Each month, this site will present information for educators, parents and researchers on emerging issues and developments in the field of children's mental health, especially those issues affecting the clients the Andrus Children's Center serves. Please email us with hot-topic requests or feedback at ACLI@jdam.org.

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February 2005: Understanding Trauma in Children
Q: What is trauma and why are children especially vulnerable to trauma?

All children experience certain levels of emotional stress. Stressful events become traumatic for children depending on their source, severity, duration, and the resources and support the child has to assist in coping. If the source of stress is a caregiver, the effects of the trauma can be especially severe. About trauma Lenore Terr writes (quoted in Bloom's "Trauma Theory Abbreviated") "Psychic trauma occurs when a sudden, unexpected, overwhelming intense emotional blow or a series of blows assaults the person from outside. Traumatic events are external, but they quickly become incorporated into the mind (1999)."

Specialists distinguish between acute or single incident trauma and chronic trauma. "Chronic trauma involves either sustained or repetitive traumatic experiences and typically occurs in an environment where there is little adult support or healthy caregiving (Bloom 1999)." Children exposed to chronic trauma have stronger negative outcomes than those exposed to "acute accidental traumas."

Children at greatest risk for trauma include: "children who are known to have been abused and neglected; children in foster care; children who witness domestic violence or the violent death or a parent, sibling or friend; children who are victims of catastrophic accidents or mass causality events associated with school violence, forms of terrorism or natural disasters; children in the juvenile justice system; refugee children from countries with major armed conflicts and civil disturbances; and children who require psychiatric hospitalization for certain symptoms of behavioral problems (Harris et. al. 2004)." Inner-city children experience the greatest exposure to violence and are at greater risk of experiencing trauma than other groups (Parsons 1994).

How does trauma effect children?
Trauma can have a profound impact on the development, self-concept and functioning of children. Bloom states, "A traumatic experience impacts the entire person - the way we think, the way we learn, the way we remember things, the way we feel about other people, and the way we make sense of the world, are all profoundly altered by traumatic experiences (1999)."

Exposure to trauma can severely impair a child's development, especially their emotional development. When a child is exposed to regular traumatic experiences over a period of time, especially if they are not experiencing nurturing and consistent caregiving, the child is experiencing chronic stress. This repeated stress and lack of protection and support affects children's ability to regulate their emotions and leaves them more vulnerable to stressful environments like school. They are more likely to react strongly to teasing, bullying, authority figures or any perceived danger- to react with extreme emotions like anger or sadness. Also, they are more likely to "release tensions more through action rather than through thinking and reflecting (Parson 1994)."

Children exposed to trauma are likely to have difficulty thinking rationally and clearly. They experience threats, often irrationally, in a state of hyperarousal- "as emergencies requiring action rather than thought (Van der Kolk 1989)." This makes functioning in many everyday environments difficult, especially school. Traumatized children are more likely to have difficulty concentrating in school, leading to high levels of academic failure (Harris et. al 2004) and behavioral problems in school.

People who experience trauma as children feel compelled to find different means to reenact trauma. This can be in the form of healthy and therapeutic reenactments, like telling the story to a sympathetic and trusted individual, or in behavioral reenactments as when a child is sexually provocative with other children (Bloom 1995). According to some, this compulsion to reenact trauma through incidents that produce extreme stimulation or hyperarousal such as self-mutilation, are behaviors, like that of the original trauma, that after a period of extreme emotional arousal produce a temporary feeling of calmness and serenity. People exposed to trauma may develop a pattern of behavior in which they reenact their trauma, despite the pain and personal and social damage, to achieve that feeling of calmness not unlike the relationship between a drug addict and a particular drug (Van der Kolk 1989).

For children who have experienced trauma through abuse, behavioral re-enactment of victimization may be exhibited through the role of victim or victimizer. Studies have found links between child abuse and criminal behavior such as drug abuse, juvenile delinquency and adult criminal behavior (Van der Kolk 1989). Abused children are also more likely to engage in self-destructive behavior such as biting, burning, headbanging and cutting. And, showing learned helplessness, they are more likely to put themselves in positions where they can be revictimized. (Van der Kolk 1989).

Trauma has also been shown to negatively effect self-esteem and sense of identity (Harris et. al 2004). Traumatized children, especially those who have been abused, often experience self-hate and engage in self-destructive behavior. As Van der Kolk sates, "When the persons who are supposed to be the sources of safety and nurturance become simultaneously the sources of danger against which protection is needed, children maneuver to re-establish some sense of safety. Instead of turning on their caregivers and thereby losing hope for protection, they blame themselves. They become fearfully and hungrily attached and anxiously obedient (1989)."

Traumatized children also often have enormous difficulty in forming healthy relationships. They are often unable to establish trust in relationships and have a tendency to form relationships that are abnormal, dangerous and abusive (Bloom 1999). The abuse is a way for the traumatized to regain some sense of power. In order to avoid a feeling of powerlessness the victimized may "assume the power of the one who has hurt you by becoming someone who terrorizes and abuses others (Ibid.)." Many also cut themselves off from their emotions and as a form of protection become cold and isolated. Many of them become "hardened to other people's needs and points of view, adopting an interpersonal aesthetic in the form of a cold, tough, aloof, and intimidating street-wise demeanor. In the aftermath of trauma, the child finds that painful, suppressed, repressed, and split-off feelings are difficult to express in words (Parsons 1994)."

