RegulatetoEducate:DevelopmentalTrauma

PBISandMTSS-B

Kym Asam, LICSW

Objectives

• DifferentiatebetweenPTSDanddevelopmentaltrauma

•Understandtheimpactoftraumaonmultipledomainsoffunctioning

• Understandthestudents’ statesofarousalandhowitimpactstheirfunctioninginschool

• Keyskillsinworkingwithchildrenwhohaveexperienceddevelopmentaltrauma

• IncreaseunderstandingofalignmentbetweentraumainformedschoolsandPBIS

PollingQuestion#1

• Howmanyparticipantshavehadsometrainingondevelopmentalorcomplextrauma?

GroundingPrinciples

Trauma-SensitiveSchoolsbenefitallchildren–thosewhosetraumahistoryisknown,thosewhosetraumawillneverbeclearlyidentifiedandthosewhomaybeimpactedbytheir

traumatizedclassmates.

SchoolsaretheCentralCommunityformostchildren.

Source: Helping Traumatized Children Learn

Multi-tieredSystemofSupport

VTMTSSisacoherentcontinuumofevidencebased,system-widepracticesthatsupport:

– proactivepreventativecoreinstructionforall;

– arapidresponsetoacademicandbehavioralchallenges;

– frequentdata-basedmonitoring;and

– instructionaldecision-making

sothateachVermontstudentachieveshighstandards.

Thetriangle– Academicandsocial/emotionalinterventions

Classroom/school wide instruction

Universal regulating interventions

Targeted academic instruction

Targeted social skill and emotional regulation instruction

Intensive academic intervention

Intensive mental health intervention

Definitions

Whatistrauma?

Traumaisnotjusttheeventitself,butratheraresponsetoastressfulexperienceinwhicha

person’sabilitytocopeisdramaticallyundermined.

WhatisDevelopmentalTrauma?

• Apsychologicalandneurobiologicalinjurythatresultsfromprotracted exposuretostressfulevents

• Derailstypicaldevelopmentacrossalldomains(attachment,affect,biology,behavior,cognitive,dissociation,self-concept)

• Experiencesoftenoccurinthecaregivingsystem.• Impactisimmediateandlongterm• Effectswillrequirealltiersofintervention

“Traumaisnotastoryofwhathappenedtoyoualongtimeago,itiswhatisin

yourbody.”

BesselvanderKolk

ToxicStressPyramid

ACE study, Felitti, 2014

Source: US Department of Health and Human Services 2014 Child Maltreatment Report

Pervasivenessinchildren

� 1,892,000substantiatedabuse(Vermont=3,919)

� 26%ofchildrenexperiencetraumabefore4(Vermont59.3%)

� 11.3%increaseinreportsinVermont

� 77.2%neglect(Vermont=4%)

� 17%physicalabuse(Vermont=46%)

� SexualAbuse=8%(54%inVermont)

SourcesofTrauma• Sexualabuse• Physicalabuse• Emotionalabuse• Neglect• DomesticViolence

– Neighborhoodviolence• Torture• Bullying• Prolongedexposuretotraumaticstress• Intrauterinestress• Epigenetics

Epigenetics

https://www.youtube.com/watch?v=AvB0q3mg4sQ

Impact Areas:

qActs without thinking, interruptsqOverreacts to small issuesqUpset by changes/ transitionsqOverwhelmed, easily frustratedqResists change or tasks that are not interestingqDoes not notice the impact of their behaviorqDoes not see their part in problemsqEasily over-stimulated, difficulty calming downqForgetful, loses things, disorganizedqLoses steam quickly, cannot sustain on

challenging tasks

©NFI-Vermont,2013

7domainsofimpairment

Biologyandthebrain

Attachmentand

relationship

EmotionalRegulation

CognitionandLearning

behavior dissociation Self-concept

The brain develops from

the bottom up

Cortex

Limbic

Diencephalon

Brainstem

and the inside out

Neocortex

Limbic

Diencephalon

Brainstem

Neocortex

Limbic

Diencephalon

Brainstem

Abstract thought

Concrete Thought

Affiliation

"Attachment"

Sexual Behavior

Emotional Reactivity

"Arousal"

Appetite/Satiety

Blood Pressure

Heart Rate

Body Temperature

Sleep

Motor Regulation

All rights reserved © 2006-2011 Bruce D. Perry and The ChildTrauma Academy

ImpactofNeglectontheBrain

Bottomup,Insideout

StagesofSleep

EffectsofTraumaonBrainFunctioning

Prefrontal Cortex(Integration and Planning)

Amygdala(Intensity/significance)

ThalamusVisual, auditory, olfactory,

kinesthetic, gustatory

Hippocampus(cognitive map)

WhatcanwedoaboutDevelopmentalTraumainourkids?

