Child Development and Trauma Guide

Child development and trauma guide

Some important points about this guide This guide has been prepared because of the importance of professionals in the Out-of-Home Care, Child Protection and Individual and Family Support areas to understand the typical developmental pathways of children and the typical indicators of trauma at differing ages and stages. It is intended to inform good practice and assist with the task of an overall assessment, and of itself is not a developmental or risk assessment framework. Rather, it is a prompt for busy workers to integrate knowledge from child development, child abuse and trauma and importantly to offer practical, age appropriate advice as to the needs of children and their parents and carers when trauma has occurred. Engaging families, carers, significant people and other professionals who know the child well as a source of information about the child, will result in a more complete picture. It is essential to have accurate information about the values and child rearing practices of the cultural group to which a child belongs, in order to appreciate that child’s development. The following points give an essential perspective for • Development does not occur in a straight line or using the information in the child development and evenly. Development progresses in a sequential trauma resource sheets about specific age groups: manner, although it is essential to note that while the path of development is somewhat predictable, • Children, even at birth, are not ‘blank slates’; they there is variation in what is considered normal are born with a certain neurological make-up and development. That is to say no two children develop temperament. As children get older, these individual in exactly the same way. differences become greater as they are affected by their experiences and environment. This is • The pace of development is more rapid in the very particularly the case where the child is born either early years than at any other time in life. drug dependent or with foetal alcohol syndrome. • Every area of development impacts on other areas. • Even very young babies differ in temperament eg. Developmental delays in one area will impact on activity level, amount and intensity of crying, ability the child’s ability to consolidate skills and progress to adapt to changes, general mood, etc. through to the next developmental stage. • From birth on, children play an active role in their own • Most experts now agree that both nature and development and impact on others around them. nurture interact to influence almost every significant aspect of a child’s development. • Culture, family, home and community play an important role in children’s development, as they • General health affects development and behaviour. impact on a child’s experiences and opportunities. Minor illnesses will have short to medium term Cultural groups are likely to have particular values, effects, while chronic health conditions can have priorities and practices in child rearing that will long-term effects. Nutritional deficiencies will influence children’s development and learning of also have negative impacts on developmental particular skills and behaviours. The development of progression. children from some cultural backgrounds will vary from traditional developmental norms, which usually Specific characteristics and behaviours are indicative reflect an Anglo-Western perspective. only. Many specific developmental characteristics should be seen as ‘flags’ of a child’s behaviour, which • As children get older, it becomes increasingly difficult may need to be looked at more closely, if a child is not to list specific developmental milestones, as the meeting them. Workers should refer to the Casework achievement of many of these depends very much Practice Manual and relevant specialist assessment on the opportunities that the child has to practise guides in undertaking further assessments of child them, and also, on the experiences available to the and family. child. A child will not be able to ride a bicycle unless they have access to a bicycle. Some important points about development The information in this resource provides a brief overview of typically developing children. Except where there are obvious signs, you would need to see a child a number of times to establish that there is something wrong. Keep in mind that if children are in a new or ‘artificial’ situation, unwell, stressed, interacting with someone they do not know, or if they need to be fed or changed, then their behaviour will be affected and is not likely to be typical for that child. Premature babies, or those with low birth weights, or a chemical dependency, will generally take longer to reach developmental milestones.

The indicators of trauma listed in this guide should not have no choice given their age and vulnerability, and become judgements about the particular child or family in more chronic and extreme circumstances, they made in isolation from others who know the child will show a complex trauma response. They can and family well, or from other sources of information. eventually make meaning of their circumstances by However, they are a useful alert that a more thorough believing that the abuse is their fault and that they contextual assessment may be required. are inherently bad. There has been an explosion of knowledge in regard • Infants, children and adults will adapt to frightening to the detrimental impact of neglect and child abuse and overwhelming circumstances by the body’s trauma on the developing child, and particularly on survival response, where the autonomic nervous the neurological development of infants. It is critical system will become activated and switch on to the to have a good working knowledge of this growing freeze/fight/flight response. Immediately the body is evidence base so that we can be more helpful to flooded with a biochemical response which includes families and child focused. adrenalin and cortisol, and the child feels agitated and hypervigilant. Infants may show a ‘frozen The following basic points are useful to keep in mind watchfulness’ and children and young people can and to discuss with parents and young people: dissociate and appear to be ‘zoned out’. • Children need stable, sensitive, loving, stimulating • Prolonged exposure to these circumstances can relationships and environments in order to reach lead to ‘toxic stress’ for a child which changes the their potential. They are particularly vulnerable to child’s brain development, sensitises the child to witnessing and experiencing violence, abuse and further stress, leads to heightened activity levels neglectful circumstances. Abuse and neglect at the and affects future learning and concentration. Most hands of those who are meant to care is particularly importantly, it impairs the child’s ability to trust and distressing and harmful for infants, children and relate to others. When children are traumatised, they adolescents. find it very hard to regulate behaviour and soothe or • Given that the infant’s primary drive is towards calm themselves. They often attract the description attachment, not safety, they will accommodate to of being ‘hyperactive’. the parenting style they experience. Obviously they

