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Holly

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Understanding Child Traumatic Stress

Responding to Danger
Before we discuss what is meant by a "traumatic experience" or "traumatic stress," let's think about how we recognize and deal with danger. Our minds, our brains, and our bodies are set up to make sure we make danger a priority. Things that are dangerous change over the course of childhood, adolescence, and adulthood. For very young children, swimming pools, electric outlets, poisons, and sharp objects are dangerous. For school-age children, walking to school, riding a bike in the street, or climbing to high places present new dangers. In adolescents, access to automobiles, guns, drugs, and time on their own, especially at night, are new dimensions to danger. Dangers change depending on where children live and on their families' circumstances. Also, dangers change over the history of societies and cultures.
There are three things that happen when we are in a dangerous situation. First, we try to figure out what the danger is and how serious it is. Second, we have strong emotional and physical reactions. These reactions help us to take action, yet they can be very distressing to feel and difficult to handle. Third, we try to come up with what to do that can help us with the danger. We try to prevent it from happening, try to protect ourselves or other people against harm, or try to do something to keep it from getting worse. How we feel about a danger depends on both how serious we think it is and what we think can be done about it.

When Danger Turns Into Trauma
We live with dangers every day. As children and adolescents grow up, they continually learn about different types of dangers. We are always looking for ways to make our lives safer. However, terrible things sometimes happen within and outside the family. They can happen suddenly without warning. Children may experience different traumas over the course of childhood and adolescence. Some traumas, such as child abuse or witnessing domestic violence, may happen repeatedly over a long period of time.
Dangers can become "traumatic" when they threaten serious injury or death. Traumatic experiences also include physical or sexual violation of the body. The witnessing of violence, serious injury, or grotesque death can be equally traumatic. In traumatic situations, we experience immediate threat to ourselves or to others, often followed by serious injury or harm. We feel terror, helplessness, or horror because of the extreme seriousness of what is happening and the failure of any way to protect against or reverse the harmful outcome. These powerful, distressing emotions go along with strong, even frightening physical reactions, such as rapid heartbeat, trembling, stomach dropping, and a sense of being in a dream.

There are large-scale dangers like disasters, war, and terrorism that threaten large numbers of children and families all at the same time. There are dangers that are particular to a community or neighborhood, like crime, school violence, or traffic accidents. And there are dangers that come from within the family through domestic violence and child abuse. Traumatic experiences fall into a number of categories.

What A Traumatic Situation Is Like for a Young Child
Think of what it is like for young children to be in traumatic situations. They can feel totally helpless and passive. They can cry for help or desperately wish for someone to intervene. They can feel deeply threatened by separation from parents or caretakers. Young children rely on a "protective shield" provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare. They often don't recognize a traumatic danger until it happens, for example, in a near drowning, attack by a dog, or accidental scalding. They can be the target of physical and sexual abuse by the very people they rely on for their own protection and safety. Young children can witness violence within the family or be left helpless after a parent or caretaker is injured, as might occur in a serious automobile accident. They have the most difficulty with their intense physical and emotional reactions. They become really upset when they hear cries of distress from a parent or caretaker.

What a Traumatic Situation is Like for School-age Children
School-age children start to face additional dangers, with more ability to judge the seriousness of a threat and to think about protective actions. They usually do not see themselves as able to counter a serious danger directly, but they imagine actions they wish they could take, like those of their comic strip heroes. So, in traumatic situations when there is violence against family members, they can feel like failures for not having done something helpful. They may also feel very ashamed or guilty. They may be without their parents when something traumatic happens, either on their own or with friends at school or in the neighborhood. Sexual molestation occurs at the highest rate among this age group. School-age children get scared of the speeding up of their emotions and physical reactions, adding new fears to the danger from outside. For example, an 8 year-old child described, "My heart was beating so fast I thought it was going to break.

"My heart was beating so fast I thought it was going to break."

Traumatic Situation is Like for an Adolescent
With the help of their friends, adolescents begin a shift toward more actively judging and addressing dangers on their own. This is a developing skill, and lots of things can go wrong along the way. With independence, adolescents can be in more situations that can turn from danger to trauma. They can be drivers or passengers in horrible car accidents, be victims of rape, dating violence and criminal assault, be present during school or community violence, and experience the loss of friends under traumatic circumstances. During traumatic situations, adolescents make decisions about whether and how to intervene, and about using violence to counter violence. They can feel guilty, sometimes thinking their actions made matters worse. Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger. They are also learning more about human motivation and intent and struggle over issues of irresponsibility, malevolence, and human accountability.

Posttraumatic Stress Responses
For reasons that are basic to survival, traumatic experiences, long after they are over, continue to take priority in the thoughts, emotions, and behavior of children, adolescents and adults. Fears and other strong emotions, intense physical reactions, and the new way of looking at dangers in the world may recede into the background, but events and reminders may bring them to mind again.

There are three core groups of posttraumatic stress reactions.

