# data[].attributes.body
This video details the basic about what trauma is and how it effects us emotionally and socially.

Who can benefit and Why?

This resource shares that 70% of people experience one traumatic event in their lifetime. A common question when facing trauma is 'Why me?'. The first step of processing trauma is understanding the signs and what that may look like

# data[].attributes.body
"A traumatic event is a scary, dangerous, or violent event." When such events happen to a child fear, loss, and distress.

Who can benefit and Why?

This resources shares common experiences that may easily relate to trauma while other instances may not be viewed as such without outside context. Trauma puts children under significant stress such as feeling helpless, developing new fears, and regressing to baby talk.

# data[].attributes.attachment_link.description
A ( traumatic event is a scary, dangerous, or violent event. An event can be traumatic when we face or witness an immediate threat to ourselves or to a loved one, and it is often followed by serious injury or harm NCTSN Parents and Caregivers Website).

# data[].attributes.body
No matter the source of the Trauma, it has three common elements It was unexpected.

"It was unexpected.

The person was unprepared.

There was nothing the person could do to stop it from happening."

Who can benefit and Why?

One thing that is to be learned from this resource is the trauma is not in the person's control. Teachers and caregivers need this kind of resource to understand the why of it.

# data[].attributes.attachment_link.description
A traumatic event involves a single experience, or enduring
repeated or multiple experiences, that completely overwhelm
the individual’s ability to cope or integrate the ideas and
emotions involved in that experience.

# data[].attributes.body
Children are considered the most vulnerable when discussing the topic of trauma, stressful, events, and abuse.

Who can benefit and Why?

Parents and caregivers learning the amount of context and information children pick up based on the world around them. Children are a product of the people around them and depend of caretakers, parents, and teachers to provide comfort and stability.

# data[].attributes.attachment_link.description
Children are among the most vulnerable after traumatic events or disasters. Traumatic stress occurs when a child (0-18 years) feels intensely threatened by an event they experience or witness. Young people often need time and emotional support to feel secure again after experiencing trauma or a disaster. Their reactions are influenced by how parents, relatives, teachers, and caregivers respond. These individuals provide comfort and stability, and play a vital role by maintaining normal routines or establishing new ones after a crisis. With proper caregiving and access to trauma-informed services, many children recover and thrive.

# data[].attributes.body
A great resource explaining the lasting effects of trauma and stress on a developing child. Throughout childhood, the brain becomes adapted to survive a threatening and unpredictable world may not adjust well to a 'normal' environment.

# data[].attributes.attachment_link.title
Childhood Trauma and the Brain | UK Trauma Council

# data[].attributes.body
Trauma in children and effect their brain development in its most delicate stages. As each portion of the brain is responsible for basic human functions physically and emotionally. The brain develops from bottom to top. "...the higher parts of the brain develop throughout childhood and adolescence, and are responsible for more sophisticated functions..."

# data[].attributes.body
Bullying or peer victimization is the act "...deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful." Bullying is a form of complex trauma as it happens repeatively.

# data[].attributes.attachment_link.provider_name
The National Child Traumatic Stress Network

# data[].attributes.attachment_link.readable_text
Bullying, also known as peer victimization, is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful. Bullying typically happens repeatedly and is a form of aggression and harassment that prevents someone from enjoying a safe, stress-free living, learning, or working environment. The harmful effects of bullying may be exacerbated by the frequency, pervasiveness, and severity of the behavior, as well as the power differential between the perpetrator and the target. Bullying can be physical (hitting, tripping, kicking, etc.), verbal (name calling, teasing, taunting, threatening, and sexual comments), and social (spreading rumors, embarrasing someone in public, being purposefully exclusive). Cyberbullying includes sending negative, harmful, and/or false content electronically via text messages or email, as well as posting mean text or hurtful pictures online through social media, blogs, etc.

Bullying can severely affect a child's or teen's self-image, social interactions, or school performance, and can lead to mental health problems.

The following resources on Bullying were developed by the NCTSN.

# data[].attributes.attachment_link.description
Bullying is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful.

# data[].attributes.body
Yoga is a great way to align the mind and body both in adults and children.

Who can benefit and Why?

Teachers can use this as a calm down tool but also to smoothen transitions. This tool can be used to calm the body and relief built up stress in a child, as the breathing techniques used help calm the body.

# data[].attributes.attachment_link.readable_text
Yoga and You

When you hear the word yoga, do you think of a person with his legs twisted up like a pretzel? If so, it may seem like yoga is very complicated or just for adults. Not true!

Kids and teens can do yoga for the same reasons grown-ups do: because it feels good to stretch out your body, slow down your breathing, and relax your mind. Yoga can help you feel calmer when life is busy and stressful. Aaahh...

What You Need

Anytime you start a new exercise routine, it's a good idea to check with a parent. A yoga class can be a great way to get started because the instructor can teach you how to get into the poses.

Find a large-enough space with few distractions. No TV or people, if possible. Wear comfortable workout clothes and no shoes or socks. A yoga mat can be helpful because it cushions a bit and keeps your feet from slipping. Yoga should not hurt, so go slow and ease into position. Go only as far as you comfortably can.

Why Yoga for Stress?

When you get stressed or nervous, many things can help you feel better. Talking with someone - a parent, friend, or school counselor - is a great idea because they can help you figure out what's wrong and start coming up with solutions.

In addition, you can ease stress through exercise. You probably know exercise is good for your health, but it's also a proven way to put you in a better mood. So it makes sense that yoga is a favorite activity among people who want to feel stronger and more relaxed.

Yoga includes a lot of stretching, but that's not all. Yoga also focuses on breathing and meditation, which means thinking calm thoughts. Practicing yoga is a chance to learn stretching/breathing/thinking skills that you can use to calm yourself down the next time you feel worried or overwhelmed. In other words, yoga can help your body stay loose and relaxed when things heat up!

Think Good Thoughts

Meditation is part of a stress-relieving yoga practice. Meditation means being calm, quiet, and focused. Some people call this "feeling centered." When you are feeling centered, you can do your best in stressful situations such as taking a test or working through a disagreement with a friend.

Try these meditation exercises:

Take a yoga vacation: Find a quiet, private place, like your bedroom. Sit in a comfortable position and close your eyes. Imagine a place where you feel safe and relaxed. Is it your best friend's backyard? Your grandma's house? Camping in the woods? Imagine yourself in this place for 3-5 minutes. You'll feel much calmer after your "yoga vacation."

Positive pictures: When you're feeling stressed about a big test, game, or performance, it can help to imagine it going really well. Sit in a comfortable position and close your eyes. Picture yourself feeling prepared for your test, kicking the winning goal in soccer, or reading your lines and getting a laugh from the audience. Of course, positive pictures can't take the place of actual preparation, but can help you feel confident!

If you meditate for just 5 minutes a day, it will help you feel good even when you're not meditating. The more you do it, the more it becomes part of your routine, like brushing your teeth or lacing up your cleats before a soccer game.

Breathe Deep

On one hand, you already know how to breathe. You're doing it right now! But learning how to breathe in yoga practice can help you notice how your breathing changes when you're anxious or upset. Often, when you start to feel nervous or uncomfortable, your breathing may get faster and you might not breathe as deeply. Once you tune in to your breath, you can try belly breathing.

Get Up and Move!

There are many different yoga poses. Some can help you stretch the neck, shoulders and back, which are most likely to get tense when you are nervous or stressed.

Try these two yoga poses when you want to de-stress yourself:

Surprise/Sourpuss: Open your mouth wide and bug out your eyes, then scrunch your face up into a little ball and pucker your lips. Alternate back and forth between "surprise" and "sourpuss." Do this while you're studying at home to help loosen up your face and jaw, which can get really tense while you're studying. If you have a study partner, make a game of it! Who can make the silliest face?

Shoulder gymnastics: Do a few gentle shoulder rolls right before a test to keep your shoulders nice and loose while you work. You can even do them during a test if you need a refreshing break.

Have Fun With Yoga

Yoga can help you in serious ways, but it also can be a lot of fun. You can smile during yoga, and even laugh, which is a great stress reliever too. Yoga can be done alone or with friends. And you can do it at home, at a yoga studio, or in the park.

We'll end with a special Sanskrit greeting - namaste (say: NAH-mus-tay). It's traditionally said at the end of a yoga practice and it means the light inside of me bows to the light inside of you. Namaste.

# data[].attributes.attachment_link.description
When you hear the word yoga, do you think of a person with his legs twisted up like a pretzel? If so, it may seem like yoga is very complicated or just for adults. Not true!

# data[].attributes.body
"Adverse childhood experiences (ACEs) are traumatic events that happen between ages 1 and 17. These negative experiences affect a child’s brain and health as they grow into adults. ACEs can lead to mental health or chronic health conditions. " Lifelong treatment and management of ACE's help children have fulfilling adult lives.

ACE's may effect's a person life, leading to mental health conditions such as behavior and drug problems. Child are like a sponge absorbing both the good and bad.

# data[].attributes.attachment_link.title
Adverse Childhood Experiences (ACEs) & Childhood Trauma

# data[].attributes.attachment_link.description
Adverse childhood experiences (ACEs) are traumatic events that happen between the ages of 1 and 17. ACEs affect a person’s overall health.

# data[].attributes.body
PEARLS is a screener in order to identify if you may have had adverse childhood experiences. This questionnaire goes through possible situations in which ACE's is more common such as close family member is prison, witnessing violence, and issues with housing.

# data[].attributes.body
Being knowledgeable of adverse childhood experiences can be a useful tool both as a parent and an educator. This resources touches on the outside factors that may lead to ACE's but also stability in the household plays a role as well. "Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with:"

Drug issues, homeless, bouncing from home to home, foster care, instability due to separation.

# data[].attributes.attachment_link.description
Overview of adverse childhood experiences, the latest data, and CDC’s approach to prevention.

# data[].attributes.body
This resource has many paths in useful information around the concept of ACES. This includes community and classroom resources. There are many organizations with info about how to manage, help, and work with children with adverse childhood experiences. "A collection of resources on Adverse Childhood Experiences (ACEs) including organizations, websites, articles, books, tip sheets, etc. suggested by the authors of articles in this issue of Network."

# data[].attributes.attachment_link.title
ACEs Resources for Family Life Educators

# data[].attributes.attachment_link.description
See all articles from this issue A collection of resources on Adverse Childhood Experiences (ACEs) including organizations, websites, articles, books, tip sheets, etc. suggested by the authors of articles in this issue of Network. Organizations and Websites

# data[].attributes.body
This resource dives deep into the science of the damage of adverse childhood experiences. Children go through a great deal of stress emotionally processing such events and left unprocessed trauma can lead to more mental health and physical issues. "ACEs are strongly associated, in a dose-response fashion, with some of the most common, serious, and costly health conditions facing our society today, including nine of the 10 leading causes of death in the U.S., as well as earlier mortality. "

# data[].attributes.attachment_link.title
The Science of ACEs & Toxic Stress - ACEs Aware

# data[].attributes.attachment_link.description
Clinical teams have an important role to play in screening for ACEs and preventing and treating toxic stress to improve patients’ physical and mental health.

# data[].attributes.body
Adverse Childhood Experiences or ACEs has a large impact on the brain, as the constant flight or fight and lack of stability along with other factors can lead to issues for the child. That can be sensory, behavioral, or attachment issues.

The stress system of the child may be overloaded and cause things such a sickness, infection, and disease.

# data[].attributes.attachment_link.title
Adverse Childhood Experiences (ACEs): Impact on brain, body and behaviour

# data[].attributes.body
Adverse childhood experiences can be attached to risky health behaviors, chronic health conditions, and low life quality. Factors such as family income may play a role in the well being and treatment of the child. " In the United States, it’s estimated that almost half of children have experienced at least one ACE and one fourth have experienced two or more. The wide-ranging health and social consequences of ACEs underscore the importance of preventing them before they happen."

# data[].attributes.attachment_link.title
Michigan Health Improvement Alliance :: Adverse Childhood Experiences (ACES)

# data[].attributes.body
Prolonged stress and trauma in early childhood changes the chemistry of your brain, which activates multiple in body systems to respond to constant threats.

" Activation of our stress response systems produces a wide range of physiological reactions that prepare the body to deal with challenges or threats, including increased heart rate, elevated blood pressure, and the release of stress hormones like cortisol."

# data[].attributes.attachment_link.provider_name
Center on the Developing Child at Harvard University

# data[].attributes.attachment_link.title
Toxic Stress - Center on the Developing Child at Harvard University

# data[].attributes.attachment_link.description
Learn how safe, stable developmental environments, including responsive relationships with caring adults, can help buffer against sources of stress, supporting early development and lifelong health.

# data[].attributes.body
This piece of literature highlights the adverse health and disease effects when put through trauma, specifically Chapter 11 Section 2 details into the biological side. Including differences of Parental Violence Abuse, Peer Abuse, or Witnessing Domestic Violence.

# data[].attributes.attachment_link.readable_text
Summary

This chapter presents new data suggesting that there are sensitive periods when particular brain regions may be most susceptible to the effects of abuse. New findings looking at the neurobiological correlates of exposure to other forms of adversity is considered including parental verbal abuse (PVA), peer verbal bullying (VB) and witnessing domestic violence (WDV). The effect of childhood trauma on the development of the left versus right hemisphere was investigated using electroencephalograph (EEG) coherence, which provides information regarding the nature of the brain's wiring and circuitry. Childhood maltreatment research has focused primarily on the effects of physical abuse (PA), sexual abuse (SA) or WDV. By comparison, PVA has received little attention as a specific form of abuse. Childhood adversity accounts for 50-75% of the population attributable risk for alcoholism, depression, suicidal behavior and drug abuse.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

# data[].attributes.attachment_link.title
Neurobiology of childhood trauma and adversity (Chapter 11) - The Impact of Early Life Trauma on Health and Disease

# data[].attributes.attachment_link.description
The Impact of Early Life Trauma on Health and Disease - August 2010

# data[].attributes.body
Although in the past the childhood trauma could be defined as acts of commission, whether that meant physical abuse, starvation, etc. This resource touches on another sector of this trauma named 'Acts of Omission' such as allowing child to witness domestic violence.

# data[].attributes.attachment_link.title
The neurobiological effects of childhood maltreatment

# data[].attributes.attachment_link.description
This paper reviews some of the recent research that has analysed the outcomes of child maltreatment as seen through the lens of the disciplines of neuroscience, psychopathology, traumatology and related fields.

# data[].attributes.body
This documentary details how although harsh words and actions may hurt a child's feelings, it also shapes the developing brain. Their threat response system, meant to protect them is sent into overdrive. This turns the world dark quickly, as fear becomes the main emotion.

# data[].attributes.attachment_link.title
When Words Leave Scars: The Neuroscience of Childhood Verbal Abuse

# data[].attributes.body
This resource dives into the function of the Amygdala in a child's brain. As the main role of this portion of the brain is to process emotions such as fear and

anxiety. When a child faces trauma, it becomes overactive.

# data[].attributes.attachment_link.title
The Neurobiology of Childhood Trauma: Insights into Brain Development

# data[].attributes.attachment_link.description
Discover the profound impact of childhood trauma on brain development.

# data[].attributes.body
In this resource, early childhood trauma can be defined as s subject of early experiences that overwhelm a child's ability maintain their integrity physiologically. " Furthermore, the effects of early-life trauma can extend into adulthood, influencing emotional regulation, stress responses, and social relationships."

# data[].attributes.attachment_link.title
Childhood and Trauma: A Neuroscience Perspective | OxJournal

# data[].attributes.attachment_link.description
Acheson, D.T., Gresack, J.E. and Risbrough, V.B. (2012). Hippocampal Dysfunction Effects on Context memory: Possible Etiology for Posttraumatic Stress Disorder. Neuropharmacology, 62(2), pp.674–685. doi:https://doi.org/10.1016/j.neuropharm.2011.04.029.

