Childhood Trauma: Identification, Treatment and Hope

 

By Sara Hegge M.A. and Rebecca L. Goffman Psy.D

What is Trauma?

Traumatic events happen every day and when they happen to the children we love, it can turn our world upside down. The National Child Traumatic Stress Network (NCTSN) defines traumatic stress as occurring “when a child experiences an intense event that threatens or causes harm to his or her emotional and physical well-being.”5 A child may also experience trauma through witnessing such an event happening to adults or caregivers. As parents, we hope the resiliency in our children, combined with the love and support from family and friends, will help them through recovering from trauma, and that everything will be okay. For the most part, this is true; however, when the trauma is too overwhelming, it is common for children to engage in puzzling and/or dramatic changes such as strong emotional responses, new or uncharacteristic behaviors, a decline in academic performance, and/or changes in their relationships with others.

Concerns about Seeking Therapy

Caregivers noticing these changes may wonder where to turn for help and contemplate seeking therapy for their child. The thought of bringing their child to see a therapist may instill a mixture of hope that things will get better and fear of what might happen (Will this make a difference? Will this explain the changes I am seeing in my child? What will the therapist want to know? Will it be painful?) Parents and caregivers of a child with hearing loss may have additional questions about how to explain the situation in a way their child will understand or if therapeutic interventions will work given their child’s unique communication needs. As mental health professionals who work with parents and caregivers of deaf and hard of hearing (d/hh) children who have experienced traumatic stress, we want you to know there is hope that you and your child can heal and recover from even the most traumatic of events.

The definition of trauma above is simultaneously vague and comprehensive, which reflects the fact that what is traumatic to one child may not be traumatic to another. It is fairly easy to compile a long list of events that fit this definition just by watching or reading the news: surviving a natural disaster or potentially lethal accident, escaping war torn countries, being a witness to violent acts, experiencing physical, emotional or sexual abuse, the death of a caregiver, etc. When one broadens the definition to say that traumatic events cause “reactions that persist and affect their daily lives after the traumatic events have ended,” the list expands exponentially to include experiences such as parental divorce, bullying, frequent moves or out-of-home placements, medical interventions, and similar chaotic, unpredictable, and difficult periods of time in a child’s life. 5 Reactions to these experiences can “include a variety of responses, including intense and ongoing emotional upset, depressive symptoms, anxiety, behavioral changes, difficulties with attention, academic difficulties, nightmares, physical symptoms such as difficulty sleeping and eating, and aches and pains, among others.”5

What About Trauma and Deaf/hh Children?

According to the NCTSN, about one of every four children will experience a traumatic event before the age of 16.5 Although there are no numbers for overall traumatic experiences for d/hh children, the estimate of d/hh youth who experience abuse is believed to be significantly higher than 25% due to vulnerabilities associated with their hearing loss. These vulnerabilities can include difficulty disclosing the abuse due to language barriers (not having the words to describe it, insufficient access to people who can understand, etc.), the high number of d/hh children who live away from their families, social skills delays, a lack of incidental learning, inadequate access to prevention programs, and the cognitive and physical disabilities sometimes associated with the cause of their hearing loss (i.e. meningitis, rubella, or developmental disabilities.)6 Additionally, there is emerging research within the d/hh world suggesting “communication isolation” can cause a child to be more vulnerable to the development of trauma symptoms when they experience an additional traumatic event in their life.6 While there exists a lack of treatment programs specific to the d/hh population, there is much that parents can do to respond to their child’s needs and access linguistic and culturally affirmative mental heath care.  

What can you do?

If you observe signs of distress in your child, such as nightmares, difficulty sleeping or eating, or any of the other signs and symptoms of trauma mentioned here, there are numerous ways caregivers can support their child.

• Talk with children about their experience in a way that matches their communication style. Validate your child’s feelings, ensure current safety, and help find hope for the future.
• Educate your child in a direct, purposeful way about personal safety, reporting harmful interactions and understanding interpersonal boundaries. Many children with hearing loss do not have access to information that is discussed among hearing family members. Their ability to overhear conversations and incidentally learn about family values and expectations is compromised by their hearing loss. Depending on your child’s academic skills, d/hh children may find it difficult to access appropriate reading materials, again making direct instruction the best way to ensure this knowledge is shared.
• If your child uses manual communication (i.e. American Sign Language, Pidgin Signed English, Signing Exact English, Cued Speech or augmentative communication) and you are not fluent or perhaps comfortable talking with your child in this modality consider :
• Talking with your child’s school to see what safety and social skill instruction is taught in the school environment.
• Taking a sign language class or ordering materials that address the content you need such as Signs of Sexual Behavior: An Introduction to Some Sex-Related Vocabulary in American Sign Language by James Woodward.
• Taking your child to see a therapist who is able to match your child’s communication needs or has access to a qualified interpreter or transliterator to support communication. The therapist should be knowledgeable of the unique linguistic, social, and emotional needs of d/hh children or be willing to consult a cultural liaison.

