Trauma: Children and Adolescent Care

Has your kid or teen been through trauma? Discover what the symptoms look like and how different approaches can help from a clinical psychologist who specializes in childhood trauma treatment.

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What Exactly Is Childhood Trauma?

Most people associate the word “trauma” with something that only happens to other people. According to a formal survey, approximately 35 million U.S. children and adolescents have experienced childhood trauma or adverse childhood experiences (ACEs). Because this number appears to be large, you may be wondering what constitutes a childhood traumatic event. Abuse (sexual or physical), witnessing domestic violence, neglect, accidents, chronic or sudden medical illness, a death in the family or parental illness, substance abuse, divorce, or incarceration are all examples of childhood trauma. For children, ACEs or traumatic events can be perplexing and upsetting. Given this, you may want to reconsider if your child or a child you know has been through a traumatic event.

Recognizing And Treating Trauma-related Symptoms In Children and Adolescents

Children and adolescents who have been exposed to traumatic experiences frequently do not recognize their symptoms. To begin with, most youngsters are unaware they are traumatized due to the high frequency of unpleasant experiences, which eventually leads to the concept of, say, abuse or neglect becoming a “normal” experience. This is also true for caregivers, who frequently have difficulty diagnosing trauma symptoms.

Following are some common indications and symptoms of trauma in children and adolescents:

• Hypervigilance/hyperarousal. This is an aberrant state characterized by enhanced receptivity to stimuli, as well as physiological and psychological problems (e.g., increased alertness, elevated heart rate, and breathing). Most traumatized children dislike loud and abrupt noises and frequently appear “jumpy” or “wide-eyed,” alert to potential danger.
• Avoidance. Avoid thinking about or talking about the traumatic incident or the places, activities, and people associated with it.
• Intrusive or unwanted thoughts. Flashbacks, thoughts, or memories of the traumatic event occur on a regular basis. A youngster may feel as if they are “reliving” the event or may have nightmares about it.

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What Trauma Looks Like In Kids From Different Ages

Trauma symptoms frequently differ according to a child’s age:

Early childhood (ages 3-8)

• Uncontrollable Behavior. If your child is between the ages of 3 and 8, you may notice an increase in aggressive, non-compliant, or oppositional behavior. This means you may have more difficulty managing your child’s behavior if they struggle to listen to directions or deliberately defy your requests. This is common because young children lack the cognitive development to effectively communicate their emotions, so they express themselves through their actions and behaviors. This may also manifest as an increase in the frequency of “temper tantrums,” as children who have witnessed traumatic events tend to try to exert control over their environments, as well as their caregivers or parents. Their need for control is a way for them to cope with their anxieties about the world’s uncertainty or unpredictability.
• Issues in social situations. These behaviors are frequently difficult to manage not only at home but also at school. Parents or caregivers may become aware of increased concerns about their child’s behavior, such as difficulty listening to teachers and authority figures, increased conflict with peers, and difficulty making or maintaining friends.
• Heightened emotions. Young children who have experienced traumatic events exhibit bursts of crying and emotionality. This can manifest as increased sensitivity or irritability, which leads to more consoling over typically unimportant stimuli, such as telling a child “no.” Finally, you may notice an increase in hypervigilance, also known as “being on the lookout for danger.” Children frequently appear wide-eyed and alert, anticipating the next unexpected event. Young children frequently place their hands over their ears to avoid hearing loud sounds.

