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March 11, 2015

Understanding children suffering trauma

The Canadian Charger

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Erica Watson rejected the old nature versus nurture argument. We are a combination of the two. She and fellow social worker Janine Lawford were giving a seminar in Ottawa on working with children, youth, and families affected by trauma.

The program was sponsored by the Canadian Mental Health Association with funding from the Ontario Ministry of Health. 

So why did Watson toss the old debate aside? 

Trauma cannot be ascribed simply to nature (inherited tendencies), nor to nurture (environmental factors).  Instead, the person’s brain comes as nature but is affected by environmental factors and changed by them.  Biochemical changes occur in the brain as a result of trauma.

Trauma is defined in the Merriam Webster dictionary as “a very difficult or unpleasant experience that causes someone to have mental or emotional problems, usually for a long time.” 

The event is beyond the person’s control and leaves him unprepared.  Trauma may be triggered by many different causes.  A list might include physical, sexual, or emotional abuse, neglect, imprisonment, terrorism, war, and natural disasters, to name a few.

Citing 2012 Statistics Canada data, they noted that in 2010 some 74,000 Canadian children and youth were victims of crime.  They were five times as likely to suffer sexual abuse as were adults.  Poor children and those living in families with a mentally ill parent are more likely to have traumatic experiences, as are those living in Aboriginal communities.  Close to a quarter of Aboriginal women have been victims of spousal violence.

The social workers expressed the view that the standard categories spelled out in the Diagnostic and Statistical Manual (DSM), the psychiatric bible, do not fully encapsulate childhood trauma. 

Common diagnoses for such children include separation anxiety disorder, oppositional defiant disorder, phobic disorders, post-traumatic stress disorder (PTSD), and attention deficit hyperactive disorder (ADHD).  As they expressed it, “None captures the whole picture of trauma” in childhood.  Because of the problem with lack of an appropriate diagnostic category, money is not allocated to treatment or research.

Yet, not everyone reacts to what may be seen as a traumatic event by experiencing trauma.  The experience of the event, not the event, determines trauma, and for that reason they caution about mass debriefing exercises.  Treatment, they argue, “is not benign.  It can be negative.”  Most people have, during their lifetime, experienced traumatic events, but most do not experience PTSD. 

Developmental trauma is defined as being multiple and/or chronic and prolonged.  Examples may include sexual abuse, war, and community violence, among other things.  This kind of trauma prepares many affected people for physical and mental illness and for criminal behavior. 

The brain is changed by the trauma, changes that are biochemical and damage biological systems, tissues, and organs.  The point in brain development where trauma occurs will affect the form in which distress is experienced.  Thus, trauma that occurs at a pre-language stage in development may not lend itself to verbal kinds of treatment.  Art, for instance, might be a possible treatment modality. 

Attachment is a necessary part of human development and is addressed in a part of the brain that is prior to language development and use. 

While, the women explained, residential care may not be abusive, it may also not produce the needed intimate attachment.  If a primary caregiver is distant, unpredictable, or violent, the child may exhibit distress due to lack of a safe environment.  Such a child may be emotionally volatile.  He has a need to be cared for but experiences rejection.  Treatment takes a long time, involving the development of attachment.  In a family situation, it can involve improving of parenting skills.

The presenters looked at some specific groups in relation to trauma. 

Aboriginals were identified as suffering from an intergenerational transfer of trauma, going back to the residential schools experience.  Children and grandchildren of Holocaust survivors would be another example. 

Refugee children may be a group at risk, depending on the degree and type of trauma suffered and the extent to which the family maintains stability, as well as how the children experience the resettlement process. 

Youth of sexual minorities are also at risk of trauma because of greater danger of mistreatment, violence, and personal loss.  The situation for these minorities is most extreme in the case of transgender youth.  According to Rainbow Health Ontario, 45% have attempted suicide.

A variety of therapeutic approaches may be appropriate for treating trauma in children.  Medicine may be helpful but would not serve as the sole treatment modality.  Depending on the stage of development the child was in when the trauma was present, treatment might include verbal or non-verbal elements, perhaps both.  The child’s resilience is a key factor in recovery from trauma. 

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