First, there are the different ways these types of experiences stay on our minds. We continue to have upsetting images of what happened. We may keep having upsetting thoughts about our experience or the harm that resulted. We can also have nightmares. We have strong physical and emotional reactions to reminders that are often part of our daily life. We may have a hard time distinguishing new, safer situations from the traumatic situation we already went through. We may overreact to other things that happen, as if the danger were about to happen again.

Second, we may try our best to avoid any situation, person, or place that reminds us of what happened, fighting hard to keep the thoughts, feelings, and images from coming back. We may even "forget" some of the worst parts of the experience, while continuing to react to reminders of those moments.

Third, our bodies may continue to stay "on alert." We may have trouble sleeping, become irritable or easily angered, startle or jump at noises more than before, have trouble concentrating or paying attention, and have recurring physical symptoms, like headaches or stomachaches.

We may try our best to avoid any situation, person, or place that reminds us of what happened.

How Development Influences Posttraumatic Stress Responses
Age, developmental maturity, and experience can influence posttraumatic stress reactions. More than twenty years of studies have confirmed that school-age children and adolescents can experience the full range of posttraumatic stress reactions that are seen in adults. We might wish to believe that children under five years of age are too young to know what was happening and whatever impression was left would be forgotten soon. However, recent studies show that traumatic experiences affect the brains, minds, and behavior of even very young children, causing similar types of reactions as seen in older children and adults.

Young Children. It is extremely difficult for very young children to experience the failure of being protected when something traumatic happens. In response, they may become passive and quiet, easily alarmed, and less secure about being provided with protection. Their minds may stay on a central action, like being hit or seeing someone fall to the floor. They may have simple thoughts about protection, for example, "Daddy hit mommy, mommy call police." They can become more generally fearful, especially in regard to separations and new situations. In circumstances of abuse by a parent or caretaker, the young child may act confused as to where to find protection and where there is threat. A child may respond to very general reminders, like the color red or the sounds of another child crying. The effects of fear can quickly get in the way of recent learning. For example, a child may start wetting the bed again or go back to baby-talk. Because a child's brain does not yet have the ability to quiet down fears, the preschool child may have very strong startle reactions, night terrors, and aggressive outbursts.

Traumatic experiences affect the brains, minds, and behavior of even very young children.
School-age Children. The post-trauma responses of school-age children include a wider range of intrusive images and thoughts. School-age children think about lots of frightening moments during their traumatic experiences. They also go over what could have stopped it from happening and what could have made it turn out differently. These thoughts can show up in what is called, "traumatic play".

School-age children respond to very concrete reminders: someone with the same hairstyle as an abuser; the monkey bars on a playground where a child got shot; feeling alone inside like they did when one parent attacked the other. They are likely to develop intense specific new fears that link back to the original danger. They can easily have "fears of recurrence," that result in their avoiding even enjoyable things they would like to do. More than any other group, school-age children may go back and forth between shy or withdrawn behavior and unusually aggressive behavior. They can have thoughts of revenge that they cannot resolve. Normal sleep patterns can be easily disturbed. They can move around restlessly in their sleep, vocalize, and wake up tired. Their lack of restful sleep can interfere with their daytime concentration and attention. It can then be more difficult for them to study because they remain on alert for things happening around them.

Adolescents. Adolescents are particularly challenged by posttraumatic stress reactions. They can easily interpret many of these reactions as regressive or childlike. They may interpret their reactions as signs of "going crazy," of being weak, or of being different from everyone else. They may be embarrassed by bouts of fear and exaggerated physiological responses. They may harbor the belief that they are unique in their pain and suffering. These reactions may result in a sense of personal isolation. Grief reactions, however painful, are often easier for them to understand and accept than posttraumatic stress reactions.

In their post-trauma thoughts, adolescents think about behavior and choices that go back to well before a traumatic situation. They are also very sensitive to the failure of family, school, or community to protect or carry out justice. Afterwards they may turn even more to peers to judge risks and to take protective action. They may be especially "grossed out" or fascinated by grotesque injury or death and remain very focused on their own scars that serve as daily trauma reminders.

Adolescents may respond to their experience through dangerous reenactment behavior.

more information
 

Holly

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Hi Everyone,
I really found this article interesting, it is important to be aware of our children who can be exposed to traumatic events.
Take care :)
 

Meg

Dr. Meg, Global Moderator, Practitioner
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Hi Holly,

This information is really interesting, thanks :)

I will pass it along to a friend who I think will find it very useful.

Meg
 

braveheart

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Thank you, I find that validating and supportive, in retrospect of my past.
 

foghlaim

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Holly have you found any article as a follow up to this one???
like what interventions can be used to help a child process and come through ptsd and go on to lead normal" lives. I can see what might happen from the above article..if no interventin is sought.

just wondering ok.
great article by the way.


nsa
 

Holly

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Hi nsa,
Good Question, I will take a look, it is important to have follow up with children and traumatic events. Intervention is a unique area, and many different opinions about the types of intervention. If I find anything I let Dr. Baxter see if it seems appropriate to post. He may have suggestions about intervention in this area, you could check with him also.
Thank you :)
 

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