Childhood in the middle age (ages 8-11)

• Behaviors regressed. The presentation of children in middle childhood (ages 8-11) is similar to that of children in early childhood. Despite being slightly older, these children’s behavioral issues persist and frequently mimic behaviors that are much younger than their actual age. This means that non-compliant, oppositional, and aggressive behaviors are still present, and are frequently more severe and unmanageable. Tantrums are still common and have begun to include increased verbal aggression (such as name-calling, cursing, and hurtful language to others).
• School difficulties. An increase in academic and behavioral challenges at school may occur. Your child’s ability to concentrate or listen to directions may suffer, resulting in lower grades. Inattention is frequently misdiagnosed and confused with Attention Deficit Hyperactivity Disorder (ADHD). Trauma in middle childhood, like early childhood trauma, can lead to behavioral problems with peers at school and in classroom settings due to increased irritability and a lower ability to tolerate frustration.
• Issues in social situations. As children’s social networks begin to expand during these years, there may be an increase in social or peer-to-peer challenges. Making and keeping friends can be difficult for children who have experienced trauma due to increased irritability, sensitivities, and hypervigilance. Children may become overly controlling of their surroundings, including their peers, causing difficulties in maintaining healthy friendships. These friendships frequently contain more conflict than usual due to a child’s behavioral challenges, as well as their need to control.
• Heightened emotions. As children begin to incorporate more language into their lives, they may exhibit increased verbal tantrums and aggression. As stressors increase (due to increased school and home responsibilities), children may become irritable and exhibit the strong emotions they are holding onto from their trauma.

Adolescents (ages 12-18)

• Behavior and involvement have regressed. We often see an increase in isolative behaviors, such as avoidance of people and healthy coping styles, as adolescents (ages 12-18) individuate more at this age. Adolescents who have experienced trauma tend to be either overly or underly expressive. Both verbal and physical aggression toward others is overly expressed behaviors. They can be lengthy and difficult to manage. Under-expressive behaviors, on the other hand, may appear to be the exact opposite. Adolescents may isolate themselves in their rooms, be verbally non-expressive and reserved, and be unresponsive. Both of these coping styles exploit the avoidance symptom by avoiding the actual problem at hand.
• Alteration in the mood. Adolescents who have experienced trauma typically experience a decline in mood. Irritability rises, and bouts of sadness and rage become more common. These emotions are frequently associated with traumatic events. At home, there is usually an increase in conflict because parents are unaware of what is going on with their adolescents and attribute much of it to the moodiness of a growing teen. While some of this may be true, it is important to remember the symptoms of trauma. They are also more likely to harm themselves due to increased feelings of sadness.
• School difficulties. Adolescents have higher academic demands placed on them during this time, which increases their stressors and makes it more difficult to manage their emotions. Adolescents typically experience a drop in grades and overall lower performance in areas where they previously performed well. Their ability to concentrate frequently deteriorates as unwanted thoughts or imagery from the traumatic event replay in their minds. A decline in mood is frequently observed and has an impact on their ability to perform. School absences and behavioral issues in the classroom may also rise.
• Problems with interpersonal relationships. Regardless of trauma experiences, peer-to-peer and romantic relationships are most important at this stage. Adolescents who have experienced trauma tend to withdraw from friendships and keep to themselves. Fear of friends not understanding, as well as a lack of desire to form friendships, all contribute to fewer social interactions. Romantic relationships are more likely to form during this time. Adolescents who have experienced trauma frequently seek attachments to anyone who exudes love or acceptance. Parents should be aware of the relationships that are formed during these times.

Pic: Trauma

Advice for Parents

Because the world can feel unpredictable, unstable, and chaotic for children and adolescents suffering from trauma-related symptoms, it is critical to create an environment that promotes a child’s socio-emotional well-being.

Here are some parenting hints:

Tip 1: Establish stability and consistency.

Limiting your child’s options for various activities, also known as containing space, can help reduce a child’s anxiety. This increases opportunities for children to feel safe because the world appears to be somewhat predictable as long as the rules remain consistent. Children who have experienced trauma frequently believe that the world is constantly changing. The child learns consistency in routine, that an authority figure is in charge, and that they are safe with rules and boundaries. Rules establish intangible parameters that foster healthy growth and well-being. Children are more aware than we realize and respond well (as evidenced by positive behavioral changes) to rule-setting, which teaches them what is and is not acceptable. They are even more likely to follow rules in other situations, such as with teachers in the classroom or with other parents at play dates!

Tip 2: Provide predictability.