# data[].attributes.body
From the Trauma Center located in Boston, MA dives into the rapid progression of the understanding of traumatic life experiences and the long effects. Trauma is early childhood can affect what the child will anticipate, organize, and process incoming information. "In the United States, approximately 3 million children are reported for abuse or neglect each year [11]; at least 15 out of every 1000 children in the United States have substantiated histories of abuse."

# data[].attributes.body
Communities Together for Children shares the long lasting effects childhood trauma creates, this except from the article reads, " The limbic system is primed to remain on alert. With an alarm system stuck on “high,” people impacted by trauma startle easier, have trouble accurately reading faces and social cues, have difficulty sleeping, and tend to avoid situations that increase stress." As the little stressors in adult life begin to pile up, adults are also need to develop phobias, fears, and avoidances.

# data[].attributes.attachment_link.description
The body’s reaction to traumatic events sets up a number of changes in the brain. When we perceive danger, the limbic system (located in the midbrain, above the brain stem) acts as our internal alarm. When we sense danger, it goes into action and cues the adrenal glands to release stress hormones. T…

# data[].attributes.body
Cyberbullying is bullying with the use of technology, this can take place on social media, gaming platforms and phones. It is repeated targeted behavior, or a form of complex trauma. Examples of this include:

-Spreading lies about or posting embarrassing photos or videos of someone on social media

-Sending hurtful, abusive or threatening messages, images or videos via messaging platforms

# data[].attributes.attachment_link.title
Cyberbullying: What is it and how to stop it

# data[].attributes.attachment_link.description
What teens want to know about cyberbullying

# data[].attributes.body
"Cyberbullying can occur through SMS, Text, and apps, or online in social media, forums, or gaming where people can view, participate in, or share content." This resource details into the concerning and complex terms of this type of bullying as this form is Permanent, Persistent, and hard to notice from the outside looking in. Being knowledgable of the signs of it may help a child suffering silently.

# data[].attributes.attachment_link.readable_text
Cyberbullying is bullying that takes place over digital devices like cell phones, computers, and tablets. Cyberbullying can occur through SMS, Text, and apps, or online in social media, forums, or gaming where people can view, participate in, or share content. Cyberbullying includes sending, posting, or sharing negative, harmful, false, or mean content about someone else. It can include sharing personal or private information about someone else causing embarrassment or humiliation. Some cyberbullying crosses the line into unlawful or criminal behavior.

The most common places where cyberbullying occurs are:

Social Media, such as Facebook, Instagram, Snapchat, and Tik Tok

Text messaging and messaging apps on mobile or tablet devices

Instant messaging, direct messaging, and online chatting over the internet

Online forums, chat rooms, and message boards, such as Reddit

Email

Online gaming communities

Special Concerns

With the prevalence of social media and digital forums, comments, photos, posts, and content shared by individuals can often be viewed by strangers as well as acquaintances. The content an individual shares online - both their personal content as well as any negative, mean, or hurtful content - creates a kind of permanent public record of their views, activities, and behavior. This public record can be thought of as an online reputation, which may be accessible to schools, employers, colleges, clubs, and others who may be researching an individual now or in the future. Cyberbullying can harm the online reputations of everyone involved - not just the person being bullied, but those doing the bullying or participating in it. Cyberbullying has unique concerns in that it can be:

Persistent - Digital devices offer an ability to immediately and continuously communicate 24 hours a day, so it can be difficult for children experiencing cyberbullying to find relief.

Permanent - Most information communicated electronically is permanent and public, if not reported and removed. A negative online reputation, including for those who bully, can impact college admissions, employment, and other areas of life.

Hard to Notice - Because teachers and parents may not overhear or see cyberbullying taking place, it is harder to recognize.

Laws and Sanctions

All states have laws requiring schools to respond to bullying. As cyberbullying has become more prevalent with the use of technology, many states now include cyberbullying, or mention cyberbullying offenses, under these laws. Schools may take action either as required by law, or with local or school policies that allow them to discipline or take other action. Some states also have provisions to address bullying if it affects school performance. You can learn about the laws and policies in each state, including if they cover cyberbullying.

Frequency of Cyberbullying

There are two sources of federally collected data on youth bullying:

The 2019 School Crime Supplement to the National Crime Victimization Survey (National Center for Education Statistics and Bureau of Justice) indicates that, nationwide, about 16 percent of students in grades 9-12 experienced cyberbullying.

The 2021 Youth Risk Behavior Surveillance System(Centers for Disease Control and Prevention) indicates that an estimated 15.9% of high school students were electronically bullied in the 12 months prior to the survey.

See also " Frequency of Bullying."

# data[].attributes.attachment_link.description
Cyberbullying is bullying that takes place over digital devices like cell phones, computers, and tablets.

# data[].attributes.body
While bullying existed prior to technology the smart phones have brought a new and very public arena when engaging in directive threatening behavior. "Nearly half of U.S. teens ages 13 to 17 (46%) report ever experiencing at least one of six cyberbullying behaviors asked about in a Pew Research Center survey conducted April 14-May 4, 2022" As research provided the answer that name calling is the most common crime, whether through social media, SMS, or gaming consoles.

# data[].attributes.attachment_link.title
Teens and Cyberbullying 2022 | Pew Research Center

# data[].attributes.attachment_link.description
Nearly half of U.S. teens have been bullied or harassed online, with physical appearance being seen as a relatively common reason why.

# data[].attributes.body
"Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words, or more subtle actions." Cyberbullying can be acts of threatening behavior within the use of technology. A bullied child typically has trouble defending themselves and finding the why of this treatment by this individual.

# data[].attributes.attachment_link.readable_text
Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words, or more subtle actions.

The bullied individual typically has trouble defending him or herself and does nothing to "cause" the bullying.

Cyberbullying is verbally threatening or harassing behavior conducted through such electronic technology as cell phones, email, social media, or text messaging.

Adapted from APA Dictionary of Psychology

# data[].attributes.attachment_link.description
Bullying is aggressive physical contact, words or actions to cause another person injury or discomfort. Cyberbullying uses an electronic device for acts such as threatening emails.

# data[].attributes.body
Episode 33 of the Speaking Of Psychology Podcast dives into a deep topic of bullying and school violence and how to put an end to it. The expert Dorothy Espelage, PhD breaks down the importance of these prevention programs and its effectiveness.

# data[].attributes.attachment_link.title
Putting an end to bullying and school violence, with Dorothy Espelage, PhD

# data[].attributes.attachment_link.description
Dorothy Espelage, PhD, talks about the effectiveness of anti-bullying programs and what parents and schools can continue to do to curb everything from cyberbullying to dating violence.

# data[].attributes.body
Although both forms of bullying can be damaging to a child's health both mentally and physically. Cyberbullying and typical bullying poses quite a few differences including :

-"Anonymous - people can hide their identities when they are online or using a cell phone

-Persistent - people can send messages instantly, at any time of the day or night

-Permanent - a lot of electronic communication is permanent and public, unless it's reported and removed. A bad online reputation can affect getting into college, getting a job, and other areas of life. This applies to the bully as well.

-Hard to notice - teachers and parents may not overhear or see cyberbullying taking place"

# data[].attributes.attachment_link.readable_text
What is bullying?

Bullying is when a person or group repeatedly harms someone on purpose. It can be physical, social, and/or verbal. It is harmful to both the victims and the bullies, and it always involves:

Aggressive behavior.

A difference in power, meaning that the victim is weaker or is seen as weaker. For example, bullies may try to use physical strength, embarrassing information, or popularity to harm others.

Repetition, meaning it happens more than once or that it probably will happen again

What are the types of bullying?

There are three types of bullying:

Physical bullying involves hurting a person's body or belongings. Examples include hitting, kicking, and stealing or breaking someone's stuff.

Social bullying (also called relational bullying) hurts someone's reputation or relationships. Some examples are spreading rumors, embarrassing someone in public, and making someone feel left out.

Verbal bullying is saying or writing mean things, including name-calling, taunting, and threatening

What is cyberbullying?

Cyberbullying is bullying that happens through text messages or online. It could be through emails, social media, forums, or gaming. Some examples are:

Posting rumors on social media

Sharing embarrassing pictures or videos online

Sharing someone else's private information online (doxing)

Making threats against someone online

Creating fake accounts and posting information to embarrass someone

Certain types of cyberbullying can be illegal. The laws on cyberbullying are different from state to state.

How is cyberbullying different from bullying?

Cyberbullying is a type of bullying, but there are some differences between the two. Cyberbullying can be:

Anonymous - people can hide their identities when they are online or using a cell phone

Persistent - people can send messages instantly, at any time of the day or night

Permanent - a lot of electronic communication is permanent and public, unless it's reported and removed. A bad online reputation can affect getting into college, getting a job, and other areas of life. This applies to the bully as well.

Hard to notice - teachers and parents may not overhear or see cyberbullying taking place

Which children are more likely to be bullied?

Children are more likely to be bullied if they:

Are seen as different from their peers, such as being overweight or underweight, dressing differently, or being of a different race/ethnicity

Are seen as weak

Have depression, anxiety, or low self-esteem

Don't have many friends or are less popular

Don't socialize well with others

Have an intellectual or developmental disability

Which children are more likely to be bullies?

There are two types of children who are more likely to bully others:

Children who are well-connected to peers, have social power, are overly worried about popularity, and like to be in charge of others

Children who are more isolated from peers, may be depressed or anxious, have low self-esteem, are easily pressured by peers, and have trouble understanding other people's feelings

There are certain factors that make someone more likely to be a bully. They include:

Being aggressive or easily frustrated

Having trouble at home, such as violence or bullying in the home or having uninvolved parents

Having trouble following rules

Seeing violence positively

Having friends who bully others

What are the effects of bullying?

Bullying is a serious problem that causes harm. And it doesn't just hurt the person who is being bullied; it can also be harmful for the bullies and for any kids who witness the bullying.

Kids who are bullied can have problems at school and with their mental and physical health. They are at risk for:

Depression, anxiety, and low self-esteem. These problems sometimes last into adulthood.

Health complaints, including headaches and stomachaches

Lower grades and test scores

Missing and dropping out of school

Kids who bully others have a higher risk for substance use, problems in school, and violence later in life.

Kids who witness bullying are more likely to abuse drugs or alcohol and have mental health problems. They may also miss or skip school.

What are the signs of being bullied?

Often, kids who are being bullied don't report it. They may fear a backlash from the bully, or they may think that no one cares. Sometimes they feel too ashamed to talk about it. So it is important to know the signs of a bullying problem:

Depression, loneliness, or anxiety

Low self-esteem

Headaches, stomachaches, or poor eating habits

Disliking school, not wanting to go to school, or getting worse grades than before

Self-destructive behaviors, such as running away from home, harming themselves, or talking about suicide

Unexplained injuries

Lost or destroyed clothing, books, electronics, or jewelry

Trouble sleeping or frequent nightmares

Sudden loss of friends or avoidance of social situations

How do you help someone who is being bullied?

To help a child who is being bullied, support the child and address the bullying behavior:

Listen and focus on the child. Learn what's been going on and show you want to help.

Assure the child that bullying is not his/her fault

Know that kids who are bullied may struggle with talking about it. Consider referring them to a school counselor, psychologist, or other mental health service.

Give advice about what to do. This may involve role-playing and thinking through how the child might react if the bullying occurs again.

Work together to resolve the situation and protect the bullied child. The child, parents, and school or organization should be part of the solution.

Follow up. Bullying may not end overnight. Make sure that the child knows that you are committed to making it stop.

Make sure that the bully knows that his or her behavior is wrong and harms others

Show kids that bullying is taken seriously. Make it clear to everyone that the bullying will not be tolerated.

Department of Health and Human Services

# data[].attributes.attachment_link.description
Bullying is when a person or group repeatedly harms someone on purpose. Cyberbullying is bullying that happens through text messages or online. Both can cause lasting harm. Learn the signs of bullying, and how to help a child who is being bullied.

# data[].attributes.body
This resource provides a large arrangement of data surrounding both bullying and cyberbullying. Many of these numbers are very eye opening as 1 in 5 children reported being bullied at some point in their lives, as females are more likely then men. "Among all students who experienced various types of bullying, the most common forms of bullying were spreading rumors (13.0%) and being made fun of or called names (11.9%). (National Center for Education Statistics, 2022"

# data[].attributes.attachment_link.description
Almost one out of every four students (22%) report being bullied during the school year (National Center for Educational Statistics, 2015). Rates of bullying vary across studies (from 9% to 98%).

# data[].attributes.body
In order to help a child that is facing bullying, knowledge of the signs can help you identify this sooner. Characteristics to look out for include things such as: "belongings getting 'lost' or damaged, physical injuries, such as unexplained bruises, being afraid to go to school, being mysteriously 'ill' each morning, or skipping school" A final sign often looked past is the bullied child also bullying.

# data[].attributes.attachment_link.readable_text
Call out bullying with WWE

We've partnered with the WWE to Call out Bullying. Together we're helping young people understand why bullying is never okay and what to do if they experience or witness it.

WWE stars are touring the country and sharing advice and support on social media to help children stay safe from bullying.

Bullying and cyberbullying can happen to any child. We've got advice to help keep children safe from bullying, wherever it happens.

# data[].attributes.attachment_link.description
We've partnered with the WWE to Call out Bullying. Together we're helping young people understand why bullying is never okay and what to do if they experience or witness it. WWE stars are touring the country and sharing advice and support on social media to help children stay safe from bullying.

# data[].attributes.body
This resource shares that generally experts agree on three things when it comes to bullying "the intent to harm, the power imbalance, and repeated acts or threats of violent behavior." Most view childhood bullying as just teasing but the long term effects have been thoroughly researched.

# data[].attributes.attachment_link.readable_text
With an estimated prevalence rate of 32% in schools and 30% in workplaces, bullying remains a complicated and devastating epidemic in the UK - and it's prevalence is further increasing through cyberbullying.
Experts agree that bullying generally entails three key elements:

an intent to harm

a power imbalance

repeated acts or threats of aggressive behaviour

and can be defined as a 'long-lasting and systematic form of interpersonal aggression where an individual is persistently and over time exposed to negative actions from superiors, co-workers or other students, and where the target finds it difficult to defend her-/himself against these actions.'

These negative actions can take the form of verbal hostility, aggressive behaviour, threats, physical violence, inappropriate comments, spreading rumours, social exclusion, and much more.

Many people view childhood bullying as 'just teasing' or 'something to just ignore' despite the severe long-term effects of bullying being relatively well documented.

Research has shown that 40.5% of girls and 27.6% of boys show PTSD symptoms at the time of being bullied, and approximately 20% of people who have been bullied experience some kind of mental health problems later in life, and an increased risk of suicide and substance abuse.

How can bullying cause PTSD?

Post-Traumatic Stress Disorder (PTSD) is a condition that some people develop after experiencing or witnessing a traumatic event. The defining characteristic of a traumatic event is its capacity to provoke fear, helplessness, or horror in response to the threat of injury or death and therefore can affect anyone, including victims of bullying.

Studies have shown that 'experiencing bullying is the strongest predictor of developing PTSD symptoms. This surpassed physical abuse, neglect, and exposure to community violence. Another literature review examining 29 relevant studies on bullying and harassment found that 57% of victims scored above the threshold for meeting PTSD criteria.'

'When you are a victim of bullying or harassment, you can experience a wide range of emotions, ranging from mild embarrassment to extreme fear as a result of being in danger where your safety is compromised. Bullying is a distinct social stressor because it represents a systematic form of interpersonal aggression coupled with intense feelings of powerlessness and defencelessness' - a 'perfect storm' for PTSD to develop.

'When a person is repeatedly bullied or harassed, they experience continued negative reinforcement, systematic abuse of power, and ongoing intimidation and emotional pain. And those who are bullied as children tend to have a greater risk of being bullied in their adult lives. The characteristic symptoms that develop as a result of bullying (feelings of powerlessness, helplessness, anger, fear) are also strongly correlated with that of PTSD, making it more likely that a person who was bullied would develop the disorder.'

