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Key Takeaways June 15, 2020 | 6 p.m.

Jason Sabo, PhD, Lee Health Pediatric Developmental and Behavioral Specialist

Jayme Hodges, MSW, LCSW-QS, Lee Health Director of Behavioral Health

How to Understand and Help Children Respond to Traumatic Experiences

Jason Sabo:

Statistics from National Institutes of Health

  • More than 2/3 of children report experiencing trauma by the age of 16
  • Of children who do experience a traumatic event, only 16 % develop into PTSD
  • If you are diagnosed with PTSD, there’s an 80% chance you will also be diagnosed with a co-morbid disorder like anxiety, depression, OCD
  1. What is a traumatic event? It’s something we really shouldn’t have to experience. It can range from a car accident, physical injury, sexual abuse, physical abuse, domestic violence, community or school violence, medical trauma, something that causes threat of injury or death. Reactions can be immediate or delayed.
  2. What is PTSD? It’s a very difficult diagnosis. There are seven different criteria that need to be met. 1. Having traumatic exposure that is directly witnessed or experienced: actual or threatened death, serious injury, sexual violence. 2. Intrusive symptoms, including memory, dreams or flashbacks. You can be sensitive to triggers that represent the trauma. 3. Avoidance of those triggers that are reminders of the trauma that create functional impairment. 4. Change in cognition or mood related to the event. Often, you’ll see detachment from other people, impacting personal relationships and the ability to communicate with others. 5. Hypervigilance about something bad happening. The fight or flight alarm system goes off in the body with no ability to turn it off or giving the body a chance to rest. 6. Impairment in multiple different areas of functioning. 7. Reactions and responses are not due to a medical condition.
  3. Difference from acute stress disorder. With PTSD, symptoms are there for a long time, 6 months or normal. Acute Stress is three days to a month. The symptoms between the two are similar.
  4. Factors that make people more sensitive or immune to impact of trauma. If we have taught coping skills and know how to deal with stress and anxiety, we are better able to handle. Risk factors for sensitivity includes poor mental health conditions, lower economic status, lack of education, child adversities and previous traumatic events change the way the brain handles stress. Impact of trauma depends on the severity of the event or prolonged exposure. Being victimized by a caregiver, or when you are the perpetrator (the military, for example) also increase impact. Poor coping skills (drinking or drug use for example and environmental cues (constant reminders) can increase the impact. Your support network is the single best indicator of how people will cope. Important to have those protective layers: friends, family, support groups, activities, church that help form a cocoon around our children to protect them.
  5. Signs of trauma in children and adolescents: Constantly replaying the event in their minds, nightmares, belief that the world is unsafe that impedes on our ability to take part in life, difficulty regulating emotions, difficulty with concentration, poor appetite and sleep issues, behavior problems (acting out or regression), withdrawal for others.
  6. Impacts on the brain. Experiencing trauma activates fight or flights response, disrupting the regulatory chemicals in the brain, and then impacts future response. Trauma lowers cortisol levels, which is what’s released in fight or flight, impacting how we physically handle stress. In a traumatic event, more norepinephrine is released, strengthening the traumatic memory. Trauma lowers serotonin, increasing risk for anxiety and depression. Children exposed to domestic violence have a lower mean IQ and achievement. Trauma effects visual memory, executive functioning and verbal memory.
  7. Impacts of trauma at different ages. At 6 months old, children can experience PTSD. Ages 2-5 don’t have solid verbal skills, which help us process information. These younger kids will act out. You’ll see them express themselves in play. They may have increased sensitivity to sounds, disturbances in eating, sleeping and toileting and clinging to caregivers. Ages 6-11 may have anxiety, increased aggression or irritability, sleep and appetite disturbances, moodiness or crying, physical discomfort, withdrawal from social interactions, academic problems. Ages 12-18 may have avoidance of feelings, constant rumination of the event, distance from friends and family, depression, suicidal ideation, panic and anxiety for future events, mood swings, changes in sleep habits, academic difficulties, risky behaviors.
  8. How do you help? Caregiver needs to care for themselves. Remain calm. Children look to parent or caregiver to see how they should behave. Create a basic foundation of safety, which sometimes means different things to different people. Be a good listener. Allow kids to talk and process. Develop and keep routines, they provide anchors, safety and security for children. Look for signs of trauma. They may not show up immediately. Questions about events may persist. It’s a way of children trying to figure it out. Understand that children cope in many different ways. Each child is different. Help children relax and teach them breathing exercises. Show them how to slow their body down and gain control. Acknowledge what your child is feeling. It’s OK to tell them it’s OK to worry, or that something is scary. Things you can say: “It looks like you are really worried.”
  9. How do I know when to get help for my child? Look at different areas of functioning. When you see multiple areas impacted, you may need an intervention. When you see a child struggling, make sure you address it and try to do something. If you see the symptoms worsening and generalizing, it is important to seek help. When you see a deviation from normal behavior, it should throw flags up.

