The document discusses trauma in childhood and its effects. It notes that PTSD in children is often underdiagnosed, and children may receive multiple incorrect diagnoses before an accurate one of PTSD. Trauma in childhood can impact brain development and lead to issues with attention, hyperactivity, aggression, and oppositional behavior. The document outlines symptoms of PTSD in early childhood, school age children, and teenagers. It discusses the two main types of dysregulation—hyperactivation and hypoactivation—that can result from trauma. Building resilience and social support are important factors in recovering from childhood trauma.

1. Trauma In ChildhoodTrauma In Childhood

2. Trauma in ChildhoodTrauma in Childhood
 PTSD in childhood is under diagnosed.PTSD in childhood is under diagnosed.
 Children with PTSD often have three or moreChildren with PTSD often have three or more
diagnosis in attempts to find an accurate diagnosis.diagnosis in attempts to find an accurate diagnosis.
 PTSD in childhood effects brain development.PTSD in childhood effects brain development.
 PTSD in childhood effects neurocognitivePTSD in childhood effects neurocognitive
development..development..

3. Common DiagnosticCommon Diagnostic
Confusion…Confusion…
 Common diagnosis given instead of childhoodCommon diagnosis given instead of childhood
PTSD.PTSD.
 Oppositional defiant disorder.Oppositional defiant disorder.
 Attention deficit hyperactivity disorder.Attention deficit hyperactivity disorder.
 Generalized anxiety disorder.Generalized anxiety disorder.

4. Events Known to Lead toEvents Known to Lead to
Symptoms of PTSD (Trauma)Symptoms of PTSD (Trauma)
ViolenceViolence
 WarWar
 Terrorist attacksTerrorist attacks
 Physical assault/ViolencePhysical assault/Violence
 Sexual assaultSexual assault
 Seeing another person hurt.Seeing another person hurt.
 Community violenceCommunity violence
 Domestic ViolenceDomestic Violence
AccidentalAccidental
 Car AccidentsCar Accidents
 FallsFalls
 Natural disastersNatural disasters
 SurgeriesSurgeries
 Animal attacksAnimal attacks
 Near DrowningNear Drowning
 PoisoningPoisoning
 CancerCancer
 Life threatening illnessLife threatening illness

5. PTSD in Early ChildhoodPTSD in Early Childhood
 More intense symptoms of traumaMore intense symptoms of trauma
 Have a chance of developing symptoms of traumaHave a chance of developing symptoms of trauma
 More incidence of hyperactivity and depression after aMore incidence of hyperactivity and depression after a
traumatic events.traumatic events.
 Higher differences in cognitive development, emotionalHigher differences in cognitive development, emotional
development due to it being a time of large scaledevelopment due to it being a time of large scale
neuroplasticity, less language abilities.neuroplasticity, less language abilities.
 Young children often do not display symptoms of numbing.Young children often do not display symptoms of numbing.
 There is a higher amount of diagnosis of oppositional defiantThere is a higher amount of diagnosis of oppositional defiant
disorder and separation anxiety disorder.disorder and separation anxiety disorder.

6. PTSD in Early ChildhoodPTSD in Early Childhood
 Yong Children (0 to 3) Display…Yong Children (0 to 3) Display…
 Difficulty sleepingDifficulty sleeping
 Night-terrorsNight-terrors
 Reduced attention spanReduced attention span
 Relationally, survivors of interpersonal trauma sufferRelationally, survivors of interpersonal trauma suffer
from a loss of trust and a sense of betrayal from afrom a loss of trust and a sense of betrayal from a
person who is loved.person who is loved.
 Personality changesPersonality changes
 Increased separation anxietyIncreased separation anxiety

7. PTSD in Early ChildhoodPTSD in Early Childhood
 Yong Children (0 to 3) Display…Yong Children (0 to 3) Display…
 Re-enactment playRe-enactment play
 Toy destructionToy destruction
 Aggression towards peersAggression towards peers
 Defiance toward parents and adultsDefiance toward parents and adults
 Living with domestic violence is related to moreLiving with domestic violence is related to more
aggressive and acting- out behavior, possibly due toaggressive and acting- out behavior, possibly due to
modeling.modeling.

