Which Factors Mitigate the Effects of Childhood Trauma?

Different children and adolescents who experience the same traumatic event (such as a devastating hurricane) or the same type of traumatic event (such as sexual abuse) have different long-term outcomes. A better understanding of the factors that tend to magnify or mitigate the effect of trauma—including feelings of helplessness, resilience, and social support—can help families, pediatricians, and mental health professionals take steps that lead to less long-term distress.

Not All Traumatic Events Make the Front Pages, but All Matter

The recent school shooting in Nashville was the 39th incident of gunfire on school grounds in just the first three months of 2023, with 18 deaths so far this year. Although school shootings tend to stay in the headlines for a few days, the trauma endures, and, for many, the impact can be impossible to measure.

In addition to something as striking as exposure to a mass shooting event (in-person or vicariously), trauma can stem from sexual abuse, physical assault, natural disasters, war, car accidents, gang violence, catastrophic medical events, and other incidents. Not all trauma exposure leads to trauma-related mental health pathology, of course, but it is important to be aware of traumatic past events; trauma symptoms can (and often do) emerge well after the event. In my practice, I have had countless adult patients who come to therapy for the first time many years, sometimes decades, after having been sexually abused as children or adolescents. For many, coping with the aftermath of abuse just wasn’t a problem they thought about until it was.

Childhood Trauma Interferes With Healthy Development

Exposure to traumatic events in childhood can have a lasting effect on an individual's mental health, emotional well-being, and academic performance. Children who experience trauma or maltreatment are more likely to engage in risky sexual behaviors (early sexual debut, multiple sexual partners, transactional sex, and unprotected sex), engage in substance abuse, face long-term physical health challenges, be arrested, and experience long-lasting feelings of fear, guilt, and helplessness.

Trauma can interfere with the normal process of brain development and result in problems with memory, attention, and other executive functions. This can make it difficult for a child to learn new information, process information effectively, and maintain focus. As a result, children who have experienced trauma are more likely to experience difficulties in school and with academic performance.

In addition to the risk of developing depression, anxiety, and posttraumatic stress disorder (PTSD), kids with a history of trauma also display behavioral problems such as aggression, hyperactivity, and impulsivity. Any combination of these symptoms can make it difficult for a child to form healthy relationships with others and can interfere with the ability to succeed in school and other domains of healthy living. Show me a kid who is feared by peers and always in conflict with teachers and other adults, and I’ll show you a kid with a likely trauma history.

Traumatic events can also disrupt the normal process of attachment and bonding between a child and primary caregivers. The traumatized child may view the world as a dangerous and unpredictable place, leading to feelings of insecurity and mistrust. In turn, this can make it difficult for a child to form close and trusting relationships, which exacerbates the long-term consequences for their mental and emotional well-being.

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Feeling Helpless

Helplessness—being unable to control or predict future events and lacking a sense of control—is a common feeling after experiencing trauma. Research has shown that feeling helpless can magnify the effect of trauma. When people feel helpless, their brain releases stress hormones, such as cortisol and adrenaline, which can increase the risk of developing posttraumatic stress disorder (PTSD) and depression. The experience of feeling helpless can also exacerbate the symptoms of existing mental health conditions, such as anxiety or depression.

Feeling helpless can also cause a person to avoid or suppress their emotions, which can prevent them from processing and healing from trauma. Such avoidance can lead to feelings of shame, guilt, and a sense of worthlessness, further compounding the effects of the trauma. (Click here for an explanation of trauma-related guilt and trauma-related shame.)

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Overcoming the Effects of Trauma

Feeling helpless is common after trauma, but it doesn’t need to be a permanent state of being. There are ways to regain control and overcome the effects of trauma. Therapy can help children and adults process their emotions and develop coping mechanisms as there are social and emotional challenges associated with trauma that uniquely influence how information is received and processed. Traumatized youth, for example, often need help with setting limits that other same-age youth may not need. Being as specific about this as possible can make a profound difference in the safety of the child and those around him or her.

There is now a great deal of evidence showing the efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) in reducing trauma symptoms and externalizing behaviors among traumatized youth. TF-CBT includes three treatment phases: stabilization, trauma narration and processing, and integration and consolidation. Sessions can include individual sessions with the youth, individual sessions with a caregiver, joint sessions with the youth and caregiver, and group therapy involving both youth and caregivers.

Social Support

Natural disasters, forced migration, wars, or an accident that affects multiple family members all tend to disrupt social support networks. In my clinical experience, I have found little to be of greater singular value in the recovery of a traumatized individual than loving social support. This could take the form of a loving caregiver for a child or adolescent, or a friend or family member for an adult. Given my clinical experiences, it is little surprise that researchers have discovered that levels of social support tend to be inversely related to posttraumatic stress symptoms among youth.

Building Resilience

A study of adults and children who experienced a traumatic wildfire found that PTSD, depression, and generalized anxiety were present at rates much higher than in the general population. After the intensity of the wildfire trauma itself, one of the most important factors in predicting outcomes was the level of resilience. People with high resilience experienced lower rates of PTSD, depression, and anxiety, and increased levels of self-esteem and quality of life.

In a different study of posttraumatic stress symptomatology of children affected by the 2008 Wenchuan earthquake, higher levels of self-esteem and coping strategies tended to make children more resilient to trauma exposure.

Screening

Because there is great variability in how children respond to traumatic events, screening can help identify the factors that make a child most vulnerable so that resources can be directed to children and adolescents with the most need. In short, we need to ask the questions, even when the questions are uncomfortable. Relationship histories, family histories, and other background interviewing need to include specific questions about abuse, natural disasters, accidents, and other common forms of trauma. This also means that clinicians need to be comfortable taking age-appropriate sexual histories for their youth clients. We can’t expect our clients to volunteer abuse histories—especially for those who are feeling shame about (or even responsible for) their own abuse.

Another important factor is assessing the level of the perceived threat and the extent of the ongoing loss. The more the child perceived that their life was threatened, and the longer the disruption persisted, the greater the risk for persistent PTSD symptoms.

An additional factor is the age of the child at the time of the traumatic experiences as younger children tend to report greater PTSD symptom severity compared to older children.

Other factors that should be screened for include anxiety, coping skills, self-esteem, social support, and additional life events that might have caused trauma.

© 2023 Dr. Adam Brown. All rights reserved.