Surviving Childhood: An Introduction to the Impact
of Trauma
By Dr. Bruce D. Perry
http://www.childtraumaacademy.com/surviving_childhood/index.html
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Contents
Lesson 1: Introduction to Childhood Trauma .......................................................................................... 3
Lesson 2: The Psychology and Physiology of Trauma ........................................................................... 10
Lesson 3: After the Trauma: The Costs of Coping ................................................................................. 19
Lesson 4: Finding Resources and Getting Involved ............................................................................... 29
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Lesson 1: Introduction to Childhood Trauma
Physical abuse, rapes, hurricanes, fires, car accidents, witnessing violence, multiple painful
medical procedures, life-threatening medical conditions, sudden death of a parent, threat of
violence at school or home.
In the United States alone, approximately five million children experience some form of
traumatic event each year. More than two million of these children are victims of physical
and/or sexual abuse. Millions more live in the terrorizing atmosphere of domestic violence.
By the time a child reaches the age of 18, the probability that he or she will have been touched
directly by interpersonal or community violence is approximately one in four. Across the
world, these numbers are even more astounding. In some war-torn countries, more than 60
percent of the children are displaced and chronically traumatized.
These numbers are more than mere statistics. No one remains unscathed by traumatic events.
First, trauma can have a devastating impact on the individual child, profoundly altering
physical, emotional, cognitive, and social development. Second, the child's experience
directly impacts his or her family and community.
We now know that a child's potential to be creative, productive, healthy, and caring depends
upon his or her experiences in childhood, and if these experiences are threatening, chaotic,
and traumatic, the child's potential is diminished. Ultimately, we all pay the price exacted by
childhood trauma, whether we are dealing with individual children or large numbers of
scarred adults assuming their places in society.
Before we continue, here are our course objectives:
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Course Objectives
1. Provide an overview of key principles of neurodevelopment crucial for understanding the
role of experience in defining functional and physical organization of the brain
2. Describe the emerging clinical and research findings in maltreated children that suggest the
negative impact of abuse, neglect and trauma on brain development
3. Outline the clinical implications of a neurodevelopmental approach to child maltreatment
4. Discuss the role of public policy and preventative practices in context of the impact of
maltreatment on children's emotional, behavioral, cognitive, social and physical health
What Exactly Is Trauma?
Before we go any further, I want to clarify what "trauma" means for the purposes of this
course. A trauma is a psychologically distressing event that is outside the range of usual
human experience. Trauma often involves a sense of intense fear, terror, and helplessness.
Trauma should not be confused with stress. As we will learn later, stress is an inevitable
component of everyone's life. Trauma is an experience that induces an abnormally intense and
prolonged stress response.
Simply by signing up for this course, you have expressed an interest in childhood trauma and
perhaps count yourself or someone you love among the statistics cited above. Maybe you
know a child who is a victim of childhood trauma, or are an adult still grappling with your
own experience.
No matter what brings you here, take a moment now and identify someone or some event in
your life or work that makes this issue real. While you take this course, your own experiences
with traumatic events and with children or families impacted by trauma will provide the true
context for learning.
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Trauma is not limited to domestic or sexual violence. We live in a world prone to floods,
hurricanes, and earthquakes, not to mention other sorts of natural disasters. Without warning,
people die or are injured every day in cars on our nation's streets and highways.
Despite wonderful technological advances in medicine, people still experience life-
threatening medical conditions and painful procedures. The media provides us with a picture
of escalating community violence, drug abuse, and other dangers. Even from an adult
perspective, the world can be a very frightening place!
Seeing the World Through a Child's Eyes
Over the next day or so, as you think of it, imagine the world through a child's eyes. What
otherwise benign sights or events might be frightening if you were a child? Consider the
evening news. What message would children receive about the world they live in if they saw
the same news item that you are viewing?
If you are at a loss for a relevant news clip, consider the following Associated Press item,
dated March 9, 2000:
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MIAMI -- A woman has been charged with attempted murder after her 15-year-old daughter
told authorities the woman doused her with gasoline and set her on fire because she didn't
like the girl's boyfriend.
Miami-Dade Police also charged Maria Tarrago on Monday with aggravated child abuse
and great bodily harm and arson resulting in injury. Her daughter was burned over 23
percent of her body.
The girl has been hospitalized since the Dec. 6 fire and unable to communicate until recently,
police spokesman Pete Andreu said. On Monday, she told her story to the father of her
roommate at Jackson Memorial Hospital's Rehabilitation Center.
Police said Wednesday that Tarrago, a maid from El Salvador, was upset because her
daughter was seeing a boy she disapproved of. The fire occurred in the apartment Tarrago
shared with her daughter and son.
Realizing what she had done, police said, Tarrago and her boyfriend extinguished the fire and
rushed the girl to Miami Children's Hospital.
At the time, Tarrago told officials the fire had been an accident.
Tarrago's daughter is now in good condition, Jackson spokeswoman Rosa Gonzalez said,
although it is not known when she will be released. She is in state custody.
Adults listening to the news report are horrified. But imagine what a child might think after
hearing such a frightening news report. Though the child may not ask you anything about
what she has heard, she will have a whole host of questions: What does it mean to be set on
fire? Will that girl be okay? What will happen to the mother? How could a mother set her own
daughter on fire? Could this happen to me?
Childhood Trauma Increases Risks in Adulthood
People who have experienced traumatic events in childhood are at increased risk for a host of
other problems, impacting all domains of functioning. Impaired emotional, social, cognitive,
and physiological functioning can result from adverse childhood events.
Social problems of traumatized children can manifest in teenage pregnancy, adolescent drug
abuse, school failure, victimization, and anti-social behavior. Victims of childhood trauma can
suffer from neuropsychiatric conditions, such as post-traumatic stress disorder, dissociative
disorders, and conduct disorders.
Medical problems such as heart disease and asthma can also be directly attributed to
childhood trauma in some cases. Childhood trauma has even been linked to increased risk for
cigarette smoking:
Researchers from Kaiser Permanente in California studied data on 9,215 patients in health
maintenance organizations. They questioned patients about their smoking habits and exposure
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to the following events: being emotionally, sexually, and/or physically abused; having a
battered mother; divorce or separation of parents; growing up around substance abuse; or
growing up with a mentally ill or incarcerated household member.
Kids exposed to five or more of the eight types of negative childhood experiences were 5.4
times more likely to begin smoking by age 14 or 15 than kids who did not have such negative
experiences. And children with negative experiences were twice as likely to be a current
smoker and nearly three times more likely to be a heavy smoker than children who were not
exposed to negative events. (This study appeared in the November 3, 1999, issue of the
Journal of the American Medical Association.)
