# data[].attributes.body
Crain, W. (2011). Theories of Development (6th ed.). Prentice Hall.

Newman, B. M., & Newman, P. R. (2018). Development through life: A psychosocial approach
(13thed.). Boston, MA, CA: Cengage Learning.

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The 3 Stages of Emotional Child Development

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Trauma, PTSD, and Attachment in Infants and Young Children

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Trauma, PTSD, and Attachment in Infants and Young Children

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Erin R. Barnett, PhD and Jessica Hamblen, PhD

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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.

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How Trauma is Changing Children’s Brains

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How Trauma is Changing Children’s Brains

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For several years, John Snelgrove began his workweek with a lengthy fax from the local police, listing the home addresses where officers had answered domestic violence calls over the weekend.

Snelgrove, head of guidance services for Brockton (Mass.) Public Schools, would check those addresses against the district's student database. When a match came up, he'd alert the counselor at that child's school, who, in turn, would take a red envelope and deliver it to the child's teacher. Inside was a slip of paper with a student's name and a quick prescription for "TLC."

A Sunday night, disrupted by violence, panic, and 911 calls, surely will make it difficult for a child to settle down to learn on Monday morning. But, even more than that, researchers have found that exposure to unrelenting stress and repeated traumas can change a child's brain, making it easier to "fight or flee" from perceived dangers and harder to focus and learn. Understanding this neuroscience makes it possible for educators to create trauma-sensitive classroom.

"It's more than one or two children in your class of 28, it could be closer to 30 percent or more," Snelgrove tells his colleagues. But even children who haven't experienced trauma will benefit from the strategies that Brockton teachers and education support professionals have learned through years of training with the Massachusetts-based Trauma and Learning Policy Initiative, and their partnerships with local police, mental health, and child welfare agencies.

"Be consistent, be kind, focus on connecting with kids," he urges.

The Traumatized Brain

Back in the 1990s, Dr. Vincent Felitti, working with very obese adults, discovered that a shocking majority of his patients had suffered significant traumas during childhood. Eventually, his work led to a mega-study, involving tens of thousands of patients, which showed the long-lasting effects of "adverse childhood experiences," or ACEs, such as child neglect or abuse, or a parent with addiction or imprisoned. Those children often grow up to be adults who are more likely to be sick, to be violent, to miss work, and to marry often.

Since then, it's become clear that the damaging effects of trauma are not saved until adulthood. It starts early and it affects students and teachers: in fact, kindergartners who have had tough experiences score below-average in reading and math, even when other factors like household income and parental education are considered, a study published this year found. Those traumatized 5-year-olds also are three times more likely to have problems with paying attention, and two times more likely to show aggression.

What neuropsychologists have found is that traumatic experiences actually can alter children's brains. In times of great stress, or trauma, the brain activates its deeply instinctive, "fight, flight, or freeze" responses, while dialing down the areas of the brain where learning, especially around language, takes place. When this happens over and again, especially in children under age 5, the brain is fundamentally changed. Basically, it adapts for survival under the worst conditions.

"It's an appropriate adaptation to their circumstances," says Amanda Moreno, professor of early-child development at the Erikson Institute in Chicago. "But it comes at enormous cost to schooling, especially with the way we do schooling in this country, which is very standardized."

Traumatized 5-year-olds are three times more likely to have problems with paying attention, and two times more likely to show aggression.

Veteran Illinois special education teacher Kathi Ritchie knows what this looks like in a classroom: "You will see kids struggling with all areas of language, word retrieval, writing... memory suffers hugely. They tend to be forgetful. They don't remember content-area ideas that have been taught to them; the next day it's like they never were taught," she says. "The other thing that is huge is the behavior."

Living in a constant, fear-activated state of hyper-awareness means these children can be quick to rage, Ritchie has seen. In their subconscious efforts to self-protect, they often can be perceived as defiant, disrespectful or overly aggressive. Others may look like they're zoning out or drifting off, she says. "It can look like kids are shutting down, but their brain is telling them, 'you need to be safe.'"

Calming Colors, Safe Spaces, Mindfulness

So what's an educator to do? First, here's what not to do: Punish a child for showing the symptoms of a medical disorder. Trauma and stressor disorders can be found in the most up-to-date Bible of mental health disorders and diagnoses, the DSM-V, which means they are a real medical issue. Out-of-school suspensions are an inappropriate response and likely feed the school-to-prison pipeline.

Instead, what helps is to create a trauma-sensitive classroom where kids can feel safe and build resilience. Although Snelgrove no longer receives faxes from the local police because of revised confidentiality requirements, he hopes the "universal precautions" that Brockton teachers and education support professionals have embraced will catch any student who has experienced trauma.

Trauma-sensitive teachers often offer a "comfort zone" to their students, a safe space where kids can retreat and calm down. Sometimes it's as simple as a beanbag chair. Their classrooms also are neat and uncluttered. Think about how you feel coming home to a messy house, Snelgrove says. A little overwhelmed, right? It's worse for hyper-aroused children. Cool colors reign on the walls.

Ritchie also recommends teaching strategies that include predictable classroom routines with advance warning to students of any changes; asking students to repeat verbal instructions, using more written instructions, and also using visual prompts for multi-step directions, like a sticky post-it note on a desk. All students can benefit from short "movement breaks" every 30 minutes to "reframe the brain," she says.

Moreno's research currently involves the effects of mindfulness exercises on students in some of Chicago's roughest neighborhoods. Although her study is not yet complete, teachers and principals have told her that the time they are spending on mindfulness actually is leading to more time for instruction. Students refocus more quickly after transitions, and calm down after upsets. This makes classrooms more efficient, but it also helps with an even bigger goal: Helping children grow up to be healthy adults.

You will see kids struggling with all areas of language, word retrieval, writing... memory suffers hugely.

- Kathi Ritchie, special education teacher.

Apart from employing a mindfulness curricula, or classroom yoga practices, which also are gaining popularity, simply greeting students at the start of the day and "acknowledging their humanity" before diving into tasks will help, Moreno says. With all the demands placed on teachers, it can be difficult, even "radical," for teachers to slow down the pace of their classes and to take time with every student, but it will pay dividends, she says.

In Brockton, Snelgrove appreciates his district's leaders for investing in years of trauma-related training for teachers and education support professionals, and developing partnerships with police, mental health, and child welfare agencies. This isn't the stuff that appears on state-mandated standardized tests, he acknowledges. But it is the stuff that engages the "hearts and minds" of teachers and education support professionals, he says.

"We're not perfect, and I know we have a way to go, but when we talk about the 'whole child,' we mean it."

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How Trauma is Changing Children's Brains | NEA

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Understanding how severe stress affects students is the important first step in creating trauma-sensitive classrooms.

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A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma

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A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma

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A book to help children process and cope with trauma.

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A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma [Holmes, Margaret M., Pillo, Cary] on Amazon.com. *FREE* shipping on qualifying offers. A Terrible Thing Happened: A Story for Children Who Have Witnessed Violence or Trauma

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Overview of adverse childhood experiences, the latest data, and CDC’s approach to prevention.

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Trauma can greatly impact the developing and vulnerable minds of young children. Here are key factors about the impact of child trauma.

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How many children and adolescents experience traumatic events?

The best information on very young children comes from annual statistics from the Department of Health and Human Services on child abuse. These rates underestimate traumatic exposure given that they address abuse only and not other types of traumatic events. Also, they underestimate abuse because not all abuse is reported.

In 2011, child protective services in the United States received 3.4 million referrals, representing 6.2 million children. Of those cases referred, about 19% were substantiated and occurred in the following frequencies (1).

more than 75 percent (78.5%) suffered neglect

more than 15 percent (17.6%) suffered physical abuse

less than 10 percent (9.1%) suffered sexual abuse

In older children there have been several national studies. The National Survey of Children's Exposure to Violence reports on 1 year and lifetime prevalence of childhood victimization in a nationally representative sample of 4549 children aged 0-17.2 More than half (60.6%) of the sample experienced or witnessed victimization in the past year. Specifically in the past year:

almost half (46.3%) experienced physical assault

1 in 10 (10.2%) experienced child maltreatment

fewer than 1 in 10 (6.1%) had experienced sexual victimization

more than 1 in 4 (25.3%) had witnessed domestic or community

As children age there is more opportunity for exposure, thus lifetime exposure was one third to one half higher than past year exposure. As an example, among 14-17 year old girls, 18.7 have experienced a completed or attempted sexual assault in their lifetime and more than a third had witnessed parental assault (2).

A second national study asked 4,023 adolescents aged 12-17 if they had ever experienced sexual or physical assault or witnessed violence (3). Almost half (47%) had experienced one of these types of traumas. Specifically in their lifetime:

8% experienced sexual assault

22% experienced physical assault

39% witnessed violence

How many children develop PTSD?

The National Comorbidity Survey Replication- Adolescent Supplement is a nationally representative sample of over 10,000 adolescents aged 13-18. Results indicate that 5% of adolescents have met criteria for PTSD in their lifetime. Prevalence is higher for girls than boys (8.0% vs. 2.3%) and increase with age (4). Current rates (in the past month) are 3.9% overall (5). There are no definitive studies on prevalence rates of PTSD in younger children in the general population.

What are the risk factors for PTSD?

Both the type of event and the intensity of exposure impact the degree to which an event results in PTSD. For example, in one study of a fatal sniper attack that occurred at an elementary school proximity to the shooting was directly related to the percentage of children who developed PTSD. Of those children who directly witnessed the shooting on the playground, 77% had moderate to severe PTSD symptoms, whereas 67% of those in the school building at the time and only 26% of the children who had gone home for the day had moderate or severe symptoms (6).

