Forgotten Victims:
Infants and Toddlers Who
Witness Violence and Trauma
Briana S. Nelson, Ph.D., LCMFT
Kansas State University
Marriage & Family Therapy Program
School of Family Studies & Human Services
bnelson@ksu.edu
785-532-1490
Psychological trauma is an affliction of the powerless.
At the moment of trauma, the victim is rendered
helpless by overwhelming force. When the force is
that of nature, we speak of disasters. When the force
is that of other human beings, we speak of atrocities.
Traumatic events overwhelm the ordinary systems of
care that give people a sense of control, connection,
and meaning.
-Herman, 1997
Objectives
To understand the impact of witnessing
violence and trauma on infants and toddlers
 To identify the immediate and long-term
effects on infants and toddlers exposed to
trauma and abuse
 To gain knowledge of effective methods for
identifying and working with infants and
toddlers who may be traumatized
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Assumptions about
Child Development
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Children do not develop in isolation; they
develop within the context of human
systems
Children both influence and are influenced
by the systems in which they are members
It is necessary to develop a
conceptualization of the systemic effects
when a child is trauma-exposed or
traumatized
What is trauma?
“... the development of characteristic symptoms
following exposure to an extreme traumatic stressor
involving direct personal experience of an event that
involves actual or threatened death or serious injury, or
other threat to one’s physical integrity; or witnessing an
event that involves death, injury, or a threat to the
physical integrity of another person; or learning about
unexpected or violent death, serious harm, or threat of
death or injury experienced by a family member or other
close associate”
(DSM-IV, 1994, p. 424)
Traumatic events that are experienced
directly by children include, but are not
limited to:
• violent personal assault (sexual abuse or
assault, physical abuse, robbery, mugging)
• being kidnapped or taken hostage
• terrorist attack
• school violence
• torture
• war
• natural or human disasters
• severe accidents
• being diagnosed with a life-threatening illness
(DSM-IV, p. 424)
“Witnessed events include, but are not limited to,
observing the serious injury or unnatural death of
another person due to violent assault, accident, war,
or disaster...
“Events experienced by others that are learned about
include… violent personal assault, serious accident, or
serious injury experienced by a family member or a
close friend; learning about the sudden, unexpected
death of a family member or a close friend; or learning
that one’s child has a life-threatening disease.”
(DSM-IV, p. 424)
Every day in America...
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6 children commit suicide
8 children are homicide victims
11 children are killed by firearms
76 babies die
131 children are reported as abused or
neglected
Children’s Defense Fund, 2001 report
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In 1998, 2.9 million children were reported as abused
or neglected in the US (903,000 confirmed)
An estimated 1,100 children died as a result of abuse
or neglect in 1998 (78% were <5 y/o)
A conservative estimate is that over 5 million children
are exposed to traumatic events every year
1/3 of physical abuse victims are less than one year
old
Current estimates of PTSD rates in children range
from 0-95% (average rate 37%)
But it doesn’t happen to
Kansas children...
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Every 13 minutes a child is reported abused
or neglected
6,790 cases of child abuse or neglect were
substantiated in 1998 (>2x the 1995 rate)
Every 7 days, 3 children die under 14 years
of age
Who is affected when a
child is traumatized?
Child
How is a child affected when the
system is traumatized?