The escalating cycles of abuse and neglect of our children seen in some of our urban and rural
communities can, in turn, become a major contributor to many other social problems. Some
would consider the deterioration of public education, the proliferation of urban violence, and
an alarming rate of social disintegration all as direct results of childhood trauma.
Dissociation and PTSD
Here are two more terms to define before we move forward:
Dissociation is the mental process of disengaging from the stimuli in the external environment
and attending to inner stimuli. This is a graded mental process that ranges from normative
daydreaming to pathological disturbances. Dissociation may include exclusive focus on an
inner fantasy world, loss of identity, disorientation, perceptual disturbances, or even
disruptions in identity.
Post-Traumatic Stress Disorder (PTSD) is a neuropsychiatric disorder that may develop
following a traumatic event. Symptoms of PTSD can include changes in emotional,
behavioral, and physiological functioning. It is characterized by three key sets of symptoms:
1) re-experiencing and re-enactment, 2) avoidance, and 3) physiological hyper-reactivity. In
later lessons we will learn more about each of these three symptom clusters.
Traumatic experiences can have a devastating impact on a child, altering his or her physical,
emotional, cognitive, and social development. In turn, the impact on the child has profound
implications for his or her family, community and, ultimately, all of us. Caregivers, childcare
providers, teachers, law enforcement, child protection workers, social workers, judges, nurses,
pediatricians, and mental health service providers all will work with traumatized or maltreated
children.
Now that we have reviewed some of the disheartening information, let's hear some good
news. With treatment, the effects of childhood trauma can be alleviated. Early and aggressive
treatment of traumatized children decreases risk for developing PTSD and other trauma-
related problems seen later in life.
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Treatments usually incorporate three elements:
1. Review and recollection of the traumatic experience
2. Information about the normal and expected processes of post-traumatic functioning
3. Focus on specific symptoms
Despite the positive effects we know treatment has on trauma sufferers, the unfortunate reality
is that most traumatized children do not get any help whatsoever. There is a dangerous belief
among adults that children are "resilient" and can weather trauma naturally. Those children
who do get services often have limited access and brief contacts. Early and sustained
treatment for children who have suffered trauma is important if the long-term effects are to be
avoided.
Typical Approaches
Individual Therapy: This is where the child has one-on-one contact with a clinician.
Depending upon the training and the specific issues, the approach is usually a combination of
the following interventions:
·ð Psychoeducational
·ð Cognitive-behavioral
·ð Insight-oriented
·ð Play
·ð Trauma-focused
·ð Pharmacotherapy
Group Therapy: In many cases, a traumatic event has been shared by several children (e.g., a
school shooting or a hurricane). In these cases, group interventions have been used. In
addition, individual trauma may be similar enough (e.g., victims of sexual abuse or domestic
violence) that the clinician will recommend group treatments. Again, the focus of the group
approach can include a combination of the following interventions.
·ð Psychoeducational
·ð Cognitive-behavioral
·ð Family
·ð Problem-focused
The better we can understand these children and the impact of traumatic experiences, the
more compassionate and wise we can be in our interactions and our problem-solving.
·ð T. is an 8-year-old boy who survived a tornado that destroyed his home. Prior to the
tornado he showed no interest in weather or fear of storms. Following the event, he
was unwilling to go outside if there were clouds in the sky. He was tearful and
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frightened when it rained, particularly when there was thunder. Rather than watching
his usual shows, T. would spend hours watching the Weather Channel. These
behaviors and feelings impeded his ability to resume his previous excellent academic,
social, and emotional functioning.
·ð M. is a 10-year-old boy who was in a car accident that killed one of his siblings. Prior
to the accident he had no academic, social, or behavioral problems. He had minor
physical injuries. Six months after the accident, his school performance had
deteriorated to the point where he was given a diagnosis of attention deficit disorder.
The physician was given the history of distractibility and inattentiveness in school, but
the family did not make any connection between these symptoms and the accident.
Since he never talked about the accident or his brother, the parents felt he "had dealt
with it." The physician with only the history of attention and behavior problems gave
the diagnosis of attention deficit hyperactivity disorder (ADHD) and prescribed
Ritalin. The medication did not help.
·ð S. is a 12-year-old girl with a history of a childhood leukemia. Diagnosed at age 3, she
had a series of hospitalizations, procedures, and treatments that resulted in complete
remission of the disorder by age 5. She had normal development in all areas following
this successful treatment. At age 12, she was entering puberty and went to a new
physician's office for a routine (non-gynecological) examination. In the waiting room,
she began to feel anxious and sweaty and had a sense of impending doom. When led
back to the examination room, she started to resist, screaming, crying, and striking out
at her mother and the nurse. Unable to calm down, she finally collapsed on the floor,
rocking and sobbing, completely unresponsive to verbal input. Over time, it became
clear that the sights, sounds, and smells of this medical office were cues associated
with the fear and feelings from her previous painful and, to a young child, confusing
medical treatments for her leukemia.
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Lesson 2: The Psychology and Physiology of Trauma
The Alarm Reaction
The human body and human mind each have a set of very important and very predictable
responses to threat. Threat may come from an internal source, such as pain, or an external
source, such as an assailant. One common reaction to danger or threat has been labeled the
"fight or flight" reaction. In the initial stages of this reaction, there is a response called the
alarm reaction .
Think about what happens when you feel threatened. Your racing heart, sweaty palms,
nausea, and sense of impending harm are all symptomatic of this alarm reaction.
When a person perceives a threat, the initial stages of a complex, total-body response will
begin. The brain orchestrates, directs, and controls this response. The more threatened an
individual feels, the further their brain and body will be shifted along an arousal continuum in
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an attempt to ensure appropriate mental and physical responses to the challenges of the threat.
The cognitive (thinking), emotional, and behavioral functioning of the individual will all
reflect this shift along the arousal continuum.
During the traumatic event, all aspects of the individual's functioning change, including
feeling, thinking, and behaving. For instance, someone under direct assault abandons thoughts
of the future or abstract plans for survival. At that exact moment, all of the victim's thinking,
behaving, and feeling is being directed by more primitive parts of the brain.
A frightened child in a threatening situation doesn't focus on the words being spoken or
yelled; instead, he or she is busy attending to the threat-related signals in their environment.
The fearful child will key in to nonverbal signs of communication, cues such as eye contact,
facial expression, and body posture, or proximity to the threat.
The internal state of the child also shifts with the level of perceived threat. With increased
threat, a child moves along the arousal continuum from vigilance through to terror. (See the
above graph for different possible response scenarios.)
The Arousal Continuum
The arousal continuum is characterized by many physiological changes. Under threat,
sympathetic nervous system activity increases in a gradual fashion. Heart rate, blood pressure,
and respiration are altered during the arousal response. Glucose stored in muscle is released to
prepare the large skeletal muscles of your arms and legs for either a fight or a flight.
