What Caregivers Need To Know About Trauma Therapy For Children
By the age of 16, it’s believed that more than two-thirds of children have experienced at least one traumatic event. Childhood trauma generally increases the risk of learning problems, substance use disorders, long-term health problems, and increased involvement with the juvenile justice system. With the support of their caregivers and trained mental health professionals, children can recover from trauma and limit its impact on their lives. However, helping a child navigate trauma can take a toll on adults, so it can be important for them to reach out for professional support as well.
What is childhood trauma?
According to the Substance Abuse and Mental Health Services Administration, childhood trauma can occur when dangerous or violent events overwhelm a child’s ability to cope.
Examples of traumatic events include the following:
- Physical, emotional, or sexual abuse
- Neglect
- Natural disasters
- Community or school violence
- Acts of terrorism
- Life-threatening illnesses
- Seeing or experiencing domestic abuse
- Becoming a refugee or experiencing war
- Having a parent deployed, injured, or killed in combat
Signs and symptoms of trauma in children
Signs of trauma tend to present differently depending on the age of the child.
Preschool-aged children
- Experiencing nightmares and/or having trouble sleeping
- Eating poorly and losing weight
- Excessive screaming and/or crying
- Becoming anxious when they’re separated from caregivers
- Behavioral regression
- Uncharacteristic irritability or aggression
- Repetition of the traumatic event
Elementary school children
- Academic decline
- Becoming fearful or anxious
- Having trouble concentrating
- Withdrawing socially
- Having trouble sleeping
- Behavioral changes, such as disobedience, engaging in risk-taking behaviors, or oppositional behavior
Teenagers
- Depression or anxiety
- Developing an eating disorder
- Engaging in self-harm
- Substance abuse
- Becoming sexually active
- Experiencing academic issues and academic decline
- Social withdrawal and isolation
The role of trauma therapy
Trauma therapy is primarily designed to help children who have been exposed to traumatic events by addressing their emotional, cognitive, and behavioral responses to the trauma. Therapy can provide a safe place for children to process what happened. They can talk about the event, how it made them feel, and how it has impacted them. Therapists can validate how a child is feeling to help them avoid experiencing a sense of isolation or shame.
During therapy sessions, children may learn coping skills to help them manage overwhelming emotions that can be triggered by traumatic memories. Trauma therapy can address behaviors that children have begun to display after trauma, such as aggression or social isolation. Therapists can also help restore a sense of safety and trust so that children can trust themselves and others.
Finally, trauma therapy can be crucial in strengthening relationships that are necessary for a child’s development and the overall healing process. During therapy, children are usually reminded that they can trust their caregivers, and caregivers may be provided with strategies and techniques to best support their children.
Types of trauma therapy approaches
Several therapy approaches can be used to treat a child who has experienced trauma. A few are outlined below. The National Child Traumatic Stress Network outlines more than a dozen others on the Interventions page of their website, such as Attachment and Biobehavioral Catch-Up, which is specifically designed for infants, and Structures Psychotherapy for Adolescents Responding to Chronic Stress.
Cognitive behavioral therapy
Cognitive behavioral approaches can be viewed as a clinically sound treatment option for children who have experienced trauma.
Trauma-focused cognitive behavioral therapy may start by helping the child understand how trauma has affected their thoughts, emotions, and behavior. From there, the child and therapist may work together to identify and challenge negative thought patterns and beliefs that come from the trauma. By replacing these with more helpful ways of thinking, the trauma may have less of a negative impact.
During trauma-focused cognitive behavioral therapy sessions, children may also learn healthy coping skills to use when they face a stressful situation or feeling. This can include relaxation techniques, problem-solving skills, and social skills.
Caregivers are sometimes encouraged to participate in CBT for a child who has experienced a traumatic event. These sessions can reaffirm the caregiver as a safe and stable person that the child can trust. Caregivers may also have key information that can help the therapist best treat the child. Finally, by being involved in the sessions, parents may learn strategies that they can continue to apply at home long after the session is complete.
Prolonged exposure therapy
During prolonged exposure therapy, patients are gradually exposed to memories, feelings, and situations associated with the trauma they experienced. The exposure generally happens in a safe and controlled environment and is guided by a trained mental health professional.
