Trauma, Bullying, and Violence

Second Annual Bullying Prevention ConferenceDecember 14, 2012Presented by LSU Baton Rouge

CARE for the Roots and the Tree Will Bloom

Effective Steps to Counteract Trauma, Bullying and Violence

k.seifert@espsmd.com http://preventbullyingnow.info http://drkathyseifert.com

Dr. Kathryn Seifert

• Bullies have been bullied or traumatized• They have learned to be bullies from a

role model. To change a bully, change the role model (teachers, parents, & School climate)

• Multi-disciplinary Teams for the most difficult cases include teachers, mental health, counselors administrators, and law enforcement

Major Concepts

• Primary Prevention – everyone• School Climate – Respect for all and talking through conflicts

• Less Severe Problems - Teachers• Teaching Social Skills – Olweus, character counts

• Moderate Problems - Behavior Coaches• Setting limits, positive reinforcement, Behavior

management• PBIS

• Severe Problems – Mental Health Referral• Very Severe Problems - Law Enforcement and/or mental

health

Interventions Depend on the Severity of Problems

• Some bullies have rather moderate problems that are fairly easily remedied with traditional methods.

• Some Bullies have very serious problems that are much more difficult to resolve

• Identification, assessment and treatment for these two groups are different.

There are little b bullies and There are BIG B Bullies.

The Severity of the Problems of a Youth that Bullies Relate to:• Severity and age at

which they experienced trauma

• Prior Bullying• Level of Aggression• Family and school

experiences• Types of

interventions

Let’s Start at the Beginning

Babies Are Born Innocent and Helpless and Need Adults to Take Care of Them

But, what if they grow up in

Violent, abusive, or neglectful homes?

THE INABILITY TO ESCAPE TRAUMA LEAVES ONE TRAPPED IN FIGHT OR FLIGHT OR FREEZE MODE

Trauma

Fight/Flight /Freeze

Numb – unable to

act

Frontal Cortex Not

in Use

New Stressor -

High Arousal -

Excitability

Hyper- Vigilant –

Poor executive function

In the days of dinosaurs this reaction to stress was a survival strategy. And led to safety.

Traumatized children may fight

Be angry, hostile, defiant and aggressive

The Under-Achiever

Or they may become good at Fleeing – Running Away from their Problems:

What do they learn?

To withdraw, hide or make themselves small (Freeze)

Development of coping skills may be so focused on fight, flight, or freeze,

• That development of more complex skills do not progress as well, such as:• Problem solving• Developing trust,

perspective taking, and relating well to others

• Emotional regulation• Brain development• Self-soothing and calming

down• Self monitoring to change

behavior.

Trauma also affects the brain and brain/body communication

• Brain still developing throughout childhood.• Make a fist with thumb sticking down –

Thumb is brain stem, inside of fist is limbic system (emotions), fingers are cerebral cortex or thinking part of brain.

• The brain develops from most primitive to most complex.

• Over proliferation followed by use it or loose it trimming.

• Amygdala – emotional regulation – may be smaller and less effective

• Brain development may be delayed• Cortisol may be in over abundance causing a

constant state of arousal

Problems caused by trauma

This attachment may be damaged by early trauma

Attachment is the heart to heart connection between infants and their caregivers

Close proximity of caregiver for protection and meeting needs of child (Bowlby)

Supports healthy development in every area Is the basis for developing trust, reciprocity, and

healthy relationships throughout the lifespanSupports healthy brain development Teaches self-soothing and how to build relationships

through attunement Is the basis for moral development (Kohlberg, 1969)Creates safe haven for exploring the world(Mary

Ainsworth)Necessary for the development of the amygdala and

limbic system for emotional regulation and for the development of mirror neurons to create empathy

8 Vital Functions of Secure Attachment

Secure Attachment

Baby has needs

Baby cries to get Mom’s

attention

Mom attends to his needs

He feels safe,

relaxed, & happy

He is good, his mom is good, the world is good.

arousal

satisfaction

• Positive view of self, others and the world

• Development of skills is appropriate for age and IQ

• Emotions well modulated after age 5

Secure attachment = Positive Development of self

• Effective coping skills and improved behavioral regulation by age 7

• Able to form trusting reciprocal relationships after age 10

• Loving and respectful relationships with parents and others

• Has empathy and compassion after age 10 (A chronic bully before and after age 10, may not have developed empathy for others.)