These changes in the central nervous system cause hypervigilance; under threat, the child
tunes out all non-critical information. These actions prepare the child to do battle with or run
away from the potential threat.
This total body mobilization -- the fight-or-flight response -- has been well characterized and
described in great detail for adults. These responses are highly adaptive and involve many
coordinated and integrated neurophysiological responses across multiple brain areas,
including the brainstem nuclei responsible for autonomic nervous system regulation.
What Does Hyperarousal Really Mean?
Hyperarousal is a multi-dimensional process characterized by both mental and physical
changes. These include an increase in the activity of those parts of the central and peripheral
nervous system responsible for the perception and processing of potentially threatening
information . This graded response also involves action.
During the hyperarousal process, many physiological systems required for survival are
activated (e.g., stress response hormones such as cortisol and adrenaline). The many
physiological changes during hyperarousal will influence the way a person thinks, feels, and
acts.
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The fight-or-flight response is a well-characterized reaction to danger, as we've already
discussed. A second common reaction pattern to threat is dissociation. Dissociation is the
mental mechanism by which one withdraws attention from the outside world and focuses on
the inner world.
It is increasingly clear that responses to threat can vary tremendously from individual to
individual. This second major adaptation response to threat involves an entirely different set
of physiological and mental changes, yet does not fall under the heading of either fight or
flight.
Many common and "normal" mental and emotional states such as anxiety, dissociation, or
anger are experienced by most of us to some degree. When any one of these becomes
pervasive and ever-present, however, it begins to interfere with the rest of one's life. This can
happen with dissociation and anxiety. When it does we characterize this as a disorder.
Because of their small size and limited physical capabilities, young children do not usually
have the fight-or-flight option in a threatening situation. When fighting or physically fleeing
is not possible, the child may use avoidant and psychological fleeing mechanisms that are
categorized as dissociative.
Dissociation due to threat and/or trauma may involve a distorted sense of time or a detached
feeling that you are observing something happen to you as if it is unreal -- the sense that you
may be watching a movie of your life. In extreme cases, children may withdraw into an
elaborate fantasy world where they may assume special powers or strengths.
Like the alarm response, this "defeat" or dissociative response is graded along a continuum.
The intensity of the dissociation varies with the intensity and duration of the traumatic event.
(Remember that even when we are not threatened, we use dissociative mental mechanisms,
such as daydreaming, all of the time.) During a traumatic event, all children and most adults
use some degree of dissociation. However, some individuals will use, or experience trauma
that induces dissociation as a primary adaptive response.
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For most children and adults the adaptive response to an acute trauma involves a mixture of
hyperarousal and dissociation. During the actual trauma, the child feels threatened and the
arousal systems will activate. With increased threat, the child moves along the arousal
continuum. At some point along this continuum, the dissociative response is activated and a
host of protective mental (decreased perception of anxiety and pain) and physiological
responses (decreased heart rate) occur (see Figure 3-4 below).
The following points are an overview of human response to threat and trauma. Don't worry if
you don't grasp all the concepts at first reading. We will be discussing these issues in greater
detail as we move through our course. Consider this a preview of sorts.
·ð The brain mediates threat with a set of predictable neurobiological, neuroendocrine,
and neuropsychological responses.
·ð These responses may include different survival strategies -- ranging from fighting or
fleeing to giving up or surrendering.
·ð There are multiple sets of neurobiological and mental responses to stress. These vary
with the nature, intensity, and frequency of the event. Different children may have
unique and individualized sets of responses to the same trauma.
·ð Two primary adaptive response patterns in the face of extreme threat are the
hyperarousal continuum (defense -- fight or flight) and the dissociation continuum
(freeze and surrender response). Each of these response sets activates a unique
combination of neural systems.
·ð These response patterns are somewhat different in infants, children, and adults --
though they share many similarities. Adult males are more likely to use hyperarousal
(fight or flight) response, while young children are more likely to use a dissociative
pattern (freeze and surrender) response.
·ð In general, the predominant adaptive style of an individual in the acute traumatic
situation will determine which post-traumatic symptoms will develop: hyperarousal or
dissociative.
Exercise: Catalog Your Alarm Response Patterns
Think back to the last time you felt threatened in some way and your alarm state was
activated. Perhaps you were walking down a dark street one night and heard footsteps close
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behind you. Perhaps you were attending a football game one afternoon when some beer-
swilling fans next to you began a fight with a fan of the opposing team seated in the row
behind you.
Pick two or three events from your life where you felt some element of threat. For each, make
two columns. In the first column, list the emotional and mental changes you remember -- for
example, a sense of unreality, intense fear, or tuning out the world. In the other, list the
physical symptoms such as racing heart, sweaty palms, or light-headedness. What physical
symptoms do you recall emerging as your brain sent the signal to your body that a threat was
near? Did you want to run? Did you feel an adrenalin surge in preparation for possible self-
defense?
Visualize your body and make a mental list, from head to toe, of every physiological response
to the perceived threat that occurred. This can illustrate two key points: 1) you probably had a
slightly different set of adaptive changes in each event and 2) the mental (i.e., psychological)
and body (i.e., physiological) changes are interrelated, interdependent, and, in fact,
components of the same neurophysiological response to threat. It is not useful or accurate to
think of "psychological" vs. "physical" responses.
Different children have different styles of adaptation to threat. Some children use a primary
hyperarousal response, while others adapt a primary dissociative response. Most children,
however, adopt some combination of these two adaptive styles.
In the fearful child, a defiant stance is often seen. This is typically interpreted as a willful and
controlling child. Rather than understanding the behavior as related to fear, adults often
respond to the "oppositional" behavior by becoming angrier and even more demanding.
The child, over-reading the nonverbal cues of the frustrated and angry adult, feels more
threatened and moves from alarm to fear to terror. These children may end up in a primitive
"mini-psychotic" regression or in a very combative state. Their behavior of the child reflects
their attempts to adapt and respond to a perceived (or misperceived) threat.
Hyperarous
RESISTANCE DEFIANCE AGGRESSIO
al REST VIGILANCE
Crying Tantrums N
Continuum
COMPLIANCE
Dissociative AVOIDANC DISSOCIATIO
REST Robotic/detache FAINTING
Continuum E N Fetal Rocking
d
Regulating NEOCORTE
CORTEX LIMBIC MIDBRAIN BRAINSTEM
Brain X
Limbic Midbrain Brainstem Autonomic
Region Cortex
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Cognitive
ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE
Style
Internal
CALM AROUSAL ALARM FEAR TERROR
State
Same Event, Different Adaptive Styles in Different Children: On a quiet Sunday
morning outside of Waco Texas, the ATF raided the Branch Davidian compound. Most of us
have seen the footage of this assault on the television. Thousands of bullets were fired into
that building. More than 80 children were in that building on that morning.