0 - 12 months  12 months - 3 years  3 - 5 years  5 - 7 years  7 - 9 years  9 - 12 years  12 - 18 years • Babies are particularly attuned to their primary • Cumulative harm can overwhelm the most resilient carer and will sense their fear and traumatic stress; child and particular attention needs to be given this is particularly the case where family violence is to understanding the complexity of the child’s present. They will become unsettled and therefore experience. These children require calm, patient, more demanding of an already overwhelmed parent. safe and nurturing parenting in order to recover, The first task of any service is to support the and may well require a multi-systemic response to nonoffending parent and to engage the family engage the required services to assist. in safety. • The recovery process for children and young people • Traumatic memories are stored differently in the is enhanced by the belief and support of non- brain compared to everyday memories. They offending family members and significant others. are encoded in vivid images and sensations and They need to be made safe and given opportunities lack a verbal narrative and context. As they are to integrate and make sense of their experiences. unprocessed and more primitive, they are likely to • It is important to acknowledge that parents can flood the child or adult when triggers like smells, have the same post-traumatic responses and sights, sounds or internal or external reminders may need ongoing support. Workers need to present at a later stage. engage parents in managing their responses to • These flashbacks can be affective, i.e. intense their children’s trauma. It is normal for parents to feelings, that are often unspeakable; or cognitive, i.e. feel overwhelmed and suffer shock, anger, severe vivid memories or parts of memories, which seem to grief, sleep disturbances and other trauma related be actually occurring. Alcohol and drug abuse are responses. Case practice needs to be child centred the classic and usually most destructive attempts to and family sensitive. numb out the pain and avoid these distressing and intrusive experiences. • Children are particularly vulnerable to flashbacks at quiet times or at bedtimes and will often avoid both, by acting out at school and bedtimes. They can experience severe sleep disruption, intrusive nightmares which add to their ‘dysregulated’ behaviour, and limits their capacity at school the next day. Adolescents will often stay up all night to avoid the nightmares and sleep in the safety of the daylight. Self harming behaviours release endorphins which can become an habitual response.

0 - 12 months  12 months - 3 years  3 - 5 years  5 - 7 years  7 - 9 years  9 - 12 years  12 - 18 years Factors which pose risks to healthy child development The presence of one or more risk factors, alongside a cluster of trauma indicators, may greatly increase the risk to the child’s wellbeing and should flag the need for further child and family assessment. The following risk factors can impact on children and families and the caregiving environment:

Child and family risk factors • inattention to developmental health needs/poor diet • family violence, current or past • disadvantaged community • mental health issue or disorder, current or past • racism (including self-harm and suicide attempts) • recent refugee experience • alcohol/substance abuse, current or past, addictive behaviours Parent risk factors • disability or complex medical needs eg. intellectual • parent/carer under 20 years or under 20 years at or physical disability, acquired brain injury birth of first child • newborn, prematurity, low birth weight, chemically • lack of willingness or ability to prioritise child’s needs dependent, foetal alcohol syndrome, feeding/ above own sleeping/settling difficulties, prolonged and frequent crying • rejection or scapegoating of child • unsafe sleeping practices for infants eg. side or • harsh, inconsistent discipline, neglect or abuse tummy sleeping, ill-fitting mattress, cot cluttered • inadequate supervision of child or emotional with pillows, bedding, or soft toys which can cover enmeshment infant’s face, co-sleeping with sibling or with parent who is on medication, drugs/alcohol or smokes, • single parenting/multiple partners using other unsafe sleeping place such as a couch, • inadequate antenatal care or alcohol/substance or exposure to cigarette smoke abuse during pregnancy • disorganised or insecure attachment relationship (child does not seek comfort or affection from Wider factors that influence positive caregivers when in need) outcomes • developmental delay • sense of belonging to home, family, community and • history of neglect or abuse, state care, child death a strong cultural identity or placement of child or siblings • pro-social peer group • separations from parents or caregivers • positive parental expectations, home learning • parent, partner, close relative or sibling with a history environment and opportunities at major life of assault, prostitution or sexual offences transitions • experience of intergenerational abuse/trauma • access to child and adult focused services eg. health, mental health, maternal and child health, • compounded or unresolved experiences of loss early intervention, disability, drug and alcohol, family and grief support, family preservation, parenting education, • chaotic household/lifestyle/problem gambling recreational facilities and other child and family support and therapeutic services • poverty, financial hardship, unemployment • accessible and affordable child care and high quality • social isolation (family, extended family, community preschool programs and cultural isolation) • inclusive community neighbourhoods/settings • inadequate housing/transience/homelessness • service system’s understanding of neglect and abuse. • lack of stimulation and learning opportunities, disengagement from school, truanting

0 - 12 months  12 months - 3 years  3 - 5 years  5 - 7 years  7 - 9 years  9 - 12 years  12 - 18 years Resources

Other useful websites Western Australian Government The Raising Children Network Department for Child Protection raisingchildren.net.au www.dcp.wa.gov.au An essential part of this resource is the references to Provides a range of child safety and family support the Raising Children Network. This is an Australian services to Western Australian individuals, children website, launched in 2006, on the basics of raising and their families. children aged 0-15 years. Centre for Parenting Excellence Talaris Developmental Timeline www.dlgc.wa.gov.au/communityInitiatives/Pages/ www.talaris.org Centre-for-Parenting-Excellence A research based timeline about how children Works with community sector providers to improve develop in the first five years. the availability and quality of parenting services.

Infant Mental Health WA Health www.zerotothree.org www.health.wa.gov.au Zero to Three website has a relational and mental WA Health is responsible for promoting, maintaining health focus. and restoring the health of the people of WA, including the provision of child health and child Secretariat of National Aboriginal and Islander adolescent mental health services. Child Care (SNAICC) www.snaicc.org.au Department of Education Student The national non-government peak body in Australia Support Services representing the interests of Aboriginal and Torres http://det.wa.edu.au/studentsupport/detcms/portal/ Strait Islander children and families.

