Parenting a Child with Anxiety and PTSD

 

What is anxiety and how do I know if it is present? Signs and symptoms:

Anxiety is considered an irrational and excessive fear and worry which has both an emotional and physical response.  Anxiety is a protection your body has, it is a part of your natural fight or flight system.  We all have anxiety sometimes. What are some of the most common symptoms of anxiety?* 

Pounding heart Sweating Stomach upset or dizziness Frequent urination or diarrhea Shortness of breath Replaying trauma through nightmares, play or story telling Feelings of apprehension or dread Trouble focusing Feeling tense and jumpy Anticipating the worst

Tremors and twitches Muscle tension Headaches Sluggish Difficulty Sleeping Clinging to parent Moody, easily angered Fidgety, Restless Hyper vigilant/Watching for signs of danger School refusal/activity refusal

What is Posttraumatic Stress Disorder (PTSD)?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD is a real illness that causes real suffering.

What are common causes of Posttraumatic Stress Disorder (PTSD)?

To begin with we need to understand what trauma is.  Many of us know that soldiers returning from war can suffer PTSD.  However, a traumatic event does not always have to involve having your life threatened and your safety in danger.  It can be any situation that leaves you feeling overwhelmed, fearful, or isolated, even if it does not involve a threat of physical harm or actual harm.  Some common causes of PTSD or Emotional/Psychosocial trauma are:

·            Falls or accidental injury (i.e. blowing a knee out in a sport event)

·            Surgery early in life, not understanding the purpose

·            The severing of a long term relationship (i.e. a break up)

·            The sudden death of someone loved or permanent separation (such as termination of parental rights)

·            A car accident

·            A humiliating, highly embarrassing situation

·            The diagnosis of a severe illness

·            Sexual Abuse

·            Witnessing an act of violence

·            Physical harm caused by another circumstance that increase the likelihood of PTSD/Anxiety

·         Many of us know that soldiers returning from war can suffer PTSD.  However, a traumatic event does not always have to involve having your life threatened and your safety in danger.  It can be any situation that leaves you feeling overwhelmed, fearful, or isolated, even if it does not involve a threat of physical harm or actual harm.

  The following are circumstances that can enhance the trauma effect a person experiences:

·            An event that happens un-expectantly, the individual was unprepared, and individual felt powerless

·            It happened repeatedly

·            It happened with the intent to harm

·            It happened in childhood

  

      As a parent, you can complete an assessment on your child to see if they meet the criteria for anxiety by doing the SCARED:  Screen for Childhood Anxiety Related Disorders

      http://www.psychiatry.pitt.edu/sites/default/files/Documents/assessments/SCARED%20Child.pdf  

Symptoms of PTSD?

u  Specific symptoms can vary in severity.  (DSM V)

u  Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.

u  Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.

u  Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.

u  Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.

u  Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person with PTSD, however, symptoms last for at least a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

People with PTSD continue to have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual who learns that a close family member or friend has died accidentally or violently.

The following are some things to consider:

Have you had your child seen by a physician?  What level of neglect or physical trauma did they suffer?  Could they have a brain injury from trauma, whether it be blunt force trauma or even exposure to led or other toxic chemicals (post birth or prior).  It is really important to consider have they child evaluated by an Adoption Specialist Physician—we have two amazing resources here in the Pacific Northwest.  The University of Washington Center for Adoption Medicine (http://adoptmed.org/ ) and the Oregon Health Science University Adoption Health Services (http://www.ohsu.edu/xd/health/services/family-medicine/specialized-services/adoption-health-services.cfm) . Both programs will do pre-placement/matching evaluations of a potential adopted child by reviewing medical, mental health, and academic paperwork for a fee.

National List of Foster Care and Adoption Medical Providers: http://www2.aap.org/sections/adoption/directory/map-adoption.cfm 

Adoption Medicine: Improving the Health and Well being of Adopted Children  (Adoption Advocate #92)  http://www.adoptioncouncil.org/files/large/6b22068b63c0248

How does your personal past trauma effect parenting a child who has suffered trauma? Do some self-reflection: Does your child’s behaviors or trauma history trigger you? Is it possible that maybe you might need some help in dealing with your past (remember childhood trauma effects you for the rest of your life)?  I have found for many parents reaching out for help for yourself can make you more present and aware for your own kids.  It can help you be the best possible parent your child can have.  Do they not deserve that?

