Webinar presenter Dr. Michael Gomez answered a number of your questions after his presentation, Recognizing the Signs of Victimization in Children with ASD. Here are just a few of his responses.
Audience Question: Can you say the name of the author again for trauma stewardship again?
Dr. Michael Gomez: Laura van Dernoot Lipsky. It’s probably easier to go on Amazon and type in trauma stewardship. It’ll pop up on there. The thing is like 15 bucks, it’ll link to The Age of Overwhelm also.
Audience Question: You talked about percentages of children and people with ACEs. Do you have a sense of how many children with ASD, how many ACEs they might have? Are they – the children of ASD tend to have more ACEs or fewer ACEs? What’s your census?
Dr. Michael Gomez: Good question. The research is just being done now and the answer is they do The long answer is we’re not sure of the types but we’re seeing a lot more on neglect rather than something like physical or sexual. It’s not because they are not being physically or sexually abused but the numbers are just more neglect in proportion. Also, take into account that if you look at all types of child maltreatment, neglect makes up the supermajority, 70 percent or higher. They are national averages, so you’re dealing with neglect. It’s not that sexual abuse or physical abuse is not happening but it’s just number-wise. We do see a higher of those child maltreatment, especially neglect and a higher ACE score overall averages for people who have ASD.
Audience Question: Is the intake guide – you know the workbook that you give that kids and parents that you talked about earlier? Is that available online? She is looking to create documents to use for autistic youth in court. Any resources or suggestions you might have would be really helpful.
Dr. Michael Gomez: Yeah I’ll actually do one better. Yes, absolutely. The longer answer is if she goes to tcfbt.org and I can email that to you later so trauma is answered, trauma-focused cognitive behavior therapy, tfcbt.org. You get information on how to do that therapy if you’re a therapist. If you’re not, you can still get the resources. Also, I’m part of co-chair for Trauma and IDD workgroup for our national network and we are the people who have created a lot of those resources so there’s any that she needs or anybody on the call needs, more than happy to talk to them directly about their specific problem scenario.
Audience Question: Where did they do the ACES study? Was it in big cities? Was it rural communities? Could that potentially change the study’s outcome?
Dr. Michael Gomez: That’s a very good question which is the first thing they did. So the answer is it absolutely could because they were actually hoping maybe country of more isolated or smaller communities. Actually, the original study was done in Southern California. So maybe they were like it was the California thing who now have replicated nationally, internationally, cross-sectionally, greatest generation, baby boomers, the 80’s babies like me. It holds water across generations, across geographies, across rural versus urban and it actually kind of scary at this point and that’s why if they can get to the CDC to help, because they like this is an international problem too. World Health Organization is now on board as an International Health Organization to help. I was actually in Southern Africa doing work on child trauma, and we were sponsored by WHO, not the band. World Health Organization. Essentially, because they are recognizing this is now a world health problem, it actually got bigger than we ever thought it would get. But Daniel is on the right path and that’s what we’re hoping that maybe smaller communities are better and actually nope, that is about the same. In some cases like when we’re out of Texas, double the national average of child maltreatment so the bigger cities are actually doing better than rural areas of West Texas and there’s a lot of complicated factors but some areas are doing worse when they’re smaller. Those are some interesting data too hopefully that answers the question.
Audience Question: How do you get details about victimization of a child with ASD without necessarily leading or suggesting details of abuse?
Dr. Michael Gomez: There are actually some publicly available screeners for PTSD and they have very simple questions. One question that I can send over probably answer after the talk is for pediatricians and they give you one question to ask: so has anything stressful, gory or violent ever happened? I also advise people to pair that with one to ten minion scale I showed them or something equivalent. They ask after they ask or as they are asking “where are you right now Billy?” So they can point in like you’re pretty stressed out and that it’s okay to ask that open-ended question more than once because a lot of times, any defense attorney will accuse you of were you leading them? You are not leading them. A good prosecutor will know how to navigate that. You will be leading them if you say you were raped right? No, no. Another way especially for body-based trauma like sexual or physical assault. We talk about private parts in private part roles (?) and say, “has anyone broken a private part?” Private parts, you don’t necessarily have to use anatomical language, though we do if therapist’s imposition. We’ll say private parts are parts of babies that we cover. That’s the definition. Has anyone touched that part? That can be now we kind of say that a lot to of our forensic examiners, our nurses, but if it’s like a casa(?), we would actually have casas(?) in Oklahoma that very neutral language and have gotten a lot of information. There’s a misconception that people don’t want to talk about this and some people don’t but actually kids are very upfront when talking about it. They may not talk about it at the front end, but if you ask them periodically, they may disclose and delayed disclosure is the statistic norm. I think it’s 90 percent or higher for kids and adults.
Audience Question: Can disrupted neuro-development happen in teenagers?