It's worth noting too, that PTSD can also be caused by an 'accumulation of many small, individually non-life-threatening incidents' - which is sometimes the case with bullying - and this is often referred to as Complex PTSD (C-PTSD). 'With complex PTSD, victims are "held captive" by their situations. Children who are subject to regular bullying may not have any way out of what they perceive as a trapped situation. Reporting incidents to teachers or other authority figures can be a daunting prospect, as this sort of "tattletale" behaviour is so apt to exacerbate the bullying instead of halting it.'

How to spot PTSD in children as a result of bullying

While PTSD symptoms are similar in adults and children, there are a few things that are different - especially if it's a result of bullying.

School-Aged Children (Ages 5-12)

'Children often do not have As a result, they believe that if they pay attention they can avoid future issues of bullying. This belief can cause flashbacks or problems remembering parts of the trauma or bullying the way adults with PTSD often do. But, they might put the events of the bullying in the wrong order. Kids also might believe that there were signs that the bullying was going to happen. hypervigilance.

Sometimes kids will show signs of PTSD in their play. For instance, they might keep repeating a part of the trauma over and over while playing. While they may be playing this way to try to overcome or make sense of what they experienced, they will not be successful in alleviating their distress. Unfortunately, this type of play will rarely diminish their worries. Kids also may fit parts of the trauma into their daily lives. For example, a child might carry a baseball bat to school for protection especially if a bully threatened him with a baseball bat.

Because teens are approaching adulthood, some PTSD symptoms in teens begin to look like those of adults. For instance, they may have upsetting thoughts or memories, recurring nightmares, flashbacks, and strong feelings of distress when reminded of the event. The one difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviours. What's more, even though kids may be plagued by thoughts of painful experiences, this does not mean they are easily observable. In fact, kids often suffer in silence.

In addition to PTSD, children, and teens often experience other effects of bullying including fear, worry, sadness, anger, loneliness, low self-worth, inability to trust others, depression, and sometimes even thoughts of suicide.'

Bullying in the workplace

As we've mentioned, bullying doesn't just affect children at school - and as adults, it can be dismissed or excused so easily by people saying things like 'it's just his robust management style' to 'it's just a bit of banter'.

Workplace bullying is defined as 'repeated, unreasonable actions of individuals (or a group) directed towards an employee (or a group of employees), which are intended to intimidate, degrade, humiliate, or undermine; or which create a risk to the health or safety of the employee(s). It is a systematic campaign of interpersonal destruction that can jeopardise your health, your career and your confidence.'

A recent survey sponsored from TUC found that ' 1 in 3 employees felt they had been bullied at work and 30% have witnessed bullying in the workplace. Bullying currently causes the loss of 18 million working days every year at a cost of £13.75 billion a year to the UK economy, from sickness related absences, staff turnover and the reduction of productivity.'

Treatment for PTSD following bullying

It is possible for PTSD and C-PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help, even if your PTSD is a result of bullying when you were much younger.

For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy. NICE guidance (updated in 2018) recommends trauma-focused psychological treatments such as EMDR, and trauma-focused cognitive behavioural therapy ( CBT). You may also want to explore holistic non-pharmacological therapies, or talk to your doctor about treatment with appropriate prescription drugs.

Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD and C-PTSD.

It's worth noting too, that many victims of bullying with PTSD also benefit from ' complementary therapy methods that help improve their sense of self-esteem and well-being'. Generally, this is because 'bullying and harassment can severely impact a person's confidence, it is essential that they learn the appropriate tools for rebuilding a positive perception of themselves' alongside getting treatment for their PTSD.

What should I do if I think I, or my child, has PTSD?

The only way to know for sure, and get a formal diagnosis of PTSD is to talk to a medical professional.

In the UK, this usually begins with a trip to your GP. They will ask about your symptoms, how you've been feeling, and perhaps ask a little about your trauma (if you feel comfortable discussing it).

Your GP will be mindful of PTSD if you've experienced a trauma and have:

re-experiencing symptoms

avoidance symptoms

arousal and reactivity symptoms

cognition and mood symptoms

If they suspect PTSD, it's likely they would then refer you to your local community mental health team for an appointment to get a full diagnosis and to discuss treatment options further. There are a number of mental health specialists you may see if you have PTSD, such as a psychologist, community psychiatric nurse or psychiatrist. Find out more about what to do if you think you have PTSD here.

You can get more information about PTSD in children here.

What can be done to prevent bullying?

It goes without saying that prevention of bullying in schools and workplaces can reduce traumatic experiences and therefore PTSD development.

In terms of schools, 'this takes a vigilant approach on the part of parents and especially on the part of school administrators, as school is the most common place that children experience the harassment of bullying.'

Additionally, it's important to note that if bullying reports go ignored or dismissed, children may also feel they have no support from teachers, parents, or other authority figures. As PTSD is more likely to develop if the trauma produces feelings of helplessness it's vital that any reports are investigated and dealt with as quickly as possible.

With regards to workplaces, one study showed '43% of those bullied at work reported that harassment stemmed from a line manager, with 38% saying that it came from colleagues. One in five had suffered bullying from a senior manager or chief executive' so it can feel very difficult to report bullying to your employer.

As bullying affects the overall "health" of an organisation, fostering 'a culture that is free from bullying behaviour is vital and needs to come from the top down. Management commitment is the most important component of preventing bullying in the workplace and is best demonstrated through a robust policy structure which is communicated to all staff.

Bullying and harassment can be verbal, non verbal, written, or physical so your policy should be comprehensive and one that covers a range of incidents, from bullying and harassment to physical violence.'

For more information and support from bullying, there are a variety of charities and organisations including:

BullyingUK is a leading anti-bullying charity in the UK. The charity provides practical information and advice to young people and their parents through its website and via email. Their support includes work with schools, youth organisations, police forces and health trusts, running workshops and speaking at conferences.

ChildLine is the UK's free, 24-hour confidential helpline for children and young people who need to talk. Trained counsellors are there to provide comfort, support and advice about any problem that's on your mind. Contact them 24 hours a day, every day, by phone or via their website. Helpline: 0800 1111 (calls are free from all existing networks - landline and mobile)

The Cybersmile Foundation offers support, advice and guidance to people of all ages who have been affected by cyberbullying and online hate campaigns. Their services are used by schools, parents and young people all over the world and the helpline is open 24 hours.

BulliesOut was established in May 2006, we are one of the UK's most dedicated and ambitious anti-bullying charities. Our award winning work is delivered across the UK and each year, through our work with individuals, schools, youth and community settings and the workplace, we provide education, training and support to thousands of people. Through our innovative, interactive workshops and training programmes, we use our experience, energy and passion to focus on awareness, prevention, building empathy and positive peer relationships all of which are crucial in creating a nurturing environment in which young people and adults can thrive.

# data[].attributes.attachment_link.description
With an estimated prevalence rate of 32% in schools and 30% in workplaces, bullying remains a complicated and devastating epidemic in the UK - and it's prevalence is further increasing through cyberbullying.

# data[].attributes.body
Kaplan, which is an early learning supply company has resources that may help children with sensory disorders. This support kit comes with a variety of materials in order to fulfill the child's needs. Books, fidgets, seat covers, and more

# data[].attributes.attachment_link.description
4 years & up. Perfect for those working with children who have sensory processing disorder (SPD), this set has everything you need to understand and support children with SPD as well as build a sensory-friendly environment for all children. The set features “Wired Differently: A Teacher’s Guide to Understanding Sensory Processing Challenges,” a 2.5 pound weighted lapdog, three textured fidgets, four liquid visual timers, flexible wiggle seats, mindfulness activity cards, and more! Chair pictured in image is not included. Contents may vary.

# data[].attributes.body
"Early trauma and neglect can have a profound effect upon a child's development. Sensory integration theory offers a way of understanding how the brain processes and stores movement experience, and how these experiences manifest at a physical and emotional level." This book details the importance of sensory integration and how trauma may effect the pathways of processing.

# data[].attributes.attachment_link.title
Improving Sensory Processing in Traumatized Children

# data[].attributes.attachment_link.description
Improving Sensory Processing in Traumatized Children [Lloyd, Sarah] on Amazon.com. *FREE* shipping on qualifying offers. Improving Sensory Processing in Traumatized Children

# data[].attributes.body
This video reviews the signs of sensory processing disorders due to trauma. Signs include impulsivity, disorganization, and avoidance of certain stimuli. Responses to these stimuli can either be heightened or blunt. "Understanding how trauma impacts sensory processing is essential, especially for those who have experienced significant or repeated traumatic events."

# data[].attributes.attachment_link.title
What Are The Signs Of Sensory Processing Issues Related To Trauma? - First Response Medicine

# data[].attributes.body
Yoga can be a great way to connect the mind and body, "Here, founder of The Minded Institute, Heather Mason, explains why these findings are so crucial for trauma informed yoga teaching and yoga therapy for PTSD, particularly given that yoga is a practice in which a great deal of somatosensory information is being provided."

# data[].attributes.body
This resource explains how trauma rewires the brain in the instance of sensory and disrupts key connections in early childhood. The result of this is sensory issues in children that may carry with them throughout adulthood. When the needs are not met, the children are not getting the input they need.

# data[].attributes.attachment_link.title
Trauma-Informed Care - Regulation and Sensory Processing

# data[].attributes.headline
Implications of Sensory When Faced With Trauma

# data[].attributes.subject
Implications of Sensory When Faced With Trauma

# data[].attributes.body
"Sensory processing refers to the ability to register, modulate, and organize incoming sensory information from one’s internal and external worlds, and in turn, guides adaptive and goal-oriented behavioral responses to sensory stimuli."

Our internal world includes things such as internal temperature, emotions, and perception of self. External factors are outside factors like sound, visuals, and touch.

# data[].attributes.attachment_link.title
Frontiers | How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD

# data[].attributes.attachment_link.description
Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks a…

# data[].attributes.body
"Our ability to absorb and process the sensory information we receive from our environment has an impact on our behavior, our ability to communicate, our attachments, our coordination and our daily living skills."

Children who have been put through serve abuse and neglect have a difficult time dealing with stress. This can be viewed as a spectrum as both displaying fight, flight, or freeze responses.

# data[].attributes.attachment_link.title
Sensory Processing and Trauma Nottinghamshire County Council

# data[].attributes.attachment_link.description
Our ability to absorb and process the sensory information we receive from our environment has an impact on our behaviour, our ability to communicate, our attachments, our coordination and our daily living skills. Children who have suffered abuse or severe neglect in the womb or early childhood may have difficulties coping with stress. These children are often hyper-vigilant and have a tendency to react to seemingly “normal” situations with a fight, flight or freeze response. This can affect their capacity to filter out irrelevant sensory information such as background sounds as they have become sensitised to the possibility of danger.

# data[].attributes.body
Trauma is not simply being reminded of painful past experiences but changing the brain entire way of processing such input.

" Skillful use of sensory integration techniques can both help mitigate the symptoms of trauma as well as assist survivors to develop sustainable regimes of life management that make them less vulnerable to re-stimulation on the long-term."

# data[].attributes.attachment_link.readable_text
Few adults understand how trauma silently handicaps some children in day-to-day functioning that appears to have nothing to do with trauma. As an adult who struggled in childhood with the aftermath of trauma, I want to help others understand what might be going on with traumatized children and what you should know about it.

The consequences of trauma are many, for both adults and children. Recent articles, blogs and online discussions demonstrate rapidly growing awareness of this fact. This week, for example, a recent study by Elsey et al., (2015) reported an association between trauma exposure in early childhood and incidence of emotional disturbances and risky behavior later in life.

Trauma and Sensory Integration

An area that has so far received little attention is the connection between trauma and sensory integration. In another post, I wrote about the impact of trauma in the pre-verbal stage on me. I inherited from this a chronic feeling that life is not safe. Every day, any moment, something terrible could happen.

"Hyper-alert" is a term often used to describe adults with post-trauma and PTSD symptoms. Children who were traumatized early enter life with a similar instinctive stance of being alert and fearful and it is, of course, the sensory systems that mediate their experience of the world.

Sensory Integration and the Seven Senses

Research in Sensory Integration (SI) has greatly expanded understanding of how the body, brain and emotions interact in processing sensory inputs. Ever found yourself yelling at people you love when you're tired? Or unable to think in the presence of loud noise? Or annoyed by smells or sounds that others barely notice?

Those are your daily reminders of the interactive relationship of body, brain and emotions. An overload or stressor in one inevitably affects the other two.

The brain is processing sensory input all the time and our emotions are affected as well. The impact of noises, sounds and smell varies from person to person and changes across a day and across life.

Sometimes, we are over-sensitive and other times, we are under-responsive to sensory inputs and each of us has patterns unique to us.

Although people speak of "five senses," there are actually seven data systems inputting to the brain: sense of touch, sense of sight, sense of hearing, sense of taste, sense of smell, sense of balance and sense of body position.

According to Kaiser et al., "sensory input is organized in a manner that enables an individual to establish a sense of where the body is in time and space, to feel safe in one's own body and to accurately perceive the body's relationship to the environment".

Add the word "not" before a few of the verbs in Kaiser's definition of sensory integration and you have an accurate description of how I felt in my body, in space and time, for as far back as I can remember, into my late twenties.

In other words, I have sensory integration issues.* Although research in Sensory Integration and trauma is pretty recent and small in data, my experiences as a trauma survivor and as a therapist have convinced me that understanding the overlap between these two greatly improves ability to respond usefully to trauma.

The Egg and the Chicken

Did I have sensory integration issues first, making me unusually vulnerable to trauma? Or did early trauma disrupt normal development of my mechanisms for sensory integration? I don't know - I was too young to have narrative memories at that time.

But it doesn't really matter. What matters is recognizing that trauma and sensory integration are deeply interwoven. Trauma greatly affects sensory integration, drastically altering survivors' responses to sensory experience.

For example, they have emotional reactions they did not have prior to trauma to certain sensory experiences of hearing, seeing, smelling or touching things.

It is not just a simple matter of "being reminded" of painful past events, though that can be a factor. It is that the whole system for processing sensory inputs is altered. Someone in trauma or deep grief may feel overwhelmed, physically weakened and defenseless, for example, in the presence of loud noise that has no apparent association with the traumatizing event.

For those working with trauma survivors, the key takeaway here is that working with survivors around sensory integration issues has great payoffs in reducing the impact of trauma. Skillful use of sensory integration techniques can both help mitigate the symptoms of trauma as well as assist survivors to develop sustainable regimes of life management that make them less vulnerable to re-stimulation on the long-term.

Connecting Sensory Integration to Trauma Treatment

One pioneering trauma researcher, Dr. Bessel van der Kolk of the Trauma Center in Brookline, Massachusetts, says that "traumatic experiences initially are imprinted as sensations or feeling states, and are not collated and transcribed into personal narratives."

In other words, traumatic experiences are primarily handled in the sensory processing networks of the body and lower brain functions, rather than the higher functions of narrative memory and rational thought.

Trauma survivors respond instinctively to reminders of traumatic events conveyed to them through sight, sound, smell, etc., with responses that are poorly or not all regulated by conscious awareness (van der Kolk et al., 1997).

We are only beginning to understand the resulting implications for treatment. One of the most important is that therapies that are restricted to higher brain functions - eg: talk therapies - have limited effectiveness with trauma survivors. Talking alone simply doesn't engage the sensory systems that are most impacted by trauma.

This theory was born out in a pilot study in 2010 by Kaiser et al., which examined the possible benefits of psychotherapy if combined with sensory integration (SI) treatment as compared to psychotherapy alone in treating complex traumatic stress among adult who experienced childhood trauma.

Results indicated a significantly higher level of improvement for the group that received psychotherapy treatment and SI.

(Post originally appeared in pro.psychcentral.com)
Odelya Gertel Kraybill, Ph.D has worked as a consultant, trauma specialist and expressive therapist for the UN and NGOs in the US, Europe, Middle East, Africa and Asia. She has recently relocated to Washington DC area where she uses an Expressive Trauma Integration approach to provide consultation, training, expressive supervision, therapy and e therapy.