Jayme Hodges:

The main message we want to get across is that traumas do occur. Traumatic events are common, but it doesn’t mean it will develop into PTSD. Everyone is different. Just because you experience trauma doesn’t mean you’ll end up with a diagnosable disorder.

Questions from viewers

Q: I’d like to learn more about the relationship between IQ and domestic violence.

A: Sabo: it was an article that listed 13 different areas of the brain that are affected. Here is the link: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3968319/

Q: What about the use of Adverse Childhood Experiences (ACE) test in school?

A: It’s a good screener for recognizing when a child may have experience trauma. I think a lot of screeners do a good job at asking a question in a way that kids feel comfortable asking and gives feedback on issues that might be there and areas that might need to be investigated. I don’t know how schools are using it.

About Kids’ Minds Matter

The goal of Kids’ Minds Matter is to raise awareness about the need for pediatric mental and behavioral health care services and to raise the funds required to make these services available in the region through Golisano Children’s Hospital of Southwest Florida and Lee Health. An estimated 46,000 Southwest Florida children are impacted by mental and behavioral health disorders like anxiety, depression, eating disorders, psychosis, substance abuse, autism and attention deficit hyperactivity disorder. As part of the region’s strategic solution to the children’s mental and behavioral health epidemic in Southwest Florida, Kids’ Minds Matter is dedicated to fostering partnerships that support existing services, identifying and filling gaps in the continuum of care, and innovating new treatments.

Philanthropic support for Kids’ Minds Matter has allowed Lee Health and Golisano Children’s Hospital of Southwest Florida to: implement a tiered model of care that clinically aligns community, inpatient and outpatient care; hire additional psychiatrists, child advocates and other mental health professionals; offer Mental Health First Aid training to local pediatricians, emergency service providers and others who work directly with children; renovate an outpatient center in Fort Myers where a child’s needs can be addressed in a therapeutic setting; and launch a first-of-its-kind Pediatric Digital Cognitive Behavioral Health diagnostic and treatment protocols interlaced with Tele-Psychology support to treat anxiety, depression and trauma. Most recently, Kids’ Minds Matter introduced mental health care navigators into Lee and Collier County schools who will help families find resources and care to address their child’s mental healthcare needs.

The “Mental Health Mondays” segments are a public forum, designed for open discussions that benefit a large audience, and to provide real-time resources and advice from pediatric mental health professionals and advocates. The information shared on this platform is intended for general public consumption and not intended for individual treatment. The views, advice, and resources shared by each guest speaker are solely their own and are not endorsed by Lee Health, Golisano Children’s Hospital of Southwest Florida and Kids’ Minds Matter. Kids’ Minds Matter is dedicated to raising awareness and essential funding to enhance pediatric mental & behavioral health programs, services and access to care in Southwest Florida. To learn more about Kids’ Minds Matter, visit KidsMindsMatter.com.