Developmental Psychopathology: Chapter 12 : Childhood Trauma

Front 1

define trauma and stressful events according to developmental psychology;

what does the new DSM category of "Trauma and stress-related disorder" contain? (5)

Back 1

traumatic events- exposure to real or threatened harm or fear or death/injury

stressful events- can be continuous or a sigle event, more common and less severe than trauma;

Acute stress disorder, Adjustment disorder, PTSD, reactive attachment disorder, and disinhibited social engagement disorder

Front 2

___ children experience some form of sexual victimization. ___ receive overly harsh physical punishment; What two reasons are there for why the legal system used to support abuse?

Back 2

1 in 10; 1 in 10;

- because of husband absolute authority and because of family privacy

Front 3

what are some signs the child is exposed to violence?

Back 3

- bed wetting, headaches, stomachaches

- older boys more aggressive w peers

- girls withdrawn and lack self esteem

- some children who live with stress become hyperresponsive to stress, and others hyporesponsive

Front 4

____ accounts for 4 out of 5 of the maltreatment cases in the US

Back 4

child neglect (such as physical neglect, educational neglect, and emotional neglect), followed by physical, sexual, and psychological/ emotional abuse;

- know ex of these

Front 5

How do sexually abused children react?

Back 5

- 1/3 never show symptoms

- younger children regress

- older children act out or have self-destructive behaviour

- sexualized behaviours such as excessive masturbation

Front 6

Who does maltreatment affect? (5)

Back 6

- boys and girls equally, except sexual abuse (80% girls)

- boys more likely to be abused sexually by nonfamily members and girls by family members

- 44% white, blacks and aboriginals have the highest rates in proportion to their own ethnicity

- less than 10% of maltreating parents actually have a mental illness

- lower SES, and single parent household

Front 7

Information-processing disturbances

Back 7

cause maltreating parents to misperceive or mislabel typical child behaviour in ways that lead to inappropriate responses

Front 8

integrated model of child abuse from parents (3)

Back 8

Stage 1: reduced tolerance for stress and disinhibition of aggression (poor child-rearing knowledge, stressful life,)

Stage 2: poor management of acute crises ans provocation (thinking child is doing it on purpose, anger and aggression)

Stage 3: Habitual patterns of arousal and aggression with family members

Front 9

Reactive attachment disorder DSM criteria: A-G + specifiers

Back 9

- disturbed or developmentally inappropriate attachment behaviours

A) a pattern of inhibited, emotionally withdrawn behaviour towards adult caregivers (rarely seeks comfort, rarely responds to comfort)

B) social and emotional disturbance (limited positive affect, min social and emoitional responsiveness, unexplained irritbility sadness etc)

C) has experienced a pattern of extremes of insufficient care (changes of caregivers, high child-to-caregiver ratio, social neglect)

D) Care in C presumed to cause A

E) not autism

F) evident before 5 years old

G) developmental age of at least 9 months

Specifiers: persistent (over 12 months) and severe

Front 10

Disinhibited Social Engagement disorder DSM criteria A-C

Back 10

A) a pattern of behaviour in which child actively interacts with unfamiliar adults and exhibits at least two of the following:

- reduced/absent issues with approaching unknown adults

- overly familiar with verbal or physical behaviour

- diminished or absent checking back with adult caregiver after venturing away

B)behaviours not limite to impulsivity (like ADHD)

C) child has experiences a pattern of extremes of insufficient care (changes of caregivers, high child-to-caregiver ratio, social neglect)

D) care in C presumed cause for behaviour+ developmental age of 9 months

Specifiers: severe+ persistent

Front 11

Acute stress disorder + prevalence

Back 11

- at least 9 symptoms associated with intrustion, negative mood, dissociation, avoidance, and arousal

- similar to PTSD but only lasts for one month

- follows trauma in 10-20% of children

Front 12

DSM criteria for PTSD: A (4) B (5) C (1) D(4)

Back 12

A) exposure to actual of threatened death, injury or sex violence either by:

- witnessing it happen to others

- directly experiencing,

- learning it happened to close relatives or friends

- repeated extreme exposure to the details ot traumatic events (not through media)

B) one or more Intrusion symptoms:

- involuntary distressing memories

- distressing dreams

- dissociative reactions (flashbacks)

- intense psych distress at exposure to cues

- marked physiological reactions to cues

C) One or more of:

1) persistant avoidance of stimuli associated with the traumatic events or thoughts or feelings related to trauma

D) Two of negative alterations in cognitions :

- negative emotional state

- diminished interest in activities

- detachment or withdrawn from others

- reduction in positive emotions

Front 13

DSM criteria for PTSD IN CHILDREN: E (5) F(1) G (1), specifiers

Back 13

E) alterations in arousal , two or more of:

- irritable and angry outbursts

- exaggerated startle response

- hypervigilance

- concentration problems

- sleep disturbances

F) B,C,D,E for more than a month

G) significant distress and not from substance

Specifiers: with dissociative symptoms (depersonalization, derealization) or with delayed expression (6 months after event)

