FASD and Trauma:

Helping Kids Recover

Thank You!

Material based on the work of:

Dr. Daniel Hughes and Dr. Arthur Becker-Wiedman

Heather Forbes, LCSW and Brian Post, LCSW
Dr. Bruce Perry
Dr. Eliana Gil
Dr. Gordon Neufeld
Dr. Peter Levine
Dr. Chuck Geddes
Dr. Diane Benoit
Paula Aguilla, OT

2010-12-22

What you will walk away with:

Learn more about the overlap between
symptoms of FASD and symptoms of
developmental trauma
Learn more about what developmental trauma is.

An understanding that if we treat FASD affected

people from a perspective of developmental
trauma, many of their symptoms can be reduced.
Learn effective strategies and approaches
Movement, environment and attachment.

The impact of the first years

Early Developmental Trauma: Maltreatment in the first 3 years of life (as well
as in utero): neglect (physical, emotional), abuse (physical, sexual, emotional).

Results in brain developing differently

Four big results:

1.
2.
3.
4.

Fear (Fighting for Survival) becomes key motivator

Trouble self-soothing (regulating emotions).
Shame based identity.
Neurological Immaturity

2010-12-22

The thinking
Brain Sciencebrain.
101
Words,
logic, reason.

Brain stem. Share with

reptiles. Time and space,
rage, terror, body
functions, movement

Aug 31, 2011

Share with all

mammals.
Relationships,
emotions, safety.

Trouble Self Soothing:

ANS Dysregulation and Regulation

Stuck on ON:
Hyperactivity
Panic
Rage\ Aggression
Hypervigilance

Window of Tolerance

2010-12-22

Stuck on OFF:
Defiance
Resistance
Dissociation
Depression

Attuned Caregiving Teaches

Self-Regulation

Window of
tolerance

2010-12-22

Shame vs. Guilt

Shame:
Feeling that there is
something wrong with
who we are .
I am bad I am
worthless
I am unloved and
unlovable
Very hard to tolerate feeling
this way: hopeless and
unlikely to change on its
own.
2010-12-22

Guilt
Feeling that we are ok, but
that there is something
wrong with what we did.
I messed up I made a
mistake
Although it is difficult to feel
we made a mistake, this is
more tolerable, more
hopeful.

Typical Behaviours:
If child does something wrong: likely to deny what he
did (lie), minimize it, make excuses for it, blame
someone else for it.
If caregiver keeps focusing on mistake: likely to
become enraged at caregiver. Yelling, screaming, bad
words, temper tantrums. Pushing pain outward.
If caregiver is loving and caring: Child is sure that
caregiver will eventually notice how bad/unlovable she
really is. To not feel totally helpless, child takes control
of this rejection. Very hurtful or bizarre behaviour
results. (Feces on walls, breaking valued objects,
hurting pets).
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10

The Closeness-Rejection Ride

Video clip

Overlap: Developmental Trauma and

FASD
Developmental Challenge

Neurological &
Biological
Immaturity

General Characteristics

Attention Problems
Easily Distracted
Task Completion Difficulties
Memory Difficulties
Fine Motor limitations
Gross Motor Lags
Sensory Sensitivities
Body Regulation Difficulties
Poor eye contact
Height below 10th %ile of correct gestational age
Delays in dressing, toileting, dressing, health

Complex Trauma

FASD

X
X
X
X
X
X
X
X
X
X

X
X
X
X

X
X

X
X

General
Characteristics
Over-Active
Stress
Response
Systems

Hypervigilance
Sleep Difficulties
Anxious
Difficulties with Change
Hyper-aroused to
fight/flight/freeze
Sensitive Startle Response
Escalation to stress
Under responsiveness to
stimulation

Developmental
Trauma
X
X
X
X
X
X
X
X

FASD

X
X
X

General Characteristics

Emotional
Regulation
& Mood

Depression
Difficulty returning to calm state
Dissociation
Hallucinations
Difficulty communicating needs
Difficulty with delaying Gratification
Volatile

