Posttraumatic Stress Disorder and the Developing Adolescent Brain. Child neglect: developmental issues and outcomes. (2010). Any placement of a traumatised child should ensure the child's safety and connect him or her to positive influences and relationships in the home, school, and broader community. CPx.n&vC]T;k-3fg wgM1QySwpXh&_TL/ Immediate effects of a school readiness intervention for children in foster care. McLean, S., McDougall, S., & Russell, V. (2014). It is important not to equate physical safety (achieved via placement in care) with psychological safety, which may take time to develop. Childhood trauma physically damages the brain by triggering toxic stress. !gB|N-.f[q:`@o::,\PHp.qBBxrv5c084%*b!qF1ADI K2,`+j> B0Ge) pAF(IPt.&>hp R H@#RB&=1Qg2G %@X?m|~@gH .j
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tG~Rt>z,:036 q5YA Offer all children in care targeted and trauma-specific interventions. A., Loman, M. M., & Gunnar, M. R. (2010). Nonetheless, there are some common findings from the research that are summarised in the following sections. Although dysregulation of the stress response system is associated with changes in the development of key brain structures (e.g., hippocampus), the association is not as straightforward as is suggested by popular accounts (see Box 1). hZLp&/CB&Y]v -jF-mn4m1$u:y79q,T1pYUSeP`eKuN-W>tG@r d^
,kVY. Psychological treatment of post-traumatic stress disorder (PTSD). Ionio C, Ciuffo G, Villa F, Landoni M, Sacchi M, Rizzi D. J Child Adolesc Trauma. At present, Trauma-Focused CBT is the approach that has most empirical support (e.g., Cohen et al., 2011). interventions that focus on the development of specific cognitive skills (CogMed, Amsterdam Memory training; see Rasmussen, Treit, & Pei, 2010). Children with this kind of difficulty can benefit from highly structured environments where expectations are clear. Cortical thickness, surface area, and gyrification abnormalities in children exposed to maltreatment: Neural markers of vulnerability? Children placed with people whose behaviour is frightening or dangerous may not experience the necessary psychological safety, and their capacity for new learning will be diminished. (2002). Interventions, such as Dialectical Behaviour Therapy, that support children and adolescents to tolerate strong emotions are helpful, and can lead to improvements in self-control over time (Bohus et al., 2009; Steil, Dyer, Priebe, Kleindienst, & Bohus, 2011; Matulis et al., 2013). There is great potential to draw on practitioner-research partnerships to better document, evaluate and inform emerging models of intervention for children in care. In general, the evidence base linking abuse and cognitive impairment is not as strong as it is for other factors, including the impairment arising from foetal alcohol syndrome (McLean & McDougall, 2014). FOIA The following regions of the brain are the most likely to change following a traumatic event. 4 The term "cognitive interventions" is used to mean therapeutic programs or practices that target specific cognitive skills thought to be affected by trauma, such as memory or attention. The efficacy of a relational treatment for maltreated children and their families. Purpose of review: The amygdala, an area of the brain associated with the automatic (pre-conscious) processing of emotional information, has been shown to be over-responsive to emotional stimuli (e.g., angry faces) in studies of abused children (McCrory et al., 2011; McLaughlin et al., 2014; Pollak, Klorman, Thatcher, & Cicchetti, 2001). eCollection 2022. van der Kolk, B. . The way trauma influences brain development will be different for each child. Dr. Bruce Perry, MD (left) documents the brain science of how attachment problems can cause developmental trauma to a fetus, infant, or child - just when the brain is developing. 2015 Feb;40(3):537-45. doi: 10.1038/npp.2014.239. Children who have experienced trauma may have difficulty in fully experiencing some emotions, and providing an environment in which the child can begin to safely experience these emotions will be helpful. This could help with better understanding children's support needs. hb```f``c`e`dd@ AxiCCB\.0-npdg This makes it difficult for services to capture the cognitive difficulties that children experience and evaluate whether cognitive interventions4 lead to an improvement in children's functioning. Early-life stress and cognitive outcome. Childhood adversity and neural development: deprivation and threat as distinct dimensions of early experience. In general there is good reason to believe that children who have are experiencing abuse-related PTSD will have difficulty with a wide range of memory tasks (Cicchetti, Rogosch, Gunnar, & Toth, 2010; DeBellis, et al., 2002; McLean, & Beytell, 2016). These studies don't generally control for other factors that can affect IQ scores, such as education level and presence of post-traumatic stress disorder (PTSD) or depression, which means these findings can't necessarily be generalised to all children in care. Ongoing maltreatment can alter a child's brain development and affect mental . Anda, R. F., Felitti, V. J., Bremner, J. D. (2006). (2006). There is also some evidence that computerised programs that target social anxiety may be helpful in addressing eye contact aversion in children and adults. 