In addition to exposure variables, other risk factors include:

female gender

previous trauma exposure

preexisiting psychiatric disorders

parental psychopathology

low social support

Parents have been shown to have protective factors (practice parameters). Both parental support and lower levels of parental PTSD have been found to predict lower levels of PTSD in children.

There is less clarity in the findings connecting PTSD with ethnicity and age. While some studies find that minorities report higher levels of PTSD symptoms, researchers have shown that this is due to other factors such as differences in levels of exposure. It is not clear how a child's age at the time of exposure to a traumatic event affects the occurrence or severity of PTSD. While some studies find a relationship, others do not. Differences that do occur may be due to differences in the way PTSD is expressed in children and adolescents of different ages or developmental levels.

What does PTSD look like in children?

As in adults, PTSD in children and adolescence requires the presence of re-experiencing, avoidance and numbing, and arousal symptoms. However, researchers and clinicians are beginning to recognize that PTSD may not present itself in children the same way it does in adults. Criteria for PTSD include age-specific features for some symptoms.

Elementary school-aged children

Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trauma. However, they do experience "time skew" and "omen formation," which are not typically seen in adults.

Time skew refers to a child mis-sequencing trauma-related events when recalling the memory. Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

School-aged children also reportedly exhibit posttraumatic play or reenactment of the trauma in play, drawings, or verbalizations. Posttraumatic play is different from reenactment in that posttraumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety.

An example of posttraumatic play is an increase in shooting games after exposure to a school shooting. Posttraumatic reenactment, on the other hand, is more flexible and involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

Adolescents and Teens

PTSD in adolescents may begin to more closely resemble PTSD in adults. However, there are a few features that have been shown to differ. As discussed above, children may engage in traumatic play following a trauma. Adolescents are more likely to engage in traumatic reenactment, in which they incorporate aspects of the trauma into their daily lives. In addition, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors.

Besides PTSD, what are the other effects of trauma on children?

Besides PTSD, children and adolescents who have experienced traumatic events often exhibit other types of problems. Perhaps the best information available on the effects of traumas on children comes from a review of the literature on the effects of child sexual abuse.

In this review, it was shown that sexually abused children often have problems with fear, anxiety, depression, anger and hostility, aggression, sexually inappropriate behavior, self-destructive behavior, feelings of isolation and stigma, poor self-esteem, difficulty in trusting others, substance abuse, and sexual maladjustment (7).

These problems are often seen in children and adolescents who have experienced other types of traumas as well. Children who have experienced traumas also often have relationship problems with peers and family members, problems with acting out, and problems with school performance (8).

Along with associated symptoms, there are a number of psychiatric disorders that are commonly found in children and adolescents who have been traumatized. One commonly co-occurring disorder is major depression. Other disorders include substance abuse; anxiety disorders such as separation anxiety, panic disorder, and generalized anxiety disorder; and externalizing disorders such as attention-deficit/hyperactivitiy disorder, oppositional defiant disorder, and conduct disorder (8).

How is PTSD treated in children and adolescents?

Although some children show a natural remission in PTSD symptoms over a period of a few months, a significant number of children continue to exhibit symptoms for years if untreated. Trauma Focused psychotherapies have the most empirical support for children and adolescents (8,9).

Cognitive-Behavioral Therapy (CBT)

Research studies show that CBT is the most effective approach for treating children. The treatment with the best empirical evidence is Trauma-Focused CBT (TF-CBT). TF-CBT generally includes the child directly discussing the traumatic event (exposure), anxiety management techniques such as relaxation and assertiveness training, and correction of inaccurate or distorted trauma related thoughts.

Although there is some controversy regarding exposing children to the events that scare them, exposure-based treatments seem to be most relevant when memories or reminders of the trauma distress the child. Children can be exposed gradually and taught relaxation so that they can learn to relax while recalling their experiences. Through this procedure, they learn that they do not have to be afraid of their memories.

CBT also involves challenging children's false beliefs such as, "the world is totally unsafe." The majority of studies have found that it is safe and effective to use CBT for children with PTSD.

CBT is often accompanied by psycho-education and parental involvement. Psycho-education is education about PTSD symptoms and their effects. It is as important for parents and caregivers to understand the effects of PTSD as it is for children. Research shows that the better parents cope with the trauma, and the more they support their children, the better their children will function. Therefore, it is important for parents to seek treatment for themselves in order to develop the necessary coping skills that will help their children.

Play therapy

Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other techniques to help the children process their traumatic memories.

Psychological First Aid

Psychological First Aid has been used for school-aged children and adolescents exposed to disasters and community violence and can be used in schools and traditional settings. Psychological First Aid involves providing comfort and support, normalizing the children's reactions, helping caregivers deal with changes in the child's emotions and behavior, teaching calming and problem-solving skills, and referring the most symptomatic children for additional treatment. See Manuals to learn more about Psychological First Aid.

Eye Movement Desensitization and Reprocessing (EMDR)

Another therapy, EMDR, combines cognitive therapy with directed eye movements. While EMDR has been shown to be effective in treating adults, research with children is not as strong. Studies indicate that it is the cognitive component rather than the eye movements that accounts for the change.

Medications

Selective serotonin reuptake inhibitors (SSRI) are approved for use in adults with PTSD. SSRIs are approved for use in children and adolescents with depression and OCD. Preliminary evidence suggests SSRIs may be effective in treating PTSD, however there may also be risks such as irritability, poor sleep, and inattention. At this time, there is insufficient evidence to support the use of SSRIs.

Specialized Interventions

Specialized interventions may be necessary for children exhibiting particularly problematic symptoms or behaviors, such as inappropriate sexual behaviors, extreme behavioral problems, or substance abuse.

References

1. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2012). Child Maltreatment 2011. Available from www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

2. Finkelhor, D., Turner, H., Ormond, R., & Hamby. S. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124, 1411-1423.

3. Kilpatrick, D., et al. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68, 19-30.

4. Merikangas, K. et al. (2010). Lifetime prevalence of mental disorders in the U.S. Adolescent Comorbidity Survey Replication-Adolescent Sample. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980-988.

5. Kessler, R., et al (2912). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Sample. Archives of General Psychiatry, 69, 372-380.

6. Pynoos, R. et al. (1987). Life threat and posttraumatic stress in school aged children. Archives of General Psychiatry, 44, 1057- 1063.

7. Browne, A. & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66-77.

8. Practice Parameters for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder. (April, 2010). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 414-430.

9. Foa, E., Keane, T., Friedman, M., & Cohen, J. (Eds.) (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guildford Press

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How many children and adolescents experience traumatic events? The best information on very young children comes from annual statistics from the Department of Health and Human Services on child abuse. These rates underestimate traumatic exposure given that they address abuse only and not other types of traumatic events.

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Take the ACEs quiz to find out your ACEs score!

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Preschoolers may not have the words but will show their distress at traumatic events through changes in behaviour and functioning.

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The National Child Traumatic Stress Network

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

Complex trauma can affect children in a multitude of ways. Here are some common effects.

Attachment and Relationships

The importance of a child's close relationship with a caregiver cannot be overestimated. Through relationships with important attachment figures, children learn to trust others, regulate their emotions, and interact with the world; they develop a sense of the world as safe or unsafe, and come to understand their own value as individuals. When those relationships are unstable or unpredictable, children learn that they cannot rely on others to help them. When primary caregivers exploit and abuse a child, the child learns that he or she is bad and the world is a terrible place.

The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Our ability to develop healthy, supportive relationships with friends and significant others depends on our having first developed those kinds of relationships in our families. A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures, such as teachers or police officers.

Physical Health: Body and Brain

From infancy through adolescence, the body's biology develops. Normal biological function is partly determined by environment. When a child grows up afraid or under constant or extreme stress, the immune system and body's stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress. For example, an individual may experience significant physiological reactivity such as rapid breathing or heart pounding, or may "shut down" entirely when presented with stressful situations. These responses, while adaptive when faced with a significant threat, are out of proportion in the context of normal stress and are often perceived by others as "overreacting" or as unresponsive or detached.

Stress in an environment can impair the development of the brain and nervous system. An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential. Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems. They may engage in risky behaviors that compound these conditions (e.g., smoking, substance use, and diet and exercise habits that lead to obesity).

Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or under-respond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result, they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse - they may complain of chronic pain in various body areas for which no physical cause can be found.

Emotional Responses

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses. Having learned that the world is a dangerous place where even loved ones can't be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous. While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions. Alternately, many children also learn to "tune out" (emotional numbing) to threats in their environment, making them vulnerable to revictimization.

Difficulty managing emotions is pervasive and occurs in the absence of relationships as well. Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed. For example, in school they may become so frustrated that they give up on even small tasks that present a challenge. Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.

Dissociation

Dissociation is often seen in children with histories of complex trauma. When children encounter an overwhelming and terrifying experience, they may dissociate, or mentally separate themselves from the experience. They may perceive themselves as detached from their bodies, on the ceiling, or somewhere else in the room watching what is happening to their bodies. They may feel as if they are in a dream or some altered state that is not quite real or as if the experience is happening to someone else. Or they may lose all memories or sense of the experiences having happened to them, resulting in gaps in time or even gaps in their personal history. At its extreme, a child may cut off or lose touch with various aspects of the self.

Although children may not be able to purposely dissociate, once they have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders. Dissociation can affect a child's ability to be fully present in activities of daily life and can significantly fracture a child's sense of time and continuity. As a result, it can have adverse effects on learning, classroom behavior, and social interactions. It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply "spacing out," daydreaming, or not paying attention.