Parenting Research Centre Trauma websites www.parentingrc.org.au Child Trauma Academy Independent non-profit research and development www.childtrauma.org organisation with an exclusive focus on parenting. International Society for Traumatic Stress Studies Ngala www.istss.org www.ngala.com.au Traumatic Stress Institute/Center for Adult & A provider of early parenting and early childhood Adolescent Psychotherapy services. The website includes parenting information on antenatal and 0-4 years. www.tsicaap.com

Telephone services healthdirect Australia (24 hour) 1800 022 222

Family Helpline (08) 9223 1100 or 1800 643 000 Monaghan, C. 1993, ‘Children and Trauma: A Guide Acknowledgements for Parents and Professionals.’ Jossey-Bass, San The Department of Communities, Western Australia Francisco. acknowledges the Department of Human Services, Paxton, G and Munro, J and Marks, M. (Editors), Victoria for providing the content of this document. 2003, ‘Paediatric Handbook, Seventh Edition’ by Some changes have been made to reflect resources the staff of the Royal Children’s Hospital. Blackwell that are relevant to Western Australia. Publishing Pty Ltd, Melbourne, Victoria. Jim Greenman and Anne Stonehouse, 1996, Prime Bibliography Times: a Handbook for Excellence in Infant and Raising Children Network raisingchildren.net.au Toddler Care (1st edition), Redleaf Press, St Paul Minnesota. Zero to Three website www.zerotothree.org Sheridan, M. Revised and updated by Frost, M and Levy, T.M and Orlans, M. 1998, Attachment, Trauma Dr Sharma, A. 1988, ‘From Birth to Five Years: and Healing. CWLA Press, Washington. Children’s Developmental Progress’. ACER press. Department of Human Services, May 2001, Child Shonkoff, Jack. P. and Phillips, Deborah. A. 2000, Health and Development: Birth to 18 Years for ‘From Neurons to Neighbourhoods: the Science of Professionals (Chart), Melbourne, Victoria. Early Childhood Development’, National Research Frederico, M., Jackson, A. and Jones, S. July 2006, Council Institute of Medicine, National Academy Press, ‘Child Death Group Analysis: Effective Responses to Washington DC. Chronic Neglect.’ Victorian Child Death Review Committee. Office of the Child Safety Commissioner, Melbourne, Victoria. Child development and trauma guide 0 - 12 months

Developmental trends

The following information needs to be understood in the context of the overview statement on child development:

0-2 weeks ••anticipates in relationship with caregivers ••is unable to support head unaided ••startles at sudden loud noises through facial expression, gazing, fussing, ••hands closed involuntarily in the grasp reflex ••reflexively asks for a break by looking away, crying arching back, frowning, and crying

By 4 weeks ••focuses on a face ••follows an object moved in an arc about ••changes vocalisation to communicate hunger, 15 cm above face until straight ahead boredom and tiredness

By 6-8 weeks ••participates in and initiates interactions with ••may start to smile at familiar faces ••turns in the direction of a voice caregivers through vocalisation, eye contact, ••may start to ‘coo’ fussing, and crying

By 3-4 months ••increasing initiation of interaction with ••may reach for things to try and hold them May even be able to: caregivers ••learns by looking at, holding, and mouthing ••keep head level with body when pulled to ••begins to regulate emotions and self soothe different objects sitting through attachment to primary carer ••laughs out loud ••say “ah”, “goo” or similar vowel consonant combinations ••can lie on tummy with head held up to ••follows an object in an arc about 15 cm 90 degrees, looking around above the face for 180 degrees (from one ••blow a raspberry ••can wave a rattle, starts to play with own side to the other) ••bear some weight on legs when held upright fingers and toes ••notices strangers ••object if you try to take a toy away

By 6 months ••uses carer for comfort and security as ••says “ah”, “goo” or similar vowel consonant ••may even be able to roll both ways and help to attachment increases combinations feed himself ••is likely to be wary of strangers ••sits without support ••learns and grows by touching and tasting ••keeps head level with body when pulled ••makes associations between what is heard, different foods to sitting tasted and felt

By 9 months ••strongly participates in, and initiates and imitates happy, sad,excited or fearful ••learns to trust that basic needs will be met interactions with, caregivers emotions ••works to get to a toy out of reach ••lets you know when help is wanted and ••unusually high anxiety when separated from ••looks for a dropped object communicates with facial expressions, parents/carers •may even be able to bottom shuffle, crawl, gestures, sounds or one or two words like • ••is likely to be wary of, and anxious with, stand “dada” and “mamma” strangers ••knows that a hidden object exists ••watches reactions to emotions and by seeing ••expresses positive and negative emotions you express your feelings, starts to recognise ••waves goodbye, plays peekaboo Child development and trauma guide 0 - 12 months

Possible indicators of trauma

••increased tension, irritability, reactivity, and ••loss of eating skills ••avoids touching new surfaces eg. grass, sand inability to relax ••loss of acquired motor skills and other tactile experiences ••increased startle response ••avoidance of eye contact ••avoids, or is alarmed by, trauma related reminders, eg sights, sounds, smells, ••lack of eye contact •arching back/inability to be soothed • textures, tastes and physical triggers ••sleep and eating disruption ••uncharacteristic aggression •loss of acquired language skills ••fight, flight, freeze response ••unusually high anxiety when separated from • primary caregivers ••uncharacteristic, inconsolable or rageful crying, and neediness ••heightened indiscriminate attachment ••genital pain: including signs of inflammation, behaviour ••increased fussiness, separation fears, bruising, bleeding or diagnosis of sexually and clinginess ••reduced capacity to feel emotions – can transmitted disease appear ‘numb’ ••withdrawal/lack of usual responsiveness ••‘frozen watchfulness’ ••limp, displays no interest

Trauma impact

••neurobiology of brain and central nervous ••regression in recently acquired developmental ••loss of acquired motor skills system altered by switched on alarm gains ••lowered stress threshold response ••hyperarousal, hypervigilance and hyperactivity ••lowered immune system ••behavioural changes ••sleep disruption

••fear response to reminders of trauma ••insecure, anxious, or disorganised ••cognitive delays and memory difficulties ••mood and personality changes attachment behaviour ••loss of acquired communication skills ••loss of, or reduced capacity to attune with ••heightened anxiety when separated from caregiver primary parent/carer ••loss of, or reduced capacity to manage ••indiscriminate relating emotional states or self soothe ••reduced capacity to feel emotions - can appear ‘numb’

