Childhood Trauma: PTSD Symptoms and Expressions
Childhood trauma comes in many forms and the expression of it can easily be missed, especially if you don’t already know trauma has occurred. How the effects of trauma and PTSD display will depend on many factors. This article highlights some of the trouble signs to consider.
Often, behavioral episodes of children and teens are not linked back to the traumatic events. Without proper context, parents and other caretakers may misunderstand the function of problematic behavior and apply interventions that don’t work or, in some cases, exacerbate trauma symptoms. Be on the lookout for some of the following behavioral of childhood trauma.
Nightmares and Night Terrors
Both nightmares and night terrors are common for children and adults who have experienced trauma. The diagnostic manual for mental disorders (DSM) now clarifies that children’s dreams do not have to specifically reference the traumatic events. Instead, nightmares may be more generalized and terrifying but vague in details. However, themes may emerge (e.g. helplessness) as the dreams recur.
Night terrors (also known as ‘sleep terrors’) are in the category of sleep disorders and are associated with PTSD but may occur for other reasons as well. During night terrors, you might awaken to you child’s piercing screams even though she is still asleep and cannot be woken. These will pass and the child will not recall anything from the episode.
Aggression or Defiance
During trauma, feeling helpless and paralyzed is common. Afterwards, it’s equally common for angry outbursts or defiance to appear or escalate. Parents’ ability to tolerate the child’s distress is incredibly important to the child feeling safe and secure again. Keep a calm tone of voice when responding and stay in control of your behavior. Be the model of stability and strength that they need.
Regression to Earlier Developmental Stages
Childhood trauma shakes the foundation of the child’s world and can instill a pervasive sense of danger. In turn, children may frequently or intensely seek refuge in their parents’ protective arms and/or revert to a earlier stage of development. This may appear in the form of separation anxiety, clinginess, regressed speech or “baby talk”, and regressed play.
Parents must strike a delicate balance between reassurance and comforting and challenging their child to return to expected behavior and routines. Be careful that too much protectiveness may paradoxically lead him to confirm his perception that the world (as a whole) is a dangerous place and people not to be trusted. However, without enough compassionate reassurance, he may come to believe that adults are not reliable sources of protection and caring.
Re-enactments Through Play
Younger children particularly lack the verbal sophistication to express the depth of their thoughts and feelings about the trauma. This does not mean, however, that their experience is any less significant. Children’s communication occurs more naturally through play. Re-enacted scenes of trauma – such as children made with toy planes after the 9/11 terrorist attacks – demonstrates their ability to symbolically express their experience.
The fact children re-enact trauma through play is generally a healthy sign as it suggests the child is attempting to make sense of what happened. However, if she replays the same incidents and the ‘storyline’ does not progress, it may be time to have your child evaluated and receive extra assistance in therapy.
Sexual Behavior & Knowledge
In the case of sexual abuse, children or teens may develop a poor sense of interpersonal boundaries and act in sexually inappropriate manners. Keep in mind, however, that the vast majority of sexually abused children DO NOT become perpetrators themselves. A child may also masturbate frequently in a manner inconsistent with expected behavior at their age. A medical evaluation may help to rule out an infection or other cause of frequent genital contact.
Children may demonstrate advanced knowledge of sexual acts and anatomy. Before rushing to judgment that your child has been sexually abused, consider asking the child how he/she came to know about the sexual terms. The answer may be more innocuous than you think. For example, she may have walked in on parents during sex or seen something the internet (exceedingly common nowadays).
Self-Harming Behavior: Cutting & More
Parents and others have a really hard time wrapping their heads around this one. Cutting to the point of bleeding. Burning the skin. Hitting oneself. It just doesn’t seem to make sense, or does it?
With intense emotions and limited skills to cope with their enormity, kids and teens may turn to these drastic measures. Does it work? Actually, yes, which is why they do it. How it works: For many, the anxious energy or panic temporarily subsides because the self-harm behavior will spur the body to ramp up endorphin production. The body will then calm down, temporarily. Some liken the feeling and relief to that of narcotics. In the process, however, they will NOT have learned more adaptive ways to respond. So, without intervention, the self-harming strategy may continue for years to be the go-to response.
Be vigilant, don’t overreact, seek to understand the function of the behavior rather than judge the teen for it or freak out in horror. Sometimes the cuts are simply unsightly and a teaching some basic coping skills may shift them away from the behavior. However, if the methods of cutting and other self-harm cause (or may cause) serious injury, then medical intervention and therapy may be needed. If you’re concerned your teen may be crossing into the dangerous territory, it might be time to come in for a formal evaluation and therapy.