• Is academically successful in school to the best of his ability and is behaviorally well adapted. Look for bullies among those frequently suspended from school across grades..

Healthy Attachment

Disrupted Attachment – disorganized/Dismissive/Disinhibited Type

Baby has needs

Baby Cries to get Mom’s

Attention

Mom rarely comes or attends to his needs

He cries & cries until he stops crying

No one can be trusted

I must take care of myself

I must have Power

• Behavior problems that begin in adolescence, often end in adolescence if routine interventions are used. (Easier to solve)

• Chronic Behavior problems that begin in elementary school may signal a life long trajectory of aggression toward others and need a different type, intensity, and length of intervention.

Trauma and attachment Problems at ages 0 – 3 can result in a Life-Long Trajectory of Interpersonal Aggression

Why is that?

• Recognizing that an individual has a mind and that others have a mind, each with a point of view, which can differ.

• Basis for perspective taking, interpreting intention of others, and empathy.

• Certain brain functions and social experiences are necessary for an individual to develop a theory of mind.

• Autistic and children maltreated in early childhood either do not have or have a poorly developed or distorted theory of mind.

• This does not allow the adequate development of empathy, perspective taking, understanding another’s intentions, or reciprocity.

Theory of Mind

• Toddlers do not have the social skills to get what they want through negotiation.

• They take what they want • They can be quite physically

aggressive – pushing, pulling hair, grabbing

• Tremblay et al.

Ages 2 ½ to 3 ½

• For those that have adults teach them other ways to get their needs met, aggression goes down to zero and stays there throughout the school years.

• For those that do not have adults teach them other ways to get their needs met, aggression remains – sometimes for a lifetime

3 ½ to 5

• Skill Development• Interpersonal Relatedness• Self Concept• Self Management• Theory of Mind• Emotional Regulation• Development of Pro-social values• Brain Development• Family Cohesiveness and relationships

Additionally, When Attachment Bonds are disrupted, There can be problems with

• Negative view of self, others and the world

• Development of skills lags behind age and IQ

• Emotions not well regulated after age 5

• Learning Problems

Disrupted attachment patterns - self

Complex PTSD (Courtois)/Developmental Trauma Disorder (Van der Kolk)

• The victim is psychologically and physically immature and dependent on others.• His or her development is often seriously compromised by repetitive abuse and inadequate response at the hands of family members or others on whom he or she relies for safety and protection.• Symptoms include dysregulation, severe problems with interpersonal relatedness, and ineffective general functioning

3 Major Outcomes for Early Trauma

• Building strengths from overcoming the trauma• When an adult helps a child overcome trauma and teaches skills

• Becoming bullies or a violent individual• When no one attempts to help child overcome trauma and teach

skills

Becoming withdrawn, anxious and depressed.

When no one helps the child recover from trauma

All maltreated children should be assessed for family therapy and skill building

DISORDERS OF DYSREGULATION IN CHILDHOOD AND THEIR RELATIONSHIP TO TRAUMA

Conduct Disorder Aggression Destroys property Deceitfulness Violates rules

Oppositional Defiant Disorder Angry/irritable Defiant Vindictive

Trauma is the likely the major source of the above disorders (Seifert, 2012; Greewald, 2002; Frick & Silverthorn, 2001; Rhee et al., 2001; van den Oord, Verhulst, & Boomsma, 1996; Waldman et al., 1998 and http://www.aacap.org/cs/root/facts_for_families/conduct_disorder

RELATIONSHIP HEALTH

Severely Disturbed

Attachment Patterns

Primarily Highly

Conflicted Relationship

s

Primarily Positive

Interpersonal

Relationships

Altruistic Relationship

s

BULLYING

Types of BulliesBully• Sadistic, Narcissistic – Purposeful. Lacks

empathy & needs to feel omnipotent. Deep seated problem requiring intensive services – Needs thorough Assessment and intensive treatment (BIG B Bully)

• Very Serious Problems

• Follower. Responds to overall culture of the group with whom he is surrounded. Needs supportive counseling, guidance and social skills. Can be led toward or away from Bullying – Olweus Bullying Program (Adolescents trying to fit into a group. Has to do with VALUES)

Imitative Bully

• Reacts to the situation. Difficulty restraining himself. May have been bullied. Evaluate for Trauma, family problems, ADHD and treat (Could be a culture/Values Issue)

Impulsive bully

• Watches and enjoys bullying and encourages the bully. Needs assessment for treatment options (May be a BIG B Bully)

Bully by proxy

• Bystander – stands by does nothing to help victim either because of fear, uncertainty, or mixed feelings (Universal

Bystander

Any Type of Bully Can be An Outgrowth of Past Trauma, but most likely the Sadistic and Impulsive Types (Big B)

• child abuse and neglect• Exposure to domestic violence• failure to teach alternative ways to get one’s

needs met• violent role models

• Prevents Victim from becoming a bully

• Yellowribbon.org – It’s OK to ask for Help

• Mental Health Referral

Help the Victim

Important Bullying Facts

Bullying is serious and should never be ignored.