# data[].attributes.attachment_link.title
Trauma & Sensory Integration: The Egg & the Chicken

# data[].attributes.attachment_link.description
Trauma & Sensory Integration: The Egg & the Chicken The consequences of trauma are many, for both adults and children. This interesting insight is from Odelya Gertel Kraybill Ph.D. into how trauma can affect children's day-to-day functioning. Few adults understand how trauma silently handicaps some children in day-to-day functioning

# data[].attributes.headline
Sensory Processing and Behavioral Implications for Children

# data[].attributes.subject
Sensory Processing and Behavioral Implications for Children

# data[].attributes.body
Children maltreatment effects the development of the brain, this resource specifically dives into the behavioral aspect and how trauma and sensory disorders play a part in such. "The purpose of this study was to gain knowledge of sensory processing patterns in children who have experienced trauma. In addition, the relationship between any sensory processing challenges and ’problem behaviors’ was explored."

# data[].attributes.attachment_link.description
Verifying you are human. This may take a few seconds.

# data[].attributes.body
Sensory Strategies for Children with Trauma Histories

This resource explores the signs of sensory issues such as

Heightened Sensory Response

Disassociation or Numbness

Mixed or Inconsistent Sensory Reponses

Trouble Self Regulating

Ways to help children Manage these processing difficulties include things such as creating a predictable environment and sensory breaks.

# data[].attributes.attachment_link.title
Building Felt Safety: Sensory Strategies for Children with Trauma Histories - Foster Kinship

# data[].attributes.body
Upsetting things happen to children, some instances children are able to process situations and move on but other issues may need further intervention. Knowing the signs that a child is going through a traumatic event or have experienced trauma through past experiences such as a fasciation with death, safety, prevention, etc.

# data[].attributes.attachment_link.readable_text
In the wake of a disturbing event or tragic loss in the lives of children, we know parents and teachers will do their best to help kids cope with their grief and anxiety in a healthy way. We have provided some tips on how best to engage kids in a calm and supportive dialog about their feelings-it's certainly not easy to do, but it can make a big difference to kids.

Still, some children are more at risk than others for suffering long-term effects from an upsetting event, including those who have lost close friends or classmates and those who might have learned about the event or loss in a particularly emotional and upsetting way.

How a child experiences an event and how it's handled by those around him have an effect on how traumatizing it can be, notes Child Mind Institute psychologist Jerry Bubrick, PhD. When families come upon news accidentally, parents can be caught off guard and respond in a highly emotional way that can impact children. Television coverage and shocking newspaper headlines can also amplify the impact of a disturbing event or loss.

So even as you try to soothe and comfort children, it is important to recognize the signs of unhealthy coping that would suggest a visit with a professional might be needed. In extreme cases, children can develop post-traumatic stress disorder, but even less extreme PTSD-like symptoms can interfere with a child's life and happiness. Here are some signs to look for and things to keep in mind.

"Everyone grieves at a different pace," Dr. Bubrick says, and an immediate reaction-or lack of one-is not really an indicator of how a child will cope with the loss. "If a child seems to be coping well now, they might still have a poor reaction later," he says. "Or it could also just be a sign that they're handling it well." So while we want to help our children as much as possible immediately after the event, a lasting and hurtful response usually won't be evident until 3 or 6 months later.

Increased thinking about death and safety

One common sign of PTSD or a PTSD-like reaction is what Dr. Bubrick calls a "hyper-focus on mortality or death." And while some kids become notably morbid and fascinated by death, others will develop an obsession with their own safety and the safety of those close to them. In the case of a fire or another disaster, their thoughts might return with disturbing regularity to the possibility of a fire in their own home, or of the earthquake or flood happening where they live.

Problems with sleeping, eating, anger, and attention

Some of the symptoms of trauma in children (and adults) closely mimic depression, including too much or too little sleep, loss of appetite or overeating, unexplained irritability and anger, and problems focusing on projects, school work, and conversation. Sometimes the symptoms appear more like an anxiety disorder-obsessive or pervasive worry, difficulty separating from parents.

A year after a tragic event, we tend to look back, take stock, and memorialize those whose lives were lost. But as Dr. Bubrick observes, there are other anniversaries connected to children's lives that could have unexpected consequences for them- the birthdays of friends or classmates who died, for instance. Children "could be basically OK between now and then, maybe with some rocky periods," he says. "And then around the time of the birthday, they could have more symptoms. It's a trigger."

When an event is connected to school, such as the loss of classmates or violence at school itself, an unhealthy reaction could take the form of avoiding school. As Dr. Bubrick points out, school is "where the most reminders of the kids' deaths will be." While episodes of depression, heightened anxiety, trouble sleeping, and a fixation on the accident may be transient, avoiding school is a clear sign that something is wrong. "For the most part, everyone is going to experience some form of those things, altogether or in pieces," says Dr. Bubrick. "But if, over time, it's not really lifting and it's continuing, it may result in school refusal altogether. At that point we definitely know the child needs help."

You should also know that stress and trauma can manifest differently in girls and boys. Although this is by no means definitive, boys often react more quickly and with more irritation and anger, while girls can have delayed reactions that are more internal.

Frequently Asked Questions

What are the signs of trauma in a child?

# data[].attributes.attachment_link.title
Signs of Trauma in Children - Child Mind Institute

# data[].attributes.attachment_link.description
What to watch for in the weeks and months after an upsetting event - signs of trauma in children and how to begin to address the issue.

# data[].attributes.headline
Trauma Signs and Symptoms- Early Childhood Mental Health Consultation

# data[].attributes.subject
Trauma Signs and Symptoms- Early Childhood Mental Health Consultation

# data[].attributes.body
Trauma in children can take many different forms and behaviors, getting a understanding on signs and symptoms. Something stated in this resource to take note of is that context is very important before making assumptions of trauma or no trauma based on the signs.

"Clingy/separation anxiety

Feeling helpless/passive

Irritable/difficult to soothe

Constricted play, exploration, mood

Repetitive/post-traumatic play

Developmental regression

General fearfulness/new fears

Easily startled

Language delay"

# data[].attributes.attachment_link.description
Trauma signs and symptoms in young children can take many forms. Understanding these signs and symptoms as trauma related depends upon sensitive information gathering from the child, family, and Early Head Start and Head Start staff. That said, the signs and symptoms listed below must always be considered in the context of a young child’s history, caregiving system, supports, etc. and with recognition that these symptoms could also be symptoms unrelated to trauma.

# data[].attributes.body
Although people of all stages can experiences trauma and traumatic events, children are considered to be more easily effected. "Their reactions are influenced by how parents, relatives, teachers, and caregivers respond. These individuals provide comfort and stability, and play a vital role by maintaining normal routines or establishing new ones after a crisis."

# data[].attributes.attachment_link.description
Children are among the most vulnerable after traumatic events or disasters. Traumatic stress occurs when a child (0-18 years) feels intensely threatened by an event they experience or witness. Young people often need time and emotional support to feel secure again after experiencing trauma or a disaster. Their reactions are influenced by how parents, relatives, teachers, and caregivers respond. These individuals provide comfort and stability, and play a vital role by maintaining normal routines or establishing new ones after a crisis. With proper caregiving and access to trauma-informed services, many children recover and thrive.

# data[].attributes.body
Preschoolers are vulnerable to traumatic events, they struggle to talk about their fears, anxieties, and need to feel safe in order to process.

These resource is a pathway to many information PDFs including 'Preschoolers know when things are not right' which touches on the idea that although a child may not be told about a situation watching those around them gives them the sense.

# data[].attributes.attachment_link.description
Preschoolers may not have the words but will show their distress at traumatic events through changes in behaviour and functioning.

# data[].attributes.body
This Resource talks about reactions to trauma as ideas such as cultural influence may determine the response to trauma. Another notable aspect of this resource is the idea of the history of the child, "A child’s previous experiences of trauma can undermine their sense of safety, stability, bonding, and, ultimately, how they respond to other adverse experiences. "

# data[].attributes.attachment_link.title
Signs of Trauma – Child Trauma and Wellbeing

# data[].attributes.attachment_link.description
Trauma can have a significant impact on children’s lives, but sometimes it can be hard to spot the signs. Children’s response to traumatic events can vary depending on:

# data[].attributes.body
This Resource is a short informational video explaining although a child may seem fine, being knowledgeable of the signs can help children receive the help they need. Also mentioning how important it is not to pressure the child if they struggle socially, signs include mood swings, trouble sleeping and Panic attacks

# data[].attributes.body
A short video going into detail the idea of the importance of the first 1001 days, or the first three years of life. These first days lay the groundwork for a healthy and happy life, shaped by environment and experience.

# data[].attributes.body
Signs of trauma is multiple different senses including uncontrollable trauma such as a house fire or the pandemic.

This video covers a idea that the closer the perpetrator is to the child, the deeper the trauma may be. Understand the signs and knowing what that may look like is very useful.

# data[].attributes.attachment_link.title
Recognizing Signs of Trauma in Children (Children & Trauma Part 1)

# data[].attributes.body
"With empathy and expertise, psychologist Elena Grace offers a compassionate guide to navigating the complex journey of recovery." This resource covers ideas such as the science behind trauma, reclaiming self worth, mindfulness, compassion, and the role of relationships. It is all about healing and growth.

# data[].attributes.attachment_link.title
Trauma in Kids: A Guide to Healing and Hope (Growing Together: Understanding and Supporting Children)

# data[].attributes.attachment_link.description
Trauma in Kids: A Guide to Healing and Hope (Growing Together: Understanding and Supporting Children) [Grace, Elena] on Amazon.com. *FREE* shipping on qualifying offers. Trauma in Kids: A Guide to Healing and Hope (Growing Together: Understanding and Supporting Children)

# data[].attributes.body
A readily available resource that dives into the impact that trauma has on a child. "This E-book on Impacts of Trauma in children is a developmentally oriented book rich in child development issues, the impact of trauma on development and functioning, and interventions directed at treating reactions to trauma are explored. Early education teachers and practitioners will find this book very useful."

# data[].attributes.attachment_link.title
Impacts of Trauma in Early Childhood (Paperback) - Walmart.com

# data[].attributes.attachment_link.description
Buy Impacts of Trauma in Early Childhood (Paperback) at Walmart.com

# data[].attributes.body
This resource helps open the conversation for children possibility having an ACE experiences. "Designed by renowned Consultant Clinical Psychologist and International Trainer, Dr Warren Larkin, this card deck features 100 full-color illustrated cards with a detailed instruction manual to help practitioner and clients to explore adverse experiences, and to identify potential sources of support and to build resilience."

# data[].attributes.attachment_link.authors[].name
Warren Larkin (Author), Jon Dorsett (Illustrator)

# data[].attributes.attachment_link.title
The Adverse Childhood Experiences Card Deck: Tools to Open Conversations, Identify Support and Promote Resilience with Adolescents and Adults

# data[].attributes.attachment_link.description
The Adverse Childhood Experiences Card Deck: Tools to Open Conversations, Identify Support and Promote Resilience with Adolescents and Adults [Larkin, Warren, Dorsett, Jon] on Amazon.com. *FREE* shipping on qualifying offers. The Adverse Childhood Experiences Card Deck: Tools to Open Conversations, Identify Support and Promote Resilience with Adolescents and Adults

# data[].attributes.body
Encouraging bouncing back and being hopeful for the future can be healing if a child may be facing an ACE experience. Children having many examples of things relating to their personal life and events help children feel safe and supported.

# data[].attributes.attachment_link.title
Helping Children to Thrive Following Adverse Childhood Experiences

# data[].attributes.attachment_link.description
This sensitively written and beautifully illustrated storybook and guide provides children (aged 7+) and the adults who support them with the resources to under

# data[].attributes.body
The majority of Americans have at least one childhood adverse experience, "Every 2 out of 3 children experience 1 or more traumatic events before turning the age of 16." As girls are more likely to be a victim to these events, and 2/3 suicide attempts can be traced back to an ACE. This can effect a person's life into a adulthood and effect the quality.

# data[].attributes.body
Parenting is a big responsibility , it can change a person. When a child experiences trauma, their behaviors can be seen as chaotic.

Who can benefit and Why?

As a child with attachment disorder may differ from the parenting books read which may lead to exhaustion. Some caregivers may been viewed is dramatic and looking to pin a name to a issue, which can be lonely.

# data[].attributes.attachment_link.title
Parenting a Child with Attachment Disorder: What to Expect | Dr. Aimie Apigian

# data[].attributes.headline
Society for Research in Child Development

# data[].attributes.subject
Society for Research in Child Development

# data[].attributes.body
Natural disasters present a serious threat to the well being of our children. "Every year, 175 million children globally are expected to be affected by natural disasters, including floods, cyclones, droughts, heatwaves, severe storms, and earthquakes" As the frequency, severity, and intensity of these natural occurrences grows so does the strain it puts on communities, schools, families, and children. "As many as 50% of children report post-traumatic stress symptoms after experiencing a disaster, such as recurring thoughts about the disaster, hypervigilance, or difficulty sleeping or concentrating."

# data[].attributes.attachment_link.title
Understanding the Impacts of Natural Disasters on Children | Society for Research in Child Development SRCD

# data[].attributes.attachment_link.description
Natural disasters present a significant threat to children's health and well-being. Actions are needed now to mitigate this threat. Greater investments in infrastructure, remediation efforts, and more effective, evidence-based responses will help promote healthy development among children exposed to natural disasters.

# data[].attributes.headline
Parent Mental Health Effects Children Mental Health- After Disaster

# data[].attributes.subject
Parent Mental Health Effects Children Mental Health- After Disaster

# data[].attributes.body
When a disaster such as a hurricane or tornado destroys your home and community as increased stress can effect the children in the household. "Parents may be unaware of important details of their child’s experience and could underestimate their distress. Moreover, the parent’s own experiences and reactions can influence the understanding of their child’s reactions." Parents influence their children in how they think, feel, and process information and events.

# data[].attributes.attachment_link.title
How Parent Mental Health Can Affect Children After Disaster

# data[].attributes.attachment_link.description
When it comes to mental health impacts after disaster, children can take their cues from a suffering parent—meaning services need to assess and address the entire family.

# data[].attributes.headline
Behaviors Common After Exposure to Natural Disasters

# data[].attributes.subject
Behaviors Common After Exposure to Natural Disasters

# data[].attributes.body
As children process intense events in a number of ways, some behaviors can be seen commonly after such as event. Understanding what behaviors to look our for can give you a deeper understanding in how to help the children process. This resource touches on topics such as regressions, Physiological and emotional reactions in three age ranges. This article explores clinginess, loss of appetite, bedwetting, school withdrawal, headaches, etc.

# data[].attributes.headline
American Academy of Children and Adolescence Physiatry 

# data[].attributes.subject
American Academy of Children and Adolescence Physiatry 

# data[].attributes.body
"The way children see and understand their parents' responses are very important. Children are aware of their parents' worries most of the time, but they are particularly sensitive during a crisis. Parents should admit their concerns to their children, and also stress their abilities to cope with the disaster."

As this resource suggests ways to discuss the disaster with the child exploring how they think and feel to process the event. It is important to understand the child's feelings are valid.

# data[].attributes.attachment_link.description
A disaster is frightening to children and adults, alike. It is important to explain the event in words children can understand.

# data[].attributes.body
This resource explores the common reactions to a traumatic disaster such as lack of energy, feeling numb, feeling confused, having trouble concentrating, and anger. Ways to support children during this is strengthen the family bond by spending time with each other and ensure regular meals and good rest. "By creating a supportive environment where children feel safe asking questions and believe their concerns are being heard, we can help them cope with stressful events and experiences and reduce the risk of lasting emotional difficulties."

# data[].attributes.body
This video resource discusses the impacts of disasters on our youth including infants, toddlers, and school age children. This touches on the idea of risk factors such as the threat to life, home, and environment. The importance of the recovery environment after disaster with support and family. "In this overview, Dr. Annette LaGreca discusses the impact of natural disasters on youth, risk and resilience factors related to post-traumatic stress outcomes, and clinical implications for the assessment and treatment of exposed youth."

