TRAUMA and PTSD

What is trauma?

Trauma is defined by the way a person reacts to events. So a trauma to one person may not be a trauma to another. It is important to remember that some children might see an event as traumatic even when the adults around them do not. Any time a child does not feel safe and protected, the event could be seen as a trauma. These experiences usually call forth overwhelming feelings of terror, horror, or helplessness. Because trauma is defined by the person who experiences it, no single list can include all the causes of trauma for children. The following list, though, will explain some of the more common traumas children face.

Surgery or Serious Illness – The child or a caregiver is in the hospital for a serious illness or surgery.
Accidents – The child has experienced an automobile accident, a serious fall or sports injury, a house fire or other major accident that threatens his or her feelings of safety and security.
Constant and Intense Bullying – The child is bullied by one or more people over a period of time. The bullies could be classmates, teammates, neighbors or others in the child’s life. Bullying can begin as early as preschool.
Separation from Loved Ones – A child might be separated from loved ones due to military deployment, a divorce, a prison sentence or even removal of a child from home due to an investigation of abuse or neglect.
Natural Disasters – A child is affected by a severe event such as a tornado, hurricane, forest fire, flooding.
Emotional Abuse – A parent or other adult in the household often swears at the child, insults the child or humiliates the child. Emotional abuse might include the adult acting in a way that makes the child afraid that he or she might be hurt physically.
Physical Abuse – A parent or other adult in the household often pushes, grabs, slaps or throws something at the child. Physical abuse can also include hitting a child so hard it leaves marks or causes injuries.
Sexual Abuse – Any sexual activity between an adult and a child. Sexual abuse can also occur between children. This sexual activity can include obscene phone calls, fondling, exposure, pornography, prostitution or rape. Specific legal definitions can be found in the Texas Penal Code.
Neglect – The child does not have enough to eat, has to wear dirty clothes and has no one to protect him or her. Parents might be too drunk or high to take care of the child or take the child to the doctor when needed.
Loss/Abandonment – The child loses a loved one through divorce, abandonment, death or other reason.
Isolation within the Family – No one in the family appears to love the child or consider the child to be important or special. The family does not look out for each other, feel close or support each other.
Domestic Violence – Domestic violence is a behavior used by one person in a relationship to gain power over or control the other. Abuse includes physical, sexual, emotional, economic or psychological actions or threats. This includes any behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure or wound someone.
Community Violence – A child either is hurt by violence or witnesses it. Sometimes a child only needs to hear about violence to experience trauma.
Substance Abuse – Someone in the child’s household abuses alcohol, street drugs or prescription drugs.
Mental Illness – Someone in the child’s household is depressed, has another mental illness and/or has attempted suicide.
Terrorism – A child either experiences or hears about terrorism, especially when it happens in a place the child believes should be safe. The child could experience even more traumatic stress if there are children among those who are injured or killed.
Flight from Home as a Refugee – A child has been uprooted from home, often after experiencing violence or intense fear of harm.

Learning how to cope with adversity is an important part of healthy childhood development, but when a child is exposed to a traumatic experience, it causes stress on brain development that needs to be addressed and "re-wired". We understand that how the brain develops in regards to stress is a crucial aspect to understand in order to be able to differentiate when a child is experiencing normal, healthy stress versus toxic stress. When the stress levels aren't regulated, a child can become cognitively impaired under stress, experience physical symptoms, rage, panic, or dissociation. The behaviors caused by trauma sometimes depend on a child’s age when the symptoms appear. However, some symptoms can affect all children, including:

Major changes in eating or sleeping
Nightmares
Anger or rage
Unreasonable fear
Unusually strong startle reactions

What is Post Traumatic Stress Disorder (PTSD)?
An acute post-traumatic change in feeling, thinking and behaving is normal – persistence or extreme symptoms are not. Many clinicians working with traumatized have noted that the persistence of symptoms beyond three months is associated with increased risk for problems. If symptoms of re-experiencing, avoidance, fearfulness, sleep problems, nightmares, sadness or poor school or social functioning persist beyond three-six months, they need to be addressed. 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.

What is the typical approach to treating trauma?
When we conduct our thorough assessment, we will learn about traumatic events that may also contribute to current levels of functioning. Research has shown that it is never too late to build resilience and process past traumas. This helps us understand how the brain developed and pathways we can work on in therapy to help re-build relationships and teach the child to regulate big emotions.

Our focus is on creating a therapeutic environment of trust and openness to change. Therapy is a safe place to work together with your child to build new neural pathways that can help your child learn how to stay in a window of tolerance when faced with stressors. The assessment includes:

Review of current symptoms, concerns, duration and intensity
A thorough review of child development and past medical history
Review of family systems
Additional important family background information including history of mental health issues

Then the best course of treatment is decided together with the caregivers. Parents and caregivers play a crucial role in treatment because family plays a crucial role in restoring balance to a child's perceived sense of insecurity. There are 4 dimensions of attachment that we will assess to determine where the imbalance has occurred for the child: Nurture, Engagement, Structure and Challenge. Coping skills and emotional attunement will be learned together with the parents and child, in order to assist in instilling coping skills with the affected child. Treatment may include a combination of the following:

EMDR, Eye Movement Desensitization and Reprocessing to resolve unprocessed traumas in the brain and fully integrate stored physiological trauma reactions causing maladaptive symptoms in the present
Theraplay® to learn emotional attunement and regulation to promote a child's sense of safety
Play therapy to assist child in expressing what is troubling them when they do not have the verbal language to express thoughts and feelings.
Family therapy including play to explore existing family dynamics and support a child's post traumatic growth
Trauma Focused Cognitive Behavior Therapy (TF CBT)- when self-regulation has already been achieved
Sensory based structured interventions to promote awareness of mind-body connection in healing trauma
Parenting support and psycho-education as needed to learn about common responses to trauma

When you bring your child to us for an intake assessment, we use evidence-based methods to gain perspective on the nature and intensity of your child's symptoms.

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