This presentation explores the impact of PTSD on learning and education. It offers tools for educators, parents and families to increase learning, growth and development for the 10's of 1000's of children and adolescents who suffer from PTSD.

2. The Story of Judith…
Trauma in Childhood
Judith is a bright and spunky 8 year old.
She lives with her mother, father, three sisters and
grand mother.
Judith has always been quiet. She has good grades
but tends to “space out.” She does not complain and
does what she is told.
Recently her grades have been falling behind. She is
“spacing out” more in class.

3. The Story of Judith…
Trauma in Childhood
Over the summer brake her grandmother was given
a diagnosis of cancer.
When you talk to Judith she is responsive but distant.
She does not seem to react much to anything.
Recently her mood has seemed more and more flat.

4. The Story of Judith…
Trauma in Childhood
Judith has stopped playing with other kids and
spends time reading alone on the playground.
In class she stares off into space and when she does
talk she is quiet, tentative and reserved.
She complains that she can not concentrate to her
parents and her mother reports that she is not
sleeping well.

5. The Story of Judith…
Trauma in Childhood
Her grandmother is in ongoing chemotherapy treatment
and is loosing her hair.
When people ask Judith about her grandmother she perks
up and smiles very big and says she will be just fine and
Judith says, “I am not worried about my grandmother.”
When Judith gets wrong answers she gives up easily. She
sometimes says things like, “I just don’t care.” When
asked if she wants to play by her friends she says no.

6. What Is
Trauma?
Trauma is a normal reaction to abnormal life events.
Trauma is psychological, behavioral biological, and
neurological change that occurs after an extreme live
event.
Trauma is in the reaction to an event not the event
itself.

7. Events Known to Lead to
Symptoms of PTSD (Trauma)
Violence
War, Terrorist Attacks
Physical assault/Violence/
Sexual assault/Domestic Violence
Seeing another person hurt.
Community violence
Accidental
Car Accidents, Falls, Natural
disasters
Surgeries, Animal attacks, Near
Drowning
Poisoning, Cancer, Life threatening
illness

8. What Is Trauma?
The Diagnosis of PTSD Cover’s Four Domains
Re-experiencing
Hyperarousal
Alterations in Cognitions and Mood
Avoidance and Numbing
For children and adolescents
neuro-developmental
disruptions are common.

9. What Is Trauma?
Re-experiencing: Upsetting thoughts, flash-bulb
memories, nightmares, emotional reactions, and
increased physiological stress about the event or
reminders of the event.
Hyperarousal: a state of increased psychological
and physiological arousal including anxiety, startle
responses, insomnia, fatigue, and increased
aggression.
Imageby:Ideago

10. What Is Trauma?
Avoidance and Numbing: Loss of
interest in life and pleasure; Feelings
of “deadness” or “numbness” and
distance from relationships; Difficulty
having positive feelings; avoidance of stressful, challenging, or
social situations; Avoidance of triggers associated with the
event.
For Children Neuro-Developmental Challenges are
Common: Attention problems, Sensory integration, Memory
deficits, Deficits in temporal-sequential processing, Neuromotor
deficits, Language deficits, Social skills deficits, Higher
cognition deficits.
Image by: worradmu

11. What Is Trauma?
Alterations in Cognitions and
Mood

12. Trauma and Learning
The Bad News…
Trauma effects multiple developmental
domains that can make learning difficult.
Trauma can increase disruptive behaviors,
conflict with peers and oppositional
behavior with adults.
More then 60% of Children with trauma
have impairments in language, writing,
memory, following directions, taking
feedback from adults, tolerating stress and
learning from their mistakes.
Image by: graur codrin

13. Trauma and Learning:
The Good News
Childhood is a time of major neuroplasticity that does not
end until ages 22 – 24.
The area’s devoted to affect regulation are some of the
most plastic areas of the brain.
Having one safe secure attachment figure in a child’s life
increases their chance of success even if that person is
only around for a short time.

14. Trauma and Learning:
The Bad News
Behavioral modification techniques
do not work well for children with trauma.
Children with trauma have an increased risk for: smoking,
teen pregnancy, alcohol abuse, drug addiction, learning
deficits, incarceration, autoimmune disease, diabetes,
and early death.
The child who develops symptoms of trauma can feel
isolated, alone, powerless and like the world is an unsafe
place.

