earthquake and tsunami that struck Japan in March were traumatic experiences
for thousands of Japanese children with serious potential implications for
their emotional and psychological health. What is not as widely recognized is
the distant natural disaster posed risks to children in the United States, whose
only exposure to the horrific event more than 5,000 miles away may have been images
of the devastation they saw on television.
repeated exposure to violence can trigger a traumatic response in children, so,
too can a single violent event —whether they experience such events directly
as, for example, a victim of physical abuse, indirectly as a witness to a
violent act, or vicariously through simply hearing about or otherwise learning
of a traumatic event such as the earthquake in Japan or, closer to home, the
terrorist attacks of September 11, 2001.
recently, the impact of trauma on young children was not well understood or
widely recognized. But among the messages to emerge from years of research and
clinical practice is that children are not oblivious to traumatic events and
that being exposed to trauma can affect their emotional and mental health.
impact in some cases can be long lasting. Traumatic events experienced in
childhood, for example, are strongly associated with chronic physical illness,
as well as with depression and other mental health problems during adulthood,
according to the Adverse Childhood Experiences study co-sponsored by the
national Centers for Disease Control and Prevention.
findings have heightened awareness of the importance of understanding
children’s traumatic experiences. In May, childhood trauma—particularly
building resiliency in children dealing with trauma—was among the themes of
National Mental Health Awareness Month.
news is that many children are able to effectively cope with traumatic experiences
through their own resilience and the support of parents or other trusted
parent, big brother, aunt, neighbor, and child caregiver can all be protective
factors for children—the child feels secure, has consistent relationships, is
not humiliated, gets a chance to experience success. Those are some of the
reasons why some children who experience trauma or come out of difficult
environments do fine," said Raymond Firth, director of the University of Pittsburgh
Office of Child Development’s Division of Policy Initiatives.
children who require additional help, such as those who experience severe or
chronic trauma, several types of treatment have been demonstrated to be
experience trauma in many ways. Sources of trauma include neglect, physical
abuse, sexual abuse, psychological abuse, and witnessing domestic violence and
other violence, for example, in the child’s community or a school. Bullying is
another source of trauma. Others include a traumatic loss of a parent, close
friend, or other loved one; injury to a parent or other person close to the child;
and being involved in a car accident. Natural disasters, terrorism, and war are
other situations that can also trigger a traumatic response in children.
children can contribute to the development of post-traumatic stress disorder
and a number of other psychiatric disorders, such as depression, generalized
anxiety disorder, panic attacks, and substance abuse later in life.
traumatic loss of a loved one, witnessing domestic violence, and living with a
parent whose caregiving ability was impaired were among the most common
traumatic experiences reported among children receiving treatment through the
National Child Traumatic Stress Initiative, a Substance Abuse and Mental Health
Services Administration (SAMHSA) program for raising the standard of care and
improving access to services to children who experience trauma. Some 40 percent
of these children had experienced four or more types of traumatic events.
place the number of children who witness their mothers being abused between 3.5
million to 10 million, and about half of those children are abused themselves,
according to a 2004 study on violence and trauma by the National Association of
State Mental Health Program Directors and the National Technical Assistance
Center for State Mental Health Planning.
of the impact experiencing trauma can have on children is offered in reports on
children receiving services through the Children’s Mental Health Initiative,
established in 1992 by the U.S. Congress to create a network of community-based
services and supports for children and youth at risk of serious mental health
issues. For example, post-traumatic stress disorder or acute stress disorder
were diagnosed in 9 percent of those children who had experienced at least one
traumatic event. And those who had been exposed to several types of traumatic
events tended to have higher levels of depression and anxiety, be more
aggressive, and break more rules.
2004 study that estimated the number of children who witness domestic abuse
also found that the overwhelming majority children in the juvenile justice
system experienced at least one traumatic event and that 18 percent of females
and 11 percent of males met the full criteria for post-traumatic stress
a traumatic experience carries the risk of contributing to such problems,
different children respond differently, experts say. For most, the effects of a
traumatic experience are short-lived. For others, the risk of developing
serious, potentially long-term problems is greater.
comes to determining how an individual child responds to trauma, studies
suggest several factors come into play.
of a child is an important factor. It was once thought that experiencing trauma
had little effect on young children. But brain research and other studies now
offer convincing evidence that young children may in fact be the most
vulnerable. One reason is that trauma is capable of altering neurochemical
processes and, in turn, affecting the growth, structure, and functioning of the
brain, which in young children is rapidly developing.
activate the body’s stress systems, increasing the levels of certain chemicals
in the body. Cortisol is one of those chemicals and it can affect the brain.
