Understanding Trauma and its Effects on Learning

1. Understanding Trauma and its Effects on Learning Why is it important for teachers to understand trauma? How do traumatic events effect students and teachers? How to respond to trauma within an educational setting Presented by Lisa Stringer / lstringer@ecs-sf.org

2. Why is it important for teachers to understand trauma? • Trauma: • Has behavioral and developmental repercussions for learning • Causes disabilities that we are required to accommodate • Raises questions about secondary trauma and teacher support • Challenges school and social systems to work together

3. Session Objectives By the end of this session you will be able to: • Define trauma and identify some of its effects • Describe how these effects influence learning, memory and behavior • Understand some of the similarities between trauma-based learning problems and learning disabilities • Discuss Universal educational strategies and accommodations

4. Definition of Trauma • Trauma involves: • Exposure to an experience involving horror, • terror or fear • Threat to your safety or the safety of those around you • 3. A change in the way you view yourself or others

7. Trauma Prevalence in the Immigrant Population • A survey of immigrants in Minnesota revealed that approximately 16,000 were victims of torture • (United Way Twin Cities, 2000) • Approximately 30% of men and women who have spent time in war zones experience PTSD • (National mental Health Association, 2004) • In a study of Latino immigrants in LA, 54% of participants reported political violence experiences in their home countries, including 8% who reported torture. Of those exposed to political violence, 36% had symptoms of depression and 18% had symptoms of PTSD . • (Eisenman DP, Journal of the American Medical Association, Vol. 290, 2003)

8. About 16% of American women (about 40 million) are sexually abused (including rape, attempted rape, or other form of molestation) before they reach their 18th birthday.Childhood abuse may be the most common cause of PTSD in American women, 10% of whom suffer from PTSD (compared to 5% for men) McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, DeChant HK, Ryden J, Derogatis LR, Bass EG (1997). Clinical characteristics of women with a history of childhood abuse: Unhealed wounds. JAMA 277:1362-1368. return

9. Neglected and abused school children (K-12) as compared to their non-maltreated peers: Scored significantly lower on standardized tests in reading and math Received significantly more C’s and D’s and fewer A’s and B’s Were 2.5 times more likely to repeat a grade Were much more likely to be referred to the principal for disciplinary action Were significantly more likely to be suspended (31% of junior and senior maltreated students in the study having been suspended) Experienced more tardy and absent days

12. Trauma Related Disabilities / Disorders • Post Traumatic Stress Disorder • Dissociative Disorders • Borderline Personality Disorder • Anxiety Disorders • Depression • Alcohol and Substance Abuse • Somatoform Disorders • Somatic Disorders (especially Sleep Disorders) • Obsessive Compulsive Disorder

13. Symptoms of Trauma and Post-Traumatic Stress Disorder

14. PTSD symptoms fall into three basic categories: • Intrusive Thoughts / Re-living the event • (One or more symptoms must be present for diagnosis) • Dissociate states • Flashbacks / Nightmares and night terrors • Intrusive emotions and memories • Physical reactions, such as chills, heart palpitations, headaches, digestive problems

15. In the last five years, I used to cry everyday, but tears have resolved nothing. I don't have anything. All I have is my children and I'm afraid for them everyday. I was afraid for them when they went to high school. I was afraid they would take the wrong path and be attacked by other kids, or hit by a car. I have to be close with my children to keep them safe. They do not know the dangers. I always say that I'm going to learn English, but it's so hard to learn. I was at a workshop one time and it was time for everyone to leave, but my son was late in coming to pick me up. The case worker was in a rush. He kept on asking me for my address and asked if I knew my phone number. All I knew was "no." So all I said was, "no." I was really shook up. I didn't want to cause trouble. It was just a good lesson for me. I was so humiliated from it that I had learned that I need to force myself to learn English – so I can be prepared for humiliation. Now I take English lessons at my house. I can't remember, just a little here and a little there. I never went to school when I was young. I don't really remember the letters, I just remember things orally. But education is the most important thing. Jewels and bracelets can be stolen, but not your education. I was born at the wrong time. I was born very poor. But I would do anything for my kids. I'll be their mother and their father. I will keep them safe. A few years ago, I didn't want to live. I wanted to be hit by a car. But I've changed my mind recently for the sake of my younger children – They must be protected. They are good children, but they remain in ignorance about the world. I always encourage them to tell me about their sorrows and their concerns. I want to make space in the world for things that are fruitful. I'm embarrassed sometimes knowing that I cannot read or write. I don't want to take up space. I'd rather make room for the intelligent people. "My“ Born 1940, in Battambang Collected and translated by Elizabeth Chey, in 1995.

16. Avoidant Behaviors • (3 or more symptoms must be present for diagnosis) • Avoiding emotions / reminders of the event(s) • Avoiding relationships / feeling emotionally detached / Avoiding responsibility • Loss of interest in everyday activities • Avoiding situations, places and people that are reminiscent of the traumatic event

17. “Beautiful,” [his wife] would murmur, nudging Septimus that he might see. But beauty was behind a pane of glass. Even taste (chocolates, sweet things) had no relish to him. He put down his cup on the little marble table. He looked at people outside; happy they seemed, collecting in the middle of the street, shouting, laughing, and squabbling over nothing. But he could not taste; he could not feel. In the tea-shop among the tables and the chattering waiters the appalling fear came over him - he could not feel. One cannot bring children into a world like this. One cannot perpetuate suffering, or increase the breed of these lustful animals, who have no lasting emotions, but only whims and vanities, eddying them now this way, now that….For the truth is…that human beings have neither kindness, nor faith, nor charity beyond what serves to increase the pleasure of the moment. They hunt in packs. Their packs scour the desert and vanish screaming into the wilderness. Virginia Woolf : Mrs. Dalloway (1925)

18. Hyperarousal States • (2 or more symptoms must be present for diagnosis) • Exaggerated startle reaction • Explosive outbursts • Extreme vigilance / feelings of vulnerability • Irritability • Panic symptoms • Sleep disturbance

19. Developmental and Behavioral Consequences of Trauma

20. The Brain and its part in Learning Brainstem: The stalk-like part of the brain connecting the spinal cord and the forebrain. It includes the midbrain.The brainstem functions as an important relay station; every nerve impulse that passes between the brain and the spinal cord must pass through the brainstem to allow the body to function normally. Midbrain: The part of the brainstem that is responsible for controlling sensory processes.