Developmental
Trauma

FASD

X
X
X
X
X
X
X
X

X
X

X
X
X
X

General
Characteristics

Attachment
&
Relational
Skills

Risky Sexual Behaviour

Poor familial relationships
Boundary difficulties
Non compliance
Running Away
Social Difficulty with Peers
Avoidant
Compliant
Interrupts/ Intrudes
Inappropriately
affectionate with strangers
Difficulty with Transitions
Poor Peer Relationships
Limited facial expression

Developmental
Trauma

X
X
X
X
X
X
X
X
X
X
X
X
X

FASD

X
X
X

X
X
X
X
X

General Characteristics

Behavioural
Regulation

Verbal Abuse
Verbal Threats
Threatening Gestures
Physical Aggression & Violence
(people & animals)
Property Damage
Constant Struggle for Control
Self-Harm
Drug Use
Process Addictions
Poor Impulse Control
Engage in activity without
considering consequences

Developmental
Trauma

FASD

X
X
X
X

X
X
X
X

X
X
X
X
X
X
X

X
X
X
X
X
X
X

General Characteristics

Cognitive &
Language
Development

Learning Delays
Language Delays
Concrete Thinking
Processing Difficulties
Memory Difficulties
Poor follow through on instructions
Poor Cause & Effect Reasoning
Poor Time Comprehension

Developmental
Trauma

FASD

X
X
X
X
X
X
X
X

X
X
X
X
X
X
X
X

Developmental Trajectories and Maltreatment

or Trauma

Typical

Level
of

Delayed
trauma

Functional

Development
Pre-natal

Early/Persistent
maltreatment

Infancy

Early Child

Teen

Adult

Factors influencing Resilience

Enhancing
Healthy extended
family/caregiver support
Intelligence
Good nutrition
Access to nature
Free play

Reducing
Isolation
Poor food
Lots of time spent in front
of screen
Little or no free play
Little or no access to nature

What we can do to help the children

heal

Take care of ourselves first

Bi-lateral movement
Proprioceptive stimulation
Sensory Soothing Activities
Attachment Enhancing Interactions

We have to calm ourselves first

These childrens behaviours are challenging!
We get triggered! Thats normal.
Anger
Fear
Shame
Childhood hurts
Fears about our own competence
Worries about their future
Worries about their moral development

Lots of Physical Activity

Movement: rough and tumble free play
3-4 hours/day for optimal development

Bilateral movement helps stimulate neuronal

growth
Rough and tumble play builds coordination and
core strength- reduces fear, builds sense of
competence
Movement helps calm emotions, teaches self
regulation

Proprioception
Sensory messages about position, force,
direction, movement of our own body parts.
Receptors: in muscles and joints.
When engaged in proprioceptive activities,
activate same neuro-chemicals as when we
are in calm, alert state.
Use as part of daily plan, especially before
transitions.

Proprioceptive Activities
Joint squeeze
Arm push-pull
Heavy work (push, pull, drag, lift)
Lots of activities in Out of Sync Child Has Fun
and Growing an In-Sync Child by Carol StockKranowitz

Safety Activities
Activities that repair missing experiences,
remind nervous system that it is safe now:
Sound machine at night with rhythmical sound
Warm bath, hot water bottle in bed
Thumb hold
Safe place hideout

Necessary Qualities of Healthy

Attachment
Able to connect with child/youth at their
developmental age (not chronological age)
Free of shaming attitudes: Make clear
distinction between who child is and what he
does, love him no matter his behaviour.
Slow pace: child is not rushed
Avoid emotional separation

Slow Pace
Why? Chronic stress or immediate danger
requires a period of calm to heal.
Examples

Let the child take the time to finish something.

