Exam 1 Midterm

What happened in Chowchilla, California (7/15/1976)?

Masked kidnappers took school bus and abducted 26 children/bus driver ages 5-14; first group of children studied that created the consideration of PTSD in children

Trauma

an uncontrollable and unpredictable event, which is beyond the score of ordinary human experience

Epidemiology

the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health

Types of Trauma are:

• Neglect

• Physical abuse

• Sexual abuse

• Natural Disasters

• Discrete (Single incident) Catastrophes

• Plus MANY more

Effects of trauma

• Disruption of healthy development

• Higher risk for emotional and behavioral problems in the present and future

Trauma symptoms are:

• Depression

• PTSD

• Sleep Problems

• Conduct Problems

• Enuresis

• Somatization

• Eating problems

• Reactive attachment disorder

• Sexualized behaviors

• Substance abuse

• Risk-taking

The stress response system involves these three types of responses:

Fight, Flight, and Freeze

Maltreatment

a person who is supposed to protect you from harm, keep you safe becomes a source of alarm/danger/pain

Maltreated children have these tendencies…

• Tend to have lower social competence

• Often have less empathy for others

• Have greater difficulty in recognizing other's emotions

• Tend to over-read anger

• Are less able to recognize their own emotional states

• Are more likely to be insecurely attached to their parents

• Are frequently hypervigilant

Child maltreatment impacts the following developmental processes:

• Attachment

• Emotional regulation

• Impulse control

• Integration of self

• Socialization

ACES Study

The more ACES (adverse childhood experiences) you have, you are more likely to have negative physical health effects

Dose-effect

increasing ACES increased the number of problems. People with more ACES have much more higher chance of being exposed/more vulnerable to more ACES

Maltreatment has greater negative effects at ________ ages

younger

The highest type of maltreatment is….

neglect

What is the challenger event?

When the space challenger crashed, millions of children watched on TV live. Lenore Terr studied the geographical impact on PTSD symptoms in children.

Taught us that children might be traumatized by events that do not directly affect their personal safety of the safety of their loved ones and that closeness to the traumatic event does play a role in severity of symptoms

Developmental Psychopathology

the development of the brain and mental processes over time; takes into account how trauma effects development and how development impacts the outcome of trauma

Children who have been maltreated of experience trauma have these developmental outcomes…

• Perform lower on exams/scales of intellect and academic performance

• Predictive of problems in expressive and receptive language

• More likely to be placed in special ed

• The risk of psychopathology increases dramatically

Basic needs of a child are:

adequate nutrition, education, adequate healthcare, maternal health, and environmental health

Temperament

the natural activity level, regularity, approach/withdrawal, adaptability, sensory threshold, quality of mood, intensity of reaction, distractibility, persistence and attention span of a baby/newborn

Easy temperament

have a lot of biological regularity, have a positive approach to more new situations, easy adaptability to change, mild or moderately intense mood that is predominantly positive

Slow-to-warm temperament

negative response to new situations, slow adaptation, may have good biological regularity, and mild expressions of mood

Difficult temperament

biological irregularities, negative withdrawal from most new situations, slow adaptability to change, and intense moods that are predominantly negative

Attachment Theory

caregiver-infant behavioral system that ensures species survival

Attachment Behavioral System

• the progression of attachment towards a primary caregiver

  • 0-8 weeks- will cry, grasp and babble

  • 2-6 months- smile clings, and visually follows

  • 6-24 months- greater range of attachment behaviors to maintain proximity: protest departure/separation, greet upon return/reunion, cling when afraid, following when able

  • Toddler uses caregiver as a "secure base" from which to explore

Complimentary Caregiver Behavioral System

a caregiver in turn shows watchfulness, protective behavior, response to distress, closeness

Attachments are consolidating between ___ and ___ months of age

6 and 24

Children will develop an attachment relationship to any caregiver providing regular care regardless of….

the quality of care provided

Mary Ainsworth's "strange situation" scenario

measures the quality of attachment based on the reaction of a child when their primary caregiver leaves the room in an unfamiliar place (with a stranger first and then with no one), and the reunion behaviors between baby and mother

Secure Attachment-

• when the mother leaves the room, they are distressed. When the mother returns, the baby wants to be close to the parent and is soothed.

