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RESPONDING TO TRAUMATIC STRESS : - Coggle Diagram

- - - - With physical abuse, the following elements are present:
        
        Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behavior will trigger a physical assault.
        
        Lashing out in anger. Abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse.
        
        Using fear to control behavior. Abusive parents may believe that their children need to fear them in order to behave, so they use physical abuse to “keep their child in line.”
        However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.
      - Physical Abuse Symtoms (Hyerim)
        
        Immediate Reaction
        Generalized anxiety, Sleeplessness, Nightmares, Difficulty concentrating, High activity levels, Increased aggression, Increased anxiety about being separated from a parent, Intense worry about their safety or the safety of a parent
        
        Long-Term Effect
        Physical health problems, Behavior problems in adolescence (delinquency, alcohol or substance abuse), Emotional difficulties in adulthood (depression, anxiety, PTSD)
        
        Exposure to IPV has also been linked to
        
        Poor school performance(impaired ability to concentrate; difficulty completing schoolwork; and lower scores on measures of verbal, motor, and social skills).
        
        Learn destructive lessons about the use of violence and power in relationships(Children may learn that it is acceptable to exert control or relieve stress by using violence, or that violence is in some way linked to expressions of intimacy and affection)
        
        Reactions by Age Group
        
        [Birth to 5] Sleep and/or eating disruptions, Withdrawal/lack of responsiveness, Intense separation anxiety, Inconsolable crying, Developmental regression, loss of acquired skills, Intense anxiety, worries, and/or new fears, Increased aggression and/or impulsive behavior
        
        [Ages 6 to 11] Nightmares, sleep disruptions, Aggression and difficulty with peer relationships in school, Difficulty with concentration and task completion in school, Withdrawal and/or emotional numbing, School avoidance and/or truancy
        
        [Ages 12 to 18] Antisocial behavior, School failure, Impulsive and/or reckless behavior(School truancy, Substance abuse, Running away, Involvement in violent or abusive dating relationships), Depression, Anxiety, Withdrawal
        
        Symptoms in School
        
        REGULATORY SKILLS
        
        Have dIfficulty expressing, managing, labeling and recognizing their own emotions or explaining their own emotional reactions to situations and events.
        
        May appear inattentive, while others seem hyperactive or fluctuate between the two.
        
        Loud or busy activities which are overwhelming and affect their ability to regulate their reactions
        
        SOCIAL SKILLS
        
        Struggling to engage in appropriate play with peers(For example, over-involvement in social interactions demonstrated as a lack of boundaries)
        
        Withdrawn socially or may need to make themselves feel in control of even small situations(For example, displaying bullying behavior or may “talk back” to others in an effort to maintain their own control)
        
        Establishing negative peer relationships, either because of a need to experience control or because of difficulties many students demonstrate in identifying characteristics of high-quality, appropriate friends.
        
        COGNITIVE FUNCTIONING
        
        Easily overwhelmed and have difficulty following single or multi-step directions
        
        Struggling to ask for help or, conversely, may be overly dependent on others to start and complete work.
        
        Resources : National education organization, Molly Cevasco, Eric Rossen, & Robert Hull, Best practices for supporting and educating students who have experienced domestic violence or sexual victimization, http://www.nea.org/home/62845.htm
        
        What it looks like in school
        
        Learning and Cognition (may look like a learning disability, ADHD, or an emotional disability)
        Difficulty processing instructions / Decreased attention, memory, and focus / Reduced executive functioning / Difficulty solving problems / Difficulty understanding consequences of actions / De-emphasis on skills/tasks that are not directly relevant to survival
        
        Behavior (may look like emotional disability or ADHD)
        Heightened vigilance; Inaccurate perception of danger / Rapid response to perceived threats (e.g., may jump or raise fists from pat on the back) / Self-protective behaviors (i.e., aggression or withdrawal)
        
        Socialization
        Social withdrawal, difficulty making friends, untrusting, involvement in bullying / Easily frustrated, quick to give up, unwilling to try new things, difficulty setting and working toward goals / Inconsistent moods, easily overwhelmed or upset, hopelessness, confusion, rigidity, perfectionism
        
        Response strategies in the classroom
        
        Maintain usual routines
        : A return to “normalcy” will communicate the message that the child is safe and life will go on
        
        Give children choices
        : Often traumatic events involve loss of control and/or chaos, so you can help children feel safe by providing them with some choices or control when appropriate.
        