In the three days following the ATF assault, 21 children were released to the FBI and became
temporary wards of the State of Texas, cared for by a clinical team directed by the
ChildTrauma Academy. These 21 children had a variety of individualized adaptive responses
to the same event; some using a primary hyperarousal response, others a primary dissociative
response -- but the majority used a combination of these two primary adaptive patterns.
Hyperarousal: T. was an 11-year-old boy. He described a sense of heightened awareness, no
primary anxiety, racing heart, and increased vigilance; he was very, very focused on the
location and behavior of the ATF agents. Only after the event did he say he felt afraid. He was
primarily afraid that the shooting would start again.
Dissociative: G. was an 8-year-old girl. She reported crawling under her bed and "kind of
falling asleep." She could not give significant details regarding the shooting. She reported that
it didn't seem real, that "it all was like a dream."
KEY POINT: Individual adaptive responses will vary. Many factors appear to play a role in
the individual response. Several important variables are age, sex, and previous history of
traumatic exposure. Young children and females are more likely to use dissociative
adaptations.
Same Child, Different Event, and Different Adaptive Style: X. is a 10-year-old boy.
Over the course of a single year, he was exposed to two different kinds of traumatic events.
The first was a shooting in the community. He was with a group of children playing in a
neighborhood when an altercation broke out between two older boys. The younger children
watched as these boys fought and then one went to his car to get a gun.
X. describes the increase in his heart rate and his sense of fear, vigilance, and conflict about
whether he should run home. When the older boy returned with the gun, X turned and ran. He
heard the gunshot and looked back to see one boy on the ground. He later returned to the site
of the shooting to see the blood on the ground. This was a classic hyperarousal response that
resulted in his flight.
Two months later, X. was visiting family in another part of Texas. A severe storm and then a
tornado threatened their home. He reports that he felt terrified and then immobilized. He was
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unable to move; his uncle took him into a closet under the stairs. In contrast to the shooting,
he has little recollection of the details of the storm except that it was dark, noisy, and it
seemed to last for a long time.
After the event he remembers walking around the neighborhood looking at the damage, then
says, "Or maybe I dreamed that." This was an inescapable event. And his response was
primarily dissociative in nature.
KEY POINT: The nature of an event can determine which response pattern is most adaptive.
In this case, fleeing was protective in the shooting, but would have been foolish in the storm.
In general, when direct physical assault (e.g., torture or the sexual assault of a child) or
inescapable threat is present, dissociation will be adaptive. In events where the individual is
capable of fighting (e.g., the assault is by someone smaller than you) or fleeing (i.e., you can
actually run away from the threat), the hyperarousal response is most adaptive.
Same Child, Different Event, Developmental Differences in Adaptive Style: T. is a 12-
year-old girl. From birth until age 5 she lived in a household characterized by domestic
violence. During this time, she was noted to be quiet, compliant, "tuned out," a daydreamer,
and generally "a good little girl." She reports little memory of the fighting, but her mother
describes finding her in her bed, rocking, with covers over her head after some of the fights in
the home.
At age 12, her mother remarried but, unfortunately, episodes of domestic violence resumed in
this household. This time, however, T. was loud, combative, and angry; she would run away
from the home each time these events took place. At school she was noted to have "attention
problems," which turned out to be hypervigilance.
Rather than "tuning out" and withdrawing into a dissociative shell, this child was sensitized to
fighting and had dramatic and pronounced hyperarousal during conflict.
KEY POINT: Traumatic events of the same nature can induce different adaptive responses in
the same child at different times during the child's development. An infant and young child is
not truly capable of fighting or fleeing, so hyperarousal is not an adaptive response. However,
by age 12, fighting back and fleeing were adaptive. In this child, both adaptive styles were
used at different times in life for the same kind of perceived threat.
When the Trauma Ends
As the traumatic event ends, the phase known as the acute post-traumatic period begins.
During this time, the mind and body slowly move back down the arousal or dissociative
continuum. The child moves from the brink of terror through fear, alarm, and, with time and
support, back to calm (see Figure 2-2 above). Heart rate, blood pressure, and other
physiological adaptations normalize.
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If a child can move back down the arousal continuum, his or her brain will resume baseline
(pre-trauma) styles of thinking, feeling, and behaving. Hypervigilance decreases and the
mental mechanisms related to attention begin to normalize as well. The child that has
dissociated will begin to pay attention once again to external stimuli.
Conversely, the child that has been completely focused on external cues related to threat will
actually pay attention once again to internal stimuli (e.g., feelings, thoughts, sensing their
pounding heart, or noticing the cut on their leg from diving under a desk during a shooting).
Making Sense of the Event
During this acute post-traumatic period, the child will now perceive the sense of fear and
anxiety. This is when they will actually feel the fear associated with the trauma. The
individual will begin to process and think about what has happened, attempting to make sense
out of the events just experienced. Because the traumatic event is so far out of the normal
range of experience, there will be a variety of mental attempts to process and "master" this
event.
The traumatic event will play itself out in the mind of the child again and again. A host of
intrusive images related to the trauma may swamp the child's thinking. This set of re-living
and re-experiencing phenomena may include telling the story over and over again to friends.
The child may act this event out in play and drawings (see below) or experience intrusions
(flashbacks or nightmares). In essence, these children have created memories of the traumatic
memory.
Living With Created Memories
The death of a loved one, for example, is a trauma that can influence memory. Over the six
months following the loss, children (as well as adults) will often experience unusual visual,
auditory, or tactile sensations. A child may think they hear the deceased person's voice, or
they think they saw them in a crowd, or out of the corner of their eye they may see their
reflection in a window. At bedtime or when awakening, these misperceptions are more
common.
Such "memories" may be disturbing to parents, caregivers, and the child. The child needs to
be reassured when these memories of the loved one occur. These "visions" are often
interpreted in context of a religious belief system ("They came back to tell me it was OK" or
"They are still with me"). This can be important for the child and there is no reason to
undermine these feelings. These "hysterical materializations" are common and often
mislabeled as visual or auditory hallucinations.
These types of memories are complex. Traumatic memory involves the storage and recall of
information at several levels. The brain stores not only traditional cognitive information, such
as who, what, when, and where, but also emotional information: feelings such as fear, dread,
and sadness.
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The old adage that "the body remembers" is referring to motor-vestibular information. An
example of this might consist of a memory of the body's position during the rape. Finally, the
brain contains a state memory, such as vigilance or physiological hyperarousal.
A Difficult Process
The normal and predictable mental mechanisms that are used to process all experiences will,
at times, fail in the attempts to master and understand a traumatic event. Because traumatic
events have features that are so outside the range of normal experience, there are very few
internal experiences with which to judge or make sense out of the event.