Parental / carer support following trauma

Encourage parent(s)/carers to: ••avoid unnecessary separations from important caregivers ••seek, accept and increase support for themselves, to manage their ••maintain calm atmosphere in child’s presence. Provide additional own shock and emotional responses soothing activities ••seek information and advice about the child’s developmental progress ••avoid exposing child to reminders of trauma ••maintain the child’s routines around holding, sleeping and eating ••expect child’s temporary regression; and clinginess - don’t panic ••seek support (from partner, kin, child health nurse) to understand, ••tolerate clinginess and independence and respond to, infant’s cues ••take time out to recharge

Developmental trends

The following information needs to be understood in the context of the overview statement on child development:

By 12 months

••enjoys communicating with family and other ••does not like to be separated from familiar ••picks up objects using thumb and forefinger in familiar people people opposition (pincer) grasp ••seeks comfort, and reassurance from familiar ••moves away from things that upset or annoy ••is sensitive to approval and disapproval objects, family, carers, and is able to be ••can walk with assistance holding on to May even be able to: soothed by them furniture or hands ••understand cause and effect ••begins to self soothe when distressed ••pulls up to standing position ••understand that when you leave, you still exist ••understands a lot more than he can say ••gets into a sitting position ••crawl, stand, walk ••expresses feelings with gestures sounds and ••claps hands (play pat-a-cake) ••follow a one step instruction – “go get your facial expressions ••indicates wants in ways other than crying shoes” ••expresses more intense emotions and moods ••learns and grows in confidence by doing ••respond to music things repeatedly and exploring

By 18 months

••can use at least two words and learning ••says “no” a lot May even be able to: many more ••is beginning to develop a sense of individuality ••let you know what he is thinking and feeling through gestures ••drinks from a cup ••needs structure, routine and limits to manage ••can walk and run intense emotions ••pretend play and play alongside others

By 2 years

••takes off clothing ••plays alone but needs a familiar adult nearby May even be: ••‘feeds’/‘bathes’ a doll, ‘washes’ dishes, ••actively plays and explores in complex ways ••able to string words together likes to ‘help’ ••eager to control, unable to share ••builds a tower of four or more cubes ••unable to stop himself doing something ••recognises/identifies two items in a picture unacceptable even after reminders by pointing ••tantrums

By 2 1/2 years

••uses 50 words or more ••follows a two-step command without gestures ••helps with simple household routines ••combines words (by about 25 months) (by 25 months) ••conscience is undeveloped; child thinks ••alternates between clinginess and “I want it, I will take it” independence

By 3 years

••washes and dries hands ••uses prepositions (by, to, in, on top of) ••conscience is starting to develop; child thinks ••identifies a friend by naming ••carries on a conversation of two or three “I would take it but my parents will be upset with me” ••throws a ball overhand sentences ••speaks and can be usually understood half ••helps with simple chores the time ••may be toilet trained Child development and trauma guide 12 months - 3 years

Possible indicators of trauma

••behavioural changes, regression to behaviour ••sleep and eating disruption ••uncharacteristic aggression of a younger child ••loss of eating skills ••avoids touching new surfaces eg. grass, sand ••increased tension, irritability, reactivity, and and other tactile experiences •loss of recently acquired motor skills inability to relax • ••avoids, or is alarmed by, trauma related ••avoidance of eye contact ••increased startle response reminders, eg sights, sounds, smells textures, ••inability to be soothed tastes and physical triggers ••reduced eye contact

••fight, flight, freeze ••unusually anxious when separated from ••loss of acquired language skills primary caregivers ••uncharacteristic, inconsolable, or rageful ••inappropriate sexualised behaviour/ touching ••heightened indiscriminate attachment crying, and neediness ••sexualised play with toys behaviour ••fussiness, separation fears, and clinginess ••genital pain, inflammation, bruising, bleeding •reduced capacity to feel emotions – can • or diagnosis of sexually transmitted disease ••withdrawal/lack of usual responsiveness appear ‘numb’, apathetic or limp ••loss of self-confidence ••‘frozen watchfulness’

Trauma impact

••fear response to reminders of trauma ••insecure, anxious, or disorganised ••memory for trauma may be evident in ••mood and personality changes attachment behaviour behaviour, language or play ••loss of, or reduced capacity to attune with ••heightened anxiety when separated from ••cognitive delays and memory difficulties caregiver primary parent/carer ••loss of acquired communication skills ••loss of, or reduced capacity to manage ••indiscriminate relating emotional states or self soothe ••increased resistance to parental direction

Parental / carer support following trauma

takes time making up his mind is learning about differences between people between is learning about differences extends the circle of special adults eg. to extends the circle baby-sitter grandparents, is asking lots of questions understands the cause of feelings and can understands the cause of feelings and can label them and limits to manage routine needs structure, intense emotions developing capacity to self soothe when distressed family independent from is becoming more seeks comfort, and reassurance from familiar familiar from seeks comfort, and reassurance and is able to be soothed family and carers, by them knows own name and age communicates freely with family members communicates freely and familiar others • • • • • • • • • • • • • • • • • • • • • • 3 - 5 years 3 - 5 Child development and trauma guide and trauma development Child The following information needs to be understood in the context of the overview statement on child development: in the context of the overview statement needs to be understood The following information Child development and trauma guide 3 - 5 years

Possible indicators of trauma

••behavioural change ••loss of focus, lack of concentration and ••sleep disturbances, nightmares, night terrors, inattentiveness sleepwalking ••increased tension, irritability, reactivity and inability to relax ••complains of bodily aches, pains or illness ••fearfulness of going to sleep and being alone with no explanation at night ••regression to behaviour of younger child ••loss of recently acquired skills (toileting, ••inability to seek comfort or to be comforted •uncharacteristic aggression • eating, self-care) ••Reduced eye contact ••enuresis, encopresis