Dr. Michael Gomez: The answer is absolutely. We actually have a model we did not talk about called Target which was developed by Doctor Julian Ford who works mainly on that idea of disrupting neuro-development after childhood. Essentially if you want a good kind of book on this, it’s called Hijack by Your Brain. You type in Hijacked by your Brain on Amazon, it’ll have Dr. Julian Ford but it’s not just about disrupting development, specifically adolescence but how stress can re-wire your brain and essentially your brain is less like the table I am tapping and more like a muscle, like your respiratory system so former smokers I apologize, if you’ve been smoking for ten years like I did and you’ve stopped, after a decade or two, your lungs will look relatively normal like you never smoked, if you start running, your lungs will look even better. So there are things you can do to alter your respiratory system which is just an organ so that the brain is like that and not the table. So it goes over that topic but the answer to Robert’s question is absolutely.
Audience Question: Are there additional considerations or steps to diagnose things like PTSD, or major depressive orders in people with ASD? What advice you might have?
Dr. Michael Gomez: That’s actually my research focus. We don’t have a lot of information on that and essentially when we’re at right now is we want to make sure that we’re not that if you’re diagnosing any of those, let’s say PTSD, major-depressive order and ASD, we don’t want screeners alone. You want a clinical interview and then something like at UCLA PTSD reaction. We don’t want to just ask a few questions about depression, and then you get a child-depression inventory. If you’re doing autism, I would highly recommend that you get the ADOS-the Autism Diagnostic Observation Schedule, which is the measure when we give it our birth centers, doctors may reference it. It is the gold standard; it is very fast. I can do it in about thirty minutes for younger kids to 45 or older and it’s really going to get that core autism symptom. Then you got to put that together. So I also looked at reading the evaluation for non-evaluators. Just look at how long in real-time they spend with a kid and that’s less than four hours. There’s probably some concerns with the diagnosis. The screeners like the CARS – child autism rating scale are screeners and so they are not technically diagnostic now. It may fly with typical developing populations with no trauma. If you have trauma or any type of mental health concern like depression, you got to do those steps. You got to really count a lot of that data from those very specific measures so the additional steps are being very methodical in that so if you’re not an evaluator especially if you’re not an advocate, advocates are something similar to that. Do they have an ADOS? We need an ADOS before we can be sure. Things like that.
Audience Question: Explain this one again. Complex PTSD is the same- so they’re basically synonyms – complex PTSD is the same as developmental trauma disorder, is that right?
Dr. Michael Gomez: Yes and no. There are technical terms there so essentially developmental trauma disorder and distinction between that and complex PTSD is we use them interchangeably a lot so it’s kind of confusing but the keyword in the developmental trauma disorder is not trauma but development which goes back to Robert’s question about the disrupted neuro-development. Kids with developmental trauma disorder- we call them swiss-cheese kids. So these are the kids that are socially amazing, can’t read, or really good at math and can’t pay attention. These things are really weird and shouldn’t go together but do and that’s because neglect and interpersonal trauma really drove off your developmental trajectory. Complex PTSD is kind of signifying those symptoms that really don’t capture traditional PTSD like dissociation, somatic problems like headaches or stomachaches, like the relational trigger. So these are the people that are usually working the DV population, IPV. She moved from Pittsburgh to Boston to Baltimore to New York City back to Baltimore and now she’s back to Pittsburgh, she finds the same guy, How does that happen? That’s a common pattern in Complex PTSD because we tend to see a lot of core distortions of like I’m worthless, my dad told me that for 10 years growing up. So we tend to look at the cognitive structures in Complex PTSD and with developmental traumas to developmental structure, though we didn’t see how those relate, we do use them fairly interchangeably.
Audience Question: Have you ever worked with non-verbal children with autism and if so, do you have suggestions on helping them to deal with past trauma and possible anxiety?
Dr. Michael Gomez: Yeah. One of my colleagues, Dr. Miko actually primarily worked with them, I have before. The best I can get Sarah and everyone on the call is work with a caregiver. How good the caregiver’s functioning will directly relate to how good that kid is functioning and that is not just me seeing that for autism and non-verbal population but is also for just complex trauma, developmental trauma, trauma period. The first thing we look at is how the caregiver’s functioning, and often they’re not doing really well. Now, it may not be something like substance abuse but it could be that they have their own PTSD. So we want to support the caregiver. Again, the study with caregiver only in PTSD, the kids got better than those with the kids only. That’s our step one. A lot of times we focus on how do I get the kid to talk about it. Again, technically, do not have to talk about trauma but you have to processes and metabolize it and there’s a lot of ways to do that. Sometimes there’s a kid, the PTSD stuff, sometimes they are relaxed enough if they regulate it. sometimes we can get them to cough up those hairballs. Sometimes we give them permission to deal or point to feelings. We have activities for our non-verbal kids called camochies(?) which are these little tiny plush things that have an emotion face and an emotion on the back, different colors for different emotions and so they can communicate that way. I guess we want to make sure that they’re given away to actually feel it but they don’t have to talk about it. But again, I would always start with the caregiver. How they’re doing will directly impact how the kid is doing which is probably you didn’t need a psychologist to tell you that right?
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