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The Effects of Childhood Trauma in Development

By Dorothy Preissner, Rawhide Social Worker

“Mama was in her bedroom. They was all fighting. Mama kicked Thomas. He grabbed up a knife. And then cut Mama. There was blood all over the floor: I should have kilt him dead. Then we went outside and there was police. My sister got to push the siren. Mama is in heaven.” ~ Six year old child describing the murder of her mother as she colored a picture of her family – with her mother as an angel in heaven.

Working with traumatized children is not an easy job. As a result, a therapist needs to know how children are affected by trauma to effectively provide the help they need. It is important to first define what is meant by trauma or stress. A trauma, as defined by the Red Poppy Company, is sudden, unexpected, or non-normative, exceeds the individual’s perceived ability to meet demands, and disrupts the individual’s frame of reference and other central psychological needs and related schemas. Excessive stress can also be traumatic for a child. Stress, as it relates to trauma, can be defined by physical, emotional, or sexual abuse, witnessing violence, or experiencing lasting separation and loss (Child Health News, 2007).

Through my research, I have noted that several prominent behaviors which a therapist needs to take into account when working with traumatized children. The most important information found in my research was the effects of trauma on children and what makes one more resilient than another.

Depending on the age of the child when the trauma occurred, the effects from the trauma differ. The majority of the research separated the age groups into categories, beginning with birth to five years and ending with twelve to eighteen. This paper will coincide with the research and divide up the categories the same.

Very young children, birth to five years, may be more fearful feeling helpless, powerless, and feeling unable to protect themselves (American Red Cross). Part of this may be a result of their lack the ability to speak to describe the events which occurred. Children of this age group often fear being separated from a parent or other important relationships. They tend to cry, whimper, scream, tremble, or are excessively more clingy than usual, more than the usual (NIMH, 2001). The older ages in this category may even revert back to a younger behavioral age by thumb sucking, bedwetting, and fear of darkness. At times memories may be acted out in their play without even knowing it.

The next age group includes children from age six to eleven. Due to the age, children who experience trauma in this age category have some similar, but also very different responses than the younger children. Like the younger children, these children may also revert back to younger behaviors as a result of the overwhelming thoughts and feelings around the trauma. However, these children tend to have more behavioral problems in school, outbursts of anger and fighting, irrational fears. Their thinking has also matured more, which can result in the children having more guilt, feelings of failure, and anger (NIMH, 2001).

The final age group is adolescence, age twelve to eighteen. Although not entirely, the reactions for these children may be most similar to those of an adult. The effects from trauma may include flashbacks, nightmares, emotional numbing, avoidance of any reminders of the event, depression, substance abuse, problems with peers, and anti-social behavior (NIMH, 2001). Like the other two age groups discussed, this age group may also regress back to earlier ages of behavior.

As one can see there are many developmental effects on children depending on the age. These effects, if not dealt with, can lead to Post Traumatic Stress Disorder, Borderline Personality Disorder, depression (most commonly a co-morbid diagnosis), Dissociative Identity Disorder, Anxiety and Panic Disorders, Eating Disorders, and Addictions (Rothschild, B. 2000).

Parents and teachers can increase the recidivism rate by providing children with care and support. Something interesting to note with the earliest age group is that parent responsiveness to the trauma has a large impact on the overall well being of the child and the effects, notably more so than other age groups. Regardless of age, when a parent shows care and concern following a traumatic experience, the child will recover more quickly. A child’s self esteem also affects the rate at which a child bounces back from a trauma (Dominguez, R. Z., Nelke, C. F., & Perry, B. D., 2002).

“Not a day goes by that I don’t think that I could have saved him. I was eight. He was a hard man, always on me. Never could please that man. That day at lunch he kept on me, telling my mother how lazy I was. He told me to go to the shop behind the house and bring back the chair he had been working on. I said yes sir…but I went to my room after lunch. I guess he went to the shop himself to get the chair. I heard an explosion. The shop had blown up. I guess it was a gas leak. My mother and I watched fire melt the shop—he never came out. My mother was screaming – and I just stood and watched. I hate to say this but part of me was happy. I didn’t cry for a long time. Later that year I took my first drink. It helped me feel good.” ~ 68-year old man talking about the guilt and shame associated with the traumatic death of his father. He traces his history of alcoholism to this event.”