••sudden intense masturbation ••mood and personality changes ••reduced capacity to feel emotions - may appear ‘numb’, limp, apathetic ••demonstration of adult sexual knowledge ••obvious anxiety and fearfulness ••repeated retelling of traumatic event through inappropriate sexualised behaviour ••withdrawal and quieting ••loss of recently acquired language and ••genital pain, inflammation, bruising, bleeding ••specific, trauma-related fears; general vocabulary or diagnosis of sexually transmitted disease fearfulness ••loss of interest in activities ••sexualised play with toys ••intense repetitive play often obvious ••loss of energy and concentration at school ••may verbally describe sexual abuse, pointing ••involvement of playmates in trauma related to body parts and telling about the ‘game’ play at school and day care they played ••separation anxiety with parents/others ••sexualised drawing ••loss of self-esteem and self confidence

Trauma impact

••behavioural changes ••regression in recently acquired developmental ••enuresis and encopresis ••hyperarousal, hypervigilance, hyperactivity gains ••delayed gross motor and visualperceptual ••loss of toileting and eating skills ••sleep disturbances, night terrors skills

••fear of trauma recurring ••loss of self-esteem and self confidence ••memory of intrusive visual images from ••mood and personality changes ••confusion about trauma evident in traumatic event may be demonstrated/ recalled in words and play ••loss of, or reduced capacity to attune with play, magical explanations and unclear caregiver understanding of causes of bad events ••at the older end of this age range, children are more likely to have lasting, accurate •loss of, or reduced capacity to manage ••vulnerable to anniversary reactions set off • verbal and pictorial memory for central events emotional states or self soothe by seasonal reminders, holidays, and other events of trauma ••increased need for control ••speech, cognitive and auditory processing ••fear of separation delays

Parental / carer support following trauma

Encourage parent(s)/carers to: ••accept and help the child to name strong feelings during brief ••seek, accept and increase support for themselves, to manage their conversations (the child cannot talk about these feelings or the own shock and emotional responses experience for long) ••remain calm. Listen to and tolerate child’s retelling of event ••expect and understand child’s regression while maintaining basic household rules ••respect child’s fears; give child time to cope with fears ••expect some difficult or uncharacteristic behaviour ••protect child from re-exposure to frightening situations and reminders of trauma, including scary T.V. programs, movies, stories, and physical ••seek information and advice about child’s developmental and or locational reminders of trauma educational progress ••take time out to recharge

Copyright © State of Victoria, Australia. Reproduced with permission of the Secretary of the Department of Human Services. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. DCP150.0112 5 - 7 years bodily aches and pains – no apparent reason bodily aches and pains – no apparent accident proneness school absconding/truanting from hurting animals firelighting, exploitative, sexualised explicit, aggressive, with other children, relating/engagement or adults older children verbally describes experiences of sexual abuse pointing to body parts and telling about the ‘game’ they played sexualised drawing with excessive concern or preoccupation private parts and adult sexual behaviour hinting about sexual experience and sexualised drawing verbal or behavioural indications of age- knowledge of adult sexual inappropriate behaviour home running away from some may be able to ride bicycle some may be able to and skill to make may use hands with dexterity things things, do craft and build may need help moving into and becoming part of a group friendships will maintain strong some children over the period may have mood swings although not all the time able to share, for self, fairly of, and level of regard perception well developed most valuable learning play occurs through likely to be followed if he/she has rules more contributed to them urges to make creative may have strong things • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Physical skills Developmental trends Developmental Possible indicators of trauma lack of eye contact ‘spacey’, distractible, or hyperactive behaviour or encopresis toileting accidents/enuresis, smearing of faeces eating disturbances of traumatic event retelling repeated affect withdrawal, depressed ‘blanking out’ or loss of concentration when at school with lowering of under stress performance Social-emotional development variation in levels of coordination and skill variation in levels of coordination skills, in proficient many become increasingly games, sports conscience is starting to be influenced by or doing the right thing internal control found out, “I would take it, but if my parents they would be disapproving” not fully capable of estimating own abilities, may become frustrated by failure routines by predictable reassured very important, although they friendships are may change regularly may require verbal, written or behavioural verbal, written or behavioural may require and to follow directions cues and reminders obey rules skills in listening and understanding may be advanced than expression more as experiences at perspective broadens school and in the community expand • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Cognitive and creative characteristics

vulnerable to anniversary reactions caused vulnerable to anniversary reactions by seasonal events, holidays, etc ‘frozen watchfulness’ ‘frozen reduced capacity to feel emotions - may reduced appear ‘numb’, or apathetic efforts to distance from feelings of shame, to distance from efforts capacity to guilt, humiliation and reduced feel emotions specific fears frightened by own intensity of feelings obvious anxiety, fearfulness and loss of obvious anxiety, self esteem regression to behaviour of younger child regression sleep disturbances, nightmares, night terrors, night terrors, sleep disturbances, nightmares, difficulty falling or staying asleep increased tension, irritability, reactivity and reactivity tension, irritability, increased inability to relax behavioural change may tire easily may tire active, involved in physical activity, activity, active, involved in physical play vigorous generally anxious to please and to gain adult generally anxious to please and to gain adult praise and reassurance approval, needs caregiver assistance and structure to assistance and structure needs caregiver of emotion extremes regulate has strong relationships within the family and within the family relationships has strong integral place in family dynamics good communication skills, remembers, tells good communication skills, remembers, and enjoys jokes variable attention and ability to stay on task; variable attention and ability to stay on task; attends better if interested emerging literacy and numeracy abilities, and writing gaining skills in reading • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

• The following information needs to be understood in the context of the overview statement on child development: in the context of the overview statement needs to be understood The following information

