Behavior management, parent training, Always consider base rates and cognitive biases Direct treatment to address traumatic and possibly medications (diagnostic overshadowing, availability and represent- stress symptoms, such as TF-CBT ativeness heuristics, conjoint probabilities, etc.; see Fagley 1988 SPR, Davidow & Levinson, 1993 PITS)
ADHD (5% of kids) Traumatic Stress (~60% past year expo- sure; 5% lifetime prev. of PTSD for teen- Inattention Difficulty concentrating agers 13-1, unknown for children) Hyperactivity Hyperarousal Exposure to traumatic event Difficulty waiting or taking turns Impulsivity Marked alterations in arousal / reactivity Talking excessively Social difficulties Re-experiencing Interrupting others Externalizing behaviors (e.g., aggres- sion) / intrusive thoughts Losing things Attention-seeking behaviors Avoidance Difficulty following instructions Sleep problems Negative alterations in cognitions or mood Difficulty controlling behaviors Low self-esteem Irritability, shame, guilt, fear, helplessness
Dissociation / withdrawal
R Mental health, medical, DFPS History of trauma exposure (onset, duration, frequency); course of symptoms and behaviors; timeline of child’s life; family tree/genogram
I Parent or caregiver—NSLIJHS Trauma History Checklist and Inter- Developmental history (age at symptom onset?); screen for trauma exposure view Ask about content and context of inattention; ask about emotions, avoidance, Child and changes in feelings and behaviors over time O Multiple settings and days/times, esp. during unstructured times Evaluate setting events, possible antecedents or “triggers” T Child PTSD Symptom Scale (CPSS), UCLA PTSD Index Exposure to possibly traumatic events
Trauma Symptom Checklist for Children (TSCC or TSCYC) PTS symptoms, dissociation, sexual concerns
Sources: DSM-5; National Center for PTSD; NCTSN; Davidson et al., 2015 RIDD; Perfect et al., 2016; Wein- © Julia Englund Strait, PhD 2018 stein , Staffelbach, & Biaggio, 2000
Applied Behavior Analysis (ABA) Social skills instruction and practice Stable, safe, consistent caregiving and positive relationships at home and at school; expectation of gradual progress ???
Autism Spectrum Disorders Attachment Difficulties Difficulties with social reciprocity (1% of kids) (RAD <10% of severely neglected kids; Inconsistent or rare eye contact DSED <20%, ? And exceedingly rare) Selective social deficits (in intentional, goal- directed communication aimed at at influ- Difficulties with social boundaries Exposure to maltreatment/ inconsistent caregiving encing the behavior of another person) Dampened expression of positive affect Social communication commensurate with IQ Attachment behavior typical for develop- Cognitive and/or language delays Demanding or attention-seeking behavior mental level Deficits in adaptive behavior Inconsistent or unpredictable social response Restricted / fixated interests Stereotypic behaviors (rocking, flapping) Overly or indiscriminately friendly (for DSED) Repetitive behaviors Hypervigilance Behavioral rigidity
R Mental health, medical, DFPS History of trauma exposure (onset, duration, frequency); course of symptoms and behaviors; timeline of child’s life; family tree/genogram
I Parent or caregiver—NSLIJHS Trauma History Checklist and Inter- Developmental history (age at symptom onset?); screen for trauma exposure; current living view situation, relationships, culture of the home/family
O Structured observations during social interactions with familiar and Evaluate quality and consistency of social interactions; attention-seeking, checking-in, and unfamiliar teachers and/or caregivers; unstructured time with other comfort-seeking behaviors; reactions to others’ coming and going children T Child PTSD Symptom Scale (CPSS), UCLA PTSD Index Exposure to possibly traumatic events; traumatic stress symptoms
Teacher Relationship Problems Questionnaire (RPQ) (?) Quality of relationships and social interactions/responses *Note: Children with maltreatment histories but NO ASD commonly receive elevated scores on ASD rating scales (ASRS, SRS, GARS, Cognitive, language, and adaptive measures etc.) Global vs. specific deficits in language/communication, intellectual functioning, socialization © Julia Englund Strait, PhD 2018 What Can the LSSP Do with Attachment Self-Regulation Competency the... Strengths and interests: Extracurricular activities, strengths inventory Affect and arousal awareness and modulation Provide “safe harbor” for student strategies, coping strategies Teach, cue, and reinforce executive skills (inhibition, WM, flexibility, goal setting, self- Build relationships with student Relaxation and stress management techniques Student monitoring, etc.) and social skills, including safety, Be an advocate for student Sense of agency—teach what you can and problem solving, conflict mgmt. can’t control Targeted interventions for developmental/ adap- tive and/or specific academic skill deficits Designate a teacher “Buddy” or mentor Train teacher in building awareness of their own responses to challenging student behaviors, Interview teacher regarding child’s positive quali- Train teacher in how to model, observe, cue, modulating own emotions ties and reinforce use of appropriate behaviors, Behavioral case consultation: appropriate limit- emotional expressions, and coping strategies Encourage teacher to provide choices where possi- setting, consistent response to student behav- at point of performance ble (give student sense of agency) Teacher iors, rich reinforcement/praise schedule, refram- Help teacher establish designated routines, Train teacher to model, cue, and reinforce execu- ing negative behaviors “code words,” places, and people within and/ tive skills, appropriate problem-solving, etc. Provide teacher with psychoeducation about or outside the classroom for the student to use Identify and implement appropriate classroom trauma impact on school functioning (generally) when in crisis modifications and/or accommodations and this student’s history (specifically) Provide teacher with strategies for “tuning in” to student’s cues and anticipating triggers
Classroom management focuses on rewards Multiple opportunities for student to demonstrate rather than punishment (Positive Behavior success Expectations posted Supports) Special roles for student (line leader, etc.) Predictable routines (morning meeting, transi- Multiple opportunities for emotional expres- Classroom tions, turning in work, etc.) sion (artistic, physical, etc.) Teach and practice planning, problem-solving, and organization systems (like HOPS) Cooperative classroom culture Teach and integrate self-regulation strategies so all students can build individualized Cooperative learning, opportunities for prosocial “regulation toolboxes” peer interaction
Safe and positive school climate, PBIS, restora- Reward student achievements across varied do- tive discipline practices Train and support all staff on recognizing trau- mains (broad definition of success) Times and spaces for relationship building (e.g., ma’s impact, recognizing signs and behaviors, Provide range of curricular, extracurricular, and lunch with teachers/principals, “town hall” trauma-sensitive/ consistent and effective re- School vocational programming meetings with students) sponse, etc. Offer instrumental mentoring and group-based Strong family-school communication and collab- Provide schoolwide SEL programming programs to target specific skills oration Adapted from: Kinniburgh, Blaustein, & Spinazzola (2005)