Understanding Childhood Trauma

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Trauma is a term defined as an emotional wound or shock that creates substantial, lasting damage to an individual’s psychological development, often leading to neurosis.

All children experience some stressful events. Early childhood trauma generally refers to traumatic experiences that happen to children aged 0-6. Since infants and young children may react differently than older children, and may not be able to verbalize their reactions to threatening or dangerous events, there is an assumption that young age protects children from the impact of traumatic experiences. However, young children are affected by traumatic events, even though they may not understand what has occurred.

Current research suggests that young children, and even infants, may be affected by events that threaten their safety or the safety of their parents/caregivers, and their symptoms have been well documented. These traumas can result from intentional violence—such as child physical or sexual abuse – domestic violence, natural disaster, accidents, or war. Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver.

Trauma for an adoptee begins at the moment of separation from a birthmother. Whether adopted from birth or later in life, all adopted children have experienced some degree of trauma. Until recently, the full impact of trauma on adopted children has not been fully understood. Since infants do not see themselves as a separate entity, it is believed they see themselves as part of the person they physically attached and bonded to for 40 weeks. When separated, infants may naturally feel they have lost part of themselves. When an adoptee is separated from a birthmother, extensive trauma is experienced. The trauma will not be remembered, but it will stay in the subconscious as it was lived. Any event from infancy can and will stay with an individual through life.

Traumatic events have a profound sensory impact on young children. Since they are less able to anticipate danger or know how to keep themselves safe, young children are more vulnerable to the effects of exposure to trauma. For example, when young children witness traumatic events, they may blame themselves or their parents for not preventing it or for not being able to change its outcome. These misconceptions of reality compound the negative impact of traumatic effects on children's development.

In today’s society, a significant number of children are exposed to traumatic life events before age 16. For example, in the US, estimated rates of witnessing community violence range from 39% to 85%, estimated rates of victimization up to 66%, and exposure to sexual abuse estimated range between 25% to 43%. Rates of children’s exposure to disasters are lower than for other traumatic events, but when disasters strike, large proportions of young people are affected, with rates varying by region and type of disaster. Children and adolescents have likely comprised a substantial proportion of the nearly 2.5 billion people affected worldwide by disasters in the past decade.

Race and ethnicity, poverty status, and gender also affect children’s risk of exposure to trauma. For example, significantly more boys than girls are exposed to traumatic events in the context of community violence, and serious injury disproportionately affects boys, children living in poverty, and Native youths.

It is more common for children and adolescents to be exposed to more than a single traumatic event. Children exposed to chronic and pervasive trauma are especially vulnerable to the impact of subsequent trauma. After exposure to a traumatic life event, short-term distress is almost universal. Nearly all children and adolescents express some kind of distress or behavioral change in the acute phase of recovery from a traumatic event. Not all short-term responses to trauma are problematic, and some behavior changes may reflect adaptive attempts to cope with a difficult or challenging experience.

Symptoms and behaviours of childhood trauma

As with older children, young children experience both behavioral and physiological symptoms associated with trauma. Unlike older children, young children cannot express their feelings in words, but their behaviors provide important clues about how they are affected.
Young children who experience trauma are at particular risk because their rapidly developing brains are very vulnerable. Early childhood trauma has been associated with reduced size of the brain cortex. This area is responsible for many complex functions including memory, attention, perceptual awareness, thinking, language, and consciousness. These changes may affect IQ and the ability to regulate emotions, and children may become more fearful and feel less safe or protected.

Young children depend exclusively on parents/caregivers for survival and protection—both physical and emotional. When trauma also impacts the parent/caregiver, it strongly affects the relationship between the parent/caregiver and children. Without the support of a trusted parent/caregiver to help them regulate their strong emotions, children may experience overwhelming stress, with little ability to effectively communicate what they feel or need. They often develop symptoms that parents/caregivers do not see.

Children suffering from traumatic stress symptoms generally have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or aggressive and impulsive. They may also have difficulty sleeping, lose recently acquired developmental skills, and show regression in functioning and behavior.