15. Trauma and Learning:
The Good News
Creating islands of safety helps the child
develop their ability to be safe in multiple situations.
To work in a trauma safe way you do not need to have years of
training (it can help) it does require what Hughes calls: “The
Attitude.”
“The Attitude” is one of disciplined acceptance, understanding,
caring and a willingness to engage with the child or adolescent.

16. Trauma and Resiliency
Resiliency is the ability to bounce back after a difficult life event.
Resiliency is normal. Only between 10 and 25% of children who
face life threatening situations develop symptoms of trauma.
Some types of trauma are more likely to produce symptoms of
PTSD.
In general the more powerless, young, intensity of the event
and the higher number of traumatic events increases risk of
developing symptoms of PTSD.

17. Trauma and
Resiliency
Broaden and Build Hypothesis
Negative emotions (e.g. Fear, Anger, and Disgust) focus the
individual on short-term solutions to problems such as
removal of a threat, self-protection, and survival.
Positive emotions (e.g. joy, happiness, comfort, safety) build
strength for the future and focus on long-term problems
solving, building relationships and learning.

18. Trauma & Resiliency
When a child feels positive emotions they are more likely to
perform at their best.
Positive emotions build up resiliency against times of stress.
Positive emotions have an “undoing effect” reducing the time
an individual spends in a stress response.
After the bombing on 911 individuals who had a higher number
of positive emotions were less likely then controls to develop
symptoms of PTSD.

19. Trauma and Resiliency
Although symptoms of trauma and traumatizing events
are common resiliency is also common
There is a large body of research on what helps kids
bounce back (a.k.a. resilience) from stressful events.
The symptoms of trauma impact education and can make
teaching and learning challenging.
There are concrete interventions that can increase a
child’s resilience, ability to learn and ability to regulate
their affect.

20. Childhood Trauma – A Silent Epidemic
Sexual Abuse Impacts: 1 in 4 girls and 1 in 5 boys and there are
1,000,000 – Substantiated Child Abuse Cases Per Year.
A study found that in 2007 Child Trauma, Abuse and Neglect had an
estimated a fiscal cost of $103.8 billion dollars (this is likely an under
estimate of true fiscal cost).
“…Exposure to interpersonal trauma can chronically and pervasively
alter social, psychological, cognitive, and biological development.”
(D’Andrea et. al., 2012)
Experiences with racism, heteorsexism, sexism, ableism and other
forms of oppression increase the risk of developing PTSD and can at
times precipitated the symptoms of trauma.
D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: why we need a
developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200.

21. Childhood Trauma – A Silent Epidemic
Brain Changes Childhood Trauma:
1. Decreased volume in the corpus callosum
2. Decreased prefrontal cortex volume
3. Decreased temporal lobe volume (memory storage)
4. Increased volume in the superior temporal gyrus.
Age of onset and duration were significantly correlated with brain
volume in those areas.
While development can mitigate disruptions in brain development it
can also increase the disruption in brain development.
D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma
in children: why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2),
187-200.

22. Methods – Researchers surveyed a a nationally representative sample of 4,549 children
and adolescents age 17 and younger about experiences of violence.

23. Key Points
PTSD is a normal reaction to
abnormal life events.
The symptoms of PTSD fall into
three domains for adults:
Hyperarousal, Re-experiencing
and avoidance and numbing.
Children who experience
traumatic events also display
neurodevelopmental symptoms.

24. Key Points
Children are more likely then adults to
develop symptoms after a traumatic
event.
Although Symptoms of trauma are
common resiliency is common too.
There are concrete ways to create
trauma safe educational environments
that increase resilience and educational
outcomes for children who face life
adversity.

26. Extreme Neglect can lead to profound changes in the brain and the
trajectory of a child’s life.
1. 38% volume reduction in brain size
2. Average IQ 50 points lower putting a child in need of
life long care.