Bullying is not a normal part of growing up.

Suspension is not an adequate answer.

Bullying is an adult problem to solve. Children cannot solve a bullying problem alone.

Parents of the bully need to be involved in solving the problem.

Stopping some types of bullying is about teaching respect for diversity and teaching social skills.

Some bullies have deep-seated problems that will take significant treatment, some do not. teachers and counselors need to know which is which because interventions will be different.

Most school shooters felt they were bullied and ostracized by another group of youth. Their attacks were often retribution toward the group that bullied them.

Bullying ApproachesFor those that do not have

severe ,deep seated problems

Olweus Bullying Program - http://www.violencepreventionworks.org/public/olweus_bullying_prevention_program.page

Operation Respect - http://operationrespect.org/

Character Counts - http://charactercounts.org/

School based mental health

http://yellowribbon.org

When you are not sure :

Assessment of severity of problems, dangerousness and appropriate interventions

• Severe problems• chronic problems• multiple problems• Past aggression• Problems began in elementary

school

When is the problem more serious?

Warning SignsYouth at Risk for Chronic Violence

have multiple problems, but may be different for girls and boys

More Problems = Greater Risk for Chronic Aggression

BoysPast assaults on others between the

ages of 5 an 12Chronic School Behavior ProblemsOppositional to authorityNot doing well in schoolFire settingChildhood maltreatment by a caregiverLacks remorseAnger management problems

Violence & School Shooters

From Bullying to Violence in Schools

Bullying can lead to violence in our schools and School Shootings

Most school shooters felt they were bullied by others

Which youth are at high risk for extreme violence?

What are the warning signs?

Which ones need intensive interventions to prevent future violence?

Warning Signs for Girls Who are Violent

Past Assaults

Harms animals

Delinquency

Childhood maltreatment

Substance Abuse (teens only)

Anger management problems

Lacks remorse

Poor problem solving skills

Bullying Behavior

Delinquent peer group

Chronic School Behavior Problems

Assessments to Determine the Best Intervention

One Size Does Not Fit All

• Problems and Strengths• Complexity or severity of

problems• Levels and types of

interventions needed• Developmental level of

coping skills• Functioning of family

What an Assessment Should Tell You

Problems and Strengths

Problems & Strengths

• Problems• School difficulties• Bullying• History of aggressive

acting out• Problems began

before adolescence• Parents not

supportive of working with school to find solution

• Strengths• Does well in school• Gets along well wit

peers• Respectful of

authority• Corrects behavior

when requested• No past aggression• No past delinquency• Talented in ________

Charles Manson (Disinhibited/ disorganized/dismissive attachment type and below average relationship health)

• Mother was a teenager and an alcoholic• She severely neglected Charles. He

ran the streets from a very young age• She once sold him for a pitcher of beer• He was delinquent and a bully• Spent most of his teenage years in

institutions• Raped a boy in one of the institutions• Drug user, never held a job• “Family” responsible for Tate &

LaBianca Murders

Mother Teresa (Secure Attachment type and above average relationship health)

• Agnes was born in Albania (Bosnia).• Father was in Albania independence

movement. Likely poisoned by opposition political group when Agnes was 8 yo.

• Parents very supportive of children, deeply religious, gave to the poor

• Financially and emotionally devastated when father died.

• Agnes was good student, active in church, and no behavioral problems.

• She was neither a bully, nor bullied • Mother became entrepreneur and

support family. Still gave to the poor and devoted to children.

• Agnes became a nun when she was 18 years old.

