> Deb Gould is a STARTTS Clinical Psychologist and clinical supervisor.

Childhood Trauma: responses, impacts or symptoms:

I hope you weren’t expecting a solid list of the symptoms of trauma responses in children. Such a list would not only be inaccurate, but more importantly miss out on the full context within which children have these responses. This context is what I would like to focus on in this edition.

Children develop in a context that needs to enable their development: This involves 4 main processes:

Internal - physical survival facilitated by adequate nutrition and protection from disease. A nervous system that is protected from extremes in activation and where repeated firing of fear response pathways is at least met with the moderating effect of a safe haven.

Familial - parents and other people available to ensure the child’s survival;

Collective - community and culture that provide support, opportunities and guidelines and

Environmental - the basic structures of the society e.g. health care and education. Safe enough for the brain to organise around developmentally appropriate functions rather than fear.

In the violence, chaos and deprivation of war, this context changes, making children more vulnerable to hitches in their development in addition to developing symptoms (traditionally the framework for understanding impacts). These hitches are reflected in struggles across the spectrum:

Soma – a body that is always ready to react has a greater vulnerability to disease. There are also interruptions in the natural processes of somatic regulation e.g. responding appropriately to sensations of tiredness, hunger and bladder/bowel fullness. This leads to vulnerability for regression in later times of stress.

Emotion – dysregulation characterises the emotional state of many refugee children (this edition’s case study focuses on this). Even apparently minor emotional arousal is experienced as being threatening – a sign that there is danger.

Behaviour – This perception of danger can escalate into hyperarousal (fight or flight) and/or dissociation (fright or freeze). Behaviours emerging from these states can be disruptive and destructive but seem out of the child’s control. In addition, it takes time to adjust to new rules governing how one acts on feelings; particularly giving up behaviours that previously enabled survival.

Relationships –loss and distortion of attachments creates a struggle to trust or find safety in others. For adolescents this translates into struggles with intimacy while the younger impulsive and disregulated child is unable to build and maintain friendships.

Identity – with the aid of their communities, children develop stories about themselves. A story scripted during conflict and outside of an appropriate cultural context is usually one characterised as “tragedy” (war and/or loss) with the hero in a state of confusion or threat. “Who am I?” or “Am I?”

Cognition – delays in learning the skills of their new worlds arise from a complex interplay of factors. Usually, the perception of threat possible in a new and challenging environment evokes survival responses that are not compatible with the task focussed processing required at school. It is hard to think when you are scared. It is easy to be scared when you have not often felt safe.

Never forget that by the time refugee children arrive at school, they have been exposed to so much more than violence and that what we see are the impacts of fear, chaos, loss and deprivation as well as resourcefulness, cohesion and attachment.

> Deb Gould
Deb is a Clinical Psychologist and clinical supervisor at STARTTS. She was trained in South Africa and has over 20 years experience as a clinician and supervisor in the psychotherapy field.

© 2009 STARTTS  Contact: hintsforhealing@startts.org.au