Childhood Trauma Happens More Than You Think It Does. How Do We Treat It?
Childhood trauma affects almost half of all American children. Now more than ever, it’s important to understand the types of trauma, as well as their causes and treatments.
Roughly half of all American children experience a traumatic event in their lifetime — abuse, violence, terrorism, disaster, or what we call traumatic loss. Many experience more than one such event and others live with chronic trauma, and no time for healing between events, according to the American Psychological Association.
Given ongoing trauma from mass shootings, the pandemic, and discrimination against minority populations, it is now more important than ever for caregivers to understand the way traumatic experiences affect a child’s developing brain.
Types of Trauma
There are three categories of trauma.
- Acute trauma results from a single experienced or witnessed event; it’s a one-time thing that is accompanied by an acute stress response.
- Chronic trauma is repeated and prolonged, like domestic violence or abuse. Chronic trauma can also be systemic trauma — racism, homophobia, poverty, sexual harassment, and being neurodivergent in a neurotypical world.
- Complex trauma is repeated exposure to multiple traumatic events, often of an intrusive interpersonal nature.
Post-traumatic stress disorder (PTSD) may result from any of these types of trauma, though it is certainly not universal or ubiquitous. The symptoms of PTSD include insomnia, flashbacks, low self-esteem, frequent painful emotions, reliving the event, or perhaps forgetting it all together. Hypervigilance and separation anxiety are also common in children. Trauma exposed children may or may not meet the criteria for PTSD — trauma does not necessarily result in PTSD but it often does.
Trauma and ADHD
When someone has experienced trauma, it affects some of the brain centers that are also affected by ADHD, but there are distinct symptoms that differentiate the conditions. PTSD involves three primary processes — re-experiencing, avoidance, and hypervigilance — that are not seen in ADHD.
PTSD includes physiological, cognitive, and emotional changes in how a person processes stressful situations, whereas inattention, hyperactivity, or impulsivity are more unique to ADHD. Of course, there is an overlap. Both share difficulty concentrating and learning in school, distractibility, inattention, disorganization, hyperactivity, restlessness, and difficulty sleeping.
Trauma Interventions for Children
Treatment for trauma varies. There are a range of clinical interventions and options based on trauma-informed care, in which “What has happened in your life that’s led you to act this way?” replaces “Why are you acting this way?”
Core components of trauma-based interventions include, among others:
- relying on motivational interviewing
- performing risk assessment
- addressing barriers that impede access for help
- teaching about the brain and bodily responses
- grieving and dealing with loss or confusion
- locating resilience and adapting personal narratives
Since trauma affects executive functioning skills, children will have less emotional regulation, more reactivity, and limited verbal and behavioral impulse control. Trauma therapies work on teaching these skills and learning other coping tools, especially those that address cognitive shifts and overwhelming feelings.
Therapies for trauma that are most highly rated are:
- trauma-focused cognitive behavioral therapy (CBT)
- cognitive processing therapy
- eye movement desensitization reprogramming (EMDR)
- prolonged exposure therapy
- somatic therapies
- internal family systems
- play therapy and expressive arts therapies
Trauma Guidance for Caregivers
Caregivers are well-served to remember and honor the four Rs of trauma-informed care:
- Realize the widespread impact of trauma
- Recognize signs and symptoms of trauma
- Respond instead of reacting by using validation and de-escalation skills
- Resist re-traumatization by incorporating stress management and relaxation skills (escape plans) to cope with distress
Compartmentalizing or avoiding a topic can be either a healthy or maladaptive response to trauma. Observe your child and refrain from asking why questions; stick to what and how. Wait for them to initiate a conversation and ask questions. Or begin a conversation related to atypical behaviors that you are noticing. It’s natural to feel out of control right now. Consider adding one more family check-in at dinner with a “Daily Happy and a Crappy” to gauge how they think they are doing and what’s important to them. Be patient. Kids may be more distracted and require additional assistance.
Treating Trauma: Next Steps
- Read: Childhood Trauma and ADHD
- Watch: How Stress and Trauma Affect ADHD
- Read: Traumatic Stress and ADHD
The content for this article was derived, in part, from the ADDitude Mental Health Out Loud episode titled, “Youth Traumas and Anxieties Today” [Video Replay and Podcast #404] with Sharon Saline, Psy.D., which was broadcast live on June 10, 2022.
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.