Reading through the material on trauma helped me to gain a better understanding of trauma victims and how they are affected. There were several new ideas which were brought to my attention after researching childhood trauma. I work with many children and adolescents who have experienced much trauma in their lives, yet I have done very little research on this topic.

Trauma affects over five million children each year (Perry, B.D., 1999). Although this does not mean that all children develop PTSD as a result of the trauma, this is a considerably large number of children each year who experience trauma. Childhood trauma should be taken seriously as the impact can last a lifetime.

Each article defined trauma a little differently. The most significant difference was in the types of trauma, between medical and psychiatric (National Institute of Mental Health). A medical trauma consists of a significant or vital medical need or emergency to the child. A psychiatric trauma can comprise of a medical trauma, including if a close family member or friend experiences a trauma, but also incorporates different traumatic experiences children can and are exposed to such as a natural disaster or catastrophic event.

With my clients, the work I do focuses on their diagnosis of conduct disorder and oppositional defiant disorder. I soon realized PTSD is often misdiagnosed (Perry, B. D., 1999). Rothschild (2000) discusses in his article the common disorders related to traumatic experiences such as Borderline Personality Disorder, depression (most commonly a co-morbid diagnosis), Dissociative Identity Disorder, Anxiety and Panic Disorders, Eating Disorders, and Addictions. This challenged me to think about how many of my clients have PTSD, but have been diagnosed with ODD, CD, or ADHD. Interestingly enough, this situation did come up with one of my clients. The doctor said he was misdiagnosed; the client did not have ADHD, but really was suffering from PTSD. Although at the time I did not entirely comprehend the doctor’s explanation to me, gaining this new information has helped me to have a better understanding.

It was interesting to understand how stress hormones work within children. The size of the hippocampus, which is directly related to memory processing and emotion and how a child works through a traumatic event, decreases when a child endures an extensive amount of stress (Child Health News). The stress does not include things such as getting into a fight or an argument which may be stressful for the moment, but an event that produces ongoing stress.

Stress has a bad connotation; nobody really wants to deal with it. People want it gone as quickly as it comes. It was shocking to read that stress is a good thing, especially for children. Although it sounds bad, it makes sense. Minor stressors in a child’s life help them to prepare for the different stressors which arise during one’s life. This, however, is not referring constant, intense stressors.

It was fascinating to learn about the effects of trauma and how they range from a wide array of symptoms and behaviors. There are so many differences and yet some similarities between the separate age groupings. The similarity which caught my attention the most was that regardless of the age the event occurred, all children tend to revert back to behaviors of a younger age. The children use this mechanism as a way to cope with the stress from the trauma. In my practice, I have seen fifteen and sixteen year old males still suck their thumb when feeling under pressure but had little understanding to this behavior. Now I have a better understanding as to why!

“Post-traumatic syndrome is the result of a failure of time to heal all wounds.~VanderKolk, 1996”

The information I have obtained for this paper is important for social workers, especially with the type of population I currently work with. As stated before, many, if not all, of my clients have lived through one or more traumas in their life. Most of these traumas are significant disturbances for a child to experience, for example, witnessing to shootings, sexual and physical abuse or they themselves have been abused, death, broken relationships, and the list goes on.

This leads to how I can focus on the self-constructivist theory in my practice. The self-constructivist theory focuses on an individual’s perceived reality of an experience in its environment (Pearlman, L.A. and McCann, I.L., 1990). This is a critical factor to understanding how the client feels and thinks about the trauma and how to work it through. As I work with clients with PTSD, it will be important to understand from the clients how they view their experiences and then to assist them as they accommodate and assimilate after the occurrence.

I have a better idea of the symptoms to look for in children who have experienced trauma. It helps to know the different symptoms to look for in certain age groups. I see many of the symptoms listed in the articles in the clients I work with, but viewed it differently as if it was always defiance. Having a larger knowledge base on this topic will help me to work better and effectively help those who have experienced trauma. I will not label a client with ADHD, conduct disorder, or oppositional defiant disorder without considering PTSD. This will be a key component as I continue to practice social work!

