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Trauma / children trauma of separation
Trauma refers to an emotional shock or wound often having long-lasting effects. This shock or wound could be caused by any accident, violence, or other such incidents, especially in the childhood, when a child feels completely helpless (Kaduson & Schaefer, 2012). Usually, trauma in the childhood is of great impact as the child is unable to use ordinary coping and defensive processes while facing any intolerable danger, anxiety, or instinctual arousal. These situations have such an overwhelming nature that they may result in an everlasting kind of impact on the mind of the child. Usually, trauma is caused by (Finkelhor, 2009):
Bullying and Physical abuse by a caregiver
Sexual assault, or
Murder of someone close to a child.
Parental separation can also result in traumatic events (separation anxiety) in children (Howard, Martin, Berlin, & Brooks-Gunn, 2011). Some other events such as nonsexual genital assault; exposure to shooting, bombs, and riots; assault with injury or a weapon; robbery by a non-sibling peer or adult, and witnessing domestic violence can also result in childhood trauma.
Diversity and difference, identity formation, and trauma
Diversity is considered as a noticeable heterogeneity, whereas difference is represented by a variation that deviates from the standard and/or norm. Diversity is associated with phenomena such as food, rituals, arts and crafts, and folktales in a culture. Diversity is, usually, accepted and supported by people of a culture as it may help in distinguishing that culture from others, while giving a separate identity to that culture and providing different ways of good living. On the other hand, difference is considered as an important cause of social problems as it may change the established rituals, rules, crafts, and other such things in a culture. It is also considered that difference is caused by immigrants, who may bring different things in a culture.
Cultural diversity and difference can play an important role in the development of separation trauma. Some cultures report less separation of children from their parents, while some cultures show more separation of children in the childhood. In a study, researchers reported that Hispanic mothers as well as non-English speaking mothers report less separation. Cultures having such parents are different from other cultures in this respect, i.e. diverse in nature, whereas difference in those cultures can develop, when people from other cultures come and marry with the people in cultures reporting less separation. On the basis of these findings, it can be found that trauma is less in culture reporting less separation, whereas difference can increase the chances of trauma of separation (Howard et al., 2011). In a culture, people have a familiarity with community support systems, thereby helping in decreasing the level of stress and traumatic experiences, whereas difference may affect that support system.
Just like the identity of a culture, identity of a caregiver also has very important role in influencing the separation’s effect on the development of trauma. Children, who are cared by their own parents or grandparents, have a very different level of life as compared to the children, who are cared by a caregiver after separation (Howard et al., 2011) as they have a different level of recognition and affection with caregiver.
Relationship between oppression, discrimination, and trauma
Oppression refers to the state of being kept down by unjust use of force or authority. Oppression can result in various problems such as anxiety, depression, hypertension, and most importantly, interpersonal conflicts. These interpersonal conflicts are directly related to discrimination, which is unfair treatment of a person or group on the basis of prejudice. Discrimination has been reported as an important risk factor in the development of trauma. Discrimination from other members in a culture and immigration status issues can increase the level of stress, thereby increasing the chances of traumatic experiences. Experts are of opinion that oppressed and minority populations can face higher rate as well as elevated intensity of trauma (Shaw, Espinel, Shultz, & Publishing, 2012). However, traumatic incidences resulting from sustained discrimination, oppression, racism, and poverty can be considered as understated and subtle forms of trauma as they are different from more terrifying incidences such as assault and violence. However, they can result in long-term adverse effects on health and several other life outcomes.
Impact of trauma on an individual’s identity, sense of safety, and privacy
The effects of trauma may change from one child to another. Some children are able to cope with the situation and show few effects, whereas others may suffer from prolonged debilitating effects. Psychological effects of trauma may include fearfulness, aggressive or provocative behavior, disturbed relationships with parents or other relatives. If the children are traumatized during separation, they may show rejection towards mothers and strangeness of the situation (Vlok, 2002).
Impact of trauma can be significantly found in individuals, who had experienced four or more than four categories of trauma in childhood as compared to children, who had experienced one or no trauma in childhood. Children with four or more categories of childhood trauma have more chances of long-term problems including substance abuse, safety issues, difficulties in relationships and job-related life, and suicidal behaviors (Grayson, Childress, Baker, & Hatchett, 2012).