        Increase the level of support and encouragement given to the traumatized child. Designate an adult who can provide additional support if needed
        
        Set clear, firm limits for inappropriate behavior and develop logical—rather than punitive— consequences.
        : Recognize that behavioral problems may be transient and related to trauma. Remember that even the most disruptive behaviors can be driven by trauma-related anxiety.
        
        Provide a safe place for the child to talk about what happened.
        : Set aside a designated time and place for sharing to help the child know it is okay to talk about what happened.
        
        Give simple and realistic answers to the child’s questions about traumatic events
        : Clarify distortions and misconceptions. If it isn’t an appropriate time, be sure to give the child a time and place to talk and ask questions.
        
        Be sensitive to the cues in the environment that may cause a reaction in the traumatized child
        : For example, victims of natural storm-related disasters might react very badly to threatening weather or storm warnings. Children may increase problem behaviors near an anniversary of a traumatic event.
        
        Resources
        The national child traumatic stress network, 5 Child Trauma Toolkit for Educators, October 2008
        https://wmich.edu/sites/default/files/attachments/u57/2013/child-trauma-toolkit.pdf
        
        Resource : The National Child Traumatic Stress Network, Intimate partner violence effect, https://www.nctsn.org/what-is-child-trauma/trauma-types/intimate-partner-violence/effects
    - - Example of emotional abuse include
        
        Exposing a child to violence against others, whether it is against the other parent, a sibling, or even a pet
        
        Limiting physical contact with a child—no hugs, kisses, or other signs of affection
        
        Ignoring or rejecting a child as punishment, giving them the silent treatment
        
        Frequent yelling, threatening, or bullying
        
        Telling a child they’re “no good,” “worthless,” “bad,” or “a mistake”
        
        Calling names and making negative comparisons to others
        
        Constant belittling, shaming, and humiliating
    - - Sexually abused children are often tormented by shame and guilt. They may feel that they are responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual and relationship problems as they grow older.
      - The shame of sexual abuse makes it very difficult for children to come forward. They may worry that others won’t believe them, will be angry with them, or that it will split their family apart. Because of these difficulties, false accusations of sexual abuse are not common, so if a child confides in you, take them seriously.
  - - - Emotional Neglect or Rejection
        Emotional neglect can be defined as a relationship pattern in which an individual’s affectional needs are consistently disregarded, ignored, invalidated, or unappreciated by a significant other. People in neglectful families are emotionally disconnected from one another, behaving as if they were living on different planets. Parents may have trouble understanding their children’s needs for love, affection, closeness, and support, or they may feel too overwhelmed or powerless to meet these needs on a consistent basis. (Ludwig S, Rostain A 2009)
      - Signs & Symptoms
        
        Parents
        :silhouette: Parents of children suffering emotional neglect were usually neglected themselves.
        :silhouette: Parents are highly ambivalent about their children’s needs, particularly when their children are hurting, crying, or looking for emotional support.
        :silhouette: may feel jealous or resentful of their children and may perceive them as excessively demanding and impossible to satisfy
        :silhouette: Resentment of their child.
        :silhouette: Self absorbed
        
        Children
        :silhouette: Child’s development is grossly delayed or shows evidence of failure to thrive.
        :silhouette: Child is exhibiting signs of emotional distress without an obvious cause.
        :silhouette: Child may shun or shy away from affection.
        :silhouette: Child may display immaturity and developmental delay.
        
