CDPP training
5th precinct supervisors
MPD
April 21st 2004
Psychological Casualties
- Boston City Hospital: 1 in 10 children had witnessed a shooting or stabbing by age 6.
- Washington, DC: 84-90% of 6-10 year olds witnessed violence toward others. More than 30% reported witnessing a shooting.
- 9th - 12th grade males: 21% witnessed a sexual assault. 82% an assault at school. 46% a stabbing. 62% a shooting.
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.
Nature v. Nurture: Is the debate over?
- What makes us who we are?
- Biological contributions
- Environmental contributions
- Combination of the two:
- We are hard-wired for brain development
- Experience affects the pattern of the wiring
Infant Development
- Infants are born with certain characteristics
- Physical attributes
- Temperament
- Prenatal influences
- Infants are born into certain environments
- Comfortable enough
- Stressful
The environment affects the way babies use resources
- Can use them for growth and development or divert them toward self-protection
- Repetition strengthens pathways
- Disuse leads to pruning
- Combination of biology and environment affects growth and brain structure
Importance of Relationships
- Infants are dependent on relationships with
primary caregivers
- Biologically wired for survival
- Attachment needs separate from nutritional needs
- Develops over time through interaction and consistent responding
- Secure attachment related to positive attributes
Predictable, stable relationships are essential
- Ongoing relationships with primary caregivers
serves many protective functions
- Provide care and nurturance
- Promote growth and development
- Foster ability to explore, learn, understand world
- Protect against danger, unknown, stress
- Provide interpretation of events, people, world
Separation disrupts the protective cocoon
- Young children use adults in order to manage stress
- Have few coping skills on their own
- withdrawal
- crying
- going to sleep
- Separation from primary caregiver during time of stress can exacerbate reactions
Trauma
- Defined as extraordinary event that overwhelms ability to cope
- “overwhelm” based on developmental level
- what might seem normal to an adult may overwhelm a young child
- accident
- fighting
- threatening
- separation
Children look to primary caregiver to mediate stress
- Child looks to parent to interpret event, provide safety
- Child checks parent’s face for cues:
- What’s going on?
- Should I be scared, worried, panicked?
- Ability of parent to soothe child and child to use parent is based on relationship history
Parent may not be available to help child understand the event
-
Parent may be hurt
- Parent may be too frightened
- Parent may be drunk, drugged, unconscious
- Parent may be arrested, gone
Child may have to rely on own resources
-
Child loses trust in adults
- Child may take on parental role
- taking care of parent
- taking care of siblings
- taking care of self
- Parentified role is at a cost to the child
Reactions to Trauma
-
One time v. cumulative trauma
- Normal development disrupted by trauma
- developmental milestones achieved
- may temporarily regress
- Stressful development with chronic trauma
- uneven development common
- coping strategies can become incorporated into personality
Reactions to Trauma
-
Physiological
- Hyperarousal
- Hypersensitivity
- Disruption in biological functioning
- Involuntary reactions to triggers
- siren
- clothing, badge
- gun
- Emotional overwhelm
- Shutting down
- Inability to process, interact, emote
- Inability to use others for coping
- Involuntary emotional response to triggers
Reactions to Trauma
-
Behavioral
- Withdrawn, constricted in play
- Regression in language skills
- Restricted interests
- Development of new fears
- Aggression toward self and others
Post-Traumatic Stress Disorder (PTSD)
-
Physiological symptoms
- startle response, hypervigilance, sleep disruption, regression in acquired skills
- Intrusive symptoms
- nightmares, unbidden reactions to triggers, repetitive play
- Avoidant symptoms
- warding off thoughts
- avoiding triggers, places, people
Reactions to Traumatic Events: Preschool Children
- Determined by developmental stage, i.e.,
- language, motor skills, biological functions
- representational thought
- can imagine “mommy”
- can imagine “bad guy”
- identity development
- internalization of important figures in child’s life
- identification with hero, bad guy
Preschool Children
-
Fantasy v. reality
- cause of the event
- rescue fantasies
- television v. real
- wish/threat v. real
- guilt: "I hoped my daddy would go away and leave us along"
What can officers do?