How do you know if trauma is the root cause of your child’s behaviors? There is no way to be 100% certain of the cause of a child’s behaviors, but professionals can make some pretty clear assessments by learning about your child’s history, past experiences and through behavior observation.  Some common symptoms of behaviors caused by trauma are:

·            Avoiding bedtime/going to sleep/sleep disturbance-night time fears are quite common for many abused and neglected children.  The dark is when repeat trauma could have taken place or it is the place where kids remember.  Their past can cause them to have nightmares or night terrors. This can cause the children to be tired in the morning or throughout the day.

·            Eating issues-controlling food, not wanting to eat certain foods, food avoidance, eating disorders (anorexia, bulimia, or gorging.)-food can be a comfort to some kids while for others it can be a trigger.  Textures can effect some kids differently.  Not having their food touch on their plate or they won’t eat it.  Once again, trying to take control in a chaotic world.

·            Seeking attention/affection of strangers—kids who started life not knowing who to trust or children who were abused by someone that was supposed to protect them, need to learn how to protect themselves and find comfort.  They often don’t know who to trust and can either completely avoid adult interaction for comfort completely or be indiscriminate in their affection.  This can be really alarming to adoptive parent.

·            Difficulties regulating their emotional response to situations. Kids who have a trauma history may be completely unpredictable in their behavior and you may not understand why your child is acting a certain way, examples of this are hitting, biting, kicking or yelling for no apparent reason.  This can be inconsistently or maybe even always.  At school they may do these things to get a toy or to hurt another child who has been receiving attention from a cared for adult.  This can be very alarming to parents, but it is not uncommon.

·            Difficulties in school including school refusal (not wanting to go to school), learning challenges, and behavioral problems. Many kids who have trauma are not even able to focus on school or have not had an opportunity to learn prior to this.  Perhaps their behaviors and the schools response may impact a child’s academic success even though they have the intellectual capacity to learn.

·            Poor social interaction-including isolation from peers (no friends when age appropriate), poor peer interactions (trying to control play, hitting, biting, yelling, etc...), or hanging out with the "wrong" crowd.

Intervention

According to Dr. Judith Cohen, MD Medical Director, Center for Traumatic Stress in Children & Adolescents at Allegheny General Hospital in Pittsburgh, Pennsylvania, Any form of child intervention related to anxiety/trauma need to involve parent—the best interventions include the following: PRACTICE

·         Psycho-education of parents-increase parents knowledge/awareness

·         Relaxation Skills-for child and family.

·         Affect Modulation-Identification of feeling using words to describe emotions

·         Cognitive Coping Skills-understanding the thoughts behind the behavior

·         Trauma Narrative-having the child share their story

·         Invio-Mastery of Trauma Reminders

·         Conjoint Sessions with Parents

·         Enhancing Safety

Seeking Help:  There are so great guidelines for what to look for in treatment.  However, a couple of the best forms of treatment are Trauma Focused Cognitive Behavioral Therapy (TFCBT http://tfcbt.musc.edu/) or ADOPTS (Addressing Post-Traumatic Stress in Adopted Children http://www.bethany.org/main/adopts-program) or Karyn Purvis and her team at Empower to Connect has a great curriculum for parents on parenting an adopted child who has suffered trauma (http://empoweredtoconnect.org/). This is a resource many of our families have loved and is worth exploring.  There are some great videos on the site.

The National Child Traumatic Stress Network has a great guide on finding treatment providers- http://www.nctsnet.org/about-us/about-this-web-site   

Individual Queries for Clinical Guidance

The National Child Traumatic Stress Network provides information on its website and through its publications as a public service. We cannot respond to specific questions regarding personal situations, appropriate diagnosis or treatment, professional resources available in your area, or otherwise provide any clinical opinions. We understand, however, that people may have arrived at NCTSN.org because they are looking for such help. Please consider the following.

If you believe you might benefit from the services of a mental health professional, consider using these resources to locate the services you need:

Your insurance provider: Contact your insurance company or "behavioral health care organization" for a list of mental health care providers included in your insurance plan.