InordertohelpyouthhealfromDevelopmentalTrauma,wemustprovideopportunities,

everyday,forpatterned,repetitiveexperiencesthatcounteract

establishedfunctioning.

PotentialInterventions:Thinkaboutbrainregions

• Touch• Rhythmic• Patterned• EyeContact• Drumming• Body-based

• MusicandMovement

• Yoga• Somatosensory• Parallelplay/learning

PollingQuestion#2

• Howmanyparticipantsusemovementwhenworkingwithstudents?

7domainsofimpairment

Biologyandthebrain

Attachmentand

relationship

EmotionalRegulation

CognitionandLearning

behavior dissociation Self-concept

4KeyPrinciplesofAttachment

• Buildschoolstaffcapacitytomanageaffect

• Buildschoolstaff-childattunement

• Buildconsistency inschoolstaffresponse tochildbehavior

• Buildroutines andritualsintoclassroomandschool

HealthyAttachmentSequencePhysicalorpsychologicalneed

Security,trust,attachment,self-regulation,object

constancy

State of high arousal

Attunement/satisfaction of need

Relaxation (parasympathetic ANS)

Beverly James

DisruptandConnect:Thestillfaceexperimenthttp://www.youtube.com/watch?v=apzXGEbZht0

UnhealthyAttachmentSequencePhysicalorpsychologicalneed

Shame,mistrust,dysregulation,disturbed

mentalblueprint

State of high arousal

Needs are disregarded/attunement

disrupted

Anxiety, rage, numbing

Beverly James

AffectManagement

Whencaregiversmodulatetheirownaffectandemotionalresponses,theycancreateanemotionallysafeenvironmentinwhichchildrenacan

learn

ATTUNEMENT

– Readingandrespondingtothecuesofanother– Synchronousandinteractive– Helpspreventmismatchbetweenneedandprovision

– Readingthenon-verbal,social-emotional“language”ofanother

Tantrums

�Whatdidyounotice?�Whatworkedwell?�Whatdidnotworkwell

https://www.youtube.com/watch?v=oa6znlKBFAg

CONSISTENCY

– EVERY DAY– EVERY GRADE– EVERY BODY– EVERY ENVIRONMENT

RoutinesandRituals

Routinesincreasespredictabilityandthechild’sabilitytoanticipatenextsteps.Establishingclassroomandschool-wideroutineshelpsreducetroublespots(transitions,substituteteachers,unstructuredactivities/days).

Interventions1. Dowel2. SilentSimonsays3. Ropecircleofsafety4. ChooChooTraingame:gamesthatenhancebodycontrol5. Say“no”withyourbody,say“yes”withyourbody6. Jumpingrope7. Drumming8. Mirroringorattunementactivities9. Feelingsgames

TargetingtheTiers,PBiSapproaches

Intensive

targeted

universal

Brain stem/diencephalon

limbic

cortex

7domainsofimpairment

Biologyandthebrain

Attachmentand

relationship

EmotionalRegulation

CognitionandLearning

behavior dissociation Self-concept

NormativeDangerResponsesAutonomicNervousResponseSystem

• Fight• Flight• Freeze• Flock

RecognizingAffect– EmotionalIdentification

FacialExpressionRecognition

Sequence of Engagement

Reason

Relate

Regulate

All rights reserved © 2007-2014 Bruce D. Perry

Bruce D Perry, MD, PhD © 2010 www.ChildTrauma.org

Cognition Abstract Concrete �Emotional�

Reactive Reflexive Mental State CALM ALARM FEAR ALERT TERROR

Primary secondary

Brain Areas

NEOCORTEX Subcortex

SUBCORTEX Limbic

LIMBIC Midbrain

MIDBRAIN Brainstem

BRAINSTEM Autonomic

Sense of Time

Days Hours

Hours Minutes

Extended Future

Minutes Seconds

Loss of Sense of

Time

ImpactAreas

It is often not the task or request that leads the child to

misbehave…

it is the feeling and negative thoughts that is evokes…

©NFI-Vermont,2013

Potentialstrategies

�Movement�Mindfulness�Non-verbalcommunication�Reflectivelylisten�Validation�Shhhhh�Attunement