Behavior

A child with a complex trauma history may be easily triggered or "set off" and is more likely to react very intensely. The child may struggle with self-regulation (i.e., knowing how to calm down) and may lack impulse control or the ability to think through consequences before acting. As a result, complexly traumatized children may behave in ways that appear unpredictable, oppositional, volatile, and extreme. A child who feels powerless or who grew up fearing an abusive authority figure may react defensively and aggressively in response to perceived blame or attack, or alternately, may at times be overcontrolled, rigid, and unusually compliant with adults. If a child dissociates often, this will also affect behavior. Such a child may seem "spacey", detached, distant, or out of touch with reality. Complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking such as operating a vehicle at high speeds. They may also engage in illegal activities, such as alcohol and substance use, assaulting others, stealing, running away, and/or prostitution, thereby making it more likely that they will enter the juvenile justice system.

Cognition: Thinking and Learning

Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills. Many children who have experienced complex trauma have learning difficulties that may require support in the academic environment.

Self-Concept and Future Orientation

Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child's sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.

To plan for the future with a sense of hope and purpose, a child needs to value him- or herself. To plan for the future requires a sense of hope, control, and the ability to see one's own actions as having meaning and value. Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances. Beliefs about themselves, others, and the world diminish their sense of competency. Their negative expectations interfere with positive problem-solving, and foreclose on opportunities to make a difference in their own lives. A complexly traumatized child may view himself as powerless, "damaged," and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in "survival mode," the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.

Long-Term Health Consequences

Traumatic experiences in childhood have been linked to increased medical conditions throughout the individuals' lives. The Adverse Childhood Experiences (ACE) Study is a longitudinal study that explores the long-lasting impact of childhood trauma into adulthood. The ACE Study includes over 17,000 participants ranging in age from 19 to 90. Researchers gathered medical histories over time while also collecting data on the subjects' childhood exposure to abuse, violence, and impaired caregivers. Results indicated that nearly 64% of participants experienced at least one exposure, and of those, 69% reported two or more incidents of childhood trauma. Results demonstrated the connection between childhood trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness such as heart disease and cancer, and early death.

Economic Impact

The cumulative economic and social burden of complex trauma in childhood is extremely high. Based upon data from a variety of sources, a conservative annual cost of child abuse and neglect is an estimated $103.8 billion, or $284.3 million per day (in 2007 values). This number includes both direct costs-about $70.7 billion-which include the immediate needs of maltreated children (hospitalization, mental health care, child welfare systems, and law enforcement) and also indirect costs-about $33.1 billion-which are the secondary or long-term effects of child abuse and neglect (special education, juvenile delinquency, mental health and health care, adult criminal justice system, and lost productivity to society).

A recent study examining confirmed cases of child maltreatment in the United States found the estimated total lifetime costs associated with child maltreatment over a 12-month period to be $124 billion. In the 1,740 fatal cases of child maltreatment, the estimated cost per case was $1.3 million, including medical expenses and productivity loss. For the 579,000 non-fatal cases, the estimated average lifetime cost per victim of child maltreatment was $210,012, which includes costs relating to health care throughout the lifespan, productivity losses, child welfare, criminal justice, and special education. Costs for these nonfatal cases of child maltreatment are comparable to other high-cost health conditions (i.e., $159,846 for stroke victims and $181,000 to $253,000 for those with Type 2 diabetes).

In addition to these costs are the "intangible losses" of pain, sorrow, and reduced quality of life to victims and their families. Such immeasurable losses may be the most significant cost of child maltreatment.

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day.

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Being There: Why Prioritizing Motherhood in the First Three Years Matters

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Being There: Why Prioritizing Motherhood in the First Three Years Matters

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Being There: Why Prioritizing Motherhood in the First Three Years Matters [Komisar, Erica] on Amazon.com. *FREE* shipping on qualifying offers. Being There: Why Prioritizing Motherhood in the First Three Years Matters

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How childhood trauma affects health across a lifetime

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How childhood trauma affects health across a lifetime

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How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED

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Childhood Trauma and the Brain | UK Trauma Council

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Play Therapy games to help cope with trauma

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Play Therapy games to help cope with trauma

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Play Therapy and Counseling Games - Card Games, Board Games, & More

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Therapy card games and board games for individual, family and group therapy. Read customer reviews, sort by price, and get free shipping.

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Trust vs Mistrust (Erikson's 1st Stage, Explained)

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What Is Autonomy Vs. Shame And Doubt? - Childhood Education Zone

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Initiative vs Guilt (Erikson's Stages) - Easiest Explanation

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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.

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Free online parenting course to help build a positive bond

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Free online parenting course to help build a positive bond

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Triple P Online for Baby = a positive start for your new family!

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Empowering new parents with knowledge and confidence: nurture baby’s development, take care of your own mental health, keep your relationship strong, and more!

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When Sad, Scary Things Happen: Coping with Childhood Trauma

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When Sad, Scary Things Happen: Coping with Childhood Trauma [Arnold-McEwan LICSW, Erika] on Amazon.com. *FREE* shipping on qualifying offers. When Sad, Scary Things Happen: Coping with Childhood Trauma

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Save when you purchase the complete kit Wide variety of tools and interventions Resources for children and young adolescents Suitable for beginning & seasoned clinicians Becoming A Superhero provides young children specific coping skills that will build their sense of resiliency and reduce PTSD symptoms. This book

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Paper Tigers follows a year in the life of a high school that has radically changed it's approach to disciplining its students, becoming a model for how to break the cycles of poverty, violence and disease that affects families.

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Paper Tigers follows a year in the life of a high school that has radically changed it's approach to disciplining its students, becoming a model for how to break the cycles of poverty, violence and disease that affects families.

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Watch Paper Tigers now on your favorite device! Enjoy a rich lineup of TV shows and movies included with your Prime membership.

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The Brain Architecture Game is a tabletop game experience that builds understanding of the powerful role of experiences on early brain development – what promotes it, what derails it, with what consequences for society.

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Explore the powerful role of relationships on brain development.

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Tara Talks - Flipping Our Lid: Trauma Edition

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The Impact of Traumatic Events on Mental Health among Older African American and Black Caribbean Adults

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The Impact of Traumatic Events on Mental Health among Older African American and Black Caribbean Adults

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This study examined the frequency and impact of traumatic events on the mental health of older African American and Black Caribbean adults. It used data from the National Survey of American Life of African American and Black Caribbean adults aged 50…

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Free mental health support for teens aged 13+

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Somethings® - Connecting Teens with Certified Peer Specialist Mentors

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Somethings connects teens with a Certified Peer Specialist Mentor who provide a safe, trustworthy space to feel their best and combat loneliness.

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The Body's Response to Trauma

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The Body’s Response to Trauma With Dr. Maureen Gallagher

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Podcast Episode · The Healing Trauma Podcast · 04/10/2025 · 39m

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The perfect place to begin your journey of wellness.

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See the offerings available on our Retreat Calendar here or explore the many learning paths. Find out how to book a retreat at the Art of Living Retreat Center.

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10 Movies That Explore the Effects of Childhood Trauma

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Peace by Piece Not since Viktor Frankl's Man's Search for Meaning have I read a narrative of trauma survival and recovery that has impacted me this profoundly. Cheryl writes in unflinching first person, giving voice to the little girl trapped in the dark heart of abject torture-the terror and loss is real-time and sensorial for the reader-and out the other side into the light of recovery and healing. It is a breathless journey that leaves the reader awe-struck and reverent to the resilience of children to survive evil with their innocence intact and the eternally-springing hope of being loved and accepted by their abusers. This book is a rare treat that navigates the path of heartbreak to the path of posttraumatic growth all the way to the restoration of life, love, safety, joy, meaning and satisfaction-peace by piece. It is an intimately personal story that shimmers with honesty and is not once melodramatic or contrived. Instead, this book is a finely chiseled heroine's story. The story of a courageous adult who returns to her painful past to rescue and champion her younger self out of the miasma of past violence to the Grace of the present that-by the end of the book-we find ourselves celebrating. Reading the last page of this book felt as though something important was achieved and something precious received-not just for Cheryl, but also for myself and all humankind. A month after reading this book I find it still continues to haunt me...in the best of ways. J. Eric Gentry, PhD, DAAETS, FAAETS President Forward-Facing Institute

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Peace by Piece Not since Viktor Frankl's Man's Search for Meaning have I read a narrative of trauma survival and recovery that has impacted me this profoundly. Cheryl writes in unflinching first person, giving voice to the little girl trapped in the dark heart of abject torture-the terror and los...