The process of healing and transformation must ultimately result in renewed developmental progression, a process in which the self-capacities are strengthened, psychological needs are balanced, and schemas are adjusted to incorporate new information in a way that enables the individual to experience satisfactions in his or her own life. (Pearlman, L.A. and McCann, I.L., 1990)

The struggles the children experience do not end when the dust settles. Children who have experienced trauma in their life feel the effects of the trauma well after the trauma occurs. It is important for a therapist to know how to detect when a child struggles with the symptoms following a trauma and how to help the child effectively work through the trauma, which in the end is the goal!

This is a very interesting topic to study. As a result, I would like to further my research by looking into the different therapies used in working with traumatized children. While very few of the articles discussed therapies used at a surface level, Perry’s article addressed more specifically common therapies used such as pharmacotherapy, individual psychotherapy, and cognitive behavioral therapies. Even though Perry’s information was helpful, I would like to see other perspectives on these common therapies.

I currently work with a large population of traumatized clients, and I need to put more of an emphasis on their different traumas. If I continue to focus on their outward behaviors and actions, then I am only scratching the surface of the real struggles. I need to go beyond that and get to where the defiance and rebellious behaviors began. For most of my clients, it began with a specific incident or a number of co-occurring events. My goal is to help them become healthy and successful members of society, and this means addressing the trauma they experienced years ago!

Sources & Readings

Dominguez, R. Z., Nelke, C. F., & Perry, B. D. (2002). Sexual abuse of children. Encyclopedia of Crime and Punishment, 1, 202-207.

Sexual abuse is a significant trauma which affects many children across the world, and can in some cases lead to PTSD. Significant physical, emotional, social, cognitive, and/or behavioral problems occur as a result of the trauma. The long term effects include depression, anxiety, posttraumatic stress disorder, sexual dysfunction, substance abuse, and/or psychiatric disorders. These problems can be more or less pronounced depending on the child’s level of self esteem. Due to extensive investigation completed after a report is made, the children are often times re-traumatized from all the interviews and reliving the incident.

Helping children and adolescents cope with violence and disasters. (2001). National Institute of Mental Health. (2001) Retrieved June 4, 2007 from www.nihm.hih.gov/publicat/violence.cfm

There are two types of trauma, medical and psychiatric. The one discussed primarily in this article focused on psychiatric which refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects. The more severe cases are children who experience avoidant behaviors and/ or emotional numbing. These children should seek the help of a professional. The more common reactions such as re-experiencing the trauma or hyperarousal can be effectively worked through with parents or teachers. The reactions to a traumatic event depend on the age of the child. However, the effects of a trauma can be increased or decreased by the parents response to the child’s needs following the event.

Helping young children cope with trauma.(2001). American Red Cross. Retrieved June 2, 2007 from Red Cross website.

After children experience a traumatic event, they sometimes begin to act out behaviors of a younger age such as bedwetting, thumb sucking, headaches, stomach aches, feeling sick, easily distractible, confused, and disoriented. Depending on the age of the traumatic experience, the symptoms and behaviors may differ. The parent’s reaction to the event can also effect the recovery time for the child. Some children need to seek professional help while it is not necessary for all. Regardless of the severity, most children have difficulties in understanding the traumatic experience.

Pearlman, L.A. and McCann, I.L. (1990). Psychological trauma and the adult survivor: Theory, Therapy, and Transformation. Brunner/Mazel, New York, NY.

The constructivist self development theory is based on the idea that the human creates and interprets their own personal reality of a particular situation or environment. An experience is considered a trauma if it is sudden, unexpected, or non-normative, exceeds the individual’s perceived ability to meet its demands, and disrupts the individuals frame of reference and other central psychological needs and related schemas. The three major psychological systems involved include the self, psychological needs, and cognitive schemas and evolve over one’s life. One assimilates or accommodates to the perceived reality. Although difficult for most trauma victims, the recovery process requires accommodation to balance out the overwhelming effects, physical sensations, and terrifying images which repeatedly occur.

Perry, B. D. (1999). Stress, trauma, and Post-traumatic Stress Disorders in children. Child Trauma Academy: Interdisciplinary Education Series, 2(5).

Trauma affects many children each year totaling more than five million. Some children may develop PTSD, while others do not. Often times, PTSD is misdiagnosed for another disorder. While the effects from trauma have negative symptoms, the stress a child endures is not always a bad thing. It is only a bad thing when it negatively and dramatically disrupts homeostasis. Discussed in the article are several common therapies effectively used to help children who suffer from the symptoms following a trauma.

Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. W.W. Norton and Company.

There are common diagnosis linked with trauma and they include Borderline Personality Disorder, Post Traumatic Stress Disorder, depression (most commonly a co-morbid diagnosis), Dissociative Identity Disorder, Anxiety and Panic Disorders, Eating Disorders, and Addictions (to alcohol, drugs, gambling, pornography, high-risk behaviors). Trauma varies depending on the severity. There is a Type I and Type II trauma survivors. Type I trauma survivors experience a single traumatic incident, whereas Type II trauma survivors experience multiple or recurring traumatic incidents. Type II separates into four sections, depending on the victims background stability and ability to separate the traumatic experiences from one another.

Red Poppy and working with Children: Managing trauma. The Red Poppy Company. Retrieved May 30, 2007 from www.theredpoppycompany.co.uk/children.htm

Studies have been done in the UK on the impact of trauma on children. Traumatic events children are exposed to, but not limited to, include bullying, physical, emotional, and sexual abuse, rape, stress, and domestic violence. The effects of the untreated trauma last a lifetime, including the ability to trust, establish relationships, and lead a healthy and successful adult life. Trauma symptoms directly related to children include repetitive play, loss of newly acquired behavior, thumb sucking, bed wetting, baby talk, separation anxiety, clinginess out of fear, not wishing to sleep alone, and anxiety about how parents are coping with the trauma. In domestic violence cases, children often times suffer with adjustment difficulties, including stuttering, withdrawal, fear, aggression, disobedience, and destructive behaviors.

Ruzek, J. (2000). Coping with PTSD and recommended lifestyle changes for PTSD patients. National Center for PTSD.

Teens and adults alike need to learn how to cope with the effects following a trauma. Ways individuals choose to cope can lead to positive or negative results, some of which may seem positive for the victim in the beginning, but end negatively. Listed in the article are different ways to cope with the effects from trauma. The overall goal would be to reduce anxiety, decrease other stressful reactions, and improve the quality of life for not only the day, but for days and years to come.

Schwartz, E and Perry, BD. (1994). The Post-Traumatic Responses in Children and Adolescents. Psychiatric Clinics of North America, 17 (2):311-326.

Schwartz and Perry stated in the article that PTSD defined as the maladaptive persistence of a previously adaptive set of mental and physiological responses to trauma organized as “malignant memories”. The experience may last only a short period of time, while the effects may go beyond childhood. The stress effects the child’s neurosystem which plays a significant role in regulating arousal, vigilance, affect, behavioral irritability, attention, response to stress, sleep and the startle response. Most children adapt better to consistent, daily stress than do children who experience an unexpected or sudden trauma. The age of the child when the trauma occurred directly relates to the effect on the child.

Severe stress can damage a child’s brain. (2007, March 5). Child Health News. Retrieved May 30, 2007 from www.news-medical.net

The stress related to significant trauma includes, but is not limited to physical, emotional or sexual abuse, witnessing violence or experiencing lasting separation and loss. High levels of the stress hormone cortisol is associated with a decrease in the hippocampus size. This is the part of the brain which helps with memory processing and emotion. The size affects how the child processes and works through traumatic events, which in turn may raise the stress and cortisol levels of the child leading to more damage. The stress hormones interferes with psychiatric therapy and draws out the symptoms. These occur as a result of the cognitive deficits in the stress hormones. Some impairments from PTSD include the child’s ability to reach social, emotional, and academic milestones. Genes and environment play an important role in the functioning of child as well.

Van der Kolk, B.A., McFarlane, A.C., and Weisaeth, L. (Eds.) (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society.The Guilford Press.

People who experience a traumatic event often struggle with the following: heightened state of alertness, disconnection of affect, anesthesia (or emotional numbing), changes in the perception of time or visual perception, de-realization, depersonalization, and amnesia for all or part of the experience. Individuals who are exposed to a trauma work through the trauma in two ways, the first is the ideal. The victim can move past the incident by working through the intrusive thoughts and memories through accommodation and assimilation towards integration. The second is the victim’s inability to move past the incident causes him/her to become fixated on the incident, thoughts, and memories by replaying the trauma over and over again and the related images, sensations relationships, behaviors, and feelings.