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Traumatic Stress in Children and Adolescents Eight Steps to Treatment

Traumatic Stress in Children and Adolescents Eight Steps to Treatment

Traumatic experiences are common in childhood and adolescence and can have significant psychological effects on the child’s emotional well-being and overall development. Outcomes can be affected positively or negatively depending on responses and interventions.

This article reviews common responses of children to trauma, variables that influence the nature of psychological responses to trauma, and protective factors that can ameliorate deleterious effects. It also outlines an 8-stage approach to treating children who have had traumatic experiences.

Causes of traumatic stress
Traumatic stress refers to the physical and emotional response to events that threaten the life or physical or psychological integrity of the child or someone critically important to the child. A traumatic experience is unexpected and unpredictable, uncontrollable, and terrifying. Emotional responses to traumatic experience are often overwhelming and may include terror, helplessness, and extreme phys­­io­log­ical arousal that do not lead to purposeful and effective reactions. These emotional responses often coincide, leading the child to feel overwhelmed, confused, and out of control.

CNS effects of this set of responses can affect later neurophysiological responses. Hyperarousal and overgeneralization of threat assessment can evolve, leading the child to react in an extreme fashion to events that resemble or remind the child of the original trauma. The degree and frequency of significant arousal responses also reinforce the avoidance of discussion or consideration of traumatic memories.

In addition, children often reexperience the traumatic event during flashbacks, nightmares, and intrusive images. Manifestations vary based on the child’s developmental stage. Separation problems and somatic complaints predominate in young children. Difficulty with affect regulation and aggressiveness are common in older children and adolescents.

The affected individual is always the person who labels an experience as traumatic. It is the responsibility of others (including mental health professionals) to help the distressed individual. These traumatic experiences vary in a number of ways:

• Proximal cause.
• Number of traumatic experiences (dose effect).
• Degree of physical effect, both im­mediate and long-term.
• The occurrence of subsequent disruptive events

Proximal causes include natural disasters, attachment trauma (physical and/or sexual abuse perpetrated by a caregiver), community violence (sexual assaults, injury of the child, or violence witnessed by the child), domestic violence (with or without phys­ical abuse). Accidental injury and serious illness often require invasive and painful treatment procedures. The pain and unpredictability of these procedures as well as any uncertainty in the medical prognosis heighten the possibility of traumatic stress for children with serious illness or injury.

A growing literature addresses the development of traumatic symptoms following potentially noxious medical interventions for severe illnesses. Other highly traumatizing experiences include war, ethnic cleansing and genocide, torture, displacement leading to a refugee experience, and the experience of being abducted and trafficked or being a child soldier.


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