Front 14

____ of all maltreated children meet criteria for PTSD; What is Dissociation?

Back 14

half!;

Altered state of consciousness in abused kids

Front 15

What are some challenges of studying incidence and prevalence of child abuse? (2) what methods do they use? what are the prevalence rates/demographics? (4)

Back 15

- reporting bias, psychs have to report it so its hard to study

- Studies and treatment focus on psychical and sexual abuse, but neglect is actually more common

- use retrospective report or ask parents about proxys for abuse like extreme physical punishment

- US: 12.1/1000 children per year

in Canada: 9.7 /1000 children per year

-10 % of parents report using forms of physical punishment that constitute child abuse

- younger children more likely ot be neglected, older >12 sexual abused, girls sexual abused

- rates higher in poverty and single -parent homes

Front 16

How can maltreatment change the developmental course? (2)

Back 16

1) long term changes in physio response to stress

2) understanding of emotion- being sensitive to anger or may change perception or experience of emotions

Front 17

Describe the lengthy-ass Pollak et al study on the understanding of emotion in maltreated kids (methods, what interested in (2), results, hypotheses of explanations, test of hypotheses+results)

Back 17

METHODS:

- looked at 15 children who were physically abused, 13 who had been physically neglected, 11 with no abuse history

- gave the emotion recognition task - given descriptions like “susans brother broke her favourite toy” and then given two pictures of faces displaying dif facial expressions

INTERESTED IN:1) sensitivity to differences between facial expressions: number of times child says angry correctly and subtract number of times they say it incorrectly
**neglected children were less sensitive to differences in facial expressions
2) bias toward labeling a stimulus as a particular emotion.
**when the physically abused kids didn’t know, they were more likely to say angry. The neglected kids however had a bias towards sad

HYPOTHESES OF EXPLANATIONS:

1) visually, children canot discriminate between faces

2) they have dif understanding of emotional displays

FOLLOW UP:

Emotional discrimination task- shown two photos of models showing emotions and asked same r different

**no dif between the three groups of this, so it isn’t that they cant tell the difference

Emotional differentiation task- shown two models and asked to rate the similarity of the facial expressions

**neglected children perceived less distinction betters angry, sad, fearful facial expressions

**physically abused children saw anger as being much more different than the other emotions

***Thus, experience of abuse changes understanding of emotion.

Front 18

describe the Pollak and Sinha follow up the the lengthy-ass study (methods, results)

Back 18

METHODS

- 24 physically abused and 23 non-maltreated children

- gave them photos of angry, sad, fearful, happy paces

- images are slowly filled in randomly so that the expression gradually appears

-had to rate their confidence for 1-5 and only correct responses with a rating of 4 or 5 were used

RESULTS:

- the two groups identified happy expressions the same

- physically abused children were better at identifying anger in the images that weren’t quite filled in, but there was no difference when it was pretty much filled in or filled in

- groups didn’t differ in terms of fear

- physically abused kids were worse at identifying sad right up until it was fully revealed

- PA kids need less info to accurately identify angry faces and more info to identify sad faces. -No difference for fearful and happy faces

Front 19

diathesis-stress model: 5-ht transporter + maltreatment

Back 19

1) Capsi et al: transporter 5-HTTPLR- short allele (diathesis) is associated with increased depression, but only for those who had significant stress (stress)

2) social support plays a protective role:

Maltreated children with a short allele and poor social support had 2X higher rates of depression than those with a short allele and social support

- there is a main effect of maltreatment, but some individuals may ne particularly vulnerable- multifiniality

Front 20

What is different about the PTSD diagnosis for children under 6? (6)

Back 20

- more behaviourally anchored

- may not show distressed affect

- only one symptom required for avoidance and neg cognitions (instead of three)

- loss of interest becomes restricted play

- feelings of detachment becomes social withdrawl

- irritable/aggressive expanded ot include tantrums

Front 21

Trauma-Focused CBT - what are the 5 components?

Back 21

A) psychoeducation

- prevalence rates or trauma

- typical reactions of stress

- many children have transient symptoms

b) cognitive techniques

c) relaxation skills

d) safety skills

e) graded exposure

- create a trauma narrative

- very detailed and graphic

- gradually read and shared

- may also need exposure around trauma cues

Front 22

Describe Cohen et al. s findings on TF-CBT for child sexual abuse (methods +child & parent effects)

Back 22

229 youths, 79% female with PTSD symptoms, 89% diagnosed

- looked at TF-CBT vs child centred therapy 12 weeks

- same therapists trained in both techniques

Child effects:

TF-CBT group had less PTSD symptoms, less shame, less depression, fewer total problems and greater trust

Parent effects:

TFCBT group had less parent depression, less self-blame, more support of child and better parenting in general

Front 23

cycle of violence; Abused children often exhibit which type of attachment behaviour?

Back 23

abused child becoming abusive towards others- not inevitable!;

insecure-disorganized attachment (mix of avoidance, approach, helplessness, disorientation)

Front 24

limbic irritability

Back 24

a term given for the result of internalizing psychopathology after abuse because of impacts the limbic system due to neurobiological excitability