Nelson Mandela• His nickname as a child was

troublemaker• Lost his father when he was 9• Regent Jongintaba became his

guardian• He was very good in school• Was bullied as a teen in Boarding

School• Led ANC’s 1952 Defiance Campaign

against apartheid• Led the ANC’s Bombing and

sabotage campaign• Imprisoned for 27 years• Became first elected president of

the new Republic of South Africa in 1995

Loss

es

Traum

a

Schoo

l Prb

Aggre

sion

Men

tal il

l

Violen

t Writ

ing

Mad

e Bom

bsBull

y

Bullied

Delinq

uent

Threa

tenin

g

Viol F

amily

0

1

2

3

4

5

6

Non Violent

Altruistic

Violent

Violent Group

All 3 groups had losses & trauma.

Violent Group

Non-Violent and Altruistic Groups had nurturing families, positive school experience and activities and helped others

Complexity or severity of problems

• Mild • Less than 4 months duration & easily

corrected. Counseling or skill group 1 a week or every other week, 6 months or less.

• Moderate• A year in duration & at risk for negative

consequences. Weekly, may need to bring in family, skill groups

• Severe and Chronic • Lasting more than a year, started before

age 13, multiple problems, few resources, at risk for placement, need to involve family

Severity and Complexity

Levels and types of interventions needed

Both Bullies and those being Bullied Need Assessment for Services

• Mild • Counseling or skill group 1 a week or every

other week, 6 months or less. Supportive or relationship counseling I likely to be sufficient.

• Moderate• Supportive counseling not sufficient. Weekly,

may need to bring in family, skill groups for 1 year. Developmental approaches may be needed for some.

• Severe and Chronic • Supportive counseling not sufficient.

Individual, family and group; intensive (multiple times per week); need to involve family; placement may be needed. Services needed for more than 1 year. Developmental approaches likely are needed.

Levels of Intervention

CARE2 Problem Complexity Score

o Uses all items on the CARE2o Clinical, historical, dynamic, and those that

predict violenceo Gives a score that can track progresso Gives EBP Treatment plano Allows agency to use more expensive

treatment for most chronic and severe caseso Can also use Strengths scoreo Can change treatment plan if youth is not

improving

CARE2 – Violence o 4 NORMS

o Male/femaleo Pre-teen/Teen

o Mark all that apply (Clinical and Risk Items)

o Items with scores are added and resiliency scores subtracted

o risk scale are statistically derived on a sample of 1000+ youth and studies of subsets

o Evidence based intervention plans

Skill Development

• Clinical Judgment no better than Chance

• SAVRY – Randy Borum – U. of S. FL., primarily for violence. Excellent tool.

• LS-CMI – Andrews. Case management tool primarily for delinquency. Found no gender differences.

• PCL-YV. Adelle Forth & Robert Hare. Measures Psychopathy. Do not use for girls

Violence Risk Assessments

Stage I – Ages 0-2. Immediate Gratification

Stage II – Ages 2 -7. Reciprocity begins to develop

Stage III – Ages 8 – 11. Empathy Develops. More organized , less impulsive.

Trauma Negatively Affects Moral Development, Kohlberg, 1969

Stage IV (12-18) Learning the importance of group membership and the “Golden Rule”

Can be blocked by Trauma

Can be blocked by Trauma

Can be blocked by Trauma

Development of Childhood AggressionAll children below the age of 3 are

aggressive

When parents teach children alternative ways to get their needs met, they stop being aggressive when they enter kindergarten or 1st grade

When no one takes on the job of teaching alternatives to aggression, the children remain aggressive after they enter school.

This is a red flag that family intervention is needed.

More in depth assessments and interventions are needed for any school age aggressive child if any of the following are true• Low level of coping skills?• Child’s behavior not appropriate

in multiple settings• Parents do not respond to

requests from school or therapist to help problem solve.

• The child appears to be physically neglected?

• The Child appears to be hyperactive, depressed, irritable, or unable to focus most of the time?

The Marshmallow Experiment

Behavioral Objective SequenceSheldon Braaten

The Behavioral Objective Sequence

• By Sheldon Braatan• A developmentally sequenced group of

skills in 6 Domains.• Age is not the determiner of skill level• Youth must learn skills in appropriate

developmental sequence.• Find out at what level they have

mastered skills (can do it 90% of the time without prompting)

Adaptive Skills

Responds in a developmentally appropriate manner to rules and expectations

AND

Changes those responses as the circumstances change

Example

I expect a __ year old to walk into the counseling office and be able hold a conversation with the counselor AND when the format is changed to group therapy, the youth is able to adapt to the different format and relate to peers in the group, not just counselor.

