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CHILD ABUSE: TRAUMA/PTSD: PART 2 (90215)

Presenter: Jeffrey N. Wherry, PhD, ABPP

The following manuscript is a word-for-word transcription of the course audio files. This is not
intended to represent an edited publication document and may not contain critical information
contained in graphics and other visual aids utilized by the course speaker. This document is provided
solely as a supplemental resource for the video presentation.

Again, let me just give you some introduction. My name is Jeff Wherry. I am a psychologist.
Please don’t let my mom know that – she’d be very ashamed – she thinks I’m a lawyer. She’s good with
it. But I’ve been working with child trauma and child abuse really since 1983. That is probably longer
than some of you are old; which is just a sad commentary on me. That’s all that is.

In terms of incidence rates and prevalence rates, let me say that there are dramatic differences
in what is called ‘incidence rates’ and ‘prevalence rates’. Child Protective Services every year collects
incidence data. It’s the number of official, formal, substantiated reports in a year’s time. That’s the
incidence. It’s usually expressed in a number per thousand of population. There might be 22 per 1,000.
But prevalence is completely different. Prevalence is over the course of childhood, has someone ever
experienced “X, Y, or Z.” So over from 0 – 18, have you ever experienced child sexual abuse? When that
question is asked, the prevalence rates for sexual abuse are one in four women; and one in six men.
Now, we’re talking about all forms of sexual abuse – not just intercourse. But that’s important because
there is a relationship, but not a particularly strong relationship, between the severity of the abuse and
symptomatology. What that means is you don’t have to be raped to be symptomatic -- and sometimes
to be very symptomatic. I work with a 17-year-old whose father abused her and she would get very
depressed and she said I don’t understand this, and these are her words, not my words: “Because it was
just fondling.” It doesn’t make a difference. For her, for whatever reasons, she was still very inclined to
severe bouts of depression and, going back to that notion of triggers, for her the triggers were
psychological triggers. They weren’t even sexual. They were about relationships. She went off to
college and as a freshman got that random roommate that some of you had, too, that was just horrible.
She came back to me and said I’m miserable and she started describing this person as someone who is
domineering and controlling and she was using all the same adjectives that she had used to describe her
dad who had sexually abused her.

Those characteristics – those attributes – triggered a response. So, when you are working with
kids, sometimes the idea is put on your detective had and think okay, what are the possible triggers.
What are the repetitive patterns? Under what circumstances does this child behave this way and is that
related to a trigger associated with trauma and abuse? Physical abuse – we’ll talk just a little bit about
physical abuse; how we define that; how it’s defined in a community has some bearing on the rates. In
this last year, for example, California was trying to pass a law that would make spanking illegal – any
form of spanking illegal. I don’t think it passed. But there was legislation – a bill sponsored in their state
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legislature to try to get that passed. I will say, and I’m being videotaped, that as a child, I was spanked
and deserved some of those spankings, too, I might add. As a parent, I didn’t spank my daughter, but if
you were to ask her who the disciplinarian in the home, she would say “Dad was.” Because when she
was young, she’d go to ‘time-out’ at the drop of a hat if I had anything to say about it. So there was a lot
of different discipline techniques used and they were used systematically and consistently, but because
of the work that I did, I just thought “I can’t go there.” That was just a personal thing. But the research
that gets cited about how negative corporal punishment is doesn’t do a really great job of controlling for
other factors. So, yeah, if all you do is hit a kid, they are going to be damaged – flat out – and when I say
hit a kid, I mean spank a kid. If that is the only… if the kid misbehaves, spank; misbehaves, spank;
misbehaves, spank – if that is the only tool in the toolbox, that is going to be problematic and that’s
going to get magnified if that doesn’t happen in the context of a nurturing relationship. There’s got to
be something positive in that relationship; otherwise, it means nothing that I’ve disappointed you. It
has no relevance at all in my life, so a nurturing relationship with boundaries and consistency is the
formula – that is called authoritative parenting – for a good outcome. The problem for some folks is
that it is a slippery slope, this business of physical punishment. Some people have been physically
abused themselves and are emotionally disregulated and to begin that trail becomes unbridled and they
lose control. Or, in many cases, again, it’s the only thing in their toolbox. If I’m a carpenter and all I’ve
got is a hammer, then all I can do is nail nails. That’s it. I can’t saw; I can’t do anything else. You’ve got
to have more tools.

