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The Effects of Trauma on Young Children. Stacey Ryan, LCSW Angela M. Tomlin, Ph.D. IAITMH 2006. Types of Trauma. Witnessing violence (domestic and other) Natural disaster Terrorism Accidents Abuse/Neglect Loss of caregiver. Do Young Children Experience Trauma?.

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The effects of trauma on young children l.jpg

The Effects of Trauma on Young Children

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.



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Types of Trauma

  • Witnessing violence (domestic and other)

  • Natural disaster

  • Terrorism

  • Accidents

  • Abuse/Neglect

  • Loss of caregiver

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Do Young Children Experience Trauma?

  • Children under 12 months account for 44% of deaths from child abuse and neglect

  • Persistent crying is an important risk factor in abuse of very young children, related to shaken infant syndrome

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Young children and sexual abuse

  • Infants and toddlers may account for as many as 10% of substantiated sexual abuse

  • Appearance of sexualized behavior is more likely than physical findings

  • The younger the child when abused, the more likely sexualized behavior appears

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Young children and domestic violence

  • Child sees attachment figure injured

  • Attachment figure cannot protect self; child is unsure if she can protect him

  • Attachment figure may in turn injure the child

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Assessing severity of trauma

  • Closeness of people involved to the child

  • What the child saw

  • Child’s developmental level

  • Reactions of important adults

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How Young Children Understand Traumatic Events and Experiences

  • Cognitive and emotional capacity determines how child experiences trauma

  • Level of understanding can also affect memory

  • 2-3 year olds do not understand the finality of death

  • Young children may believe they caused a traumatic event

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Clinical Patterns in Abused/Neglected Infants Experiences

Gaensbauer & Mrazek (1981) observed 4 clinical patterns:

  • Developmentally and Affectively retarded group

  • Depressed Group (sad and sensitive to change)

  • Ambivalent Group (rapid shifts in emotion)

  • Angry Group (emotional intensity and low frustration tolerance)

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Effects of Trauma Experiences

  • Can appear immediately or after days, weeks

  • May remind young child of previous traumas, making reaction more severe

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Effects of Trauma Experiences

  • Physical & Self-Regulation Effects

  • Traumatic Reminders

  • Development

  • Play

  • Behavior

  • Relationship

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Physical and Self-Regulation Effects Experiences

  • Self-regulation is important task of infancy

  • In babies and young children, problems with self-regulation look like:

    Sleep problems

    Eating problems

    Exaggerated startle


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Physical and Self-Regulation Effects Experiences

  • Exposure to traumatic events seems to change the way the infant reacts to future stressors

  • Animal and human studies shows changes in hormones and brain chemicals after trauma

  • These brain changes can be long lasting, leading the child to feel numb or anxious

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Traumatic reminders Experiences

  • Can be difficult to identify in nonverbal child

  • Sensory (siren, smell)

  • Dreams

  • Re-experiencing the event

  • Irrational fear of benign objects

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Developmental Effects of Trauma Experiences

  • Developmental delays are expected—developmental assessment is advised

  • Problems may occur in development of attachments and other social emotional skills

  • Regression is possible

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Effects on Play Skills Experiences

  • Repetitive actions

  • Driven quality

  • Constricted quality

  • Preoccupation with separation, loss, and reunion

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Effects on Behavior—infants and toddlers Experiences

  • Increased irritability/inability to soothe

  • Sleep disturbance

  • Emotional distress; sadness

  • Fears of being alone; clinging; refusal to separate

  • Motor agitation

  • Temper tantrums

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Effects on Behavior—toddlers and preschoolers Experiences

  • Being too clingy with adults

  • Not able to be comforted when upset

  • Problems with exploration: either reckless or too inhibited

  • Aggression toward caregivers, peers, animals

  • Angry noncompliance

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Effects on Relationship Experiences

  • Difficulty forming positive relationships

  • Poor sense of self

  • Lowered self esteem

  • Expectation of being treated poorly

  • Loss of secure base

  • Loss of sense of trust

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Long Term Effects of Trauma Experiences

  • Persistent grief reactions (Bowlby)

    Protest: efforts to find the parent through crying, calling, and searching

    Despair: lethargy, sadness, emotional withdrawal, loss of interest in activities

    Detachment: apparent indifference to reminders; selective forgetting*

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Long Term Effects of Trauma Experiences

  • Increased risk for academic problems

  • Substance use and abuse

  • Early pregnancy

  • Criminal involvement

  • Psychiatric symptoms and disorders

  • Experiencing abuse as a child is linked to abusing one’s own child

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Abused children as parents Experiences