21. Hierarchy of Brain Function In the brain of someone who has experienced a variety of emotional, behavioral and cognitive stimuli, a “top heavy” ratio develops. In this ratio, the brain matures to moderate the more primitive instincts of the midbrain/brainstem. When key experiences (Which develop the cortical/limbic part of the brain) are absent or minimal, the “higher” to “lower” brain ratio is impaired. In this case, the ability of the brain to moderate impulsive, reactive responses and to work through frustration is diminished significantly. Children raised in environments characterized by domestic violence, physical abuse or other persistent trauma will develop an excessively active midbrain/brainstem. This results in an overly active and reactive stress response and a predisposition to aggression and impulsiveness. Bruce Perry M.D., Ph.D. 1997

22. The amygdala is a brain structure that is essential for decoding emotions, and in particular stimuli that are threatening to the organism.Many of our body’s alarm circuits are grouped together in the amygdala. The amygdala regulates chemical reaction to fear and can override “higher” functioning parts of the brain. The hippocampus plays an essential role in memory and moderating reactions. MRI imaging has shown that people with PTSD symptoms experience a significant reduction in the size of their hippocampus, and an inhibited ability to recreate neurons in this area.

23. Chemical Reactions to Fear Scary Event Chemical Release Blocking of pain and “thought” to aid action Potent, emotional memory of event The changes brought about in the brain as a stress reaction are helpful in the immediate face of danger; however, these same reactions on an on-going basis cause damage. Specifically, they impair use of the prefrontal cortex (instrumental in planning, organizing and utilizing working memory), inhibit explicit memory, numb us to our environment, and cause us to be indiscriminately fearful.

24. Brain Pathways New brain cells sprout a thicket of connectors called dendrites. Each dendrite could form a connection with another cell; however, the brain usually regulates the number of dendrites by pruning away any extra ones that the brain does not need. Pruned dendrites produce streamlined system for transmitting information without interruption. Scans of brains that have experienced persistent trauma have shown an excess of unnecessary dendrites. Dendrite cluster before pruning Dendrite after pruning

25. Sitting still Setting Goals Academic tasks that are difficult when experiencing trauma related conditions Concentrating Processing Oral Information (When experiencing stress reaction) Talking (When experiencing stress reaction) Organizing Remembering Contextualizing (associating concepts appropriately)

26. Trauma Related Disabilities Characteristics and Symptoms

27. The Effects of Trauma on the Brain

28. Trauma Related Disabilities Characteristics and Symptoms

29. Trauma Related Disabilities Characteristics and Symptoms

30. Guidelines for the Classroom

31. Guidelines for the Classroom

32. Guidelines for the Classroom

33. Guidelines for the Classroom

34. Guidelines for the Classroom

35. Guidelines for the Classroom

36. Difficulty Learning Vocabulary: An Example of Multiple Needs

37. rage irritation anger rage

38. Sample Student Self-Assessment What is the word _____________________________________ What did I write? _____________________________________ What is the difference? ________________________________ • Is the word on my sight word list? • Did I mix up the order of the letters in the word? • Did I leave out part of the word? • Can I say this word? • Is it difficult to read my handwriting?

39. Sample Student Self-Assessment / ADD Question about class today:

40. RED Main Ideas • BLack Specific Details • YELLOW I don’t know if this is the correct word • UNDERLINE Questions I need to ask someone I feel you have more of a say when you vote. You have to take time out to learn about the issues and sometimes this is taxing. I feel I have more of a say over my life when I vote, especially when you are a poor person and people take advantage of you. My landlord always takes advantage of me and this is true for my neighbors also because we are poor. With voting you have more control over things like politics and you have to believe in the person. You have the right to vote so that you can have a say in the world. Before, people like me could not vote and we had to fight to have our say. History. Voting for the person you believe in is important the reason why is because each person is a separate candidate that will make a difference in your life. Next Elections.

41. Today in class we will study: ________________________

42. Resources • Local resources for Students: • Survivors International offers counseling, medical services and advocacy • to survivors of political torture. Also offer ESL classes and tutoring for people too impacted by their torture to function in a mainstream classroom. www.survivorsintl.org Free. • Center For Special Problems Adult outpatient mental health services for SF residents. Specialize in trauma, gender identity, violence and HIV / AIDS. 415-292-1500 Medical / Medicare and sliding scale. • Sunset Mental Health Individual, group and family therapy. Mandarin, Chinese and Russian. Medical / Medicare and sliding scale. 415-753-7255 • Institute for Traditional Chinese Medicine. Low-cost acupuncture and traditional Chinese medicine. 415-252-8711 • Mission Mental Health. Short-term psychotherapy, medication and referrals. Spanish, Russian and French. 415-554-9980

43. Education and Teacher Resources • www.casel.org/trauma.htm • Links page for educators • www.colorado.edu/cspv • Center for the Study and Prevention of Violence Institute of • Behavioral Science Information • University of Colorado, Boulder (303)-492-8465 • www.escapinghades.com/helpfulmeds • Commonly prescribed Medications and their side effects • www.tlcinst.org/impact • Article on interventions in schools