Substance Abuse in Teens
Apart from common exploration and risk-taking that comes with adolescence, use of substances – including abuse of prescription medications – may also be a way to numb pain from childhood trauma. Be alert for signs of potential use: dramatic change in personality, dropped grades, sudden mood changes, agitation or lethargy, etc. If the start of use or escalation coincides with traumatic events, it is likely to be part of their way to cope with the powerful feelings and thoughts associated with trauma. Wise parents will keep the lines of communication open and seek help if serious consequences occur or the teen is using harder drugs.
Numbing and Internalized Responses
This may be the most frequently overlooked behavioral aspect of childhood trauma responses. In part, I believe this owes to our culture’s prizing of behavioral compliance. Lack of outbursts is a good thing, right? Maybe. But he may have turned inwards to process the trauma instead, perceiving that it is not safe to talk about or express. This may appear quietly in the form of dissociation or restricted emotional expression. Parents’ receptiveness to discussing the trauma without forcing the issue is critical.
Children may complain of frequent tummy aches or headaches after trauma. While some children might feign such aches and pains to avoid school for learning difficulties or social problems, chronic pains are likely real. Rule out medical causes first to help determine if medical intervention is needed or if therapy is more warranted. Consider the frequency and associated triggers to better understand the function of the pains.
Particularly young children (and teenagers to an extent) have developmentally higher levels of egocentric thoughts and beliefs. This is normal. When trauma occurs, this normal orientation can be a liability as children may erroneously believe what happened to them was their fault. They may assume more responsibility or power than is realistic to expect of them. Without addressing this, she might carry this mistaken guilt and shame into adulthood for years.
Common feelings that occur after childhood trauma include: fright, guilt, regret, anger, sadness, and confusion. Children may express these directly and verbally or, more commonly, non-verbally. In addition to the behavioral signs discussed previously, here you’ll learn how and why trauma therapists work with kids to process the trauma without words.
As described above in regards to play, younger children are less likely to verbalize their experience of childhood trauma. Older children may be more expressive verbally yet lack knowledge, vocabulary, or sophistication to really give meaning to what happened. While expressing the events with greater complexity, teens may need help putting the experience in context of their developing sense-of-self.
Play and creative arts ARE the words when it comes to young children. They will use these methods frequently in their effort to make sense of and resolve the trauma. Even without toys that match objects involved in trauma, children will use their imagination and improvise. Note: during such play, the child may or may not exhibit obvious expression of feelings. Nonetheless, they feel this acutely and toys or art supplies serve as regulators of the emotional intensity. This is why therapists often use play and art as it allows them to process this trauma indirectly without becoming overwhelmed with emotion or tasked with talking about it.
Respecting Pace of Child’s Expression
Trauma doesn’t resolve itself overnight. Recovery may take months or even years. We can invite the child into a process of healing but we cannot force it to occur on a certain timetable. In fact, given that much of trauma involves violation of boundaries, intrusiveness and pressure to talk about it (or, worse, “get over it”) will backfire, sometimes dramatically. Give them space and respect their pace. Even in therapy, it may take several sessions before a child warms up first to the process of therapy and then to the painful aspects of trauma recovery. He needs a safe person to come to with questions and concerns.
When to Seek Professional Help
Behavioral Outbursts You Can’t Control
When you’re at a loss with your child’s behavior, that’s a perfect time to reach out for more assistance. Sure, you may find on the internet some general parenting wisdom or maybe even blogs like this to guide you. However, working with a professional therapist will help identify the problem areas and collaboratively address them directly.
Stuck and Unable to Move Forward
Has it been months and your teen can’t seem to move forward and rejoin life? Did their zest and spunk disappear? Perhaps years have past with little improvement? Don’t keep waiting and hoping for trauma to resolve itself. Your child may need help processing this in therapy to get unstuck. As mentioned before, teens may be reluctant to open up to parents (depends on the relationship and other factors). Professional therapy can be the safe space your teen needs to work through childhood traumatic events.
Self-Harming Behavior including Substance Abuse
If you notice either of these challenging behaviors, this may suggest your teen needs additional support to cope with powerful feelings. Your care and concern, along with encouragement to seek therapy, is important. If they worry about privacy and your involvement in treatment as a parent, please contact me or, heck, have him or her contact me directly! I totally get it. After speaking with me about confidentiality, most teens walk away from the first session seeing me as approachable and safe when it comes to sharing really painful emotions.
- National Child Traumatic Stress Network – Age-Related Reactions; 12-Core Concepts
- National Center for PTSD – Children and Adolescents resource page
- American Psychological Association – Children and Trauma Update
Obviously, this post couldn’t possibly cover every situation. Already I can see how I overlooked some ways in which child neglect (definitely traumatic) presents differently. I’ll be sure to write a future post more specific to that subject and link it up here. What questions or reflections do you have on the topic of childhood trauma? Have you found the article helpful? If so, consider sharing the article using the links below or to the side of the screen.