Trauma in Children and Adolescents

1. Trauma in Children and Adolescents

2. Definition • A significant number of children in American society are exposed to traumatic life events. • A traumatic event is one that threatens injury, death, or the physical integrity of self or others and also causes the victim(s) to feel horror, terror, or helplessness at the time it occurs. • Traumatic events can include sexual abuse, physical abuse, domestic violence, community and/or school violence, medical trauma, motor vehicle accidents, acts of terrorism, war experiences, natural and human-made disasters, suicides, or other traumatic losses.

3. Statistics • In community samples, more than two-thirds of children report experiencing a traumatic event by age 16 years. • A child has a 39 to 85 percent estimated rate of witnessing community violence. • The estimated rate of victimization can be as high as 66percent. • A youths’ exposure to sexual abuse is estimated to be between 25 and 43 percent.

4. Statistics • Children and adolescents make up a substantial proportion of the nearly 2.5 billion people affected worldwide by disasters in the past decade. • It is more common than not for a child or adolescent to be exposed to more than one single traumatic event. • Children exposed to chronic and pervasive trauma are especially vulnerable to the impact of subsequent trauma.

5. Signs and Symptoms Children and adolescents vary in the nature of their responses to traumatic experiences; however, nearly all children and adolescents express some kind of distress or behavioral change in the acute phase of recovery from a traumatic event.

6. Symptoms May Include: • Preschoolers: Thumb sucking, bedwetting, clinging to parents, sleep disturbances, loss of appetite, fear of the dark, regression in behavior, withdrawal from friends and routines. • Elementary-school children: Irritability, aggressiveness, clinginess, nightmares, school avoidance, poor concentration, withdrawal from activities and friends. • Adolescents: Sleeping and eating disturbances, agitation, increase in conflicts, physical complaints, delinquent behavior, poor concentration.

7. Recovery • The majority of children and adolescents manifest resilience in the aftermath of traumatic experiences. This is especially true of single-incident exposure. • Youths who have been exposed to multiple traumas, have a past history of anxiety problems, or have experienced family adversity are likely to be at higher risk of showing symptoms of posttraumatic stress.

8. Recovery • Research has provided evidence about predictors of trauma recovery, although there are no perfect predictors. Recovery can be impeded by: • Individual and family factors • The severity of ongoing life stressors • Community stress • Prior trauma exposure • Psychiatric comorbidities • Ongoing safety concerns • Poverty and racism • Caretaker responses to trauma

9. Recovery On a positive note, individual, family, cultural, and community strengths can facilitate recovery and promote resilience. Social, community, and governmental support networks are critical for recovery, particularly when an entire community is affected, as when natural disasters occur.

10. Treatment • A substantial minority of children develop severe acute or ongoing psychological symptoms. • Most children and adolescents with traumatic exposure or trauma-related psychological symptoms are not identified and, consequently, do not receive any help. Those who do receive a wide variety of treatments.

11. Treatment • Literature has focused largely on adults until recently and limited empirical data is available on the application of treatments with children and adolescents with traumatic exposure. • Cognitive–behavioral therapy (CBT) techniques have been shown to be effective in treating children and adolescents who have persistent trauma reactions. • Most evidence-based, trauma-focused treatments include opportunities for the child to review the trauma in a safe, secure environment under the guidance of a specially trained mental health professional.

12. Role of Mental Health Professionals Mental health professionals have an important role in facilitating the recovery of children, adolescents, and families when traumatic events occur. Opportunities include: • Working with first responders and community organizations that serve families with children • Working with existing clients who experience trauma • Reaching out to help children and families affected by trauma in their community • Developing and implementing research studies to determine effective, evidence-based treatments • Psychologists and other mental health providers can also register with the American Psychological Association’s (APA) Disaster Response Network or volunteer their services through their local chapter of the American Red Cross

13. Role of Assessments • Using standardized, well-established measures helps to ensure efficient assessment and diagnosis, as well as provides critical information for treatment design. • Enables tracking of symptom progression in the recovery process and return-to-baseline functioning. • Aids in the identification of co-morbid conditions. • Facilitates broad screening for traumatic exposures upon intake or in community and agency settings.

14. Assessments of Trauma and Child Abuse • Trauma Symptom Checklist for Young Children™ (TSCYC™) • Trauma Symptom Checklist for Children™ (TSCC™) • Trauma Symptom Checklist™ Software Portfolio (TSC™-SP) • Checklist for Child Abuse Evaluation (CCAE) • Child Sexual Behavior Inventory (CSBI™) • House-Tree-Person and Draw-A-Person as Measures of Abuse in Children: A Quantitative Scoring System (H-T-P/D-A-P)

15. Assessments of Depression • Reynolds Child Depression Scale™-2nd Ed. and Short Form (RCDS™-2 and RCDS™-2:SF) • Reynolds Adolescent Depression Scale, 2nd Ed. and Short Form (RADS-2™ and RADS-2™:SF) • Clinical Assessment of Depression™ and Scoring Program (CAD™ and CAD™ SP) • Adolescent Psychopathology Scale™ and Short Form (APS™ and APS-SF™) • Personality Assessment Inventory®- Adolescent (PAI®-A) • Reynolds Depression Screening Inventory™ (RDSI™)

16. Assessments of Anxiety/Irritability • Adolescent Psychopathology Scale™ and Short Form (APS™ and APS-SF™) • Personality Assessment Inventory®- Adolescent (PAI®-A) • Clinical Assessment of Behavior™ (CAB™)

17. Assessments of Behavioral Disturbance(Sleep disruption, acting out, loss of appetite, somatic complaints, etc.) • Emotional Disturbance Decision Tree™ (EDDT™) • EybergChild Behavior Inventory™ (ECBI™) • Sutter-EybergStudent Behavior Inventory-Revised™ (SESBI-R™) • Clinical Assessment of Behavior™(CAB™) • Pediatric Behavior Rating Scale™ (PBRS™) • Personality Assessment Inventory®-Adolescent (PAI®-A) • Revised Behavior Problem Checklist-PAR Edition (RBPC) • Children’s Aggression Scale™ (CAS) • Reynolds Adolescent Adjustment Screening Inventory™ (RAASI™)

18. Assessments of Interpersonal Relationships • Parenting Stress Index™, 4th Ed. (PSI™-4) • Stress Index for Parents of Adolescents™ (SIPA™) • Clinical Assessment of Interpersonal Relationships™ (CAIR™)

19. Risk Assessments • Psychosocial Evaluation & Threat Risk Assessment™ (PETRA™) • Structured Assessment of Violence Risk in Youth™ (SAVRY™) • Suicidal Ideation Questionnaire (SIQ) • Adolescent & Child Urgent Threat Evaluation™ (ACUTE™) • Firestone Assessment of Violent Thoughts™-Adolescent (FAVT™-A)

20. References and Resources • 2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents • http://www.apa.org/pi/families/resources/children-trauma-update.aspx • Coping With a Disaster or Traumatic Event: Information for Individuals and Families • http://www.bt.cdc.gov/mentalhealth/general.asp • Post-Traumatic Stress Disorder (PTSD) • http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml • Treatments That Work • http://www.nctsnet.org/resources/audiences/parents-caregivers/treatments-that-work • Topic Specific Resources: Trauma and Justice • http://www.samhsa.gov/children/earlychildhood_trauma.asp • How Children Cope With Trauma and Ongoing Threat • http://www.nasponline.org/resources/crisis_safety/ongoingthreat.aspx