# data[].attributes.attachment_link.title
PROFESSIONALS— The Impact of Disasters on Youth: Risk, Resilience, and Interventions

# data[].attributes.body
Natural disasters is traumatic to a child's life as their environment changes and is put through stress. Children can process PTSD from such events as racing thoughts of a reoccurrence can cause them to lose sleep, interest in school, and their appetite. "This short animation video discusses how natural disaster events can impact a child's mental health and wellbeing, even four years after the event."

# data[].attributes.attachment_link.title
The impact of Natural Disaster-related ACES on children’s mental health

# data[].attributes.headline
Challenges of Childhood and Natural Disasters

# data[].attributes.subject
Challenges of Childhood and Natural Disasters

# data[].attributes.body
This article brings light the topic of the challenges brought when children face natural disasters. " The research literature has demonstrated that children are at risk post disaster for negative mental health outcomes, such as posttraumatic stress disorder and depression" Mental health conditions such as PTSD and depression was the most common among post disaster children. "Because preschool children may lack the language necessary to express feelings of helplessness and fear, their distress is often manifested in behavioral indicators such as loss of previously acquired developmental skills." As regressions are seen as a way to process what is going on.

# data[].attributes.headline
Disaster and Trauma Stephen J. Cozza, MD Judith A. Cohen, MD Joseph G. Dougherty, MD

# data[].attributes.subject
Disaster and Trauma Stephen J. Cozza, MD Judith A. Cohen, MD Joseph G. Dougherty, MD

# data[].attributes.body
A deep dive in the exposure of disaster and how that negatively impacts the development of children biologically, physically, and emotionally. This also includes future risk of quality of life as the risk can increase for mental conditions in adulthood. "Children’s traumatic exposure risks, outcomes, and therapeutic needs must be understood within a developmental context. Typically, children do not have the capacity to fend for themselves, care for themselves, or communicate fully their complex emotional needs to others"

# data[].attributes.body
Climate change has caused an increase and how often natural disasters occur, living through a natural disasters impacts your family routine and your child's version of normal. "Children who survive natural disasters are at increased risk of mental health concerns. Depending on their age, kids may not know how to process what they’ve experienced; their imaginations may run wild, or their thoughts may gravitate to the most upsetting things they’ve witnessed." If signs and symtomns of processing the disasters continue after three weeks, it may be time for further intervention.

# data[].attributes.attachment_link.authors[].name
Rose M. Alvarez-Salvat, PhD, ABPP, Pediatric Psychologist at Nicklaus Children’s Hospital

# data[].attributes.attachment_link.title
Helping Children Affected By Natural Disasters

# data[].attributes.attachment_link.description
Natural disasters can be scary for adults and kids. Our experts share mental wellness skills you can use with your child that can help them begin to recover.

# data[].attributes.body
Going through a serious medical event or illness such as cancer, sickness, surgeries and other procedures would be stressful for any person especially a child. Experiencing pain, feeling helpless and out of control, and being separated from one’s parents are all factors that contribute to the potentially traumatic nature of medical events. PTSD may developed from these unprocessed experiences months later.

# data[].attributes.attachment_link.provider_name
Journal of Ethics | American Medical Association

# data[].attributes.attachment_link.readable_text
Abstract

Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stress-psychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice. Health care systems and professionals are encouraged to apply the principles of trauma-informed care to address the effects of pediatric medical traumatic stress.

Introduction

For the sick or injured child, being treated in the emergency department (ED) or admitted to the hospital can be a frightening and confusing experience that leads to subsequent psychological distress [1]. Experiencing pain, feeling helpless and out of control, and being separated from one's parents are all factors that contribute to the potentially traumatic nature of medical events. How does a physician's ethical obligation to "first, do no harm" square with the prospect of providing a therapeutically necessary procedure for a frightened child who does not understand what is being done and why? How do we understand the ethical issues involved when a medically beneficial course of treatment for a pediatric patient also has the potential to engender stress, fear, anxiety, pain, or discomfort for this child? In this brief review, we first describe two concepts that are key to understanding and addressing the psychological distress that can affect ill and injured children: pediatric medical traumatic stress and trauma-informed pediatric care. We then discuss four core principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice [2]) and explain how the application of these principles underscores the need for trauma-informed care.

Pediatric Medical Traumatic Stress and the Need for Trauma-Informed Care

Pediatric medical traumatic stress is a set of psychological and physiological responses of children to potentially traumatic events such as pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences [3]. During and immediately after acute treatment, it is common for ill and injured children to experience distressing traumatic stress reactions such as unwanted and intrusive thoughts, bad dreams, hypervigilance, exaggerated startle response, and avoidance of reminders of the medical event [1], which are symptoms of posttraumatic stress disorder (PTSD). Pediatric medical traumatic stress is not a diagnostic entity; rather, it is a conceptual framework for understanding children's negative responses to medical experiences. These responses include, but are not limited to, symptoms of PTSD. On average, a substantial minority (12 to 20 percent) of ill and injured children will develop symptoms of PTSD that persist for months and interfere with quality of life [4]. In children, PTSD symptoms related to medical events are associated with poorer health and functional outcomes [1], including decreased adherence to treatment or poorer health-related quality of life for up to two years posttreatment [5-8]. A burgeoning empirical literature regarding pediatric medical traumatic stress is beginning to identify potentially modifiable elements of medical care related to the risk of developing traumatic stress in pediatric patients. Pertinent factors that can be targets for intervention in the acute care setting include the child's fear and subjective sense of life threat, pain, acute physiological arousal (e.g., elevated heart rate), severe anxiety or traumatic stress during acute care, and the availability of interpersonal social support [4, 9-12]. The principles of trauma-informed care illuminate ways in which health care professionals can intervene to address these risk factors.

Trauma-informed care for vulnerable children has been defined across a variety of service systems, from schools to law enforcement to health care [13]. A trauma-informed system is one that recognizes the impact of trauma exposure for children in that system and applies knowledge about trauma to policy and practice in order to prevent retraumatization (i.e., iatrogenic harm) and reduce negative sequelae [14]. (Note that in this context, the term "trauma" refers to psychological or emotional trauma rather than physical injury.) Following this definition, a health system providing trauma-informed pediatric care (a) recognizes the potentially traumatic nature of medical events and medical care for children and (b) incorporates this understanding into organizational culture, policies, procedures, and each encounter that pediatric patients and their families have with the physician and health care team. Trauma-informed health care also incorporates an understanding of the impact that children's prior traumatic exposure (e.g., to violence, abuse, or other frightening experiences) could have on their current health status and on the clinician-patient encounter.

Practice Standards and the Ethical Case for Trauma-Informed Care

There is little empirical data about the extent to which current practice in pediatric care is trauma informed, although several indicators suggest that there is room for improvement. For example, among level I trauma centers that see children, only 20 percent systematically address posttraumatic stress in pediatric patients [15], and surveys of health care professionals indicate wide variation in knowledge and practice of trauma-informed pediatric care [16-18]. Nevertheless, practice standards are beginning to enumerate elements of trauma-informed care as key components of pediatric health care in such diverse areas as pediatric oncology [19] and pediatric trauma care [20].

Building on an understanding of the potentially traumatic nature of medical experiences for children and the risk for ongoing pediatric medical traumatic stress, we can now apply core principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice [2]) to delineate an ethical case for provision of trauma-informed pediatric care.

Respect for autonomy. The principle of respect for autonomy asserts that physicians must respect their patients' decision-making capacities and involve patients in their own care by providing information, choices, and control [2]. Children in the acute care setting commonly report feeling lack of control over what is happening to them [21, 22], which increases the potential for a challenging medical event to be experienced as traumatic. The legal capacity to consent to treatment generally falls to a child's parents or guardians, who are the primary decision makers throughout the course of pediatric medical care [23]. Nevertheless, physicians can ensure that children are provided with developmentally appropriate information and involved (even informally) in assenting to care [23]. Presenting opportunities for children to exercise some degree of control and providing choices (e.g., as to their position or their selection of a distracting activity) in the midst of painful or distressing symptoms or procedures can mitigate the traumatic nature of these experiences [24, 25].

Beneficence and nonmaleficence. With regard to pediatric medical traumatic stress, the principles of beneficence and nonmaleficence suggest that physicians and health care systems must strive to provide care that does not cause iatrogenic emotional distress during treatment and that maximally protects against the development of ongoing traumatic stress reactions. The challenges in achieving this care are clear. Providing effective medical care often involves the risk, or even the certainty, of pain or discomfort that is not easily remedied. Despite the use of pain management strategies, during their hospital admission many children experience pain that is not well controlled [26]. Many medically necessary procedures can be perceived as frightening by young patients, and children in acute care settings are often exposed to sights and sounds that can frighten them (e.g., machines, alarms, and other patients' pain or distress) [21, 22].

Fortunately, there is a growing empirical evidence base to guide practices that reduce a child's risk for immediate and long-term traumatic stress. Promising practices grounded in this evidence base include managing pain through pharmacological and nonpharmacological interventions, supporting parental presence and involvement, and providing effective support for children during procedures [24, 27]. As one example, when a child shows distress during a procedure, many clinicians (and parents) naturally want to provide emotional reassurance, saying things like "You're OK" or "Don't worry." Counterintuitively, a large body of research has found that this kind of verbal reassurance from parents or clinicians during procedures can exacerbate a child's pain and distress [24, 28]. The evidence also suggests that active distraction strategies, such as engaging the child in interactive play or in nonprocedural talk, are most effective in reducing distress [29]. By optimizing pain management, promoting parental presence, and helping parents use distraction techniques effectively during a potentially painful or frightening procedure, trauma-informed physicians and health care teams are acting consistently on the principles of beneficence and nonmaleficence.

Justice. The principle of justice requires that physicians work to uphold a fair and just distribution of benefits and risks. Physicians should be aware of, and strive to prevent, health disparities that increase their patients' risk of experiencing pediatric medical traumatic stress. Relevant disparities can be seen across settings. Surveys of pediatric readiness suggest that EDs at community hospitals are less likely than pediatric EDs to have clear policies supporting family presence for their pediatric patients [30]. And research has documented racial and ethnic disparities in care that could impact children's risk for medical traumatic stress. For example, one study showed that black children in the ED were less likely than white children with similar levels of abdominal pain to receive analgesic medication [31]. In another study, children whose parents had limited English language proficiency had their pain assessed less frequently during postsurgery care and experienced greater pain levels before receiving analgesic medication [32]. And a growing body of research demonstrates that physicians and other health care professionals exhibit implicit (i.e., unconscious) biases based on race [33, 34]. To actively combat unconscious bias in pain management and other aspects of trauma-informed pediatric care, professionals can take concrete steps such as acknowledging their own susceptibility to implicit bias and practicing taking the perspective of stigmatized groups; there is empirical support for at least short-term reductions in implicit bias based on these steps [35]. However, persistent reductions in implicit bias may require more sustained and strategic interventions [36].

Conclusion

In summary, the concepts of pediatric medical traumatic stress and trauma-informed pediatric care are essential for understanding the potential iatrogenic psychological effects that medical care can have on children and how to mitigate those effects. The process of providing medical care has the potential to be protective and to ameliorate risk for traumatic stress in ill or injured children or to inadvertently engender traumatic stress reactions in these children. Improving health care practice for the good of our pediatric patients (beneficence) and avoiding iatrogenic harm (nonmaleficence) will require continuing research and systematic quality improvement efforts. The research and quality improvement agenda begins with identifying promising trauma-informed policies and practices, such as those delineated in this brief review, and then systematically evaluating the effectiveness of those practices in reducing immediate and longer-term pediatric medical traumatic stress. Although there is a strong empirical basis for specific trauma-informed practices [1, 37], we know of no study to date that has addressed the impact of systemic implementation of trauma-informed pediatric medical care.

Effective implementation of trauma-informed care will require changes not only in the knowledge and practice of individual professionals but also in institutional protocols and policies [37], such as protocols for supporting family presence during procedures or for optimizing pain management. It is also likely to require a commitment from institutional leadership to train all staff who interact with pediatric patients in specific new skills and sensitivities (e.g., recognizing the psychological impact of medical events and treatment on children, providing effective support for children during challenging treatment experiences, and helping parents provide effective assistance to children throughout a child's ED or hospital stay) [37]. Even brief training can increase professionals' knowledge and confidence in implementing trauma-informed practices in their daily interactions with pediatric patients, an important first step [38]. Physicians can play a key role in training medical staff and in providing leadership in trauma-informed care in collaboration with nursing leaders and psychosocial staff. Tools-including brief, focused, online training resources-are available to help physicians and health care teams learn and implement specific skills necessary for trauma-informed pediatric health care [25, 39-41].

Citation

AMA J Ethics. 2017;19(8):793-801.

DOI
10.1001/journalofethics.2017.19.8.pfor1-1708.
The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.

Author Information

Nancy Kassam-Adams, PhD is a research associate professor of clinical psychology in pediatrics at the University of Pennsylvania Perelman School of Medicine in Philadelphia. She also directs the Center for Pediatric Traumatic Stress and serves as the associate director for behavioral research at the Center for Injury Research and Prevention at Children's Hospital of Philadelphia. Her research focuses on understanding how children and families respond to potentially traumatic experiences such as medical emergencies, injury, and violence, and developing practical prevention protocols that can be integrated into health care settings or delivered via electronic health tools.

Lucas Butler, MD is an emergency medicine resident at the University of Washington in Seattle. A recent graduate of the Yale School of Medicine, his research interests include application of and training in patient- and family-centered care in the emergency department as well as the use of telemedicine in acute care.

# data[].attributes.attachment_link.title
What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

# data[].attributes.attachment_link.description
Trauma-informed care ensures ethical treatment for children experiencing physical or psychological distress associated with a medical event or procedure.

# data[].attributes.body
This kind of trauma is typically grouped into three groups. Traumatic stress reactions can include psychological and physiological symptoms of re-experiencing, avoidance, and hyper-arousal, as well as changes in thinking and mood. Children are especially vulnerable to the loss of safety that a medical experience may bring. The age and developmental level of the child may determine the coping strategies the child may demonstrate.

# data[].attributes.attachment_link.readable_text
Initial distress among children and families in medical settings is common, expected, and understandable. Many families cope well, with support and with time. However, some may develop persistent traumatic stress reactions, which can impede health and psychosocial functioning.

What is Pediatric Medical Traumatic Stress?

Pediatric medical traumatic stress is "a set of psychological and physiological responses of children and their families to pain, injury, medical procedures, and invasive or frightening treatment experiences" - National Child Traumatic Stress Network, 2003

Traumatic stress reactions can include psychological and physiological symptoms of re-experiencing, avoidance, and hyper-arousal, as well as changes in thinking and mood. These reactions may include:

having unwanted and intrusive thoughts about what happened,

strongly avoiding things that are reminders of the event,

feeling numb or detached, blaming oneself or others, and

having trouble sleeping, eating, or concentrating.

When a constellation of these symptoms persists and causes distress, the individual may have Post-traumatic Stress Disorder (PTSD).

Children may have other kinds of reactions to illness and injury as well, including behavioral changes or symptoms of depression or anxiety.

Traumatic stress reactions are common in the aftermath of an injury, a scary new diagnosis, or a difficult medical event. When they persist, these reactions may get in the way of a child's or parent's everyday functioning and may warrant further attention.

Over the past several decades, a growing body of research has helped healthcare providers understand the development of traumatic stress reactions after a wide range of pediatric illness, injury, and medical experiences.

In the aftermath of a potentially traumatic event such as illness or injury, traumatic stress can be caused by a loss of a sense of personal safety, and by feelings of fear and helplessness. Children are especially vulnerable to the loss of safety that a medical experience may bring. Age and developmental stage impact how children understand illness, injury, and treatment, as well as their range of coping strategies.

What is traumatic about medical experiences?

Traumatic medical experiences are rarely a single event. All along the continuum of care, children and families in medical settings can experience multiple traumatic experiences (and things that will trigger feelings or remind them of those experiences).

A specific scary or shocking event (injury / initial diagnosis)

Pain / painful procedures

Treatment setbacks

Ongoing uncertainty about prognosis

The medical environment (hospital sights / sounds, etc.)