  • Shows us that Parent is responsive and available

  • Is a predictor of positive social outcomes and higher cognitive functioning

Insecure-Avoidant attachment

• the baby is not extremely distressed when mother leaves, when mother returns they ignore the mother or turn away and don't return to prior level of play

  • Tells us that parent is unavailable and rejecting

Insecure-Ambivalent attachment

• the baby is distressed when mother leaves, when mother returns they reject the mother's comfort and are angry at mother, does not return play immediately

• Tell us that parent is inconsistent, unreliable and sometimes intrusive

Disorganized attachment

baby is distressed when mother leaves, but shows avoidant, mistimes, incoherent and freezing behaviors when the mother returns

• Parent is the source of security and also a source of fear, typically associated with parental trauma

___________ attachment type is most predictive of concurrent and later psychopathology

disorganized attachment

Reactive Attachment Disorder

a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by bother of the following: the child rarely or minimally seeks comfort when distressed and the child rarely or minimally responds to comfort when distressed

Symptoms of reactive attachment disorder

• There is also minimal social and emotional responsiveess to others

• Limited positive affect

• Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening situations and environments

• The child must have experienced a pattern of extreme insufficient care

  • Social neglect/deprivation

  • Repeated changes of primary caregiver (ie foster care)

  • Rearing in unusual settings that severely limit opportunities to form selective attachments (ie raised in an orphanage/institution that has low child-to-caregiver ratios)

Disinhibited Social Engagement Disorder-

• a pattern of behaviors in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:

  • reduced or absent reticence in approaching and interacting with unfamiliar adults, overly familiar verbal or physical behavior (that is not consistent with age/cultural boundaries), diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings, or willingness to go off with an unfamiliar adult with minimal or no hesitation

  • The child similarly to reactive attachment, they must have experienced a pattern of extreme insufficient care

Romanian orphanage studies found a strong relationship with time in institution and quality of care received in the orphanage and __________________-

the child's long-term health and development after adoption

Chisholm study

found that children adopted after spending 8 months in an orphanage had more insecure attachments and indiscriminate friendly behavior (even after a successful adoption) compared to children who spend 4 months, or were adopted but not in an international orphanage

Macarthur study

found that if adoption occurs before or close to the sensitive period of attachment, the risk for enduring difficulties decreased

“still-face" experiment (1970)

• The parent is interacting normal with the baby and then asked to stop interacting and is "flat"

• First the baby starts to demand attention and eventually goes into distress (for ONLY 2 MINUTES)

Imprinting

baby geese would attach to the first moving object they see after hatching

Harry Harlow

Harry Harlow studies baby monkeys, and found that monkeys separated from their mother preferred a "comforting" cloth mother over a wire mother that provided food

Hysteria

derives from the word "uterus"; was used to describe acute emotional and physical symptoms caused my psychological pathology

Jean-Martin Charcot

interested in what neurological damage caused from somatic symptoms. Found that under hypnosis, these symptoms disappeared; called this the "Great Nuerosis"

Sigmund Freud

began to study hysteria in search of its underlying cause through analyzing his patients; be began to notice that the almost universal experience of childhood sexual trauma. Wrote a book that he found that the most common cause of hysteria was premature sexual experiences; because of this most people detested this

Shell Shock

after WW1 men who had been exposed to the horrors of trench warfare displayed symptoms of "nervous breakdowns". Shell Shock victims experienced extreme emotional and physical distress; though shell shock was recognized as a real entity by some, it was not classified as a diagnosis

Which war initiated the conversation about PTSD and trauma for war veterans?

Vietnam War

The ________ movement in 1990s claimed that the characteristics in war veterans were also applicable to women's sexual abuse and allowed for rape to be redefined as a crime of violence rather than a sexual act and rape was finally understood to occur not just by strangers but also within marriage or by an acquaintance

women's liberation

PTSD was first only studied in _______ and _______; nothing else was considered traumatic stressors

war veterans and rape

PTSD Criteria A

exposure to actual or threatened death, serious injury or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event, witnessing the event in person, learning that the traumatic event occurred to a close family member or friend that was violent and unexpected, experiencing repeated or extreme exposure to aversive details of the traumatic events (eg first responders, police officers)

PTSD Criteria B

• Intrusion symptoms

  • Recurrent, involuntary, and intrusive distressing memories of the traumatic events

    • Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event

    • Dissociative reactions in which the individual feels or acts as if the traumatic events were recurring

    • Intense of prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

    • Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event

PTSD criterion C

• persistent avoidance of stimuli associated with the Trauma

  • Avoidance or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events

  • Avoidance or efforts to avoid external reminders that around distressing memories, thoughts, or feelings about or closely associated with the traumatic events

