Approximately four million adolescents have been victims of a serious physical assault, and nine million have witnessed serious violence during their lifetimes. The Adverse Childhood Experiences (ACE) Study, one of the largest scientific research studies of its kind, found that individuals with four or more of ten adverse life experiences were affected well into their adulthood and throughout their lifespan. The Childhood Traumatic Stress made them more likely to smoke cigarettes, abuse drugs or alcohol, become obese, develop depression or battle health problems such as diabetes and heart disease. The ACE Questionnaire was taken voluntarily by 17,000 Kaiser Permanente patients participating in routine health screenings. Data resulting from their participation revealed staggering proof of the health, social and economic risks that result from childhood trauma.

The Substance Abuse and Mental Health Services Administration's (SAMHSA) National Center for Trauma Informed Care (NCTIC) has a cadre of technical assistance tools and practice information. NCTIC is a technical assistance center dedicated to building awareness of trauma-informed care and promoting the implementation of trauma-informed practices in programs and services.

SAMHSA's National Registry of Evidence- based Programs and Practices (NREPP) is a searchable online registry of more than 260 interventions supporting mental health promotion, substance abuse prevention, and mental health and substance abuse treatment. It connects members of the public to intervention developers so they can learn how to implement these approaches in their communities.

Some examples of best practices on the NREPP website:

• Eye Movement Desensitization and Reprocessing (EMDR) is a one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning.
• Helping Women Recover: A Program for treating Substance Abuse and Beyond Trauma: A Healing Journey for Women are manual-driven treatment programs that, when combined, serve women in criminal justice or correctional settings who have substance use disorders and are likely to have co-occurring trauma histories (i.e., sexual or physical abuse).
• The Trauma Recovery and Empowerment Model (TREM) is a fully manualized group-based intervention designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse.

The National Association of Mental Health Program Directors Guidebook: Engaging Women in Trauma Informed Peer Support was created as a technical assistance document to help make trauma-informed peer support available for women who receive or have received services in behavioral health or other human services setting. The 13-chapter document includes segments on gender politics, culture, religion, self-awareness, healing practices and reclaiming power.

Most of us can recall a major life event that disrupted our lives in some way. It could be a natural disaster, the loss of a loved one, a medical treatment, or the memory of abusive words or physical assault. Trauma is widespread, but the intensity level of these experiences differs, as does the way we deal with these events. A child’s coping skills can be overwhelmed, resulting in extreme emotional, psychological and physiological distress. Trauma can involve actual or perceived threats to the safety and well-being of a child, or to someone close to them. Whether single occurrences, recurring or multiple unrelated events, these experiences result in feelings of fear and helplessness. These are normal responses to abnormal events, not signs of weakness. A child can be affected at any developmental stage, beginning at infancy. Some children recover quickly with few complications, while others have more extreme reactions. For some, the response is immediate; for others, it is delayed. These reactions may have wide ranging effects on a child’s physical health, emotional responses, behaviors and school success. Experiencing trauma can result in immediate distress to children and their families, which may lead to lifelong problems. Children need to know that they’re safe and that people care and will help them through whatever events they have experienced. Caregivers, teachers and service providers can be more effective in providing care and support if trauma-informed and sensitive to a child’s needs.

Trauma affects the central nervous system. It interferes with a child’s ability to relax and focus, and ultimately shapes how the child sees his or her future. Childhood trauma can affect critical developmental milestones. It is natural for youth to regress to behaviors they had previously moved beyond in an attempt to feel the comfort of an earlier developmental stage.

Traumatic memories are often stored without words deep within the brain. The tendency to avoid discussing their feelings leads children into isolation. Their anxiety is compounded by fears that the tragic event may happen again.

Children with traumatic stress need to feel secure emotionally and physically at all times to maintain balance and self-control. They tend to interpret disciplinary actions as rejections and may act out. Any form of stress may be considered to be a threat. Fear can lead to the instant and automatic survival reactions of fight/flight/freeze whenever a threat is sensed.