Sense of life threat (regardless of objective prognosis)

Separation from parents

Exposure to distress, pain, or death of others (e.g., other patients)

Reminders of past traumatic medical experiences

Physical limitations or impairment / visible changes in appearance

Research has shown that when a child is ill or injured, all family members can be affected - the ill or injured child, siblings, and parents. Research has also shown that children and parents may find different aspects of the experience traumatic.

Take-home message from the research data:

What counts in risk for traumatic stress is NOT the objective severity of the child's illness or injury, but the SUBJECTIVE experience of the child or parent.(Are they feeling scared or helpless? Do they think they might die?)
Read more about risk factors
How does traumatic stress affect child health outcomes?

Traumatic stress symptoms (including post-traumatic stress disorder - PTSD) are associated with worse health outcomes in children preschool through adolescence.

Unaddressed, these reactions can have serious implications for medical treatment and can represent a "hidden cost" to the health care system. Traumatic stress symptoms have been associated with:

poorer adherence with needed treatment and medication

adverse health outcomes

worse functional outcomes

Important Finding:

In a study of injured adolescents followed for 2 years post-injury, teens with more severe PTSD symptoms had lower health-related quality of life at each assessment point across the 2 years.

Research has suggested several possible mechanisms, including:

Biological effects: PTSD symptoms might lead to poorer medical outcome in ill or injured children because of physiological changes (i.e., increased heart rate, changes in stress response) associated with PTSD.

Impact of avoidance symptoms on adherence and follow-up care: PTSD symptoms might indirectly lead to poor medical outcome due to avoidance (for example, a child not taking prescribed medications because taking the meds has become a traumatic reminder).

Common underlying risk factors: PTSD symptoms may also be linked with poorer medical outcomes because of important associated features (i.e., prior trauma exposure, experiences of systemic racism) that hamper optimal recovery.

# data[].attributes.attachment_link.title
Pediatric Medical Traumatic Stress - The Basics | Patient Centered Care and Trauma Informed Care for Pediatric Patients - HEALTHCARE TOOLBOX

# data[].attributes.attachment_link.description
Initial distress among children and families in medical settings is common, expected, and understandable. Many families cope well, with support and with time. However, some may develop persistent traumatic stress reactions, which can impede health and psychosocial functioning.

# data[].attributes.headline
Topical Review: Medical Trauma During Early Childhood 

# data[].attributes.subject
Topical Review: Medical Trauma During Early Childhood 

# data[].attributes.body
Children getting serious medical care are considered at high risk for developing medical trauma. " It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. " Although some children may be sick for a long period of time and others experience a traumatic event such as a car accident can develop PTSD

# data[].attributes.attachment_link.description
Verifying you are human. This may take a few seconds.

# data[].attributes.body
This resource gives information on how to support your child through medical trauma. As many things feel out of your control, you are able to choose the support you give your child through this difficult event.

Who can benefit and Why?

"No parent wants to see their child get hurt, feel sick or struggle with something. Medical procedures, diagnoses and other health events can be challenging for both children and parents alike. "

# data[].attributes.attachment_link.title
Support Your Child Through Medical Trauma

# data[].attributes.attachment_link.description
We explore what medical trauma is and provide strategies for parents to minimize and address medical trauma in their children.

# data[].attributes.body
As the stress of a medical event affects a family, this can be divided into two groups resilient families and families who struggle with the weight of the situation. Ways to help a child's family include things such as

- Providing general support for social and emotional functioning

- Focusing on natural coping systems and strengths

-Providing information regarding common reactions

-Screening or asking about indicators of higher risk.

# data[].attributes.attachment_link.description
Learn about pediatric traumatic stress including how its symptoms and how it’s diagnosed at the Center for Pediatric Traumatic Stress.

# data[].attributes.body
Struggle with a child may be stemmed into something further. As asking questions and bringing concerns is important but it is crucial not to accuse. As the parent knows the child best while the para may only be with your child for a short period of the day.

# data[].attributes.attachment_link.title
Understanding Trauma Responses in Children with Intellectual and Developmental Disabilities

# data[].attributes.headline
Understanding and Managing Medical Stress

# data[].attributes.subject
Understanding and Managing Medical Stress

# data[].attributes.body
PMT stands for Pediatric Medical stress, as children may face trauma from often being in and out of the hospital. " Other reactions can include changes in one’s thinking, behaviour, and emotions, as well as dissociation, or a sense of being disconnected from reality." As medical trauma can happen to a number of children it is important for long term symtomns to be noted.

# data[].attributes.attachment_link.provider_name
Children's Heart Network | Working together throughout BC to educate, support, and enhance the lives of children, youth, and families living with congenital heart disease.

# data[].attributes.attachment_link.readable_text
By Dr. Winnie Chung, Registered Psychologist
As you may all know from personal experiences, a child's heart condition can impact the entire family in profound ways. In this article, I will discuss ways for children, youth, and families to cope with a heart condition and associated medical interventions, and to minimize risk for developing longer-term trauma-related mental health symptoms.

What is pediatric medical traumatic stress?

The National Child Traumatic Stress Network provided a definition of pediatric medical traumatic stress (PMTS) a number of years ago: "A set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences."[1] From initial diagnosis (or beyond), to hospitalizations, to treatment-related experiences, to ongoing tests and procedures, there are unfortunately many medical experiences, necessary as they are, that can be traumatic for children and families coping with a cardiac condition.

There are many different ways that PMTS can affect individuals. Some common reactions include symptoms of arousal, re-experiencing, and avoidance. Other reactions can include changes in one's thinking, behaviour, and emotions, as well as dissociation, or a sense of being disconnected from reality. For individuals who experience symptoms of hyperarousal, they may be more easily startled than usual, become extra vigilant to signs of something being wrong or dangerous, and react more strongly to different sensations in their bodies and sights and sounds in their environment. For those with re-experiencing symptoms, they may find themselves thinking a lot about the trauma, experience intrusive memories of a frightening experience, and have nightmares and flashbacks of the trauma. Individuals can also experience avoidance symptoms, where one tries to not think about or talk about the frightening experiences they have had. They may seek to stay away from places, people, or activities that remind them of the trauma. Other traumatic stress symptoms can include changes in one's memory, attention, and ability to manage challenges. Individuals may notice differences in their mood, where they may be more irritable or sad than normal. They may feel more anxious and worried, and sleep can become disrupted. Some also feel disconnected from the world around them and may feel like they are in a dream or in a daze.

How common are these experiences? Is this the same as post-traumatic stress disorder, or PTSD?

It is important to know that many individuals experience some of these symptoms following medical trauma. However, most people do not go on to have long-term significant stress reactions. Some individuals do have persistent symptoms that impact their functioning in significant and distressing ways; these are what health professionals describe as symptoms of acute stress disorder (symptoms that last from several weeks to one month) or post-traumatic stress disorder (PTSD; symptoms that last for more than one month). A qualified mental health professional such as a psychologist or psychiatrist can help identify whether these diagnoses are applicable to your child or you.

Research suggests that between 12% and 31% of children with congenital heart disease may develop PTSD following cardiac surgery.[2] Among parents of children with congenital heart conditions, up to 30% of parents are reported to have symptoms consistent with PTSD, and over 80% experience prominent trauma symptoms.[3] In addition to trauma symptoms, 25% to 50% of parents may experience elevated symptoms related to depression and anxiety, and between 30% and 80% of parents have reported significant psychological distress.

Regardless of whether someone meets diagnostic criteria for a "disorder" or not, if you and/or your child are experiencing emotional or other difficulties that impact your daily functioning, it is helpful to speak with your health care team about your concerns.

What are some practical ways to cope with medical trauma and prevent lasting stress symptoms?

Although one has little control over the diagnosis of a heart condition and the interventions that are needed, there are certainly practical things that families and health care providers can do to help minimize negative psychological impacts and promote adaptive coping and adjustment. Let's focus here on ways to foster resilience and coping at the time of a potentially traumatic medical experience, after the experience, and ongoing interventions that can be considered.[4] These ideas are not exhaustive, and some of them apply more to children and youth, while others are more for parents and caregivers. I strongly encourage families to work closely with their health care team to develop strategies and coping plans that are tailored to your family.

At the time of a medical experience (e.g., during a medical test or procedure, during a hospitalization or medical appointment)

Have control. During a frightening and scary experience, having a sense of control is important. This can look like giving your child a choice about who and how many people they want present in the treatment room, what they would like to do to occupy their attention during a procedure, and how much information they would like about their condition or the intervention they are receiving. Encourage your child to express questions or concerns they have, either to you as caregivers or to their medical team. Work with your health care team to figure out how to explain medical information to children and youth in a developmentally appropriate way. For parents and caregivers, having control can look like being given the amount of information you want in the way that you prefer (e.g., having information written down, receiving information in small bits, having information repeated several times), and having the support people that you need when receiving medical information.

Build trust and confidence. Remember and remind yourself and your child that you are being well taken care of by their health care team. As scary as a procedure or treatment experience may be, having the reassurance that your medical team members are experts in what they do can ease some worries and fears. Of course, you should feel free to share any concerns or questions you have openly with your medical team.

Focus on basic needs. Eating, drinking, and getting adequate rest and sleep can often become very challenging in stressful situations. For children and adolescents undergoing medical interventions, their condition and treatments themselves can interfere with these basic needs. For parents and caregivers, it is important to offer yourself permission to take care of your own needs, and to recognize that your wellness in and of itself is critical to prioritize and also allows you to care for your child in the ways that they need.

Receive support. For children and youth undergoing procedures or experiencing other medical-related stress, the presence of parents, caregivers, or other support individuals can often be helpful. Stay connected with friends or other family members, whether that is virtually or in other ways.

Understand normal reactions to trauma. It can be helpful to educate yourself and your child on what are normal and expected emotional reactions to the stressful situation that you are in. It is normal to experience a range of different emotions, and it is important and helpful to acknowledge and be aware of these feelings.

Use what already works! Consider what typically helps you and your child cope with difficult and stressful situations outside of the medical setting, and use those strategies in the medical context where possible. Are there comfort objects, games and toys, or other activities that soothe your child or offer distraction? Are there other strategies and activities that are helpful, such as calm breathing, visualizations, reading engaging books, watching shows, listening to a favourite playlist, journalling, taking walks, or talking with loved ones?

Involve psychosocial supports in health care settings. Ask about services from child life specialists, medical psychologists, and social workers in your health care setting who can help support your child and your family with medical procedures, appointments, and hospitalization.

Following a difficult medical experience

In addition to the above...

Monitor mood and behavioural changes. Some increase in anxiety, minor behavioural regression (e.g., more clinginess in younger children), and mood fluctuations can be an expected part of their medical experience. Work with your child's health care team to monitor these symptoms and promote coping.

Focus on social interactions and routine. As medically appropriate, continuing to stay connected and have positive and supportive interactions with loved ones can be very helpful. If possible, establish a daily routine to help each day feel more predictable-this is important for children, youth, and caregivers alike.

Be mindful of the mutual impacts of children's and parents' coping. Children's and youth's emotional responses can often mirror those of parents and caregivers, particularly in times of stress and uncertainty. I encourage parents and caregivers to take opportunities to share their emotional experiences openly with other trusted and supportive adults. When interacting with your child, encourage open conversations about any worries, sadness, fears, or frustrations they may have, while also focusing on confidence and trust in the care that your child is receiving from their medical team.

Ongoing interventions

In addition to the above...

Re-establish routines and a sense of normalcy. Traumatic experiences can shake one's sense of safety and predictability in this world. As soon as possible, establishing or re-establishing daily routines and structure can help with recovery from a distressing experience. Resuming normal limit-setting and expectations as medically safe and appropriate can help foster a sense of normalcy and promote confidence and independence in your child's recovery and ongoing coping. For parents and caregivers, scheduling time in your daily life for opportunities for self-care and rest can be very supportive; even five minutes of breaks sprinkled throughout the day can go a long way.

Take opportunities to share emotional experiences. People differ in terms of how much and when they are ready to talk about the impact of distressing experiences. As mentioned above, it can be normal to either spend lots of time thinking about a trauma or to avoid it altogether as much as possible. Identify individuals with whom you and your child can share your experiences, and create time and space to do so, if desired.

Explore beliefs about a traumatic event. This may be done in a therapeutic setting with a mental health professional. How one interprets and makes sense of the distressing experiences they have had can shape their coping and adjustment. For example, excessive focus on the most frightening parts of a medical experience can lead to ongoing fears about the hospital or doctors in general, whereas also remembering the helpful care one has received and the brave ways your child has coped with the difficulties can promote resilience and confidence in one's ability to manage any future challenges.

Access therapeutic and other supports. Working with a mental health professional to help manage experiences of traumatic stress can be beneficial, particularly if you or your child are feeling distressed and finding it difficult to cope with what you have experienced. For many heart families, there can be multiple medical experiences over time that are highly distressing, and establishing a relationship with a mental health clinician who can be a source of support on an ongoing basis can be very helpful. If you or your child is experiencing a mental health disorder such as PTSD, working with a qualified mental health professional is certainly encouraged.

Where can I find additional help?

It can be tough to know where to go or who to ask for help in coping with traumatic stress symptoms. For children and youth, you can speak with your child's family doctor, their pediatrician, and your cardiology team about concerns you may have about your child's emotional and behavioural functioning. If your child's cardiac condition has led to impacts on brain function, speak with your health care team about whether a neuropsychological evaluation may be helpful. Your child's school counsellor can be a very helpful part of their support team, particularly as it relates to assisting with a smooth transition back to school after a hospitalization, identifying academic supports that may be needed, and promoting a positive school experience. For adults, you are also encouraged to speak with your family doctor about your coping, and consider looking into any workplace employee assistance programs or other mental health benefits that may be available to you. The next section provides more information on finding a therapist who can work with you and your child-both public and private options are available.

Finding a mental health professional in British Columbia

Mental health crisis supports

Other helpful resources

It is not possible to fully depict the depth and breadth of the challenges that heart families face. It is also not possible to fully describe the inspiring courage and strength displayed by children, youth, and families navigating complex medical concerns and managing experiences of traumatic stress. I hope our heart families are reminded that they are not alone in dealing with these difficult experiences. Support is available to help families take each step forward day by day, one moment at a time. ♥

"Understanding and Managing Medical Traumatic Stress in Children, Youth, and Families" is from our winter 2022 newsletter, Heart Matters. See our Newsletters page for more stories and to subscribe.

[1] National Child Traumatic Stress Network. (2003, September). Definition of medical traumatic stress. Paper presented at the Medical Traumatic Stress Working Group meeting, Philadelphia, PA.

[2] Meentken et al. (2017). Medically related post-traumatic stress in children and adolescents with congenital heart defects. Frontiers in Pediatrics, 5(20).

[3] Wolff-King et al. (2017). Mental health among parents of children with critical congenital heart defects: A systematic review. Journal of the American Heart Association, 6(2).

[4] Kazak et al. (2006). An integrative model of pediatric medical traumatic stress. Journal of Pediatric Psychology, 31(4).

# data[].attributes.attachment_link.title
Understanding and Managing Medical Traumatic Stress in Children, Youth, and Families | Children's Heart Network

# data[].attributes.attachment_link.description
As you may all know from personal experiences, a child's heart condition can impact the entire family in profound ways.

# data[].attributes.body
Eli & Alicia are best friends. They experience a scary event together, and both need to go to the hospital. This video explains the impact that medical trauma can have on children and families, and how they can recover. As this video touches on symtomns such as bad dreams and certain behaviors. The emotional impact of these experiences can be identified in order to benefit the child and support them.

# data[].attributes.attachment_link.authors[].name
UCSF Dept. of Psychiatry and Behavioral Sciences

# data[].attributes.body
Children that have undergone medical trauma require complex needs and so do their families. Children with complex needs, as well as their parents, caregivers and family members, are at risk of traumatic experiences during the course of their illness and their time in hospital. Our research has uncovered potential hidden sources of trauma by interviewing parents about their experiences. We are also in the process of establishing how commonly parents in particular experience symptoms of post-traumatic stress disorder.

