ADHD and Trauma. Disclosure. Nothing to disclose 6/13/2016

Transcription

1 ADHD and Trauma Sara Kemper, LCSW Bethany Harvey, MSW Intern Children s Developmental Health Services Albertina Kerr Disclosure Nothing to disclose 1

2 Case Presentation: Leo and Julie Leo is a 3.2 years old male child who is experiencing bouts of aggression mainly aimed at his biological mother, Julie. Occasionally Leo will act out with his father as well. Julie shared that Leo is a happy child, but he is struggling with biting, pinching, kicking, and head butting. Julie shared that most of the aggression happens around nap time. When Julie brought these concerns up with the pediatrician they performed a sleep study to help find out if this was the cause of the behaviors. Julie reports that no significant findings resulted from the sleep study. Julie did report that Leo has been experiencing more talking and crying out in his sleep and she used to sleep walk so they added childproof locks on the doors as a precaution. Leo can have emotional outbursts that last from 2-15 minutes and occur daily, but Julie is not sure the outbursts are out of the range of normal. Julie shared that Leo does really well at communicating now, before he could talk he used aggression and she thought communication was the issue. Julie shared that Leo touches others and is in their space saying He is hands on, he likes to hug and that this sometimes interrupts his play with peers. Problem Behaviors for Leo Aggression that mom labels as willful Biting mom daily (has broken the skin but usually just leaves a bruise ) Aggression when feeling extreme emotions (both joy and frustration) Not sitting still at circle time Very physically active 2

3 Problem Behaviors for Leo Difficulty engaging with peers using pro-social behaviors Emotional Outbursts Defiance Sleep disturbance Irritability Resistant to potty training Fine motor delay Are these behaviors caused by ADHD or Trauma? ADHD Symptoms: Inattentiveness Disorganized Trouble staying on task Forgetful Hyperactivity Poor regulation Impulsivity 3

4 Are these behaviors caused by ADHD or Trauma? Affective Trauma Symptoms: Common symptoms include fear, anxiety, depression, anger, and affect dysregulation. Children experience fear as a reaction to life-threatening or frightening events. Traumatic memories are encoded in the brain differently than non-traumatic memories. Thus, some children will experience the same physiological and psychological fear reactions when exposed to reminders of the traumatic event. Children may develop general anxiety when the fear response becomes generalized and people places and things cause the same level of fear as the original trauma. Are these behaviors caused by ADHD or Trauma? Affective Trauma Symptoms: Children may experience depressive feelings which may stem from an abrupt loss of trust in people and the world as a result of the trauma. Anger may result from a child s understanding that the traumatic event was unfair. Children who have experienced trauma may overreact to stress, be easily overwhelmed and have difficulty regulating their emotions. 4

5 Are these behaviors caused by ADHD or Trauma? Behavioral Trauma Symptoms: Children may develop behaviors to help protect them from feeling pain such as avoiding people, places or things that remind them of the trauma. For example, if a child was sexually abused at night, he or she may avoid sleepovers and unfamiliar places at night. Are these behaviors caused by ADHD or Trauma? Cognitive Trauma Symptoms: Trauma can distort a child s thoughts about themselves, other people, and social interactions. After a traumatic event, a child will search for reasons why the traumatic event happened to them. If they cannot come up with a rational explanation, they will develop irrational beliefs about causation in order to feel some sense of control or predictability. The most common irrational belief that children have around trauma is accepting responsibility and blaming themselves directly. 5

6 Examples of Traumatic Events Acute: School shootings Sexual assault Natural disasters A serious accident Sudden or violent death of a loved one Examples of Traumatic Events Chronic: Domestic violence Long-term sexual or physical abuse Wars, political turmoil or persistent neighborhood violence Poverty What are kids really afraid of? Loss of a limb, injury, or death Anything bad happening to a primary caregiver 6

7 How to Quickly Screen for Trauma Asking questions: How was growing up for you? How are you doing now? Have you or your child ever experienced something scary? What happened when I asked these questions to Julie? How was growing up for you? Experienced severe physical abuse by mother and brothers Injured enough to visit the ER for x-rays and physical examinations (she was never admitted for her injuries) Spanked by her mother until you couldn t sit down Exposed to domestic violence between her parents Exposed to substance abuse by her caregivers Younger sibling is still aggressive towards her and using substances Biological mother was confined to a wheel chair 7

8 What happened when I asked these questions to Julie? How was growing up for you? Used to sleep walk, so put locks on all the doors after Leo started talking in his sleep As a child, was in therapy with her older brother when one of the therapists did something hurtful and added stress Julie has been in mental health treatment on and off since age 10 to help with anxiety and depression Dad did not have any of these experiences What happened when I asked these questions to Julie? How are you doing now? Biological father is actively abusing substances and alcohol Chronic medical condition that is painful Depression and Anxiety Have you or your child ever experienced something scary? Leo witnessed his mother try to commit suicide. 8

9 Corresponding Symptoms of Trauma and ADHD Anxiety can look like impulsivity Hyper arousal can look like restlessness or fidgeting It can be both so when there is a diagnosis of ADHD make sure to screen for trauma as well Trauma Treatment Recommendations Seek a Mental Health Therapist who prioritizes opportunities to: Interrupt thinking errors and dig out the yucky stuff Replace negative thoughts with positive thoughts Teach coping strategies Build a healthy relationship between the primary caregiver and child 9

10 Trauma Treatment Recommendations Child-Parent Psychotherapy Attachment based strategy where the caregiver and child work towards healing together through play and creating a trauma narrative Increases the parent and child s emotional attunements Trauma Focused Cognitive Behavioral Therapy Working with the child and parent separately until they are ready to work together Education of parent Create a trauma narrative References Cohen, J., Mannarino, A., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York. The Guilford Press. Defining Trauma and Child Traumatic Stress. (n.d.) Retrieved May 03, 2016, from 10

11 References Lieberman, A.F. & Van Horn, P. (2005). Don t hit my mommy!: A manual for child-parent psychotherapy for young witnesses of family violence. Washington, D.C.: Zero To Three Press. Szymanski, K., Sapanski, L., & Conway, F. (2011). Trauma and ADHD: Association or diagnostic confusion? A clinical perspective. Journal of Infant, Child, and Adolescent Psychotherapy, 10(1), CME Topic for the next Project ECHO tele-clinic: Collaborative Problem Solving Ted Layman, LCSW Licensed Clinical Social Worker Children s Developmental Health Services Albertina Kerr 11