  • Harsh discipline

  • Failure to respond to child’s needs

  • Inconsistent limit setting

  • Inability to express affection

  • Inability to enjoy interactions with child

  • Minimize or deny child’s painful experiences

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Young children and neglect Experiences

  • Failure to provide for child’s physical and emotional needs

  • Leaving child alone for long periods

  • Leaving child for long periods with varied and unreliable caregivers

  • Effects of neglect can be as devastating as physical or sexual abuse

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Effects of neglect Experiences

  • Lack of play and other developmental skills

  • May hoard food

  • Unfamiliar with things we take for granted

  • Expects to take care of self or siblings

  • Challenges adult authority

  • Lacks trust in adults

  • Avoids adults when upset; hard to soothe

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Expected difficult reactions to placement in foster care Experiences

  • Previous relationship failures lead the child to behave in ways that alienate foster parents

  • Caregivers misread behaviors and respond in ways that increase problems

  • Child responds to loss of attachment figure with behavioral, emotional, and physiological dysregulation

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Expected difficult behaviors of children in care Experiences

  • Acting like they do not need caregivers, even under threatening conditions

  • Acting angry when adult makes efforts to soothe

  • Turning away when hurt

  • Behaving aggressively toward caregivers

  • Behaving aggressively toward peers

  • Problem behavior after visits

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Why do we see behavior problems after visits with family? Experiences

  • Visits with parents are traumatic reminders of events that led to the separation or of the separation itself

  • Both the child and parent may feel anxious and angry

  • Supervised visits increasing parents feelings of incompetence

  • Child feels safer expressing angry feelings toward foster parent/family

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How Foster Care Helps Experiences

  • One of the most important things a foster parent can do is to help young children have positive relationships

  • Doing this will help with development and behavior

  • To do it right, you have to pay attention to attachment

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Arousal-Relaxation Cycle Experiences

Child experiences a need

Child feels upset

Child feels content

Adult satisfies need

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Are there children with no attachments? Experiences

  • There are children with no attachments

  • It is more likely that a child have an attachment problem rather than no attachment at all

  • The child will develop an attachment with the adult that is available

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Why do children form attachments to abusive parents? Experiences

  • Children’s need for survival and safety results in attachment to any available adult, even those who abuse or threaten them

  • Children prefer the familiar, even when what is familiar is frightening

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Insecure Attachments Experiences

  • Avoidant patterns (turning away from the caregiver when distressed) develop when caregivers reject baby’s request for nurturance.

  • Resistant patterns (fussy, resistant behavior) develops when caregivers inconsistently respond to the baby

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Insecure Attachments Experiences

  • Infants show disorganized pattern when adults demonstrate frightening or frightened behavior with them

  • Infant is afraid of the person they look to for reassurance and nurturance

  • Infant behavior is unorganized and bizarre

  • These patterns are common when children are abused or they witness domestic violence

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Long term Effects of Disorganized Attachments Experiences

  • Aggression with peers

  • Dissociative behaviors

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Role of Foster Parent in Attachment Experiences

  • Help the child develop a healthy attachment

  • Help child extend attachment to you and improved behaviors to birth family, new fosterfamily, or adoptive family

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How Foster Parents Can Help Experiences

  • Work with the parents

  • Avoid judgments about the biological parents

  • Provide transitional objects to child

  • Provide family pictures

  • Have a plan for the first visit

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How Foster Parents Can Help Experiences

Responding to parent anger

  • Listen

  • Be non-reactive

  • Acknowledge how difficult it is to be away from child

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How Foster Parents Can Help Experiences

  • Recognize that the child needs you, even when they do not show it

  • Understand rejecting behaviors as old coping methods

  • Listen

  • Put words to behaviors

  • Attend to your own reactions

  • Encourage touch, but do not force it

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How Foster Parents Can Help at Home Experiences

  • Safety

  • Routine that shows an adult is “in control”

  • Soothing sensory activities

  • Stop activities that result in re-enactment (including television)

  • Advocate to reduce moves to provide continuity

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Question and Answer Experiences

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Factors in Determining Types of Interventions, (Osofsky & Fenichel, 1994)

  • Safety and Stability of Current Living Situation

  • Child’s Developmental Capacities to Make Use of Certain Types of Interventions

  • Quality of Pre-Traumatic and Current Care-Giving Environment

  • Type of Violent Event or Situation

  • Acuteness vs. Chronicity of Trauma

  • Actual and Psychological Proximity of the Violent Events

  • Post Traumatic Symptoms in Child and Caregiver

  • Strengths and Protective Factors in Infant

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Goals for Intervention (Lieberman & Van Horn, 2005) Fenichel, 1994)

  • Return to Normal Development

  • Increase Capacity to Respond to Trauma.

