), increased language sophistication, reality - fantasy, etc.

Violence and school-aged children

Disillusionment with the outside world poor academic performancelying stealingfightingsleep and eating disturbancesclinging false bravado

School age contd.experience "time skew" and "omen formation” regarding the trauma Time skew refers to a child mis-sequencing

trauma related events when recalling the memory.

Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

School age contd.posttraumatic play -a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety. An example of posttraumatic play is an increase in shooting games after exposure to a school shooting. reenactment of the trauma - more flexible than PT play- involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

Puberty/early adolescence – expected development

psychological concomitant to physical changespreoccupation with body sense of distinctivenesschange in relationship with parents peer pressure

Impact of violence on early adolescents

feelings of inadequacyunrealistic feelings of guiltexaggerated preoccupation with body somatic manifestationsacting out:

unsafe sex, criminal and illegal activities, drugs, pregnancies, etc.

Adolescence – typical development

revival and culmination of previous developmental issuessexual and aggressive urges foster autonomy and independenceadult physical and cognitive maturation without the emotional component identity definition and personality resolution (2nd opportunity)

Impact of violence on adolescents

can act as younger childreninadequate solutions that can be physically dangerous to self and others 2nd opportunity for separation and individuation experienced as threatening

Adolescence contdSymptoms more closely resemble PTSD in adults Traumatic play still evident Traumatic reenactment still evidentMore likely than younger children or adults to exhibit impulsive and aggressive behaviors.

Short Term Effects: Acute Disruptions in Self Regulation

EatingSleepingToiletingAttention & ConcentrationWithdrawalAvoidance

FearfulnessRe-experiencing /flashbacksAggression; Turning passive into activeRelationshipsPartial memory loss

Long Term Effects: Chronic Developmental Adaptations

DepressionAnxietyPTSDPersonality Substance abusePerpetration of violence

Trauma, risk and resilience Trauma & Cumulative Risk Overlap

Risks ‘pile up’ (Rutter, 1985)Secondary adversities during trauma events (Pynoos et al., 1996)Multi-problem families risk for trauma (Widom, 1989; 1999) Other risks contribute to posttraumatic stress disorder

Trauma, Resilience, & Parenting

Resilience: capacity to recover functioning following cessation of the traumatic event (Luthar et al., 2000).Effective parenting is a key correlate of resilience (e.g. Masten et al., 1999).

Why be concerned with trauma and posttraumatic stress in parents?

Associations between adult trauma and:Child distress and child PTSDParenting impairmentsParents’ difficulties interacting with child serving systems

How might parents respond differently to other adults when they are dealing with traumatic stress?And most important, how might they deal differently with their children?

How does adult PTSD affect parenting?

Growth in fathers’ PTSD is associated with self-reported impairments in parenting one year after return from combat

Gewirtz, Polusny, DeGarmo, Khaylis, & Erbes, (2010), Journal of Consulting and Clinical Psychology, 78, 5, 599-610

Parenting practices predict children’s recovery from a traumatic incident

Mothers’ observed parenting is associated with steeper reductions in child-reported traumatic stress over a period of four months following a domestic violence incident

Gewirtz, Medhanie, & DeGarmo, (2011), Journal of Family Psychology, 25, 29-38.

Interventions that buffer parenting show improvements to child internalizing and stress regulation

Parent training directed at mothers only resulted in improvements to child internalizing (later associated with reductions in externalizing) (DeGarmo, Patterson, &Forgatch 2005)Foster parent training associated with changes in children’s cortisol levels (Fisher et al., 2000; 2006)

How does trauma impact parenting?

Parents who are traumatized may be:Suffering from PTSD and related disorders (e.g., depression, anxiety)Using drugs to mask the painDisempoweredParents of children who have become “parentified” (i.e. responsible beyond their years)

How might parents’ trauma histories affect their parenting?

A history of traumatic experiences may:Compromise parents’ ability to make appropriate judgments about their own and their child’s safety and to appraise danger; in some cases, parents may be overprotective and, in others, they may not recognize situations that could be dangerous for the child.Make it challenging for parents to form and maintain secure and trusting relationships, leading to:

Disruptions in relationships with infants, children, and adolescents, and/or negative feelings about parenting; parents may personalize their children’s negative behavior, resulting in ineffective or inappropriate discipline. Challenges in relationships with caseworkers, foster parents, and service providers and difficulties supporting their child’s therapy.

Trauma history can: Impair parents’ capacity to regulate their emotions.Lead to poor self-esteem and the development of maladaptive coping strategies, such as substance abuse or abusive intimate relationships that parents maintain because of a real or perceived lack of alternatives.Result in trauma reminders—or “triggers”—when parents have extreme reactions to situations that seem benign to others. These responses are especially common when parents feel they have no control over the situation, such as facing the demands of the child welfare system. Moreover, a child’s behaviors or trauma reactions may remind parents of their own past trauma experiences or feelings of helplessness, sometimes triggering impulsive or aggressive behaviors toward the child. Parents also may seem disengaged or numb (in efforts to avoid trauma reminders), making engaging with parents and addressing the family’s underlying issues difficult for caseworkers and other service providers. Impair a parent’s decision-making ability, making future planning more challenging.Make the parent more vulnerable to other life stressors, including poverty, lack of education, and lack of social support that can worsen trauma reactions.

Traumatized parents may…

Find it hard to talk about their strengths (or those of their children)Need support in managing children’s behaviorHave difficulty labeling their children’s emotions, and validating themHave difficulty managing their own emotions in family communication

When posttraumatic stress symptoms interfere with daily interactions with children, parents should seek individual treatment

Traumatized parentsTrauma and adversity affect children’s adjustment because they impair parenting:

Disrupt emotion socialization of parentsIncrease experiential avoidanceIncrease emotion dismissingIncrease withdrawal and coercion, bids for attention and other atypical family processes

emotion socialization includes:discussion of emotions, teaching about and responding to children’s emotions responding to own emotions

increase coercive parenting

Resourceswww.NCTSN.org

Birth parents with trauma histories in the child welfare systemSix fact sheets on parent trauma for child welfare stakeholders

Psychological first aid for families in shelters :http://www.nctsnet.org/sites/default/files/assets/pdfs/PFA_Families_homelessness.pdf Facts on trauma and homeless childrenhttp://www.nctsnet.org/sites/default/files/assets/pdfs/Facts_on_Trauma_and_Homeless_Children.pdf

Thank you!Abi Gewirtzagewirtz@umn.edu