Consequences+of+Developmental+Trauma

=**Consequences of Developmental Trauma**=


 * 1. Describe the effects of child maltreatment.**

Maltreatment harms the physical, psychological, cognitive, and behavioral development of children. Children who have been maltreated have a 2x greater risk for arrest for violent crime, and earlier, more chronic involvement in criminal behavior. Maltreated children also suffer from depression and anxiety, and can be later diagnosed with post-traumatic stress disorder. About 1/3 of abused children grow up to be abusive or neglectful parents.


 * 2. Describe the effects of exposure to violence on youth.**

Exposure to violence can be through trauma by the effects of war or witnessing an inner city violent act (robbery, stabbing, shooting, or killing). Exposure to community violence relates to increased violence, aggression, depression, anxiety, etc. Children witnessing or are victims of violence, particularly at home, are at high risk for perpetuating violence as adolescents and adults.


 * 3. Describe the presentation of children with post-traumatic stress disorder.**

Children presenting with PTSD may present with repeatedly perceiving memories or images of traumatic event. They may engage in behavioral reenactments and repetitive play related to the event and fears related to traumatic event. Also, they may develop pessimistic attitudes, including hopelessness about the future and life in general, hyperarousal, hypervigilance, and hyperactivity.

The DSM-IV-TR defines PTSD as an exposure to a traumatic event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and a response involving intense fear, helplessness, and horror. Children may be disorganized or agitated. To be diagnosed with PTSD, patient must meet 1 or more re-experiencing symptoms, 2 or more arousal symptoms, and 3 or more avoidance symptoms. Symptoms may develop some time after traumatic event but last longer than 1 month and cause significant impairment.

__Re-Experiencing (One or More)__ (1) Recurrent, intrusive, distressing recollections of the event through images, thoughts or perceptions; may present in young children with repetitive play involving aspects of the trauma. (2) Repeated distressing dreams of the event. Young children may present with frightening dreams without recognizable content. (3) Acting/feeling as if the traumatic event where recurring (reliving experiences, illusions, hallucinations, and flashbacks) and may present in young children with trauma-related reenactment. (4) Intense psychological distress at exposure to things that symbolize or resemble the trauma or aspect of it. (5) Physiological reactivity on exposure to cues that symbolize or resemble the trauma or aspect of it.

__Arousal (Two or More)__ (1) Difficulty falling or staying asleep (2) Irritability or outburst of anger (3) Difficulty concentrating (4) Hypervigilance (5) Exaggerated startle response

__Avoidance (Three or More)__ (1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma. (2) Efforts to avoiding activities, places, or people that arouse recollections of the trauma. (3) Inability to recall an important aspect of the trauma. (4) Markedly diminished interest or participation in significant activities. (5) Feeling of detachment or estrangement from others. (6) Restricted range of affect (i.e., unable to have loving feelings). (7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).


 * 4. Discuss the social, regressive, cognitive, and psychobiological problems related to PTSD in children.**

Children with PTSD often have related social, regressive, cognitive, and psychobiological problems.

Social related problems include less interpersonal sensitivity, less attentive to social cues, less competent at social perspective-taking, less pro-social behavior, less able to generate competent solutions to social problems, more likely to generate aggressive solutions, and more likely to attribute biased hostile intent.

Regressive symptoms include bedwetting, decreased verbalization, and separation anxiety.

Cognitive symptoms include decreased concentration and lower school achievement.

Psychobiological symptoms include alterations in overall arousal, increased muscle tone, increased startle response, sleep disturbance, and increase catecholamine activity. Elevations in the dopaminergic system may be related to hypervigilance, which is adaptive during trauma, but problematic over long periods of time. Other psychobiological symptoms include limbic system abnormalities and deregulation of the hypothalamic-pituitary-adrenal axis. Deregulation of HPA axis leads to prolonged sympathetic activation, increased responsiveness to stress and symptoms of PTSD. Inability to inhibit the sympathetic response can cause difficulty thinking about a present stress and cause new or minor stressors to elicit intense distress, attentional problems, and impulse control problems.


 * 5. Describe the presentation of children with acute stress disorder.**

The DSM-IV-TR defines acute stress disorder as an exposure to a traumatic event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and a response involving intense fear, helplessness, and horror. These symptoms are similar to diagnosis with PTSD in that it must meet re-experience, arousal, and avoidance symptoms. However, symptoms occur within 4 weeks of the traumatic event and must last a minimum of 2 days up to a maximum of 4 months. Additionally, ASD diagnosis must also include 3 or more of the following symptoms: (1) sensing of numbing, detachment, or absence of emotional responsiveness, (2) reduced awareness of surroundings, (3) derealization, (4) depersonalization, and (5) dissociative amnesia. Symptoms must cause significant impairment.


 * 6. Integrate general issues related to developmental psychopathology and treatment of trauma-related disorders and symptomatology.**

Treatment of trauma-related disorders includes crisis intervention. The safety of the patient bust me assessed and ensured, the patient must be removed form the source of stress/trauma, and be provided with new or renewed sources of support. Therapy includes trauma-focused cognitive behavioral therapy which involves overcoming denial and avoidance of the event, encourage processing trauma in safe environment or through exposure techniques, teach anxiety reduction and relaxation techniques, and teaching coping skills.

SSRI and anticonvulsants may also be used.


 * 7. Explain the dimensions of stress in the context of the effects of trauma on children, including stressor event factors and protective factors.**

At different developmental stages, children face different developmental tasks and challenges that may be disrupted by trauma.

Youngest and oldest patients are most affected by traumatic events and there is better prognosis related to earlier onset of symptoms. However, younger the age and longer the trauma is associated with greater the problems with self-regulation.

Stressor event factors include sudden or unexpected stressor, stressor is caused by a family member, event was one of may stressors experienced, event is still ongoing, duration was long or event occurred frequently, child exposed to death, dying, destruction and/or social chaos, child experienced a physical injury, source of trauma was man-made rather than natural, child is separated from family, and if child is separated from home.

Protective factors include strong relationship with mothers, parenting skills, and opportunity to talk about the trauma and process trauma with support of others.


 * 8. Define the State of Ohio requirements for mandatory reporting of child abuse and neglect and the UTMC policy and procedures regarding suspected child abuse and neglect.**

You’re a mandatory reporter and have to report when you have knowledge of or even suspicion of child abuse or neglect. You need to report up to 18 years of age or a mentally disabled person up to age 21. You can report hypothetically and ask child services if they will take the case.

Go read the boring ass slides on the notes.


 * 9. Describe the presentation of children with reactive attachment disorder of infancy and early childhood, and failure to thrive syndrome.**

__Reactive Attachment Disorder in Infancy and Early Childhood__ RAD is defined as markedly disturbed or developmentally inappropriate social relatedness, with onset before age 5. It is characterized with:

(1) failure to initiate or respond in a developmentally appropriate fashion to most social interactions (inhibited, hypervigilant, or ambivalent/contradictory responses). (2) Varied or indiscriminate attachments, indiscriminating sociability, or no appropriate selective attachments.

See the extensive notes on RAD for associated features.

__Failure to Thrive Syndrome__ Children with failure to thrive fail to gain weight and grow as expected. It is characterized by significantly below a certain weight range for their age, disengaging baby, uninteresting in others/surroundings, very limited eye contact, irritability, and failure to reach developmental milestones.

Failure to thrive can result from inappropriate food restriction, failure to feed the child enough, social/emotional neglect, conditions involving the gastrointestinal system, or other specific medical factors.