        7 Signs of Childhood emotional neglect
        
        10 Signs of Emotional Abuse
        
        The Effects of Childhood Emotional Neglect
        
        Actions/Diagnosis
        
        Childhood emotional neglect (https://themindfool.com/childhood-emotional-neglect/)
        
        4 Steps to Recovering from Childhood Emotional Neglect
        Childhood emotional neglect (CEN) doesn’t disappear when you grow up. Adults carry it with them into their lives, and it affects everything—their relationships, their self-image, and their mental well-being. But emotional neglect is something you can recover from. Here are four strategies to help:
        1. Get to know and accept yourself. Understanding your high sensitivity is an important step toward accepting your needs as normal and valid. And learning about the CEN “emotional style” can help you identify — and change — patterns you’re not even aware of.
        A good starting point is Webb’s checklist to determine if you grew up with CEN: https://drjonicewebb.com/cenquestionnaire/
        2. Accept that your feelings, needs, and wants matter as much as anyone else’s. This may mean doing more of the talking in a friendship, voicing your needs clearly to others, or drawing boundaries.
        3. Start to express your needs. People recovering from CEN typically keep their emotions hidden or even feel “numb” because their emotions are walled off. As an HSP, that may mean you only express your needs when you’re completely overwhelmed (or you withdraw and never express them at all). But the time to express your feelings is in normal, daily interactions. “When you begin to treat yourself as if you matter,” Webb has written, “the people in your life begin to see you differently and respond to you differently. They start to see your personality, your emotions, and your needs. And they start to respond to what they can finally see.”
        4. Practice self-soothing. Self-soothing is something that most people learn how to do as kids when being soothed by the adults who love them. If you grew up with emotional neglect, you likely never learned this skill — but it’s not hard to learn now. You can find a guide here.
        And, of course, many people will benefit from talking to a therapist about their childhood emotional neglect.
        
        Emotionally Neglectful Parents
  - - - The effects of any mental illness in a parent will vary on the child and household. Some risks will be noted but not all children are affected negatively. Keeping a watchful eye on the student for any signs of neglect, or behavior and address it to the team. The condition of the parents and the age of the child will be factors to consider.
    - - A child subject to domestic abuse are at risk for physical and mental health issues themselves. Are also at higher risk to be involved in violent relationships themselves.
    - - The separation of parents, household and even siblings.
        
        Impact:
        
        Poor Performance in Academics
        
        Loss of interest in social activities
        
        Difficulty adapting to change
        
        Emotional sensitivity
        
        Anger and Irritability
        
        Feelings of Guilt
        
        Introduction of destructive behavior
        
        Increase in health problems
        
        Lose of faith and family units
    - - If a child has a parent who is incarcerated, could have lasting impact on a child's mental health, social behavior and educational prospects. The child could suffer from emotional and financial burdens in and out of the household. Many children may be subject to foster care as well.
    - - What is Substance Abuse?
        
        When a person Substance abuse is when you take drugs that are not legal. It’s also when you use alcohol, prescription medicine, and other legal substances too much or in the wrong way.
      - Effect on students
        
        Negativism: anything demining to a child ie complaints, critiques, and criticism.
        
        Parental inconsistency: a child may be lacking boundaries and could act out to test them.
        
        Parental denial: Parents could take an offense and deny any such problems.
        
        Miscarried expression of anger: Child may bear the brunt of a lot of anger.
        
        Self-medication: Either the parent or child may use drugs to 'feel better'
        6: Unrealistic parental expectations: Parents may set standards too low if parents are distracted.
  - - - Racial Trauma: Traumatic events that occur as a result of witnessing or experiencing racism, discrimination, or structural prejudice (also known as institutional racism) can have a profound impact on the mental health of individuals exposed to these events ("Addressing Race and Trauma in the Classroom", n.d.). Racial trauma can be cumulative effects of frequent experiences of racism.
      - Symptoms of Racial Trauma
        
        Fear
        
        Increased vigilance and suspicion
        
        Increased sensitivity to threat
        
        Shame or guilt following experiences racism
        
        Self-Blame
      - What is Racism: Beliefs, attitudes, behaviors, and institutional and systemic approaches that degrade, belittle and devalue groups based on the color of the skin or ethnoracial background (Clark et al., 1999)
      - What does racism looks like:
        
        Structural/institutional Racism: voter disenfranchisement;
        harsher sentencing in the justice system
        
        Individual level: racial bias can impact how teachers perceive students' learning ability, engagement in school activities and how they might interpret students' behavior
        
        Internalized Racism: Acceptance by the marginalized group, of negative beliefs about one's wroth
      - Response Strategies
        
        Mutual understanding: the attitudes and tensions that lead to racism are often deeply rooted in stereotypes and misconceptions. Teachers should promote knowledge about, and understanding of, different cultures in their teaching practice ("Racism and discrimination", n.d.).
        
