Childhood Trauma and Resilience: A Practical Guide

240 Pages·2021·22.944 MB·English

by  Heather C. Forkey MD FAAP, Jessica L. Griffin PsyD, Moira Szilagyi MD PhD FAAP

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Pediatric care is on the cusp of a transformation, from reactively identifying and treating the H CCHHIILLDHOOD
consequences of childhood adversity to proactively building the skills needed for resilience, healing,
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and thriving. Childhood Trauma and Resilience is a must for all pediatric professionals interested
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in transforming their practice from “trauma-informed” to “resilience-centered” care.
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—Andrew Garner, MD, PhD, FAAP, coauthor of Th inking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health O TTTTRRRRAAAAUUUUMMMMAAAA &
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A Practical Guide
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Heather C. Forkey, MD, FAAP • Jessica L. Griffi n, PsyD • Moira Szilagyi, MD, PhD, FAAP
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ith this practical guide, pediatricians and other child health professionals will learn to identify, evaluate, and treat
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children and families aff ected by trauma and adversity when they present at the offi ce. In addition to instruction for
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hands-on acute care, the cohesive approach lays out a framework and concrete steps to focus proactively on resilience
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and provide the best, most impactful care to all patients.
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Childhood Trauma and Resilience includes mnemonics, charts, tables, reproducible handouts, and numerous case E
studies to reinforce learning, as well as timely information on physician burnout and secondary traumatic stress. :

