Core Concepts Paper

Children’s health and well-being remain a priority in community health preservation initiatives. Child trauma is a significant point of concern and a contributing factor to compromises in a child’s health and well-being. Early childhood trauma has been associated with mental health illnesses later in the child’s life. The National Child Traumatic Stress Network, established by Congress in 2000, is a federal initiative that focuses comprehensively on child trauma. It aims to enhance standards of care and access to care for affected individuals. This task force oversaw the development of core concepts for understanding traumatic responses in children. This paper details a case presentation through the lens of the core concepts.

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Case Summary

The case presented is of an 11-year-old female child named Rachel, who presented with significant post-traumatic stress disorder (PTSD) symptoms. She developed those symptoms after a rock broke through her bedroom window in the middle of the night. Her history revealed a traumatic event in her early childhood. Witness report revealed that Rachel’s father broke through a window of an apartment in which Rachel and her mother were living and, in the process, shattered the glass on the window. He then followed them to the neighbor’s house, where they fled and shot dead Rachel’s mother, his wife.

Assessment findings revealed that Rachel was not physically hurt when the rock broke through her window. However, she exhibited an extreme response consistent with the symptoms she manifested when her mother was killed. She also avoided topics related to either of her parents and had no recollection of the initial incident that saw her mother dead. She has been having trouble sleeping in her bed because of fear, feels shaky and trembles violently, experiences loss of appetite, and cannot withstand being alone in any room of the house. Rachel’s presentation met the criteria for the diagnosis of PTSD per the Diagnostic and Statistical Manual for Mental Health Illnesses (DSM). She was started on therapy a month after the rock incident.

Core Concepts

The core concept of traumatic concepts being inherently complex details specific particulars of a traumatic event. According to this concept, every traumatic event is a sum of various traumatic moments in an individual’s life. These events include but are not limited to physical violations, exposure to a potential life threat, and witnessing death or injury. The client’s case presented is of a child exposed to early childhood trauma. Rachel witnessed her mother being shot dead by her father. She also witnessed her father break into their apartment through the window.

Subjective reactions to traumatic moments often accompany traumatic experiences and may manifest as alterations in feelings and thoughts, concerns for safety, and altered physiologic responses. This provision of the core concept highlights post-traumatic responses that often manifest in persons exposed to trauma. These reactions are often subjective and are accustomed to post-traumatic cognitions. Kangaslampi & Peltonen (2019) define post-traumatic cognitions as dysfunctional appraisals of a traumatic event. It conditions how an individual responds to perceived threats. Negative and catastrophizing appraisals that are often seen in individuals with PTSD are related to their perception of self, with many considering themselves as incompetent or fragile while others perceive the world as a scary or dangerous place to live. Such experiences were manifested in the client in the case presented. Assessment findings on the client revealed that she manifested varying symptoms reflective of trauma. Collaborative history with Rachel’s grandmother revealed that she felt shaky most of the time, exhibited avoidance of topics related to either of her parents despite having no recollection of the initial events, and could not withstand being left alone in the room. All these are an indication of post-traumatic conditioning that she underwent after being exposed to a traumatic moment.

Children’s thoughts and actions during a traumatic moment often result in a feeling of conflict or confusion that progresses to anger. These provisions form the core concept outlined by NCTSN and are attributable to social information processing bias and enhanced emotional reactivity that often follows exposure to a traumatic event. This processing bias facilitates rapid identification and perception of environmental threats. Increased perceptual sensitivity to fear or anger is an example of social processing bias that becomes apparent after being exposed to a traumatic event (Kealy et al., 2018). Assessment findings in Rachel’s case revealed that she had a perceptual sensitivity to fear and anger. She had hyper-arousal symptoms, sometimes appeared spaced out and confused, and often became upset, sad, and angry when something reminded her of what happened. These presentations are a consequence of emotional reactivity and social processing bias that often accompany exposures to trauma.

The nature of children’s responses to traumatic moments is strongly influenced by their developmental stage. The propensity to adverse responses to traumatic events is high when an individual is exposed to trauma in early childhood. According to Stevens et al. (2018), fear neurobiology depends on the developmental stage of the child. Amygdala hyperactivity, seen in patients with chronic PTSD, varies with the developmental stage in which an individual is exposed to traumatic events. Early childhood is a sensitive developmental stage principally because, at this stage, the brain is still developing. Children exposed to traumatic events in their early adulthood tend to have a larger amygdala volume and are thought to have a higher propensity to develop PTSD later in their lives (McLaughlin et al., 2020). The child in the case was exposed to traumatic events in her 19^th month. This developmental stage is considered sensitive and may have made her vulnerable to PTSD.

Another provision of the core concept outlined by NCTSN is that the degree of complexity of the childhood trauma is increased in case the primary caregiver is involved in or is a perpetrator of the traumatic events. The involvement of the child’s caregiver in a traumatic event has been implicated in more intense subjective responses in the child. Parental homicides, for instance, result in more severe emotional traumatization and stigmatization (McLaughlin et al., 2020). The child in the case presented witnessed her mother being shot dead by her father. Consequently, this may have imprinted traumatizing and stigmatizing effects in her brain and is contributory to the current emotional bursts and symptoms that she is manifesting.

Risk and Protective Factors

Risk factors for PTSD are factors within an individual’s ecology that make them vulnerable to this illness. These factors may either be intrinsic or extrinsic. Intrinsic factors are factors of the individual. These include the history of psychopathologies, history of traumatic event exposures, and temperament. On the other hand, extrinsic risk factors are the surrounding physical environment, the community, the cultural environment, and the familial environment (Tang et al., 2021). Specific risk factors that have been implicated as risk factors for childhood traumas include a history of abuse, exposure to trauma, family history of PTSD and other mental health illnesses, inadequate parenting skills, and family crisis and isolation. All these are risk factors for developing PTSD later in life.

