Trauma&and&Development:& … · Sensory%Modulation • Ability%to%grade ... Body%Temperature Sleep...

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Trauma and Development: An Integrated Best Practice

ApproachATTACH Conference-‐ September 27, 2015

Kathy Ryan, Ph.D., LCSWClinical Coordinator, Circle Preschool Program, GRSCAN, Richmond, VA

Denise Powers, M.Ed.

Early Childhood Specialist, Circle Preschool Program, GRSCAN

Shelly Lane, Ph.D., OTR, FAOTAFaculty of Health and Medicine Department of Occupational Therapy

Newcastle University, Callaghan, NSW, Australia

Workshop Objectives

• Participants will explain the impact of developmental trauma on function within the relational, regulatory, and cognitive domains.

• Participants will list 5 essential treatment techniques to support healing in a child who has experienced developmental trauma.

• Participants will create a treatment plan for a young child who has experienced developmental trauma.

And Who Are You?

Circle Preschool ProgramGRSCAN (Stop Child Abuse Now)

Richmond, VA

• Therapeutic Classroom within a typical preschool setting• 3-‐5 year olds; trauma backgrounds + unsuccessful adaptation to typical settings• Provision of therapeutic, play-‐based , educational milieu, psychotherapy, occupational therapy • Family/ Caregiver therapy – group and individual • Goal-‐ To transition into typical setting and healing from trauma

• Length of stay-‐ dependent on need or age

Typical Development

Development is a neuro-‐biologic process…

vEpigenetics & Genetics…

vBrain says…Survival is key!

vOrganization & functional capacity of brain is hierarchical & sequential

v Use dependent development

v State based dependency

Brain is Use Dependent

The brain changes in response to specific patterns of activation (experience )

Sensation as Nourishment

• Essential for brain functioning• A starting place for the development of adaptive environmental interactions

• Critical for• Attachment and social relationships• Arousal regulation• Organization of action

Emphasis: body centered sensory systems

Vestibular

Sensory intake and processing

• Sensory intake: Receptors• Organization of sensation: brain structures• Brain hierarchy• Lays a foundation for regulation of alertness and emotions

• Results in production of an adaptive response

Sensory Modulation• Ability to grade behavioral responses in relation to intensity, complexity, or novelty of sensation

•When modulation is working well, child can automatically• Filter out non-‐relevant stimuli• Notice relevant stimuli

The “State” of the BRAIN

Function is STATE Dependent

• From calm to alert to alarm to fearful to terror….

• With increasing level of arousal, the primary area of neural activity shifts to lower levels within the brain

Sensitive periods of Development

“Experience can change the mature brain, but experienceduring the critical periods of early childhood organizes brain systems.” Perry, 2006

Trauma

Trauma is…

• Experiences which are overwhelming, and over stimulating -‐-‐ more than a person can cope with at the time.

• Physical abuse, sexual abuse, emotional abuse (relational), domestic violence, chronic neglect

• Severe disasters, witnessing violence

Healthy Development vs. Developmental Trauma

What Children Need:

• Dependent on predictable consistent nurturing attention

• Secure attachment patterns

• Fewer primary caregivers

• Co-‐regulation is needed àindependence

What children experience:• Primary caregivers abuse• Repeated abuse from adults• Highly aroused, negative environments• Domestic violence• Severe Neglect• Insufficient nurturing

Abstract thought

Concrete Thought

Affiliation/reward

"Attachment"

Sexual Behavior

Emotional Reactivity

"Arousal"

Appetite/Satiety

Blood Pressure

Heart Rate

Body Temperature

Motor Regulation

ANS -‐ body

Symptoms of Trauma

Trauma Core symptoms

Depressive and Affective symptoms

Relational difficulties

Guilt & Shame

Alcohol & substance abuse

•Genetic vulnerabilities and gifts•Age at which trauma occurred

•Nature of the trauma•Pattern of the trauma•Style of adaptation•Relational supports

•Therapeutic experiences

Trauma:Will symptoms develop?

When Children Are: Caregivers tend to feel…

•Worried• Anxious• Aroused and Reactive• Alone & Helpless• Hopeless• RESULTING IMPACT ON CHILD?

5 min.

4 yr. old Michael

M’s Functional Domains

Trauma-‐informed Interventions: An Integrated Approach

Treatment Goals & Interventions

Regulate

Relate

Reason Perry, 2010

Respond to the developmental age

Quality Relationships-‐ Essential, YET

•With Complex Trauma: people are perceived as dangerous, until PROVEN otherwise…..