The more outside the range of the normal experience and the more life-threatening the
experience, the more difficult it will be for the normal mental mechanisms to work efficiently
to process and master that experience. The inability to control elements of the traumatic
event, or the intrusive thoughts that follow, lead to a set of predictable mental and
physiological responses.
Dissociation is not always a response to threat or trauma. It is often a normal coping mechanism used
for excessive boredom or for another purpose. For example, meditation, Lamaze childbirth exercises,
daydreaming, and highway hypnosis are all mild forms of dissociation.
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Lesson 3: After the Trauma: The Costs of Coping
After the trauma passes, the child remains. While the mental and physical adaptations used during a
traumatic event will slowly subside, there will be residue from the experience. Indeed, for some
children, this post-traumatic period is filled with more confusion, emotional pain, distress, and fear. In
about 50 percent of the children who have experienced a severe traumatic event, these symptoms
become so severe that the children develop serious post-traumatic stress disorders.
This lesson is about the development of these symptoms and what you can do to help children in the
post-traumatic period.
Children Re-Experience Trauma
For almost all children, a traumatic experience will play itself out repeatedly in their minds, even after
the event has ended. The thoughts, emotions, and feelings of being out of control and threatened will
be re-experienced, as will the fear, anxiety, and pain associated with the event. Each time the child has
an intrusive thought, a nightmare, or reenacts the event through play, the emotional or affective
memory of being in the midst of the threatening event is evoked.
Figure 3-1: How memory is stored in the brain.
Figure 3-2: Trauma and memory.
A classic set of predictable symptoms and physical changes is evident in the acute post-traumatic
period because of memory. Not only can children remember the facts and narrative details of the event,
they can recall and relive the emotional and physiological changes that were present in the alarm
19
reaction. In effect, the child has both emotional and state memories from the traumatic event, causing
a state of hyperarousal.
This hyperarousal may be characterized by an increased startle response, increased muscle tone, a fast
heart rate (tachycardia) and/or elevated blood pressure. Even at rest in the weeks following a traumatic
event, children and adolescents often exhibit signs of physiological hyperarousal, such as tachycardia,
despite outwardly normal behaviors. The inability to move back down the arousal continuum has
profound implications for the child's long-term functioning, which we'll discuss shortly.
Persistent physiological and emotional distress is both physically exhausting and emotionally painful.
Because of the pain, discomfort, and emotional and physiological "memories" associated with these
recurring intrusive thoughts, a variety of protective avoidance mechanisms are used to escape
reminders of the original trauma. These include active avoidance of any reminders of the trauma and
the mental mechanisms of numbing and dissociation.
Exercise: Where are different memories stored in the brain?
Reexamine Figure 3-2 at the beginning of this section and correlate it with David's story in Figure 3-3
above. Which specific parts of David's brain are stimulated by his father's presence or scent? Have you
ever had a strong reaction yourself to an odor, without having cognitive memories to associate with
your response? Or have you ever smelled something that inexplicably brought back an old memory of
smelling that same scent elsewhere? If you are able to remember particulars, what part of your brain is
at work? Why are the lower parts of the brain often referred to as "primitive?"
Children, when faced with reminders of the traumatic event they suffered, may experience so much
pain and anxiety that they become overwhelmed. In situations when they cannot physically withdraw
from those reminders, they may dissociate. Following a traumatic experience, children may act
stunned or numb.
Dissociating children will not readily respond to questions by adults. Their answers to questions will
seem unclear, unfocused, or evasive. This is understandable if we remember that while these children
are present in body, their minds may be off in another place -- dissociated, trying to avoid the painful
reminders of the original trauma.
Figure 3-3: Patterns of dissociation and arousal.
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Figure 3-4: The adaptive balance.
In the first days and weeks following the traumatic event, re-experiencing phenomena,
attempts to avoid reminders of the original event, and physiological hyperreactivity are all
relatively predictable, highly adaptive physiological and mental responses to a trauma.
Unfortunately, the more prolonged the trauma and the more pronounced the symptoms during
the immediate post-traumatic period, the more likely it is that there will be long-term chronic
and potentially permanent changes in the emotional, behavioral, cognitive, and physiological
functioning of the child.
If the post-traumatic stress response lasts longer than one month, it becomes categorized as
post-traumatic stress disorder. It is this abnormal persistence of the originally adaptive
responses that results in trauma-related neuropsychiatric disorders such as post-traumatic
stress disorder (PTSD).
Figure 3-5: Symptoms of PTSD.
PTSD is a diagnostic label that has typically been associated with combat veterans. More
recently it has been well-described in children who are survivors of physical abuse, sexual
abuse, exposure to community or domestic violence, natural disasters, motor vehicle
accidents, and a host of other traumatic events.
Children who survive a traumatic event and have persistence of this low-level fear state may
be behaviorally impulsive, hypervigilant, hyperactive, withdrawn, depressed, or have sleep
21
difficulties (including insomnia, restless sleep, and nightmares), and anxiety. In general, these
children may show some loss of previous functioning or a slow rate of acquiring new
developmental tasks. Traumatized children may also seem to regress and retain persistent
physiological hyperreactivity (such as fast heart rate or borderline high blood pressure).
Who Develops PTSD?
Whether or not someone develops PTSD following a traumatic event is related to a variety of
factors. The more life-threatening the event, the more likely a child is to develop PTSD. The
more the event disrupts the child's normal family or social experience, the more likely he or
she is to develop PTSD. Having an intact, supportive, and nurturing family appears to be a
relative protective factor.
Unfortunately, a great majority of children who survive traumatic experiences also have a
concomitant major disruption in their way of life, their sense of community, or their family
structure. These children are thus exposed to a variety of ongoing provocative reminders of
the original event (e.g., ongoing legal actions or high press visibility). The frequency with
which children develop post-traumatic stress disorders following comparable traumatic events
is relatively high (45-60 percent).
Children who survive traumatic events and exhibit this diverse set of symptoms and physical
signs are frequently able to meet diagnostic criteria for attention deficit hyperactivity disorder,
anxiety disorder NOS, major depressive disorder, conduct disorder, and a variety of Axis I
DSM III-R diagnoses. Knowing that the symptoms exhibited are reflective of core changes
related to the event will help the professionals and caregivers involved provide better care for
these children.
22
Hallmark Symptoms of PTSD :
RE-ENACTMENT
·ð Play
·ð Drawing
·ð Nightmares
·ð Intrusive ideations
AVOIDANCE
·ð Being withdrawn
·ð Daydreaming
·ð Avoiding other children
PHYSIOLOGICAL HYPERREACTIVITY
·ð Anxiety
·ð Sleep problems
·ð Hypervigilance
·ð Behavioral impulsivity
Basic Guidelines for Those Living or Working With Traumatized Children:
1. Don't be afraid to talk about the traumatic event. Children do not benefit from "not
thinking about it" or "putting it out of their minds." If children sense that caretakers are upset
about the event, they will not bring it up. In the long run, this only makes the child's recovery
more difficult. Don't bring it up on your own, but when the child brings it up, don't avoid
discussion. Listen to the child, answer questions, and provide comfort and support. We may
not have good verbal explanations, but listening and not avoiding or overreacting to the
subject, and then comforting the child, will have a critical and long-lasting positive effect.