27. In Brief Report (Harvard) - The Impact of Early
Adversity on Children's Development
https://www.youtube.com/watch?v=NG4Sejgtxgc
This video from the Center on the Developing Child at Harvard University
(http://developingchild.harvard.edu/) outlines basic concepts from the
research on the biology of stress which show that major adversity can
weaken developing brain architecture and permanently set the body's
stress response system on high alert.
Science also shows that providing stable, responsive environments for
children in the earliest years of life can prevent or reverse these conditions,
with lifelong consequences for learning, behavior, and health.

29. Age and Brain Development
Total brain volume peeks at the ages of 10.5 for girls and 14.5 for boys.
Gray matter is pruned and white matter increases until 24+/-
Over childhood the brain several periods of intense growth in the brain
followed by a period of pruning back the connections.
After the age of 14 for most areas of grey matter enter a pruning phase.
Pruning later in life is associated with academic success. It maybe an
experience rich context in these years supports a later pruning period
there by academic success.
Timing Matters: Some areas are blooming (creating rich webs of
connections) when other areas are pruning (trimming back connections to
the most useful).

31. Disruptions in Attention
More then 60% of children who have been traumatized have
moderate to extreme difficulty with attention.
Attention is a highly complex concept.
Fundamentally attention is the ability to focus one’s mind on
single task. It is not awareness which is broad in focus.
Attention is vital to learning. It increases synaptic plasticity.

32. Attention: Level of Arousal
Alertness is a key domain of attention. Alertness and arousal
can be changed by PTSD in two ways.
• Hyperarousal (fight/flight stress): When a child is hyperaroused they
appear to bounce off the walls, have a heightened startle response,
increased aggression, and it is hard to maintain focus on a single task.
• Dissociation (freeze response): When a child becomes dissociated
their ability to maintain optimal arousal levels can be impaired. The
child’s mind can feel foggy, unfocused and their ability to take in
new information is impaired.

35. Poly-Vagal Theory
The way it works… V.V.C. Brake Disengages
Sympathetic Nervous
system Engages
V.V.C Brake Engaged
at rest and Socially
Engaged.
DMNX Engages
Shutting Down
Consciousness

36. Stress and Arousal in Attention
• Teachers can create environments that help children spend more
time in the optimal arousal range.
• Relationships make safety. The teacher’s ability and willingness
to build a solid relationship with the child translates into that
child’s ability to focus.
• Neuroception – “Limbic Safety-Check”
• Fast circuit – Creates a very quick snap impression of events. Source of
intuition used by the conscious self to identify what is importation
• Slow Circuit – Creates a detailed realistic image of an event and is
informed by the assessment in the fast circuit.

37. Development of Emotional Regulation
Overview: The rupture repair cycle is one of the key tools
that grows emotional regulation. It also grows the
emotional regulation centers in the brain.
If there are small ruptures in the relationship that are
followed by repairs the relationship gets stronger.
If there are difficult emotions followed by positive
emotions and social engagement the ability to regulate the
emotions get stronger.

38. Threat and Arousal in Student Behaviors
Recognizing threat is important.
Physical signs of fight/flight arousal:
Fidgeting, tense jaw, tight shoulders or fists, flush or pale
skin, pupils dilated, sweating, breathing changes,
defensive postures.
Vocal signs of fight/flight arousal:
Lack of musicality (vocal prosody), short clipped
sentences, angry tone or silence.

39. Threat and Arousal in Curriculum
Movies manage our threat arousal cycle very well. They scare us
and then make it ok. They use the “rupture repair cycle.” This is
important for children with PTSD as well as helping all kids learn.
Build learning around the four zones:
1. Safety Zone (easy work)
2. Stretch zone (slightly difficult work)
3. Growth Zone (difficult work)
4. Danger Zone (Overwhelm no learning possible)
If there has been too much stretch for too long it can be
overwhelming there needs to balance and a movement.

40. The “Attitude”
The “Attitude” creates safety and lays the ground work for effective
teaching.
Calm: Stay calm ware the poker face and remain warm.
Firm: Stick to the rules while remaining kind and supportive.
Accepting: Accept the child fully not the actions.
Empathic: Your empathy helps the child grow empathy for ot
hers
Playful and Curious: Enjoyment is key for a child or
teen with trauma. Curiosity is the Hallmark of safety.