# data[].attributes.attachment_link.title
The Hidden Harms - Medical trauma in children with complex needs and their families

# data[].attributes.body
This pdf covers things such as

What is medical traumatic stress, Common reactions in babies and young children, Trauma, and Supporting your child. This document explains the what, why, how and what you can do to support this child. This resource also touches on the infant side of child medical trauma as babies also experience stress from medical events. "Young children and caregivers might find different aspects of the experience stressful. For example, caregivers may worry about the long-term effects of the illness. Children, however, may be more scared about separating from their caregiver/s, sibling/s or pet, the bright lights and noises or painful medical procedures."

# data[].attributes.body
When a child has a medical emergency in school, it is important to be equipped with the knowledge to support the child. "About 1 in 5 kids in the United States has a special health need or a chronic medical condition that requires ongoing medications. Examples include asthma, seizures, diabetes allergies, and behavioral and mental health conditions. " Having an Action Plan of what to do minimizes the stress of the child and the people around you.

# data[].attributes.attachment_link.readable_text
By: Rani S. Gereige, MD, MPH, FAAP & Toni Gross, MD, FAAP

Children spend a big part of their day in school. That's why it is important to make sure your child's school is prepared to deal with emergencies. Injuries can happen in or out of the classroom. Many kids also have medical conditions that may flare up and require urgent attention.

You and your child's pediatrician can work together to prepare for these situations. It helps to become aware of medical response plans at your child's school. Then, provide the school with as much information as possible to help your child in an emergency.

Caring for chronic medical conditions & injuries at school

About 1 in 5 kids in the United States has a special health need or a chronic medical condition that requires ongoing medications. Examples include asthma, seizures, diabetes allergies, and behavioral and mental health conditions. Chronic medical conditions, even when under control, sometimes have symptom flare-ups that can lead to a medical emergency while at school.

In addition, 10%-25% of childhood injuries occur while children are in school. Not every school has a licensed health professional or a nurse onsite. That is why parents of children with chronic medical conditions, in particular, should learn whether their child's school can administer medications and treat medical emergencies and injuries if needed.

As you consider enrolling your child in a school, ask these questions:

Does the school have trained or licensed medical personnel such as a school nurse onsite? Full-time or part-time?

Do school personnel have the skills and capabilities to follow your child's disease action plan? Can they administer the medication your child needs and follow the emergency action plan from your child's pediatrician?

Is the school equipped or does it have a process or policies in place to address medical emergencies with local emergency medical services (EMS)? Do school personnel receive routine training for these situations?

Have an action plan

Work with your child's pediatrician to ensure that all disease-specific action plans, including orders for medication to be given in school, are carried out appropriately. Your child's pediatrician can help you communicate with school personnel and advocate for your child. This includes school readiness for disease-specific emergencies. Together, you can make sure that your child's medical needs in school are met.

Your child's pediatrician can access standardized emergency health information forms and help you complete them for the school. Information could include your contact information, health provider contact information, medications, allergies, dietary restrictions, any emergency treatment plans for certain conditions (such as asthma or seizures, severe allergies) recommended activity levels and information about health equipment.

After a medical emergency at school

If an emergency occurs in the school, your child's pediatrician may follow-up with the school to debrief on what happened and the actions taken. Also, be sure to follow-up with your pediatrician to ensure your child's safe return to the classroom and provide any necessary instructions to the school including any changes in the action plan and/or medications.

If your child has special conditions or needs, work with your child's pediatrician to ensure that these needs and recommendations are communicated to your child's school. A strong team of family, pediatrician and school is the best preparation for medical emergencies that occur at school.

More information

About the authors

Rani S. Gereige, MD, MPH, FAAP is a member of the AAP Council on School Health and the Chair of the AAP Committee on Continuing Medical Education. He is a general pediatrician who serves as the Director of Medical Education and Designated Institutional Official at Nicklaus Children's Hospital in Miami, Florida.

Toni K. Gross, MD, MPH, FAAP is a former member of the AAP Committee on Pediatric Emergency Medicine who practices pediatric emergency medicine and EMS medicine in New Orleans, Louisiana, serving as Chief of Emergency Medicine at Children's Hospital New Orleans.

American Academy of Pediatrics Council on School Health (Copyright © 2022)

# data[].attributes.attachment_link.keywords[]
a minute for kids~ health care needs in school~ medical emergencies~ anaphylaxis~ injuries at school~ how schools respond to emergencies~ medical emergency in school~ children~ parents~ pediatrics

# data[].attributes.attachment_link.title
When Your Child Has a Medical Emergency at School

# data[].attributes.attachment_link.description
Children spend a big part of their day in school. That's why it is important to make sure your child's school is prepared to deal with emergencies. Injuries can happen in or out of the classroom. Also, many kids have medical conditions that may flare up and require urgent attention.

# data[].attributes.body
Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity. Reactions vary in intensity and can be adaptive or may become disruptive to functioning. The majority of pediatric patients and their families are resilient and do well.

This article touches on passed trauma onto the other members of the family, with parents (20-30%) and siblings (15-20%) also go through the stress of the event.

# data[].attributes.attachment_link.provider_name
The National Child Traumatic Stress Network

# data[].attributes.attachment_link.title
The National Child Traumatic Stress Network

# data[].attributes.attachment_link.description
CFTSI is a brief (5‐8 session), evidence‐based early intervention for children 7 to 18 years old that reduces traumatic stress reactions and the onset of PTSD. CFTSI is implemented within 30-45 days following a traumatic event or the disclosure of physical or sexual abuse.

# data[].attributes.body
The Child and Adolescent Trauma Screen or CATS is a questionnaire to administer to children, there is different measures based on ages.

The CATS is based on the DSM-5 and is a measure of potentially traumatic events and of posttraumatic stress symptoms (PTSS).

Who can benefit and Why?

The CATS can be administered as a self-report or as an interview and is appropriate for preschoolers, children and adolescents. There is a self-report measure for 7-17 year old children/youth, and two caregiver versions; one for 3-6 year old children and one for 7-17 year old children/youth. The younger child version conforms to the DSM-5 3-6 year old PTSD symptom criteria.

# data[].attributes.attachment_link.readable_text
Overview

The Child and Adolescent Trauma Screen (CATS) questionnaire is a brief, freely accessible screening instrument based on the DSM-5 criteria for Posttraumatic Stress Disorder (PTSD). It is a measure of potentially traumatic events and of posttraumatic stress symptoms (PTSS).

Author/Publisher Details

The developers are Prof. Lutz Goldbeck (Ph.D.) & Prof. Lucy Berliner (Ph.D.)

The CATS Consortium consists of Prof. Lucy Berliner (Ph.D.), Cedric Sachser (Ph.D.), Elisa Pfeiffer (Ph.D.), Prof. Tine Jensen (Ph.D.), Prof. Elizabeth Risch (Ph.D.), Prof. Rita Rosner (Ph.D.), Prof. Lutz Goldbeck (Ph.D.)

Corresponding Author: Cedric Sachser, Ph.D., cedric.sachser@uniklinik-ulm.de

Date

Description

The CATS is based on the DSM-5 and is a measure of potentially traumatic events and of posttraumatic stress symptoms (PTSS). The CATS can be administered as a self-report or as an interview and is appropriate for pre-schoolers, children and adolescents. There is a self-report measure for 7-17 year old children/youth, and two caregiver versions; one for 3-6 year old children and one for 7-17 year old children/youth. The younger child version conforms to the DSM-5 3-6 year old PTSD symptom criteria. The interview format may be preferable with younger children or youth with reading comprehension challenges.

The CATS has 15 items measuring traumatic events, 20 items measuring DSM-5 PTSD symptoms, and 5 items measuring psychosocial functioning, and can be administered in approximately 15 minutes.

The CATS is available in several languages, including German, Norwegian, Spanish, Swedish, Arbabic, Dari, Farsi, Paschtu, Tigrinya, Turkish. Please contact the corresponding author for further information on these translations.

Access

The measure can be freely accessed by clicking below. There are no copyright or licensing fees associated with the assessment. Feel free to contact the corresponding author for other versions of the CATS.

Scoring and Interpretation

The CATS is a screening instrument for posttraumatic stress symptoms (PTSS) in children and adolescents. A clinical diagnosis of PTSD should not be based on completion of the CATS alone. Positive results on the CATS should be followed up with a semi-structured clinical interview.

To score the CATS, respondents need to verify whether they have experienced at least one potential traumatic event (PTE) (A-criterion). For those without any reported PTE the assessment is finished. Those respondents with at least one endorsed PTE indicate their (child's) most distressing event and rate their (child's) stress symptoms (criteria B, C, D and E) on page 2. Additional items describe any restrictions of functioning in different domains. The 4-point symptom response scales indicate the reported frequency/severity of each symptom. There are differences in calculating the scores for children from age 7 and adolescents vs. preschool children (see below).

Using the DSM-5 algorithm:
You can use the stop light sheet or scoring sheet to guide you through the process.

Using the total symptom score:
The determination of preliminary cutoff scores was done based on an estimation derived from the validation of a previous DSM-IV based questionnaire (see below).

Ages 3-6: The total symptom score is calculated by summing up the items 1-16 (possible range = 0-48). We recommend to use a cut-off ≥ 16 as indication of a clinically relevant level of symptoms in preschool children.

Ages 7-17: A total symptom score is calculated by summing up the raw scores of items 1-20 (possible range = 0-60). We recommend to use a cut-off ≥ 21 as indication of a clinically relevant level of symptoms.

Include scoring for total scores and subscale scores as well as information on diagnostic or severity cut offs (if any).

Psychometrics

An international validation study (Sachser et al., 2017) proved good to excellent reliability with α ranging between .88 and .94. The convergent-discriminant validity pattern showed medium to strong correlations with measures of depression (r = .62-.82) and anxiety (r = .40-.77) and low to medium correlations with externalizing symptoms (r = −.15-.43) within informants in all language versions. Using CFA the underlying DSM-5 factor structure with four symptom clusters (reexperiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported (n = 475 for self-report; n = 424 for caregiver reports).

Key/Core References

Sachser, C., Berliner, L., Holt, T., Jensen, T. K., Jungbluth, N., Risch, E., ... & Goldbeck, L. (2017). International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS). Journal of affective disorders, 210, 189-195.
https://pubmed.ncbi.nlm.nih.gov/28049104/

Nilsson, D., Dävelid, I., Ledin, S., & Svedin, C. G. (2020). Psychometric properties of the Child and Adolescent Trauma Screen (CATS) in a sample of Swedish children. Nordic Journal of Psychiatry, 1-10. https://www.tandfonline.com/doi/full/10.1080/08039488.2020.1840628

Akkuş, P. Z., Serdaroğlu, E., Kömürlüoğlu, A., Asena, M., Bahadur, E. İ., Özdemir, G., ... & Özmert, E. N. (2021). Screening traumatic life events in preschool aged children: cultural adaptation of Child and Adolescent Trauma Screen (CATS) Caregiver-report 3-6 years version. Turkish Journal of Pediatrics, 63(1). http://www.turkishjournalpediatrics.org/abstract.php?id=2262

Manual

Administration of the CATS should be conducted as a clinical encounter. The CATS may be part of routine assessment procedures and/or occur at a later point with the assigned clinician. It may be used as a stand-alone screening or be part of a larger assessment and clinical interview. The Clinical Guide for administering the CATS is available here

# data[].attributes.attachment_link.description
The Child and Adolescent Trauma Screen (CATS) questionnaire is a brief, freely accessible screening instrument based on the DSM-5 criteria for Posttraumatic Stress Disorder (PTSD). It is a measure of potentially traumatic events and of posttraumatic stress symptoms (PTSS). The developers are Prof. Lutz Goldbeck (Ph.D.) & Prof. Lucy Berliner (Ph.D.)

# data[].attributes.body
Who can benefit and Why?

Risk of development when children face trauma both long and short term, early identification of this trauma allows intervention as soon as possible.

"For example, both Head Start and Early Intervention intake protocols include questions about domestic violence in families. Other protocols may include targeted questions about accidents, loss of family members, and/or significant medical history. Most young children are seen at regular intervals by providers in the pediatric health care system, enabling repeated opportunities for identifying early childhood trauma."

# data[].attributes.attachment_link.provider_name
The National Child Traumatic Stress Network

# data[].attributes.attachment_link.readable_text
Screening and Assessment Within Multiple Systems

Due to the particular developmental risks associated with young children's traumatic experiences, it is essential that vulnerable children be identified as early as possible after the trauma. Many community resources-including health systems, Early Intervention programs, child welfare agencies, Head Start, child care programs, and early education systems-play an important role in identifying children, and in linking them and their families with services.

Some of these systems now try to address possible traumatic experiences by including questions about specific traumas into their intake and/or assessment protocols. For example, both Head Start and Early Intervention intake protocols include questions about domestic violence in families. Other protocols may include targeted questions about accidents, loss of family members, and/or significant medical history. Most young children are seen at regular intervals by providers in the pediatric health care system, enabling repeated opportunities for identifying early childhood trauma. As such, medical providers can also play an important role in diminishing risks and in maximizing protective factors associated with young children's exposure to trauma. They can supply information to prevent accidents and can incorporate questions about stressful and traumatic experiences into their interviews with families.

Focus of Assessment for Young Children

Assessment of trauma in young children must focus on the presenting problem in the context of the child's overall development. This information can be gathered though interviews with the parents and significant caregivers in the child's life, observation of the parent/caregiver-child interaction, and standardized assessment tools. Clinical assessment should include review of the specifics of the traumatic experience including:

Reactions of the child and parents/caregivers

Changes in the child's behavior

Resources in the environment to stabilize the child and family

Quality of the child's primary attachment relationships

Ability of parents/caregivers to facilitate the child's healthy socioemotional, psychological, and cognitive development

When conducting an assessment of a young child, it is also important to assess developmental delays (e.g., gross/fine motor, speech/language, sensory processing), which may indicate that the child could benefit from evaluation and/or services from another professional (e.g., occupational therapist, speech/language therapist, physical therapist). It is often helpful to consult and to work collaboratively with these professionals.

Instruments for Assessing Traumatic Stress in Young Children

Below is a list of some of the standardized instruments used within the NCTSN to assess traumatic stress in young children.

Child Behavior Checklist (CBCL): Achenbach, and Rescorla (2001). Ages 1½-5

Posttraumatic Stress Disorder Semi-Structured Interview and Observation Record: Scheeringa and Zeanah (1994). Ages 0-4

Posttraumatic Symptom Inventory for Children (PT-SIC): Eisen (1997). Ages 4-8

Preschool Age Psychiatric Assessment (PAPA): Egger and Angold (1999). Ages 2-5

PTSD Symptoms in Preschool Aged Children (PTSD-PAC): Levendosky, Huth-Bocks, Semel, and Shapiro (2002). Ages 3-5

Traumatic Events Screening Inventory-Parent Report Revised (TESI-PRR): Ghosh et al. (2002). Ages 0-6

Trauma Symptom Checklist for Young Children (TSCYC): Briere et al. (2001). Ages 3-12

Violence Exposure Scale for Children-Preschool Version (VEX-PV): Shahinfar, Fox, and Leavitt (2000). Ages 4-10

Violence Exposure Scale for Children-Revised Parent Report (VEX-RPR): Shahinfar, Fox, and Leavitt (2000). For parents of preschool-aged children aged 4-10

# data[].attributes.attachment_link.description
Due to the particular developmental risks associated with young children's traumatic experiences, it is essential that vulnerable children be identified as early as possible after the trauma. Many community resources-including health systems, Early Intervention programs, child welfare agencies, Head Start, child care programs, and early education systems-play an important role in identifying children, and in linking them and their families with services.

# data[].attributes.headline
National Network for Youth- Trauma Screening

# data[].attributes.subject
National Network for Youth- Trauma Screening

# data[].attributes.body
This resource is a great branch to ways to get ahold of different trauma screening tools.

Who can benefit and Why?

This includes a variety of handouts such as screening for sex trafficking trauma and a table of stand measures in order to help children and families who faced trauma in many ways.