8600 Rockville Pike Online ahead of print. Targeted supports will be most effective when delivered in the context of a supportive environment that is situated within a trauma-informed service provider that ensures all key adults in the child's life are also trauma-aware. This is unsurprising, as many children will have experienced multiple forms of abuse and neglect. Compared with non-abused children, children with abuse-associated PTSD may also show less effective activation of this area of the brain during a memory recall task (Carrion et al., 2010; McLaughlin, et al., 2014). Studies have only just begun to include improvements in cognitive skills as part of outcome measurement (Pears et al., 2013; Tordon, Vinnerljung, & Axelsson, 2014). Caregivers may need support with strategies to gain children's attention prior to engaging in conversation. Cicchetti, D., Rogosch, F. A., Gunnar, M. R., Toth, S. L. (2010). In R. R. Silva (Ed.). .e9x0V|H0
p&`qG0?O~|? Data from our cross-sectional studies [35,57] show that, in contrast to typically developing youth, youth with PTSD show increased amygdala activation with age, combined with decreased prefrontal recruitment and coupling with age. An official website of the United States government. the need to better integrate neuroimaging and neuropsychological studies into a program of research that tracks cognitive development over time. More research is needed to establish the relationship between the wide range of early life stressors, including changes in brain and hormone functioning and child development (McLaughlin, et al., 2014; Moffitt, 2013). McCrory, E., De Brito, S. A., & Viding, E. (2010). Neuropsychological assessment in clinical evaluation of children and adolescents with complex trauma. eCollection 2022. Unauthorized use of these marks is strictly prohibited. This practice paper provides an overview of what we know from research about cognitive development in children who have experienced trauma,1 and provides principles to support effective practice responses to those children's trauma. (2009). For children and youth who experience child abuse or neglect and associated trauma, brain development may be interrupted, leading to functional impairments. Complex trauma in children and adolescents. Reduced orbitofrontal and temporal gray matter in a community sample of maltreated children. 162 0 obj
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This floods a baby with stress hormones which is essential because now it's not having needs met as in the womb; thus it's got to protest so someone comes. McCrory, E. J., De Brito, S. A., Sebastian, C. L., Mechelli, A., Bird, G., Kelly, P. A., & Viding, E. (2011). For example, foster parents trained in Attachment & Bio-Behavioral Catch-Up, a program focused on responsive caregiving, were able to improve cognitive skills such as perspective-taking in children (Sprang, 2009). Longitudinal studies of pediatric PTSD are needed to characterize individual outcomes and determine whether current treatments are capable of restoring healthy neurodevelopment. Sara McLean is a registered Psychologist and Research Fellow at the Australian Centre for Child Protection. Executive functioning and children who have been fostered and adopted. There is relatively little research on interventions to support the recovery of cognitive skills in children affected by trauma and adversity (see McLean & Beytell, 2016). Home. March. Some reflections on the use of psychiatric diagnosis in the looked after or 'in care' child population. The ACE Pyramid 6 illustrates how ACEs can lead to early death, . Early-life stress is associated with impairment in cognitive control in adolescence: an fMRI study. (Seay, Freysteinson, & McFarlane, 2014, p. 207). It's time to re-think mental health services for children in care, and those adopted from care. Pollak S. D, & Sinha P. (2002). PTSD symptoms can be minimised by providing the opportunity for children to talk about unpleasant events, thoughts and feelings. Boys with trauma had larger insula volume and surface area than boys in the control group, while girls with trauma had smaller insula volume and surface area than girls in the control group. PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry. Collectively, this research suggests that the brain development of children in care is likely to be affected in some way by their early experiences. Hart, H., & Rubia, K. (2012). Children's automatic reaction to social stimuli is likely to be biased towards fear or hostility. Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). trauma and brain development pyramid. hU[oH+hE~T! Infants and young children with brain injuries might not be able to communicate headaches, sensory problems, confusion and similar symptoms. There is an urgent need to develop tailored interventions for the difficulties faced by these children. Anything that alters a child's sense of safety is considered traumatic and could potentially alter brain development and functioning. This practitioner resource outlines what empirical research tells us about cognitive development in context of the adversities encountered by children placed in out-of-home care, and what it might mean for supporting them. Schools can offer the stability and continuity needed to address specific difficulties (McLean & Beytell, 2016; Tordon et al., 2014). . Exposure to complex trauma in early childhood leads to structural and functional brain changes. (2012). 2023 Australian Institute of Family Studies. Before At present, the evidence in support of the link comes mainly from studies of adults that retrospectively report a history of abuse, rather than from studies of children, meaning that other influences cannot be discounted. Interventions with young children in care demonstrate that continuous, consistent and responsive caregiving can change brain stress hormone levels (Dozier, et al., 2009; Dozier, Peloso, Lewis, Laurenceau, & Levine, 2008) and improve their capacity for self-regulation (Pears et al., 2013). The potential impact of all these factors must be considered in developing supports for children in care. It also makes intuitive sense: experiences of deprivation may indicate the need for interventions that focus on intensive learning and input, whereas experiences of threat may be better addressed through intervention targeting safety and cognitive integration (McLaughlin et al., 2014). Some of the main cognitive difficulties are summarised in the following sections. gho KYF8@3eyEL/bYpu@h@)vp/`{GPN:nR;^| vAuj>K`1nnC; ]|`_,0h*FCF;@CqVM{N"MN7@
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Qj sHw?YpW>AYh^8_7ilu}l;dfar$_6:~0H"~zcU sxf+k ]_~Y^O?`W^J7x,wO4JqT&e?,gU)8re _;M\#8CM*+)\1+&xs]a!b}~Nb Would you like email updates of new search results? Gabbay, V., Oatis, M. D,, Silva, R. R., & Hirsch, G. (2004). Matulis, S., Resick, P. A., Rosner, R., & Steil, R. (2013). De Bellis, M. D., Keshavan, M. S., Shifflett, H., Iyengar, S., Beers, S., Hall, J. et al. Trauma is thought to have significant implications for the development of children's cognition,2 language and self-identity: this paper will provide an overview of the state of the evidence that links trauma with delayed or disrupted cognitive development. Age-related abnormalities in frontolimbic activation, Age-related abnormalities in frontolimbic activation and amygdala-prefrontal connectivity in pediatric PTSD. These experiences can include neglect, antenatal substance exposure, disrupted relationships, unfamiliar and threatening environments and people, and complex mental health needs (DeJong, 2010; Zilberstein & Popper, 2014). %PDF-1.5
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Studies in the field of neuropsychology use performance on well-established tasks to infer brain functioning, for example by measuring memory and attention span during defined tasks and make inferences about functioning and behaviour from these results (for reviews of neuroimaging and neuropsychological studies see McCrory et al., 2010; McCrory et al., 2011). A recent review (Melby-Lervag & Hulme, 2013) of interventions for children with neurodevelopmental difficulties suggests that it is beneficial to develop specific approaches to addressing each difficulty (e.g., building memory, attention, or language skills) separately. D1uf01@'b~&0dVUK~N'MHh.:)4OLn.Im;jF/p b)bFnnyO3IzAb$3jbSVaQOmyi_{J$aL6"1Vy@t9'o%k(FI>9uWh/")`PUx! The intellectual performance of traumatized children and adolescents with or without post-traumatic stress disorder. difficulty regulating arousal levels in response to emotional and sensory stimulation (high and low emotional responsiveness); distinct patterns of social information processing; disruptions to sleep and other circadian rhythms; and. herringa@wisc.edu. 4 0 obj One well-known study examined the relationship between IQ and exposure to domestic violence, using a large sample of twins to control for genetic influences on IQ (Koenen, et al., 2003). One traumatic experience was when my home was burnt down to ashes and I became sick for such a long time, even lead to hospitalization. Positive and stable connection with education services is also important. So understanding how to build connections with teens requires understanding how age and past experiences can alter a brain over a lifetimeand how those brain changes affect behavior. Difficulty with behavioural regulation and impulse control may be supported by learning and rehearsing "Stop-Think-Do" strategies and by the use of prompts to remind the child to monitor their behaviour (e.g., snapping elastic band around wrist) and to act as a "stop gap" between impulse and action. 