Child
Characteristics of
Childhood Traumas
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Acute vs. Chronic
Single event vs. multiple events
Age of onset
Relationship to “perpetrator”
Adult vs. peer perpetrator
Intrafamilial vs. extrafamilial
Parental response
Cycle of Violence
Characteristics that Distinguish
Traumatic from Normative Stressors
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the amount of time one has to prepare
previous experience with the stressor
sources of guidance/support available
the extent to which others have experienced the
event
the amount of time in a “crisis” state
sense of loss of control or helplessness
sense of loss
disruption and destruction
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danger experienced by those exposed to the
event
emotional impact of the event
medical problems associated with exposure to the
event
personal role in the stressor event
pretrauma vulnerability
intensity and duration of the event
postevent responses
Early Intervention in At-Risk Families:
Recognizing Children’s Reactions
to Abuse and Trauma
 Cognition
 Affect
 Interpersonal
relations
 Behavior
 Symptom
formation
 Spiritual/moral
Effects specific to
preschool-age children
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Children typically only develop verbal
memory of a traumatic event between
2 ½ to 3 years of age
Even then, most recollections are spotty
and incomplete
Most common symptoms reported in
younger victims of trauma fall under the
category of behavioral effects, rather
than cognitive symptoms
Effects specific to
preschool-age children
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withdrawal
reenactments and play involving traumatic
themes
anxious attachment behaviors/separation
fears
regression to previous levels of
developmental functioning
disruptions in sleeping and toileting
startle responses/“freezing” behaviors
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repeated retelling of traumatic event
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increased aggressive, anti-social, and
hyperactive behaviors
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changes in behavior, mood, personality
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general or trauma-specific fears
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psychosomatic symptoms
Effects specific to
school-age children
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decline in school performance
increased inner behaviors
repeated retelling of traumatic event
isolation of affect
constant anxious arousal/hypervigilance
fearfulness/fear of recurrence
sleep disturbances
behavioral problems
regression to previous levels of developmental
functioning
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visual image and traumatic memory intrusion
problems relating to peers
more elaborate reenactments
psychosomatic symptoms
loss of interest in pleasurable activities
feelings of personal responsibility
Effects specific to adolescents
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acting-out behavior
self-criticism
fear of repetition of event in the future
efforts to avoid overwhelming feelings
hypervigilance
social withdrawal
thoughts of revenge and action-oriented responses
to trauma
acute awareness and distress related to intrusive
trauma images and memories
increased vulnerability to psychiatric disorders
flight into adulthood
The 3 R’s of Trauma Recovery
 Reliving
 Releasing
 Reorganizing
(Johnson, 1998)
Long-term Consequences:
The Adult Survivor
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Many adults continue to be affected by
traumatic experiences in childhood and
adolescence
Often the connection between early
experiences and continuous cycles of
problematic behavior are not recognized
Traumatized child--Traumatized parent?
Family System Effects
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Parents may constantly search for ways to
make sense of or explain the traumatic
event their child has experienced
Often attempt to reduce their sense of
helplessness or lack of power
The family may serve as a resource for
increased support and coping or an
obstacle that blocks the traumatized child’s
adjustment and recovery
“Trauma membrane”
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Parental reaction to the child’s trauma is of
primary importance in dealing with trauma in
children
The reactions of parents or significant others may
have a greater negative impact on children than
the children’s own direct exposure or severity of
their trauma experiences
When parents or caretakers are distressed, it
may impede their ability to assist their children
with their own stress reactions
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“Parents who must deal with the sudden
traumatization of someone they love; who
must cope with the physical, emotional,
and behavioral changes that often follow
trauma; and who must face their own
uncertainty and personal vulnerability are
clearly candidates for…secondary
traumatization” (Barnes, 1998, p. 76)
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It is important to note the family’s current
level of adaptation and the amount of
disruption caused by trauma
• If parents have different reactions or coping
styles, a cycle of tension may occur in the
couple relationship that negatively affects the
child
• Some parents may be overwhelmed by the
traumatic event and minimize the effects on
themselves and/or their child
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Parents who are able to manage and
regulate their reactions to traumatic
events will be more likely to effectively
support and protect their child in his/her
recovery
Impact of Parental Trauma
on Children
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Children may experience secondary
traumatic stress as a result of parental
traumatization, through:
• Direct witnessing of a parent’s trauma (e.g.,
domestic violence, sexual assault)
• Direct experiencing of the post-traumatic