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"I highly recommend this book to psychotherapists working with PTSD and other trauma-related presenting problems. Dr. Gentry's book has the potential to substantially increase the effectiveness of psychotherapy for the traumatized with a one-two punch: (1) Direct exposure to the root of the traumatic memories paired with (2) resilience-building self-care practices that promote principle-based living. In contrast to therapist-centered treatments, Forward-Facing Trauma Therapy helps to resolve PTSD symptoms with a client-guided approach that focuses on current and future challenges while rapidly optimizing the client's quality of life." - Prof. Charles R. Figley, Ph.D., The Paul Henry Kurzweg, MD Distinguished Chair in Disaster Mental Health at Tulane University, pioneer of traumatic stress treatment and research

"As a leader in the field, J. Eric Gentry brings an invaluable new perspective on treating traumatic stress and compassion fatigue that is firmly grounded in the latest brain science. In Forward-Facing Trauma Therapy, he makes a compelling case that stress reduction and symptom alleviation are only the first steps in the healing process and that our ultimate goal must be to help our clients achieve a congruent life based on integrity and choice. Whether you're a counseling professional or simply looking to derive more meaning and satisfaction from your life, you will find much to value in Gentry's informative and thought-provoking book."- Robert Rhoton, Psy.D., LPC, D.A.A.E.T.S., CEO of the Arizona Trauma Institute, VP of the International Association of Trauma Professionals

"FFTT is a gift. This powerful growth model outlines a sure pathway to healing while engaging your moral compass. This book is a wonderful resource for trauma professionals and survivors alike."- Anna Baranowsky, Ph.D., C. Psych., founder/CEO of the Traumatology Institute (Canada), author of Trauma Practice: Tools for Stabilization and Recovery and What

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Forward-Facing(R) Trauma Therapy - Second Edition: Healing the Moral Wound

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Forward-Facing(R) Trauma Therapy - Second Edition: Healing the Moral Wound [Gentry PhD, J Eric] on Amazon.com. *FREE* shipping on qualifying offers. Forward-Facing(R) Trauma Therapy - Second Edition: Healing the Moral Wound

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Dr. Lisa Weed Phifer is a trauma-informed social emotional specialist, school psychologist and author. Additionally, she holds certification as an Evergreen Certified Child & Adolescent CBT Clinician (CBT-CA) and Certified Youth Mental Health Specialist (CYMHS. Dr. Phifer is the author of the newly released, the CBT Toolbox for Young Adults. She is also the lead author of the CBT Toolbox for Children and Adolescents, Trauma-Informed Social Emotional Toolbox, and the Parenting Toolbox.

Dr. Phifer has expertise in developing the social emotional capacities of children and empowering service providers to reframe challenging issues with a trauma informed approach. Her work has also been published in the School Mental Health Journal and both editions of the book Supporting and Educating Traumatized Students (Rossen, 2020). She has created and facilitated virtual professional training programs to increase educator's awareness off trauma on social, emotional and educational growth.

Dr. Phifer holds a Bachelor's of Science in Neuroscience and Psychology from Allegheny College, a Masters in Educational Psychology from Edinboro University of Pennsylvania, and earned her Doctorate of Education from Indiana University of Pennsylvania.

Family comes first. She enjoys time with her husband, daughter and her doodles Midas and Hobart. Her other interests include singing in the car, football Sundays, baking with her daughter, spending time at the lake in the summer and traveling.

Follow Dr. Phifer on Twitter @drweedphif

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Trauma-Informed Social-Emotional Toolbox for Children & Adolescents: 116 Worksheets & Skill-Building Exercises to Support Safety, Connection & Empowerment

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Empower children and adolescents to cope with trauma and build resiliencyWritten by expert clinicians, the activities in this workbook support a foundation of social-emotional language, an increase in consistency and routine, regulation of tough emotions, and the formation of connections with oth...

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Laurie Halse Anderson is the New York Times-bestselling author who writes for kids of all ages. Known for tackling tough subjects with humor and sensitivity, her work has earned numerous American Library Association and state awards. Two of her books, Speak and Chains, were National Book Award finalists. Chains also earned a spot on the Carnegie Medal Short List.

Laurie received the 2009 Margaret A. Edwards Award given by the Young Adult Library Services Association division of the American Library Association for her "significant and lasting contribution to young adult literature."

Mother of four and wife of one, Laurie lives in Northern New York State, an hour south of the Canadian border, where she likes to watch the snow fall as she writes. Right now she's finishing up her next YA novel and researching Ashes, which will conclude the adventure of Isabel and Curzon that readers enjoyed in her historical novels Chains and Forge.

You'll find loads more information about Laurie and her books on her website: http://madwomanintheforest.com/. You can follow her adventures on Twitter, http://twitter.com/halseanderson, on Facebook, https://www.facebook.com/lauriehalseanderson, and on her blog, http://madwomanintheforest.com/blog/.

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Amazon.com: Speak: 9780312674397: Anderson, Laurie Halse: Books

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How is attachment related to trauma? | Kati Morton

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How to Cope with a Later-Life Crisis

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If current life expectancy is 78.7 years and adulthood begins at age 18, your midlife crisis should hit around age 48. But the definition of midlife crisis, as first coined in 1965 by psychologist Elliott Jaques, was a bit vague on the specifics. He didn't specify an age or give any concrete symptoms. It is merely described as a time when adults contemplate their mortality and the waning years they have left to enjoy life.

And truthfully, that can hit at any age, says Johns Hopkins geriatric medicine physician Alicia Arbaje, M.D., M.P.H.

Recognizing the Feelings

If you find yourself spending too much time looking into the rearview mirror of life, you may be experiencing a midlife, or later-life, crisis. You're not alone: In fact, recent research found that one in three people over the age of 60 will go through this experience. Here are some of the signs-and the psychology behind them.

You're over age 50.

For many people, the mid-40s is the time in life when our future isn't a scary unknown, our past is something we can laugh about, and our present is filled with marriage, kids, careers, and a general satisfaction in knowing who we are and what we want out of life, says Arbaje. So it's not surprising that we may feel melancholy beyond our 40s, when the future can once again seem uncertain.

Your family is driving you crazy.

Middle-aged people aren't inherently more stressed-out than younger folks, but the type of stress is different, says Arbaje. Research shows that only 8 percent of young adults reported no daily stressors, compared with 12 percent of middle-aged adults (ages 40 to 59) and 19 percent of older people (ages 60 to 74). But the midlifers were more likely to experience conflicts involving children-so getting older can bring more relationship stress with friends and family.

You feel lost and lonely.

When researchers from another institution examined the factors that contribute to psychological well-being, they found that some are genetic, but some are based on having a sense of purpose and a good social network. As we head into retirement and bid adieu to careers, if we're not careful to stay active in other ways, we risk losing our social networks and sense of self-worth, says Arbaje.

You've experienced a recent loss.

Research has found that another key trigger of later-life crisis is loss, especially bereavement. Loss of someone close can bring you face-to-face with your own mortality, bringing you down if those feelings aren't confronted and resolved in a healthy way, says Arbaje.

Moving Beyond the Crisis

So what can you do to deal with these feelings healthfully? "To start, I would recommend you stop thinking of it a crisis," says Arbaje. "It sets you up for the idea that this is inevitable, instead of thinking about it as an opportunity for growth." Instead:

Reframe what it means to get older.

Instead of lamenting what you never did, or what you've lost, Arbaje suggests thinking about this time as a chance to take on new challenges and embrace life in a new way. For example, if you're approaching or in retirement, you may have more time and freedom to pursue volunteering or travel.

Share your feelings.

Find a friend you can confide in-one who will let you answer the question "How are you?" honestly. You might find that your friend is experiencing (or has gone through) similar feelings and can share coping strategies. Research shows that writing (in a journal or a blog) is another healthy way of letting out feelings, and that can help minimize the chances of becoming depressed.

Enjoy movement.

Regular physical exercise boosts both your energy and your mood, and it reinforces your power to take charge of your own health and well-being.

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If current life expectancy is 78.7 years and adulthood begins at age 18, your midlife crisis should hit around age 48. But the definition of midlife crisis, as first coined in 1965 by psychologist Elliott Jaques, was a bit vague on the specifics.

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The Crisis of Elderly Poverty and Its Health Consequences

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The Crisis of Elderly Poverty and Its Health Consequences - MedCity News

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Poverty significantly impacts the mental and physical health of older adults. Lack of access to care and unaddressed SDOH issues lead to poorly managed chronic conditions, delays in treatment, medication non-adherence, and lower utilization of preventive services.

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The growing ranks of Americans aged 85 and older require a lot of care and caregivers; we don’t have enough of either

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Trauma and posttraumatic stress disorder in older adults

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Trauma and posttraumatic stress disorder in older adults

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Up to 90% of older adults have experienced at least one traumatic event in their lifetime, such as military combat, the unexpected death of someone close, serious illness or injury to self or someone close.1,2

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Caring for Traumatized Elders

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H ave you ever wondered how you could identify which of your elderly patients is most vulnerable? Have you been concerned about how care can be complicated by the sequelae of trauma? Have you been wary of retraumatizing patients in your effort to manage their distress? Have you been uncertain about whether you could enhance their trust in you and in your recommendations? If you have, the following case vignette and discussion should prove useful.

CASE VIGNETTE

Ms X, a 68-year-old woman with a history of coronary artery disease, diabetes mellitus, and cataracts, was admitted to the surgical service with increasingly severe claudication; revascularization was planned. However, while being prepped to go to the operating room, she became panic-stricken and insisted on returning to her room. Shortly after she returned to her room, she left the hospital against medical advice. Two weeks later, with persistent and severe claudication, she was readmitted to the surgical service. Once again, she became filled with panic en route to the operating room, and she insisted upon returning to her room.

A psychiatric consultation was requested. The consultant suspected that Ms X could be a trauma survivor. 1 To this end, after establishing rapport with Ms X, the consultant used the Life Events Checklist (LEC) 2 to screen Ms X for a history of trauma. The consultant learned that Ms X had been raped as a teenager by a group of men as she walked home from school. She had never told her medical providers about this event. She recounted to the psychiatrist that being hastily undressed in preparation for her surgical procedure brought back the terror and loss of control that she experienced during (and after) her rape. She understood that her surgery was crucial for her ongoing health, and she wanted to undergo the surgery; however, she felt ill equipped to handle the distress that was triggered by her preoperative care.

Following the principles of trauma-informed care (TIC), which emphasize safety, trust, empowerment, choice, and collaboration, the consultant worked with Ms X and her surgical team to develop a collaborative plan that would minimize her psychological distress and allow her to undergo the necessary surgery. The plan included having a nurse review each part of the procedure in detail with Ms X the day before the surgery, allowing her to disrobe herself, and allowing her to maintain control over which of her team members could attend to her needs.