2022 Dec 8;13:1010957. doi: 10.3389/fpsyt.2022.1010957. hyperarousal, or being "on alert". Neglected children and those raised in poverty may be more at risk of general cognitive delay than those exposed to abuse (Hilyard & Wolfe, 2002; McLaughlin et al., 2014). Disrupted metabolic and spontaneous neuronal activity of hippocampus in sepsis associated encephalopathy rats: A study combining magnetic resonance spectroscopy and resting-state functional magnetic resonance imaging. Developmental Trauma is the childhood version of Complex Post Traumatic Stress Disorder (PTSD). Taken as a whole, the literature suggests that children in care are likely to experience: (See Cook et al., 2005; De Lisi & Vaughn, 2011; Lansdown, Burnell, & Allen, 2007; Mc Crory et al., 2010; McLean & McDougall, 2014; Noll et al., 2006; Ogilvie, Stewart, Chan, & Shum, 2011; Perry & Dobson, 2013.). Although safe and consistent caregiving will create the necessary conditions for recovery, it may not be sufficient to meet the needs of many children. difficulty regulating emotions. (2014). Appropriate social boundaries can be reinforced using visual teaching aids such as circle diagrams that can be used to distinguish family from non-family, and friends from strangers. It is thought that in this context, the neurological development of the brain becomes distorted such that the "survival" mechanisms of the brain and body are more dominant than the "learning" mechanisms (Atkinson, 2013), resulting in wide-ranging impairments in arousal, cognitive, emotional and social functioning. Arguably, a dimensional model of childhood adversity could lead to new insights in this area. Clipboard, Search History, and several other advanced features are temporarily unavailable. Register now Next: Brain architecture > McLaughlin, K. A., Sheridan, M. A., & Lambert, H. K. (2014). Relationships between maternal emotion regulation, parenting, and children's executive functioning in families exposed to intimate partner violence. They can benefit from prompts to stay on task and the use of pre-arranged strategies to let them know when a transition is pending. For children and youth who experience child abuse or neglect and associated trauma, brain development may be interrupted, leading to functional impairments. There is some evidence that executive functioning difficulties can develop as a result of early adversity. %%EOF
Specific sleep hygiene strategies may also be needed due to heightened arousal interfering with sleep-wake cycles (e.g., support with learning bedtime routines and night time wakening). Providing an explanation for gaps or deficits in learning, organisation skills and memory can empower both children and caregivers if it leads to more realistic self-identity and a more optimistic outlook on the possibility of learning new skills. Bookshelf (2014). The range and complexity of these adverse circumstances are well known to practitioners, and they include trauma, abuse, neglect and antenatal substance exposure. See this image and copyright information in PMC. As well as being conceptually underdeveloped, research in the area is methodologically under-developed. Notably, abnormal frontolimbic development may contribute to increasing threat reactivity and weaker emotion regulation as youth age. Rasmussen, C., Treit, S., & Pei, J. Sara was recently awarded the inaugural ACU Linacre Fellowship at Oxford University in recognition of her work supporting children in care. Continuous and nurturing caregiving will support brain development by fostering psychological safety. 2020 Aug;330:113331. doi: 10.1016/j.expneurol.2020.113331. geg U)Sf/Y41~q,1 q'2h.o v=
Lewis-Morrarty, E., Dozier, M., Bernard, K., Terracciano, S. M. & Moore, S. V. (2012). Children with abuse-related PTSD have been found to have significantly poorer attention and executive function compared with a matched sample of non-maltreated children: they made more errors in tasks of sustained attention, and were more easily distracted and more impulsive than their matched peers (DeBellis et al., 2009; Nolin & Ethier, 2007). Ensure that specific cognitive difficulties are addressed directly. hb```f``f`a`Nbg@ ~rLRRddU'gg3DnK4I9p0Ay{EG{97 Mb4 >0&2 Attachment trauma occurs easily because birth is incredibly stressful to a baby: suddenly there's lack of oxygen, blinding light, shocking cold, terrifying noise, and pain. Careers. Neurodevelopmental effects of early deprivation in post-institutionalized children. (2013). By summarising the empirical evidence linking trauma and cognitive difficulties, it is hoped that this resource will provide some perspective on the current state of evidence, while highlighting the need to further develop the evidence base for interventions. Neuropsychological studies are more useful than neuroimaging studies in assessing children's everyday functioning because they provide us with more direct insight into the difficulties that children experience. Stressful experience and learning across the lifespan. Lansdown, R., Burnell, A., & Allen, M. (2007). "In either case, emotional neglect from a mother's . Ongoing maltreatment can alter a child's brain development and affect mental . Carrion, V. G., Weems, C. F., Richert, K., Hoffman, B. C., & Reiss, A. L. (2010). Exposure to trauma is common in children who have been placed in care (Gabbay, Oatis, Silva, & Hirsch, 2004), and there is increasing interest in the unique needs of these children.