One of the things that’s really a puzzlement for physicians is accidental versus intentional harm
in children. That, oftentimes is the crux of the issue and for you that may be the part that you have to
weigh because a parent says “Well, they fell off the slide -- that is why they are bruised.” Rarely, do
parents go to the emergency room and say: “You know what, I abused my kid and I need to get some
help for that.” It just doesn’t happen that way. So, oftentimes kids that have been physically abused
will show up in the emergency room and the pediatrician, the nursing staff, maybe you as someone who
has reported that, the hard call is ‘is it accidental or not?’ Now, let me turn the tables and tell you that
as a parent, I know what it feels like to be suspected of maltreatment. Remember I told you that I had
never spanked my daughter? But, as a kid, she had chronic ear infections and on top of that, she had a
pain tolerance that was unbelievable. So, she wouldn’t cry. That old ear would get all pusy and swollen
and just nasty and we never knew until she started tugging her ear. She didn’t cry. At the time, I
worked at the medical school so I could go to the ER with her. So that is what I’d do… my wife and I
would take her to the ER and that pediatrician would look in that ear and then give us the hairy eyeball…
like “you’ve been neglecting your child.” You could see at that moment there of “I may call this in
because you’ve let this go.” We’d have to explain that this isn’t the first time, trust me, she’s got a high
pain tolerance, she gets ear infections all the time, and they won’t put tubes in her ears… So we’re
being really defensive and trying to explain ourselves. My point here is that it’s a difficult call to make
and pediatricians who are board-certified in child abuse will get special training in how to make the
differentiations between different kinds of bruises that are pathognomonic for abuse and those that are

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not. There is a… a slap to the face leaves a five-finger mark; a five-finger bruise. That is perhaps the
only pathognomonic thing for physical abuse. But it gets really difficult sometimes.

About 10% of kids that are seen in emergency rooms are estimated to be abused, so it is very
tough. Sometimes, a parent will say that they fell off the bed or whatever, and people have gotten very
sophisticated – physicians have become very sophisticated in terms of being able to tell what is possible
and what is not possible from different kinds of accidents.

One of the characteristic issues, though, is a parent whose child is injured and they delay
seeking help. When the injury is days old and they have delayed, then oftentimes – not always – not
always, but oftentimes that is an indication that they were afraid that they would get in trouble by
bringing the child in early.

Who are the people that are reported for abuse? There are certain parental characteristics that
elicit reporting. So if the professional thinks that a parent is lazy, they are more likely to report them.
Let me tell you that it’s not only lazy parents who abuse their kids. There are bankers and lawyers,
hospital administrators… these are all experiences that I’ve had in different parts of the country – who
abused their children. So, you don’t have to be lazy. And we’re talking about physical abuse. Parents
who are perceived as angry and then the poor are more likely to be reported. That’s according to when
you ask professionals. Now, you’ve I’m sure received more than your fair share of information about
mandated reporting. You don’t have to know that something has happened – there just has to be some
reasonable suspicion and then other people are sort of charged with trying to vet that out – figure it out.
And ultimately, that responsibility may rest with a judge or, in some cases, with a jury.

A lot of times people fail to report suspected abuse and everybody can tell a story about how
reporting abuse didn’t work out well. But it is the system that we have. It’s not a perfect system, but if
we don’t use it, we can’t make improvements. Professionals that say: “Well, I’ll handle it on my own”
make a big mistake. I once did a lecture… it was interesting… it was a court settlement. There were
these parents in southeast Missouri whose kids were involved sexually with each other – on the
playground and they were not properly supervised by the teachers. The teachers didn’t do the
sexualizing, but they were not properly supervised and the parents brought a lawsuit against the
teachers, the school, the school district and the entire department of education for the state of
Missouri. But what they said was “We don’t want money. We want teachers to be trained.” I thought
that was pretty… you know they kind of had their foot on the throat of the state and said “We don’t
want money – we want teachers to be educated.” So the settlement was that they’d go to training and I
was picked to do the training and it was supposed to be all of the teachers in the state. I was told there
will be thousands of them. It was a smaller group than this, so the families didn’t get what they thought
they were going to get. There was this one principal who took me to task and said “I’m not going to do
that. I investigate every suspected abuse case on my own. I go out to the family; I go out to the home
and I talk with the parents. Then, if I determine that the child has been abused, then I make the report.”