DISCUSSION

What Types of Trauma Experienced Earlier in Life Can Complicate the Lives and Medical Treatments of Elderly Patients?

Traumatic experiences occur throughout the lifespan. Most older adults who experience trauma do not suffer from long-term adverse sequelae. However, for a smaller proportion of older adults, trauma may continue to impede physical and emotional functioning, even when experienced early in life. Impaired functioning caused by trauma may manifest as disorders of affect, behavior, or cognition as well as by medical illnesses, and impaired interpersonal functioning or autonomic arousal.

Myriad traumatic events (eg, natural disasters, 3 war, 4 interpersonal violence, 5 elder mistreatment, 6 and surviving the Holocaust ⁷) may increase the risk for psychiatric disorders, impaired functioning, and interpersonal challenges even decades after the initial trauma. Compared to other types of trauma, interpersonal trauma is typically associated with more severe psychopathology. ⁸

Childhood adversity is a type of interpersonal trauma with a documented impact on health and function later in life. Since the original research was published in the 1990s, trauma and chronic instability that occur during childhood and adolescence have been operationalized as adverse childhood experiences (ACEs), 9 which are defined as abuse, neglect, and household dysfunction that occurs before the age of 18. Specifically, ACEs include verbal, physical, and sexual abuse, witnessing interpersonal violence between one's parents, household substance abuse, household mental illness, having incarcerated family members, and parental separation or divorce. ACEs contribute to negative emotional, social, and medical outcomes in later adulthood. 9 Importantly, the original research on ACEs showed that the impact of trauma is "dose-dependent," with the severity of adverse outcomes being dependent upon the type, frequency, and severity of traumatic events. 10 The timing of adverse events seems to be important as well, with specific deficits and psychopathology corresponding to certain types of abuse that occur at different developmental stages. ¹¹

ACEs have been linked to both psychiatric and medical problems in later life, as well as to interpersonal and affective disturbances. For example, childhood trauma is associated with a higher risk of late-life posttraumatic stress disorder (PTSD), 12 depression, 13 anxiety, 14 personality disorders, 15 and substance use disorders. 12 Compared to adults with these psychiatric conditions but without a history of ACEs, older adults with ACEs tend to experience symptoms earlier and with a greater severity. 16 ACEs have also been linked to a range of medical problems (including arthritis, back problems, high blood pressure, migraine, chronic bronchitis/emphysema/chronic obstructive pulmonary disease [COPD], cancer, stroke, bowel disease, and myalgic encephalomyelitis/chronic fatigue syndrome). ¹⁷

Underlying these specific psychiatric and medical diagnoses, ACEs are associated with a range of transdiagnostic processes that can interfere with social functioning and cognitive and affective processing 18 and lead to increased pain and decreased physical functioning 5 as well as hypervigilance, loneliness, aggression, somatization, emotional dysregulation, interpersonal instability, and insecure attachments. 19,20 These processes can complicate medical care, interfere with the doctor patient relationship, and elicit strong emotional reactions in clinicians. ²¹

How Can You Identify Which of Your Elderly Patients Are Most Vulnerable?

Trauma may contribute to a range of psychiatric disorders among older adults. In this discussion of assessment, we will focus on PTSD as the disorder with the clearest causal link to trauma. Accurate identification of PTSD in older adults requires an age-appropriate assessment of the diagnostic criteria, as well as an assessment of factors that may place older adults at greater risk for more severe symptomatology.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5), 22 PTSD may only be diagnosed when certain criteria are met. Criterion A defines a traumatic event as exposure to actual or threatened death, serious injury, or sexual violence (through directly experiencing the event, witnessing the event, learning that it occurred, or experiencing repeated exposure to details of the traumatic event). Importantly, not every traumatic event meets this definition. Other types of trauma may contribute to psychopathology but would not warrant assessment or diagnosis of PTSD. The LEC is a useful instrument for determining the nature of the traumatic event. Criterion B describes intrusive symptoms, such as flashbacks or nightmares (1 symptom required). Criterion C addresses persistent avoidance of stimuli associated with the traumatic event(s) (to avoid distressing memories, thoughts, or feelings associated with the traumatic event; 1 symptom required). Criterion D includes impaired cognitions and mood (2 symptoms), and Criterion E specifies changes in arousal and reactivity, including hypervigilance and sleep disturbance (2 symptoms).

The PTSD Checklist for DSM-5 (PCL-5) 2 is a commonly used diagnostic tool. The commonly used PCL-5 threshold for likely PTSD is 33, although some researchers recommend a lower threshold for older adults, given lower overall symptom endorsement among this population. ²³

When evaluating older adults, it is helpful to remember that symptoms of PTSD may manifest in different ways. Compared with younger adults, older adults with PTSD report less severe symptoms, fewer intrusive thoughts, and less avoidance, while endorsing higher levels of hypervigilance and more somatic symptoms. 24 Subthreshold PTSD is far more common than full PTSD, and it is also associated with impaired psychological functioning. Thus, even in the absence of full DSM-5 PTSD criteria, patients may still experience distressing and impairing traumatic reactions. 25 Early-life trauma is associated with an increased risk for a range of psychiatric illnesses among older adults; thus, a trauma history should be assessed independently of any specific diagnosis. Importantly, care must be taken when inquiring about painful traumatic events, such as childhood maltreatment or sexual abuse, as older patients may be reluctant to disclose this information. ²⁶

Numerous factors increase an older adult's vulnerability to trauma-related pathology. Demographic factors (such as lesbian, gay, bisexual, transgender, queer [LGBTQ+] identity, 27 female sex, 28 and black race/ethnicity ²⁹) all increase the risk for psychopathology following trauma. Life stressors may also be relevant; PTSD can manifest as a fluctuating course among older adults or may be dormant until it is reactivated by a new stressor or a trauma that arises in later life. 30 Therefore, older adults with a trauma history who are experiencing significant stress in the form of illness, loss, life transition, or functional impairment may be vulnerable to increased symptom severity.

Personal and interpersonal variables are also relevant to trauma-related pathology. For example, personality features, such as high neuroticism and low extraversion, have been shown to mediate the relationship between childhood trauma and late-life depression and anxiety. 31 Trauma increases the risk for disrupted attachment in older adults, putting them at risk for loneliness, impaired coping with stressful situations, and poor social support. 19 Older adults who felt invalidated by others following their traumatic experiences may also be at increased risk for problems in later life, 32 as may those who have experienced racial or ethnic discrimination. 33 Importantly, for providers, older adults who were victimized as children are at greater risk of being revictimized in later life. 34 This underscores the importance of assessing older patients for current physical, sexual, and emotional abuse, neglect, and financial fraud. ³⁵

Awareness of older patients' demographic risk factors and experiences with discrimination and invalidation, and assessment of patients' loneliness, social support, and coping skills can help clinicians identify patients who most need trauma-informed approaches. This information may also help providers protect their patients against future revictimization.

How Common Are Physical, Sexual, and Emotional Abuse and Neglect in Adulthood?

Although much attention has been paid to understanding the various types of abuse (eg, physical, sexual, or emotional) and neglect in childhood, they are also common in adults. Physical abuse among adults encompasses the intentional use of force that results in harm or injury, and it can be inflicted by intimate partners, family members, or staff in institutional settings. According to the National Intimate Partner and Sexual Violence Survey (NISVS), 36 nearly 20 people every minute are physically abused by an intimate partner in the United States; this accounts for more than 10 million adults (both women and men) who experience such abuse each year. Moreover, approximately 1 in 4 women and 1 in 7 men have been the victim of severe violence (eg, beatings, burnings, or strangulation) at the hands of an intimate partner. Among the elderly, physical abuse is an important public health problem. A large systematic review (involving 52 geographically diverse studies) 37 reported that adults older than 60 have experienced physical abuse in community or institutional settings at rates ranging from 2.6% to 14.1%, respectively. Emerging data also indicate that the prevalence rates of any form of abuse, including physical abuse, in both community and institutional settings substantially increased during the COVID-19 pandemic; thus, approaches to TIC should be tailored specifically to the geriatric population. ³⁸

Sexual abuse refers to nonconsensual sexual activity that is imposed upon an individual, regardless of their gender. Certain groups face a higher risk of sexual abuse, including those who have been subjected to coercive behaviors in intimate partner relationships, members of vulnerable populations (eg, sex workers, individuals with physical or functional disabilities, and those with serious mental illness or cognitive impairment), individuals in institutional settings (eg, nursing homes and residential care facilities), and those who are marginalized or socioeconomically disadvantaged (eg, individuals facing poverty, racial discrimination, homelessness, and low social support). 39 Extensive research that spans more than 40 years suggests that sexual abuse is common in adulthood. It is estimated that approximately 17%-25% of women and 1%-3% of men have been sexually abused during their lifetime; moreover, according to the NISVS, approximately 1 in 5 women and 1 in 71 men in the United States have been raped. 36,40,41 Nevertheless, sexual abuse is commonly underreported, and these survey rates may be an underestimate of the true extent of the problem.

Emotional or psychological abuse often occurs in adult relationships with intimate partners, family members, friends, and colleagues. Certain individuals are at a higher risk of experiencing emotional abuse, including those who have been subjected to psychological manipulation in intimate partner relationships, the elderly residing in institutional care settings, and individuals with intellectual disabilities. 42 The lifetime prevalence rate for emotional abuse varies by gender, with women consistently reporting higher rates of emotional abuse over their lifespan compared to men. ⁴³

Neglect of adults can manifest in a variety of contexts (eg, caregiving relationships, dependent adult relationships, and situations where individuals fail to adequately care for themselves). However, there is a scarcity of epidemiologic data regarding the prevalence of neglect in adulthood. The paucity of research in this area underscores the need for further investigation to understand the drivers and the impact of adult neglect. By bridging these knowledge gaps, clinicians can develop more effective strategies for prevention and intervention in cases of adult neglect in myriad settings. These efforts will contribute to enhancing their well being and safety.