Exposure therapy often includes two strategies: in vivo exposure and imaginal exposure. During in vivo exposure, a child is guided to gradually confront real-life situations they associate with their trauma. For example, a child who has post-traumatic stress disorder from an extended hospital stay may work to build up their tolerance to visiting the hospital. During imaginal exposure, children may recount and discuss the traumatic event in detail. They may retell it again and again, in great detail, to reduce the emotional intensity associated with the fear or memory.
Prolonged exposure therapy typically takes place during 60- to 90-minute sessions that occur once or twice a week, for a total of eight to 15 sessions.
Play therapy
Child psychologist Jean Piaget is quoted as saying, “Play is the work of children.” Play therapy was created based on similar lines of thinking by psychologists like Virginia Axline and Anna Freud.
Play therapy is often used to help children process their experiences and emotions through play. When a child has experienced trauma, such as being abused or witnessing an act of violence, play therapy can be effective because it helps them express themselves in a way that they perceive as safe.
Play therapists typically provide children with toys, games, and art materials that they can use to express their emotions and thoughts. During play therapy sessions, children may be able to indirectly process traumatic events, such as reenacting scenes with dolls or depicting them in a drawing. This can give the therapist insight into how the child is feeling and what support they need. Play therapists are typically trained to adapt their therapy techniques based on the child’s age, developmental level, and specific needs related to their trauma.
In some cases, therapists will ask parents to join sessions to support the child’s healing and maintain progress outside of the therapy sessions.
Eye movement desensitization and reprocessing
Sometimes used to treat adults with post-traumatic stress disorder, EMDR can also be used to treat children after a traumatic event. The treatment is usually recommended for children who have experienced a trauma with a clear beginning and end, such as a tornado or a school shooting, and it can be effective for children as young as two years old.
During EMDR, the therapist will normally ask the child to concentrate on the traumatic event in their mind while rapidly moving their eyes back and forth. Typically, they follow the therapist’s fingers. Treatment may occur over six to 12 sessions, and the length of each session may depend on the ability of the child to sit and engage.
Trauma systems therapy
Trauma systems therapy is primarily designed to address both the emotional needs of a child and the social environment in which they live. It’s largely based on the idea that trauma impacts children in all areas of their world (within their home, at school, and in the community).
Before treatment begins, the team providing TST normally assesses the child and creates a treatment plan with them and their family. This usually determines with which of the three phases of TST the child should begin. In the safety-focused phase, the team usually makes sure that all of the patient’s physical and emotional needs are being met. During the regulation-focused phase, providers may teach the child how to regulate their emotions and teach caregivers how to better support the child. During the “beyond trauma” stage, the child and their caregivers may learn new cognitive coping skills and work to process the traumatic event.
TST can be especially helpful for children who are in foster care or living in residential treatment centers.
Challenges in trauma therapy for children
- It may be difficult to communicate with a child in a way that is both understandable and age-appropriate. A young child may not have the vocabulary or cognitive development to completely understand what happened.
- Trauma can disrupt a child’s development and contribute to delays or regressions in their cognitive, emotional, and/or social development. Therapists must find a way to address these disruptions while also encouraging growth.
- Having caregivers involved in treatment can be key to the healing and growth process. However, some caregivers may find this difficult while they’re navigating their own feelings about the trauma their child experienced.
How to support children post-trauma
The support of a caregiver is often identified as a critical part of a child’s healing process. However, this can be challenging. Caregivers may be struggling with the impact that the traumatic event had on them, as well as the worries they may be experiencing regarding their child. They may not know the best ways to connect with their child or talk about what happened, and they may not have effective strategies to regulate their own emotions related to the event.
A therapist may be able to help caregivers overcome many of these hurdles, but it can be challenging for parents to find the time to visit a therapist in person. By working with an online therapist, parents and caregivers can schedule sessions when it’s convenient for them, whether that’s after the kids go to bed or during the school day when the house is empty.
A 2023 study looked at the impact of online CBT in treating post-traumatic stress disorder. They found that online therapy was usually just as effective as face-to-face therapy in supporting individuals with the condition. Online therapy can also effectively treat depression, anxiety, and other mental health conditions.
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