8. Key PointsKey Points
Trauma in Young ChildrenTrauma in Young Children
 Young Children Display:Young Children Display:
 More intense symptoms of trauma;More intense symptoms of trauma;
 Increased risk of developing PTSD;Increased risk of developing PTSD;
 More incidence of hyperactivity and depression thenMore incidence of hyperactivity and depression then
older children.older children.
 Young Children:Young Children:
 Act out the trauma in play more often the olderAct out the trauma in play more often the older
children;children;
 Tend to have a higher incidence of destructive behaviorTend to have a higher incidence of destructive behavior
and violence;and violence;
 Can display higher levels of oppositional behaviors thenCan display higher levels of oppositional behaviors then
older children.older children.

9. Key PointsKey Points
Trauma in Young ChildrenTrauma in Young Children
 Young children often do not display “numbing/Young children often do not display “numbing/
avoidance symptoms.”avoidance symptoms.”
 They often display what one researcher called,They often display what one researcher called,
“New fears and aggressions.”“New fears and aggressions.”
 Young children display an increase of externalizingYoung children display an increase of externalizing
(acting out) and internalizing (acting in) behaviors.(acting out) and internalizing (acting in) behaviors.

10. Key PointsKey Points
Trauma in Young ChildrenTrauma in Young Children
 Trauma effects Seven Domains of a Child’sTrauma effects Seven Domains of a Child’s
Functioning…Functioning…
1.1. Symptoms of PTSDSymptoms of PTSD
2.2. Psychological meaningPsychological meaning
3.3. Developmental disruptionsDevelopmental disruptions
4.4. The effects of developmental disruptions on laterThe effects of developmental disruptions on later
developmentdevelopment
5.5. Direct Impact of the traumatic event on social supportDirect Impact of the traumatic event on social support
systems. (Other’s symptoms of trauma).systems. (Other’s symptoms of trauma).
6.6. Impact of child’s symptoms on others.Impact of child’s symptoms on others.
7.7. Cumulative Effects of Trauma. (Trauma Stacking).Cumulative Effects of Trauma. (Trauma Stacking).

11. Key PointsKey Points
Trauma in Young ChildrenTrauma in Young Children
 Educators can create islands of safety.Educators can create islands of safety.
 Children who have been traumatized often feel anChildren who have been traumatized often feel an
“I can’t…” where other children feel an “I can!”“I can’t…” where other children feel an “I can!”
 A class room can be an island of safety where theA class room can be an island of safety where the
child can build mastery experiences and learn tochild can build mastery experiences and learn to
trust again.trust again.

12. Key PointsKey Points
Trauma in Young ChildrenTrauma in Young Children
Adults who support children withAdults who support children with
trauma Report on the CBCL thattrauma Report on the CBCL that
the child…the child…
 Argues a lot.Argues a lot.
 Can’t sit still, restless, orCan’t sit still, restless, or
hyperactive.hyperactive.
 Fears certain animals, situations,Fears certain animals, situations,
or places.or places.

13. Key Points: School AgeKey Points: School Age
ChildrenChildren
 Children have less difficulty remembering events andChildren have less difficulty remembering events and
often experience feelings of isolation, Shame, Fear, andoften experience feelings of isolation, Shame, Fear, and
Guilt.Guilt.
 Children often have less re-experiencing symptoms butChildren often have less re-experiencing symptoms but
participate in traumatic play.participate in traumatic play.
 Teacher reports of child aggression were associatedTeacher reports of child aggression were associated
with…with…
 The child’s age when exposed to the traumatic event;The child’s age when exposed to the traumatic event;
exposure to community violence and domesticexposure to community violence and domestic
violence.violence.