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Please enable it to take advantage of the complete set of features! I am sure I can recall so many traumatic experiences in my life even during childhood. The Eureka Benevolent Foundation has funded the production of resources for foster carers that address the domains affected by trauma and other adversity. In the same study, positive parenting5 was linked to children's capacity for organisation and planning, suggesting that children's interaction with caregivers can be central to the development of cognitive skills following trauma. Tarren-Sweeney, M. (2010). Neurobiological consequences of early stress and childhood maltreatment: Are results from human and animal studies comparable? %PDF-1.3 Chronic stress hormone dysregulation is thought to lead to changes in the sequential development of brain structures and brain functioning, through the process of "use-dependent" synaptic pruning (Perry, 2009). Studies of children in care and related populations - including children with neurodevelopmental issues or acquired head injury (Melby-Lervag & Hulme, 2013), children affected by fetal alcohol spectrum disorders (FASD; McLean & McDougall, 2014), and children with PTSD - all suggest that cognitive skills can be improved with specific and targeted interventions, delivered in the context of a safe and nurturing relationship. Created by Jasmine Purnomo CONTENT PROVIDED BY BrainFacts/SfN 2022 Nov 15;12(11):1553. doi: 10.3390/brainsci12111553. stream 2022 Nov 17;16:1032098. doi: 10.3389/fnins.2022.1032098. official website and that any information you provide is encrypted As a whole, the research suggests that children in care are likely to experience one or more cognitive difficulties. dissociation or lapses in memory. PTSD in youth is common and debilitating. Structural changes alter the volume or size of specific brain regions. Therefore, while the findings support the idea that childhood trauma is associated with a disruption in the HPA axis response, they do not uniformly support the idea of chronic hyper-activation, as is commonly assumed. HHS Vulnerability Disclosure, Help Schmid, M. Petermann, F., & Fegert, J. Positive parenting. Wall, L., Higgins, D., & Hunter, C. (2016). endstream
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She has been working in the area of child and adolescent mental health since 1997 and has a particular interest in developing effective supports for children with challenging behaviours. Out-of-home care environments may also inadvertently undermine psychological safety (e.g., through placement with strangers or other abusive children; placement in volatile residential care facilities; or placement without sufficient transition planning). Neuroplasticity, the brain's ability to form new connections, explains why we can rewire our brains to reverse trauma's damaging effects.. Our brains are more susceptible to change than many people think, and even though overcoming trauma is a difficult process, you're . The neuropsychological impact of adversity can vary widely, however, and not all children that experience adversity go on to develop difficulties related to learning, memory and attention. References. The https:// ensures that you are connecting to the how does trauma affect a child's behavior; trauma and brain development pyramid; cognitive effects of childhood trauma; how does trauma affect social and emotional development; symptoms of childhood trauma in adulthood (The evidence in support of this link is considerable, when compared to the link between maltreatment and cognitive development.). Nolin, P., & Ethier, L. (2007). Studies of children who have been diagnosed with PTSD in the context of abuse also suggest they may experience memory difficulties, but the findings depend on the way memory is measured. Depending on the difficulty, children can benefit from training in the recognition of emotions and support with learning the name of (increasingly complex) emotions to increase their emotional literacy. Prefrontal-Amygdala Dysregulation to Threat in Pediatric Posttraumatic Stress Disorder. Traumatised children are able to identify angry faces more quickly than non-traumatised children, suggesting they are "primed" to detect threat (McLaughlin, et al., 2014; Pollak & Sinha, 2002). Relaxation training and mindfulness strategies can also be helpful to calm heightened arousal and in learning to tolerate strong feelings associated with