        Ideas for Action for Teachers and Students:
        
        Celebrate the day for the Elimination of Racial Discrimination in your school by conducting different activities.
        
        Design posters or an anti-racism badge.
        
        Research about women and men in the history of your country or in the world which have stood up against racism and discrimination
        
        Set up a multi-cultural desk in the classroom where students bring in something that reflects cultural diversity.
        
        Self-compassion and Racism
        
        Understanding, acknowledging, and accepting the fact we are human. Being human involves many things that society deems "bad", "wrong", or "unpleasant".
        
        Understand that our responses and reactions to racist experience make sense. It can be really difficult and painful to experience racism.
        
        Say phrases to oneself that cultivate compassion. "This is a tough moment", "I'll give myself the kindness I deserve and need in this moment."
  - - - Following an event such as a hurricane, children may feel anxious, scared, and vulnerable. Meanwhile children who have lost their homes, belongings, or loved ones may go through lengthy periods of grief and pain (Koplewicz & Cloitre, 2006).
      - After a disaster strikes, youth are at greater risk than adults of developing psychiatric disorders (Adams et al., 2015).
      - Following a natural disaster, increases in depression and anxiety among children have been reported, with some symptoms persisting over time (Coombe et al., 2015).
      - They also may experience physical symptoms following a natural disaster (for example, stomach pain, trouble sleeping, back pain, indigestion, fast heartbeat, or fainting spells) (Speier, 2000; Zhang, Zhang, Zhu, Du, & Zhang, 2015).
      - Reactions
        
        Common Regressive
        Reactions
        
        Fear of darkness, fear of being alone/clinginess, crying, dependent on others to help with daily tasks, competing for attention, failing to perform chores and responsibilities, decline in certain behaviours
        
        Common Physiological
        Reactions
        
        Loss of appetite, indigestion, sleep problems, physical aches and problems
        
        Common Emotional and
        Behavioral Reactions
        
        Nervous. anxious about being away from caregivers, irritable, disobedient, School withdrawal, School phobia, loss of interest in activities, poor school performance, resistance to authority, depression, isolation, substance abuse
  - - - Bullying facts:
        
        More than 1/4 of students between grades 6 and 12 have experienced some form of bullying
        
        Could be physical or verbal aggressions
        
        Bullying can also have negative outcomes for the bully
        
        Parents are only aware that their child is a victim of bullying about 50% of the time
      - What is bullying?
        
        Is a repeated behavior by an individual or a group directed at another individual and with the intention of causing harm (physically or emotionally)
      - Effects
        
        Short-term
        
        Shame
        
        Sleep & eating disturbances
        
        Social Isolation
        
        Low self-esteem
        
        Anxiety
        
        Poor school performance
        
        Psychosomatic symptoms (ex. headaches with no known medical cause)
        
        Depression
        
        Long-term
        
        Self-destructive behavior
        
        Substance abuse
        
        Increased risk of suicidal thoughts
        
        Difficulty establishing positive relationships
        
        Mental disorders (depression, anxiety, PTSD)
    - - Signs & Symptoms
        
        (S)he appears jumpy when messages/emails appear
        
        (s)he unexpectedly stops using computer/phone
        
        (S)he is consistently anxious, angry, frustrated after using a technological device
      - What is cyberbullying?
        
