Childhood Trauma

Trauma is defined as a physical or psychological threat or assault to a child’s physical integrity, sense of self, safety or survival or to the physical safety of another person significant to the child.

Early childhood traumas (i.e. those that happen before the age of six) lie at the root of most long-term depression and anxiety, and many emotional and psychological illnesses.

Due to traumatic experiences children are susceptible to psychological disorders and serious emotional turmoil, often needing the assistance provided in trauma therapy.

These experiences may be positive or negative, ranging in their severity.

Some of these experiences occur on a semi-regular basis, and others only happen once. Despite their varying factors however, each of these events make an impact in the life of a child.

In some cases trauma treatment centers are incorporated to help the child overcome such trauma.

Symptoms of Trauma in Children

A child can react in a number of different ways as a result of trauma. The following are some examples:

Anxiety, terrorWithdrawn from othersConstantly alertRe-enactment of situation with various

objectsIrritability

Difficulty sleepingLack of energyInability to concentrateAmnesiaPoor self-imageBedwettingGuilty feelingsShows signs of obsessive or compulsive

behaviors

Panic attacksRecurrent nightmares, flashbacksShynessAvoidance of situations similar to the

traumatic eventPainInability to give or receive proper love and

affection

Effects of Trauma in Children

Self-injuryPost-Traumatic Stress DisorderPhobiasDepressionDrug Abuse (typically requiring the help

of a drug rehab facility)Insomnia

PromiscuityDifficulty learning, struggling in schoolBrain alterationsSuicideEating disorders which sometimes may

require the attention of a qualified eating disorder treatment center

Extreme anger and hostility

In some cases, trauma is not immediately evident. Sometimes trauma does not show up until much later in life or until it is triggered by certain circumstances.

In these cases, drug abuse is common and is often so severe that drug rehab at a drug treatment center is needed.

Brain Alterations from Trauma

When trauma occurs in someone early in life the brain is much more susceptible to drastic alteration.

Many of the children exposed to such events will develop neuropsychiatric symptomatology.

During a traumatic experience, various areas of the brain respond. These areas are often altered as a result, permanently impacting future functioning in the brain.

After these alterations, if recovery is to be sought, special trauma therapy sessions are necessary to attempt to activate parts of the brain.

Types of Childhood Trauma

Community Violence

Community violence includes predatory violence (robbery, for example) and violence that comes from personal conflicts

Shootings, rapes, stabbings, and beatings

Complex Trauma

The term complex trauma describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development.

Results in emotional deregulation and the loss of safety, direction, and the ability to detect or respond to danger cues

Domestic Violence

Domestic violence includes actual or threatened physical or sexual violence or emotional abuse between adults in an intimate relationship.

Studies suggest that the majority of children who are exposed to domestic violence are young-under the age of 8.

Early Childhood Trauma

Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6.

Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver.

Medical Trauma

Medical traumatic stress refers to reactions that children and their families may have to pain, injury, and serious illness; or to "invasive" medical procedures (such as surgery) or treatments (such as burn care) that are sometimes frightening.

Natural Disasters

A disaster is any natural catastrophe (for example, tornadoes, hurricanes, and earthquakes) or any fire, flood, or explosion that causes enough damage that local, state, or federal agencies and disaster relief organizations are called into action.

Neglect Child neglect occurs when a parent or

caregiver does not give a child the care he or she needs according to its age, even though that adult can afford to give that care or is offered help to give that care.

Neglect is the most common form of abuse reported to child welfare authorities.

Physical Abuse Physical abuse means causing or

attempting to cause physical pain or injury. It can result from punching, beating, kicking, burning, or harming a child in other ways.

Sometimes, an injury occurs when a punishment is not appropriate for a child's age or condition.

School Violence

School violence includes fatal and nonfatal student or teacher victimization, threats to or injury of students, fights at school, and students carrying weapons to school.

Sexual Abuse Child sexual abuse includes a wide range

of sexual behaviors that take place between a child and an older person or alternatively between a child and another child/adolescent.

Traumatic Grief Childhood traumatic grief may occur

following a death of someone important to the child when the child perceives the experience as traumatic. The death may have been sudden and unexpected or anticipated

The trauma symptoms interfere with the child's ability to go through the typical process of bereavement.

Case 1

An 8 year old boy witnesses his brother’s death.

Faces a tremendous sense of loss and guilt by experiencing his mother’s grief.

The child was referred for assessment prior to initiating any psychological treatment. The interview revealed pervasive references to survivor guilt and a profound sense of responsibility for failure to save his brother.

He commonly experienced intrusive recollections which he attempts to avoid or disrupt; these are not even known to the mother.

Later, during a psychological evaluation, his drawings reflected feelings of loss and fear and he admitted to intrusive recollections of his brother’s death.

Assessment revealed that the boy was experiencing disruptions in a variety of areas, including the following:

1. Compromised learning at school due to intrusive thoughts

2. Increased peer isolation and difficulty attending school due to anxiety in being away from his mother

3. Developmental regression and compromise of previously mastered developmental tasks

4. Persistently sad mood

A thorough analysis of his prior life functioning revealed no comparable experience and his reports of emotional difficulty were specifically linked to the experience of witnessing his brother die.

Case 2

2 children were driving with their father but in an accident there father died and both of them survived.

In this case, while the children suffered tremendous anxiety and loss from the death of their father, the mother provided tremendous support, continuity and reassurance to the children.

Extended family members provided the children with a continuing sense of stability, helping them maintain preexisting school relationships and routines.

The professional conducting the evaluation determined that the child being evaluated was resilient, with excellent coping skills. Psychological counseling was provided.

Treatment of Childhood Trauma

TF-CBT

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a components-based model of psychotherapy that addresses the unique needs of children with PTSD symptoms, depression, behavior problems, and other difficulties related to traumatic life experiences.

TF-CBT is a short-term treatment approach that can work in as few as 12 sessions. It also may be provided for longer periods of time depending on the child’s and family’s needs.

Individual sessions for the child and for the parents or caregivers, as well as joint parent-child sessions, are part of the treatment

The specific components of TF-CBT are summarized by the acronym PRACTICE:

PsychoeducationRelaxation and stress management skillsAffective expression and modulationCognitive coping and processingTrauma narrationIn vivo mastery of trauma remindersConjoint child-parent sessionsEnhancing future safety and development

TF-CBT primarily reduces symptoms of Posttraumatic Stress Disorder (PTSD).

Intrusive and upsetting memories, thoughts, or dreams about the trauma

Avoidance of things, situations, or people which are trauma reminders

Emotional numbingPhysical reactions of hyper arousal,

trouble concentrating, or irritability

In addition to improving PTSD symptoms, TF-CBT results in improvements in:

DepressionAnxietyBehavior problemsSexualized behaviorsTrauma-related shameInterpersonal trustSocial competence

When children experience serious traumas, other family members are affected as well. This is why TF-CBT typically includes parents or caregivers in treatment. TF-CBT is effective in helping parents to:

Overcome general feelings of depressionReduce PTSD symptomsReduce emotional distress about the child's

traumaImprove parenting practicesEnhance their ability to support their

children

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