Table of Contents
Acknowledgements ix
Introduction xi
Chapter 1 Definition of Trauma 1
Trauma among individuals with intellectual disabilities 2
Vulnerability to trauma and PTSD 4
Types of trauma 6
The disability itself 7
Sexual trauma 8
Dysfunctional childhoods 8
Foster care 8
Uncomplicated, complicated, and traumatic grief 9
Loss of a job 12
Loss of family home and change of residences 12
Institutionalized living 13
Restraint use/aversive techniques 14
Bullying and teasing 14
Medical procedures and medical hospitalizations 14
Changes in physical health 15
Use of psychotropic medications 15
Chapter 2 Impact of Trauma on the Brain 17
Emotional regulation and emotional dysregulation 20
Executive functioning skills and deficits 22
Emotional regulation skills training 23
Developmental trauma 23
Chapter 3 Diagnosis of PTSD and Trauma Based Reactions in Individuals With Developmental Disabilities 25
Historical references to PTSD 25
The Diagnostic and Statistical Manuals 26
DSM-I 26
DSM-II 26
DSM-III 26
DSM-III-R 27
DSM-IV 28
DSM-IV-TR 28
DSM-5 29
The Diagnostic Manual-Intellectual Disability and the DM-ID-2 30
DM-ID-2 31
Signs and symptoms of PTSD in individuals with intellectual disabilities and diagnostic complications 32
Sub-threshold PTSD 36
Assessing for co-morbidity 38
PTSD and somatic symptoms 39
Psychosis and PTSD 40
Chapter 4 The Identification of Trauma: Methods of Assessment in Individuals with Intellectual Disabilities 43
Challenges in assessment 43
Assessment measures 44
PTSD symptoms and symptom severity scales 44
Trauma exposure measures 44
Assessment of PTSD in children 46
Assessment of traumatic events and traumatic exposure for individuals with ID 46
Possible trauma related or trauma induced behaviors 53
Avoidance behaviors 53
Alterations in arousal and reactivity 53
Marked alterations in cognitive and mood 54
Intrusive symptoms 54
History taking and getting to know the individual 55
Chapter 5 Trauma-Informed Treatment and Trauma-Informed Care 57
Specific trainings in trauma sensitive interventions 60
Strategies for administrators and managers of adult residential facilities 60
Strategies for group home or adult residential facility staff 65
Strategies for parents 67
Care for the caretaker 68
Care provider stress and burnout 70
Self-care plans 71
Trauma informed systems 74
Chapter 6 Risks and Resiliency 77
Pre-traumatic factors 78
Peri-traumatic factors 79
Post-traumatic factors 79
Predictor variables for PTSD among individuals with intellectual disabilities 80
Resiliency 80
Promoting resiliency from trauma and stressful events among individuals with intellectual disabilities 81
Neuroplasticity and PTSD and recovery 83
Chapter 7 Treatment of Traumatic Reactions in Individuals with ID 85
Being safe with oneself 86
Physical safety 86
Feeling safe with others 87
Specific therapies for the treatment of PTSD 88
PTSD treatment approaches for individuals with intellectual disabilities 89
Eye Movement De sensitization Reprocessing (EMDR) 90
Cognitive Behavioral TherapyCognitive Behavioral Therapy (CBT) 92
Stress Inoculation Training (SIT) 93
Dialectical Behavior Therapy (DBT) 94
Mindfulness 95
Meditation 96
Psychodynamic Psychotherapy 97
Neurofeedback 97
Yoga 98
Relaxation Response Training 99
Exposure Therapy 99
Sensory Modulation Strategies 100
Emotional Regulation Skills Training 102
Animal Assisted Therapy 105
Assertiveness Training 106
Music Therapy 107
Pharmacological Interventions 107
Basic supportive approaches for managing trauma based reactions among individuals with intellectual disabilities 108
Interventions for specific trauma based or stress induced behaviors 112
Sleep disturbances 112
Anger outbursts 115
Aggression 117
Medical trauma - fearfulness with medical examinations and procedures 119
Family Environment and social support 122
Chapter 8 Individual Stores/Case Studies 123
How to incorporate a trauma sensitive approach into an analysis of behaviors 124
Step 1 Identify the challenging behavior 125
Step 2 Identify the type and cause of the developmental disability 125
Step 3 Developmental history/ACEs 126
Step 4 Past and present psychiatric diagnosis 126
Step 5 Psychotropic medications 126
Step 6 Medical conditions past and present 126
Step 7 Placement history 126
Step 8 Timeline of events 127
Step 9 Changes in functioning 127
Step 10 Current environment 127
The final analysis 127
John's story 128
The analysis 129
The final analysis-putting it all together 134
Interventions 136
Michael's story 139
The analysis 140
The final analysis 143
Interventions 143
David's story 144
The analysis 145
The final analysis 147
Interventions 147
Case Reflections 148
Chapter 9 A Summary 151
The future 154
References 157
Index 173
