Surviving Childhood: An Introduction to the Impact of Trauma
 

   
 
Lesson 1: Introduction to Childhood Trauma

Too Many of Our Children Experience Trauma

Figure 1-1: Introduction to childhood trauma.

Physical abuse, rapes, hurricanes, fires, car accidents, witnessing violence, multiple painful medical procedures, life-threatening medical conditions, sudden death of a parent, threat of violence at school or home.

In the United States alone, approximately five million children experience some form of traumatic event each year. More than two million of these children are victims of physical and/or sexual abuse. Millions more live in the terrorizing atmosphere of domestic violence.

By the time a child reaches the age of 18, the probability that he or she will have been touched directly by interpersonal or community violence is approximately one in four. Across the world, these numbers are even more astounding. In some war-torn countries, more than 60 percent of the children are displaced and chronically traumatized.

These numbers are more than mere statistics. No one remains unscathed by traumatic events. First, trauma can have a devastating impact on the individual child, profoundly altering physical, emotional, cognitive, and social development. Second, the child's experience directly impacts his or her family and community.

We now know that a child's potential to be creative, productive, healthy, and caring depends upon his or her experiences in childhood, and if these experiences are threatening, chaotic, and traumatic, the child's potential is diminished. Ultimately, we all pay the price exacted by childhood trauma, whether we are dealing with individual children or large numbers of scarred adults assuming their places in society.

What Exactly Is Trauma?

Before we go any further, I want to clarify what "trauma" means for the purposes of this course. A trauma is a psychologically distressing event that is outside the range of usual human experience. Trauma often involves a sense of intense fear, terror, and helplessness.

Trauma should not be confused with stress. As we will learn later, stress is an inevitable component of everyone's life. Trauma is an experience that induces an abnormally intense and prolonged stress response.

Simply by signing up for this course, you have expressed an interest in childhood trauma and perhaps count yourself or someone you love among the statistics cited above. Maybe you know a child who is a victim of childhood trauma, or are an adult still grappling with your own experience.

No matter what brings you here, take a moment now and identify someone or some event in your life or work that makes this issue real. While you take this course, your own experiences with traumatic events and with children or families impacted by trauma will provide the true context for learning.

Figure 1-2: Children and war.


 



Trauma Comes in Many Varieties

Trauma is not limited to domestic or sexual violence. We live in a world prone to floods, hurricanes, and earthquakes, not to mention other sorts of natural disasters. Without warning, people die or are injured every day in cars on our nation's streets and highways.

Despite wonderful technological advances in medicine, people still experience life-threatening medical conditions and painful procedures. The media provides us with a picture of escalating community violence, drug abuse, and other dangers. Even from an adult perspective, the world can be a very frightening place!

Seeing the World Through a Child's Eyes

Over the next day or so, as you think of it, imagine the world through a child's eyes. What otherwise benign sights or events might be frightening if you were a child? Consider the evening news. What message would children receive about the world they live in if they saw the same news item that you are viewing?

If you are at a loss for a relevant news clip, consider the following Associated Press item, dated March 9, 2000:

MIAMI -- A woman has been charged with attempted murder after her 15-year-old daughter told authorities the woman doused her with gasoline and set her on fire because she didn't like the girl's boyfriend.
Miami-Dade Police also charged Maria Tarrago on Monday with aggravated child abuse and great bodily harm and arson resulting in injury. Her daughter was burned over 23 percent of her body.
The girl has been hospitalized since the Dec. 6 fire and unable to communicate until recently, police spokesman Pete Andreu said. On Monday, she told her story to the father of her roommate at Jackson Memorial Hospital's Rehabilitation Center.
Police said Wednesday that Tarrago, a maid from El Salvador, was upset because her daughter was seeing a boy she disapproved of. The fire occurred in the apartment Tarrago shared with her daughter and son.
Realizing what she had done, police said, Tarrago and her boyfriend extinguished the fire and rushed the girl to Miami Children's Hospital.
At the time, Tarrago told officials the fire had been an accident.
Tarrago's daughter is now in good condition, Jackson spokeswoman Rosa Gonzalez said, although it is not known when she will be released. She is in state custody.

Adults listening to the news report are horrified. But imagine what a child might think after hearing such a frightening news report. Though the child may not ask you anything about what she has heard, she will have a whole host of questions: What does it mean to be set on fire? Will that girl be okay? What will happen to the mother? How could a mother set her own daughter on fire? Could this happen to me?

Childhood Trauma Increases Risks in Adulthood

People who have experienced traumatic events in childhood are at increased risk for a host of other problems, impacting all domains of functioning. Impaired emotional, social, cognitive, and physiological functioning can result from adverse childhood events.

Social problems of traumatized children can manifest in teenage pregnancy, adolescent drug abuse, school failure, victimization, and anti-social behavior. Victims of childhood trauma can suffer from neuropsychiatric conditions, such as post-traumatic stress disorder, dissociative disorders, and conduct disorders.