Children affected by trauma may feel very guilty or confused about what happened to them. Youth who have experienced trauma frequently feel deep shame over their inability to manage their emotions or their actions during the traumatic event. The desire for revenge is a natural and predictable aspect of an adolescent’s reaction. 

Some children worry about the frightening experience and may have sleep disturbances. Children and teens may react to trauma with depression, angry outbursts and anxiety. Suicide attempts and completions are more prevalent among individuals who have experienced traumatic stress, as are obesity and chronic health problems. Prevention and early intervention efforts are crucial to addressing these long-term problems that may emerge later on in adulthood.

Coping with a child’s traumatic experience can be confusing and stressful not only for the child but also for the parents or other caregiver. Deciding when and where to go for help is an important decision. Not all children exposed to traumatic events develop a traumatic stress reaction.

However, if a parent or other caregiver thinks a child may have symptoms of traumatic stress, it is important to seek help from qualified professionals. When selecting a mental health provider, parents/caregivers need to ask if the provider has been trained in trauma-focused interventions.

Trauma-focused interventions occur on many different levels. In addition to family and other natural supports, a variety of service systems (child welfare, law enforcement, education, faith-based, health, juvenile justice, mental health, etc.) may become involved in providing informal or formal care to a child.

A number of therapies have been proven to be effective and others are being studied. Several components will be considered to find the best treatment for a specific child. Several of these treatments are based on what mental health professionals call cognitive-behavioral approaches. The National Child Traumatic Stress Network has identified several elements that need to be part of these approaches:

• Teaching children stress management and relaxation skills to help them cope with the unpleasant feelings.
• Exploring the traumatic event and feelings about it at a speed that doesn’t distress the child.
• Creating a coherent story of what happened, either in words, art, music or dance.
   
• Clarifying perceptions about what happened and why.
• Understanding and correcting unhealthy beliefs and behaviors that have resulted from the trauma.
• Engaging parental support whenever possible. Parents and other caregivers can create a stable and caring environment so the child learns that traumatic experiences do not have to dominate life.
• Providing opportunities to symbolically create more effective and empowering resolutions to trauma stories.

Regardless of the trauma experienced, the first step in receiving care should be an assessment. This involves bringing together a number of people who know the child – caregivers, teachers, social workers, case managers, law enforcement. Getting professionals together at once assures the child does not have to repeat his/her story numerous times.

Can medication help? Research for the use of psychotropic medications in children has been limited. Therefore, parents must use caution in finding a psychiatrist with pediatric trauma expertise. While medications may help with treating specific symptoms, there is no definitive medication treatment to “cure” children’s traumatic stress.

When left undiagnosed and untreated, Childhood Traumatic Stress (CTS) can affect people over the lifespan, increasing demands on health and human service systems. Surveys of national data reveal the following statistics:

• Approximately four million adolescents have been victims of a serious physical assault, and nine million have witnessed serious violence during their lifetimes.
• Every year, up to 10 million children in the United States are exposed to domestic violence.
• Over 300,000 children in the United States are injured in motor vehicle accidents each year.
• Fires injure about 40,000 children each year.
• More than 25 percent of abused children require special education programs.
• The Adverse Childhood Experiences (ACE) Study found that individuals with four or more of the ten adverse life experiences (including child abuse and/or neglect, domestic violence, parental loss and parental substance abuse) are:
  • Nearly 2 times more likely to smoke cigarettes
  • 4 ½ times more likely to engage in drug abuse
  • 7 times more likely to suffer from chronic alcoholism
  • 11 times more likely to abuse drugs via injection
  • 19 times more likely to have attempted suicide
  • More likely to have health problems (diabetes, heart disease, cancer, and compromised immune systems, etc.) that put them at risk of early death
  • Have double the risk of obesity
  • Often develop mental illness such as depression