14. Key Points: School AgeKey Points: School Age
ChildrenChildren
• More then 60% of children who have been traumatized haveMore then 60% of children who have been traumatized have
moderate to extreme difficulty with attention.moderate to extreme difficulty with attention.
• Adults Report that Children with Trauma: “argue a lot;” “can’t sitAdults Report that Children with Trauma: “argue a lot;” “can’t sit
still, restless, hyperactive;” “have fears certain animals, situations,still, restless, hyperactive;” “have fears certain animals, situations,
or places”or places”
 In recent years the number of adults involved in a child’s life haveIn recent years the number of adults involved in a child’s life have
been reduced. Because of this there are decreases in positivebeen reduced. Because of this there are decreases in positive
transactions with adults and mentorstransactions with adults and mentors
• In the school age years emotion regulation centers in the brain areIn the school age years emotion regulation centers in the brain are
growing. Interactions with adults build the ability to regulate.growing. Interactions with adults build the ability to regulate.

15. Key Points: School AgeKey Points: School Age
ChildrenChildren
 Alertness (a key domain of attention) and arousal can beAlertness (a key domain of attention) and arousal can be
changed by PTSD in two ways: Hyperarousal (looks likechanged by PTSD in two ways: Hyperarousal (looks like
hyperactivity) and Dissociation (looks like withdraw)hyperactivity) and Dissociation (looks like withdraw)
 Stress Levels can effect the ability to maintain attentionStress Levels can effect the ability to maintain attention
 Educators can regulate arousal through social contact.Educators can regulate arousal through social contact.
 It is always important to assess how much miss-It is always important to assess how much miss-
attunement a child can tolerate.attunement a child can tolerate.
 Emotions are thoughts plus sensations.Emotions are thoughts plus sensations.
 Neuroception is the way that we intuitively assess if weNeuroception is the way that we intuitively assess if we
are safe or not.are safe or not.

16. Trauma in the TeenTrauma in the Teen
Years…Years…
 Teen who have Face TraumaTeen who have Face Trauma
Often experience:Often experience:
 Fear,Fear,
 Worry,Worry,
 Sadness,Sadness,
 Anger,Anger,
 Feeling alone and apartFeeling alone and apart
from others,from others,
 Feeling as if people areFeeling as if people are
looking down on them,looking down on them,
 Low self-worth, andLow self-worth, and
 Unable to trust others.Unable to trust others.
 Teen who have Face TraumaTeen who have Face Trauma
Often Display DysfunctionalOften Display Dysfunctional
Behaviors:Behaviors:
 Increased aggression.Increased aggression.
 Out-of-place sexualOut-of-place sexual
behavior.behavior.
 Self-harm.Self-harm.
 Abuse of drugs orAbuse of drugs or
alcohol.alcohol.
 Dropping out of schoolDropping out of school
 Risk of pregnancy at aRisk of pregnancy at a
young age.young age.
 Attempt suicide.Attempt suicide.

17. Externalizing BehaviorsExternalizing Behaviors
The Hyperarousal TypeThe Hyperarousal Type
 Increased Externalizing Behaviors: Externalizing behaviorsIncreased Externalizing Behaviors: Externalizing behaviors
manifest in children's outward behavior.manifest in children's outward behavior.
 The child acts out their hurt on the external world. Such as:The child acts out their hurt on the external world. Such as:
 Disruptive behavior;Disruptive behavior;
 Hyperactivity;Hyperactivity;
 Aggressive behaviors;Aggressive behaviors;
 Delinquency;Delinquency;
 Impulsivity.Impulsivity.
 These Children are often referred to as having conductThese Children are often referred to as having conduct
problems;problems;
 Display antisocial behaviors.Display antisocial behaviors.
 Appear undercontrolled.Appear undercontrolled.

18. Internalizing BehaviorsInternalizing Behaviors
The Dissociative TypeThe Dissociative Type
 Some teens implode and don’t explode.Some teens implode and don’t explode.
 Teens who are the most overwelemed sometimes appear quiet,Teens who are the most overwelemed sometimes appear quiet,
withdrawn and isolated.withdrawn and isolated.
 Increased Internalizing Behaviors:Increased Internalizing Behaviors:
 With-drawing into their own world;With-drawing into their own world;
 Acting and feeling anxious;Acting and feeling anxious;
 Being inhibited in normal exploration;Being inhibited in normal exploration;
 Feeling unsafe;Feeling unsafe;
 Depressed mood and behaviors.Depressed mood and behaviors.
 Negative Emotions and beliefs.Negative Emotions and beliefs.
 Can appear “overcontrolled."Can appear “overcontrolled."