41. Emotion Regulation Tools
Self-Regulating Adult: Remember emotions are contagious! Therefore it’s
important to learn some skills at regulating your own responses to intense
emotions.
Orienting: Is paying attention to the here and now through the five
senses.
Resourcing: Is accessing a previous memory or a current felt experience
of mastery, positive emotion, safety, or pleasurable sensation.
Distress Tolerance: Is recognizing that life is often difficult, and
sometimes all you can do is tolerate a difficult. With more practice it
becomes easier to remain present even in the face of a highly
uncomfortable and stressful emotional event.

42. Emotion Regulation Tools
Breath: Breathing into your belly can be a powerful way to stabilize
your consciousness when you’re feeling of intense emotion.
Self soothing: This is the skill that can help increase your tolerance
of difficult emotions.
You can soothe with in the five senses: touch, sight, smell, taste,
hearing.
You can soothe with your thoughts: positive self talk can help soothe a
difficult emotion.
You can soothe your imagination. Imagining a time when you felt good,
safe, loved or tolerated a difficult situation can help you learn to be with
the most difficult emotions.

43. Emotion Regulation Tools
Humor: Finding ways to be irreverent, take a
difficult situation lightly, and seeing the humor in
challenge can be a profound way to learn to tolerate
emotions.
Half smile: Your face is connected into the
parasympathetic nervous system. When you put a
half smile on your face, you tell your body to your
safe. This can reduce stress, increase pleasure, and
help you tolerate challenging emotions.

44. Vignette – Addressing Stress
Jane is a bright 15-year-old girl. Over the summer Jane was out with
her family and was in a terrible car crash. According to every one
who knows Jane she is respectful, motivated, and a good student.
Over the next three months Jane starts being more irritable in class.
Her test scores are low. In class she fidgets a lot and sometimes
appears to be staring off into space at nothing.
Jane’s parents call a conference and try to help Jane. Jane
becomes embarrassed about this meeting and starts becoming
more withdrawn at school. As the year progresses she appears to
be less able to concentrate and starts to cut class Jane’s parents
report that she is withdrawn, irritable, yells at her siblings for the
smallest things, and no longer listens at homes. They say this is a
dramatic change for her.

46. Social Emotional Context
In recent years the number of adults involved in a child’s life have
been reduced.
Average children have three adults in a home. Because of this
there are decreases in positive transactions with adults and
mentors.
Children learn by doing not by telling. They are educated in
empathy by their interactions with adults.
The job of teachers is both vital and very challenging.

47. Social Emotional Context
• In the school age years emotion regulation centers in the brain
are growing. Interactions with adults build the ability to
regulate.
The most important thing for creating environments that
heal trauma is…
Connection to other humans.
A connection that is consistent, patient, kind, and attuned.

48. Learning, Emotions, and PTSD
Learning is Impacted by Emotional States.
The development of brain structures requires learning.
PTSD or high stress disrupts the ability to pay attention, learn
from mistakes and understand one’s experience.
Affect Regulation: Is not simply the process of experiencing
and expressing emotions but it is rather the modulating one’s
emotional reaction in an adaptive way to meet the changing
needs or life situations, relationships and one’s own inner state.

49. Theory of Mind and Education
There are two major classes of factors that lead to development of ToM. These are
internal factors and situational factors.
Internal factors increasing the development of ToM:
Language abilities: Understanding language gives the child more ability to test a
hypothesis they are making about another’s experience. It also allows the child to develop
a narrative that connects their emotional reactions to previous events. This allows the child
to remember the events and consider the implications of events more freely.
Executive functions: These are the cognitive abilities to think about emotions. ToM
requires some degree of “meta-cognitive processes.” A child needs to be able to think
about their thinking and feel about their feelings in order to effectively understand their
own world and the inner life of another.

50. Theory of Mind and Education
External factors increasing the development if ToM:
Having siblings.
Participating in pretend play.
Reading story books with adults.
Talking about their past experiences with peers and adults.
If parents, teachers and care providers: Talk about: thoughts,
wishes, and feelings.
Parents and adults who provide reasons to the child when
correcting their behavior.

