PAC 414 Module 7 Trauma and the Needs of Maltreated Children Example

A Brain Built for Danger: Trauma, Long-Term Risk and Trauma-Focused Treatment for a Nine-Year-Old in Kinship Care

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 414: Child Abuse and Neglect

Instructor Name

Month Day, Year

A Brain Built for Danger: Trauma, Long-Term Risk and Trauma-Focused Treatment for a Nine-Year-Old in Kinship Care

Maya is nine and has lived with her maternal grandmother in Wichita for five months. For two years before that, she lived with her mother, who used methamphetamine daily, and her mother's boyfriend, who hit Maya when she cried or made noise. Child protective services placed her with her grandmother after a teacher saw bruises on her arms. Her mother is now in residential treatment. Maya flinches when adults raise their voices, startles at slammed doors, sleeps with the light on and rarely smiles. She has fallen a year behind in reading. She is also kind to younger children, loves drawing animals and has formed a close bond with her grandmother's dog. Her caseworker at Heartland is planning her services. Maya, her grandmother and her mother are fictional; the neuroscience and treatment research are not.

How Maltreatment Shapes the Developing Brain

Teicher and Samson (2016) reviewed research on the neurobiological effects of childhood abuse and neglect. They described consistent differences in the brains of maltreated children and adults, including in regions involved in detecting threat, such as the amygdala, in regions involved in memory, such as the hippocampus, and in prefrontal regions that regulate emotion. Maltreated individuals often showed heightened responses to threatening faces and reduced responses to anticipated reward. The authors proposed that these changes may be adaptations that help children survive in dangerous environments, by making them quick to detect threat, but that they carry costs in safer settings, such as anxiety, difficulty feeling pleasure and vulnerability to psychiatric disorders. They also proposed that maltreated people with psychiatric disorders may represent a distinct subtype, with earlier onset and differing responses to treatment.

Maya's startle, vigilance and flat mood fit this account: her brain learned that danger could come at any moment.

Long-Term Risks

Norman et al. (2012) conducted a meta-analysis of studies on the long-term health consequences of physical abuse, emotional abuse and neglect. Each form of maltreatment was associated with higher risk of depressive disorders, anxiety disorders, suicide attempts, drug use and risky sexual behavior in later life. The associations were found across many studies and settings. The authors concluded that preventing maltreatment and helping children who have experienced it could reduce a substantial burden of later illness.

The findings describe increased risk, not fate. Many maltreated children do well, especially when they have safe, stable caregivers and effective treatment.

Trauma-Focused Treatment

Cohen et al. (2004) compared trauma-focused cognitive behavioral therapy with child-centered therapy for children aged eight to fourteen with posttraumatic stress symptoms related to sexual abuse, along with their caregivers. Trauma-focused therapy included psychoeducation, relaxation, recognizing and expressing feelings, recognizing the links between thoughts, feelings and behavior, gradually creating a narrative of the trauma and correcting distorted beliefs, enhancing safety and parallel sessions with caregivers. Children who received trauma-focused therapy showed greater improvement in posttraumatic stress, depression, behavior problems, shame and beliefs about the abuse, and their caregivers showed reduced distress and improved parenting. The treatment has since been tested with children who experienced other kinds of trauma, including physical abuse.

Maya's Needs

The Plan

Maya will begin weekly trauma-focused cognitive behavioral therapy with a therapist trained in the model, with her grandmother attending parallel caregiver sessions. In early sessions, Maya will learn about trauma reactions and practice relaxation and naming feelings, using her drawings. Later, when she is ready, she will create a narrative of her experiences at her own pace. Her grandmother will learn to respond calmly to Maya's startle and nightmares and to praise her coping. The caseworker will meet with Maya's school to set up reading help and a quiet space she can use when overwhelmed. Contact with her mother, who is in residential treatment, will begin with letters and supervised visits, as her mother's treatment team and Maya's therapist agree it is safe and as Maya wishes. Her grandmother, who is sixty-eight, will receive kinship caregiver support, including respite and a support group.

Her Grandmother's Role

Maya's grandmother is the most important part of her treatment. Children recover from trauma within relationships, and the caregiver sessions in trauma-focused therapy exist because a calm, predictable adult who understands trauma reactions can help a child more than any hour in a therapist's office. At sixty-eight, Maya's grandmother is also grieving her daughter's addiction, managing her own health and adjusting to raising a child again. She sometimes takes Maya's flinching personally or worries that she is doing something wrong. The caregiver sessions will help her understand Maya's reactions as trauma responses and give her specific ways to respond, while the kinship support group gives her a place to talk with other grandparents in the same situation.

Contact With Her Mother

Maya asks about her mother often and keeps a photograph of her by the bed. Contact can be healing or harmful depending on timing and preparation. Maya's therapist, her mother's treatment team and the caseworker will decide together when contact begins, starting with letters, which allow Maya to respond at her own pace, then supervised visits. Her mother's boyfriend, who abused Maya, will have no contact. Maya's own wishes, expressed to her therapist, will guide the pace.

Conclusion

Maya's vigilance and sadness reflect a brain that adapted to danger, as Teicher and Samson describe, and Norman and colleagues show that maltreatment raises risks for her future health. Cohen and colleagues show that trauma-focused treatment, with her grandmother involved, can reduce her symptoms. A plan that provides safety, treatment, school support and careful contact with her mother gives Maya's brain and her life a chance to adapt to safety.

References

Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393-402. https://doi.org/10.1097/00004583-200404000-00005

Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLOS Medicine, 9(11), e1001349. https://doi.org/10.1371/journal.pmed.1001349

Teicher, M. H., & Samson, J. A. (2016). Annual research review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241-266. https://doi.org/10.1111/jcpp.12507