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Well, dear, that’s just wrong. You’ve become judge and jury. Did she put more work in it than
somebody who would just pick up the phone and call? Absolutely, she did, but she was just jar-headed,
bone-headed, knuckle-headed wrong. When she would do that, she would be placing some of those
kids at risk to get a beating after she left. That wasn’t her job. So, people cite all kinds of reasons for
not reporting abuse – “I can do a better job; it’s going to cost me money; it’s going to get messy; people
are going to be upset with me”, etc., etc., etc. But it’s what we need to do.

There are risk factors and I’m going to skip over some of these. People have looked at some of
the sociological community, neighborhood factors. Frankly, I think if you’re talking about physical
abuse, that misses the main point and the main issue would be parents, not the neighborhood. So these
are some things that are pretty indicative of abuse – physical abuse. Here is the slap marks to the face;
a torn frenulum – that’s that little part that connects your tongue to the base of the mouth. In an infant
when someone tries to force-feed with a bottle, they tear that frenulum – that’s pretty diagnostic. The
fractured teeth; problems in terms of the eyeball and ruptured veins in the eyeball – those are things
that can be pretty diagnostic. Then there are things that are kind of confusing – is this abuse or is it a
rash; is it a birthmark or is it abuse? What is it? There are even some cultural practices that may lead
to certain kinds of effects, like there is something called “coining” and I forget exactly what cultural
group does that, but it’s like placing hot coins on someone to help them get well. It also burns them and
I think it’s pretty questionable about whether or not it helps, but it is a cultural practice.

Now, that then gets to “where do we draw the line in terms of cultural practices?” There are
still some things that may be the norm in one culture, but by our laws are not proper. When I worked in
New York, I worked with a lot of first generation families from Haiti. The Haitian parents use pretty
severe physical punishment with kids that would constitute abuse by any definition in any town in the
United States. So to just say “Well, that’s your culture – it’s okay” that’s the challenge when you are a
melting-pot society. How do we… do we integrate people or do people stay in their own little enclaves
and do what it is they do? It’s a challenging question.

Some different theories that get talked about, again, this sort of ecological theory – it’s the
neighborhood; it’s the community; it’s the family – and all of these different sort of circles or systems.
There are certain child characteristics that tend to put kids at risk – low IQ; physical disabilities; birth
complications – all of these things can place children at risk. Temperament – those of you who have two
of your own kids know that temperament can be vastly different from one child to the next. So, the
child who is impulsive, cries a lot, is defiant, or angry – those kinds of behaviors, that kind of
temperament tends to lead to more physical punishment. Prematurity, being a twin, a child who has a
chronic illness – those all create stress for parents – having twins, having closely-spaced children, having
very young children creates stress. A child who is delayed developmentally, hyperactive, perceived as
different, all of those things put kids at risk for physical abuse. In terms of other caretaker factors, if it is
an unwanted pregnancy, then the child may be at risk; single parents… When I talk to students and we
talk about this, I say I know some of you have grown up in a single-parent home and so my suggestion to
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you is when you go home tonight, call your parent on your cellphone and say “Thank-you because I
know you made huge sacrifices.”

My wife and I had one kid when we were 30, so I had been through school; had a good job;
didn’t owe a dime (paid as we went); had this one kid with a wonderful temperament (she was like a
Labrador retriever – you could have just slapped her around and she would have come right back to play
some more). She had this wonderful temperament – till she became a teenager and then it was
payback. But I can’t imagine being a single parent. It was still like tag-team wrestling. You’re it – you
deal with her for awhile. And so that was as mature as I was going to get. Mature parents, good
situation, and it was still the hardest work I’ve ever done in my life. I loved it, but it was also the hardest
work I’ve ever done.

