Behavior management, parent training, Always consider base rates and cognitive biases Direct treatment to address traumatic and possibly medications (diagnostic overshadowing, availability and represent- 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)