What Are the Acute and Chronic Manifestations and Sequelae of Abuse and Neglect?

Table 1 lists several acute and chronic manifestations of abuse and neglect. In brief, the signs and symptoms that arise in response to maltreatment include physical injuries, emotional distress, fear, and neglect-related health issues. Chronic manifestations often involve profound and enduring effects on physical and mental health (eg, chronic pain, psychiatric disorders, difficulties forming and maintaining social relationships, and chronic health problems).

What Is Meant by TIC and Who Can Provide It?

TIC is based upon the principles and practices of understanding and responding to the high prevalence and widespread impact of trauma. 44 The 4 "Rs" of TIC are ealizing the impact of trauma in the general population, ecognizing its signs and symptoms, esponding by integrating knowledge of the impact of trauma across all levels of the institution, and making all efforts to avoid etraumatizing survivors. 45 The key components of TIC are assuring safety, trustworthiness, and transparency; providing peer support; being collaborative; facilitating empowerment; and providing care in a cultural and historical context with sensitivity to gender issues. 45 Anyone who cares for patients (on an individual, organizational, or policy level) is encouraged to embrace the principles of TIC.

Several TIC concerns are relevant to the care of older adults. Given the high prevalence of abuse and neglect, all patients should be screened for a trauma history. Interviewers should be mindful of general cultural, historical, and gender issues for their patients while inquiring about their individual experience. 46 Older adults may not perceive their life events as traumatic and view labeling their experiences as such as being self indulgent. As a result, they may minimize or deny their experiences. 47 Given the inherent power imbalance between interviewers and patients, interviewers should emphasize that they are working on a team, and the patient's strengths (eg, resilience and support systems) should be highlighted. 46 Finally, interviews should adapt to the clinical context and the role of the interviewer ( Table 2). 44,46,48,49

How Can You Enhance Trust in You and in Your Recommendations?

Opportunities for enhancing trust in your recommendations include prioritizing clear communication and transparency around clinical decision-making, enhancing clinical continuity by offering provider consistency and thorough chart review, acknowledging that your patient may have had retraumatizing interactions with health care providers, and demonstrating a commitment to avoid repetition of those mistakes.

Clear communication. Trustworthiness and transparency form the foundation of health care. Ashworth and colleagues 46 recently recommended that providers introduce themselves and their role in their patient's care at the beginning of each visit and then state their goals for the appointment; in addition, they suggested that clinicians explicitly ask their patients whether they have any questions for them. Before any procedures, even noninvasive ones, the rationale for the procedure should be reviewed (and include how the information gleaned from the examination or test will be used to further their care). 46 When planning treatment, each option should be discussed in layperson's terms; this facilitates asking the patient about their hopes and concerns related to each path, leaving time for questions, whenever possible. 50 Although the next steps of treatment may appear obvious to health care providers, these steps may not be clear for patients.

Continuity. Patients with a history of trauma often endorse frustration around a lack of continuity in their health care providers, as this lack of continuity inhibits the development of trust in their health care team, 51 and feeling that providers may not understand their history or its context. 51 Unfortunately, provider continuity is not always feasible. However, trust can be enhanced by demonstrating that you have thoroughly reviewed your patient's medical record before their visit and that you will take the time to listen carefully to their story.

Efforts to prevent retraumatization. Trust can also be facilitated by avoiding retraumatization. Organizations and health care systems can inadvertently create situations and environments that are reminiscent of your patient's trauma (by creating a sense of disempowerment and helplessness). 52 It is also useful to avoid unintentional blaming of the victim, which quickly erodes trust. Such an approach is particularly important when your patient feels marginalized and discriminated against (due to their race, gender identity, sexual orientation, disability, or another stigmatized status). ⁵³

How Can the Sequelae of Trauma Be Managed?

The sequelae of trauma can be managed through psychotherapy, medications, or a combination of both. The American Psychological Association (APA) strongly recommends the use of cognitive-behavioral therapy (CBT), cognitive therapy, cognitive processing therapy (CPT), and prolonged exposure (PE) therapy for individuals with PTSD. ⁵⁴

CBT is a widely used form of therapy that helps patients to identify and modify unhelpful or harmful thoughts and beliefs, thereby resulting in positive changes to thoughts, feelings, and behaviors. 55 Cognitive therapy focuses primarily on thoughts or cognitions. In CPT, patients are taught to identify "stuck points" and challenge trauma-related beliefs that adversely impact their functioning. 56 Finally, in PE therapy, patients engage in imaginal exposures of the traumatic event, and in vivo exposures to associated feared stimuli. 57 Treatments with a provisional recommendation by the APA include eye movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), and brief eclectic therapy. ⁵⁴

In addition to these cognitive behavioral and exposure based interventions, other psychotherapies that can help manage the sequelae of trauma are life review therapy, spiritually focused therapy, and integrative treatments. 23,58 Yoga and mindfulness-based interventions are effective and feasible options that can be adjunctive or an alternative to traditional talk therapies. 59,60 While there is a dearth of literature on evidence-based interventions for older adults with PTSD, there is a larger body of research that supports evidence-based interventions for older adults with depression. In general, older adults are likely to benefit from mental health treatment. ²³

It is useful to know that older adults engaging in psychotherapy may have age-related health concerns, such as impairments in cognition, hearing, and vision, as well as pain. 23 Apprehension about cardiovascular or respiratory issues can be addressed through careful monitoring and collaboration with a patient's physician. Most older adults can tolerate exposure-based therapies that may induce a stress response. 61 Attention should be given to other psychiatric comorbidities, and a TIC approach should be used throughout. ²³

The primary pharmacologic treatments for PTSD and trauma-related sequelae (eg, anxiety and depression) are the selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, escitalopram, and paroxetine, and the serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine. 62 Additional medications include mirtazapine, a noradrenergic and specific serotonergic antidepressant, and amitriptyline, a tricyclic antidepressant. Providers should exercise caution when prescribing psychotropics to older adults and consider the risks and benefits in the context of a patient's current treatment plan and medical morbidities. 63 For example, benzodiazepines and beta-blockers may lead to adverse health effects (eg, increasing the risks for falls) among older adults. 64 Escitalopram and sertraline have also been recommended over other SSRIs because they have fewer drug-drug interactions. 65 Providers can refer to clinical guidelines and best practices for prescribing medications for older adults, such as the Beers Criteria. ⁶⁶

How Can Emotional Reactions to Past Trauma Interfere With Medical Examinations and Treatments?

Medical examinations or procedures may serve as triggers for traumatic memories that pose challenges to communication, patient-provider trust, medical examinations, and treatments. Patients with a history of trauma may experience heightened anxiety and fear when faced with medical settings, examinations, or treatments. These distressful feelings can interfere with their ability to provide accurate medical information, discuss their concerns with their provider, and follow treatment recommendations, particularly when managing multiple medications and their potential interactions. The interference in communication brought on by these feelings of distress may further result in skepticism or resistance to recommended medical interventions and hinder accurate treatment planning. Beyond communication complications, some patients with a trauma history may engage in avoidance behavior to protect themselves from reexperiencing distressing emotions or memories. While patients may engage in avoidance as a protective behavior, avoidance may contribute to resistance to undergoing necessary medical examinations or treatments, effectively reducing the patient's ability to access necessary care. As a result, patients may miss appointments, fail to follow prescribed medications, or disengage from recommended therapies due to emotional barriers. Additionally, trauma can influence an individual's perception of pain, potentially leading to heightened pain sensitivity and emotional numbing in response to pain. Either response may influence pain reporting, complicate the management of pain and other conditions, and cloud treatment decisions. 67,68 Further, trauma-related stress can manifest in physical symptoms that have no apparent medical cause, leading to various unexplained physical complaints, posing additional challenges for health care providers in differentiating between trauma-related symptoms and other medical issues.

Patients who have experienced trauma may exhibit angry outbursts, negative mood states, difficulty trusting authority figures, and wariness about medical advice, all of which may create problematic interactions with medical providers. 69-71 At its worst, difficulties in or strain on the patient-provider relationship may lead to misdiagnosed symptoms. For example, nightmares and emotional or behavioral outbursts may be mistaken for symptoms of other conditions like Alzheimer's disease, rather than being related to the patient's history of trauma. 72,73 More commonly, when reactions due to past trauma are poorly understood, this misinterpretation may lead to patients being viewed negatively and labeled as "difficult" and interfere with the quality of care received. ⁷⁴

A myriad of reactions to past trauma can interfere with medical examinations and treatments. Patients with a history of repeated injuries may develop chronic pain, physical disabilities, and chronic health conditions that can hinder their ability to undergo medical examinations and treatments effectively. Chronic manifestations of anxiety, depression, and social withdrawal can lead to reluctance in seeking or complying with medical care. For example, individuals who have experienced sexual trauma may suffer from PTSD and sexual dysfunction, which may effect their willingness to undergo sensitive medical examinations. Additionally, adults who have endured neglect may exhibit reluctance to undergo medical examination due to the long-standing effects of neglect, such as a history of malnutrition, dehydration, or living in unsafe conditions. In these ways, a patient's history of trauma may influence their feelings or perceptions of medical settings as safe spaces in which they can trust providers to perform examinations with care and recommend necessary treatments in earnest. Understanding and addressing these reactions empathically is essential for providing effective care in medical settings that may be seen as safe and ensuring the well-being of those who have experienced trauma.