51. Theory of Mind and Education
Theory of mind (ToM) relates to the understanding that other
humans have there own mental states, feelings, motivations and
beliefs. Children with high ToM have many strengths over
lower ToM peers. Children with high ToM:
Are better communicators.
Can resolve conflicts with peers more effectively.
Display pretend play that is more complex.
Teachers rate them as more socially skilled.
They are happier in school.
Are more popular with their peers.
Their school work is often more advanced.

52. Theory of Mind and Education
Like with any powerful skill good supportive education is
needed on how to manage it effectively. A list of some of
the most common pitfalls of high ToM are:
ToM can be used to manipulate others.
ToM can be used to tease other children and hurt another more
effectively.
ToM can lead to more effective bulling of peers.
ToM can lead to more effective lying.
ToM can be used to gain social control and thus lead to the child
avoiding learning from their social mistakes.

53. Emotional Processing – Early Childhood
Time of profound development of emotional inhabbition,
modulation and self-regulation.
Brain Systems: Amygdala, Septal Neucleus, Anterior
Cyngulate, Frontal Regulation
As the toddeler emerges into childhood there are
Large increases in emotional language and understanding of
emotions.
Increases in the ability to identify the causal factors leading
to feelings and the consequences of experiencing emotional
states.

54. Emotional Processing – Early Childhood
Children see that different individuals can have different emotions in the same situation.
This is the foundation of social and moral understanding.
The late toddler years and early child hood there are increases in the ability to manage
and regulate emotions to meet social standards
This development leads to increases in the amount of self-conscious emotions such as
guilt, shame, pride and shyness.
These emotions are also highly important in the development morality and empathy.
The development of these emotions is influenced by parents and adults suggestions of
how to react to situations. Adult statements such as “you should be ashamed of this” or
“you should be proud of your work” help the child develop their emotional reactions to
events.

55. Theory of Mind – Early Childhood
By 2yrs: Infants show the ability
To differentiate between their thoughts about an object and
the object itself.
To understand that those that get what they want will be
happy and those who do not will not.
Infants start to see that there is a difference between their
wants and the wants of others.

56. Theory of Mind – Early Childhood
2 – 3 yrs: Children in this age group can understand three mental states. They are able
to recognize that some one see’s what is in front of the person not what the child sees
from their perspective.
If a three year old is allowed to discover that a box that contained candy contains pencils they
will assume that a friend who has not had the same discovery would have the same knowledge.
They will also not remember what they had previously thought was in the box after the
discovered that it contained pencils.
They will forget all together that they had thought that it had contained candy.
Children in this age group also realize that others might be motivated to help them meet their
needs if they ask.
Emotional awareness is a key domain of ToM. Children in this age group can distinguish
hedonic (pleasure or displeasure) tone of emotions (e.g. I feel good, I feel bad). By the age of
two children can talk about what others want and feel.
At the age of three children also talk about what other’s think.

57. Theory of Mind – Early Childhood
4 – 5 yrs Children in this age group realize
That the mind can create accurate and inaccurate beliefs or rendition of events
(e.g. false beliefs are possible). A child at the age of our will four understand that
the thoughts in their mind might not be true.
This allows the child to make and test guesses about their experiences of others
and to have more flexibility in choosing how to manage emotional reactions. In
middle to late childhood children start to see the mind as constructing or creating
knowledge.
In the classic study mentioned above a four year old will know that others will not
know the candy has been switched and will remember the change them self.
A four year old will understand both what their friend will think and what they
believed before their discovery of the pencils.

58. Emotional Processing – Childhood
TERM: Complex Emotions - Require the integration of multiple primary emotions and
social cognition and perspective taking
School age children understand that more then one emotional response is possible to
a situation.
Before this period – children required nearly entirely co-regulation with adult to manage
emotions
New Emotional Skills in Childhood:
See the link between events and emotional reactions.
Increased ability to suppress emotions for due to the social situation
Increased ability to suppress socially negative emotions.
Children begin to using self-initiated strategies for regulating emotions.

59. Theory of Mind - Childhood
Ages 6 – 10 Children have:
More introspection about behaviors and more self-reflection
capacity.
Beginning of third order social beliefs. In third order beliefs a child
can sequentially understand what two others think such as. “Jane
thinks that Mary thinks that there is a pack of gum in her bag.”
Ages 10 – 11 Children in this age group are able:
To understand rudimentary irony and complex social events. This
requires the ability to have a meta-reflection on the social setting
and their own position.
Perform more complex 3 – 4 level analysis of behaviors requiring
broader contextualization of social understanding.