• Seeking help and support for yourself. Many caregivers experience a number of feelings after they find out a child they love has experienced trauma. In the case of natural disasters, leaving a war torn country or domestic abuse, parents often experience the same traumatic stress as their children. Consider seeking support from your own therapist, support group or members of your community.

For a more extensive explanation of parental/caregiver support please see “How Can Parents and Caregivers Help” found at http://www.nctsn.org/.

Effective Treatment

One of the most effective treatments for children experiencing traumatic stress is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). While more research is needed on this treatment modality for d/hh children, this treatment has been implemented by one of the authors of this article (Ms. Hegge). In her practice, she found that, with modification, this treatment approach is effective in reducing the symptoms of traumatic stress in children with hearing loss as well as hearing children of parents who are deaf or hard of hearing. As outlined in NCTSN’s document, Effective Treatments for Youth Trauma, TF-CBT helps children to

• Learn “stress management and relaxation skills to help them cope with unpleasant feelings and physical sensations about the trauma.”
• Talk about the traumatic event and feelings surrounding that event “at a speed that doesn’t distress the child.”
• Create a “narrative” or story of what happened to enable them to “master painful feelings about the event and to resolve the impact the event has on their life.”

A large component of a child’s recovery from trauma is the involvement of safe caregivers who can provide support as their child builds the skills to manage their trauma response. This sometimes requires caregivers seek help for themselves and it always involves a lot of love, flexibility and understanding.

Regardless of the source of the trauma, a child’s response, or the treatment approach chosen, caregivers can take comfort in knowing there is help and things they can do. For example, knowing your child and building a relationship of care and trust goes a long way toward creating and recreating feelings of support and safety. Being purposeful about the way personal and family values are shared, as well as giving routine, predictable protective messages are critical to ensure that children have the basic concepts necessary to keep themselves safe and report worrisome events to adults. Parents who can recognize the symptoms of trauma and seek help early can help their child regain their previous level of functioning. Engaging qualified professionals who understand the impact of hearing loss on development and can communicate in a way that matches your child’s needs (or are at least willing to consult with people who have that expertise) will help improve recovery time and effectiveness. Lastly, taking care of your own needs so you are more available to support your child will help create a “stable, consistent, and caring environment in which the child can learn that a traumatic experience doesn’t have to dominate life.”1

More information about the authors:

By Sara Hegge, MA, MSW, LICSW, Therapist at the Volunteers of America of Minnesota, Mental Health Clinics, Deaf and Hard of Hearing Program and

Rebecca L. Goffman, Psy.D., LP, Psychologist and Manager of the Volunteers of America of Minnesota, Mental Health Clinics, Deaf and Hard of Hearing Program

Editors note:  This article is brought to you for further learning from the H&V O.U.R. Project

Resources

Rochester Institute of Technology. (1993). The Grey Area: His Date/Her Rape videotape and instructor's manual can be ordered from Campus Connections. This video clarifies, educates, and offers strategies to young deaf women and men to help ensure communication and control in dating and other social situations. Deaf actors, using American Sign Language (ASL), sensitively and dramatically portray the realistic story lines as narrators candidly review the action and ask questions that will prompt important discussions.

Tate, Candice. (2012). Trauma in the Deaf Population: Definition, Experience, and Services. Alexandria, VA: National Association of State Mental Health Program Directions (NASMHPD).

E. Krents. (1991). No-Go-TELL! – Protection Curriculum for Young Children with Special Needs.

James Stanfield Company. Retrieved from http://www.stanfield.com/.

Woodward, James. (1979). Signs of Sexual Behavior: An introduction to some sex-related vocabulary in American Sign Language. Silver Spring, MA: T.J. Publishers, Inc.

Woodward, James. (1980). Signs of Drug Use: An introduction to drug and alcohol related vocabulary in American Sign Language. Silver Spring, MA: T.J. Publishers, Inc.

References

1. Effective Treatments for Youth Trauma. National Child Traumatic Stress Network. Retrieved from http://www.nctsnet.org/.

2. Facts on Trauma and Deaf Children. National Child Traumatic Stress Network (2004). Los Angeles, Calif., and Durham, NC: National Child Traumatic Stress Network, 2004, www.NCTSN.org.

3. Glickman, N. S. and Harvey, M. A. (1996). Culturally Affirmative Psychotherapy with Deaf Persons. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.

4. How Can Parents and Caregivers Help? National Child Traumatic Stress Network. Retrieved from http://www.nctsn.org/.../for-parents-and-caregivers#q1.

5. What is Child Traumatic Stress? National Child Traumatic Stress Network. Retrieved from http://www.nctsnet.org/.../what_is_child_traumatic_stress_0.pdf. 

6. White paper on addressing the trauma treatment needs of children who are deaf or hard of hearing and the hearing children of deaf parents. Revised. Los Angeles, Calif., and Durham, NC: National Child Traumatic Stress Network, 2006, www.NCTSN.org.

7. Woodward, James. (1979). Signs of Sexual Behavior: An introduction to some sex-related vocabulary in American Sign Language. Silver Spring, MA: T.J. Publishers, Inc.