Trauma Information
All children and adolescents experience stressful events which can affect them both emotionally and physically. Their reactions to stress are usually brief, and they recover without further problems. A child or adolescent who experiences a catastrophic event may develop ongoing difficulties known as posttraumatic stress disorder (PTSD). The stressful or traumatic event involves a situation where someone's life has been threatened or severe injury has occurred (ex. they may be the victim or a witness of physical abuse, sexual abuse, violence in the home or in the community, automobile accidents, natural disasters (such as flood, fire, earthquakes), and being diagnosed with a life threatening illness). A child's risk of developing PTSD is related to the seriousness of the trauma, whether the trauma is repeated, the child's proximity to the trauma, and his/her relationship to the victim(s).
Following the trauma, children may initially show agitated or confused behavior. They also may show intense fear, helplessness, anger, sadness, horror or denial. Children who experience repeated trauma may develop a kind of emotional numbing to deaden or block the pain and trauma. This is called dissociation. Children with PTSD avoid situations or places that remind them of the trauma. They may also become less responsive emotionally, depressed, withdrawn, and more detached from their feelings.
-National Institute of Mental Health
Attachment Trauma
Very Young Trauma Survivors: The Role of Attachment
Years ago, little was known about PTSD in infants and young children. Today, we know that trauma and abuse can have grave impact on the very young. We also know how much the attachment or bond between a child and parent matters as a young child grows. This can make a difference in how a child responds to trauma. Below we discuss rates of trauma-related problems in infants and young children, as well as treatment options.
How many infants and young children are abused?
In the United States, Child Protective Services receives reports on the abuse or neglect of about 5.5 million children in a year. Infants and young children have more risk of abuse than older children. Over one-third of proven reports to child protection services are for children under the age of 5 years. Further, children are most often hurt or killed from abuse when they are in the first year of life. Over three quarters of children killed due to abuse are under the age of 3 years.
How do trauma and neglect affect infants and young children?
As with adults, following trauma, most children will have some symptoms. Young children may show a fear of strangers or be scared to leave their parent. They might also have sleep problems or bad dreams. Young children may also repeat themes of the trauma in their play. For example, a child who was sexually abused in her bed might play out "dark" bedroom scenes with dolls. They might also be more fussy, irritable, aggressive, or reckless. Young children may lose skills they once had, such as toilet training. They might go back to earlier habits, like sucking their thumb. Very young children may not show the same PTSD symptoms we see in adults. This may be because many of the symptoms of PTSD require that the child be able to talk about what happened.
Early trauma affects the child's nervous system. The nervous system is shaped by the child's experiences. Stress over a period of time can lead to changes in the parts of the brain that control and manage feelings. That is to say, stress and trauma early in life can change the brain. This can have long-term effects on physical, mental, and emotional growth. What's more, the impact of early abuse often extends into later childhood, teen, and even adult years.
Diagnosing PTSD in infants and young children
Although most children have symptoms following trauma, only a few will go on to get PTSD. Diagnosing PTSD in children can be difficult. The definition of trauma that is used to diagnose PTSD is specific. It says that a person must feel fear, helplessness, or horror for an event to be a "trauma". It is hard to say if this happens for a very small child. Young children are often not able to describe in words the event or how they felt about it. For this reason, other ways of diagnosing PTSD have been created for use with children ages 0 to 3 years.
What is attachment?
Attachment is the connection found in the main relationship in a child's life. Usually it is with his or her caregiver. Children and parents are meant to form attachments with each other. For example, your baby is born knowing how to cuddle and cry, and it causes you to respond. Also, infants like their caregiver's face and voice more than other sights and sounds. The type of attachment between a child and caregiver can affect how a child will relate to the people she or he comes across in life.
Why is attachment important when dealing with trauma?
Very Young Trauma Survivors: The Role of Attachment
Years ago, little was known about PTSD in infants and young children. Today, we know that trauma and abuse can have grave impact on the very young. We also know how much the attachment or bond between a child and parent matters as a young child grows. This can make a difference in how a child responds to trauma. Below we discuss rates of trauma-related problems in infants and young children, as well as treatment options.
How many infants and young children are abused?
In the United States, Child Protective Services receives reports on the abuse or neglect of about 5.5 million children in a year. Infants and young children have more risk of abuse than older children. Over one-third of proven reports to child protection services are for children under the age of 5 years. Further, children are most often hurt or killed from abuse when they are in the first year of life. Over three quarters of children killed due to abuse are under the age of 3 years.
How do trauma and neglect affect infants and young children?
