Trauma in Children and Adolescents
Common Presentations:
Trauma originating from unexpected events that are beyond the individual’s ability to cope, or from interpersonal relationships involving sexual/physical/emotional/verbal contact
Establishing Boundaries: difficulty “staying out of your bubble,” fear regarding physical touch, hiding/developing intricate “forts,” adopting protective stances, or other protective behaviors
Executive Functioning: trouble engaging in and/or establishing motivation to complete school-work, perfectionistic behaviors, difficulty understanding or sensitivity to academic expectations
Emotional Regulation: heightened awareness and sensitivity to others’ emotions, nonverbal and verbal cues coupled with irritability and anger, depression and internalization or externalization
Developmental Considerations: seemingly developmentally behind other children or exceptionally mature, noticeable sensitivity to authority figures including need for validation or difficulty with trust, negative self-appraisal including “it’s my fault,” separation anxiety and social anxiety
Considerations:
Modern child and adolescent mental health care providers typically acknowledge that traumatic experiences underlie many symptoms that lead families to seek treatment (anxious behaviors, difficulty in school, etc.)
We only have our own frame of reference. Children and young people are often not able to define experiences as physical/sexual/verbal abuse, medical trauma, accidents, complex bereavement, bullying, etc.
The younger the individual experiencing trauma, the more crucial it is to approach treatment non-verbally, involving play. Additionally, when relevant, defined and consensual “good touch experiences” (ex. child asks safe adult for a hug), as well as consistent validation to develop positive self-esteem may be helpful
Treatment:
Diagnosis: as trauma can look like many other mental health conditions, a psychological assessment involving cognitive, and psychological testing may be recommended when alternative diagnoses are considered
Interdisciplinary Care: it can be helpful to gather information from a variety of sources (medical, school, home, extracurricular) to gain insight into relevant behaviors in context
Referrals: common referrals include medical doctors, occupational therapy, and an array of relevant strengths/movement/arts based extracurricular activities
Psychotherapy: trauma focused cognitive behavioral therapy is an evidenced based treatment approach involving establishing safe coping skills (ex. music, deep breathing/relaxation techniques, and individualized considerations), developmentally considerate therapy to explore the trauma (often play-based), and offering corrective/reparative relational healing. When relevant, family members may be involved in treatment. Parents must be involved in sessions with children under the age of 4, and likely will not be regularly involved in work with adolescents 14 years and older. There are always exceptions to these recommendations, depending on the needs of the child, adolescent and family
