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How can PTSD manifest in children
- reduced play
- repetitive play of event
- social withdrawal
- negative emotions
- self-blame
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What two extremes may a child suffer in regards to relationship trauma following inadequate, caregiving environment
- reactive attachment disorder
- disinhibited social engagement
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What is a consistent pattern of inhibited, emotionally withdrawn behavior, causing the child to rarely direct attachment behavior toward any adult caregiver
reactive attachment disorder
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What causes reactive attachment disorder
lack of bonding experience with caregiver by the age of 8 months
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What disorder is characterized by children who display no normal fear of strangers, seem unfazed in response to separation from caregiver, and will usually willingly go off with people unknown to them
disinhibited social engagement
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When does the most rapid phase of brain development occur
before 5 years
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What hemisphere develops first and is responsible for processing social-emotional information, promoting attachment functions, regulating body functions, and supporting the individual in coping with stress
right
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When are neural connections between the prefrontal cortex and limbic system established
10-18 months of age
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What are neural connections between the prefrontal cortex and limbic system crucial in?
modulating arousal and emotional regulation
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What pathophysical change causes dissociation
following trauma, PNS triggers hypoaroused state with dysregulation oh hypothalamic-pituitary-adrenal axis
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What is a disconnection in thoughts, emotions, sensations, and behaviors connected with a memory
dissociation
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Describe the 3 different responses of polyvagal theory
- Myelinated Ventral: Social/Intellectual: shut off Sympathetic responses
- Unmyelinated Ventral: Perceived threat: Sympathetic arousal
- Dorsal Vagal: Dampen SNS with parasympathetic response
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What is the positive adaptation or the ability to maintain or regain mental health despite adversity
resilience
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What are two priority nursing diagnosis for children with trauma
- risk for impaired parent/child attachement
- risk for delayed development
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What is the stage model for treatment of children with trauma
- Stage 1: SAFETY and STABILIZATION
- Stage 2: REDUCE AROUSAL & REGULATE EMOTION
- Stage 3: Developmental skills catch up
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What is the balance between the sympathetic and parasympathetic arousal
window of tolerance
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What is the most important healing ingredient of a child with trauma
relationship and connection with others
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Name important trauma interventions for a child with PTSD
- Establish trust and safety
- developmentally appropriate language
- relaxation techniques b4 trauma exploration
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What are two therapies recommended as first line treatment for children with PTSD
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What is characterized by persistent re-experiencing of a highly traumatic event that involves actual or threatened death or serious injury to self or others to which the individual responded with intense fear, helplessness, or horror
PTSD
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4 major features of PTSD in adults
- 1. rexperience trauma
- 2. avoidance of stimuli
- 3. Persisnt symptoms of increased arousal
- 4. Alterations in mood
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What may develop after exposure to a highly traumatic event displaying 8 of 14 symptoms during or after event (within 3 days to 1 month)
acute stress disorder
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When does debriefing take place for ASD if used (although studies indicate higher incidence of PTSD if treated with this)
within 12-48 hrs after event
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What is the hallmark of adjustment disorder and when is it diagnosed
- cognitive, emotional, behavioral symptoms that negatively impact functioning precipitated by a stressful event
- immediately or within 3 months of exposure
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What is an intense yearning/longing for the deceased and intense sorrow and emotional pain or preoccupation with the deceased or the circumstance of their death
complicated grief
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What is an unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation resulting in disturbances in memory, consciousness, self-identity, and perception
dissociative disorder
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What is intact reality testing
when a patient has flashbacks triggered by a current event that are not hallucinatory or delusional
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What refers to unwanted additions to mental activity such as flashbacks
positive symptoms
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What refer to deficit to mental activity such as memory problems, or the ability to sense or control different parts of the body
negative symptoms
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What 3 disorders fall under dissociative disorder
- depersonalization/derealization
- dissociative amnesia
- dissociative identity disorder
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What is the theory of structural dissociation of the personality
patients with complex trauma have different parts of their personality, the normal part, and emotional part. They are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. One dominant personality operates depending on situation of the moment
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What is the difference between depersonalization and derealization
- depersonalization: focus on self (observing ones own body, not apart of it)
- derealization: focus on outside world (distant)
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What is marked by an inability to recall personal information, often of a traumatic or stressful nature, this lack of memory is too pervasive to be explained by ordinary forgetfulness
dissociative amnesia
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What is characterized by sudden, unexpected travel away from the customary locale and an inability to recall one's own identity and information for some of all of the past
dissociative fugue
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What is the presence of 2+ distinct personalities that recurrently take control of behavior? Each alter has its own pattern of perceiving, relating to, and thinking about environment
Dissociative identity disorder
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