  • Maintain Regular Levels of Arousal

  • Re establish Trust in Bodily Sensations

  • Restore Reciprocity in Close Relationships

  • Normalize Reactions to Trauma

  • Encourage a Differentiation Between Reliving and Remembering

  • Place the Traumatic Experience in Perspective

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Common Intervention Needs (Osofsky & Fenichel, 1994) Fenichel, 1994)

  • Improving the caregivers ability to attend to and provide for the child’s needs

  • Further develop caregiver’s ability to interpret child’s feelings, reactions and support child

  • Address cognitive distortions child may have regarding trauma

  • Assist the child in re experiencing trauma in affectively tolerable doses

  • Assist the child and caregiver in coping with any losses

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Results of Interventions Assist Child in Understanding… Fenichel, 1994)

  • Stressful body experiences can be alleviated with help of others and coping strategies

  • Adults can support and protect child

  • Child is not to blame

  • Can talk about emotions rather than only acting them out

  • Life can contain elements of mastery, fun and hope

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Methods for Intervening Fenichel, 1994)

  • Using Play, Physical Contact and Language to Promote Developmental Progress

  • Offering Unstructured Reflective Developmental Guidance

  • Modeling Appropriate Protective Behavior

  • Interpreting Feelings and Actions

  • Providing Emotional Support/Empathetic Communication

  • Offering Crisis Intervention and Concrete Assistance

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Areas of Clinical Concern include… Fenichel, 1994)

  • Play

  • Sensorimotor Disorganization

  • Fearful Behavior

  • Self Endangering Behavior

  • Aggression Toward Parent

  • Aggression Toward Peers

  • Parental Use of Physical Discipline

  • Parental Use of Threats, Criticisms of Child

  • Relationship with Perpetrator

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Play Fenichel, 1994)

  • Encouragement of Play with Dyad

  • Help the Parent Understand and Support Use of Play

  • Allow the Parent to Be Main Supporter to Child

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Sensorimotor Disorganization Fenichel, 1994)

  • Help the Parent Understand How these behaviors Affect Them (triggers feelings of rejection, anger and frustration in parent)

  • Develop New Meanings for Parent

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Child Fears Fenichel, 1994)

  • Support Parent Understanding of Fears

  • Bring Attention to Cues Child Gives Regarding Fears

  • Develop with Parents Strategies for Containing Fears

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Aggression Toward Parent Fenichel, 1994)

  • Give Parents Meaning for This Behavior

  • Assist Parents In Containing Feelings Regarding this Behavior

  • Develop Strategies for Controlling Anger/Aggression

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Aggression Toward Peers Fenichel, 1994)

  • Build Understanding of Reasons for Behavior

  • Clinician Gives Resources for Deescalating Behavior

  • Empower Parents to Take Action and Assist Child

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Parental Use of Physical Punishment Fenichel, 1994)

  • Explore with Parent Feelings and Concerns

  • Contain Own Emotions and Reactions

  • Educate on Reasons Physical Punishment May Worsen Symptoms

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Parental Criticism Fenichel, 1994)

  • Focus on Effects of Relationship

  • Acknowledge Parent Issues/Feelings

  • Build Awareness of Child Experience

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Relationship with Perpetrator Fenichel, 1994)

  • Educate on Child Needs/Experiences

  • Support/Listen to Parent Concerns/Feelings

  • Mutually Develop Strategies

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What Evaluation Research Tells Us (Landy & Menna, 2006) Fenichel, 1994)

  • Home Visiting is Critical Component

  • Need to Distinguish Between Early Intervention and Prevention

  • Starting Early is Critical

  • Intensity and Duration Counts

  • Ongoing Assessment is Critical

  • Services Most Effective for Moderate Levels of Risk

  • Need for Well Trained Service Providers

  • Use a Variety of Approaches

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Treatment Videos Fenichel, 1994)

  • Discussion

  • Questions/Comments

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Experience Case Based Discussion Fenichel, 1994)

  • Structured way of thinking and talking about situations with families

  • Method for promoting Reflective Supervision and Further Learning

  • 3 Phases:

    • Understanding the Experience

    • Exploring and Sharing the Collective Knowledge and Experience of the Group

    • Summarizing Discussion and Identifying Next Steps

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Another Way to Help Fenichel, 1994)

  • Speak for the babies..

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Want to learn more? Fenichel, 1994)

  • Indiana Association for Infant and Toddler Mental Health (

  • 317/638-3501 EXT 221

  • Zero to Three (

  • The Center for Social and Emotional Foundations for Early Learning (

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Contact us…. Fenichel, 1994)

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The Effects of Trauma on Young Children Fenichel, 1994)

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.