1. 2. Provide a consistent, predictable pattern for the day. Make sure the child has a
structure to the day and knows the pattern. Try to have consistent times for meals,
school, homework, quiet time, playtime, dinner, and chores. When the day includes
new or different activities, tell the child beforehand and explain why this day's pattern
is different. Don't underestimate how important it is for children to know that their
caretakers are in control. It is frightening for traumatized children (who are sensitive
to control) to sense that the people caring for them are, themselves, disorganized,
confused, and anxious. Adults are not expected to be perfect; caregivers themselves
have often been affected by the trauma and may be overwhelmed, irritable, or anxious.
If you find yourself feeling this way, simply help the child understand why, and
explain that these reactions are normal and will pass.
3. Be nurturing, comforting, and affectionate, but be sure that this is in an appropriate
context. For children traumatized by physical or sexual abuse, intimacy is often associated
with confusion, pain, fear, and abandonment. Providing hugs, kisses, and other physical
comfort to younger children is very important. A good working principle for this is to be
physically affectionate when the child seeks it. If the child walks over and touches you, return
it in kind.
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Try not to interrupt the child's play or other free activities by grabbing them and holding
them, and be aware that many children from chronically distressed settings may have what we
call attachment problems. They will have unusual and often inappropriate styles of
interacting. Do not tell or command them to "give me a kiss" or "give me a hug." Abused
children often take words very seriously, and commands reinforce a very malignant
association linking intimacy/physical comfort with power (which is inherent in a caregiving
adult's command to "hug me").
4. Discuss your expectations for behavior and your style of discipline with the child.
Make sure that the rules and the consequences for breaking the rules are clear. Make sure that
both you and the child understand beforehand the specific consequences for compliant and
non-compliant behaviors. Be consistent when applying consequences. Use flexibility in
consequences to illustrate reason and understanding. Utilize positive reinforcement and
rewards. Avoid physical discipline.
5. Talk with the child. Give them age appropriate information. The more the child knows
about who, what, where, why, and how the adult world works, the easier it is to make sense of
it. Unpredictability and the unknown are two things that will make a traumatized child more
anxious, fearful, and, therefore, more symptomatic. They may become more hyperactive,
impulsive, anxious, and aggressive, and have more sleep and mood problems. Without factual
information, children (and adults) speculate and fill in the empty spaces to make a complete
story or explanation. In most cases, the child's fears and fantasies are much more frightening
and disturbing than the truth. Tell the child the truth, even when it is emotionally difficult. If
you don't know the answer yourself, tell the child. Honesty and openness will help the child
develop trust.
6. Watch closely for signs of reenactment (e.g., in play, drawing, behaviors), avoidance
(e.g., being withdrawn, daydreaming, avoiding other children) and physiological
hyperreactivity (e.g., anxiety, sleep problems, behavioral impulsivity). All traumatized
children exhibit some combination of these symptoms in the acute post-traumatic period.
Many exhibit these symptoms for years after the traumatic event. When you see these
symptoms, it is likely that the child has had some reminder of the event, either through
thoughts or experiences. Try to comfort and be tolerant of the child's emotional and
behavioral problems. Again, these symptoms will wax and wane -- sometimes for no apparent
reason. Record the behaviors and emotions you observe and try to notice patterns in the
behavior.
7. Protect the child. Do not hesitate to cut short or stop activities that are upsetting or re-
traumatizing for the child. If you observe increased symptoms in a child that occur in a certain
situation or following exposure to certain movies or activities, avoid them. Try to restructure
or limit these activities to avoid re-traumatization.
8. Give the child choices and some sense of control. When a child, particularly a
traumatized child, feels that they do not have control of a situation. they will predictably get
more symptomatic. If a child is given some choice or some element of control in an activity or
in an interaction with an adult, they will feel safer and more comfortable and will be able to
feel, think, and act in a more mature fashion. When a child is having difficulty with
compliance, frame the consequence as a choice for them: "You have a choice -- you can
choose to do what I have asked or you can choose . . ." Again, this simple framing of the
24
interaction with the child gives them some sense of control and can help defuse situations
where the child feels out of control, and therefore anxious.
9. If you have questions, ask for help. These brief guidelines can only give you a broad
framework for working with a traumatized child. Knowledge is power: the more informed
you are and the more you understand the child, the better you can provide them with the
support, nurturing, and guidance they need. Take advantage of resources in your community.
In the final course lesson, we will talk about how to access some of these resources. While
each community has agencies, organizations, and individuals coping with the same issues,
you may need assistance finding the expertise that can help traumatized children.
After the Trauma: The Costs of Coping
QUIZ
Choosing from the following list, tell what kind of memory is
involved in the following examples of "recall."
1. Playing piano:
Cognitive
Emotional
Moto-vestibular
State
2. Typing:
Cognitive
Emotional
Moto-vestibular
State
3. Performance Anxiety:
Cognitive
Emotional
Moto-vestibular
State
4. Increased heart rate after car-backfire:
Cognitive
Emotional
Moto-vestibular
State
25
5. Describing a perpetrator to the police:
Cognitive
Emotional
Moto-vestibular
State
6. Nostalgia:
Cognitive
Emotional
Moto-vestibular
State
7. First Impressions:
Cognitive
Emotional
Moto-vestibular
State
After the Trauma: The Costs of Coping
QUIZ
Choosing from the following list of symptom types, tell what
category of symptoms each of the following falls into.
1. Nightmare:
Re-enactment
Aviodant
Physiological hyperarousal
2. Sweaty Palms:
Re-enactment
Aviodant
Physiological hyperarousal
3. Daydreaming/Tuning Out:
26
Re-enactment
Aviodant
Physiological hyperarousal
4. Intrusive Ideations:
Re-enactment
Aviodant
Physiological hyperarousal
5. Aggressive Play:
Re-enactment
Aviodant
Physiological hyperarousal
6. Increased Heart Rate:
Re-enactment
Aviodant
Physiological hyperarousal
After the Trauma: The Costs of Coping
QUIZ
Identify the following statements as either True or False.
1. Doctors cannot always predict what symptoms and physical
changes might present in any given individual's acute post-
traumatic period.
True
False
2. Hypervigilance is a dissociative behavior.
True
False
3. Tachycardia (a fast heart rate) is one of the characteristics of
physiological hyperarousal.