As with adults, following trauma, most children will have some symptoms. Young children may show a fear of strangers or be scared to leave their parent. They might also have sleep problems or bad dreams. Young children may also repeat themes of the trauma in their play. For example, a child who was sexually abused in her bed might play out "dark" bedroom scenes with dolls. They might also be more fussy, irritable, aggressive, or reckless. Young children may lose skills they once had, such as toilet training. They might go back to earlier habits, like sucking their thumb. Very young children may not show the same PTSD symptoms we see in adults. This may be because many of the symptoms of PTSD require that the child be able to talk about what happened.
Early trauma affects the child's nervous system. The nervous system is shaped by the child's experiences. Stress over a period of time can lead to changes in the parts of the brain that control and manage feelings. That is to say, stress and trauma early in life can change the brain. This can have long-term effects on physical, mental, and emotional growth. What's more, the impact of early abuse often extends into later childhood, teen, and even adult years.
Diagnosing PTSD in infants and young children
Although most children have symptoms following trauma, only a few will go on to get PTSD. Diagnosing PTSD in children can be difficult. The definition of trauma that is used to diagnose PTSD is specific. It says that a person must feel fear, helplessness, or horror for an event to be a "trauma". It is hard to say if this happens for a very small child. Young children are often not able to describe in words the event or how they felt about it. For this reason, other ways of diagnosing PTSD have been created for use with children ages 0 to 3 years.
What is attachment?
Attachment is the connection found in the main relationship in a child's life. Usually it is with his or her caregiver. Children and parents are meant to form attachments with each other. For example, your baby is born knowing how to cuddle and cry, and it causes you to respond. Also, infants like their caregiver's face and voice more than other sights and sounds. The type of attachment between a child and caregiver can affect how a child will relate to the people she or he comes across in life.
Why is attachment important when dealing with trauma?
A child's main attachment helps him learn to control his emotions and thoughts. When a caregiver's responses are in tune with a child's needs, the child feels secure. The child then uses this relationship pattern as practice to build coping skills. On the other hand, a child who gets confusing or inconsistent responses from the caregiver might be fussy, have a hard time calming down, withdraw from others, or have tantrums.
Children also use their caregivers to guide how they should respond to events. Have you noticed how a child sometimes looks at his or her parent to know how to respond? When you stop your child from doing something unsafe, he in time learns to stop himself. So a parent's reaction to trauma affects the child. Through a relationship with their caregiver, children learn how to be in charge of feelings and behaviors, and how to act with other people.
Here are some examples:
If a caregiver often helps a child manage her feelings, the child can build coping skills. This could lead to better healing for children who go through trauma.
A traumatic event might hurt the attachment between a caregiver and child due to strong feelings that get in the way of a good relationship. Sometimes a child can be angry toward her parent for not keeping her safe. Even very young children can have these feelings. Or, a parent might feel guilty about the event and this might affect the relationship.
If the caregiver has her own trauma history, her symptoms (trying not to feel, always worried about danger) might get in the way of caring for her child.
Child Abuse and Reactive Attachment Disorder
Severe abuse early in life can lead to reactive attachment disorder. Children with this disorder are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones. They need special treatment and support.
Children with pre-existing attachment problems are often more prone to be victimized and abused. This is due to their propensity to keep secrets, lack of boundaries with strangers, and often seeking attention form adults. If you have a child who has attachment issues, please teach them how to build a 'bubble' around their body as well as respecting the personal space of others.
Effects of Child Abuse and Neglect
All types of child abuse and neglect leave lasting scars. Some of these scars might be physical, but emotional scarring has long lasting effects throughout life, damaging a child’s sense of self, ability to have healthy relationships, and ability to function at home, at work and at school. Some effects include:
Lack of trust and relationship difficulties. If you can’t trust your parents, who can you trust? Abuse by a primary caregiver damages the most fundamental relationship as a child—that you will safely, reliably get your physical and emotional needs met by the person who is responsible for your care. Without this base, it is very difficult to learn to trust people or know who is trustworthy. This can lead to difficulty maintaining relationships due to fear of being controlled or abused. It can also lead to unhealthy relationships because the adult doesn’t know what a good relationship is.
Core feelings of being “worthless” or “damaged.” If you’ve been told over and over again as a child that you are stupid or no good, it is very difficult to overcome these core feelings. You may experience them as reality. Adults may not strive for more education, or settle for a job that may not pay enough, because they don’t believe they can do it or are worth more.Sexual abuse survivors, with the stigma and shame surrounding the abuse, often especially struggle with a feeling of being damaged.
Trouble regulating emotions. Abused children cannot express emotions safely. As a result, the emotions get stuffed down, coming out in unexpected ways. Adult survivors of child abuse can struggle with unexplained anxiety, depression, or anger. They may turn to alcohol or drugs to numb out the painful feelings.
