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Trauma during childhood is bad enough. But it is compounded by widespread misinformation that undermines correct diagnosis and treatment. Perhaps the most damaging myth is that trauma damages the brain.
What led you to write a book about PTSD in children?
I spent over 20 years doing clinical and research work with trauma and children, and I got tired of seeing children misdiagnosed and given the wrong treatments. Parents and consumers need to be empowered. In short, we cannot depend on professionals to get the right information to patients. Our current model of relying on professionals to be well-informed and to use the best practices voluntarily must be given a respectful burial. Despite all the great research that has been conducted, we, as clinicians and scientists, have failed to get the right information to the consumers that we want to help. PTSD still goes undetected in most individuals who have it. Clinicians who consider themselves experts miss the diagnosis the vast majority of the time. Parents are being inappropriately blamed for their children’s problems because of misinterpretations of the research data. Patients are being told extraordinary stories that trauma has damaged their brains, despite the lack of evidence. Treatments that work are being ignored by clinicians.
In what percentage of cases does trauma lead to PTSD?
Approximately 30 percent of individuals exposed to life-threatening traumas will develop PTSD. The figure can vary depending on the type of trauma. For example, burns and rape may lead to higher percentages.
What are the most common types of trauma children are subjected to?
Natural disasters, witnessing domestic violence, motor vehicle accidents, physical abuse, sexual abuse, and accidental injuries.
Why is PTSD under-recognized in children?
Under-recognition of PTSD is due to a number of factors. Historically, professionals have been reluctant to believe that children can be affected by trauma, probably due more to wishful thinking than any good developmental reasons. Also, many symptoms of PTSD are internalized, meaning the symptoms are thoughts and feelings that occur inside individuals’ minds, and are difficult to observe in behaviors. Some psychological disorders are relatively easy to recognize by observation, such as depression or attention-deficit/hyperactivity disorder. I tell folks that I’ve probably seen more youths with PTSD than anybody in the world and I can’t tell who has PTSD just by looking at them.
But modern professionals are supposed to know these things. The biggest problem of recognition now is that professionals are poorly trained. They are not trained adequately to know how to use questionnaires or how to ask questions appropriately about PTSD symptoms. In the book, I talk about how “educational interviewing” is needed, which is a more directive method of interviewing than professionals have been taught.
How does PTSD show up in their lives?
Panicky fear that gets triggered by reminders of their traumas. Isolation from loved ones. Difficulty concentrating and sleeping. In general, when individuals develop PTSD they’ve become different individuals trying to cope with the new normal, and it can often become increasingly frustrating over time when they realize they’ve lost some control over their lives and they can’t snap back to the way they were.
Why do so many people conflate all stress with trauma?
PTSD has become its own worst enemy in a way. Because the concept of PTSD has become so well known in our culture, when an advocate for a special cause wants to draw attention to their cause they often try to link it to PTSD. Want to draw more attention to the impact of divorce? Claim that it causes PTSD. Want to draw attention to children watching violence on TV? Claim that it’s traumatizing. Want to get more funding for your cause? Claim that it’s traumatizing. In short, it’s about politics. Individuals with political and personal agendas try to hitch their horses to the trauma and PTSD bandwagon. This practice is bad because in the long run the misinformation does not help improve people’s lives.
How is the research data misinterpreted?
Based mostly on brain imaging studies, researchers have been claiming that trauma damages the brain, but the data do not support that claim for a couple of reasons. Most of the studies have been cross-sectional study designs in which individuals’ brains were scanned after the traumatic events already happened. In cross-sectional study designs, one cannot know if any brain abnormalities that are found were there before the trauma occurred or developed after the trauma. It’s the old correlation-is-not-causation problem. When newer studies have been conducted that examined individuals both before and after traumatic events, researchers are consistently finding that the brain abnormalities were present before the traumas.
What are the best kinds of treatments for children?
The best approach is directive and structured treatments that gently guide children to learn new coping strategies and confront the painful memories of their traumas. Cognitive behavioral therapy is the best studied. Youths do not necessarily have to confront their painful memories in great detail, but there has to be some level of re-engagement with the past events. That’s why nondirective therapies, including play therapy for younger children, are usually ineffective.
What do the adults in children’s lives need to know about trauma and PTSD?
There are many things adults need to know. PTSD is under-recognized. PTSD can have major impacts on children’s lives in a variety of ways. Most professionals are poorly trained. Adults will often need to take matters into their own hands to get proper assessment and treatment in place. Trauma does not damage the brain. Mothers should not be blamed for causing PTSD by their parenting. There are effective psychotherapies for PTSD, and it may take some shopping around to find the right therapist.
What to you is the most impressive research about trauma in children and adolescents?
Currently, the research that I cite the most is two studies that demonstrated that licensed mental health professionals miss the diagnosis of PTSD about 90 percent of the time.
What myths abound about children and trauma?
The myths include the belief that young children can’t remember traumatic events; that stress and trauma damage the brain; that the parenting practices of mothers are to blame for PTSD; that PTSD is not a good enough diagnosis; that repeated and interpersonal trauma causes more severe problems and needs different kinds of treatment than single-blow, non-interpersonal trauma; and that complex PTSD and developmental trauma disorder are real disorders.
Who would most benefit from reading your book?
When children have experienced life-threatening trauma, I want this to be the first book that is recommended to parents. But I wrote it so that it is also highly relevant for adults who were traumatized as children, mental health professionals, pediatricians, students and trainees who are interested in trauma.
If you had one piece of advice, what would it be and for whom?
For parents, it’s up to you. Most professionals are poorly trained to deal with PTSD. PTSD will not go away on its own and you need to stop waiting and get your children appropriately diagnosed and treated.
About THE AUTHOR SPEAKS: Selected authors, in their own words, reveal the story behind the story. Authors are featured thanks to promotional placement by their publishing houses.
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