So, single parenting… it doesn’t mean that you or anybody else who is a single parent will abuse.
Don’t misunderstand me. It’s just like teenagers driving a car. Statistically, you are in a higher risk
group. Those of you who have teenagers driving cars, you know what I mean. My daughter had four
wrecks in one year. Being a young parent… closely-spaced children; substance abuse, of course; being
isolated and that may be geographically isolated, but you don’t have to be geographically isolated to be
socially isolated. As an adult – as a parent, you can feel completely alone in a room full of people. It’s
more about those psychological things. Limited knowledge about child-rearing… I had this
undergraduate student, a guy, and he would come to me and talk to me and say “What do you think, Dr.
Wherry, about having a child not wed the bed by the time they are one?” I’d say, well that’s crazy. He’d
say: “Well, that’s what I’m going to do. My child…” This guy really worried me because he thought that
all of these developmental milestones were unrelated to maturity – that he could just will it and he
could teach his kid to be continent at a year old. And he really, really worried me. He wasn’t even
married yet, but he was already planning on what he was going to do. Sometimes, parents have these
unrealistic expectations -- again, emotional disturbance in a child; lack of control on the part of a parent;
lack of empathy; and then a parent who is developmentally-delayed. Again, it doesn’t mean that they
are going to abuse, but you are just in a higher-risk category. None of these things are written in stone.
And sometimes people will ask me in terms of physical abuse and sexual abuse – well, my child has been
physically abused – does that mean they are going to grow up and physically abuse? Absolutely not.
You are in a higher-risk category, but is it written in stone? Absolutely not. Among people who sexually
abuse, are there fairly high rates of having been sexually abused? Yes, but do most people that have
been sexually abused go on to sexually abuse? The vast majority – the overwhelming majority – do not.

Sometimes the media takes these studies and blows them out of proportion. There was a study
done in a Tennessee prison and what they did was they asked all of these guys… it was a unit for
perpetrators of sexual abuse. So they interviewed them and asked them “Were you abused as a child?”
“Oh, yes, I was abused as a child; it was just terrible – can I have some special privileges?” So they had
66% that said yes, I was abused as a child. It got published and people said wait a second – wait, wait,
wait, wait. You know what, criminals sometimes lie. I know that’s an epiphany, but sometimes they lie.
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So what they did was they went back and said now, let’s do the study again only polygraph them. The
rates were cut in half. It’s like the cat was already out of the bag. Everyone heard that study and was
citing that study and everyone was sort of running around… “Oh, my gosh, my child has been abused;
they are going to become an abuser.” But even if that was true, that is not the proper methodology for
studying that. You would have to know every child that was abused and you’d have to follow them
throughout their lifespan and you’d have to be confident that you knew whether or not they abused.
It’s an impossible study to do. It cannot be done.

Alright, I’m going to move along here. Parents who are depressed are more inclined to be
physically abusive; negative attributional style – seeing their child more negatively; making attributions
to kids. Let me give you an example. I had an employee… a female employee who had a baby in St.
Louis and I went to visit her and her husband and, of course, the new baby. So the baby was in the
nursery – not in the room at the time. So I went to the nursery, which is always just a wonderful thing.
We should all do that once a month – just go to a nursery. I could see her kid and there was this family
that came and it was this large, extended family – I mean there were 12-15 people – and there was a
little boy who was crying. He had just been smooshed through the birth canal and he was crying and
they started saying things like: “Woo, he’s gonna be a mean one, isn’t he? He is an angry kid.” I
wanted to slap somebody. No, the attributions that you are making… this kid isn’t angry; he’s 3 minutes
old. It’s a shock to be here. Give him a break. This is not about a mean, angry kid. That is attributions.
Sometimes, people have these… they see every behavior negatively on the part of their child.

There is an instrument… and I will just tell you one of the things that… you ask what is CPS
doing? CPS is not doing this; hospitals are not doing this; pediatricians are not doing this; psychologists
are not doing this. I’ve tried to convince CPS in Arkansas, Missouri and Texas to do this and it hasn’t
been done. But there is an instrument called ‘The Child Abuse Potential Inventory’ and it has the
capability… it has this property that’s called ‘Predictive Validity’ which means you can have someone
take this test and not even see them; not even talk to them and the hit rate is accurate 90% of the time.
That’s pretty powerful stuff. Ninety percent of the time… combined, it gets those that will abuse and
who will not abuse. And yet we don’t use it in screening foster parents; we don’t use it (for the most
part) in evaluations of parents who have been abusive in looking at treatment effects. Audience: What
was the reasoning not to use it? I don’t know. I’ve never gotten a good explanation. I’ve tried… I really
have… I’ve tried to pitch it to folks. I discovered it accidentally, just on my own reading and found out
about it. I’ve met the guy who developed it. He’s trying to develop one for sexual abuse, but the hit
rates for it are at 80% and so he is very afraid of that. He’s afraid that innocent people are going to get
targeted and labeled. So he’s very cautious about releasing that. But it’s something that doesn’t get
utilized.

