Down will Come Baby, Cradle and All: Diagnostic and Therapeutic Implications of Chronic Trauma on Child Development

Abstract

Exposure to intrafamilial violence and other chronic trauma results in pervasive psychological and biological deficits. Treatment needs to address issues of safety, stabilise impulsive aggression against self and others, promote mastery experiences, compensate for specific developmental deficits, and judiciously process both the traumatic memories and trauma-related expectations.

You Learn What You Live: Prevalence of Childhood Adversity in the Lives of Juveniles Arrested for Sexual Offenses

“…Adverse childhood experiences create toxic stress, leading to an over-production of hormones associated with survival responses (fight or flight), and producing neurobiological changes in the brain that can impede cognitive processing and selfregulation capacities (Alink, Cicchetti, Kim, & Rogosch, 2012;Creeden, 2009;Finkelhor & Kendall-Tackett, 1997;SAMHSA, 2014a;Streeck-Fischer & van der Kolk, 2000;van der Kolk, 2006). Research has indicated that the multiplicity, frequency, and chronicity of early adversity creates what has become known as complex post-traumatic stress, manifesting in a constellation of maladaptive coping strategies, mental health symptoms, and behavioral problems (Cloitre et al, 2009;Herman, 1992;van der Kolk, 2014).…”

Trauma-Exposed Infants and Toddlers: A Review of Impacts and Evidence-Based Interventions

“…A traumatic event may be defined as an event that is overwhelming to the child's senses or self-regulatory abilities, threatens the child's well-being or that of their caregiver, indicates the world is uncontrollable and unpredictable, and/or involves stressors that exceed the child (or caregiver's) normal resources (Cordón, et al, 2004;Van Horn & Lieberman, 2008). Chronicity of trauma (Streeck-Fischer & Van der Kolk, 2000), the child's pretrauma adjustment (Feldman & Vengrober, 2011), and the caregiver's reaction to the trauma (DeVoe, Klein, Bannon, & Miranda-Julian, 2011) have all been linked to the severity of children's post-trauma functioning.…”

“…The process of attachment is arguably most important in the earliest years, as it creates a biological framework for managing future stress and arousal (Streeck-Fischer & Van der Kolk, 2000), thus shaping how a child interprets and reacts to future experiences. As infants are not able to decipher between distinct, different arousal states or verbalize their needs, they are dependent on caregivers to modulate their arousal and to care for their basic needs ( Van der Kolk, 2006).…”

“…This lack of regulation risks imprinting in a child's developmental processes that emotions and arousal in general are dangerous/frightening, leading to potential avoidance of arousal in the form of numbing/dissociation or a response in the other direction such as arousal in the form of aggressive behaviors (Streeck-Fischer & Van der Kolk, 2000). In the Strange Situation, often used to observe and assess a toddler's response to separation from their primary caregiver, maltreated toddlers were found to be more likely to have disorganized attachments to caregivers (Cicchetti & Toth, 1995) as well as higher levels of cortisol after parental separation (Twardosz & Lutzker, 2010).…”

“…Just as young children in responsive attachment relationships are able to organize their internal biological framework around expectations of safety and responsiveness from their caregivers (Streeck-Fischer & Van der Kolk, 2000), early trauma can impact a child's organization by creating expectancies of the world as unsafe and unpredictable ( Van der Kolk, 2005). The earlier discussed "use dependent" plasticity of the brain creates neural changes in children with chronic traumatic stress; creating a template of danger and survival through which later relationships and experiences are evaluated and processed (DeBellis, 2001;Pynoos et al, 2009).…”