Early Childhood Trauma
As parents, care-givers of children, teachers or school personnel, we are likely to interact with a child who is dealing with or has dealt with a traumatic event. Early childhood trauma commonly refers to the traumatic experiences that occur to children aged 0-6. A traumatic event is defined as, “one that threatens injury, death, or the physical integrity of self or others and also causes horror, terror, or helplessness at the time it occurs. Traumatic events include sexual abuse, physical abuse, domestic violence, community and school violence, medical trauma, motor vehicle accidents, acts of terrorism, war experiences, natural and human-made disasters, suicides, and other traumatic losses.” (2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents) Given that traumatizing events can include such a wide range of incidents, one study of children ages 2-5 suggests that more than half (52.5%) had experienced a severe stressor in their lifetime. Another survey found that 78% of children had experienced more than one trauma type and that the initial exposure on average occurred at age 5 (National Child Traumatic Stress Network- Early Childhood Trauma). Sexual molestation also occurs at the highest rate among school-aged children (National Child Traumatic Stress Network- Understanding Child Traumatic Stress). In 2006, 7.9 million U.S. children received emergency medical care for unintentional injuries (from motor vehicle crashes, falls, fires, dog bites, near drowning, etc.) and more than 400,000 for injuries sustained due to violence. Race, 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, youths living in poverty, and Native American youths (2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents).
It is important to note that trauma and danger coincide and our minds, brains, and bodies are intended to make danger a priority. For very young children swimming pools, electric outlets, poisons, and sharp objects can also present danger. For school-aged children walking to school, riding a bike in the street, and climbing to high places can present new threats. Some incidents, although they may seem like a normal part of growing up, can leave a lasting stressful impression on a child depending on factors such as your child’s temperament, as well as the severity and duration of the event. Sometimes there is chronic or repeated trauma that does not allow a child to heal and recover from one set of occurrences before new ones are brought on, and in fact, children who have suffered from prior traumatic experiences may be apt to more intense reactions to another trauma. Children and adolescents dealing with trauma or grief may also develop symptoms of Depression and Separation Anxiety Disorder (National Child Traumatic Stress Network- Understanding Child Traumatic Stress) Secondary traumas, such as, police investigations, court proceedings, funerals, disruption of and displacement from school and other routines, housing and custody issues, loss of possessions, friends, and pets, and financial stress, can all play a part in the extent of symptoms, treatment, and recovery (2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents).
Impact on Development
Powerful, distressing emotions go along with strong, even terrifying physical reactions, such as rapid heartbeat, trembling, stomach dropping, and the sense of being in a dream (National Child Traumatic Stress Network- Understanding Child Traumatic Stress). 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 the child may become more fearful and may not feel as safe or as protected. More information on the impact of trauma on brain development can be found in Excessive Stress Disrupts the Architecture of the Developing Brain, a working paper from the Center on the Developing Child (National Child Traumatic Stress Network- Early Childhood Trauma). The brain also controls hormones in the body. The brain starts major hormonal changes in puberty although some of these changes may begin early in children who are sexually abused during pre-adolescence. Another major objective of development is emotional maturity. Intense fear can easily overwhelm young children’s beginning efforts to manage emotions and can create different emotional challenges for school-aged children such as learning to distinguish between the intensity and appropriateness of their emotions (National Child Traumatic Stress Network- Understanding Child Traumatic Stress).
Children vary in the nature of their responses to traumatic experiences. The reactions of individual youths may also be influenced by their developmental level, ethnicity/cultural factors, previous trauma exposure, available resources, and preexisting child and family problems. Nevertheless, nearly all children express some level 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 difficult or challenging experiences. Some typical reactions include:
· development of new fears
· separation anxiety
· sleep disturbance
· loss of interest in normal activities
· reduced concentration
· decline in schoolwork
· somatic complaints
(2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents)
Basic survival instincts allow for traumatic experiences, long after they are over, to continue to take priority in the thoughts, emotions, and behavior of children. Triggers, such as sights, sounds, and smells can also bring these experiences back to the forefront of a child’s mind. There are three core groups of post traumatic stress reactions:
· First, there are different ways these types of experiences stay on our minds. We continue to have upsetting images of what happened. We can also have nightmares. We have strong physical and emotional reactions to reminders that are often part of our daily life. We may overreact to other things that happen, as if danger were about to happen again.
· Second, we may try our best to avoid any situation, person, or place that reminds us of what happened, fighting hard to keep the thoughts, feelings, and images from coming back. We may even “forget” some of the worst parts of the experience, while continuing to react to reminders of those moments.
· Third, our bodies may continue to stay “on alert”. We may have trouble sleeping, become irritable or easily angered, startle or jump at noises more than before, and/or have recurring physical symptoms, like headaches or stomachaches.
(National Child Traumatic Stress Network- Understanding Child Traumatic Stress)
When young children experience a traumatic stressor, their first response is usually to look for reassurance from the adults who care for them. The most important adults in a young child’s life are his/her caregivers and relatives. These adults can help reestablish security and stability for children who have experienced trauma by:
· Answering child’s questions in language they can understand
· Developing family safety plans
· Engaging in age-appropriate activities that stimulate the mind and body
· Finding ways to have fun and relax together
· Helping children expand their “feelings” vocabulary
· Setting and adhering to routines and schedules
· Showing love and affection
For many young children who have been affected by a traumatic experience, the most effective help is the comfort, support, and reassurance provided by parents and trusted caregivers. However if the trauma is severe or chronic, if it affects those close to the child, and/or if the child continues to be upset or have symptoms after a month or so has elapsed, it is advisable to seek additional help for the child. Parents/caregivers may wish to consult their pediatrician and/or their child’s teacher for suggestions of professionals who can help. Due to the developmental risks associated with young children who experience traumatic events, it is fundamental that vulnerable children be identified as soon as possible after the trauma. Many community resources play a significant role in recognizing children and in linking them and their families with services and are even including questions about specific traumas into their intake and/or assessment protocols. Community resources may include:
· Health Systems
· Early Intervention Programs
· Child Welfare Agencies
· Head Start Programs
· Child Care Programs
· Early Education Systems
(National Child Traumatic Stress Network- Early Childhood Trauma)
There are many factors to consider when choosing an approach for treatment and recovery such as a families cultural perspective, the child’s developmental level, confidentiality and privacy issues, among many others. In this rapidly evolving and expanding field it is important that professionals keep up with advances in assessments and treatment programs and receive on-going training in new intervention methods (2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents). See handout: (The National Child Traumatic Stress Network-Empirically Supported Treatments and Promising Practiices).