What kind of impact does exposure to traumatic events have on children? While the trauma that children in different parts of the world might experience can include childhood physical and sexual abuse, surviving a natural or political disaster, or being a witness to a wide range of violent events, the psychological impact that trauma can have on children can vary widely. Since trauma responding is often subjective, there can be a wide variety of ways that a child can react to being traumatised. What influences how a child might respond to the trauma includes:
While some children are able to experience traumatic events without apparent ill-effects, the long-term consequences for many children can be serious, whether by developing later psychological problems or even physical problems including substance abuse, personality problems, depression, or suicide.
In many cases, traumatized children can develop full-blown posttraumatic stress disorder and the latest version of the Diagnostic and Statistical Manual of Mental Disorders is expected to include a new diagnosis called Developmental Trauma Disorder (DTD) to be used for children who face repeated traumas while their brains are still developing. The proposed criteria for DTD include:
The need for a specific diagnosis for childhood trauma stems from years of research showing how common exposure to trauma actually is in young people. According to one 2002 study involving interviews with 1,420 children and adolescents, one out of every four adolescent children had experienced at least one extreme stressor, such as being the victim of abuse or other extreme stress, at some point in their lives. Eighteen percent of the children studied reported two or more stressors and the researchers found that exposure to one extreme stressor increased the likelihood or being exposure to additional stressors over time. These findings have been supported by other studies showing that adolescents experiencing trauma need treatment as soon as possible to prevent or reduce long-term damage.
But what type of treatment works best for childhood trauma? A recent article published in Canadian Psychology provides a comprehensive overview of the different forms of treatment available for children and adolescents who have had traumatic experiences. Written by a team of psychologists at the University of British Columbia and Kelowna, B.C.’s Youth Forensic Psychiatric Services, the article points out that research into how effective different treatment methods for dealing with adolescent trauma is still fairly limited compared to similar research in treating traumatized adults.
Cognitive-behavioural therapies (CBT) are still the leading choice by most therapists, particularly since the available research tends to be far stronger than research looking at psychoanalytic or purely medication-based treatment. While CBT was first developed for trauma in adults and later adapted to adolescents, the special needs that adolescent trauma patients have has inspired the development of treatment methods focusing on children and adolescents alone. These treatment approaches include:
Although there are other CBT approaches that can be used to treat trauma in children and adolescents including exposure therapy, art therapy and EMDR, it is CBT-type approaches that seem to work best for dealing with posttraumatic symptoms. For the CBT methods that have been developed specifically for younger clients, there are some common features including psychoeducation to teach children about traumatic stress and the effects it can have on them, relaxation techniques, a trauma narrative to encourage children to describe their experience in detail, and some sort of cognitive restructuring to correct maladaptive thoughts about the traumatic experience.
For all of the recognized CBT approaches for treating traumatized children, it is vital that children be encouraged to face their traumatic experience gradually and only in a way that they can handle emotionally. Since all children do not develop emotionally at the same pace, it is important to tailor the treatment to the child’s level of emotional and cognitive development. Otherwise, the therapist could end up doing more harm than good by retraumatizing their child patients.
In an ideal world, there would be no children experiencing trauma since potentially traumatic experiences would be prevented. Unfortunately, children and adolescents will experience things that they are not emotionally or psychologically equipped to handle. These experiences can disrupt their natural emotional and cognitive development if left untreated. The five CBT approaches described in the Canadian Psychology article seem to be the most promising treatment methods available to date. Parents and mental health professionals need to be especially vigilant to make sure that traumatized children and adolescents get the treatment they need in time to prevent later mental health problems.