Traumatic Stress in Children and Adolescents
Children, Trauma, and Stress
Childhood and adolescence are no stranger to traumatic experiences, which may have significant negative effects on a child’s emotional well-being and future development. In his article, “Traumatic Stress in Children and Adolescents,” Tufts University School of Medicine Division of Child and Adolescent Psychiatry Director John Sargent, M.D. reviews common causes and responses to trauma and an eight-step approach to treating children who have suffered traumatic experience.1
Causes of traumatic experiences vary greatly from individual to individual; however, overall, they are unexpected and unpredictable. According to Sargent, the term traumatic stress is the physical and emotional response to certain events that may threaten the life or physical or psychological integrity of the child or someone close to the child.1 They may experience feelings of terror or helplessness that are overwhelming and make the child feel as if they are out of control. Events that remind the child of the traumatic experience can later lead the child to react in a more intense fashion.1 The child may also revisit the experience through flashbacks and nightmares.1 Examples of traumatic experiences include natural disasters, community violence, domestic violence, war, torture, physical and sexual abuse, and death or serious injury of a close relative.
Treatment for Children with Traumatic Stress
According to Sargent, treatment should always begin with a thorough assessment of the child, which should include a history of the child’s traumatic experiences and an assessment of symptoms.1 Children may develop symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral manifestations such as aggression impulsivity, substance use, and self-harm.1 Evaluating family relationships and family members’ understanding of the traumatic event are also essential.1
Treatment goals include assisting the child in developing and maintaining expectations of safety and predictability, helping to reestablish self-control, and aiding the child in becoming resilient to future adversary.1 Sargent presents eight steps for treating children with traumatic stress:
Step one is to ensure the child’s physical safety.1 Caring involvement of police and rescue workers, child protective workers, and health care professionals increase the chances that the child will feel safe in their care.1 Abused children may lack a sense of safety, and Sargent states that relaxation techniques may help them to become comfortable in therapeutic settings and help them to participate in therapy.1 When domestic or community violence is involved, the child’s parents may need to help the child feel safe.1
The second step is to give attention to the child’s basic needs of food, shelter, sleep, and medical care.1 Sargent states that both nutrition and sleep are essential to the treatment of traumatic experiences.1 At times, psychopharmacology is used to assist with sleep and to alleviate anxiety.
During step three, the child and family will become knowledgeable regarding all of the aspects of trauma recovery.1 The clinician may provide information about treatment, recovery, and future expectations. The child and their family should be encouraged to ask questions in order to fully understand their situation and what can be expected of their treatment.1
The fourth step is to establish the behavioral competency of the child. 1 Sargent states that the child should be encouraged to attend school and achieve good grades, participate in after-school activities, and complete chores at home.1 This should aid in building the child’s sense of competency and self-control.1
Step five is to encourage the child and their family to understand that the traumatic experience produced an emotional response, such as fear and powerlessness, and continued feelings of fear, anger, sadness, and shame are normal.1 While these feelings can be confusing to both the child and their family, identifying the emotions and helping the child understand how each is appropriate to their situation will allow the child’s emotions to become predictable and understandable to both the child themselves and their family.1
The sixth step is to create an atmosphere of support for all participants, states Sargent.1 It can be difficult being involved with traumatized children, and the clinician should provide support to all parents and relatives as needed, as well as to involved first responders, child welfare workers, and others.1
Step seven is to organize the child’s traumatic memories into a narrative.1 Sargent states that this helps the child understand fully what has happened, recognize and cope with anxiety, and learn to fully cope with the situation.1 The goal of the narrative is to have the child be able to tell their story and manage their response.1 In the end, the child will present the trauma narrative to their caretakers, who will encourage and praise the child for their courage.1 The narrative helps the trauma become a memory which the child is able to control.1
The eighth and final step is to make meaning of the trauma.1 According to Sargent, this may be done through self-expression, such as artistic expression, journal writing, and volunteer activities, or through community expression, such as through joining or creating an organization.1
Children and a Full Recovery
Overall, it is not uncommon for an individual to experience a trauma during childhood. However, through understanding and intervention, the child will be able to understand and process their trauma and reach a full recovery.
 Sargent, J. (2009, March 13). Traumatic Stress in Children and Adolescents. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/traumatic-stress-disorders/content/article/10168/1388613 children.