Exposure to trauma in early childhood is a leading risk factor for PTSD. These traumatic events encompass all personal encounters that are marked by the perception of or potential for threat to life, helplessness, and serious injury. These events may be apparent in case an individual witnesses a serious injury or death, is seriously injured, or when they are discriminated against, or physically violated. Exposure to traumatic events results in enhanced threat processing, as evident in enhanced emotional reactivity, social processing bias, altered emotional learning, and difficulties in emotional regulation. These factors often result in internalizing and externalizing psychopathologies and even PTSD. Individuals exposed to traumatic events are thus at increased risk for developing PTSD. Risk is higher when the traumatic events are current or intense, as in the case of parental homicides. The client in the case presented witnessed her mother being shot dead in her early childhood. This may have put her at risk of developing PTSD.

Protective factors define factors bordered on the child’s emotional, social, and neurobiological domains that shelve them from developing psychopathology after exposure to a traumatic event. Protective factors for childhood traumas include caregiver support, sensitivity to reward, and the social and emotional competence of the child (Racine et al., 2020). Sensitivity to positive reward stimuli is thought to be protective against the anhedonic feeling that often accompanies childhood traumas. As informed by a mature prefrontal-amygdala circuitry, social and emotional competence is also thought to shelve vulnerable persons from developing PTSD.

Caregiver support is a broad area that encompasses the caregiver’s ability to nurture resilience, knowledge of parenting, and commitment. Positive relations between a caregiver and the child are vital for protecting the child against the onset of PTSD. Research findings reveal that children with supportive caregivers have a lower propensity to develop PTSD. Rachel’s grandmother was her principal caregiver, having taken her in after the death of her mother and father. She was actively involved in her treatment process and saw marked improvement in her symptoms.

Relation between the Core Concept and the Risk and Protective Factors

The provisions form the core concept selected that details the inherent complexity of traumatic experiences and reveals a nexus between trauma moments experienced by a child and their subjective reactions. These trauma moments defined in the core concepts correlate with the risk factors for PTSD. Trauma moments such as witnessing serious injury or death and experiencing a potential threat to a life defined under core concepts highlight risks defined under risk factors for PTSD. This nexus helps understand the risk factors and provides a framework for managing them.

The provisions of the core concept also detail the subjective reactions a child exposed to trauma exhibits. These subjective reactions include alterations in feelings and thought processes, physiological responses, and the child’s concern for the safety of self and others. These provisions enable the understanding of the caregiver’s role in protecting the child from internalizing psychopathologies. Understanding that the child’s responses are a consequence of their past exposure to trauma and not deviant behavior may help the caregiver be diligent in their role and provide optimal care. It also underpins their significance in maintaining close connections with the child to better their understanding of the subjective responses that the child is likely to manifest.

Conclusion

Childhood traumas remain a significant compromise to the child’s well-being. The core concepts outlined by NCTSN provide a framework for understanding and approaching these childhood traumas. These concepts outline various aspects of these illnesses, including factors surrounding their etiologies and risks, and provide a nexus between past and present experiences. These concepts also help better the understanding of protective and risk factors for childhood traumas, as outlined above.

References

Kangaslampi, S., & Peltonen, K. (2019). Changes in Traumatic Memories and Posttraumatic Cognitions Associate with PTSD Symptom Improvement in Treatment of Multiply Traumatized Children and Adolescents. Journal of Child & Adolescent Trauma, 13(1), 103-112. https://doi.org/10.1007/s40653-019-00255-3

Kealy, D., Rice, S., Ogrodniczuk, J., & Spidel, A. (2018). Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt. Psychiatry Research, 268, 169-174. https://doi.org/10.1016/j.psychres.2018.06.072

McLaughlin, K., Colich, N., Rodman, A., & Weissman, D. (2020). Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience. BMC Medicine, 18(1). https://doi.org/10.1186/s12916-020-01561-6

Racine, N., Eirich, R., Dimitropoulos, G., Hartwick, C., & Madigan, S. (2020). Development of trauma symptoms following adversity in childhood: The moderating role of protective factors. Child Abuse & Neglect, 101, 104375. https://doi.org/10.1016/j.chiabu.2020.104375

Stevens, J., van Rooij, S., & Jovanovic, T. (2018). Developmental Contributors to Trauma Response: The Importance of Sensitive Periods, Early Environment, and Sex Differences. Behavioral Neurobiology of PTSD, 1-22. https://doi.org/10.1007/7854_2016_38

Tang, F., Tan, J., Guo, X., Huang, J., Yi, J., & Wang, L. (2021). Risk factors for post-traumatic stress disorder in acute trauma patients. Medicine, 100(17), e25616. https://doi.org/10.1097/md.0000000000025616

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Question

Using a case that we have covered in class, summarize the key points of the case through the lens of one core concept. Discuss the facts in an organized manner that promotes a clear understanding of the child’s/ family’s experience of trauma. Define risk and protective factors and cite sources of definitions. Discuss how the core concept you have selected relates to the understanding of risk and protective factors. This assignment is designed for you to organize, conceptualize case data, and demonstrate an in-depth understanding and application of core trauma concepts presented in the course.

Core Concepts Paper

The paper should be double-spaced, type-written, and 6min-7max pages in length.
A grading rubric will be provided to detail assignment expectations.
Provide citations and reference the Core Concepts, the case you are using, and the definitions of risk and protective factors.

Saxe, G.N., Ellis, B.H., & Brown, A.D. (2015). Trauma Systems Therapy for Children and Teens