• District branches of the American Psychiatric Association (APA) for names of APA members in your area: Click here to find your APA district branch online.
• The psychiatry or psychology department at a teaching hospital or medical school in your community.
• National Association of Social Workers' Register of Clinical Social Workers.
• American Psychological Association (APA) for a list of psychologists in your area: Call 1-800-964-2000 or access APA's list online.
• Mental Health America (MHA) resources for finding treatment
• American Academy of Child & Adolescent Psychiatry (AACAP) Child and Adolescent Psychiatrist Finder.

Resources:

·       
         American Academy of Child and Adolescent Psychiatry: Separation Anxiety http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_Who_Wont_Go_To_School_07.aspx

·          
     American Metal Health Alliance http://americanmentalhealth.com/
Provides a listing of ethical therapist. On the "THERAPIST LOCATOR" page of the website you can locate a therapist or counselor in your area.

·         Anxiety BC http://www.anxietybc.com/resources/ptsd.php How do you know if it is PTSD?     
    

·         Anxiety and Depression Association of America www.adaa.org       

·         Bethany Life Lines Magazine:  Effects of Complex Trauma http://www.bethanylifelines.org/complex-trauma/    

·         PTSD for Children 6 & Younger http://www.ptsd.va.gov/professional/PTSD-overview/ptsd_children_6_and_younger.asp

·          

·         *Help Guide www.helpguide.org       

·         National Institute of Mental Illness: Children and Violence http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/children-and-violence.shtml     
     

·         The National Child Traumatic Stress Network: http://www.nctsnet.org/

·         Oregon Post Adoption Resource Center list of Resources for parents on Trauma & PTSD: http://www.orparc.org/library/materials/lists Trauma+Post_Traumatic_Stress_Disorder_%28PTSD%29.pdf  

·         Treating Children with PTSD Pod Cast: http://www.adaa.org/resources-professionals/podcasts/treating-children-with-ptsd     

·         ADOPTS (Addressing Post-Traumatic Stress in Adopted Children http://www.bethany.org/main/adopts-program) Locally Northwest Family Life has trained therapist in ADOPTS.

·         American Academy of Pediatric article on parenting a traumatized child:  http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf

     

·         Empower to Connect has a great curriculum for parents on parenting an adopted child who has suffered trauma http://empoweredtoconnect.org 

·         National Child Traumatic Stress Network http://www.NCTSN.org          

·         The International Society for traumatic stress studies http://istss.org       

·         Trauma Focused Cognitive Behavioral Therapy TFCBThttp://tfcbt.musc.edu/

Books:

·         What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety (What to Do Guides for Kids) by Dawn Huebner and Bonnie Matthews (Sep 15, 2005)

·         Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries, and Phobias...2^nd Edition by Tamar Chansky Ph.D. (2014)

·         Anxiety-Free Kids: An Interactive Guide for Parents and Children by Bonnie Zucker (Nov 1, 2008)

·         The Relaxation and Stress Reduction Workbook for Kids: Help for Children to Cope with Stress, Anxiety, and Transitions... by Lawrence E. Shapiro Ph.d., Robin K. Sprague, Matthew McKay and Matthew McKay PhD (Feb 2, 2009)

·         Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety by Donna B. Pincus (Aug 28, 2012)

·         The Anxiety Workbook for Teens: Activities to Help You Deal with Anxiety and Worry by Lisa M. Schab (Apr 1, 2008)

Video:

·         PTSD Video Seeking help http://www.ptsd.va.gov/

·         Child & Adolescent PTSD https://www.youtube.com/watch?v=thhz9sGqffI Powerful video on trauma.

·         Children, Violence & Trauma: Treatments that work:  https://www.youtube.com/watch?v=3EyvaEk0K-k      

·         What is PTSD https://www.youtube.com/watch?v=YMC2jt_QVEE&feature=youtu.be more direct at adults, but great!

Paulette Caswell, LICSW

Director, Bethany Christian Services
Serving children and families throughout the Pacific Northwest

1501 N. 200^th St. Ste. 103 Shoreline, WA 98133  
O – (206) 367-4604 x7972  F – (206) 367-1860

www.bethany.org/washington

pcaswell@bethany.org

Regular working hours are Monday to Friday 9 a.m. to 6 p.m.

