RESPONDING TO TRAUMATIZED CHILDREN AND YOUTH:

Signs and Symptoms of Post Traumatic Stress Disorder

Lindsay Caldwell, MSW, LCSW

Hope Services, LLC

Clinical Director

DJJ and Mental Health Facts• A high percentage of youth (65 to 70 percent) involved

with the juvenile justice system have a diagnosable mental health disorder and nearly 30 percent of those experience severe mental health disorders.

• A large number of youth in the juvenile justice system have a history of trauma, emotional, and behavioral problems.

• Youth in contact with the juvenile justice system experience higher prevalence rates across various types of mental health disorders.

• Most youth in the system meet the criteria for or are diagnosed with more than one mental health disorder.

DJJ and Child Welfare: overlapping risk factors that stem from trauma

• The factors that lead to involvement with the child welfare system often contribute and coincide with those that bring youth to the attention of the juvenile justice system.

• Trauma: Trauma experienced prior to and during system involvement can negatively affect development for youth involved in both the juvenile justice and child welfare system. 

• Family: Compromised social and family networks can make it difficult for youth to establish prosocial coping mechanisms as they mature emotionally and cognitively. Family tensions, which may result from abuse and neglect or out-of-home placement, can make it difficult for youth to establish a support network to help them overcome personal barriers to life success.

• Abuse and Neglect: Child abuse and neglect increase the risk of any arrest of a juvenile by 55 percent, and the risk of committing a violent crime by 96 percent. Persistent maltreatment and neglect extending from infancy to adulthood are significantly correlated with an increased risk of juvenile delinquency and criminality.

.Findyouthinfo.gov

What is Trauma?• Something terrible or scary that you experience, see or hear about,

it could be something that happens to you or someone close to you. • You are afraid that your life or someone else’s life is in danger or

there could be serious injury.• Examples:

• Physical abuse (hitting, smacking etc.)• Sexual abuse (forcing to engage in or witness sexual acts)• Serious accidents (Car, animal attack etc.)• Natural disasters (fire, tornado, hurricane, flood or earthquake)• Witnessing abuse or a traumatic death• Witnessing war or terrorism

QUESTION: Around how many people experience a traumatic event in their lives?

70%

Normal Responses to Trauma• Our brain wants to keep us safe, so, usually, we have a

natural reaction to danger—Fight, Flight or Freeze.

• Some symptoms right after trauma are normal, it is when they persist for several weeks (or longer) when it become serious enough to seek help.

What is PTSD?• Post Traumatic Stress Disorder develops in some people when

they experience a traumatic event (or more than one) and they are not able to control their stress/anxiety responses.

• PTSD was typically associated with veterans who have been in combat, but it can happen to anyone—including children and adolescents.

• 1 out of every 3 girls is sexually abused by the time they are 18 and 1 out of every 6 boys (based on reported statistics).

QUESTION: About what percent of people who experience a traumatic event develop PTSD?

15%

Trauma’s Affect on a Child’s Brain• Trauma in early childhood affects how

the brain develops and can lead to symptoms. The brain is overreacting to triggers because it thinks they are dangerous based on previous trauma experience.

• Trauma over stimulates the “protective” part of the brain and it gets stuck in “flight, fight, freeze” mode. The other areas of the brain don’t have the opportunity to develop, leading to learning, social, and behavioral problems.

Symptoms of Traumatic Stress• Nightmares, flashbacks, re-experiencing• Repetitive behaviors: safety behaviors, re-

enacting the trauma in play• Clinging and withdrawal (Can look like

anxiety)• Fear and avoidance of certain places, things

or situations that remind them of the event• Complaints of aches and pains with no

medical explanation• Difficulty concentrating and easily startled

(Can look like ADHD)

Symptoms Continued• Irritability, impulsiveness, anger and hostility (can look like

ADHD)• Accident-prone and reckless behavior• Depression and overwhelming sadness or hopelessness• Loss of interest in previously enjoyed activities• Disruption in sleeping and eating• Distorted thoughts about self, others and the world

(Example: “I am bad”, “The world is unsafe”, “It’s all my fault”)

• Disassociation: Depersonalization or Derealization

Triggers• Anything that reminds a person (or their brain) of a

previous trauma and causes their brain to go into “protective mode” leading to an anxious reaction in their brain and body (symptoms).

• Psychological (thoughts, memories)

• Physiological (rapid heart rate, sweaty palms) response

Triggers • Example: A 15-year old adolescent was the victim of a

rape by a middle aged Caucasian man with a beard in the park. • Triggers might be: middle aged Caucasian men, beards, a man’s

voice, parks, children laughing, the sound of swings, being naked, being restrained.

• Example: A 7- year old child grew up in a home with domestic violence for the first 5 years of their life and witnessed several fights between their parents including lots of yelling. • Triggers might be: other people fighting, loud noises, the

neighborhood where they used to live, certain smells, certain colors, physiological and psychological reminders (heart racing), POLICE INVOLVEMENT

Minimizing police involvement as a trigger for traumatized youth• Find out as much information about the youth as you can

before approaching them.• Start the conversation from a distance.• If possible ask permission to approach or talk with the youth.• Use anticipatory guidance to explain what is happening/will

happened next. • Tap out with your partner if you become aware that you may

be a trigger for the youth. • Avoid restraints when possible, especially down on the

ground. • Use validation and reassurance – “I know this is hard” “I’m

sorry this is scary.” “I don’t want to hurt you.”

Ariana’s Story• A first hand experience of a teenager with PTSD’s

involvement with CIT.

• Reflections• What was helpful?• What did you learn? • What is one way this will change the work you do in the future?

Treatments for PTSD• Therapy: Developing coping

skills, social skills, relaxation techniques

• Parent Training• Gradual exposure• Diet/Nutrition and Exercise• Medication evaluation

Treatment Options• Therapy:

• Trauma Focused-Cognitive Behavioral Therapy: 90% effective at reducing trauma symptoms

• Cognitive Behavioral Therapy• Dialectical Behavioral Therapy: teaching coping skills and mindfulness• Behavioral Interventions: Rewards and consequences system• Psychodynamic Therapy• Group therapy: coping skills, social skills

• Parent Training and Education• Medications for anxiety, depression, sleep problems, attention

issues• Treatment can be in the home or the office and should always

include parents• Treatment could help relieve symptoms even if full PTSD is not

diagnosed

Referral Information• Hope Services, LLC• 3000 Highwoods Blvd, Raleigh, NC• 919.714.7500

• Open Access • Monday – Friday • 9am-3pm• Medicaid, Healthchoice, IPRS, BCBS, Tricare, self pay

Resources• Attention Deficit Information Network: support, information, community

resources• www.addinfonetwork.org• 781-455-9895

• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): Support, information, resource center• www.chadd.org• 301-306-7070, 800-233-4050

• Find Youth Infohttp://www.findyouthinfo.gov/youth-topics/juvenile-justice/youth-involved-juvenile-justice-system

• National Child Traumatic Stress Network: www.nctsn.org • National Center for PTSD: www.ncptsd.org

• Links to interdisciplinary index database, publications, books, research quarterly, clinical quarterly, assessment instruments.

• National Institute of Mental Health (NIMH): www.nimh.nih.gov• Free educational materials for professionals and the public.

• NC Child Treatment Program Ncchildtreatmentprogram.org