        A form of bullying using technology
    - - Katie Hurley. (2018, September 26). Short Term and Long Term Effects of Bullying: Psychological & Societal. Retrieved June 22, 2020, from https://www.psycom.net/effects-of-bullying
        Information & advice about all forms of bullying. (n.d.). Retrieved June 22, 2020, from https://www.nationalbullyinghelpline.co.uk/
        Roxanne Dryden-Edwards, M. (2019, July 15). Bullying Facts, Statistics, Prevention & Effects. Retrieved June 22, 2020, from https://www.medicinenet.com/bullying/article.htm
        Signs and Symptoms of Teen Bullying and Abuse. (2018, August 21). Retrieved June 22, 2020, from https://www.childhelp.org/story-resource-center/signs-symptoms-teen-bullying-abuse/
- - - - Children are often forced to move to refugee camps where they might lose many years in difficult circumctances with no/poor education
      - Country's economy and infrastructure is destroyed, children are forced to drop school to stay at home to help raise their siblings or work to help provide for their family
      - Many children become physically disabled, sexually abused and emotionally traumatized.This causes high rates of anxiety, depression and inability to form social relatioships with adults and peers.
- - - - Some children develop traumatic grief responses, making it harder for them to
        Remember or enjoy positive memories of the deceased person
        Cope with the many changes that occur as a result of the death, and
        Continue with normal development.
        
        Any thoughts of the person—even happy ones—can lead to upsetting images or memories of the way that person died. These images may occur repeatedly in the child’s mind and—because they are so upsetting—the child may avoid thinking or talking about the person or even going places or doing things associated with the person or the death.
        Traumatic reactions may exacerbate existing mental health issues, disrupt learning, and be misinterpreted by parents, teachers, and others.
      - Difficulties specific to childhood traumatic grief that may occur across developmental stages include the following:
        
        Intrusive memories about the death. These can appear through nightmares, guilt, or self-blame about how the person died, or recurrent or intrusive thoughts about the horrifying manner of death.
        
        Avoidance and numbing. These can be expressed by withdrawal, the child acting as if not upset, or the child avoiding reminders of the person, the way she or he died, or the event that led to the death.
        
        Physical or emotional symptoms of increased arousal. These can include irritability, anger, trouble sleeping, decreased concentration, drop in grades, stomachaches, headaches, increased vigilance, and fears about safety for oneself or others.
      - In childhood traumatic grief, the interaction between trauma and grief symptoms is such that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, or memories of how the person died.
        Three types of reminders may trigger distress in children experiencing childhood traumatic grief:
        
        Trauma reminders: places, situations, people, sights, smells, or sounds reminiscent of the death. These may include the street corner where a fatal accident occurred, the bedroom where a parent died, or the sound of an airplane reminding a child of a mother who died in a crash.
        
        Loss reminders: people, places, objects, situations, thoughts, or memories that are reminders of the person who died—for example, photo albums or a new coach who has replaced a parent who previously headed a child’s sports team.
        
        Change reminders: situations, people, places, or things reminding the child of changes in his or her life resulting from the death—for example, moving to a new house or having to walk home with a babysitter rather than with an older sibling who died.
  - - - Trauma and Grief Component Therapy for Adolescents
        
        TGCT-A is a manualized group or individual treatment program for trauma-exposed or traumatically bereaved older children and adolescents that may be implemented in school, community mental health, clinic, or other service settings. It is a modularized, assessment-driven, flexibly tailored treatment manual and accompanying youth workbook that includes detailed instructions for conducting individual or group sessions. Specific treatment modules (and specific sessions within modules) are selected, prioritized, sequenced, and emphasized based on clients’ specific needs, strengths, circumstances, and informed wishes. The intervention contains a variety of components organized into four modules.
        
        Targeted Populations:
        12-20; both males and females; for trauma-exposed or traumatically bereaved older children and adolescents
      - Trauma-Focused Cognitive Behavioral Therapy
        
        TF-CBT is an evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers. It is a components-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques. TF-CBT has proved successful with children and adolescents (ages 3 to 18) who have significant emotional problems (e.g., symptoms of posttraumatic stress disorder, fear, anxiety, or depression) related to traumatic life events. It can be used with children and adolescents who have experienced a single trauma or multiple traumas in their lives.
        
        3-21; both males and females; for children with Posttraumatic Stress Disorder (PTSD) or other problems related to traumatic life experiences, and their parents or primary caregivers