Trauma has also been shown to negatively effect children's physical development and health. There is research that shows that people exposed to chronic stress have more medical illnesses and use medical services more frequently (Friedman and Schnurr 1996).

What can be done to protect children from the effects of trauma and help them through it?
Children are more resistant to the effects of trauma when they have adequate support, a more positive and established self-image, maturity and coping skills. Protector factors include intelligence and the capacity for emotional regulation, the presence of social supports provided by caring and competent adults, holding a positive belief about self, belief in the safety and fairness of their situation and the ability to frame current life experiences and a motivation to act effectively in one's environment. Trauma undermines these attributes - the things that protect children from trauma are not allowed to develop or are damaged by trauma.

Although, depending on the child's environment and outside events, exposure to certain kinds of trauma is unavoidable, important in both helping children through traumatic experiences and in providing them the resources to protect them from its negative effects is stable and nurturing caregiving. Van der Kolk states, "The availability of a caregiver who can be blindly trusted when their (children's) own resources are inadequate is very important in coping with threats (1989)." Physical and emotional maturation are also strongly influenced by early attachment bonds. A safe and nurturing environment is crucial in the "social and biologic development" of children (Van der Kolk 1989).

In order to understand, process and avoid debilitating effects of trauma it is important that children are provided opportunities of developing health relationships with peers and adults.

References:
Bloom, S. (1999) Trauma Theory Abbreviated, from the Final Action Plan: A Coordinated Community-Based Response to Family Violence. Attorney General of Pennsylvania's Family Violence Task Force.

Friedman, Matthew and Schnurr, Paula (1996) Trauma, PTSD and Health. NCP Clinical Quarterly, Vol. 6, No. 4.

Harris, William et al. (2004) Mobilizing Trauma Resources for Children. Paper presented at the meeting of the Johnson and Johnson Pediatric Institute: Shaping the Future of Children's Health, San Juan Puerto Rico.

Parsons, Erwin A., (1994) Inner City Children of Trauma: Urban Violence Traumatic Stress Syndrome (U-VTS and Therapists' Responses. In J.P. Wilson & J.D. Lindy (Eds.) Countertransference in the Treatment of PTSD (pp157-178). New York: Guilford Publications, Inc.

Van der Kolk, Bessel A., (1989) The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics of North America, Vol. 12, No. 2, PP. 389-411.

Useful links on the subject of trauma in children:

David Baldwin's Trauma Information Pages: Collection of links related to PTSD and childhood trauma for clinicians and researchers:
http://www.trauma-pages.com/

The ChildTrauma Academy: The ChildTrauma Academy focuses on service, training and research in the area of child maltreatment. Their website contains trauma-related material for caregivers and professionals.
http://www.childtrauma.org/

The Trauma Center: Massachusetts based center offering comprehensive services to traumatized children and adults and their along with training, consultation, and educational programming for post-graduate mental health professionals.
http://www.traumacenter.org/

The Center for Traumatic Stress in Children and Adolescents: The center serves children and families who experience traumatic or stressful events in their lives. http://www.pittsburghchildtrauma.com/

The center also conducts investigations on treatment of trauma in children and adolescents. This is a link for a paper that describes one therapy, Trauma-Focused Cognitive Behavioral Therapy:
http://modelprograms.samhsa.gov/pdfs/Details/TFCBT.pdf

Community Works: Community Works is a consultative, educational and organizational development company focusing on reducing the potential for conflict and violence in treatment settings, at school, or in the workplace using The Sanctuary Model. Their website contains information on childhood trauma and in a program model for treating it.
http://www.sanctuaryweb.com/

Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices: The Findings of the Kauffman Best Practices Project to Help Children Heal From Child Abuse. Includes a description of best practices including: Trauma Focused-Cognitive Behavioral Therapy for Child Sexual Abuse.
http://nationalcalltoaction.com/

The Child Trauma Institute: Provides training, consultation, information, and resources
for those who work with trauma-exposed children and adolescents. Includes an information page for parents.
http://www.childtrauma.com/

The Sidran Institute: A nationally focused nonprofit organization providing education and advocacy in the field of traumatic stress. Contains resources for trauma survivors, parents and professionals.
http://www.sidran.org/index.html

Handling your Psychiatric Disability in Work and School: An interactive and informative web site for people with a psychiatric condition that addresses issues and reasonable accommodations related to work and school.
http://www.bu.edu/cpr/jobschool/

The National Child Traumatic Stress Network: Congressional initiative comprised of 54 centers intended to serve as a resource on child traumatic stress for other professionals and the public.
http://www.nctsnet.org/

HealthPlaces.com: Provides comprehensive information on psychological disorders and psychiatric medications from both a consumer and expert point of view. Includes information for parents with children who have mental disorders including those who have experienced trauma.
http://www.healthyplace.com