reactions of symptoms in the parent (e.g.,
nightmares, flashbacks, startle responses)
Impact of Children’s Trauma
on Other Subsystems
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Siblings of traumatized children may experience
feelings of guilt, fear, anxiety, and secondary
trauma symptoms
Surprisingly, the issue of sibling abuse has been
relatively unaddressed in clinical and empirical
literature
Because of the impact of the child’s trauma on
parents, secondary stress reactions in siblings
may be overlooked or ignored
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In taking an ecological perspective of
trauma, the “circle of impact” should be
expanded beyond the immediate family
system
Symptoms present in a traumatized
child can affect those with whom the
child interacts at all system levels
Resiliency
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Certain individuals manage to succeed in
spite of the odds
Interplay between the child’s basic traits and
the environment
Post-traumatic growth
Resiliency Factors
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Personality factors
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Agreeable
Social
Compassionate
Internal locus of control
Cognitive factors
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Creativity
Insight
Initiative
World-view beyond trauma
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Affective factors
• Ability to manage affective reactions
• Broad range of emotions
• Sense of humor
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Behavioral factors
• Persistence
• Ability to generate relationships with peers
and adults
• Resourcefulness
• Ability to self-soothe
Secondary Traumatic Stress
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“Secondary Traumatic Stress (STS) is the
experience of tension and distress directly related
to the demands of living with and caring for
someone who displays the symptoms of posttraumatic stress disorder (PTSD)” (Figley, 1998)
Because of the emotional connection, being in
close, prolonged contact with a traumatized
person becomes a constant stressor
Family members and professionals often
experience symptoms of traumatization
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Also referred to as compassion fatigue, vicarious
traumatization, trauma transmission, burnout
Symptoms = “communicable” “infect” “mimic”
Symptoms are considered “secondary” because
they occur in those who have not directly
experienced the event.
May resemble PTSD-like symptoms, but may be
less intense
Therapists may not be aware of or they may deny
secondary trauma effects
“Savior”/”Rescuer”
Secondary trauma in professionals
may include the following:
• Sharing the survivors’ nightmares
• Sharing the hopelessness of survivors
• Feelings of aggression
• Confronting one’s own vulnerability and moral
values
• Feelings of numbing and avoidance
• Victim blaming/dehumanizing
• Other PTSD-like symptoms
Secondary Traumatic
Stress Guidelines
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Professionals should acknowledge the effects of secondary
trauma on themselves and their colleagues and take regular,
ongoing actions to insure the welfare of professionals and to
preserve their ability to deliver quality services;
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Professionals should not work alone but instead should seek
out or create arrangements in which they have regular and
open input from other professionals regarding the effects of
secondary trauma and its impact on the services they deliver,
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Professionals should recognize an ethical duty to self care
(Munroe, 1995)
Suggestions for Parents and
Child Care Workers
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Recognize the value of multiple perspectives
Watch and listen to the children
Use development as a guide for action with
adult and child
Identify factors related to poor growth,
learning and relationships within the family
system and work for change in the system
Help promote strengths and find opportunities
to increase resiliency in children
Where do we go from here?
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More prevention will reduce the need for
intervention
Training non-mental health professionals
Recognizing potentially traumatic events
Societal awareness and education
When one thinks about how a traumatic event
impacts one child and then begins to piece
together the number of people with whom that
one child has contact throughout his or her life,
the realization that a single event does not have
a single victim becomes clear. The
repercussions from trauma are infinite.
Beginning to identify and understand these
repercussions on traumatized children is critical
to prevent further loss of innocence.
Recommended References
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Barnes, M. F. (1998). Understanding the secondary traumatic stress of parents. In C. R.
Figley (Ed.), Burnout in families: The systemic costs of caring (pp. 75-89). Boca Raton,
FL: CRC Press.
Herman, J. L. (1997). Trauma and recovery (2nd edition). New York: BasicBooks
Johnson, K. (1998). Trauma in the lives of children: Crisis and stress management
techniques for teachers, counselors, and student service professionals (2nd edition).
Alameda, CA: Hunter House.
Monahon, C. (1993). Children and trauma: A guide for parents and professionals. San
Francisco: Jossey-Bass.
Nelson, B. S., & Schwerdtfeger, K. L. (2002). The systemic impact of traumatized
children. In D. Catherall (Ed.), Handbook of stress, trauma, and the family. Washington
DC: American Psychological Association. (Peer-reviewed chapter submitted for
publication; revise and resubmit).
Pynoos, R. S., Steinberg, A. M., & Goenjian, A. (1996). Traumatic stress in childhood
and adolescence: Recent developments and current controversies. In B. A. van der
Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of
overwhelming experience on mind, body, and society (pp. 331-358). New York: Guilford.