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About the Authors r
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Heather C. Forkey, MD, FAAP, is a professor of pediatrics and pediatric vice chair for wellness at the University of Massachusetts c
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Medical School (UMMS) and division director of the Child Protection Program and Foster Children Evaluation Service of the i
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UMass Memorial Children’s Medical Center. She also serves as medical director of Lifeline4Kids at the UMMS. a
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Jessica L. Griffi n, PsyD, is a clinical psychologist, an associate professor of psychiatry and pediatrics at the UMMS, and executive
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director of the UMMS Child Trauma Training Center. In 2020, she was awarded a multiyear, multimillion-dollar grant to develop
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the national Resilience Through Relationships Center, housed at the UMMS, aimed at supporting parents, caregivers, and i
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children exposed to trauma. She also serves as executive director of Lifeline4Kids at the UMMS.
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Moira Szilagyi, MD, PhD, FAAP, elected to serve as 2021 president-elect and 2022 president of the American Academy of
Pediatrics, is a primary care pediatrician, professor of pediatrics, and division chief of developmental-behavioral pediatrics
at UCLA, where she is also the Peter Shapiro Term Chair for Enhancing Children’s Developmental and Behavioral Health in
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Pediatrics. She is editor of Fostering Health and has worked for 30 years with children and teens in foster care. o
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For more pediatric resources, visit the fi n MMMoooiiirrraaa SSSzzziiilllaaagggyyyiii,,, MMMDDD,,, PPPhhhDDD,,, FFFAAAAAAPPP
American Academy of Pediatrics at shop.aap.org. • S
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AAP
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Available From the American Academy of Pediatrics
AAP Developmental and Behavioral Pediatrics
Addressing Mental Health Concerns in Pediatrics:
A Practical Resource Toolkit for Clinicians
Building Resilience in Children and Teens:
Giving Kids Roots and Wings
Child Abuse: Medical Diagnosis and Management
Managing Behavioral Issues in Child Care and Schools:
A Quick Reference Guide
Managing Mental Health Concerns in Pediatrics:
A Clinical Support Chart
Medical Evaluation of Child Sexual Abuse:
A Practical Guide
Mental Health Care of Children and Adolescents:
A Guide for Primary Care Clinicians
Pediatric Mental Health: A Compendium of AAP Clinical Practice
Guidelines and Policies
Pediatric Psychopharmacology for Primary Care
Promoting Mental Health in Children and Adolescents:
Primary Care Practice and Advocacy
Raising Kids to Thrive: Balancing Love With Expectations
and Protection With Trust
Reaching Teens: Strength-Based, Trauma-Sensitive,
Resilience-Building Communication Strategies Rooted
in Positive Youth Development
Thinking Developmentally: Nurturing Wellness in
Childhood to Promote Lifelong Health
For additional resources, visit https://shop.aap.org.
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dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may be appropriate.
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Disclosures: Dr Griffin consults independently as a Trauma-Focused Cognitive Behavioral Therapy trainer. Dr Szilagyi disclosed a president-elect relationship
with the American Academy of Pediatrics, a principal investigator relationship with the Substance Abuse and Mental Health Services Administration,
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Authors
Heather C. Forkey, MD, FAAP
Professor of Pediatrics
Vice Chair for Wellness
Medical Director, Lifeline4Kids
University of Massachusetts Medical School
Chief, Child Protection Program and Foster Children Evaluation Service
UMass Memorial Children’s Medical Center
Worcester, MA
Jessica L. Griffin, PsyD
Associate Professor of Psychiatry and Pediatrics
Executive Director, Child Trauma Training Center
Executive Director, The Resilience Through Relationships Center
Executive Director, Lifeline4Kids
University of Massachusetts Medical School
Worcester, MA
Moira Szilagyi, MD, PhD, FAAP
Professor
David Geffen School of Medicine
Mattel Children’s Hospital
Division Chief, Developmental-Behavioral Pediatrics
Peter Shapiro Term Chair for Enhancing Children’s Developmental and Behavioral Health in Pediatrics
University of California, Los Angeles
Los Angeles, CA
American Academy of Pediatrics Reviewers
Council on Child Abuse and Neglect
Council on Community Pediatrics
Council on Foster Care, Adoption, and Kinship Care
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ß
To all our patients and their families
for making us better at what we do
and to our families,
our safe harbors in life
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Equity, Diversity, and Inclusion Statement
The American Academy of Pediatrics is committed to principles of equity, diversity, and inclusion in its
publishing program. Editorial boards, author selections, and author transitions (publication succession plans)
are designed to include diverse voices that reflect society as a whole. Editor and author teams are encouraged to
actively seek out diverse authors and reviewers at all stages of the editorial process. Publishing staff are
committed to promoting equity, diversity, and inclusion in all aspects of
publication writing, review, and production.
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Contents
ix Acknowledgments
xi Introduction
1 Part 1. Building the Resilient Child
3 Chapter 1. Brain Development: Early Childhood Through Adolescence
11 Chapter 2. Promoting Resilience
19 Chapter 3. Attachment
33 Chapter 4. Parenting
51 Chapter 5. Cultural Connections (Andrea Ocampo Rosales, MA)
57 Part 2. Effects of Adversity and Trauma
61 Chapter 6. Pathophysiology of Trauma
73 Chapter 7. How Trauma Can Manifest in Children and Teens
89 Part 3. Promoting Recovery From Trauma
91 Chapter 8. Engagement
97 Chapter 9. Patient Evaluation and Differential Diagnosis
107 Chapter 10. Surveillance and Screening
123 Chapter 11. Pediatric Management
141 Chapter 12. The Intersection of Trauma and Culture (Andrea Ocampo Rosales, MA)
153 Chapter 13. Supporting the Caregiver
159 Chapter 14. Integrated Care
169 Chapter 15. The Role of Medication
177 Part 4. Supporting the Clinician and Pediatric Settings
179 Chapter 16. Burnout and Secondary Traumatic Stress
187 Chapter 17. Trauma-Informed Systems of Care
199 Conclusion
201 Appendixes. Selected Handouts by Topic
203 Appendix A. Promoting Resilience Handouts
204 Appendix B. Attachment Handouts
206 Appendix C. Parenting Handouts
207 Appendix D. Cultural Connections Handouts
208 Appendix E. Signs and Symptoms of Trauma Handouts
209 Appendix F. Engagement Handouts
210 Appendix G. Pediatric Management Handouts
217 Index
vii
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