In all things I have shown you…the Lord Jesus, … said, ‘It is more blessed to give than to receive.’ Acts 20:25

  

Parenting a Child with Trauma

The Aces Study

 What is ACES (Adverse Childhood Experience Study)?

http://www.cdc.gov/violenceprevention/acestudy/     

 Five are personal

u  physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect

 Five are related to other family members

u  a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment.

Each type of trauma counts as one.

Resilience

 1. They believed their mother loved them when they were little.

 2. They believed their father loved them when they were little.

 3. When they were little, other people helped there parent(s) take care of them and they seemed to love them.

4. When they were an infant someone in their life enjoyed playing with them, and they enjoyed it, too.

5. When they were a child, there were people in their life who made them feel better when they were sad or worried.

6. When they were a child, neighbors or friends’ parents seemed to like them.

 7. When they were a child, teachers, coaches, youth leaders or ministers were there to help them.

 8. Someone in they were life cared about how they were doing in school.

9. Their family, neighbors and friends talked often about making their lives better.

10. They had rules in their house and were expected to keep them.

11. When they felt really bad, they could almost always find someone they trusted to talk to.

12. As a youth, people noticed that they were capable and could get things done.

13. They are independent and a go-getter.

14. They believe life is what you make it

What the experts say: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf

Have a routine so they know what to expect-life is predictable.

Give your child a sense of control. Give simple choices. Respect your child’s decisions

Do not take your child’s behaviors personally.

Try to stay calm. Find ways to respond to outbursts that do not make things worse.

Lower your voice.

Do not yell or show aggression.

Do not stare or look directly at your child for too long. Some children see this as a threat

When your child keeps you at a distance, stay available and responsive

The ACES Study

https://www.aap.org/en-us/Documents/ttb_aces_consequences.pdf

The brain is not structurally complete at birth

Among other things, optimal development of the neuroendocrine system (mechanism the body uses to regulating reproduction, metabolism, eating and drinking behavior, energy utilization, and blood pressure.) is dependent on adequate nutrition and absence of toxins like lead, mercury, alcohol, other drugs, and toxic stress.

Structural development is guided by environmental cues

Proper structural growth depends on a nurturing, loving, and stimulating environment, one that prepares the child for future circumstances.

Effective stimulation requires interaction with other people

Other people must be present, attentive enough, and consistent or predictable enough to teach the lessons the developing brain needs. Stimulation from television, smartphones, or tablets does not replace interaction with people. 

Play Laughter Joy Brings…..

 Develops attachment

Stimulates executive functioning (the brain)

Decreases impulsive

Increases focus

Increases organization

Increases Generalization

Self-Control

         Increases short term memory

Parent Directed Play

Balloons

Bubbles

Lotion

Gum

Hershey's Kisses & Hugs

Lollipops

Straws

Resources/References:

The ACES Study http://www.cdc.gov/violenceprevention/acestudy/

The Aces Consequences: https://www.aap.org/enus/Documents/ttb_aces_consequences.pdf

Trauma Consequences https://thrivewa.org/work/trauma-and-resilience-3/

Parenting after Trauma: Understanding your child’s needs: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Documents/FamilyHandout.pdf

Healthy Foster Care America: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx

Life with Toddlers http://www.lifewithtoddlers.com/

25 Ways to Nurture Hurt Children https://www.adoptivefamilies.com/adoption-bonding-home/attachment-cycle-older-child/  

Ultimate Gifts for Sensory Seekers http://mamaot.com/ultimate-gift-list-for-sensory-seekers/

Project Sensory http://www.projectsensory.com

Deborah Gray, MSW, MPA www.deborahdgray.com   

Lark Eshleman, PhD http://larkeshleman.com/profession.html

Daniel A. Hughes, PhD http://www.danielhughes.org/

Dr. Daniel Siegel http://www.drdansiegel.com/  

ACES Too High http://acestoohigh.com/category/resilience/

Summary of Trauma and the Aces Study http://formedfamiliesforward.org/images/Trauma-informed-care-information-from-Allison-Sampson-Jackson.pdf

Star Center What is Sensory Processing Disorder? http://spdstar.org/what-is-spd/