Trauma, Development, and Co-Morbidity

Clinical Presentations and Diagnostic Challenges

About the Course:

Early trauma—especially chronic—affects children’s development. Maltreatment, invasive medical treatments, domestic violence, accidents, disasters, grief, loss, war, terror, and many developmental issues: all place children at a high risk for attachment issues, frustration, overwhelm, and distress. Children have limited ability to verbalize distress. Therefore they often communicate it in behavior (and misbehavior), in how they relate to others, how they react, respond, remember, and learn. Traumatized children often present with difficulties in attending and learning, as well as with behavioral and social issues. They are more likely to require Special Education, repeat grades, drop out of school, get in trouble, and be diagnosed with mental-illness. What further complicates the picture is that children who have some form of childhood disability (communication disorders, physical limitations, developmental delays, sensory sensitivities, etc.) can have similar clinical presentations and that as a group these children are at very high risk for maltreatment, behavior issues, and posttraumatic stress.

Trauma can have profound impact on children’s development and clinical presentation. When trauma is not directly assessed, children can accumulate hosts of diagnoses: ADHD, Bipolar Disorder, Autism, Auditory-Processing-Disorder, Conduct Disorder, Childhood Psychosis, and more. Misdiagnosis and missed diagnoses can lead to ineffective intervention, increased frustration, and added need for dissociation. Awareness to the fact duress affects children has improved in recent years, but many professionals remain uncertain about how to differentiate symptoms and behaviors from underlying causes, about the particular ways children communicate distress, and how to address these needs.

This presentation will detail some of the ways trauma affects development, and how traumatic aftermath manifests in the behaviors, abilities, and communication of children. The challenges of differential diagnosis, co-morbidity, and primary versus secondary issues will be discussed, and possible ‘rules of thumb’ guidelines will be offered. Case study vignettes and quotes will be used to elucidate the relationship and complexity of trauma, development, behavior, communication, and differential diagnosis.

Journal/Publisher:

ISST-D

Publication Date:

April 2018

Author

Na'ama Yehuda, MSC, SLP

About the Author:

Na’ama Yehuda, MSC, SLP, is a speech-language pathologist and audiologist with over 25 years’ experience. A clinician in private practice, she consulted for the New York City Department of Education; provides international professional development and consultations on communication, language, trauma, and development; and is the author of the book, “Communicating Trauma” and several other publications on the topic. She was elected to serve on the boards of directors of the Israeli Speech Hearing Language Association (ISHLA) and the International Society for the Study of Trauma and Dissociation (ISSTD), chaired and volunteers on taskforces and committees, and co-chairs the Child and Adolescent Committee of ISSTD. She also writes and publishes fiction.

Course Objectives:

  1. List three ways chronic stress affects development

  2. Identify two diagnostic challenges in assessing traumatized children

  3. Discuss common co-morbidities in traumatized children

Exam Questions

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