by Maxie Morgan, JD, Sorensen & Hahn
Nearly eighty percent of abused children have faced at least one mental health challenge by age 21.1 Eighty percent is astounding, but when I consider my own juvenile clients individually, I believe it. While I would not preach to memorize numbers, this is one statistic that ought to be known by anyone involved with the juvenile justice system, including attorneys, guardians ad litem, caseworkers, foster parents and judges. Such a mental health challenge may very well be the symptom of childhood trauma.
What is trauma?
Trauma is a psychologically distressing event that involves a sense of intense fear, terror and helplessness.2 Examples include child abuse or neglect, witnessing violence, being a victim of violence, natural disasters, war and terrorism, accidents, medical diagnoses, and severe grief.3 Child traumatic stress is the response to such a psychologically distressing event and can affect a child’s capacity to cope, ability to trust others, sense of personal safety and effectiveness in navigating life changes.4 Other stressors common for children involved in the juvenile justice system include poverty, discrimination, separation from parents and/or siblings, unstable housing or schooling, and refugee or immigrant status.5
What are the types of trauma?
Trauma may be acute (a single traumatic event), chronic (multiple traumatic events) or complex (exposure to chronic trauma along with the resulting impact on the child).6 The impact of a potentially traumatic event is very subjective; what may be traumatic to one child may not be traumatic to another. When I stop to consider these types of trauma, I realize that it is not only the children who have experienced significantly high rates of trauma, but often their parents and caregivers as well. Several factors can influence the impact of a potentially traumatic event, including: (1) the child’s age and developmental stage; (2) the child’s perception of the danger faced; (3) whether the child was the victim or a witness; (4) the child’s relationship to the victim or perpetrator; (5) the child’s past experience with trauma; (6) the adversities the child faces following the trauma; and (7) the presence or availability of adults who can offer help and protection.7
How do I recognize trauma?
To recognize trauma, watch for affective symptoms such as fear, sadness, anger, anxiety, depression, physiological stimulation, emotional distress and difficulty in soothing oneself.8 Also be aware of cognitive symptoms such as irrational beliefs, blaming oneself, distrust of others, distorted self-image, or accurate, but unhelpful, cognitions.9 Behavioral symptoms of trauma may include avoidance of thoughts, feelings or places, sexualized or violent behavior, associating with an aggressor, substance abuse, self-injury, or suicidal ideations.10 Children in the child welfare system are commonly diagnosed with reactive attachment disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, bipolar disorder and conduct disorder.11 Many children with such diagnoses have a complex trauma history, although these diagnoses generally do not identify the full extent of the developmental impact of trauma. 12
How does trauma affect child development?
Trauma can affect the brain differently at various points in development. It can hinder coordination, communication or academics. Young children who have experienced trauma may be passive, quiet or easily alarmed, or on the opposite extreme, may display aggressive outbursts.13 I have had clients on both ends of the spectrum. They may be fearful of new situations or experience separation anxiety or suffer from night terrors. Particularly in cases where a parent or caretaker is the aggressor, children may be confused about assessing a threat and also finding protection.14 Young children may also regress to recent behaviors such as bed-wetting, crying or baby talk. 15
The development of traumatized school-aged children may cause unwanted and intrusive thoughts and images, or preoccupation with past distressing events.16 They may develop intense new fears linked back to the trauma.17 Sometimes school-age children will alternate between shy and withdrawn behavior and unusually aggressive behavior.18 They may seek revenge.19 Their fear of recurrence may become so intense that they avoid previously enjoyable activities.20 Sleep disturbances may also interfere with daytime concentration and attention.21
Adolescents responding to trauma may feel that they are weak, strange or going crazy22. Anxiety, depression, intense anger, low self-esteem and helplessness are common feelings.23 They may also be embarrassed about their fears or exaggerated physical responses.24 Adolescents who have experienced trauma often feel unique and alone in their pain.25 Such trauma reactions may cause aggressive or disruptive behavior, and expectations of maltreatment or abandonment.26 Sleep disturbances may be masked by studying or watching television late at night or partying.27 Many traumatized teenagers use drugs or alcohol as a coping mechanism to deal with stress.28 Danger may be over-estimated or under-estimated and they have an increased risk of re-victimization.29
What can I do?
Anyone involved with juveniles in the child welfare system can work to reduce system-related stress by recognizing that interventions by child protective services may either increase or decrease the impact of trauma. Professionals can help minimize the risk of system-induced secondary trauma by alleviating a child’s concerns. Trust must be developed through listening, frequent contacts and honesty.30 However, professionals need to avoid repeated interviews regarding a traumatic event. I have had cases where children meet with a caseworker, a guardian ad litem, a court-appointed special advocate, parents, foster parents, teachers and therapists. To repeatedly explain a traumatic event to everyone involved may be damaging for the children and have the unintended result of exacerbating the trauma impact. A possible solution is for the professionals to obtain information from the children’s therapist, not continuously from the children themselves, and to direct the children to speak to their therapist, unless they want to share with other professionals involved. That way, the children do not have to repeat their stories over and over, potentially reliving the trauma.
The focus should be on utilizing adaptive coping mechanisms and maximizing a child’s sense of safety, as safety is critical for functioning and growth.31 Professionals need to know that many challenging behaviors are not simply because the child is “being bad,” but may have been adaptive for the child in the past in responding to trauma.32 For example, neglected children may act out at school, seeking attention, if they do not receive the attention they need at home. It is not necessarily because they are deliberately “being bad,” but because they may have disinterested and uninvolved parents and acting out is a behavior through which their needs are met.
Those involved with children in the juvenile justice system should support permanency by evaluating possible long-term placements at the beginning of a case, not the end.33 I have had cases where children have been with the same foster family for 18 months or more and social services then searched for and located relative placements, and wanted to uproot the children simply to be with family. The result could be a potentially traumatic, broken bond with the foster family and not necessarily in the children’s best interests. The best practice would have been to search for relatives at the beginning, so a relationship between children and their extended family could be fostered while their cases were pending.
Permanent caregivers also need access to the support and services that will enable the child to heal. Any mental health assessments or treatment should be trauma-focused and should include caregivers in treatment, educating them about the impact of trauma on a child’s development.34 Children need reminded that they are not at fault for their involvement with child protective services. Remember, whatever the statistics may be, exposure to trauma or other “mental health challenge” for children in the juvenile justice system is the rule, not the exception.
Where can I find more information?
For more information about childhood trauma, please refer to the following resources:
Maxie Morgan is a Guardian ad Litem with Sorensen & Hahn in Scottsbluff. She may be reached at email@example.com or 308-632-5111.
3 Id. at 5.
4 Id. at 4.
5 Id. at 11.
6 Id. at 6-8.
7 Id. at 13.
8 Id. at 14.
9 Id. at 15.
10 Id. at 16.
11 Id. at 19.
13 Id. at 27.
16 Id. at 28.
18 Id. at 29.
22 Id. at 30.
26 Id. at 31.
30 Id. at 34.
31 Id. at 35.
32 Id. at 36.
33 Id. at 38.
34 Id. at 39.