19. Incident DrivenIncident Driven
DysregulationDysregulation
 This is the main focus of the current PTSD liturature.This is the main focus of the current PTSD liturature.
 Two main forms of dysregulation (These types are notTwo main forms of dysregulation (These types are not
exclusive but people show a predominance in a direction)exclusive but people show a predominance in a direction)
 Hyperactivation: Reflects an upregulation of stress hormoneHyperactivation: Reflects an upregulation of stress hormone
production and an underactivation of emotion regulationproduction and an underactivation of emotion regulation
centers. Display increased Cortisol and Heart Rate when readcenters. Display increased Cortisol and Heart Rate when read
a trauma script. (70% of sample)a trauma script. (70% of sample)
 Hypoactivation: Reflects an under-activation of stress responseHypoactivation: Reflects an under-activation of stress response
and an over activation cortical structures, which regulateand an over activation cortical structures, which regulate
stress. Displays a decreased Cortisol production and Hearstress. Displays a decreased Cortisol production and Hear
Rate when read a trauma script. (30% of sample)Rate when read a trauma script. (30% of sample)

20. HyperactivationHyperactivation
 The hyperactivated individual floods with informationThe hyperactivated individual floods with information
from the body and has less capacity to regulate thefrom the body and has less capacity to regulate the
intense sensation.intense sensation.
 Ruth Lanius Found in an fMRI Study…Ruth Lanius Found in an fMRI Study…
 Over activation in the insula (bringing extreme amounts ofOver activation in the insula (bringing extreme amounts of
information from the body’s interceptive cues)information from the body’s interceptive cues)
 Under-activation of the anterior cingulate cortex (ACC)Under-activation of the anterior cingulate cortex (ACC)
(area needed to regulate the body sensations brought up(area needed to regulate the body sensations brought up
from the insula)from the insula)
 Under-activation medial prefrontal cortex (mPFC) (areaUnder-activation medial prefrontal cortex (mPFC) (area
needed to regulate the body sensations brought up fromneeded to regulate the body sensations brought up from
the insula)the insula)

21. HypoactivationHypoactivation
 For the hypoarousal type, only a small amount ofFor the hypoarousal type, only a small amount of
interceptive cues get into the limbic cortex and areinterceptive cues get into the limbic cortex and are
quickly squelched by cortical structures, leaving thequickly squelched by cortical structures, leaving the
individual feeling disconnected, emotionally flat, andindividual feeling disconnected, emotionally flat, and
dissociated.dissociated.
 Ruth Lanius Found in an fMRI Study…Ruth Lanius Found in an fMRI Study…
 Down regulation of physical sensations from the insulaDown regulation of physical sensations from the insula
cortex.cortex.
 Hyperactivation activation in the anterior cigulet cortexHyperactivation activation in the anterior cigulet cortex
(ACC).(ACC).
 Hyperactivation in the medial prefrontal cortex mPFC.Hyperactivation in the medial prefrontal cortex mPFC.

23. Two types of ADHDTwo types of ADHD
Hyperactive: Charicterized byHyperactive: Charicterized by
hyperactivity and poor impulsehyperactivity and poor impulse
control…control…
Inattentive: Charicterized byInattentive: Charicterized by
inattention.inattention.
Some overlap with two types ofSome overlap with two types of
PTSD…PTSD…

24. Trauma and ResiliencyTrauma and Resiliency
Some Good News to CloseSome Good News to Close
 Resiliency is the ability to bounce back after aResiliency is the ability to bounce back after a
difficult life event.difficult life event.
 Resiliency is normal. Only between 10 and 25% ofResiliency is normal. Only between 10 and 25% of
children who face life threatening situationschildren who face life threatening situations
develop symptoms of trauma.develop symptoms of trauma.
 There are many things clinicians can do to promoteThere are many things clinicians can do to promote
resiliency.resiliency.

25. QuestionsQuestions