Your Child - Childhood Trauma and Its Effects

Excerpts from Your Child on Childhood Trauma and Its Effects

All children experience some stressful events. The majority, however, grow up in kind, loving, nonabusive families and never experience a life-threatening disaster like a hurricane, earthquake, or bomb explosion. Most children never witness a murder or drive-by shooting. But some do face and are overwhelmed by traumatic events.

Trauma is defined as an event more overwhelming than a person ordinarily would be expected to encounter. For example, while a divorce in the family is stressful, it would not be considered a life-threatening traumatic event. In contrast, one parent knifing the other would. Children who experience horrible external events may experience emotional harm or psychic trauma. Left untreated, all but the mildest of childhood trauma can have an impact on the child.

Researchers have identified two basic types of psychic 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 arises from long-standing, repeated events, such as sexual or physical abuse. Each type of psychic trauma has characteristic signs.

One-Episode Trauma Also called Type I post-traumatic stress disorder (PTSD), single-blow trauma produces a number of characteristic symptoms. Children who experience one-episode or single-blow trauma usually retain detailed memories of the event for a long time. No matter how much a child may try to forget, these memories remain vivid. Unlike regular memories, these are uncontrollable; they intrude into their day-to-day activities and can interfere with play, school, and family life.

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 tend to startle easily and be very vigilant. Children often attempt to gain mastery over the randomness and lack of control experienced in a sudden disaster by asking “Why me?” They become preoccupied with finding reasons and ways in which the traumatic event could have been averted. When this reworking and rethinking is not successful, a child can become pessimistic about the future and feel little purpose in life. Some children also experience visual hallucinations both immediately following and long after the single-event trauma. After witnessing his mother’s murder, for example a child may see monsters lurking in corners that are understandably terrifying.

Repeated Trauma Also Called Type II post-traumatic stress disorder, repeated trauma 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. Because the trauma is repeated or prolonged, the child develops 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. Often these children appear detached and seem to have no feelings. Such 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 of the traumatic experience. Children who suffer through repeated traumatic horrors develop and use a variety of psychological mechanisms to cope.

Some children (such as youngsters who are regularly abused physically) may develop a type of self-hypnosis that enables them to deaden, at least in their minds, the pain of the trauma. This is called dissociation, and reliance on such emotional distancing as a frequent coping mechanism can have negative effects on a child’s development.

Long-standing or repeated abuse also produces rage in children. Anger festers, occasionally exploding as tantrums and violent behavior. A child may turn this rage against herself, engaging in self-mutilating and self-endangering behavior, or by making physically damaging suicidal gestures. She may direct her anger outward through aggressive or delinquent behavior, or identify with the aggressor by turning the rage toward other children, victimizing and humiliating them. On the other hand, the child may also experience aggression as dangerous, so her behavior may become extremely passive, too, resulting in victimization.

Internal changes may occur as the child tries to adapt to both the trauma and the loss caused by the trauma. For example, psychic numbing may minimize the pain. Holding tenaciously to the specific memory of the trauma may be an effort to master the experience. Developing a belief in omens – attaching meanings to unrelated occurrences like associating a teacher’s yellow sweater with bad weather, for example – may be an attempt to reduce the child’s feelings of helplessness. However, the resulting state of unresolved mourning, and continuing grief interferes with the child’s ability to move on with her life.

In cases where the event has resulted in disfigurement, disability, or prolonged pain, a child may feel guilt, shame, self-revulsion, or rage if her peers shun or tease her. Suicide attempts or self-mutilating behavior may occur among these children.

Reliving the Traumatic Event Traumatic events may be repressed but are not fully forgotten. The child may reexperience the trauma through any of her senses. She may experience vivid and unwelcome flashbacks, often during quiet, unfocused times, such as when bored in class, falling asleep, listening to the radio, or watching television.

In the child’s play or behavior, she will recall and attempt to rework the event. Her drawings and stories may incorporate and reflect the traumatic event(s). Although referred to as “play,” repetitive post-traumatic play is more often grim work. Reliving the event represents an attempt to master fears that continue to haunt or overwhelm the child.

Tragically, trauma shatters the natural sense of invincibility and trust basic to normal childhood. This shakes the child’s confidence about the future and can lead to limited expectations. Traumatized children often have a pessimistic view of career, marriage, having children, and even life expectancy.

Other signs common to children who suffer post-traumatic stress disorder include sleep problems; nightmares; exaggerated startle response; panic; deliberate avoidance of reminders of the trauma; irritability; immature or regressed behavior; and hypervigilance.

Causes and Consequences
Childhood psychic trauma (PTSD Type I and PTSD Type II) occurs as a result of overwhelming, horrible external events over which the child has no control. The experience renders the young person temporarily helpless.

Childhood trauma can be closely related to other serious emotional disorders both in childhood and later in adulthood. It is not uncommon to discover that a child who is brought to a mental health professional for other problems – conduct disorder (see page 349), major depression (see page 329), attention-deficit/hyperactivity disorder (see page 337), obsessive-compulsive disorder (see page 315), panic disorder (see page 312), antisocial or violent behavior (see Anxiety and Avoidant Disorder, page 311) – has also experienced an intense, terrible trauma or series of traumatic events.

Childhood trauma darkens the child’s vision of the future as well as her attitudes about people. Young people who have been traumatized will voice cautious, one-day-at-a-time attitudes. They may say that you can’t count on anyone. Sexually traumatized girls may shrink from men (using avoidance to cope with the trauma) or approach them with overly friendly sexual advances (in an attempt to master the trauma by trying to relive it). Traumatized children tend to recognize the profound vulnerability in all people, especially themselves.

Trauma-related fears often persist into adulthood. While some anxious children express apprehension about growing up or getting married, sexually abused children may grow up fearing sexual contact.

Passing fears – of strangers, the dark, being alone – are not uncommon at certain developmental stages of childhood and also appear in other emotional disorders. However, extreme panic and avoidance of these situations may be the result of earlier exposure to severe trauma.

Within the traumatized child, internal changes may occur which can affect her later in life, surfacing in adolescence or early adulthood. Without treatment, some childhood traumas can result in later problems characters by violent behavior, extremes of passivity and revictimization (people who were raped or incestuously abused as children often fail to protect themselves from rape), self-mutilation, suicidal or self-endangering behavior, and anxiety disturbances.

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

Individual Psychotherapy Therapy that allows the child to talk about the trauma or integrate it into her play may help the child move beyond the pain to cope better.

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

Therapy may make it easier for the child to describe feelings. In time, she may be able to understand her symptoms, behavior, and characteristic ways of dealing with the trauma. Moreover, talk and play eventually give a child the opportunity to look at the traumatic event in context and to gain perspective. Gradually, the child is helped to see the event as an encapsulated experience, a personal tragedy that occurred in 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).

Children who experience trauma can be helped and are responsive to treatment. With the sensitivity and support of their families, such youngsters can accommodate the memories of their trauma as individuals who survived, and go on to lead healthy, productive, satisfying lives.

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