Although trauma can affect the children in different ways, there are certain areas of potential impact requiring special attention of child welfare workers. These areas of potential impact are as follows (Grayson et al., 2012):
Child’s developing brain can be affected as a result of trauma. Children may become hyper-alert, and it is difficult for hyper-alert children to attend the academic sessions because learning requires attention and calmness. Children, who have faced trauma, may show problems with concentration, learning and retaining new information, language skills, and cognitive abilities. Changes in these abilities usually change the identity of children.
Emotional regulation of traumatized children is affected. They may start showing the signs of anxiety and depression. Due to disturbance in emotional regulation, it becomes difficult for children to identify their feelings and work according to those feelings. Those children may also show anger outbursts.
Self-concept may change as a result of trauma, thereby affecting sense of identity, self-worth, and body image.
Trauma can also affect the key relationships, thereby affecting the sense of safety, protection, and support. Traumatized children may start feeling isolated, and develop few social skills.
Traumatized children may also show poor behavioral control, and some children may also show oppositional behaviors.
Dissociation is also commonly found in traumatized children, and those children may show disturbed memory or altered states of consciousness.
As a result of trauma some other problems such as PTSD, ADHD and Oppositional Defiant Disorder can also develop. Therefore, traumatic patients may also show the signs related to these problems.
Strategies to address trauma as a human rights and social justice issue
Trauma is related to several emotional responses such as fear, sadness, shock and disbelief, helplessness, anger, guilt, and shame. Therefore, it is important to deal with trauma while considering these responses.
One of the most important strategies to address trauma is to connect with other people rather than withdrawing from friends and other social activities. Connecting with others and engaging with them socially can help in giving comfort from memories of traumatic events. Normal behaviour is difficult to achieve, but doing normal things with family members, friends, and other loved ones is important to get out of the traumatizing memories. In this strategy of social connection with others, trauma patients can also find support groups and community organizations that can help in moving out of the sense of helplessness.
Some other helpful strategies to address trauma are as follows:
Talking about the traumatic event with empathic listeners can help in relieving the bad experience,
Hard exercises such as jogging, walking, and bicycling helps in diverting the mind,
Relaxation exercises such as stretching, yoga, and massage can support positive thinking,
Minimizing media exposure, especially media exposure to disaster, distressing images, and video clips, can help in reducing further traumatizing the situation,
Commitment to something important and meaningful can help in giving a goal to the life, thereby reducing constant negative thoughts, and
Proactive responses to the personal as well as community safety can help in remaining socially active.
Theories and their application to clinical intervention
Cognitive behavioral therapy
Cognitive Behavioral Therapy is based on cognitive behavioral theory, which shows the importance of both behavior and cognition in understanding and helping other people. Cognitive Behavioral Therapy also incorporates elements from developmental theories, which are dealing with the developmental stages of children (Grayson et al., 2012).
In order to deal with the problem of trauma and traumatic grief in children and adolescents Cognitive Behavioral Therapy can be used (Grayson et al., 2012). Trauma-Focused Cognitive Behavioral Therapy, which is derived from Cognitive Behavioral Therapy, for Traumatic Grief (TF-CBT) helps children and their parents sort through their feelings of grief and re-negotiate relationships. Usually, TF-CBT consists of psychoeducation, relaxation skills, parenting skills, cognitive coping skills, affective modulation skills, trauma narrative and processing, parent-child sessions, and increasing safety and planning for the future. Healthcare experts may also work on the psychoeducation, affective expression, positive memories, resolving ambivalent feelings, relaxation, and cognitive coping.
Evidence for the use of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). In a study, researchers reviewed various published studies on the use of TF-CBT for the treatment of trauma-related symptoms in children (Ramirez de Arellano et al., 2014). Researchers found that TF-CBT shows positive outcomes in decreasing the symptoms caused by trauma-related events. Based on the research, it can be said that TF-CBT services have to be covered in health plans. However, further research is required to recognize best practices for TF-CBT in different settings and with different individuals from several racial as well as ethnic backgrounds having varied symptoms, trauma histories, and stages of social, emotional, and intellectual development.
Parent-Child Interaction Therapy
Parent-Child Interaction Therapy (PCIT) is based on developmental theory, thereby showing that authoritative parenting including a combination of nurturance, behavioral regulation, and good communication can help in producing optimal mental health outcomes for the growing children (Grayson et al., 2012).
