UNDERSTANDING CHILD TRAUMATIC STRESS
Prof. Dr. Nasir Sulman
Department of Special Education
University of Karachi
What is Childhood Trauma?
The word trauma is used to describe negative events that are emotionally painful and that overwhelm a person’s ability to cope. Examples of such events include experiencing an earthquake or hurricane, industrial accident or vehicular accident, physical or sexual assault, and various forms of abuse experienced during childhood.
Childhood trauma includes child abuse in all its forms, neglect, witnessing or experiencing domestic violence in childhood as well as other adverse childhood experiences. What is child abuse? The World Health Organization (1999) defines child abuse as:
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.
While definitions of abuse remain ambiguous, some behaviours are objectively deleterious to healthy child development. All the same acceptability around behaviour varies widely from one social group to another and from culture to culture.
The Adverse Childhood Experiences Study (Felliti and Anda, 1998) classifies childhood trauma in ten categories:
- Abuse of child: psychological, physical, sexual
- Trauma in child’s household environment: substance abuse, parental separation and/or divorce, mentally ill or suicidal household member, violence to mother, imprisoned household member
- Neglect of child: abandonment, child’s basic physical and/or emotional needs unmet
Childhood Trauma Leaves Legacy of Brain Changes
A difficult reality for psychiatrists and counselors of child abuse is that young victims are at high risk of becoming offenders themselves one day, although it’s unclear why. But now a team of behavioral geneticists report a possible reason: early psychological trauma may actually cause lasting changes in the brain that promote aggressive behavior in adulthood.
Why would early traumatic experiences crave permanent changes in the brain? Evolutionarily, such brain changes may have helped us to survive a harsh and cruel environment, by keeping us on edge and ready to confront any possible threats, Sandi says. Today, however, those same changes may do more harm than good, leading some victims of abuse to slip into a vicious cycle, seeing threats where none exist, and overreacting to situations, often with violence. It’s possible that some people may be genetically more sensitive to the changes triggered by painful experiences, and therefore more likely to benefit from treatments that can address those genetic differences. Better understanding of why vicious cycles of violence exist may help researchers to find ways to break them.
Negative childhood experiences can set our brains to constantly feel danger and fear. A report by the University of San Diego School of Law found that about 686,000 children were victims of abuse and neglect in 2013. Traumatic childhood events can lead to mental health and behavioral problems later in life, explains psychiatrist Bessel van der Kolk, author of the recently published book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
The human brain is a social organ that is shaped by experience, and that is shaped in order to respond to the experience that you’re having. So particularly earlier in life, if you’re in a constant state of terror; your brain is shaped to be on alert for danger, and to try to make those terrible feelings go away.
The brain gets very confused. And that leads to problems with excessive anger, excessive shutting down, and doing things like taking drugs to make yourself feel better. These things are almost always the result of having a brain that is set to feel in danger and fear.
As we grow up and get a more stable brain, these early traumatic events can still cause changes that make us hyper-alert to danger, and hypo-alert to the pleasures of everyday life.
Developmental trauma research now argues that trauma exposure during childhood affects children’s self-regulatory capacities by disrupting the normal functioning of the body and brain stress-response systems, which can affect emotional and cognitive functioning.
Neuroscience research has underscored the understanding that the brain is the central system linking neurobiological and psychosocial development, which can explain how trauma exposure may help initiate a ‘cascade’ of impaired functioning across seemingly unrelated pathways in childhood, adolescence and adulthood (DeGregorio, & McLean, 2013; Kearney, Wechsler, Kaur, & Lemos-Miller, 2010; Pechtel, & Pizzagalli, 2011).
In addition, neuroscience research has shifted the focus from a cognitive perspective of the child brain to a focus on the emotional development of the brain (Schore, 2015). Since environmental and relational experiences in childhood influence neurobiological development, childhood trauma exposure has the potential to become the organizing system of the brain (Perry, 2009).
Developments in neuroscience research have helped change understandings of how the brain develops during childhood and how physiological changes in response to stress can interact with children’s neurodevelopment. Children’s brains may be particularly susceptible to the timing and severity of trauma exposure as brain development in childhood is not linear. This means that brain structures and processes have different timing and patterns of development. For example, some regions develop most during childhood, others during adolescence, and yet others into adulthood. This may help explain, in part, wide-ranging variation in subsequent emotional and cognitive functioning among children after trauma exposure.
In the classroom, children’s trauma symptoms may be understood as attention deficits, learning disabilities, or behavioural or conduct problems. Researchers argue that trauma-informed behaviours are important coping mechanisms that a child may develop to survive extremely stressful experiences, and that focusing on eliminating these behaviours may be damaging to the child. Therefore, it is important for educators working with traumatized children to understand the key developmental pathways that may be affected by childhood trauma, and how to support resilience through these pathways.
Research has identified three areas where teachers and schools can focus attention to support traumatized children’s needs:
- attachment – developing positive attachment to a teacher or mentor helps traumatized children normalize their disrupted body and brain stress-response systems, and to develop self-regulatory capacities
- competencies – teachers may provide traumatized children with opportunities to improve competencies and to develop a positive self-concept that may be unrelated to academic achievement, and
- Self-regulation – different approaches to behaviour management in schools can help traumatized children learn to regulate their emotions and behaviour.
Many factors may cause trauma-informed behaviour, and teachers should not be afraid to try different behavioural management strategies to learn what is most effective for children in their classrooms.
A better understanding of the developmental pathways associated with trauma exposure may help stop trauma symptoms from being attributed to low ability or behavioural problems. Educators and schools already have many of the skills and resources to help traumatized children, and can promote healthy development through a holistic focus on attachment, competencies and self-regulation.
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.
The Lessons of Traumatic Experiences
As children grow up, they learn from their experiences and form a picture of what the world is like. What is it that they learn from traumatic experiences? They may learn positive things about how they conduct themselves in the midst of danger, of the heroic efforts of others to protect or rescue, and of the helpful support trauma survivors may receive afterwards. However, children may also take on “traumatic expectations.” Their view of the world, its safety and stability, help govern how they behave. Children and adolescents are forming a world view that is constantly changing. Trauma experiences can create the sense that things can go horribly wrong at a moment’s notice, that no one can really provide protection, and that laws don’t really work. Adolescents can then think it is not worth working toward a better future or that it is better not to get close to others just to lose them in a tragic way.
Children and adolescents are building up confidence in the “social contract,” a trust that the rules of a family, community, or society are fair and look after the best interests and welfare of its members. After family violence, young children may learn that feelings of love can be betrayed through abuse. If abuse occurs in the larger community, they may conclude that children can be taken advantage of by adults in positions of authority.
But there may be positive lessons as well. Most important, traumatic experiences can lead children and adolescents to be more compassionate, to work harder to make the world better and safer, and to do something valuable with their lives.