Types of Child Abuse
There are several types of child abuse, but the core element that ties them together is the emotional effect on the child. Children need predictability, structure, clear boundaries, and the knowledge that their parents are looking out for their safety. Abused children cannot predict how their parents will act. Their world is an unpredictable, frightening place with no rules. Whether the abuse is a slap, a harsh comment, stony silence, or not knowing if there will be dinner on the table tonight, the end result is a child that feel unsafe, uncared for, and alone.
Emotional Abuse
Sticks and stones may break my bones but words will never hurt me? Contrary to this old saying, emotional abuse can severely damage a child’s mental health or social development, leaving lifelong psychological scars. Examples of emotional child abuse include:
Constant belittling, shaming, and humiliating a child
Calling names and making negative comparisons to others
Telling a child he or she is “no good," "worthless," "bad," or "a mistake."
Frequent yelling, threatening, or bullying.
Ignoring or rejecting a child as punishment, giving him or her the silent treatment.
Limited physical contact with the child—no hugs, kisses, or other signs of affection.
Exposing the child to violence or the abuse of others, whether it be the abuse of a parent, a sibling, or even a pet.
Neglect
Child neglect—a very common type of child abuse—is a pattern of failing to provide for a child's basic needs, whether it be adequate food, clothing, hygiene, or supervision. Child neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as with a serious injury, untreated depression, or anxiety. Other times, alcohol or drug abuse may seriously impair judgment and the ability to keep a child safe.
Older children might not show outward signs of neglect, becoming used to presenting a competent face to the outside world, and even taking on the role of the parent. But at the end of the day, neglected children are not getting their physical and emotional needs met.
Physical Abuse
Physical abuse involves physical harm or injury to the child. It may be the result of a deliberate attempt to hurt the child, but not always. It can also result from severe discipline, such as using a belt on a child, or physical punishment that is inappropriate to the child’s age or physical condition.
Many physically abusive parents and caregivers insist that their actions are simply forms of discipline—ways to make children learn to behave. But there is a big difference between using physical punishment to discipline and physical abuse. The point of disciplining children is to teach them right from wrong, not to make them live in fear.
Physical Abuse vs. Discipline
In physical abuse, unlike physical forms of discipline, the following elements are present:
Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behavior will trigger a physical assault.
Lashing out in anger. Physically abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse.
Using fear to control behavior. Parents who are physically abusive may believe that their children need to fear them in order to behave, so they use physical abuse to “keep their child in line.” However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.
Sexual Abuse
Child sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. It's important to recognize that sexual abuse doesn't always involve body contact. Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved.
While news stories of sexual predators are scary, what is even more frightening is that sexual abuse usually occurs at the hands of someone the child knows and should be able to trust—most often close relatives. And contrary to what many believe, it’s not just girls who are at risk. Boys and girls both suffer from sexual abuse. In fact, sexual abuse of boys may be underreported due to shame and stigma.
The problem of shame and guilt in child sexual abuse
Aside from the physical damage that sexual abuse can cause, the emotional component is powerful and far-reaching. Sexually abused children are tormented by shame and guilt. They may feel that they are responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual problems as they grow older—often either excessive promiscuity or an inability to have intimate relations.
The shame of sexual abuse makes it very difficult for children to come forward. They may worry that others won’t believe them, will be angry with them, or that it will split their family apart. Because of these difficulties, false accusations of sexual abuse are not common, so if a child confides in you, take him or her seriously. Don’t turn a blind eye!
Warning signs of child abuse and neglect
The earlier child abuse is caught, the better the chance of recovery and appropriate treatment for the child. Child abuse is not always obvious. By learning some of the common warning signs of child abuse and neglect, you can catch the problem as early as possible and get both the child and the abuser the help that they need.
Of course, just because you see a warning sign doesn’t automatically mean a child is being abused. It’s important to dig deeper, looking for a pattern of abusive behavior and warning signs, if you notice something off.
Warning signs of emotional abuse in children
Excessively withdrawn, fearful, or anxious about doing something wrong.
Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
Doesn’t seem to be attached to the parent or caregiver.
Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, tantruming).
Warning signs of physical abuse in children
Frequent injuries or unexplained bruises, welts, or cuts.
Is always watchful and “on alert,” as if waiting for something bad to happen.
Injuries appear to have a pattern such as marks from a hand or belt.
Shies away from touch, flinches at sudden movements, or seems afraid to go home.
Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.
Warning signs of neglect in children
Clothes are ill-fitting, filthy, or inappropriate for the weather.
Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
Untreated illnesses and physical injuries.
Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
Is frequently late or missing from school.
Warning signs of sexual abuse in children
Trouble walking or sitting.
Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.
Makes strong efforts to avoid a specific person, without an obvious reason.
Doesn’t want to change clothes in front of others or participate in physical activities.
An STD or pregnancy, especially under the age of 14.
Runs away from home.