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BHIPP Bulletin

Trauma and Adverse Childhood Experiences (ACEs)
Volume 2, Issue 8
February 2017

We often receive calls from providers who are treating patients who have experienced a traumatic event(s). It is important to understand the impact on the patient’s social, emotional, and physical well-being. We look to the experts at the National Child Traumatic Stress Network to define and explain the impact of trauma on children and adolescents:

What Is Trauma, and How Do Children and Adolescents Respond to It?
Traumatic events can involve an actual death, other loss, serious injury, or threat to the child’s well-being. These events could include natural or man-made disasters, interpersonal violence, car accidents, war, or terrorist acts, among many other possibilities. A child may be traumatized by directly experiencing or witnessing a traumatic event or by hearing about another person’s experience with such an event. Children respond to trauma in different ways, and their responses can change over time. In the immediate aftermath of a traumatic event, children may experience feelings of terror, intense fear, horror, helplessness, lack of control, and physical stress reactions such as a rapidly beating heart or shakiness. Intense feelings such as fear and helplessness are likely to be experienced in the first weeks following a traumatic event or after repeated exposure, such as in child abuse. These acute responses can be disruptive to the child’s functioning but may go away naturally over time.
For some children and adolescents, responses to traumatic events can have a profound effect on the way they see themselves and their world. These children may experience important and long-lasting changes in their ability to trust others, their sense of personal safety, their effectiveness in navigating life challenges, and their belief that there is justice or fairness in life. Traumatized children may develop changes in behavior that are often referred to as externalizing problems or acting out. They may become involved in fights or other conflicts with peers, have difficulty interacting with authority figures, become socially isolated or withdrawn, develop poor school attendance, and begin using illicit substances. They may also experience changes in their emotional and psychological functioning, referred to as internalizing problems, such as depression or anxiety. These internal changes may be more difficult for others to detect than external changes but can still cause significant impairment in functioning.

What Is Post-Traumatic Stress Disorder?
In some cases, the difficulties resulting from exposure to trauma persist over time and can result in what is called Post-Traumatic Stress Disorder (PTSD). PTSD is diagnosed when the child has specific symptoms that continue for a month or more following exposure to a traumatic event. Not all children exposed to a trauma will develop PTSD, and for some children PTSD symptoms will lessen naturally over time. However, children who experience the disorder often have a variety of symptoms that can significantly impact their day-to-day functioning. These symptoms fall into the following general categories:
  • Re-experiencing: recurrent upsetting thoughts about the event, repeated distressing nightmares, or repetitive play in young children
  • Hyperarousal: nervous, jumpy, or agitated behavior, irritability or anger, and hypervigilance or increased startle reaction
  • Avoidance: avoiding thoughts, feelings, or places that remind the child of the trauma, withdrawing, becoming  disinterested in activities, or developing emotional distance
If left untreated, PTSD can lead to more serious difficulties over time. PTSD has been linked to adult depression, substance abuse, eating disorders, and other psychiatric difficulties. If a child shows symptoms of PTSD, it is important that he or she be evaluated, and consultation with a qualified mental health professional is encouraged.

Source: National Child Traumatic Stress Network

It is important to habitually ask about traumatic experiences, but asking is not always easy. Questioning may start broadly and then the provider may wish to follow up with questions that are more specific.

  • For example: Start by asking, "Have you (your child) ever experienced anything scary?"
  • Then you may wish to follow up with questions such as:
    • "Has anyone ever hurt you (your child)?"
    • "Have you (your child) ever seen anyone get hurt?"
    • "Have you (your child) ever seen/experienced something that made you feel uncomfortable?"

The following tips may be especially helpful when working with families whose children have experienced trauma:

  • Families should be encouraged to maintain their routines as much as possible
  • Enable children to feel a sense of control by giving them simple choices
  • Encourage children to safely express their feelings
  • Exercise consistency, predictability, care, and patience
  • Remain available and responsive
Additional Resources on Trauma
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BHIPP Announcements

Holiday Closures

The BHIPP telephone consultation line will be closed on the following days:
  • Monday, February 20, 2017
  • Monday, May 29, 2017
  • Tuesday, July 4, 2017
  • Monday, September 4, 2017
  • Monday, October 9, 2017
  • Friday, November 10, 2017
  • Thursday, November 23, 2017
  • Friday, November 24, 2017
  • Monday, December 25, 2017

BHIPP Bulletin Newsletter Archive

January 2017: FAQs about Stimulant Dosing
December 2016: Bullying
November 2016: Learning Disorders and Intellectual Disability
October 2016: Educational Services: Know Your Rights and Resources
September 2016: Goodbye Summer, Hello School (Refusal)
August 2016: College Students and ADHD
July 2016: It's Summertime! ADHD and "Drug Holidays"
June 2016: Understanding Vyvanse
May 2016: Children's Mental Health Awareness Week, May 1-7, 2016
April 2016: "Universal" approaches for child mental health problems
March 2016: Pharmacological interventions for sleep concerns
February 2016: Behavioral interventions for sleep concerns
January 2016: Assessment of sleep disorders
November 2015: 5S's: Key questions for consultation
October 2015: Case discussion regarding school refusal
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