5 - 7 years 5 - 7 Child development and trauma guide and trauma development Child • • • • • • Child development and trauma guide 5 - 7 years

Trauma impact

••changes in behaviour ••trauma driven, acting out, risk taking ••post-traumatic re-enactments of traumatic ••hyperarousal, hypervigilance, hyperactivity behaviour event that may occur secretly and involve siblings or playmates ••regression in recently acquired developmental ••eating disturbances gains ••loss of concentration and memory ••loss of interest in previously pleasurable activities ••sleep disturbances due to intrusive imagery ••flight into driven activity or retreat from others ••enuresis and encopresis to manage inner turmoil

••fear of trauma recurring ••may experience acute distress when ••child is likely to have detailed, long-term and ••mood or personality change encountering any reminder of trauma sensory memory for traumatic event ••loss of, or reduced capacity to attune with ••lowered self-esteem ••Sometimes the memory is fragmented or caregiver ••increased anxiety or depression repressed ••loss of, or reduced capacity to manage ••fearful of closeness and love ••factual, accurate memory may be emotional states or self soothe embellished by elements of fear or wish; perception of duration may be distorted ••increased self-focusing and withdrawal ••intrusion of unwanted visual images and •concern about personal responsibility for • traumatic reactions disrupt concentration trauma and create anxiety often without parent ••wish for revenge and action oriented awareness responses to trauma ••vulnerable to flashbacks of recall and anniversary reactions to reminders of trauma ••speech and cognitive delays

Parental / carer support following trauma

Encourage parent(s)/carers to: ••expect some time-limited decrease in child’s school performance and ••seek, accept and increase support for themselves to manage their help the child to accept this as a temporary result of the trauma own shock and emotional responses ••protect child from re-exposure to frightening situations and reminders ••listen to and tolerate child’s retelling of event – respect child’s fears; of trauma, including scary television programs, movies, stories, and give child time to cope with fears physical or locational reminders of trauma ••increase monitoring and awareness of child’s play, which may involve ••expect and understand child’s regression or some difficult or secretive re-enactments of trauma with peers and siblings; set limits uncharacteristic behaviour while maintaining basic household rules on scary or harmful play ••listen for a child’s misunderstanding of a traumatic event, particularly ••permit child to try out new ideas to cope with fearfulness at bedtime: those that involve self-blame and magical thinking extra reading time, radio on, listening to a tape in the middle of the ••gently help child develop a realistic understanding of event. Be mindful night to undo the residue of fear from a nightmare of the possibility of anniversary reactions ••reassure the older child that feelings of fear or behaviours that ••remain aware of your own reactions to the child’s trauma. Provide feel out of control or babyish eg. night wetting are normal after a reassurance to child that feelings will diminish over time frightening experience and that the child will feel more like himself or ••provide opportunities for child to experience control and make choices herself with time in daily activities ••encourage child to talk about confusing feelings, worries, daydreams, ••seek information and advice on child’s developmental and educational mental review of traumatic images, and disruptions of concentration progress by accepting the feelings, listening carefully, and reminding child that •provide the child with frequent high protein snacks/meals during the day these are normal but hard reactions following a very scary event • ••take time out to recharge ••maintain communication with school staff and monitor how the child is coping with demands at school or in community activities

Copyright © State of Victoria, Australia. Reproduced with permission of the Secretary of the Department of Human Services. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. DCP150.0112 7 - 9 years toileting accidents/enuresis, encopresis or encopresis toileting accidents/enuresis, smearing of faeces reason bodily aches and pains - no apparent accident proneness school absconding/truanting from hurting animals firelighting, verbally describes experiences of sexual abuse and tells stories about the ‘game’ they played with excessive concern or preoccupation private parts and adult sexual behaviour verbal or behavioural indications of age- knowledge of adult sexual inappropriate behaviour sexualised drawing or written ‘stories’ home running away from may be a competent user of computers or play a musical instrument improved stamina and strength improved peers seen as important, spends more time peers seen as important, spends more with them based on common interests friendships are likely to be enduring and are from feelings of self worth come increasingly peers friendship groups friends often same gender, small can manage own daily routines may experience signs of onset of puberty near end of this age range (girls particularly) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Self concept Physical skills Developmental trends Developmental Possible indicators of trauma lack of eye contact ‘spacey’ or distractible behaviour ‘blanking out’ or lacks concentration when at school with lowering of under stress performance eating disturbances of traumatic event retelling repeated or black outs affect withdrawal, depressed in concentration blanking out/loss of ability to concentrate at school with when under learning stress lowering of performance exploitative, sexualised explicit, aggressive, with other children, relating/engagement or adults older children hinting about sexual experience Social-emotional development has increasingly sophisticated literacy and has increasingly numeracy skills often practises new physical skills over and often practises new physical over for mastery sports and enjoys team and competitive games conscience and moral values become feel good internalised “I want it, but I don’t about doing things like that” independent and confidence, more increased responsibility takes greater understands increased needs reassurance; leads to improvements effort humour is component of interactions with others may compare self with others and find self may compare wanting, not measuring up and curb desires self control can exercise to engage in undesirable behaviour - has understanding of right and wrong • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Cognitive and creative characteristics

vulnerable to anniversary reactions caused vulnerable to anniversary reactions by seasonal events, holidays, etc. reduced capacity to feel emotions - may reduced appear ‘numb’ efforts to distance from feelings of shame, to distance from efforts guilt, humiliation specific post-traumatic fears frightened by own intensity of feelings obvious anxiety, fearfulness and loss of obvious anxiety, self‑esteem regression to behaviour of younger child regression sleep disturbances, nightmares, night terrors, night terrors, sleep disturbances, nightmares, difficulty falling or staying asleep increased tension, irritability, reactivity and reactivity tension, irritability, increased inability to relax behavioural change engages in long and complex conversations can contribute to long-term plans skilled at large motor movements such as skilled at large motor games skipping and playing ball improved coordination, control and agility control coordination, improved to younger children compared able to resolve conflicts verbally and knows able to resolve when to seek adult help begins to see situations from others begins to see situations from perspective – empathy increasingly independent of parents; still needs independent of parents; increasingly their comfort and security is increasingly able to regulate emotions able to regulate is increasingly strong need to belong to, and be a part of, strong family and peer relationships learns with success and failure to deal increasingly influenced by media and by peers increasingly can take some responsibility for self and as a can take some responsibility family member • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 7 - 9 years 7 - 9 Child development and trauma guide and trauma development Child The following information needs to be understood in the context of the overview statement on child development: in the context of the overview statement needs to be understood The following information • • • • • • • • Child development and trauma guide 7 - 9 years