60. Emotional Processing –Teen Years
Adolescents – Time between physical maturity and adult responsibility.
Earlier physical maturity and longer time to taking on adult
responsibility
Increased Dopamine Expression – Increased risk taking, emotional
expression and need for intensity.
Teens read facial expressions with their limbic system not their frontal
Lobes.
Teen Emotional Processing
Hot Cognitions (Thinking when intense emotions are present) – Teens struggle with mastery
with cognitions during intense emotions.
Cool Cognitions (Thinking when emotional system is in a more neutral homeostasis) – Teens
are effective in this type of thinking.

61. Emotional Processing –Teen Years
Adult Scaffolding of Emotional Development: Monitoring and interest from
adults that support teens to make sense of inner experience, choices about
actions and learn to regulate “hot” cognitions.
Scaffolding should be reduced over time and the teen supported to increase
their own autonomy. There are three major approaches for a teen:
Support and Care – This role is taken when the teen is solid in their skills and able to manage
situations effectively.
Coaching - This role is taken when a teen is in the developmental process of an emotional skill and
needs support.
Directing – This role is taken when a teen is more at risk of making decisions that could negatively
impact their future and needs to be balanced with support to move towards autonomy.
Igniting the Passion of a Lifetime – Meaning Mastery and Movement

62. Theory of Mind – Adolescence
While children can understand the existence of a false belief at the age of four it
is not until the age of 12 that they can effectively interpret and use this
knowledge in a social setting.
Higher order social cognition allows for a preteen to understand that you think
something is true and have a reaction to that thought.
It is in this period that higher order complexity emerges where teens can not
only understand that their mind is thinking and feeling but also understand how
a the mind creates interpretations.
At this stage a teen will be able to think, “A friend is tiered and misses their
sister who is at college so that is why she became sad so easily at the
commercial.”

63. Key Points – Emotional Learning
In recent years the number of adults involved in a child’s life
have been reduced.
Children learn by doing not by telling. They are educated in
empathy by their interactions with adults.
• In the school age years emotion regulation centers in the brain are
growing. Interactions with adults build the ability to regulate.
The most important thing for creating environments that heal
trauma are: 1. Connection to other humans. 2. A connection that
is consistent, patient, kind, and attuned.

64. Key Points – Emotional Learning
PTSD or high stress disrupts the ability to pay attention, learn
from mistakes and understand one’s experience.
Affect Regulation: Is not simply the process of experiencing
and expressing emotions but it is rather the modulating one’s
emotional reaction in an adaptive way to meet the changing
needs or life situations, relationships and one’s own inner state.
There are two major classes of factors that lead to development
of ToM. These are internal factors and situational factors.

65. Key Points – Emotional Learning
Theory of mind (ToM) relates to the understanding that other humans have
there own mental states, feelings, motivations and beliefs. Children with
high ToM have many strengths over lower ToM peers.
Time of profound development of emotional inhabbition, modulation and
self-regulation.
Children see that different individuals can have different emotions in the
same situation. This is the foundation of social and moral understanding.
The late toddler years and early child hood there are increases in the
ability to manage and regulate emotions to meet social standards This
development leads to increases in the amount of self-conscious emotions
such as guilt, shame, pride and shyness.

66. Key Points – Emotional Learning
2 – 3 yrs: Children in this age group can understand three mental states. They
are able to recognize that some one see’s what is in front of the person not
what the child sees from their perspective.
School age children understand that more then one emotional response is
possible to a situation. Before this period – children required nearly entirely co-
regulation with adult to manage emotions
Adolescents – Time between physical maturity and adult responsibility. At this
point in history there is earlier physical maturity and longer time to taking on
adult responsibility.
Adolescents Emotional Processing: Hot Cognitions (Thinking when intense
emotions are present) – Teens struggle with mastery with cognitions during
intense emotions. Cool Cognitions (Thinking when emotional system is in a
more neutral homeostasis) – Teens are effective in this type of thinking.