Treatment of Complex Trauma in Young Children: Developmental and Cultural Considerations in Application of the ARC Intervention Model

Figures & data

Figure 1. Attachment, self-regulation, and competency (ARC): A framework for intervention with complexly traumatized youth. Adapted from “Attachment, Self-Regulation, and Competency: A Comprehensive Framework for Intervention With Complexly Traumatized Youth. A Treatment Manual,” by K. Kinniburgh and M. Blaustein, 2005, p. 426. Copyright 2005 by authors. Reprinted with permission.

Table 1 Types of trauma experienced (N = 93)

Trauma Type	Yes (%)	Suspected (%)	Total (%)
Impaired caregiver	90.3	2.2	92.5
Neglect	88.2	4.3	92.5
Traumatic loss/bereavement	89.2	1.1	90.3
Domestic violence	73.1	11.8	84.9
Emotional/psychological abuse	57.0	16.1	73.1
Physical maltreatment/abuse	48.2	21.5	69.7
Sexual maltreatment/abuse	20.4	26.9	47.3
Other trauma	8.6	4.3	12.9
Sexual assault/rape	4.3	7.5	11.8
Physical assault	8.6	3.2	11.8
Community violence	4.3	6.5	10.8
Illness/medical	7.5	1.1	8.6
Extreme interpersonal violence	4.3	2.2	6.5
Serious injury/accident	5.4	1.1	6.5
Forced displacement	2.2		2.2
Natural disaster	2.2		2.2
School violence	1.1		1.1
Kidnap		1.1	1.1
Note. War/terrorism/political violence experienced inside the United States, war/terrorism/political violence experienced outside the United States are not included because no trauma was reported.

Table 2 Affect modulation exercises for children 3–5 years

Upregulation	Downregulation	Alternating states
“I Spy” engagement games	Deep slow breathing with a stuffed animal held against stomach	Bubble blowing: small (requires fast breathing) and big bubbles (requires slow breathing)
“Do the Hokey Pokey” or a movement game	Create a small, contained “safe place” with soothing objects inside	Rolling cars at different speeds
Twirling like a top	Yoga for kids	“Red Light, Green Light”
Balloon kick	Mirroring game: child and caregiver face each other and move slowly	“If You're Happy and You Know It”: songs with alternating soft and loud states; “Head, Shoulders, Knees, and Toes”: songs with fast and slow movements
Jump rope	Story time	“Walk like a turtle, run like a bear” Imaginary games with slow and fast animals
Play sword fight	Feather balancing: balancing a peacock feather on hand	“Simon Says”
Exercise ball	Sand wheels or sand tray	“Hide-and-Go-Seek”
Hula hoop	Coloring	“Mother May I?”

Figure 2. Comparison of baseline and discharge Child Behavior Checklist (CBCL) scores. Adapted from “Alaska Child Trauma Center Summary Report,” J. Atkinson and R. Lamar, 2009, p. 10. Copyright 2009 by University of Alaska Anchorage. Reprinted with permission.

Figure 3. Child Behavior Checklist (CBCL) overall t-score comparison. Adapted from “Alaska Child Trauma Center Summary Report,” J. Atkinson and R. Lamar, 2009, p. 16. Copyright 2009 by University of Alaska Anchorage. Reprinted with permission.

Kinniburgh , K. and Blaustein , M. 2005 . “ Attachment, self-regulation, and competency: A comprehensive framework for intervention with complexly traumatized youth. A treatment manual ” . Boston, MA : Author .

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Atkinson , J. and Lamar , R. 2009 . Alaska Child Trauma Center Summary Report , AK : University of Alaska Anchorage . Center for Human Development

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