• Even then… by the nature of interventions…. you may be perceived as a threat

Play-‐ The Language of children

• Child has an intrinsic motivation to play• Starts with child’s strengths and interests

• Aids in developing positive therapeutic alliance

Co-‐Regulation with Sensory-‐Motor Materials

Bubbles in Jar Sand in Sensory Bin

Weighted Super Hero Vest

Basket of Weights to PullQuiet Space, Bean Bags, Balls

Reduce sensory overload from the environment; provide a safe place

Lane, 2014

The 1st Step …. RESPONSIVITY• Noah

VALIDATE

Soft Voice

Gentle Tone

Kind Face

Healthy Attachment Responses + Regulation

Adult Helps Child to Regulate

Child Begins to Self-‐Regulate with

Adult’s Coaching

Child’s Trauma is Triggered

Self-‐ Esteem in the beginning…..

YOU ARE…

After a Positive Relational Climate….

I am …an artist

Cognitive Development emerges when….

Relationships with Safe Adults

Co-Regulation

Successful Interactions and Experiences

Embedded Learning

Michael – age 4

Strengths

• Vivacious greetings • Outgoing, highly social

• Gross motor skills; sports • Long term memory • Empathetic to other’s physical pain• Stable home

Challenges • Interactions shallow • Play skills • Hungry -‐ hoards food, normal wt.• Severe ADHD, anxiety• Changes à anxiety• Fear of being left out• Easily aroused -‐Hard to down regulate • Loud, aggressive verbally & physically

Provide continual sensory motor opportunities

TRAUMA TREATMENT-‐Setting a Positive Relational Climate

Following Interests to Represent the World Series and Concession Stand

Interventions with MichaelIndividual

• Proprioceptive, vestibular, tactile: • Gum, Play Dough • Therapy ball• Rhythmic activity• Regulatory walks with staff

• Auditory:• Quiet, non-‐reactive voices (adults)• Rhythmic beats/music

• Predictable Change; Repetition

• Milieu and Play therapy

• Therapeutic holds with rocking and soothing

Family

• Parent psycho-‐educational • Impact of trauma • Sensory Integration & Regulation tools

• Family change is gradual process

• Ongoing need • strong relationship based interactions• appreciation for severity of illness

• Family acquired ‘new language’ and experienced a paradigm shift in caregiving

Trauma informed Interdisciplinary Interventions

Mental Health

Occupational Therapy Education

1. Interest/ strength-‐based

2. Regulation 3. Relational safety4. Play-‐based5. Embedded

learning

Questions and Your Case Examples

Take Away Messages

Early trauma à neurodevelopmental impact àfunctional consequences (regulation, relationships, cognition)

HEALING from predictable, consistent, repeated, positive experiences

Safe relationally

Safe physically-‐Sensory-‐Motor interventions, Play-‐based, then Cognitive

Regulate Relate Reason

STATE LEVEL and BRAIN FUNCTION

Responsive Teachable Moments

DEFUSING THE FIGHTEveryone wants to be heard:

• LISTEN to the child • WAIT until the child LISTENS to YOU• LISTEN to EACH CHILD in the GROUP• BRIDGE the GROUP’S IDEAS• Go meet sensory needs and try again…

Trauma informed-‐Therapeutic Interventions

Care-‐givers

School Community

CPP does make a difference… Even when healing continues.

• Of the 22 children who have attended Circle Preschool for over 3 months in the past 3 years.

• 17 have entered typical kindergarten rooms with some special supports• 2 have left precipitously• 3 have required special ed classroom• 20 have required ongoing support to caregivers / child therapy

• Overall-‐ caregivers give positive feedback-‐ especially in noting the increased play skills and regulation skills children are demonstrating.

• Changes in resting heart rates• Chronic health problems, breathing issues, eating issues, sleep difficulties

• Arousal/ Dissociative Issues • Clumsiness, motor delays• Emotional reactivity, attachment difficulties

• Social skill issues… lack of empathy• Impulsivity, distractibility, • Cognitive delays…uneven cognitive picture• Limited play skills• perseveration • poor problem solving

Symptoms of Trauma

Trauma-‐ informed Interdisciplinary Contributions

• Mental Health• Therapy with regulation & relational focus• Family therapy

• Occupational Therapy• Trauma sensitive-‐ relationships• Sensory Integration increasing regulation

• Education• Trauma sensitive relationships • Multiple regulation opportunities• Strength-‐based learning

Relationships

Sensation as a Tool

Sensory integration

and processing

Trauma informed care

Regulating arousal

• Deep pressure and proprioception• Vestibular • Rhythmic, repetitive inputs

Trauma&and&Development:& … · Sensory%Modulation • Ability%to%grade ... Body%Temperature Sleep...

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