# data[].attributes.attachment_link.description
Introduction What Is Trauma? Stress vs. Trauma Adverse Childhood Experiences (ACES) Complex Trauma Impact on Youth Experiencing Homelessness Trauma-Informed Care 101 Trauma Screening and Assessments Organizations must ensure that individuals have an inclusive space to heal. TRAUMA SCREENING AND ASSESSMENTS
The

# data[].attributes.body
Screening children for trauma gives their support system some guidelines and information about the child and their experiences.

Who can benefit and Why?

"Screening is a way to identify children who are experiencing high levels of distress and may need additional support to overcome trauma exposure. While childhood trauma exposure is common, it often goes unidentified."

# data[].attributes.attachment_link.provider_name
The Child Health and Development Institute of Connecticut, Inc.

# data[].attributes.body
Who can benefit and Why?

Assessment helps build context and background to a traumatic event, when assessing we need to find what the problem is along with details such as when it started, how long it has gone on, and the number of people present.

"Initial and ongoing assessment of symptoms is a crucial step in identifying the need for trauma treatment and guiding considerations throughout mental health treatment. This webinar will help mental health clinicians review important considerations for initial assessments of trauma symptoms and the role of assessment instruments (e.g., the Child and Adolescent Trauma Screen) in intakes and ongoing treatment monitoring."

# data[].attributes.attachment_link.title
The Role of Assessment in Trauma Treatment

# data[].attributes.body
Who can benefit and Why?

This resource is an example of what a quick screening for trauma may look like. Starting with open ended questions such as how things are going at home? This leaves oppunitunity for the child to talk about their parents and some challenges they might be facing at home.

Talking through kinds of abuse allows the child to give their perspective in the matter which can lead to the issue at hand.

# data[].attributes.attachment_link.title
Conducting a Quick Screen for Trauma - Child Interview

# data[].attributes.body
This video breaks down the five ways to that trauma screening is viewed as an effective assessment.

Who can benefit and Why?

This can benefit from a family deciding if it is the correct choice to move further with additional screening, supporting the benefits.

Effective trauma screening and assessment can lead to:

1. Screening for health care access, trauma exposure and trauma symptoms

2. Probing for helpful and unhelpful coping skills for stress

3. Enhancing motivation for help-seeking behavior

4. Referral to health, mental health, behavioral health and/or social services

5. Reduction in misdiagnosis of common mental health disorders that share similar symptoms with trauma exposure

# data[].attributes.attachment_link.title
How trauma screening and assessment impact child and family well-being

# data[].attributes.body
Who can benefit and Why?

This resource provides a link tree to many different kinds of screening tools for children and adolescents.

Trauma Exposure and Symptom Measures:

-Clinician-Administered PTSD Scale for DSM-5 - Child/Adolescent Version (CAPS-CA-5) Includes information on CAPS-CA for DSM-IV.

-UCLA Child/Adolescent PTSD Reaction Index for DSM-5

# data[].attributes.attachment_link.description
Apply for and manage the VA benefits and services you've earned as a Veteran, Servicemember, or family member-like health care, disability, education, and more.

# data[].attributes.body
Who can benefit and Why?

This resource covers the role of screening and assessment as the large part of caring for the youth and the challenges they may face.

"This meeting analyzes: the difference between screening, assessment, and evaluation; the importance of using a trauma-informed lens; the involvement of families and youth as partners in this work; and the movement toward standardized tools to provide decision support and individualized service planning."

# data[].attributes.attachment_link.title
Screening & Assessment: Best Practices for Youth & Families

# data[].attributes.body
With the presenter being a Professor in Social Work at Western Michigan University, James Henry PHD dives into many topics.

Who can benefit and Why?

"Being able to accurately understand the potential impact of trauma to mental health functioning demands trauma screening and comprehensive neurodevelopmental trauma assessment. A trauma screening tool will be introduced for both children and adults that can be completed by non-clinicians which can further delineate the linkage between trauma and mental health for families which can increase empathy on behalf of those caring for children/adults with trauma."

# data[].attributes.attachment_link.title
Trauma Screening and Assessment for Children and Adults

# data[].attributes.body
This resource is from the APA or American Psychological Association.

Who can benefit from this?

"Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains." This therapy is typically ranging from 12-16 sessions in either a group or individual format.

# data[].attributes.attachment_link.title
Cognitive Behavioral Therapy (CBT) for Treatment of PTSD

# data[].attributes.attachment_link.description
Cognitive behavioral therapy focuses on the relationship among thoughts, feelings and behaviors. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation.

# data[].attributes.body
Eye movement desensitization and reprocessing therapy, commonly known as EMDR, is a mental health therapy method.

Who can benefit from this?

EMDR treats mental health conditions that happen because of memories from traumatic events in your past.

# data[].attributes.attachment_link.title
EMDR Therapy: What It Is, Procedure & Effectiveness

# data[].attributes.attachment_link.description
Eye movement desensitization and reprocessing (EMDR) therapy is a treatment for conditions involving traumatic memories. It’s best known for its use in treating post-traumatic stress disorder (PTSD).

# data[].attributes.body
While issues facing people and children with disabilities today include exclusion, bullying, discrimination and other types of violence. "While disabled people have known for centuries that discrimination, exclusion, and inaccessibility are inherently stressful and traumatic, modern research is just beginning to incorporate these important ideas into studies and solution-building."

# data[].attributes.attachment_link.title
Disability-Related Stress and Inaccessibility as Trauma

# data[].attributes.attachment_link.description
Disability-related stress is a type of toxic stress related to identity-based stress that can lead to pre-traumatic stress, trauma, and long-term negative health and mental health outcomes.

# data[].attributes.body
People and children are at a greater risk for traumatic experiences because it is more likely they face unfair treatment in life, school, and home. "Communication is a major challenge in understanding trauma and providing trauma-informed care to people with disabilities. It can be hard to understand a person’s needs if they have trouble putting them into words."

# data[].attributes.attachment_link.title
Plain Language Summary - Trauma-Informed Care for People with Developmental Disabilities - MHDD National Training Center

# data[].attributes.attachment_link.description
Plain Language Summary – Trauma-Informed Care for People with Developmental Disabilities Trauma is when a person experiences an event, series of events, or situation that causes lasting negative effects. The traumatic event or situation is viewed by the person as being physically or emotionally harmful or life-threatening. People with disabilities have a greater risk of experiencing […]

# data[].attributes.headline
Disability Evidence Portal- Addressing Trauma

# data[].attributes.subject
Disability Evidence Portal- Addressing Trauma

# data[].attributes.body
People with interlettucal disabilities are more likely to develop mental health conditions based on experience trauma throughout their life. "Both facility-based service providers and community-based services are ill-equipped to provide appropriate assessments and responses for trauma exposure among people with intellectual disabilities, and families may lack skills and knowledge to support their loved ones in the face of trauma exposure."

# data[].attributes.body
Trauma is more common in children then thought to believe, SAMHSA reported up to 2/3 of children experiencing a traumatic event before the age of 16. "Because of varied cognitive abilities, some individuals may not understand they’re being placed in dangerous and potentially traumatic situations; for example, they may not receive needed medication, therapy or even daily meals."

# data[].attributes.attachment_link.readable_text
By Pam Dewey * disability, disability and trauma, disabled children and trauma, trauma and people with disabilities, disabled kids and trauma, processing trauma, what causes trauma, how to help children with disabilities process trauma, trauma treatment for disabled children * March 09, 2023

Trauma is much more common among children than you may think. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), " More thantwo-thirds of childrenreported at least 1 traumatic event by age 16." That may seem unbelievable, but trauma isn't just witnessing gun violence or being abused. The National Child Traumatic Stress Network states, " A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child's life or bodily integrity."

To give you an idea of what traumatic events look like, here is a list from Psych Central:

With such a broad definition of trauma, it makes sense that so many children have faced a traumatic event. Unfortunately, some groups of children are even more likely to experience trauma.
Disabled children are more at risk
The National Child Traumatic Stress Network states, " Studies show that children with intellectual and developmental disabilities also experience childhood adversities and trauma at much higher rates than children without disabilities." Experts also believe trauma experienced by people with disabilities is underreported because of issues like barriers in communication.

Some factors put children with intellectual and developmental disabilities at higher risk of experiencing trauma. The National Child Traumatic Stress Network states, " These risk factors include varied cognitive abilities, physical limitations and reduced communication skills." Because of varied cognitive abilities, some individuals may not understand they're being placed in dangerous and potentially traumatic situations; for example, they may not receive needed medication, therapy or even daily meals. For children with physical disabilities, being neglected by a caregiver could mean they are not turned often enough so they develop bedsores, they are not bathed regularly or they are confined to their room for long periods of time.

Also, when a person with disabilities has limited speech, non-standard speech or is a non-vocal communicator, it's harder to communicate with others about traumatic events. It also means they might not be believed. The National Child Traumatic Stress Network states, " Children with [intellectual and developmental disabilities] are less likely to be believed due to their disability." In other words, a child's concerns are more likely to be dismissed because others may think they don't understand the situation or are exaggerating. When their claims are ignored, a child's unsafe situation may continue, and the resulting trauma may also be unacknowledged, so treatment for their trauma doesn't occur.
More caregivers means more risk for abuse
Children with disabilities also typically have more caregivers than other children. In addition to their parents, they might work with home healthcare workers, therapists, special education staff, residential staffing and other medical staff. The National Child Traumatic Stress Network quotes a study by P.M. Sullivan and J.F. Knutson that states, " Sixty-four percent of the children who were maltreated had a disability ...The most common type of maltreatment was neglect." In addition to neglect, caregivers might also abuse or exploit disabled children. This could include stealing money from them, bullying or belittling them and withholding necessary physical accommodations. Again, caregivers may think they can get away with it because the child has difficulty communicating, or because they're disabled and less likely to be believed.
Medical procedures can cause trauma
Children with disabilities typically undergo more medical procedures and endure lengthy hospital stays. This, too, can cause trauma. The National Child Traumatic Stress Network states, " Children's responses to medical trauma are often more related to their subjective experience of the medical event rather than its objective severity." For example, a child might be scared before surgery, even when it's not a major surgery. But their fear causes trauma. Many medical procedures also cause pain, which can be traumatizing for anyone, including children with disabilities. Additionally, being surrounded by beeping machines, strange smells and other sick people can be upsetting and may also cause trauma for children.
Their response may differ from others
Children with disabilities may process trauma differently than other children. The National Child Traumatic Stress Network states, "Accordingly, children with [intellectual and developmental disability] may be exposed to the same types of trauma as any other child but may experience and process the trauma differently and therefore may respond differently. Further, due to their dependence on others for assistance and security, children with [intellectual and developmental disability] may also have an increased trauma response to any threat to the safety of caregivers."

A typical child might tell their parents about a traumatic event they experienced, burst into tears or act fearful. However, children with disabilities may experience communication struggles and differences in understanding that prevent them from responding in these ways. According to The National Child Traumatic Stress Network, for children with disabilities, trauma responses "may include: changes in behavior (for example, increased irritability, loss of previously acquired skills, new fears, bed-wetting, and avoiding previously enjoyed activities or people) and trauma-related mental health conditions (for example, anxiety, PTSD, and depression)." Unfortunately, changes in behavior might be attributed to a child's disability, instead of recognized as a response to trauma.
Trauma can be treated
Children with disabilities don't have to suffer long-term consequences from trauma. Parents and caregivers know their children better than anyone. If you notice a change in your child's behavior or they seem off, talk with them. They may have experienced a traumatic event and not know how to respond. Your child might not understand what happened to them was wrong, or that they shouldn't have been exposed to it. You can talk through these events and teach your child how to respond.

You also might need help uncovering what happened to your child and what is causing the change in their behavior. Some children may benefit from the support of a therapist who specializes in trauma and serving children with disabilities. Fraser is Minnesota's largest and most experienced provider of autism and mental health services for children. Many of our clinicians are also trained in treating children who've experienced trauma.

While children with disabilities are more likely to experience trauma, they can heal and move forward. As a parent, you should watch for changes in behavior and listen to their concerns. If your child needs help processing trauma, Fraser can help. Fraser has served children with disabilities for more than 85 years and specializes in supporting children with co-occurring conditions.

# data[].attributes.attachment_link.title
Fraser Blog - Are Children with Disabilities More Likely to Experience Trauma?

# data[].attributes.attachment_link.description
Trauma is much more common among children than you may think. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “More than two-thirds of children reported at least 1 traumatic event by age 16.” That may seem unbelievable, but trauma isn’t just witnessing gun violence or being abused.

# data[].attributes.body
A traumatic event can happen to anyone at anypoint, as 60% of men and 50% of Women face an event in their lifetime it is much higher for those with intellectual disabilities. "Trauma is more likely to happen to those with intellectual disabilities since they are often left in vulnerable positions and are unable to speak up for themselves. Because of this, they may struggle to communicate when something traumatic happens or when something triggers them."

# data[].attributes.attachment_link.title
Navigating Trauma with Intellectual Disabilities

# data[].attributes.attachment_link.description
Trauma affects everyone at some point in life. Expert Kimberly Knickerbocker shares how Individuals with disabilities deal with trauma.

# data[].attributes.body
In 2019, 2/3 of Michigan adults reported an adverse childhood experience. This resources dissects the midline of disabilities and ACE experiences in the state of Michigan and how they might be related. "Individually, the populations examined in this brief – people who have experienced Adverse Childhood Experiences, and people with disabilities – face significant and well documented health disparities."

# data[].attributes.body
This presentation explores the definitions of trauma and disabilities. This resource also touches on the both and the connection between the two. "Individuals can acquire a disability from trauma and what happened to them can be wrong AND individuals can live with that disability and not be broken."

# data[].attributes.body
As children face trauma experiences on a daily basis, the risk increases when the child also has a intellectual or physical disability. "Young people with mental illness and cognitive or learning disabilities (e.g., attention deficit hyperactivity disorder and autism) are especially likely to experience violence, and overall, children with disabilities are more than twice as likely to experience violence compared to those without disabilities, which can have a serious and long-lasting impact on their health and wellbeing."

# data[].attributes.attachment_link.provider_name
Columbia University Mailman School of Public Health

# data[].attributes.attachment_link.title
One in Three Children With Disabilities Has Experienced Violence: Global Study

# data[].attributes.attachment_link.description
Children and adolescents with disabilities experience physical, sexual, and emotional violence, and neglect at considerably higher rates than those without disability, despite advances in awareness and policy in recent years. This is according to a systematic review of research involving more than 16 million young people from 25 countries conducted between 1990 and 2020. The study provides the most comprehensive picture of the violence experienced by children with disabilities around the world.

# data[].attributes.body
Finding and understanding the signs of trauma when caring for an intellectual or physically disabled person allows early intervention. "It may not be something that many people think about that often but people with intellectual or developmental disabilities can benefit from therapy, too. Just like everyone else, they suffer from depression, anxiety, and other mental health concerns including trauma.

In fact, people with disabilities, particularly intellectual or developmental disabilities, are more susceptible to trauma and the resultant PTSD."

# data[].attributes.attachment_link.provider_name
Western Tidewater Community Services Board

# data[].attributes.attachment_link.title
Signs of Trauma in a Child or Adult With an Intellectual Disability | WTCSB

# data[].attributes.attachment_link.description
Individuals with developmental disabilities suffer 2.5 to 10 times the abuse and neglect of their non-disabled peers. Here are signs of abuse to be aware of.

# data[].attributes.body
Trauma is a persisted problem, as it stems from one or a serious events that were dispurting in a way.

Who can benefit and Why?

"People affected by trauma may develop coping mechanisms to help alleviate the emotional and/or physical pain they feel as a result of trauma. Sometimes, these strategies involve maladaptive behaviors — such as unhealthy eating, tobacco use, or drug and alcohol use. "

# data[].attributes.attachment_link.title
What is Trauma? - Trauma-Informed Care Implementation Resource Center

# data[].attributes.attachment_link.description
Learn about trauma, its causes, and the negative long-term effects of trauma on health and wellbeing.