Medical problems such as heart disease and asthma can also be directly attributed to childhood trauma in some cases. Childhood trauma has even been linked to increased risk for cigarette smoking:

Researchers from Kaiser Permanente in California studied data on 9,215 patients in health maintenance organizations. They questioned patients about their smoking habits and exposure to the following events: being emotionally, sexually, and/or physically abused; having a battered mother; divorce or separation of parents; growing up around substance abuse; or growing up with a mentally ill or incarcerated household member.
Kids exposed to five or more of the eight types of negative childhood experiences were 5.4 times more likely to begin smoking by age 14 or 15 than kids who did not have such negative experiences. And children with negative experiences were twice as likely to be a current smoker and nearly three times more likely to be a heavy smoker than children who were not exposed to negative events. (This study appeared in the November 3, 1999, issue of the Journal of the American Medical Association.)

The escalating cycles of abuse and neglect of our children seen in some of our urban and rural communities can, in turn, become a major contributor to many other social problems. Some would consider the deterioration of public education, the proliferation of urban violence, and an alarming rate of social disintegration all as direct results of childhood trauma.

Dissociation and PTSD

Here are two more terms to define before we move forward:

Dissociation is the mental process of disengaging from the stimuli in the external environment and attending to inner stimuli. This is a graded mental process that ranges from normative daydreaming to pathological disturbances. Dissociation may include exclusive focus on an inner fantasy world, loss of identity, disorientation, perceptual disturbances, or even disruptions in identity.

Post-Traumatic Stress Disorder (PTSD) is a neuropsychiatric disorder that may develop following a traumatic event. Symptoms of PTSD can include changes in emotional, behavioral, and physiological functioning. It is characterized by three key sets of symptoms: 1) re-experiencing and re-enactment, 2) avoidance, and 3) physiological hyper-reactivity. In later lessons we will learn more about each of these three symptom clusters.



 



Treatment

Traumatic experiences can have a devastating impact on a child, altering his or her physical, emotional, cognitive, and social development. In turn, the impact on the child has profound implications for his or her family, community and, ultimately, all of us. Caregivers, childcare providers, teachers, law enforcement, child protection workers, social workers, judges, nurses, pediatricians, and mental health service providers all will work with traumatized or maltreated children.

Now that we have reviewed some of the disheartening information, let's hear some good news. With treatment, the effects of childhood trauma can be alleviated. Early and aggressive treatment of traumatized children decreases risk for developing PTSD and other trauma-related problems seen later in life.

Treatments usually incorporate three elements:

  1. Review and recollection of the traumatic experience
  2. Information about the normal and expected processes of post-traumatic functioning
  3. Focus on specific symptoms

Despite the positive effects we know treatment has on trauma sufferers, the unfortunate reality is that most traumatized children do not get any help whatsoever. There is a dangerous belief among adults that children are "resilient" and can weather trauma naturally. Those children who do get services often have limited access and brief contacts. Early and sustained treatment for children who have suffered trauma is important if the long-term effects are to be avoided.

Typical Approaches

Individual Therapy: This is where the child has one-on-one contact with a clinician. Depending upon the training and the specific issues, the approach is usually a combination of the following interventions:
  • Psychoeducational
  • Cognitive-behavioral
  • Insight-oriented
  • Play
  • Trauma-focused
  • Pharmacotherapy
Group Therapy: In many cases, a traumatic event has been shared by several children (e.g., a school shooting or a hurricane). In these cases, group interventions have been used. In addition, individual trauma may be similar enough (e.g., victims of sexual abuse or domestic violence) that the clinician will recommend group treatments. Again, the focus of the group approach can include a combination of the following interventions.
  • Psychoeducational
  • Cognitive-behavioral
  • Family
  • Problem-focused

The better we can understand these children and the impact of traumatic experiences, the more compassionate and wise we can be in our interactions and our problem-solving.



 



Case Material: Post-Traumatic Presentations in Children

  • T. is an 8-year-old boy who survived a tornado that destroyed his home. Prior to the tornado he showed no interest in weather or fear of storms. Following the event, he was unwilling to go outside if there were clouds in the sky. He was tearful and frightened when it rained, particularly when there was thunder. Rather than watching his usual shows, T. would spend hours watching the Weather Channel. These behaviors and feelings impeded his ability to resume his previous excellent academic, social, and emotional functioning.
  • M. is a 10-year-old boy who was in a car accident that killed one of his siblings. Prior to the accident he had no academic, social, or behavioral problems. He had minor physical injuries. Six months after the accident, his school performance had deteriorated to the point where he was given a diagnosis of attention deficit disorder. The physician was given the history of distractibility and inattentiveness in school, but the family did not make any connection between these symptoms and the accident. Since he never talked about the accident or his brother, the parents felt he "had dealt with it." The physician with only the history of attention and behavior problems gave the diagnosis of attention deficit hyperactivity disorder (ADHD) and prescribed Ritalin. The medication did not help.
  • S. is a 12-year-old girl with a history of a childhood leukemia. Diagnosed at age 3, she had a series of hospitalizations, procedures, and treatments that resulted in complete remission of the disorder by age 5. She had normal development in all areas following this successful treatment. At age 12, she was entering puberty and went to a new physician's office for a routine (non-gynecological) examination. In the waiting room, she began to feel anxious and sweaty and had a sense of impending doom. When led back to the examination room, she started to resist, screaming, crying, and striking out at her mother and the nurse. Unable to calm down, she finally collapsed on the floor, rocking and sobbing, completely unresponsive to verbal input. Over time, it became clear that the sights, sounds, and smells of this medical office were cues associated with the fear and feelings from her previous painful and, to a young child, confusing medical treatments for her leukemia.


 



   
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