I’m going to move through some of this just because of time. I want to talk a little bit about
child sexual abuse. I’ve talked about the prevalence here: One in four; one in six. Risk factors: Living
with a male other than a biological father; lack of supervision by parents; most of the time, the
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perpetrator is known to the child – this notion of ‘stranger danger’ is by far and away not the most
common sort of situation. More often than not, it’s a male, but it’s not exclusively males. Let me just
say that there are females that sexually abuse. I worked with a 12-year-old boy whose grandmother
sexually abused him. It is by far and away more common that males are perpetrators. Sorry guys, it’s
the way it is. But that is not the only situation. And it used to be said that a woman only did this if she
was schizophrenic. I remember reading that. Well, that’s just nonsense. That is just absolute nonsense.
It also used to be said in 1982 that the sort of Bible of psychiatry by Kaplan – it’s one of these things that
gets published every year and it has been going on since the 80’s. They had a paragraph – one tiny
paragraph on child sexual abuse in the entire textbook and they said “An estimated one in a million
women is the victim of sexual intercourse.” Now that is not the same thing as sexual abuse – more
broadly speaking; but one in a million. One in four; one in a million… hmmmm. How close are we?

Let me say that medical exams, when it comes to sexual abuse, are not the litmus test. Most
physical examinations do not yield anything that is absolutely, positively diagnostic for abuse and that is
even in studies where you have a confession by the perpetrator of vaginal or anal intercourse; or a
criminal conviction or something else. Because here is the deal – we don’t know what normal genitalia
look like in kids. I mean, think about it. Think about it. Would you volunteer your child for that study?
“What we want to do is we want to study the normal genitalia of children and what we’d like to do is
we’d like to examine your child every three months from here until the time that they are 18. Are you
okay with that? C’mon, jump up in the stirrups – let’s do this thing.” What parent in their right mind is
going to consent to that? So we don’t know what is normal. And, even when people do exams, there
are at least three different positions and the genitalia present very differently in those three positions.
There is on the back; on the side; and tucked knees. So the genitalia present very differently, so if you
were a physician and you were going to document, it would look very different.

The other thing, if we haven’t done the study on normal genitalia, which we haven’t done; then
the other thing that we haven’t done is what about healing? What we do know is that there is healing
that occurs over time. So this is an area that is fraught with problems and so what is the practical
application for you? If a parent were to come to you and say “They thought my child was sexually
abused, but we took her to the hospital and they said she had a ‘normal exam’. I don’t know whether or
not to believe her or not.” Then you could give her information that says “Well, did they take time to
explain to you that most of the time, these exams are normal?” Because what parents hear is that there
is no definitive finding and then what they conclude is you lying, no good, sorry, so-and-so. Why did you
make this up? And even the courts oftentimes put too much credence in physical findings. So it’s not
the litmus test. Here is literature here to support that. These are studies that were done. So when we
look at the number of normal or non-specific findings. It is not the end-all and the be-all.

In terms of the effects, it would be nice if I could come to you and say “Okay, well abuse causes
X, Y and Z. That’s it. Take those notes – you’ve got it down – live happily ever after.” If would be nice if
it was that linear. It’s not. So, for years, people studied the effects of abuse and looked at things like
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duration, frequency, severity of the abuse, and relationship to the perpetrator. They said “Oh, if we
could just figure this out, then we would know about the effects.” Now, knowing this, we can predict
about 16-19% of the variance in outcome. That’s a statistical phrase. That can be what’s called
statistically significant. But, practically speaking, that means that somewhere between 81% and 84% is
explained by other things – 81-84% of the outcome. The symptoms are explained by other factors. So
this model was offered by a fellow by the name of Steve Spaccerelli in 1994 and let me just quickly go
through this. What he says is, yeah, there are events around the abuse that shape and contribute to the
outcome here. Things like severity and duration and that kind of thing. And, add to that, sorry you’re in
the front row, the perpetrator that puts a gun to the head and says “If you tell, I’ll kill your mother.” It
worked for the kid – the guy shot the pet dog and said “I’ll do that to your sister if you tell.” Gee whiz,
whether or not it was fondling or intercourse really didn’t make a big difference at that point, right? You
guys can see that. There are other factors beyond the abuse itself. Then there are things that happened
at the time of disclosure.