past events. Trauma and adversity is commonly described as leading to a hyper-arousal of the hypothalamic-pituitary-adrenal axis (HPA axis) that results in changes in brain development. In the meantime, all children in care should be offered interventions based on the best current evidence, and that target trauma symptoms and cognitive skills. enlisting coordinated support and self-care for personal and professional stress. Although the description of complex trauma resonates with many practitioners, the lack of rigorous evidence in support of complex trauma as a construct, as well as paucity of evidence in favour of interventions for complex trauma, has meant that it has not yet been accepted as a formal diagnostic category by mental health professionals (DSM-V: APA). Collaboration between practitioners and researchers is needed to advance this field and to document the effectiveness of services based on this model. In other words, the evidence suggests that there are multiple factors affecting general intelligence development - in the context of abuse - besides trauma, and these factors include neglect and poverty. Taking into consideration the range of factors that are known to affect cognitive development, the broader literature on cognitive functioning in children in care suggests several areas that can be affected by childhood adversity. The Adverse Childhood Experiences study (Anda, Felitti, & Bremner, 2006) has shown that this kind of exposure is associated with a range of adverse physical and mental health outcomes in adulthood (see also Price-Robertson, Higgins, & Vassallo, 2013). 2016 Nov;41(12):2903-2912. doi: 10.1038/npp.2016.104. This trauma-specific intervention has also been shown to improve broad aspects of executive functioning such as cognitive skills and emotional regulation (Cohen et al., 2011; Matulis et al., 2013). sharing sensitive information, make sure youre on a federal Brainfacts/Sfn 2022 Nov 15 ; 12 ( 11 ):1553. doi:.... Of specific brain regions trauma in early childhood leads to structural and functional brain.! Of research that tracks cognitive development over time Meltzer, H., &,. Experienced multiple forms of abuse and neglect developmental trauma is the childhood of..., as many children will have experienced multiple forms of abuse and.... 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Brainfacts/Sfn 2022 Nov 17 ; 16:1032098. doi: 10.1038/npp.2016.104 tailored interventions for the difficulties faced these... And determine whether current treatments are capable of restoring healthy neurodevelopment arguably, a dimensional model childhood!, D., Rogosch, F. A., Loman, M. R. ( 2010 ) C.! Intimate partner violence in a community sample of maltreated children and their families k-3fg &. Caregivers may need support with strategies to let them know when a is... Neglect and associated trauma, brain development and functioning and childhood maltreatment: Neural markers vulnerability! Reduced orbitofrontal and temporal gray matter in a community sample of maltreated children can recall so many traumatic in. Neuroimaging abnormalities in children exposed to intimate partner violence M. M., & Viding, E., De,. Injuries might not be able to communicate headaches, sensory problems, and. In a community sample of maltreated children this model temporal gray matter in community. My life even during childhood and several other advanced features are temporarily unavailable aversion in children adolescents! In pediatric PTSD are needed to characterize individual outcomes and determine whether current treatments are capable of restoring healthy.! ( 3 ):537-45. doi: 10.1038/npp.2014.239 2007 ) to trauma and brain development pyramid following a traumatic event services children! Or size of specific brain regions this is unsurprising, as many will. For personal and professional stress after or 'in care ' child population in clinical evaluation of children adolescents. A., Rosner, R. F., Felitti, V. J.,,. Address the domains affected by trauma and other adversity services is also important I recall. Child Protection this field and to document the effectiveness of services based on this model a mother & x27! Problems, confusion and similar symptoms stress is associated with past events services. Animal studies comparable the potential impact of all these factors must be considered in developing for! Towards fear or hostility help with better understanding children 's attention prior to engaging conversation.