I-4. Adjustment to Past Trauma Increased Arousal (PAST 30 DAYS) – No evidence of increased Infant / child may have a Infant / child demonstrates Severe problems with arousal. Concerns are age / history of increased arousal increased arousal most of attachment. A child who developmentally appropriate or currently shows this the time. Infants appear is unable to separate or a or this information is unknown behavior on an infrequent wide eyed, over reactive to child who appears to have to me. basis. stimuli, and have severe problems with exaggerated startle forming or maintaining response. Older children relationships with may have all of the above caregivers. with behavioral reactions such as tantrums. If the needs / functioning fall within a shaded box, explain why: child’s I-5. Adjustment to Past Trauma Numbing Response (PAST 30 DAYS) – No evidence of numbing Child exhibits some Child has moderate Child has significant response. Concerns are age / problems with numbing. difficulties with numbing numbing responses or developmentally appropriate Child may have a restricted responses. Child may have multiple symptoms of or this information is unknown range of affect or an inability blunted or flat emotional numbing. Diminished to me. to express or experience state or have difficulty interest or participation in certain emotions (e.g., anger experiencing intense activities. or sadness). emotion or feel consistently detached or estranged from others. If the needs / functioning fall within a shaded box, explain why: child’s I-6. Regulatory (PAST 30 DAYS) Child has no evidence of Some problems with Moderate problems with Profound problems with regulatory problems including regulation. Infants may regulation. Children may regulation are present that ability to control bodily have unpredictable patterns have severe reactions to place the safety, child’s functions such as eating, and be difficult to console. stimuli and emotions that well being and / or sleeping, eliminating, Older children may require a interfere with their development at risk. sensitivity to external great deal of structure and functioning and ability to stimulation, etc. or this need more support than progress developmentally. information is unknown to me. other children in coping with Unpredictable patterns in frustration and difficult eating and sleeping routines emotions. that disrupt the rest of the family. If the needs / functioning fall within a shaded box, explain why: child’s A. EMOTIONAL CHARACTERISTICS (Ages Birth to 5) (Continued) I-7. Eating (PAST 30 DAYS)
I-4. Adjustment to Past Trauma – Increased Arousal (PAST 30 DAYS) No evidence of increased arousal. Concerns are age / developmentally appropriate or this information is unknown to me. Infant / child may have a history of increased arousal or currently shows this behavior on an infrequent basis. Infant / child demonstrates increased arousal most of the time. Infants appear wide eyed, over reactive to stimuli, and have exaggerated startle response. Older children may have all of the above with behavioral reactions such as tantrums. Severe problems with attachment. A child who is unable to separate or a child who appears to have severe problems with forming or maintaining relationships with caregivers. If the child’s needs / functioning fall within a shaded box, explain why: I-5. Adjustment to Past Trauma – Numbing Response (PAST 30 DAYS) No evidence of numbing response. Concerns are age / developmentally appropriate or this information is unknown to me. Child exhibits some problems with numbing. Child may have a restricted range of affect or an inability to express or experience certain emotions (e.g., anger or sadness). Child has moderate difficulties with numbing responses. Child may have blunted or flat emotional state or have difficulty experiencing intense emotion or feel consistently detached or estranged from others. Child has significant numbing responses or multiple symptoms of numbing. Diminished interest or participation in activities. If the child’s needs / functioning fall within a shaded box, explain why: I-6. Regulatory (PAST 30 DAYS) Child has no evidence of regulatory problems including ability to control bodily functions such as eating, sleeping, eliminating, sensitivity to external stimulation, etc. or this information is unknown to me. Some problems with regulation. Infants may have unpredictable patterns and be difficult to console. Older children may require a great deal of structure and need more support than other children in coping with frustration and difficult emotions. Moderate problems with regulation. Children may have severe reactions to stimuli and emotions that interfere with their functioning and ability to progress developmentally. Unpredictable patterns in eating and sleeping routines that disrupt the rest of the family. Profound problems with regulation are present that place the child’s safety, well being and / or development at risk. If the child’s needs / functioning fall within a shaded box, explain why: A. EMOTIONAL CHARACTERISTICS (Ages Birth to 5) (Continued) I-7. Eating (PAST 30 DAYS)
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