How Often Do Traumatic Experiences Arise in the Elderly and Get Reactivated by Therapeutic Interventions?

Most adults older than 65 have experienced some form of trauma during their lifetime; the lifetime prevalence among this age group is as high as 70%. 75 Unfortunately, many events that are experienced as we age can reactivate memories of trauma that in turn may interfere with adherence to treatment and medical examinations. The frequency with which reactivation occurs due to medical examinations and treatments is influenced by the nature of the trauma experienced, the type of medical treatment, and the characteristics of individual patients and providers. Exposure to a similar environment within which the trauma was experienced increases the likelihood of reactivation. For example, for some patients preparing for surgical treatment may trigger unwanted memories and feelings related to past traumas. The severity and recency of the traumatic experience may effect the intensity of memory reactivation in these circumstance. Experiences of severe traumas may have a more profound and lasting impact on patients' responses, and the more recent the traumatic event, the more likely it may be to resurface during medical procedures. 23 Additionally, whether the individual has had adequate time and support in coping with their trauma may affect the likelihood of memory reactivation. Importantly, as traumatic experiences and their effects can accumulate throughout life, older adults may be particularly susceptible to the reactivation of traumatic memories.

Reactivated memories often retain a vivid intensity and a feeling of present threat, even when reactivation occurs decades after the original trauma. 23,76 These memories can be reactivated by common age-related events, such as changes in health status and mobility, the loss of social support networks following retirement, or the deaths of loved ones. 23,77 Additionally, some evidence suggests that older adults may respond with stress-related symptoms more often than younger adults, particularly when experiencing events like the loss of a spouse, 78 the risk of which increases with age. ²³

Older adults are more likely to have experienced certain types of trauma that can affect the risk of reactivation during medical examinations. Since it is more likely for older adults to have faced major medical events, surgeries, and health challenges without the benefit of contemporary medical advancements and technology, these medical experiences can influence their experience and perception of care in the present. 79 Older adults are more likely to have experienced multiple personal losses, as well as historical events (such as World War II, the Korean War, and the Vietnam War) that may have involved direct exposure to violence, loss, and displacement. 80 Adults from racial and ethnic minority groups may have also experienced historical racial discrimination, segregation, or civil rights struggles, which have lasting psychological, social, and physical health impacts and contribute to disparate health outcomes. While older adults may have experienced these potentially traumatic events, each generation may have unique traumas and stressors, and understanding these differences is crucial for providing age-appropriate TIC and support.

By recognizing and addressing the potential for trauma reactivation, health care providers can contribute to the overall well-being of their patients and ensure that respectful medical care can be delivered in a manner that considers their emotional needs. In this way, health care professionals can create a supportive and understanding environment that reduces the risk of trauma-related distress during medical procedures. The implementation of TIC practices during medical procedures can minimize the chances of reactivating traumatic memories. Being sensitive to trauma history, creating a safe environment, and providing appropriate support can mitigate the potential for reactivation. Understanding the factors that contribute to trauma in this population and tailoring therapeutic interventions is crucial to promoting their well-being and safety. ²³

What Are the Behavioral and Medical Sequelae of Trauma?

Traumatic experiences can influence health-related choices and behaviors, interactions with medical providers, and health care utilization. Past trauma can create barriers to seeking health care, including the fear of medical settings, distrust of health care providers, or difficulty expressing health concerns due to trauma related symptoms. Trauma survivors may struggle with adhering to medical treatment plans, which can affect their ability to manage chronic conditions and achieve better health outcomes. Some forms of trauma can alter an individual's perception of their health, leading to a focus on physical symptoms and perceived vulnerabilities rather than overall well-being. Traumatic experiences can effect an individual's self-efficacy in health behaviors, leading to reduced self-care and neglect of health needs. Further, trauma survivors may engage in risky behaviors or have a sense of invulnerability, which can lead to increased exposure to health risks. ⁸¹

Other medical comorbidities can interact with the sequelae of trauma-related symptoms bi-directionally to further compromise overall health. For example, PTSD frequently co-occurs with chronic conditions like COPD. PTSD symptoms may worsen adherence to COPD treatment, and COPD exacerbations may, in turn, interact with and worsen PTSD symptoms. 82 Further, among those living with PTSD, there is an increased risk for accelerated aging and disability. Importantly, these effects of comorbidities can be particularly pronounced in end-of life care settings, where patients may struggle to describe their traumatic experiences, and symptoms may be misinterpreted as other conditions. 75 Additionally, the emotional distress caused by trauma can lead to an increase in appetitive behaviors, such as eating, drinking, and smoking. In this way, traumatic experiences can lead to negative health behaviors and negatively effect quality of life, leading to lower reported levels of well-being and life satisfaction. 83 Some studies suggest that individuals with high ACEs scores may experience accelerated biological aging, which can manifest in cellular and molecular changes. 84,85 Individuals with a history of ACEs may utilize health care services more frequently due to an increased risk of physical and mental health issues. 86,87 Further, adults who experienced ACEs may also engage in unhealthy coping mechanisms or adopt poor health behaviors, 88 such as smoking, excessive alcohol consumption, sedentary lifestyles, and poor dietary habits. These coping behaviors may increase trauma survivors' risk of developing chronic health conditions, such as cardiovascular disease, autoimmune disorders, gastrointestinal disorders, and chronic pain syndromes. The physiological impact of trauma itself may further contribute to the development or exacerbation of these conditions.

Sensory changes associated with aging can be influenced by trauma. Hearing loss, which is common among older adults, can lead to mishearing and an increased risk of auditory hallucinations (associated with PTSD). Adjusting communication methods (such as using hearing aids, pocket talkers, and adjusting voice tone, speed, and volume) may be necessary in facilitating effective communication. Trauma can also affect the amount of pain that patients report, and it is essential to encourage reporting and educate patients, rather than accepting the notion that pain is a normal part of aging. ⁷⁵

Overall, the influence of trauma on current health behaviors is multifaceted, affecting cognitive functioning, sensory perception, pain perception, and psychiatric conditions. Understanding these influences and adopting strategies that consider the specific needs of patients with trauma histories is crucial for providing effective and empathetic care.

THE SIGNIFICANT IMPACT OF PAST TRAUMA ON HEALTH BEHAVIORS TODAY

Reactions to past trauma can vary widely, from disengagement to tearful recounting to panic, leading to problematic interactions with medical providers. Patients may exhibit resistant behavior or experience reactivating memories during medical examinations, influencing their willingness to seek or comply with medical care. The role of comorbidities is also crucial, with trauma-linked PTSD being associated with increased risk for chronic health conditions and accelerated aging. Cognitive, sensory, and pain-related alterations may also be observed in patients with trauma histories. Understanding these effects and adopting strategies to address patients' unique needs is essential for providing effective and empathic care in medical settings. Understanding the impact of trauma on health behaviors is essential in order for health care providers and support systems to provide TIC. Tailoring interventions that address the emotional and psychological aspects of trauma can help create a supportive environment that encourages healthier behaviors and promotes overall well-being for trauma survivors. By recognizing the potential influence of trauma on health behaviors, health care providers can offer appropriate support and interventions to address trauma-related challenges and promote positive health outcomes.

What Are the Benefits of Facing Past Traumas in the Present?

Being the beneficiary of support and treatment for past traumas can be dramatically helpful (eg, reducing the adverse effects on physical and mental health [such as depression, PTSD, problematic substance use and loneliness, obesity, and inflammatory bowel diseases]). 18,89,90 For example, in a study of middle-aged and older adults, investigators identified that individuals with more feelings of mastery over their lives demonstrated greater resilience against the adverse health effects of trauma. 44 Treating trauma-related illness can provide patients with insight on the connection between prior experiences and current medical and psychological disorders. This insight offers opportunities for trauma-exposed patients to address the role that trauma has played in their lives, increasing their agency to make helpful health decisions and foster mastery over their lives. For older adults, unaddressed sequelae of trauma exposure (eg, depression, hypertension, obesity, diabetes, excessive alcohol consumption, and low social contact) become risk factors for cognitive decline. 91 Fortunately, each of these conditions is modifiable, and those who address them may be able to mitigate the multiple risk factors for poor cognitive health later in life. Thus, from a medical perspective, addressing and treating trauma can have preventive benefits that help reduce patients' risk for adverse health outcomes.

What Happened to Ms X?

After undergoing a successful operation, Ms X was discharged from the hospital to complete her recovery at home. As part of her discharge instructions, she received information about mental health services in her area. A few weeks later, she began treatment with a mental health counselor in her community who helped her to better understand how traumatic experiences early in life can lead to enduring symptoms of anxiety, depression, or posttraumatic stress across the lifespan. Ms X engaged in a 12-week, evidence-based trauma treatment that alleviated many of her trauma-related mental health symptoms.

CONCLUSION

Traumatic experiences occur throughout the lifespan; unfortunately, even when they were experienced early in life, they may continue to impede physical and emotional functioning. Moreover, the impact of childhood trauma is "dose-dependent," with the severity of adverse outcomes being dependent upon the type, frequency, and severity of traumatic events.

Patients with a history of trauma may experience heightened anxiety and fear when faced with medical settings, examinations, or treatments; these distressing feelings can interfere with patients' ability to provide accurate medical information, discuss their concerns with their provider, and follow treatment recommendations. When the principles of TIC are used to guide providers' behavior, patients are more likely to feel safe, empowered, and respected and are thus more likely to collaboratively engage in their care.