Here are possible reactions of children aged 0 – 6 and adolescents exposed to traumatic stress.
Children aged 0 – 2:

• Withdrawn
• Demand attention through positive and negative behaviors
• Poor verbal development
• Excessive temper tantrums
• Aggressive behaviors
• Memory problems
• Regressive behaviors
• Experience nightmares, sleep difficulties or have poor sleep habits
• Fear adults who remind them of the traumatic event
• Have poor appetite, low weight and/or digestive problems
• Scream or cry excessively
• Show irritability, sadness and anxiety
• Startle easily

Children aged 3-6:

• Act out in social situations
• Withdrawn
• Demand attention through positive and negative behaviors
• Excessive temper
• Anxious, fearful and avoidant
• Unable to trust others or make friends
• Verbally abusive
• Believe they are to blame for the traumatic experience
• Learning disabilities
• Aggressive behaviors
• Experience nightmares, sleep difficulties or have poor sleep habits
• Experience stomachaches and headaches
• Fear adults who remind them of the traumatic event
• Fear being separated from parent/caregiver
• Difficulties focusing or learning in school
• Imitate the abusive/traumatic event
• Lack self-confidence
• Show irritability, sadness and anxiety
• Show poor skill development
• Startle easily
• Wetting bed or self wetting after toilet training or showing other regressive behaviors

Many of the reactions displayed by children and adolescents who have been exposed to traumatic events are similar or identical to behaviors that mental health professionals see on a daily basis in their practice.

These include:

• Development of new fears
• Separation anxiety (particularly in young children)
• Sleep disturbance, nightmares
• Sadness
• Loss of interest in normal activities
• Reduced concentration
• Decline in schoolwork
• Anger
• Somatic complaints
• Irritability

Functioning in the family, peer group, or school may also be affected as a result of these symptoms. Therefore, when working with children who show these types of reactions, a careful assessment of possible exposure to trauma must be conducted.

There are two basic types of psychological trauma: one-episode or single-blow psychic trauma, which results from a single, sudden, and unexpected event such as a rape, a bad car accident, or a devastating tornado; and repeated trauma, which develops from long-term, repeated events, such as sexual or physical abuse. Each type has characteristic signs.

One-episode trauma or single-blow trauma

Also called Type I post-traumatic stress disorder (PTSD), produces a number of characteristic symptoms that include:

• Nightmares are also common among children with post-traumatic stress disorder, as are recollections of the traumatic event that occur during waking hours and intrude into the child’s thoughts.
• These children may be easy to startle easily, be very vigilant, become preoccupied with finding reasons and ways in which the traumatic event could have been averted, and can become pessimistic about the future and their purpose in life. Some children also experience visual hallucinations both immediately following and long after the single-event trauma.

Repeated trauma

Also called Type II PTSD is trauma that is repeated and occurs in children who have been abused often and for a long time. Chronic trauma is also common in children who have been reared in violent neighborhoods or war zones. Increasingly it is found in children who witness violence in the home or in their communities.

Many of the same symptoms that accompany Type I or single-episode trauma occur, as well as additional ones with Type-II. Since the trauma is repeated or prolonged, a child will develop a sickening anticipation and dread of another episode. After being repeatedly brutalized, children may have a confusing combination of feelings, at times angry and sad, at others fearful. These children often appear detached and seem to have no feelings. This emotional numbness is a hallmark of this type of trauma.

Identifying the Signs

Immediately following any kind of traumatic event, children commonly experience brief and usually limited denial and emotional numbness. They will often try to stop thinking about the traumatic experience. Children who suffer through repeated traumatic horrors develop and use a variety of psychological mechanisms to cope. They include:

• Dissociation – a psychological coping mechanism that enables emotional distancing from the pain of trauma
• Rage – festering anger that occasionally explodes as tantrums and violent behavior in children.
• Extreme passivity – resulting in victimization
• Internal changes may occur as the child tries to adapt to both the trauma and the loss caused by the trauma.
• Suicide attempts or self-mutilating behavior may occur among these children.
• Reliving the traumatic event - re-experiencing the trauma through any of the senses such as vivid and unwelcome flashbacks at any given time, in play or behavior.