One of the things that you can do for parents, is that when parents hear about their child being
abused, it is every parents’ nightmare. It’s the thing that none of us want for our kids, right? And most
often, it is someone that you know – it’s not a stranger. So, there is that… How could this have
happened? How could I have been fooled? How could I have been duped? And one of the questions
that parents almost inevitably ask is “Why didn’t you tell me or why didn’t you tell me sooner?” That
gets sort of kicked back in the child’s mind as “It’s my fault. I should have told. I should have told
sooner.” It’s logical… it’s almost universal that parents want to ask that question. But the thing you can
do for a parent is to encourage them not to ask their child that question. But see, parents become very
isolated at that point. It’s not like they pick up the phone and call their best friend and say “Oh, I’ve got
some news. My daughter was sexually abused.” They don’t go across the street to their neighbor and
share that information with them. One of the things that I wish we did better, CPS and every part of the
system, would be to support those non-offending parents (plural). Sometimes, it’s both mom and dad;
it’s a grandfather that’s the perpetrator; it’s an uncle… but oftentimes, we leave them alone. We don’t
get them the support that they need. It is a crisis for non-offending parents and that is where you can
play an important role in terms of encouraging people to get help. Many parents feel guilty because
their like… “I don’t need it; my child does.” And they are very sacrificial in that way. They really, really,
really want to see their child get help, but they need help, too. A parent has to take care of themselves
so that they can take care of the child. And the child that has been abused does (and this is… I don’t
know if it is absolutely true, but it’s true in my clinical experience) that children do only as well as the
least functional parent. Meaning if one parent is screaming and hollering and having a hissy-fit, then the
child is going to take their cues from that parent. Does that make sense?

At disclosure, sometimes parents are angry – they are angry at the abuser, but what does the
child think? They’re angry at me. And parents will often say “Well, I’m not talking in front of my kid.”
Baloney – you were a kid once; you could hear through the walls just like kids can now. So, the parent is
on the phone talking to so-and-so and they are angry and their voice is animated and the kid is “Oh, it’s
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my fault – I’ve disappointed them – I’ve created stress.” For many kids, they then recant. They take it
back. They say it didn’t happen. And probably the best study by Snow and Sorenson published in 1991
– 22% of kids recanted. Twenty-two percent… And 95 of 96% of those who recanted went on to re-
assert that no, it did happen. I just got fed up with the process. I just got tired of people asking me
about it. So, 95% went on to say “Yes it did happen.”

Then there are the related events and these are the things that happened downstream, like
being placed in a foster home. Now, good foster parents will have jewels in their crown. They are
special, wonderful people but… If I steal this purse and I rifle through it (your eyes got big there, didn’t
they?) and I walk out and I take the purse and so Kathy calls the Lubbock police and they say “Kathy,
come with us. We’ll go downtown and so Kathy dutifully follows them downtown and goes into the
office and they lock you in jail. Kathy, they lock you in jail. I’m a trained psychologist. I can ask this
question: “How does that make you feel?” How does that make you feel, Kathy? Not very good. What
is the emotion you feel? Scared, angry… I would be livid. They would have to tie me up in duct tape.
What? You are putting me in jail? You are putting me in jail when someone else did something bad to
me? That sounds a lot like being placed in a foster home from the perspective of the child. I’m not
impuning the motives of foster parents, but I’m being punished. I’m losing my bedroom; my posters; my
bicycle; my friends; my teacher; my siblings (sometimes); my school; my neighborhood; my TV… all of
these things and some of them not just material possessions -- friends – that’s important; I’m losing this
stuff. Audience: Is there a benefit to children who are placed in RTC’s? I think either way, it can be
experienced by kids as I’m being wrongfully punished. So my point is… it’s not that we don’t do that;
that we don’t put kids in foster care, but I think one of the things that we should do is do a really good
job of explaining why. This doesn’t have anything to do with you and yes, it’s horrible. I said I work out
at the Children’s Home of Lubbock… most of those kids don’t care a whit about their abuse; they want
to be back with their parents. They desperately… Have you seen the movie “Second-Hand Lions”? It’s a
great movie if you haven’t seen it. That little boy, he knows his mom, he knows what his mom is up to
when she places him with the great uncles. He knows she is not coming back. At some level, many of
those kids know that, too. “Second-Hand Lions” – Robert Duval and Michael Caine – it’s a great movie.
You’ll e-mail me and thank me.