Dont rush.
Sit with him/her while he calms down
Speak slow, walk slow, etc. Allow for lots of silence.
Use lots of tactile activities (play do, cush balls, clay,
etc)

Collecting Kids
Must get smile and nod before can do any
work, get any compliance, have any deeper
conversation, etc
Smile and nod can be about anything:
Ex: my goofy shoes
the lousy weather, etc
Do not move on until have smile and nod.

Bridging
Bridging: letting the child know that your
relationship will remain intact, even if there is
some separation.
You will be close again
You are looking forward to what you will do when you
are close again.
Ex: I am so looking forward to seeing you tonight. Well have supper and then play that card
game you wanted.
I know we had a bit of a rough time just now, but I am really looking forward to talking to baking
cookies later.

Purpose: Reducing emotional separation.

The Skill of Guessing

Often, kids (especially if they are young, or have
experienced abuse/neglect) dont know what they are
feeling or thinking.
To help them learn, we need to develop the skill of
guessing.
In order to guess, we need to have some idea of the kinds
of things this child is scared of, feels ashamed about or
wants to avoid.

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30

Empathetic Guessing
Wow, I see you are getting real upset. I wonder if
you are scared that I am going to leave you too?
Huh, I bet you are thinking he doesnt like you. If
I thought that, Id be really hurt too. Is that what
you are thinking?
It must be so hard when mom doesnt come. I
wonder if you are thinking that she doesnt care
about you?
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31

Guessing Practice
What might child be feeling?
Scenario 1:
Four year old Amanda tends to dawdle during transitions. This
time, she is busy playing with the blocks, building a tower. You tell her
that it is time to stop playing with the blocks, because it is time for
circle time. First time you tell her, she ignores you. You get more
insistent, and she gets mad, throws the blocks at you, and yells: I
hate you.
Background info: Amandas parents struggle with drug addictions, and
theyve relapsed. Last night, like most nights, Amandas only
connection with her parents was when she watched a crime show with
them. Then, she was told to go to bed, and spent the night listening to
them getting stoned and aggressive.

Guessing practice contd

Scenario 2:
Three year old Peter is playing on the
playground. He has been playing with a little
girl, running around and climbing things. All of a
sudden, he hits the girl.
Background: This is late in the afternoon, past
his nap time. Mom is depressed, and dad works
up north. When Peter is home, he spends most
of his time in front of the TV, as always.

Empathy
Empathy is like aspirin, it works with everything
Daniel Hughes

Feeling with
Entering into childs felt experience
Empathy is not reassurance.
If you cant think of anything to say, experience
and express empathy. It will buy you some time,
and most likely also be helpful.

Aug 31, 2011

Examples of Empathy

Looks like you are having a hard time!

It is so hard to wait!
You seem to really want to finish that now!
Kind of disappointing when you cant go to your
friends house.
You really seem to be angry about that!
That must be so hard... being all alone.
It is so difficult when you try hard as a parent and
it doesnt seem to be working.
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35

Structure
Incorporate daily attachment/snuggle time.
Not conditional, happens even if kid
has misbehaved. 15-20 minutes/day.
Examples: reading a story, unstructured
play, bed time ritual. Screen time is not
attachment/snuggle time.
Time in-not time out. Sit with the child when
he calms down, dont make him leave.
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36

How to Calm a Child/Youth Down

Match the intensity of the childs emotion
Reflect back the emotion you are noticing
ex: You are furious! Something really
scary just happened!
Make yourself smaller than child
Avoid direct eye-contact, avoid leaning
forward
Stand along- side instead of face to face

Making mistakes is ok!

In fact, messing up will help build attachment
security if dealt with well.
Apologize and
make amends

Repair
Find a way to be
close with new
learning about
each other.

You or your
child make a
mistake
Rupture

Aug 31, 2011

Reattunement

38

Summary
Many symptoms of FASD overlap with those
of developmental trauma.
Those symptoms can be reduced using
attachment enhancing principles, movement,
proprioception and structure.
Match the intensity when calming a child
down.
Making mistakes is totally ok, as long as you
repair it.

Thank you!