Other signs common to children who suffer post-traumatic stress disorder include:

• Sleep disorders
• Nightmares
• Exaggerated startle response
• Panic
• Deliberate avoidance of reminders of the trauma
• Irritability
• Immature or regressed behavior
• Hypervigilance

Theoretically, adopted children have experienced being unwanted before they were born. In addition, they may have experienced the loss of the mutual and deeply satisfying mother-infant bond. This experience can affect them in more than one-way, including:

• Grieving the loss of their birthmother
• Being emotionally vulnerable
• Anger
• Shutting people out, depression, or overcompensation

Tragically, trauma destroys the natural sense of invincibility and trust basic to normal childhood. This ruins the children’s confidence about the future and can lead to limited expectations. Childhood trauma darkens the child’s vision of the future as well as attitudes about people.
Traumatized children often have a pessimistic view of career, marriage, having children, and even life expectancy.

Trauma-related fears often persist into adulthood.

Without treatment, some childhood traumas can result in later problems characterized by violent behavior, extremes of passivity and re-victimization, self-mutilation, suicidal or self-endangering behavior, and anxiety disturbances.

Managing childhood trauma

Over time, most children show resilience in the aftermath of traumatic experiences. This is especially true of single-incident exposure. Children who have been exposed to multiple traumas, have a past history of anxiety problems, or have experienced family adversity are at higher risk posttraumatic stress disorder (PTSD). Despite exposure to traumatic events and experiencing short-term distress, most children and adolescents recover or return to their previous levels of functioning after several weeks or months and resume normal development. This resilience typically results in a reduction in both psychological distress and physiological arousal.

Unfortunately, for both adopted children and their families, the traumatic experiences typically occur in the context of human relationships. From that point forward, stress in the midst of a relationship will create a traumatic re-experiencing, leading adopted children to feel threatened, fearful, and overwhelmed in an environment which otherwise may not be threatening to other people.

However, most children with distress related to trauma exposure and in need of help do not receive psychological treatment, and those who do, receive a wide variety of treatments. The small group of children that go on to develop severe acute or ongoing psychological symptoms (including PTSD symptoms), experience interference with their daily functioning, and warrant clinical attention. Some of these reactions can be quite severe and chronic. While these children frequently do not get the help they need because of social factors including poor access to mental health services, children who do receive help generally receive evidence-based treatment.

Cognitive–behavioral therapy (CBT) techniques have been shown to be effective in treating children and adolescents who have persistent trauma reactions. CBT has been demonstrated to reduce serious trauma reactions, such as PTSD, other anxiety and depressive symptoms, and behavioral problems. Most evidence-based, trauma-focused treatments include opportunities for children to review the trauma in a safe, secure environment under the guidance of specially trained mental health professionals. CBT and other trauma-focused techniques can help children with cognitive distortions related to the trauma, such as self-blame, develop more adaptive understanding and perceptions of the trauma.

How to Respond

Early intervention in childhood psychological trauma is critical. Families that offer support, understand, and provide a sense of safety as close to the time of the traumatic event as possible can effectively limit the effects of trauma on children. Your child’s doctor may also recommend consulting a child and adolescent psychiatrist or other mental health professionals for evaluation and treatment.

Individual Psychotherapy

Therapy that allows children to talk about the trauma or integrate it into play may help in moving beyond the pain to better cope.

Play therapy - Psychotherapy in which children are encouraged to use actions and play materials to express emotions, thoughts, and fantasies – allows younger children to reenact the traumatic event in a safe environment, moving gradually to verbal expression. For example, drawing the scene of the event may help children start talking about the trauma.

Therapy may make it easier for children to describe their feelings. In time, they may be able to understand their symptoms, behavior, and characteristic ways of dealing with the trauma. Furthermore, talk and play eventually give children the opportunity to look at the traumatic event in context and to gain perspective. Gradually, children are helped to see the event as an encapsulated experience, a personal tragedy that occurred at a moment in time, rather than as a fate that determines and controls the rest of her life.

Medication

Occasionally, medication is prescribed to treat symptoms of post-traumatic or acute stress disorder. Among the medications that might be prescribed are anti-depressants such as imipramine (Tofranil), and nortriptyline (Pamelor), and anxiety-reducing agents like clonazepam (Klonopin) or lorazepam (Ativan).

Help from mental health professionals

Mental health professionals have an important role in facilitating the recovery of children, adolescents, and families when traumatic events occur. For instance, they can provide consultation to other professionals (in schools, health care settings, spiritual settings, and other service systems) about responding to trauma-exposed children, adolescents, and families. Mental health professionals can also support the whole family, provide education about trauma reactions and hope for full recovery, advocate for trauma-focused treatment for those who do not make a full recovery.