Trauma impact

••changes in behaviour ••enuresis and encopresis ••trauma driven, acting out, risk taking ••hyperarousal, hypervigilance, hyperactivity ••eating disturbances behaviour ••regression in recently acquired developmental ••loss of concentration and memory ••flight into driven activity or retreat from others to manage inner turmoil gains ••post-traumatic re-enactments of traumatic ••sleep disturbances due to intrusive imagery event that may occur secretly and involve ••loss of interest in previously pleasurable siblings or playmates activities

••fear of trauma recurring ••may experience acute distress when ••child is likely to have detailed, long-term ••mood or personality changes encountering any reminder of trauma and sensory memory for traumatic event. Sometimes the memory is fragmented or •loss of, or reduced capacity to attune with ••lowered self-esteem • repressed caregiver ••increased anxiety or depression ••factual, accurate memory may be •loss of, or reduced capacity to manage •fearful of closeness and love • • embellished by elements of fear or wish; emotional states or self soothe perception of duration may be distorted ••increased self-focusing and withdrawal ••intrusion of unwanted visual images and ••concern about personal responsibility for traumatic reactions disrupt concentration trauma and create anxiety often without parent ••wish for revenge and action oriented awareness responses to trauma ••vulnerable to flashbacks of recall and anniversary reactions to reminders of trauma ••speech and cognitive delays

Parental / carer support following trauma

Encourage parent(s)/carers to: ••expect some time-limited decrease in child’s school performance and ••seek, accept and increase support for themselves to manage their help the child to accept this as a temporary result of the trauma own shock and emotional responses ••protect child from re-exposure to frightening situations and reminders ••listen to and tolerate child’s retelling of event – respect child’s fears; of trauma, including scary television programs, movies, stories, and give child time to cope with fears physical or locational reminders of trauma ••increase monitoring and awareness of child’s play, which may involve ••expect and understand child’s regression or some difficult or secretive re-enactments of trauma with peers and siblings; set limits uncharacteristic behaviour while maintaining basic household rules on scary or harmful play ••listen for a child’s misunderstanding of a traumatic event, particularly ••permit child to try out new ideas to cope with fearfulness at bedtime: those that involve self-blame and magical thinking extra reading time, radio on, listening to a tape in the middle of the ••gently help child develop a realistic understanding of event. Be mindful night to undo the residue of fear from a nightmare of the possibility of anniversary reactions ••reassure the older child that feelings of fear or behaviours that feel ••remain aware of your own reactions to the child’s trauma. Provide out of control or babyish eg. night wetting are normal after a reassurance to child that feelings will diminish over time frightening experience and that the child will feel more like himself ••provide opportunities for child to experience control and make choices or herself with time in daily activities ••encourage child to talk about confusing feelings, worries, daydreams, ••seek information and advice on child’s developmental and educational mental review of traumatic images, and disruptions of concentration progress by accepting the feelings, listening carefully, and reminding child that •provide the child with frequent high protein snacks/meals during the day these are normal but hard reactions following a very scary event • ••take time out to recharge ••maintain communication with school staff and monitor how the child is coping with demands at school or in community activities

Copyright © State of Victoria, Australia. Reproduced with permission of the Secretary of the Department of Human Services. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. DCP150.0112 9 - 12 years bodily aches and pains - no reason accident proneness school absconding or truanting from hurting animals firelighting, exploitative, sexualised explicit, aggressive, with other children, relating/engagement or adults older children verbally describes experiences of sexual abuse and tells ‘stories’ about the ‘game’ they played with excessive concern or preoccupation private parts and adult sexual behaviour hinting about sexual experience and telling stories verbal or behavioural indications of age- knowledge of adult sexual inappropriate behaviour sexualised drawing or written ‘stories’ home running away from uses language in sophisticated ways; for example, tells stories, argues, debates between fantasy and knows the difference what is real of the value of money has some appreciation may look more adult-like in body shape, may look more height and weight often interact in pairs or small groups; each often interact in pairs or small groups; member has status and position although interact generally one gender, groups with the other and to have opinions sought desire strong respected • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Physical skills Developmental trends Developmental Possible indicators of trauma Social-emotional development Social-emotional development reduced eye contact reduced ‘spacey’ or distractible behaviour or encopresis toileting accidents/enuresis, smearing of faeces eating disturbances or black outs affect, withdrawal, depressed in concentration ‘blanking out’ or lacks concentration when at school with lowering of under stress performance does well at games/sports requiring skill, requiring does well at games/sports and agility strength concentrates for long periods of time if but needs worries to be sorted interested, may have sophisticated literacy and numeracy skills and major interest of great popular culture influence may experience embarrassment, guilt, curiosity and excitement because of sexual awareness puberty during this time girls may reach important; is extremely belonging to a group peers largely influence identity/self-esteem • • • • • • • • • • • • • • • • • • • • • • • • • •