Anxiety is commonly defined as a fear of the unknown. So, addressing and dismantling a child’s uncertainty gives them control and knowledge. Setting expectations for events and activities ahead of time improves predictability. We cannot control every event in our children’s lives, but we can help them succeed by providing information about what to expect in different situations. For example, if you leave the house to go to the store and your child is concerned about your whereabouts, informing them about the details of your trip, time frame, and how to contact you while you’re gone will help to reduce anxiety. This prepares your child for what is to come.

Tip 3:Encourage safety.

Children can grow in safer environments that limit chaos and increase predictability. This does not imply having an argument-free relationship with your partner, but rather taking those arguments to a private space to limit your child’s exposure to conflict. Furthermore, informing your child about who to contact and what to do in case of an emergency will help your child succeed. It is beneficial to promote safe spaces for growth by providing open spaces for your child to disclose their feelings and thoughts without judgment. Children who have experienced trauma are frequently afraid of sharing information with caregivers for fear of being punished. Informing your child of your unconditional and supportive stance prior to traumatic events may increase the likelihood that your child will share their challenges and experiences with you.

Professional Treatment Options

When your child’s behavior or symptoms appear unmanageable or interfere with his or her functioning (academic, social, or emotional), it’s critical to seek professional mental health services from a trauma-informed clinician.

The following mental health treatment interventions can be extremely beneficial in relieving your child’s symptoms:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a treatment for children and adolescents (ages 3 to 18) as well as their parents who have been through a traumatic event (or events). It uses a cognitive-behavioral therapy model to address a wide range of emotional and behavioral issues caused by trauma. Furthermore, TF-CBT emphasizes a gradual exposure component, which means that the traumatic event is discussed throughout treatment. According to research, the more exposure that is disseminated, the better mental health well-being and the reduction of trauma symptoms. TF-CBT is an 8-step process that can be remembered using the acronym:

• Symptoms of trauma Psychoeducation
• Relaxation skills to use when distressed
• Affect regulation – Learning about feelings
• Cognitive coping entails understanding how our thoughts influence our feelings and behaviors.
• Trauma narrative – A detailed story is told about a traumatic event that occurred in the child or adolescent (s)
• During the intervention, the clinician will expose the child to address any significant trauma triggers.
• Conjoint sessions entail sharing the narrative with the caregiver or parent.
• Improving safety by teaching future generations healthy habits

Parent-Child Interaction Therapy (PCIT) is a parent-child dyadic play-based therapy that helps children (ages 3-7) with trauma-related symptoms such as aggression, noncompliance, and oppositional behavior. PCIT fosters positive parent-child relationships while also teaching parents effective behavioral management techniques. PCIT’s two components address enhancing the parent-child relationship in a module called Child-Directed Interaction and strategies to gain compliance in a module called Parent-Directed Interaction. Parents are taught how to implement these skills (e.g., engaging and using positive play skills, giving effective and direct commands) during these modules, with the ultimate goal of achieving the following:

• Increasing the bond between parent and child
• Negative behavior reduction
• Improving Positive Behavior
• Reducing aggressive behavior
• Reducing non-compliant behavior

Dialectical Behavior Therapy (DBT) is a cognitive, supportive, and collaborative intervention that assists adolescents in managing safety risks (e.g., suicidal or self-injurious thoughts) and challenging irrational thoughts. Because one of the main goals of this intervention is to manage safety and at-risk behaviors, DBT requires individual treatment in addition to a DBT-based group intervention with peers of the same age. This intervention addresses four modules, including:

• Mindfulness and nonjudgmental thinking about oneself, the world, and others
• Interpersonal effectiveness in relationship management and how to interact with others in a healthy manner
• Distress tolerance is the ability to tolerate distressing and painful events by accepting life in its current state. For example, radical acceptance is a type of distress tolerance that teaches adolescents how to change their thoughts and distinguish between willingness and willfulness.
• Emotion regulation skills are taught to help manage suicidal thoughts, anxiety, sadness, irritability, anger, and other emotions in a healthy manner.