In instances where trauma-related disorders contribute to clinical distress and/or functional impairments in older adults, a range of psychotherapeutic and psychopharmacologic treatments have demonstrated efficacy in managing these conditions.

Article Information

Published Online: April 23, 2024. https://doi.org/10.4088/PCC.23f03643
© 2024 Physicians Postgraduate Press, Inc.
Submitted: September 14, 2023; accepted December 18, 2023.
To Cite: Popescu D, Mellen E, Ander I, et al. Caring for traumatized elders: lessons learned from trauma-informed care. Prim Care Companion CNS Disord. 2024;26(2): 23f03643.
Author Affiliations: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (all authors).
Author Information: Drs Popescu, Vyas, Ishikawa, Mellen, and Ander are co-first authors.
Corresponding Author: Rachel Zack Ishikawa, PhD, MPH, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 ([email protected] ).
Relevant Financial Relationships: Dr Vyas has received research support from Nestlé Purina PetCare Company, Mars Edge, and American Foundation for Suicide Prevention. All other authors report no conflicts of interest related to the subject of this article.
Funding/Support: None.

Clinical Points

Patients with a history of trauma may experience heightened anxiety and fear when faced with medical settings, examinations, or treatments; these distressful feelings can interfere with their ability to provide accurate medical information, discuss their concerns with their provider, and follow treatment recommendations, particularly when managing multiple medications and their potential interactions, and may result in skepticism or resistance to recommended medical interventions.

The 4 "Rs" of trauma-informed care are realizing the impact of trauma in the general population, recognizing its signs and symptoms, responding by integrating knowledge of the impact of trauma across all levels of the institution, and making all efforts to avoid retraumatizing survivors.

Opportunities for enhancing trust in your recommendations include prioritizing clear communication and transparency around clinical decision making, enhancing clinical continuity by offering provider consistency and thorough chart review, acknowledging that your patient may have had retraumatizing interactions with health care providers, and demonstrating a commitment to avoid repetition of those mistakes.

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Caring for Traumatized Elders: Lessons Learned From Trauma-Informed Care

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Patients with a history of trauma may experience heightened anxiety and fear when faced with medical settings, examinations, or treatments.

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Understanding the Developing Brain

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Trauma, Adolescence, and the Developing Brain - thewaveclinic.com

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This blog explores the different ways that trauma may affect the adolescent brain, mind, body, and behaviours.

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Trauma and teenagers – common reactions

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A traumatic experience is any event in life that causes a threat to our safety and potentially places our own life or the lives of others at risk. As a result, a person experiences high levels of emotional, psychological, and physical distress that temporarily disrupts their ability to function normally in day to day life.

Teenagers who experience a distressing or frightening event are often concerned by these strong emotions. Despite the fact that these reactions usually subside as a part of the body's natural healing and recovery process, it is important for parents or carers to understand the ways in which a teenager manages distress and trauma so they can support and help the young person.

Teenagers can also be deeply upset by local, national or international tragedies, or trauma that affects their friends. Your teenager will handle trauma differently to younger children or adults. A younger child depends directly on their family, whereas many teenagers look to their peer group for support. In order to help them, parents need to understand the ways in which teenagers manage distress.

Common reactions to trauma in teenagers

Every young person is different, but common symptoms of distress include:

strong emotions such as sadness, anger, anxiety and guilt

overreacting to minor irritations

repetitively thinking about the traumatic event and talking about it often

disturbed sleeping patterns

withdrawing from family and friends

wanting to spend more time alone

being very protective of family and friends

returning to younger ways of behaving including giving up responsibilities or a sudden return to rebellious behaviour

increased need for independence

self-absorption and caring only about what is immediately important

loss of interest in school, friends, hobbies, and life in general

pessimistic outlook on life, being cynical and distrusting of others

depression and feelings of hopelessness

difficulties with short-term memory, concentration and problem solving.

Normal healing and recovery process after trauma

Any event that places your life or the lives of others at risk results in your body going into a state of heightened arousal. This is like an 'emergency mode' that involves a series of internal alarms being turned on. Emergency mode gives people the capacity to access a lot of energy in a short period of time to maximise the chance of survival.

Most people only stay in emergency mode for a short period of time or until the immediate threat has passed. However, being in emergency mode uses up vital energy supplies and this is why people often feel quite tired afterwards.

The normal healing and recovery process involves your body coming down out of a state of heightened arousal. In other words, your internal alarms turn off, the high levels of energy subside, and your body re-sets itself to a normal state of balance and equilibrium. Typically, this should occur within about one month of the event.

Adolescence and independence

The transition from child to adult can be rocky. A teenager may lose the confidence they had as a child. Unlike a younger child, a teenager isn't as dependent on their family. A younger child realises they couldn't survive without their parents, whereas a teenager is more aware of their ability to make it 'on their own'.

For teenagers, friends and peer groups are very important. By comparing themselves with their friends, a teenager gets a sense of how 'normal' they are. Teenagers tend to seesaw between independence and insecurity after a distressing event. This sort of contradictory behaviour can be confusing to the teenager and to the parents trying to help them.

Breakdowns in communication

A teenager may be deeply upset by the event, but despite this, they may not want to share their feelings with their parents.

Some of the reasons for this include that they:

are needing more time to absorb what has happened

are not wanting to acknowledge the event by talking about it

don't want to upset their parents

are wanting to be strong for parents and other family members

don't think their parents will understand them

think that parents will tell them what to feel or what to do

don't agree with their parents' point of view on the event

prefer to talk to their peers about it

find instead that peers help take their mind off the event

feel confused about how they think and feel about the event

don't know how to express complicated, unfamiliar thoughts

are frightened of strong feelings and fear they are 'losing the plot'

would rather distract themselves than think about the event

already have a problem with communication before the event.

Family problems that can develop after a traumatic event

Family problems can occur if:

the family doesn't talk about the event

the family misunderstands the teenager's behaviour and assumes the teenager is just being difficult or taking advantage of the situation

parents try to keep the teenager from their peer group or criticise their choice of friends

parents feel hurt or angry because the teenager prefers to talk to friends about the event rather than the family

the family argues over different points of view

parents try to get emotional support from the teenager.

Tips to help teenagers resolve traumatic reactions

There are a number of strategies that can be put in place to help a teenager resolve traumatic reactions.

Some common suggestions include:

Encourage the young person to communicate without judging or advising them until they ask for your feedback.

Show them that you really care for them and are genuinely interested and enjoy being with them.

Negotiate changes in roles and responsibilities during recovery and be flexible. Don't try to stick rigidly to the way things were before the event.

Continue to give love, support and trust, even if things are extremely difficult.

Remember your teenager is the same person they were before the event, even if they seem different.

If asked, gently let the young person know that they are having a 'normal' reaction to a frightening experience and that in time these very strong reactions will subside.

When to seek help from a health professional after a traumatic event

Traumatic stress can cause very strong reactions in some teenagers and may become chronic (ongoing).

Signs that you should seek professional help include:

Their behaviour is dangerous, reckless or harmful.

They seem persistently depressed or anxious.

They start abusing substances, such as cigarettes or alcohol, or their use increases dramatically.

They won't communicate about where they're going, what they're doing or how they're feeling.

They don't seem to be showing any signs of recovery.

Your teenager's behaviour does not make sense to you and seem completely out of character.

You are worried about them for any reason at all.

If at any time you are worried about your mental health or the mental health of a loved one, call Lifeline 13 11 14.

Where to get help

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National Alliance on Mental Illness (NAMI)

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The Effects of Racial Trauma on Mental Health: Deaths Captured on TV and Media

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Racial tension is once again at a critical tipping point in the U.S. Many people have asked, “Why now? Why was the death of George Floyd the catalyst for this national reckoning on racial injustice?” The truth is: this movement is over 500 years in the making. Only now, with the widespread use of videos […]

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Culture, Development, Trauma and Socio-Cultural Responsive Interventions with Youth Ages 7 and Older

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Generational trauma among Native American cultures affects infant feeding - Our Milky Way

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Dressed in vibrant, traditional Native American clothing, adolescents stand together holding a sign that reads, “I Support Breastfeeding.” A man pictured in head dressing, a child with beautifully braided hair and a young woman in glistening jewelry hold signs in support of breastfeeding too. “All walks of life” demonstrated their support for breastfeeding at this … Continue reading “Generational trauma among Native American cultures affects infant feeding”

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CECE Early Childhood Videos at Eastern CT State U.

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Understanding the Potential Effects of Trauma on Young Children

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How Do People Experience Historical Trauma?

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How the body keeps the score on trauma | Bessel van der Kolk for Big Think+

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Babies Bodies Remember Separation Trauma at Birth Jeanette Yoffe M.F.T. #adoption adoption expert

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Infant and Early Mental Health Promotion (IEMHP)

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Understanding the Impact of Trauma on Infants and Young Children in Care (Foster/Kin/Customary)

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The Effects of Exposure to Domestic Violence on Babies and Children

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1965. Effect of emotional deprivation and neglect on babies. Subtitled in English

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How Childhood Trauma Can Make You A Sick Adult | Big Think

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How Every Child Can Thrive by Five | Molly Wright | TED

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Center on the Developing Child at Harvard University

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How Do Cultural And Historical Events Cause Generational Trauma? - Better Family Relationships

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Black Folk Mental Health: Generational Trauma, Traditions & Truth | Jelan Agnew | TEDxDelthorneWomen

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The Impact of Trauma on Young Children of Color and Their Families

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Studies show that Black children are more likely to experience more adverse childhood experiences (ACEs) than their peers.

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Amazon.com: What My Bones Know: A Memoir of Healing from Complex Trauma: 9780593238103: Foo, Stephanie: Books