Surviving Childhood: An Introduction to the Impact of Trauma

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Lesson 3: After the Trauma: The Costs of Coping
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After the Trauma: The Costs of Coping

Children, when faced with reminders of the traumatic event they suffered, may experience so much pain and anxiety that they become overwhelmed. In situations when they cannot physically withdraw from those reminders, they may dissociate. Following a traumatic experience, children may act stunned or numb.

Dissociating children will not readily respond to questions by adults. Their answers to questions will seem unclear, unfocused, or evasive. This is understandable if we remember that while these children are present in body, their minds may be off in another place -- dissociated, trying to avoid the painful reminders of the original trauma.

Figure 3-3: Patterns of dissociation and arousal.
Figure 3-3: Patterns of dissociation and arousal.
Figure 3-4: The adaptive balance.
Figure 3-4: The adaptive balance.

In the first days and weeks following the traumatic event, re-experiencing phenomena, attempts to avoid reminders of the original event, and physiological hyperreactivity are all relatively predictable, highly adaptive physiological and mental responses to a trauma. Unfortunately, the more prolonged the trauma and the more pronounced the symptoms during the immediate post-traumatic period, the more likely it is that there will be long-term chronic and potentially permanent changes in the emotional, behavioral, cognitive, and physiological functioning of the child.

If the post-traumatic stress response lasts longer than one month, it becomes categorized as post-traumatic stress disorder. It is this abnormal persistence of the originally adaptive responses that results in trauma-related neuropsychiatric disorders such as post-traumatic stress disorder (PTSD).

Figure 3-5: Symptoms of PTSD.
Figure 3-5: Symptoms of PTSD.

PTSD is a diagnostic label that has typically been associated with combat veterans. More recently it has been well-described in children who are survivors of physical abuse, sexual abuse, exposure to community or domestic violence, natural disasters, motor vehicle accidents, and a host of other traumatic events.

Children who survive a traumatic event and have persistence of this low-level fear state may be behaviorally impulsive, hypervigilant, hyperactive, withdrawn, depressed, or have sleep difficulties (including insomnia, restless sleep, and nightmares), and anxiety. In general, these children may show some loss of previous functioning or a slow rate of acquiring new developmental tasks. Traumatized children may also seem to regress and retain persistent physiological hyperreactivity (such as fast heart rate or borderline high blood pressure).

Who Develops PTSD?

Whether or not someone develops PTSD following a traumatic event is related to a variety of factors. The more life-threatening the event, the more likely a child is to develop PTSD. The more the event disrupts the child's normal family or social experience, the more likely he or she is to develop PTSD. Having an intact, supportive, and nurturing family appears to be a relative protective factor.

Unfortunately, a great majority of children who survive traumatic experiences also have a concomitant major disruption in their way of life, their sense of community, or their family structure. These children are thus exposed to a variety of ongoing provocative reminders of the original event (e.g., ongoing legal actions or high press visibility). The frequency with which children develop post-traumatic stress disorders following comparable traumatic events is relatively high (45-60 percent).

Children who survive traumatic events and exhibit this diverse set of symptoms and physical signs are frequently able to meet diagnostic criteria for attention deficit hyperactivity disorder, anxiety disorder NOS, major depressive disorder, conduct disorder, and a variety of Axis I DSM III-R diagnoses. Knowing that the symptoms exhibited are reflective of core changes related to the event will help the professionals and caregivers involved provide better care for these children.

Figure 3-6: Rachel's story.
Figure 3-6: Rachel's story.

Hallmark Symptoms of PTSD :


  • Play
  • Drawing
  • Nightmares
  • Intrusive ideations


  • Being withdrawn
  • Daydreaming
  • Avoiding other children


  • Anxiety
  • Sleep problems
  • Hypervigilance
  • Behavioral impulsivity


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