�Matchaffectwithoutreplication

Morestrategies

• Usingasong,wordsorothercuestohelppreparechangeinactivity

• Patterned,repetitiveproprioceptiveOTactivitiessuchasisometricexercises(chairpush-ups,wall-sits,bearhugswhilechildtriestopulltheadultsarmsaway,applyingdeeppressure),

• Weightedvests,blankets,ankleweights

7domainsofimpairment

Biologyandthebrain

Attachmentand

relationship

EmotionalRegulation

CognitionandLearning

behavior dissociation Self-concept

Bottomup,Insideout

“Nomatterhowexcitingandmeaningfulandsupported

thelearningexperienceisdesignedtobe,achildcannotreap

thecognitivebenefitsofitunlessshefeels

calmenoughtobecurious.”

(McMahon,2011)

Pollingquestion#3

• Howmanyparticipantshaveamorning,coffeeroutine?

SequentialThinking

Achild’ssuccessfulcompletionofmanyacademictasksdependsontheabilitytobringalinearordertothechaosofdailyexperience.Traumaticexperiencecanlimitthisabilitytoorganizematerialsequentially,leadingto

difficultyinreading,writingandcommunicatingverbally.

FromHelpingtheTraumatizedChildLearn

Competency3KeyPrinciples

• Buildstudentexecutivefunctioningskills• Targetself-developmentandidentity• Targetadditionalkeydevelopmentaltasks

The child develops an ability to evaluate situations, inhibit impulsive responses and actively make

choices.

ALL

SOME

FEWMTSS

Math

Reading

AdultRelationships

AngerMgt.

Attendance

PeerInteraction

Science

(Universal)

(Targeted)

(Intensive)

CompetingDemands

Survivalvs.learning

Itisnearlyimpossibletodedicateyourfullattentionandenergytosurvivalandlearningatthesametime.

Potentialinterventions

Generalstrategies• Multi-modallearning• Regulatetoeducate• Buildoncompetencies• Multiplemotorbreaks• Brainbreaks• Differentiated

instruction/DifferentiatedDiscipline

Facilitatingsequentialthinking• Todolists• Visualschedules• Repeatdirections(toneof

voice)• Givenotes

7domainsofimpairment

Biologyandthebrain

Attachmentand

relationship

EmotionalRegulation

CognitionandLearning

behavior dissociation Self-concept

Bottomup,Insideout

Pollingquestion#4

• Howmanypeoplehaveusedsomesourceofheatintheirhomesinthelastweekorso?

Whatdoyouseeandwhy?

KeyTriggers� Lackofpowerorcontrol�Unexpectedchange� Feelingthreatenedorattacked� Feelingvulnerableorfrightened� Feelingshame

And…�Relationships– evenpositiveones� Intensefeelingsofanykind

But…whataboutconsequences?

Relationalandrelevant

Restorativeandreparative

Potentialinterventions/considerations

� Behaviorisaboutsurvival� FunctionANDfeelingbehindbehavior� Skilldeficit� Validation/attachment/comfortseekingvs.attentionseekingormanipulative

� Focusonconnection,notconsequence� Connect,rupture,repair� Ritualizetransitions(withmovement)� Evaluativeprocess(evenpraise)cancreatedefensiveness� Rememberwheretheyarelikelyintheirbrain

HelpfulReframes:

ChildSays: StudentBelieves:

“thisisstupid” “Iamstupid”“Ican’tdothis” “Iampowerless”“You’rean______ “Iamnotsafe”“whydoyoualways…” “Iamtoblame”“I’mouttahere” “Iamoverwhelmed”“Iwon’tdothis” “Ican’tdothis”“Youcan’tmakeme” “Ineedtoprotectmyself”

©NFI-Vermont,2013

PossibleCollisionPointsatSchool

• Schoolsfocusonpreparingchildrenforandinformationrelatedtotheexternalworld– StudentswithDTfocusonthepresentandinternallytostaysafe.

• Muchofschoolismotivatedbyconnectionandparticipationwithothers

• Schoolsoftenusedelayedgratification– StudentswithDTarefocusedonthepresenttostaysafe.Delayinggratificationisdangerousandunpredictable.

• Teachersoftensetlimits/goalsforthecommongood– YouthwithDTdon’toperatewithatemplatethatunderstandsthecommongood.

HowtoIntervene

Consistency

Predictability

Patternedand

Repetitive

Attunement

ManagingAffect

RoutinesandRituals

ALIGNING PBIS PRINCIPLES

Questions?????