27
True
False
4. Children may experience so much pain and anxiety as a result
of a traumatic event that they become overwhelmed and
dissociate.
True
False
5. Dissociation is more common in older children, whereas
hyperarousal is more common in younger children.
True
False
6. A post-traumatic stress response lasting longer than six weeks
becomes characterized as Post-Traumatic Stress Disorder (PTSD).
True
False
State and affect memories elicited in a non-conscious state:
David is a 9 year-old boy. From age 2 through 6, he was sexually abused by his father. This abuse
induced severe physical injuries. At age 6 he was removed from the family.
At age 8, he was seriously injured in a fall. He suffered from serious brain injury resulting in a coma
state for 8 months following the injury.He continues to be difficult to arouse and is non-verbal. He
exhibits no form of meaningful communication. In the presence of his biological father, he began to
scream, moan, and his heart rate increased dramatically; audiotapes and the scent of his father
elicited a similar response. These "memories" are stored in lower parts of the brain and do not require
cognitive memory or consciousness to be expressed.
28
Lesson 4: Finding Resources and Getting Involved
Childhood trauma impacts the physical and mental health of individuals throughout a lifetime.
Millions of children are traumatized each year, yet few resources are dedicated to the
problem. In fact, children's mental health in general and childhood trauma, specifically, are
terribly underfunded by both research and direct service systems. The lack of resources makes
treating children who have suffered trauma extremely difficult. The problem of resources is
most acute in rural or smaller urban communities.
Fortunately, new technologies, more public awareness, and some policy and practice changes
are making it easier to help these children. In the last 20 years, the concept of childhood
PTSD and the importance of early childhood experiences in shaping the child have been
slowly entering public and professional awareness. This process is just beginning. You can
help play a role by sharing what you learn with your colleagues and coworkers. There are
resources out there -- often difficult to find and access, but out there nonetheless. Start by
looking on the Web.
Internet Resources
Remember the exercise we did back in Lesson 1, the one where we all took out our trusty
Yellow Pages and searched for local resources in the field of childhood trauma? I suspect that,
even with great creativity and diligence, you were not able to find too many pertinent listings
through Ma Bell!
Fortunately for all of us, the Internet has radically changed the face of researching and
networking for every conceivable issue, including childhood trauma. If you are taking this
class, I know that you are fortunate enough to have access to a computer. Your Internet search
engine and a few well-chosen key words can easily launch you into a world of information
and support in the field of childhood trauma.
An excellent jumping-off site for you to get started on your search is www.ChildTrauma.org.
The ChildTrauma Academy provides direct services for maltreated and traumatized children,
conducts research, and develops programmatic innovations within the public and private
systems that are mandated to protect, heal, and educate children. The ChildTrauma Web site
is updated regularly, so you will want to check it often as new links and articles are posted.
Another incredible resource is David Baldwin's Trauma Information Pages at
http://www.trauma-pages.com. This site is without question the best trauma-related resource
that exists on the Web. Dr. Baldwin has done a remarkable job of collecting, sorting, and
commenting on this information. Check out this site early in your search and you won't be
disappointed.
David Baldwin's Trauma Pages focus primarily on emotional trauma and traumatic stress,
including PTSD, whether the causation is individual traumatic experience(s) or a large-scale
29
disaster. New information is added to this site about once a month. The purpose of this award-
winning site is to provide information for clinicians and researchers in the traumatic-stress
field, but with careful reading anyone can benefit from the information posted.
Baldwin's interests include both clinical and research aspects of trauma responses and their
resolution. For example, he tackles such topics as:
1. What goes on biologically in the brain during traumatic experience and its resolution?
2. Which psychotherapeutic procedures are most effective for which patients with
traumatic symptoms and why?
3. How can we best measure clinical efficacy and treatment outcome for trauma survivor
populations?
Supportive resources supplement the more academic and research information of interest to
clinicians, researchers, and students.
Don't let yourself be limited to these two Web sites. Using various search engines, you can
look up key words, such as "trauma," "memory," "abuse," "brain," and "children" (and
others!), to lead you to all sorts of information and resources on the proverbial information
superhighway.
Books and Articles On Child Trauma
Although the Internet is a terrific resource, let's not discount the value of the good, old-
fashioned book! I've already recommended a number of books as reading relevant to this
course (which you may recall from your course overview), but you are certainly not limited to
these few.
Many books have been published on childhood trauma, ranging from the highly academic
and/or clinical to self-help for caregivers or adult survivors of childhood trauma. And, within
the major groupings, there are sub-genres, i.e., sexual abuse, war, and family violence. To get
a better overview of what's in publication, I suggest that you check out Barnes & Noble's Web
site at http://www.bn.com, where you'll find a comprehensive selection of trauma-related
books publications. For instance, a search with the keyword trauma netted a list of 617 books!
Obviously, not all 617 books will contain the information that you are attempting to find, or
even be of interest to you. I am just trying to drive the point home that there is much related
material in print!
Remember, we've only talked books so far. Periodicals are also full of pertinent information.
Consider the following articles as a starting point:
Perry, B. D. and Azad, I. Post-traumatic stress disorders in children and adolescents. Current
Opinions in Pediatrics 11: 4, 121-132, 1999
http://www.bcm.tmc.edu/cta/PTSD_opin6.htm
30
Perry, B. D. and Pollard, R. Homeostasis, stress, trauma, and adaptation: A
neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of
North America 7[1], 33-51.1998.
http://www.bcm.tmc.edu/cta/pollard.htm
Pfefferbaum, B. Posttraumatic stress disorder in children: A review of the past 10 years.
J.Am.Acad.Child Adolesc.Psychiatry 36[11], 1503-1511. 1997.
Terr, L. Childhood traumas: An outline and overview. Am J Psychiatry, 1991. 148: 10-20.
Although there is much in publication written for doctors and clinicians, you will also find
articles written for the layperson or the caregiver. Your local university or library will have
scores of periodicals with approachable, germane articles for you to research and read. Don't
be shy about asking your local librarian for help. Most librarians these days are extremely
computer literate. If you're not clear on how to conduct your search, your librarian is a
valuable ally!
Here is a selection of organizations that will be able to offer you information and referrals.
They are all easily accessible on the Web and many have toll-free telephone numbers. Don't
forget, many of these agencies and organizations need volunteers. If you are able to give your
time and energy to this important cause, some of these groups will be able to steer you toward
volunteerism in your own locale.