-
Preschool
- Explain (even if you think the child won’t understand)
- Answer questions as best you can
- Get down on child’s level (so that he’s not looking at your utility belt)
- Kids respond in many different ways - some may appear ‘hyper’, some ‘spaced out’, some ‘hardened’. These are all traumatic responses
Interventions
-
Confusion breeds anxiety: clarity helps
- Routine and familiarity help - keep as much the same as possible
- Use language skills to facilitate coping
- Use non-verbal techniques - drawing, pictures
- Reassure them about their parent - too scary not to know
Interventions
- Help them use a safe, predictable, known adult
- relative, neighbor
- clinician
- officer (watch for triggers)
Coping strategies if removed from home
- transitional objects - blanket, picture, animal
- coloring book for children (what happened next?)
- record of changes (for adults)
Summary
- Young children are strongly affected by separation, trauma, and stress of all kinds
- They do not have many effective coping skills of their own
- Positive relationships with primary caregivers can mitigate some of the effects
- Caring adults can help them understand and process what happened
- Keeping as much the same as possible will help them re-establish a sense of safety
Child Development and Trauma
4-6 years old
Expected development
-
play: to express feelings and ideas
- increased cognitive capacities
- increased sophistication of language
- less action
- reality and fantasy
- oedipal conflict
Child Development and Trauma
4-6 years old
Stress and Trauma
- regression: loss of previously attained milestones
- nightmares
- temper tantrums
- toilet training difficulties
- etc.
Child Development and Trauma
Short Term Effects:
Acute Disruptions in Self Regulation
- Eating
- Sleeping
- Toiletting
- Attention & Concentration
- Withdrawal
- Avoidance
- Fearfulness
- Re-experiencing /flashbacks
- Aggression; Turning passive into active
- Relationships
- Partial memory loss
Child Development and Trauma
Long Term Effects:
Chronic Developmental Adaptations
- Depression
- Anxiety
- PTSD
- Personality
- Substance abuse
- Lower school attainment
- Perpetration of violence
Child Development and Trauma
Elementary school age
Expected development
- Rely less on cues from parents
- Understand situations of potential threat “big wide world”. Children invoke fantasies of superhuman powers to protect themselves
- Energy directed to school and learning,
- Increased language sophistication,
- Distinguish reality from fantasy
- Cognitive limitations - continued brain development
- Mastery and control, self awareness - self esteem,
Child Development and Trauma
School age
Stress and Trauma
- disappointment in the outside world
- poor academic performance
- lying
- stealing
- fighting
- sleep and eating disturbances
- clinging
- false bravado
Responding to school-aged kids
- Use their natural curiosity
- Acknowledge that the situation is terrifying and awful, and offer containment (by telling them what’s being done to keep them safe)
- Let them stay close to parents when possible (secure base behavior)
- Don’t expect them to understand the irreversibility of death
- Children are traumatized when fantasy (nightmare) meets reality
Child Development and Trauma
Puberty and Early Adolescence
Expected development
- psychological concomitants to physical changes
- preoccupation with body
- sense of distinctiveness
- change in relationship with parents
- peer pressure
Child Development and Trauma
Puberty and Early Adolescence
Stress and Trauma
- feelings of inadequacy
- unrealistic feelings of guilt
- exaggerated preoccupation with body
- somatic manifestations
- acting out:
- unsafe sex, criminal and illegal activities, drugs , pregnancies, etc.
Child Development and Trauma
Adolescence
Expected development
- revival and culmination of previous developmental issues
- sexual and aggressive urges foster autonomy and independence
- adult physical and cognitive maturation without the emotional component
- identity definition and personality resolution (2nd opportunity)
Child Development and Trauma
Adolescence
Stress and Trauma
- can act as younger children
- inadequate solutions that can be physically dangerous to self and others
- 2nd opportunity for separation and individuation experienced as threatening
Adolescent case vignette
Working with adolescents
- Setting limits is critical, but…
- Indirect confrontation more effective than overt challenging (they want you to get confrontational so they can return the challenge)
- Separate leaders from the group
- Speak to their ‘emerging adulthood’
- Respect individuality