‘frozen watchfulness’ ‘frozen repeated retelling of traumatic event retelling repeated vulnerable to anniversary reactions caused vulnerable to anniversary reactions by seasonal events, holidays, etc. reduced capacity to feel emotions - may reduced appear ‘numb’ or apathetic efforts to distance from feelings of shame, to distance from efforts capacity to guilt, humiliation and reduced feel emotions specific post-traumatic fears frightened by own intensity of feelings obvious anxiety, fearfulness and loss of self- obvious anxiety, esteem/self confidence regression to behaviour of younger child regression sleep disturbances, nightmares, night sleep disturbances, nightmares, difficulty falling or staying asleep terrors, increased tension, irritability, reactivity and reactivity tension, irritability, increased inability to relax enjoys risk taking large and fine motor skills becoming highly large and fine motor coordinated growing sexual awareness and interest in the and interest sexual awareness growing opposite gender parents and home important, particularly for parents support and reassurance may challenge parents and other family may challenge parents members growing need and desire for independence need and desire growing and separate identity capable of abstract thinking, complex problem capable of abstract thinking, complex problem solving, considers alternative and possibilities perspectives broadening beginning to think and reason in a more logical in a more beginning to think and reason adult-like way • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

9 - 12 years 9 - 12 Child development and trauma guide and trauma development Child Child development and trauma guide 9 - 12 years

Trauma impact

••changes in behaviour ••enuresis and encopresis ••trauma driven, acting out, risk taking ••hyperarousal, hypervigilance, hyperactivity ••eating disturbances behaviour ••regression in recently acquired ••loss of concentration and memory ••flight into driven activity or retreat from others to manage inner turmoil developmental gains ••post-traumatic re-enactments of traumatic ••sleep disturbances due to intrusive imagery event that may occur secretly and involve ••loss of interest in previously pleasurable siblings or playmates activities

Parental / carer support following trauma

secondary sex characteristics affect self secondary sex characteristics affect with others and concept, relationships activities undertaken can be pre-occupied with self can be pre-occupied girls have ‘best friends’, boys have ‘mates’ peer assessment influences self concept, behaviour/need to conform spends time with peers for social and and family emotional needs beyond parents values and a moral system become firmer values and a moral system become firmer views and opinions and affect ability to make decisions (moral) empathy for others may take an interest in/develop opinions may take an interest about community or world events thinks logically, abstractly and solves abstractly thinks logically, thinking like an adult problems, develops greater expertise/skills in sport expertise/skills develops greater significant physical growth and body changes significant physical growth • • • • • • • • • • • • • • The following information needs to be understood in the context of the overview statement on child development: in the context of the overview statement needs to be understood The following information

12 - 18 years 12 - Child development and trauma guide and trauma development Child • • • • • • • • • • Child development and trauma guide 12 - 18 years

Possible indicators of trauma

••increased tension, irritability, reactivity and ••enuresis, encopresis ••aggressive/violent behaviour inability to relax ••eating disturbances/disorders ••firelighting, hurting animals ••accident proneness ••absconding or truanting and challenging ••suicidal ideation ••reduced eye contact behaviours ••self harming eg. cutting, burning ••sleep disturbances, nightmares ••substance abuse

••efforts to distance from feelings of shame ••increased self-focusing and withdrawal ••trauma flashbacks and humiliation ••reduced capacity to feel emotions – may ••acute awareness of parental reactions; wish ••loss of self-esteem and self confidence appear ‘numb’ to protect parents from own distress ••acute psychological distress ••wish for revenge and action oriented ••sexually exploitative or aggressive responses to trauma interactions with younger children ••personality changes and changes in quality of important relationships evident ••partial loss of memory and ability to ••sexually promiscuous behaviour or total concentrate avoidance of sexual involvement ••running away from home

Trauma impact

••sleep disturbances, nightmares ••flight into driven activity and involvement ••vulnerability to depression, anxiety, stress ••hyperarousal, hypervigilance, hyperactivity with others or retreat from others in order to disorders, and suicidal ideation manage inner turmoil ••eating disturbances or disorders ••vulnerability to conduct, attachment, eating ••vulnerability to withdrawal and pessimistic and behavioural disorders •trauma acting out, risk taking, sexualised, • world view reckless, regressive or violent behaviour

••mood and personality changes and changes ••flight into adulthood seen as way of escaping Memory for trauma includes: in quality of important relationships evident impact and memory of trauma (early ••acute awareness of and distress with intrusive ••loss of, or reduced capacity to attune with marriage, pregnancy, dropping out of school, imagery and memories of trauma caregiver abandoning peer group for older set of friends) ••vulnerability to flash backs, episodes of recall, ••loss of, or reduced capacity to manage anniversary reactions and seasonal reminders emotional states or self soothe ••fear of growing up and need to stay within of trauma family orbit ••lowered self-esteem ••may experience acute distress when encountering any reminder of trauma ••partial loss of memory and concentration

Parental / carer support following trauma

Encourage parent(s)/carers to: ••address acting-out behaviour involving aggression or self destructive ••seek, accept and increase support for themselves to manage their behaviour quickly and firmly with limit setting and professional help own shock and emotions ••take signs of depression, self harm, accident proneness, recklessness, ••remain calm. Encourage younger and older adolescents to talk about and persistent personality change seriously by seeking help traumatic event with family members ••help young person develop a sense of perspective on the impact ••provide opportunities for young person to spend time with friends who of the traumatic event and a sense of the importance of time in are supportive and meaningful recovering ••reassure young person that strong feelings - whether of guilt, shame, ••encourage delaying big decisions embarrassment, or wish for revenge - are normal following a trauma ••seek information/advice about young person’s developmental and ••help young person find activities that offer opportunities to experience educational progress mastery, control, and self-esteem ••provide the young person with frequent high protein snacks/meals ••encourage pleasurable physical activities such as sports and dancing during the day ••monitor young person’s coping at home, school, and in peer group ••take time to recharge