Flashcards in Pediatric Trauma Deck (21):
What is trauma?
Not any stress, but a serious threat or assault on bodily integrity, one that may involve the threat of death.
Includes sexual assault even without the risk of death (assault on body integrity)
The threat can be towards a loved one (parent or sibling) rather than the child himself/herself.
Can involve either witnessing or learning about it.
The degree of trauma is determined by how the individual interprets the trauma.
Give some examples of childhood trauma.
Invasive medical procedures
Approx how many children die from abuse & neglect each year?
1,760 children die/year from abuse or neglect
What happens to the brain with early trauma?
Neuroendocrine studies indicate an association between early adversity and atypical development of the HPA axis stress response, which can predispose to psychiatric illness.
structural differences in the hippocampus and corpus callosum, and decreased activity of the prefrontal cortex.
WHat's the deal with MAO-A gene?
if you are abused & have this gene--more likely to develop antisocial personality disorder
Give a summary of the things associated with ACE.
More likely to initiate drinking alcohol at a younger age.
More likely to use alcohol as a means of coping with stress.
More likely to smoke, use drugs, become obese and engage in promiscuity.
Higher risk of school failure, gang membership, unemployment, homelessness, violent crime, incarceration and becoming single parents.
High risk adults who become parents are unlikely to provide stable, supportive parenting (intergenerational cycle).
Poor health-related quality of life and increased risk for diseases such as COPD and liver disease.
What are some individual resilience factors?
Problem solving abilities
An internal locus of control
An active coping style
Enlisting people to help
Acquiring language and reading well
Sense of harmony
Desire to contribute to others
Faith that one’s life matters
T/F Majority of foster care children are not receiving mental health treatment.
What are some of the barriers preventing foster children from receiving mental health support?
Lack of trained providers in the community
Difficulties in ensuring continuity of care across settings as children transition.
Lack of integrated care (eg, care being provided in “silos”)
What are some risk factors that increase likelihood of trauma?
Intensity of trauma exposure and proximity
High media exposure
History of previous trauma, abandonment or attachment problems
History of anxiety, depression, low resilience,high reactivity
Parents’ level of stress
Aside from PTSD, what are some other conditions that can arise from childhood trauma?
Acute Stress Reaction
What is the DSM5 criteria for a PTSD diagnosis?
Criterion A: Exposure to actual or threatened death, serious injury or sexual violence
Criterion B: Reexperiencing Cluster: at least one symptom (trauma play, nightmares, trauma-specific re-enactment)
Criterion C: Avoidance
Criterion D: Negative alterations in mood/cognition (need two): inability to remember, negative beliefs, blame, decreased interest, detachment, inability to experience positive emotions
Criterion E: Alterations in arousal and reactivity (need two): irritable, aggressive, reckless, hypervigilance, exaggerated startle response, decreased concentration, sleep disturbance
What is traumatic play?
not imaginative or fun, but replaying bad memories
Chowchilla pretending to be a bus driver
Barbies having sex
What are some signs of trauma?
***Regulation of affect and behavior
Deterioration of ability to inhibit aggression
Conversely, fear of agression may promote excessive inhibition and lack of assertion.
Substance abuse to manage painful emotions
**can have a neg. effect on core identity--powerlessness, guilt, less empathy
**withdrawal from normal social activities
What are signs of trauma in preschool children?
Feel helpless and uncertain
Fear of being separated from their parent/caregiver
Cry and/or scream a lot
Eat poorly and lose weight
Return to bedwetting
Return to using baby talk
Develop new fears
Recreate trauma through play
Are not developing to the next growth stage
Have changes in behavior
Ask questions about death
What are some signs of trauma in elementary school children?
Become anxious and tearful
Worry about their own or others’ safety
Become clingy with a teacher or parent
Tell others about the event again and again
Become upset if they get a small bump or bruise
Have a hard time concentrating
Have fears that the event will happen again
Have difficulty sleeping
Show changes in school performance
Become easily startled
What are some signs of trauma in middle & high school children?
Feel depressed and alone
Discuss the traumatic events in detail
Develop eating disorders and self-harming behaviors
Start using or abusing alcohol or drugs
Become sexually active
Feel like they are going crazy
Take too many risks
Have sleep disturbances
Don’t want to go places that remind them of the event
Say that they have no feeling about the event
Show changes in behavior
What are the developmental stages at preschool, latency, and adolescent ages? HOw does this relate to trauma?
Preschool: Attachment, Magical Thinking, Oedipal Complex, Fantasy Play
Latency Age: Mastery, peer relationships, self-esteem, organized play
Adolescents: Experimentation/risk-taking, individuation, identity, intimacy.
What are the treatment options for childhood trauma?
Psychotherapy is the mainstay of treatment. Medication might be used as adjunctive treatment. There isn’t much evidence base supporting medication use.
Antidepressants, particularly SSRI’s, are the medication treatment of choice. Sertraline and Paroxetine have FDA indications for PTSD in adults.
Alpha-adrenergic agents (clonidine/guanfacine) can reduce autonomic nervous system arousal.
Mixed results for benzodiazepines and buspirone.
Only for single-event traumas.
Not sure how/why it works.
What is CBITS?
cognitive behavioral intervention for trauma in the schools
similar to CBT
helpful b/c you get better f/u with children