Support – resources… the support that the child gets from the parent, but someone has to
support the parent. That’s something that you can do. You can be that ear. These are more sort of
psychological processes, but here is this business of PTSD and so, again, it starts with the ‘fight or flight’
response and so if I came to you tonight and I had a burlap sack and the burlap sack was moving all on
its own… And I reach into the sack and I pull out a western diamond-back rattler and I heave it out over
the group. While that snake is flying through the air, you don’t say to yourself “Oh, my, it’s a snake. And
the color and pattern remind me of a western diamond-back rattler. Moreover, the head is triangular,
and therefore, it must be a viper and poisonous. What is the best way for me to make my exit without
disturbing my neighbor?” That doesn’t happen, does it? You’re turning over tables; you’re throwing
chairs; you’re walking on each other; you’re screaming and hollering; and you are saying very ugly things
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about me. That is that ‘fight or flight’ response. It’s not a cerebral thing. It’s not a cognitive thinking
process. It’s in a Nano-second. You’re not thinking those things about that event. It is all autonomic or
automatic. And that is that ‘fight or flight’ response and that is what leads to many of the symptoms of
disregulation, concentration problems, hyperarousal, avoidance, and so this all comes out of the Viet
Nam war. What happened there was we sent 18-19-year-old boys off to fight in a jungle, to fight an
enemy (and I’ve talked to some of these guys – just let this sink in for a second, okay). They could smell
the enemy, but they couldn’t see them. The jungle was that thick. And this isn’t paintball or laser-tag.
These are bombs and real bullets. That is what happened. And then one day they are out on point in
that situation and then two days later they are on the west coast because they’ve been flown and
they’ve been discharged. Now, no other war that we ever fought was fought like that. Men and soldiers
came back on ships – it took weeks – they talked to each other and all of that. But what is interesting is
we study these guys (when they are 30 years old) that’s when they got studied, most of them. So they
are 30-year-old men and oddly enough, they don’t look exactly like traumatized children. Who would
have thunk it? The problem is that children do present with different kinds of symptoms. They do have
more separation anxiety and they can’t do some of the avoidance that adults do. So there are these
hyperarousal symptoms: hyper-vigilance; concentration problems; irritability – and that is sort of that
‘fight or flight’ response, sort of reenacted. Then there are intrusive or re-experiencing symptoms.
These are things like nightmares – it’s feeling like it is happening all over again. Now, when those two
things are going on, it feels physically uncomfortable – it’s distressing. If you think about it, that’s not a
fun feeling to have when you are really, really anxious. That’s not pleasurable. So they seek to avoid the
situations that cause that. For Viet Nam veterans – many of them did substance abuse and alcohol
abuse and it worked very effectively – it just ruined their lives in other ways.

Adults who have been traumatized – let’s say by a hurricane – they’ll stay away from situations.
But kids don’t have that liberty sometimes – they can’t avoid and they can’t even tell us that they are
avoiding if they are because they don’t have the meta cognitive skills – the ability to think about their
thinking. That is why if you ask a 7-year-old “What were you thinking when you did that?” What do
they say? “I dunno.” They’re not lying to you. That is developmentally beyond their capability – they
can’t think about their thinking and report on it. So, oftentimes, kids that have PTSD go undiagnosed.

I’m sorry – I’ve done a horrible job in terms of managing my time. We’ve talked about the
disregulation; we talked a little bit about the sexualized behavior and how that can be many other things
besides sexual abuse; the biting and aggression – again if you go back to that ‘fight or flight’ response, I
think for some kids what you get is this over-reactive, defensive “I’ll get to you before you can hurt me.”
There are plenty of aggressive kids, though, that have not been sexually abused. There are plenty of
aggressive kids that have seen a parent be aggressive. So, again, it’s not necessarily indicative. We’ve
talked a little bit about the system and how that might improve and then we’ve talked a little bit about
triggers and someone had the question about the child that sort of moves away from hugs and that sort
of thing and it may just be that that is a trigger.

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I apologize – we needed more time and I didn’t use my time well. If you need any help doing
those evaluations, I’ll be happy to help you with them.

Presenter: Jeffrey N. Wherry, PhD, ABPP

SLP: 070512

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document with occasional corrections for pauses, etc. (HHT).

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