Prevent Child Abuse
Prevent Child Abuse (formerly the National Committee to Prevent Child Abuse) is nationally
recognized as one of the most innovative leaders in child abuse prevention. It has a
nationwide network of chapters and their local affiliates in hundreds of communities. Through
their media campaigns, people are finding ways they can help prevent abuse. PCA seeks to
equip professionals with the latest, proven prevention approaches through training and
technical assistance. To find out more about your local affiliate and the national program
activities contact:
Prevent Child Abuse
200 S. Michigan Avenue, 17th Floor
Chicago, Illinois 60604-2404
(800) CHILDREN
Tel: [phone]
Fax: [phone]
www.preventchildabuse.org
[e-mail]
Child Welfare League of America
31
CWLA is an association of more than 1,000 public and private nonprofit agencies that assist
over 2.5 million abused and neglected children and their families each year with a wide range
of services. They have many resources for families and professionals working with
traumatized children. For more information contact:
Child Welfare League of America
440 First Street NW, Third Floor
Washington, DC 20001-2085
Tel. [phone]
FAX [phone]
http://www.cwla.org
American Professional Society on the Abuse of Children (APSAC)
APSAC's mission is to ensure that everyone affected by child maltreatment receives the best
possible professional response. This organization has many useful scholarly and clinical
materials aimed primarily at the professional audience. Caregivers working with abused or
maltreated children may find this a useful resource, nonetheless. For more information
contact:
APSAC
407 South Dearborn Street Suite 1300
Chicago, IL 60605
http://www.apsac.org
The National Center for PTSD
The National Center for PTSD is a program of the U.S. Department of Veterans Affairs and
carries out a broad range of activities in research, training, and public information. The
primary focus of the Center has been combat veterans and their families. Over the last few
years, however, this focus has been expanded. There are many useful programs, activities, and
resources for anyone interested in the effects of traumatic stressors.
The PILOTS database is an electronic index to the worldwide literature on PTSD and other
mental-health consequences of exposure to traumatic events. It is available to Internet users
courtesy of Dartmouth College, whose computer facilities serve as host to the database. No
account or password is required, and there is no charge for using the PILOTS database.
The National Center for PTSD
http://www.dartmouth.edu/dms/ptsd/
International Society for Traumatic Stress Study
The International Society for Traumatic Stress Studies (ISTSS), founded in 1985, provides a
forum for the sharing of research, clinical strategies, public policy concerns, and theoretical
32
formulations on trauma in the United States and around the world. ISTSS is dedicated to the
discovery and dissemination of knowledge and to the stimulation of policy, program, and
service initiatives that seek to reduce traumatic stressors and their immediate and long-term
consequences.
International Society for Traumatic Stress Studies
60 Revere Drive, Suite 500
Northbrook, Illinois 60062 USA
Phone: [phone]; Fax: [phone]
http://www.istss.org
National Clearinghouse for Child Abuse and Neglect (NCCAN)
The National Clearinghouse on Child Abuse and Neglect Information is a national resource
for professionals seeking information on the prevention, identification, and treatment of child
abuse, child neglect, and related child welfare issues.
National Clearinghouse on Child Abuse and Neglect Information
330 C Street, SW
Washington, DC 20447
Phone: [phone] or [phone]
Fax: [phone]
http://www.calib.com/nccanch/
[e-mail]
Our society has been ineffective in preventing, identifying, and responding to the
maltreatment of children. The impotence of our social systems to help children does not mean
that you, as an individual, are powerless. Your actions can have dramatic impact on children
in your community and, by supporting the efforts of effective organizations, your actions can
impact thousands of children in this generation and in generations to follow.
There are many ways that you can choose to fight the maltreatment and trauma of children.
Whatever method you choose, know that however small your effort seems, your participation
is critical. In the end, unless we all participate in some fashion, we will always fall short of
our true potential as individuals and as a society. Choose to help in a way that works for you.
You may want to work directly with maltreated children, or you may choose to contribute in
any variety of important ways. Please remember, you don't need to work directly with the
child to be able to make a dramatic difference in their life.
Give Your Time
In your community, there are children that need the gift of attention, respect, instruction,
comfort, and hope. So many children from abusive settings have lost hope. Even brief
interactions with respectful, honest, and nurturing adults can be helpful to the abused or
traumatized child, allowing them to know that adults can be kind.
33
There are many ways to find children who need your time. Volunteer to be a foster parent, to
rock the crack-addicted infant in the hospital, to teach a child to read, to be an aide in the local
public school, to answer phones at a battered women's shelter. In all of these settings, you can
enrich the life of a child. You can give a child hope.
Give Your Skills
You may not realize how your skills can benefit maltreated children. Desperately underfunded
child protection, child welfare, and child mental health systems can always benefit from the
innovative use of your skills. A residential treatment center may need help with accounting or
computer programming. A local children's shelter may not have a library.
A dancer can teach some foster children how to dance. A computer programmer can teach
these children computer skills. A writer can write editorials/articles/books about these issues
or help an agency create a newsletter. Your skills, whatever they are, can be used to fight
abuse.
Give Your Money
In the United States, we spend more money on studying and treating abusers than we do on
their child victims. Research, clinical services, and specialized professional training in child
abuse are dramatically underfunded. You can help support these critical activities by
financially supporting effective and innovative programs such as the ChildTrauma Academy.
Please direct donations to:
The ChildTrauma Academy
5161 San Felipe, Suite 320
Houston, Texas 77056
Attn.: J. Rubenstein
Checks should be made payable to "The ChildTrauma Academy."
As you give time, skills, or money to help these broken children, you may find that your life
will be enriched and that hope has a new meaning for you. You can make a difference in the
life of a child with your time, and in the lives of many children with your financial support.
Choose to act.
Give Your Voice
Play a role in helping change the policies and practices that have allowed our society to ignore
children. Remember, children don't vote. And far too many traumatized children have no
effective adult advocacy. We allocate research and service-delivery dollars in the United
34
States in a way that reflects political power. Maltreated children have no political power in
this country, nor any other country.
Whenever you can, talk to the media. Talk with your local, state, and federal representatives
to inform them and urge them to think about the future of our children. Write letters or send e-
mails to make them aware of your concern. They all say that children are our future. Make
them walk the walk and not just talk the talk.
A Final Word From Your Instructor
I have really enjoyed the opportunity to teach all of you about childhood trauma. This course
is just the start. As you know, this is a subject that is very near and dear to my heart and I
have spent much of my professional life endeavoring both to care for and facilitate public
awareness of maltreated and traumatized children. I urge all of you to continue learning.
Read, question your colleagues, network in your community, and find ways to help these
children.
It is my sincerest hope that you will be able to harness both the scientific facts and research
skills that you have learned here and take them out in the world with you. With your new
knowledge you will undoubtedly make the world a better place for these children who so
desperately need our love and understanding. Whether you are caring for an individual child
or volunteering your time locally, the work you are doing is vitally important to our greater
community.
I wish you the best of luck in your endeavors and thank you for your time and commitment to
issues of childhood trauma.
Bruce D. Perry, MD, Ph.D.
35