The chemical can, for example, affect the hippocampus, which plays a key role
in forming new memories of experienced events and in identifying new events,
places, and stimuli. Studies suggest elevated cortisol levels can strengthen
memories of emotional events and diminish children’s ability to unlearn
memories related to the trauma they experienced.
of such damage is greater when trauma is a repeated experience, which is
another factor that influences a child’s response to a traumatic event. In most
cases, fear responses are quickly activated, but brief. But with repeated
trauma, a child’s fear system can stay activated longer. In such cases, fear
might become generalized over time. Abused children, for instance, might
experience fear and anxiety when exposed to people who resemble their abusers
or places that remind them in some way of where the abuse occurred. If left
untreated, such a condition could impair a child’s ability to learn or interact
factors that are considered in assessing a child’s response to a traumatic
experience include the proximity and severity of the traumatic event, whether
the child has experienced previous traumatic events, and family
characteristics, such as a history of domestic violence, other family dysfunction,
and disrupted relationships with parents or other key caregivers.
responses may be influenced by several such factors. For example, children who
experience trauma directly are typically at higher risk of developing serious
traumatic reactions or post-traumatic stress disorder than children who
experience trauma in other ways. But with a particularly vulnerable child, the
way the child experiences trauma is only one of several important
considerations in assessing the child’s response.
vulnerable children it also has to do with their past experiences,” said
Christopher Peterson, MD, a child and adolescent psychiatrist and associate
professor of psychology at Pennsylvania State University. “Did they have traumatic
experiences in the past? That would make them more vulnerable to having a more
serious reaction in the future. What kind of upbringing did they have? Did they
have a secure attachment to their caretaker and was that disrupted? If they had
a disrupted childhood—maybe a mother was hospitalized for quite awhile—do they
feel there is somebody stable whom they can count on? If that has been
disrupted, they are more vulnerable to trauma in the future.”
Dealing with trauma
and experience offer a number of lessons about helping children deal with
traumatic experiences. Among them is that children—even very young children—are
not oblivious to such experiences or immune from the harm that a traumatic
event can cause.
is that it is important to take steps to address a child’s traumatic experience
and the earlier those steps are taken the better. Effective responses range
from parents calmly offering support and understanding to treatment
administered by mental health professionals. “Simply removing these children
from a dangerous environment isn’t enough,” Firth said.
cases, professional help is not needed. Resiliency among children is associated
with several protective factors, such as a supportive family environment,
nurturing caregiver skills, stable family relationships, optimistic beliefs and
values, open communication, and consistent household rules and monitoring of
who offer support, understanding, and a sense of safety as early as possible
can often limit the effect of trauma on a child. “Children are very resilient
and with adequate support from their family will over two to four weeks recover
most if not all of their functioning and kind of get back to their life,” said
just some basic things will help—talking with them and appreciating what their
understanding is of what happened, letting them know what the reality is, and
offering them reassurance, but within what is truthful. Those can go a long way
in helping a child to deal with the anxiety, depression, and stress of the
traumatic reactions they might have.”
children, however, will need the help of mental health professionals,
particularly those who experience chronic trauma or are otherwise severely
traumatized. Effective treatment recognizes the fact that there isn’t one
therapy that is the right fit for all children and considers several factors,
including a child’s age and developmental stage.
most therapies have been more thoroughly studied with adults than with
children, a growing body of evidence suggests that several types of individual
and group therapy have been used effectively to help children deal with trauma
and support them through that process.
Cognitive Behavior Therapy, for example, is one of the most frequently used
treatments with children and youth who range in age from 3 to 18 years. The
short-term intervention encourages them to become more aware of how their
thoughts about the traumatic event affect their reactions and behaviors.
Child-Parent Psychotherapy is mostly used to address the needs of infants,
toddlers and preschool-aged children by focusing on the way the traumatic event
has affected the parent-child relationship. Structured Psychotherapy for
Adolescents Responding to Chronic Stress, an example of a group intervention,
seeks to help older children cope effectively with their traumatic experience
and establish supportive relationships.
Recognizing Signs of a Problem
important aspect of helping a child deal with trauma is recognizing signs that
the experience has affected the child in some way. In most cases, symptoms will
dissipate over a period of two to four weeks.
more common signs are refusal to go to school, clinging behavior with a parent
or other close caregiver or adult, persistent fear, loss of concentration,
jumpiness, behavioral problems, sleep disturbances, withdrawal, and physical
complaints, such as stomach aches or headaches. “You don’t have to be a
psychiatrist or clinical social worker to see those things,” Dr. Petersen said.
“Any parent or teacher with their eyes wide open will appreciate that those
things are going on and they can ask questions to better determine what the concerns
who experience a single traumatic event and children who are exposed to
repeated trauma might show many of those same symptoms. However, some children
may develop acute stress disorder or post-traumatic stress disorder. Signs for
post-traumatic stress disorder include a child seeing the traumatic event
happening again, acting out the event while playing, fearing things and places
linked to the event, being easily frightened, having a difficult time trusting
people, and acting out in anger.
may be different in older children than in younger children. Teenagers, for
example, are more likely to show signs of depression than young children. With
young children, irritability and an increase in activity level and agitation
are more likely to be seen than sadness.
deciding whether a child’s problem is severe enough to seek professional help,
both the severity of the symptoms and how long symptoms persist are
informative. “If children are having severe difficulties in the first 30 days
after a traumatic event they should see someone,” said Dr. Petersen. “And if
children are still having difficulty functioning after 30 days—even if it is
only in some areas—they should see someone for evaluation and possibly
For more information
used to produce this report include the following:
- National Scientific Council on the
Developing Child (2010). Persistent Fear and Anxiety Can Affect Young
Children’s Learning and Development: Working Paper No. 9. developingchild.
- National Scientific Council on the
Developing Child (2005). Excessive Stress Disrupts the Architecture of the
Developing Brain: Working Paper No.