Trauma-Informed Practices With Children and Adolescents

by William Steele

So what does being trauma-informed mean? In brief, it means that trauma is a predominately sensory process for many children and adolescents that cannot be altered by cognitive interventions alone.

Because the experience of trauma is often one of terror, and being vulnerable and powerless to do anything about one’s situation, trauma-informed care must engage children and adolescents in sensory, neurosequential experiences to help restore a sense of safety and bring about a renewed sense of empowerment. Practices that address individuals’ “survival

brains” through sensory and somatic (body-oriented) experiences, and enhance self-regulation, trauma integration, and healthy relationships and environ...

The recognition of societal, domestic, and interpersonal violence against children during the mid-1980s precipitated significant research on its impact and revealed strong evidence that “acute posttraumatic stress symptoms result from violent life threat, and that severity is related to the extent of exposure to the threat or witnessing of injury or death”

trauma specialists realized that trauma and PTSD were not only specific

to exposure to violence, but also to other traumatic events such as natural disasters,

“while the victim of a single acute trauma may feel after the incident that she is not herself, the victim of chronic trauma may feel herself to be changed irrevocably or she may lose the sense that she has any self at all”

when a terrifying incident such as trauma is experienced and does not fit into a contextual memory, a new memory or dissociation is established and memories are “stored initially as sensory fragments that have no linguistic components” and furthermore, “that intrusive sensations, even after the construction of a narrative, contradict the notion that learning to put the traumatic experience into words will reliably abolish the occurrence of flashbacks (and other reactions)”

memories of trauma are not stored “explicitly” (cognitively) or within a contextual framework, but “implicitly” in iconic

and sensory forms. In essence, trauma memories are experienced and remembered throu...

memories of traumatized individuals are far more emotional and perceptual in content th...

when memory cannot be linked linguistically in a contextual framework, it remains at a symbolic (iconic) level and there are no words to d...

Before traumatic memory can be encoded, expressed through language, and successfully integrated, it must be retrieved and implicitly externalized in its symbolic (iconic) sensory forms (p. 142). The trauma experience, therefore, is more easily communicated through imagery and activities associated w...

trauma is experienced primarily in the nervous system and that it is a physiological phenomenon as much as a purely psychological one.

when children’s physiological survival systems are activated by threat, the excess energy used to defend oneself must be expended. If that energy is not fully discharged and metabolized, it does not simply disappear. Instead it remains as a kind of highly charged body memory creating the potential for repeated traumatic symptoms.

the sensations experienced at the time of trauma are contained in the body rather than stored solely as cognitive memories; these sensations are activated when similar events are experienced after the actual trauma passes.

“For therapy to be effective it might be useful to focus on the patient’s physical self-experience and increase their self-awareness, rather than focusing exclusively on the meaning that people make of their experience …”

A child’s brain/body develops and is shaped through the experiences s/he has, both traumatic and reparative. Fortunately, because of the brain’s plasticity and the biological imperative to move toward self-regulation, with a little understanding and skill of how to engage a child’s instinctual resources, clinicians (and parents) can help transform symptoms of fear to robust self-confidence and resilience.

Somatic Experiencing® (SE) is currently being employed successfully in the prevention and healing of trauma. The premise of SE is that trauma is a fact of life; but so is resilience.

In order to help children feel secure and balanced, it is necessary to recognize the underlying roots of trauma, how the trauma response is held in the body as implicit/procedural memory, and how it disturbs the child’s self-regulatory

capacities.

trauma is a physiological phenomenon, rather than a purely...

Trauma happens when an intense experience stuns a child like a bolt out of the blue; it overwhelms the child, leaving him or her altered and disconnected from his body, mind, and spirit. Coping mechanisms are undermined and he feels utterly helpless.

Trauma can also be the result of ongoing fear and nervous tension. Long-term stress responses wear down a child, causing an erosion of health, vitality, and confidence.

trauma resides not in the event itself; but rather [its effect] in the nervous system.

the guidance of a therapist or other adult is imperative to alleviate their traumatic stress response and to build up their resilience and confidence.

Furthermore, younger children generally protect themselves not by running away, but by running toward (and attaching to) the protective adult. Hence, to help children resolve a trauma, there must be a safe adult to support them. The adult who has the skills of emotional first aid can help them literally “shake things off” and breathe freely again as their nervous system “resets.”

to avoid being traumatized, the excess energy mobilized to defend oneself must be used up. When the activation is not fully discharged and metabolized, it does not simply go away; instead it remains as a kind of highly charged “body memory” creating the potential for repeated traumatic

symptoms.

Children who are guided with consistent, patient support to release this highly charged state can easily return to healthy, flexible functioning.

When a child is overwhelmed, whether from a traumatic event or cumulative stress, his or her self-protective reflexes and fight-or-flight mechanisms become unavailable. With physical shutdown, children develop feelings of helplessness and hopelessness. The recipe for recovery lies in restoring these bodily resources, which lead to self-regulation.

Traumatic events have their most pervasive and significant influence during the first 10 years of children’s lives,

grief is an emotional response that accompanies loss; when experiencing a trauma, there is often grieving about what is lost whether it is a significant person, possessions, home, or even the loss of innocence when betrayed by abuse or abandonment.

Reactions to grief and trauma are different and it is important to distinguish these reactions in traumatized children and adolescents;

Psychodynamic therapy has a long tradition in addressing childhood trauma and has had some success. When successful, it includes two factors: (1) a consistent relationship between therapist and child and involvement of parents or caretakers during treatment, and (2) longer, more intensive intervention to support change, growth, and improvement in developmental achievements.

Evidence from psychodynamic therapy tells us that traumatized children do benefit from stable, consistent relationships with adult caretakers; that trauma recovery takes time; and that early intervention is key to establishing positive attachment and normal developmental gains.

the body’s reactions to trauma must be addressed in order to attend

to normal developmental functions such as learning and social interaction.

trauma reactions involve a fear network—a set of responses to threatening stimuli and situations that produce a fight, flight, or freeze reaction.

what differentiates PTSD from anxiety disorders is that trauma is a psychological and physiological state that destabilizes a sense of safety. As a result, experiences that previously felt safe become associated with danger and subsequent fear and terror.

PTSD can occur at any age and can result from a broad spectrum of traumatic experiences.

children most often “re-see” their trauma during leisure times, when they are resting, daydreaming, or trying to fall asleep, rather than in nightmares or the characteristic flashback of adult PTSD.

Furthermore, children engage in repetitive posttraumatic play that can consist of reenacting a specific aspect of the traumatic event or simply reenacting the violence they experienced,

Children exhibit specific fears, which are easier to identify if the traumatic event is known. However, when a child presents with intense fear toward specific objects, individuals, or situations, the physician should carefully obtain a thoro...

Traumatic experiences can also change a child’s attitudes about people, life, and the future.

Understanding PTSD symptomatology in children provides a framework for physicians to organize their thinking about childhood trauma, and can help them avoid overlooking the condition.

the optimal time for intervention is during the first few weeks following the trauma.

The effects of emotional trauma in children can last for decades, influencing the child’s development of trust, initiative, interpersonal rela...

Children being treated for “behavioral problems” may actually be suffering from PTSD.

While individuals react to trauma in idiosyncratic ways depending on the nature of the incidents and a variety of circumstances, trauma often becomes a defining characteristic that affects psychological, social, physical, and cognitive aspects of life, even for its youngest survivors.