PTSD Criterion D

• negative alterations in cognitions and mood

  • Inability to remember an important aspect of the traumatic event

  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world

  • Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame him/herself or others

  • Persistent negative emotional state

  • Markedly diminished interest or participation in significant activities

  • Feelings of detachment or estrangement from others

  • Persistent inability to experience positive emotions

PTSD Criterion E

• marked alterations in arousal and reactivity

  • Irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects

  • Reckless or self-destructive behavior

  • Hypervigilence

  • Exaggerated startle response

  • Problems with concentration

  • Sleep disturbance

PTSD Criterion F

duration of the disturbance is more than one month

PTSD Criterion G

the disturbance causes clinically distress or impairment in social, occupational or other important areas of functioning

PTSD Criterion H

the disturbance is not attributable to the physiological effects of a substance or another medical condition

Acute stress disorder requires person to have PTSD Criteria ____ and happened in under ___ days

criteria A and under 30 days

Adjustment disorders

• Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and cultural factors that might influence symptom severity and presentation

• The symptoms do not represent normal bereavement

Complex trauma (Judith Herman)

involves Alterations in regulation in affect and impulses, Alterations in attention or consciousness and Alterations in self-perception

PTSD for children 6 years and younger

• • Trauma exposure

    • Disorganized or agitated behavior may be an expression of intense fear, helplessness or horror

  • Re-experiencing

    • In young children, repetitive play may occur in which themes of aspects of trauma are expressed (intrusive thoughts)

    • In children, there may be frightening dreams without recognizable content (dreams)

    • In young children, trauma-specific reenactments may occur (flashbacks)

Homeostasis

a dynamic equillibrium, or middle resting point that all organisms thrive to be at during all points

Limbic system

consists of the amygdala and hippocampus, thalamus, etc

• Controls our fight, flight, freeze response

• Regulates our emotional responses to stimuli

• Controls our stress response

Amygdala

• evaluates emotional stimuli and influences emotional memory and determines the emotional meaning of events

• Hippocampus

• forms memory and the retrieval of memory

  • Can help us in our stress response

Trauma causes a hyperactive _______ and smaller ______

amygdala, hippocampus

Pre-frontal cortex

dictates the response to the stressor or emotion

Two systems at work in the stress response system are:

neurotransmiiter system and neuroendocrine system

Neurotransmitter system

• Sympathetic nervous system is activated and controls the adrenal glands

  • When stress is triggered, adrenaline (epinephrine) and norepinephrine are released

Neuroendocrine system

• controls the HPA axis that is triggered during stress responses

  • HPA has the secretion of cortisol which prepares the body for fight/flight response

The two modes of operation in the stress response system are:

acute and chronic

Acute stress response

behavioral flight-flight response which serves to respond to immediate danger

Chronic stress response

• promotes long-term adaptation and recovery to stress

  • Chronic traumatic stress causes an excess of cortisol to change brain structure, lead to less of some neurons, and growth of other types of neurons

Stress is not always ___

bad

• A normal response to threat is necessary for survival and can heighten our awareness and performance

• There are positive types of stress

Each person's different intrinsic stress response system is determined by:

• Genetic background

• Early life traumatic experiences/early life experiences

  • If it happens 3 and under, this has more long-lasting consequences due to brain development

• Amount of chronic stress and subsequent changes in the brain function and structure

  • Can change brain size, PFC and emotional cortex, neural networks, etc that change stress response

• Temperament

The onset of PTSD is facilitated by a failure to ….

contain the biological stress response at the time of the trauma, resulting in a cascade of alterations that lead to intrusive recollections of the event, avoidance of the reminders of the event and symptoms of hyperarousal

The limbic system communicates with the _______ to assess the potential threat and activate the stress response

prefrontal cortex

The HPA Axis communicates with the rest of the organs through receptors (MR and GR) and the release of _______

cortisol

A traumatic event that occurs from ages _____ may be more likely to have lasting consequences on brain development and function than one that happens when a child is older

0-3 years

epigenetics

the study of the functional modifications of the genome that do not involve a DNA nucleotide change (how the environment changes genetic outcomes)

Different alleles lead to different ________(observable characteristics of an individual resulting from the interaction of its genotype with the environment)

phenotypes

risk allele

gene variant that increases your likelihood of developing a problem.

The interaction between the ______ and the environment leads to both positive and negative

allele

__________ and _____________ alter the expression of genetic material

DNA methylation and histone acetylation