As parents, we work hard to protect our children and keep them safe from traumatic experiences. So here’s a statistic that will surprise you: between 60% and 80% of kids will experience a traumatic event before the age of 18. “From crime to domestic abuse, accidents, natural disasters and school shootings, it’s very common that children will be exposed to trauma in the U.S.,” says Douglas Barnett, Ph.D., Director of the Wayne State University Psychology Clinic in Detroit. Ten to 15% of these children will go on to develop trauma-related symptoms enough to be diagnosed with post-traumatic stress disorder or PTSD, Barnett says.
For these children, trauma has an impact not only for the child, but for parents and the entire family. Parents often experience confusion, distress, and a sense of helplessness about what they can do to help their child reach their full potential. Fortunately, there is a highly effective therapy for trauma that supports both children and parents.
When a child is in distress, parents may not always be aware of the cause, and may not immediately seek therapy for trauma for their child. Nationally, among mental health providers, there is an increased awareness of the need for trauma-informed therapy by organizations like the National Child Traumatic Stress Network, which is funded by federal agencies and research organizations.
“It’s a great organization that is really trying to increase and improve everything we do around childhood trauma, including specialized training on trauma-focused CBT (cognitive behavioral therapy), which research suggests is most effective for children with trauma,” Barnett says, adding that Wayne State University Psychology Clinic is embracing trauma-focused CBT for children and can offer this therapy free of charge for the next year through a grant from DMC Foundation. Research has shown that this therapy is effective with children across age groups, children with various cognitive or social impairments and children from different ethnic and economic backgrounds.
Barnett says he and his colleague Marilyn Franklin, Ph.D., have seen high rates of success in treating children with trauma-focused CBT from kindergarten age through adolescence. As licensed psychologists, Franklin and Barnett also supervise Ph.D. students who are gaining practical experience in making diagnoses and conducting therapy — including trauma-focused CBT for children.
“Trauma is so common and this new treatment is a great way to help kids feel more in control and safe and back to being kids again. It’s effective at treating PTSD and helping kids move past trauma,” Barnett says. “It’s also a relatively brief treatment and children are often able to make significant progress in as few as eight to 20 sessions.” Within six to seven weeks, kids typically start to feel better and parents are able to observe improvement in their child’s functioning and behaviors as well as feel more competent in responding to their child’s needs.
Recognizing symptoms and causes
Trauma in children can stem from a variety of diverse and not always obvious factors, says Barnett. Vehicle accidents and house fires can be scary and traumatic for children, as well as witnessing domestic violence. “Children can worry about the safety of their caregivers. This is all too common,” he says. “Also, children who have experienced abuse themselves, either physical, sexual or psychological maltreatment, can have trauma.”
Children who have had significant medical procedures, including invasive surgeries and transplants or who have witnessed or been involved in a violent crime, can also experience trauma. “This includes a school shooting, certainly,” Barnett says. Dog bites or animal attacks and natural disasters, such as earthquakes, floods or tornadoes can cause trauma, too.
Every child is different, but there are some common warning signs parents can look out for. Sadness, anxiety, trouble concentrating and interrupted sleep or the need to sleep with parents can be signs a child is affected by trauma. “They may try to avoid what reminds them of the trauma but find it hard to stop thinking about it. They may have flashbacks and feel like the event is happening again and they feel like they’re in danger, even though there is no danger,” Barnett says. Some children show signs of just feeling unsafe in general, even coming up with reasons not to go somewhere that reminds them of the trauma.
“After a child has experienced a traumatic event, they may be too young to have the ability to recognize and verbalize their thoughts and emotions. Some children may not be forthcoming about their thoughts and feelings because they want to protect their parent from worry,” explains Franklin. “Children may experience guilt and shame regarding traumatic events that prevents them from bringing attention to their struggles.”
However, Franklin adds, parents are the experts on their own children and they play a critical role in observing changes in their child’s behaviors and changes in their ability to function at home and in school. “A change in your child’s behavior following exposure to a traumatic event is often the key to recognizing that trauma-focused treatment is necessary,” she says.
All of these symptoms are normal and common for anyone in the first month following the trauma, Barnett says. “Many children will recuperate on their own, so we don’t recommend therapy for trauma in the first month and we see what happens naturally for them on their own,” he says. When symptoms persist, trauma-focused CBT can be highly effective.
“Unfortunately, parents are often not able to prevent the traumatic events that occur in their child’s lives because these events may be unpredictable or outside of parents’ control. Parents hope for the best possible outcome when these unpredictable events occur. Often, this is the ability to be resilient or the ability to cope with trauma in an effective way that prevents long-term suffering or negative consequences on functioning at school, in home or socially with peers,” Franklin says.
“Importantly, resilience does not automatically occur after experiencing traumatic events, but rather through learning how to understand and manage responses that occur following these events. Parents can help to support resilience in their children and prevent long-term problems related to these events by seeking out trauma-specific treatment that helps their child develop coping skills related to problem solving and self-soothing in challenging situations following a traumatic event,” she says.
How therapy for trauma works
Trauma has a way of making kids feel vulnerable, so they become less playful and carefree. Trauma-focused CBT helps children feel empowered and safe again because it helps them learn to let go of unhelpful thoughts and focus on the future.
“While there are many interventions that can be useful at treating trauma, one strength of trauma-focused CBT is that it incorporates both the parent and child. This helps the parent feel more empowered and capable in supporting their child in managing trauma-related concerns outside of the therapy sessions,” Franklin says. “Trauma-focused CBT therapists not only focus on helping the child cope with trauma, but also focus on helping parents understand their child’s behaviors in the context of trauma and providing concrete skills to manage problematic thoughts, feelings and behaviors that occur in their child’s daily life.”
When a family meets with a therapist at Wayne State University Psychology Clinic — or through convenient telehealth — they begin with a comprehensive assessment. Sessions are structured and broken down into manageable steps with the child setting the pace. Children and their parents learn about what trauma and PTSD are — and how common they are. “Children often feel less alone when they realize others have experienced what they are going through and many are able to overcome this and get back to being a child,” Barnett says.
Through trauma-focused CBT, kids learn that what’s scary to talk about eventually loses its power when they learn to reframe how they are thinking about it. “We help children develop simple coping and relaxation techniques so if they get anxious, they have the resources to handle it. They don’t talk about the trauma until they are ready and have mastered coping and relaxation skills,” he explains. When they feel ready, kids are encouraged to create a trauma narrative, using their own words.
“It’s tangible and deals with the here and now,” says Barnett. “We’re finding positive responses to the treatment and kids like it. They don’t like the fact that they have experienced trauma and they are worried, but once they meet with us and after a session or two, their parents don’t have to drag them here. They want to be here.”
Learn more about trauma-focused CBT through Wayne State University Psychology Clinic by visiting clas.wayne.edu/PsychClinic or by calling 313-577-2840.