PCIT is a parent training model consisting of two-phases (Jamison, Psychology, & Education, 2007). In the first phase of therapeutic intervention, parent child relationship is improved with the help of play therapy as well as behavioral techniques. In the second phase, parents give effective instructions to their children, thereby helping them in the development of desired behaviors. A defining feature of the PCIT is direct coaching of the parent by use of a wireless earphone while the parent and child interact. Motivation and engagement are very important in PCIT.
Evidence for Parent-Child Interaction Therapy (PCIT). In a study, researchers worked on the efficacy of PCIT on high-risk families (Pearl et al., 2012). Fifty nine clinicians from 31 different agencies in eight states were asked to take part in the study. Moreover, 154 families were approached and 53 families completed posttreatment measures. Researchers found significant improvement in child trauma symptoms with the help of PCIT. The study also showed significant improvements in several other measures such as child dissociative characteristics, child behavior, and caregiver stress.
The Child and Family Traumatic Stress Intervention
The Child and Family Traumatic Stress Intervention (CFTSI) is a brief therapy that has been designed for children in the age range of 7 years to 17 years. This intervention deals with extensive reporting about the feelings and symptoms of the traumatized children (Shaw et al., 2012). It helps in decreasing the negative impact of the children’s exposure to traumatic events of life.
CFTSI consists of four sessions. During an intake appointment that is conducted by a trained staff member other than the designated CFTSI provider, the child and the parent or caregiver are screened separately for symptoms of post-traumatic stress to determine if the child is in need of trauma-focused treatment. The CFTSI provider begins the second session by meeting with the child. The third and fourth CFTSI sessions are conducted conjointly with the caregiver and the child. In these sessions, the child completes the questionnaires together with the caregiver indicating areas of agreement and sharing additional observations.
Evidence for CFTSI. In a study, researchers checked the efficacy of CFTSI in preventing the development of chronic PTSD in children (Berkowitz, Stover, & Marans, 2011). In the study, researchers divided the participants of the study into two groups and one group was exposed to the therapeutic intervention. Researchers found that the intervention group showed fewer problems of PTSD. The results showed that early intervention for youngsters, who had faced a Potentially Traumatic Event (PTE), is a potent approach to prevent Chronic PTSD.
Concluding Remarks
Trauma based incidences are among the most important problems faced by society. These trauma based events in the childhood can result in lifelong problems in children. Therefore, children with traumatic experiences need extra support and reassurance, so that they would be able to move out of those traumatic thoughts. In this regard, relatives and other loved ones of those patients of trauma can help them in expressing their feelings and decreasing their depressing and traumatic thoughts. Moreover, healthcare experts and welfare workers may also use some cognitive and family based interventions such as TF-CBT, PCIT, and CFTSI for the children to deal with trauma related problems in life.
References
Berkowitz, S. J., Stover, C. S., & Marans, S. R. (2011). The child and family traumatic stress intervention: Secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry, 52(6), 676-685.
Finkelhor, D. (2009). Children's exposure to violence: A comprehensive national survey: DIANE Publishing.
Grayson, J., Childress, A., Baker, W., & Hatchett, K. (2012). Evidence-based treatments for childhood trauma. Virginia Child Protection Newsletter, 95.
Howard, K., Martin, A., Berlin, L. J., & Brooks-Gunn, J. (2011). Early mother–child separation, parenting, and child well-being in Early Head Start families. Attachment & human development, 13(1), 5-26.
Jamison, T. R., Psychology, U. o. K., & Education, R. i. (2007). The Effects of Parent-Child Interaction Therapy on Problem Behaviors in Three Children with Autistic Disorder: University of Kansas.
Pearl, E., Thieken, L., Olafson, E., Boat, B., Connelly, L., Barnes, J., & Putnam, F. (2012). Effectiveness of community dissemination of parent–child interaction therapy. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 204.
Ramirez de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Delphin-Rittmon, M. E. (2014). Trauma-Focused Cognitive Behavioral Therapy: Assessing the Evidence. Psychiatric Services (Washington, D.C.), 65(5), 591–602.
Shaw, J. A., Espinel, Z., Shultz, J. M., & Publishing, A. P. (2012). Care of Children Exposed to the Traumatic Effects of Disaster: American Psychiatric Pub.
Vlok, M. E. (2002). Manual of Nursing: Juta.
Kaduson, H. G., & Schaefer, C. E. (2012). Short-Term Play Therapy for Children, Second Edition: Guilford Publications.