Adaptive: Responds appropriately toroutine and new expectationsrespond independently to materials for amusementappear alert and able to focus attentionbring no weapons to schooluse amusement materials appropriatelywait for turn without physical interventionuse and return equipment without abuseaccept positive physical contacttouch others in appropriate waysrefrain from stealingrespond when angry without hittingrecognize and show regard for possessionsaccept verbal cue for removal from a situationrespond when angry without abuse of propertyrespond appropriately to substituterespond when angry without threatswalk to timeout without being moved by an adultwork or play without disrupting othersrefrain from inappropriate behavior when otherslose controlrespond to provocation with self-controlrespond when angry with self-removal

Self-Management Skills

Responds appropriately to challenging experiences with self-control in order to achieve success

Example

Gets upset with brother because he broke something that belonged to client.

Client is able to use alternative strategies to manage self and situation and not harm brother, ie. ask for help

Communication• Ability to share with and

receive information from other people to meet a need or affect another person in a positive way.

• Example: • You need to turn in your book

report by Friday• Tell him you would like a turn

with the _______.

Interpersonal Behaviors• Interacting with others in social and

task situations in ways that meet personal and interdependence needs and contribute to a sense of belonging

• Example:• Can participate in group• Can give and accept positive or

negative feedback

Task Behaviors

• Student engages in task or activity with or without assistance

• Example:• Finish a homework

independently• Can set the table without

assistance

Personal Behaviors• Student engages in a counseling

dialogue with a helping person, permitting adult to help resolve issues or solve problems or build self esteem.

• Example:• Can ask for help from an adult

when stressed• Can discuss problems with

counselor and generate possible solutions

Level 3 (skills typically mastered during preschool years):Focus: Self; Significance; SuccessIssues: Trust; Pleasure; Security; SupportInterventions: Routines; Repetitions; Modeling; Rewards; Limit Setting; Consistent and Planned Consequences; Continuous SupervisionAdult Role: “Benevolent Dictator”

Level 2 (skills typically mastered during elementary years):Focus: Group membership; Competence; Sensitivity to Others; Awareness of Values; Communication SkillsIssues: Applying Skills in Groups; Balancing Personal and Group Needs; Responding to New Settings and People; Managing MovementInterventions: Routines; Repetitions; Verbal Rewards; Limit Setting with Expanded Choices; Consistency with Group Consequences; Natural and Logical ConsequencesAdult Role: “Group Leader”

Level 1 (skills typically mastered during adolescence and early adulthood):Focus: Belonging; Cooperation; Personal “Power,” IndividuationIssues: Applying Skills in New Situations; Expanding and Reinforcing Competencies; Transitions to New EnvironmentsInterventions: “Normal” Expectations; Social Rewards; Expanded Choices; Group Problem Solving; Self Selected GoalsAdult Role: “Guide/Facilitator”

Functioning of family

• Parenting Skills• Communication Skills• Conflict Resolution Skills• Acceptance of Diversity• Mental Illness• Substance Abuse• Homelessness

Assess Family Functioning

Interventions

General Interventions

Try correcting the behavior first. Use behavior management and contracts.

Teach the method to parents to use, as well.

Teach respect for differences

If children respond, it is likely not a deep seated problem.

• School wide education campaign• It’s OK to Ask for Help

http://Yelllowribbon.org

Severe Behavior Problems RemainIf child is still:

Frequently Assaultive

Has chronic, moderate to severe behavior problems

Has history of childhood maltreatment

His/her behavior is out of control and cannot be corrected

Child lacks respect for authority

Assessment is needed to determine severity of problems and treatment and if it is a family problem.

Refer for Mental Health Evaluation

Assess Youth For:

• Level of strengths and problems

• Developmental Level

• Types of interventions needed

• Family Functioning

• Right Intervention for Right Youth• Interventions for needs of youth and family• More structure• Parent education and therapy• Behavioral Objective Sequence• More intensive services• Services for years, rather than months• Case Management• Coordination of multiple agencies

School Based Mental Health

• Early childhood trauma can interfere with the development of important skills

• Those that receive appropriate support and assistance can grow up to be healthy

• Those that do not receive what they need can become bullies and violent

• Appropriate treatment can change behavior and skill developmental level

• Adolescence specific and life long trajectory aggression toward others are very different and require different treatment.

• School wide skill building programs are only appropriate for less severe forms of bullying and aggression

• More severe and complex problems require more intensive and a broader spectrum of services.

Summary

Elephant Story