Parenting childhood trauma

Childhood trauma can influence the ability to learn normally and can affect emotional stability. It can also impair social development, since children will often withdraw. This may cause children to get bullied or become a bully themselves, and have further problems communicating with peers and building relationships with others. This means that children who are exposed to trauma in childhood will need extra nurturing.
Fortunately, all children who experience early trauma can be helped and are responsive to treatment. With the sensitivity and support of their families, these children can accommodate memories of their trauma as individuals who survived, and move on to lead healthy, productive, satisfying lives.

Trauma for an adopted child is very common. They have already been removed from at least one caregiver, and maybe several others before they enter their adoptive families. While some children have suffered a traumatic family situation prior to being adopted, the process of adoption in itself is enough change, stress and turmoil for anyone, especially a child. How you handle this delicate situation as a parent, will contribute to their mental and emotional development.

As many adoptive parents know, adoption is never easy, even if you adopted your child as an infant. However, adopting an older child with many behavioral problems as a result of early trauma is a serious challenge that few are willing or able to manage.

Before any potential adoptive parent thinks about adopting an older child, domestic or international, you must remember that a child is not a purchased object, nor a financial investment. The responsibility will likely be the most difficult one you have ever have in your life. If you have not carefully done your research, and established much support from friends, family, health services, and the community, then it is best to consider other options.

Teaching adopted children to deal with the loss, grief and anger is a first step in their healing from trauma. As a parent you must first be aware of what caused the trauma and empathize with this innocent child’s situation. Below are some tips to help.

10 helpful ways to parent childhood trauma

• Understand that trauma creates fear and stress sensitivity in children.
• Recognize and be more aware of fear being demonstrated by your child. Be more sensitive and tune in to the small signals given such as clinging, whining, not discriminating amongst strangers, etc.
• Self-understanding - recognize the impact of trauma in your own life.
• Reduce external sensory stimulation when possible – such as television, overwhelming environments, number of children playing together at one time, and large family gatherings.
• Do Time-In instead of Time-out not for lecturing but to allow your child an opportunity to calm down and then think more clearly.
• Never hit traumatized children – it will only identify you as a threat.
• Give lots of affection - apply the simple technique of affection prescription 10-20-10. Give your child 10 minutes of quality time and attention first thing in the morning, 20 minutes in the afternoon, and 10 in the evening.
• Encourage an IEP in the classroom to develop an understanding of the child’s stress and fear.
• Educate yourself regarding the impact of stress and trauma on families. There are many resources available online and in your community.
• Seek support. Parenting a child with trauma history can take its toll on the best of parents. Seek out a support system for occasional respite care, discussing of issues, and the sharing of a meal.

There are many methods and support tools to help build foundation of love and stability for childhood trauma. Talk to your child’s doctor about finding supports and resources in your area or community or work with a family specialist to build a healthy platform for your child’s development

Helpful links or resources for childhood trauma

Center on the Developing Child - http://developingchild.harvard.edu/

Child Witness to Violence, Boston Medical Centre - http://www.childwitnesstoviolence.org/

LifeWorks Northwest – Children/Families-Mental Health - http://www.lifeworksnw.org/who-we-serve/children-teens-families/mental-health/

How Kids Develop - http://www.howkidsdevelop.com/

Twenty Things Adopted Kids Wish Their Parents Knew - http://www.amazon.ca/Twenty-Things-Adopted-Adoptive-Parents/dp/044050838X

Cope with Life Article - http://www.copewithlife.ca/adoption/trauma-for-the-adopted-child/

The Post Institute - http://www.postinstitute.com

Adoption.com - http://library.adoption.com/articles/adoption-trauma-that-last-a-life-time.html

Content references

National Child Traumatic Stress Network - http://www.nctsn.org/trauma-types

American Psychological Association -http://www.apa.org/pi/families/resources/children-trauma-update.aspx

Starr Training - https://www.starr.org/training/tlc

Center on Trauma and Children - http://www.uky.edu/CTAC/

Street Directory - http://www.streetdirectory.com/travel_guide/201812/child_adoptions/the_adopted_child_trauma_and_its_impact.html