Trauma in Children and
Adolescents
Definition
• A significant number of children in
American society are exposed to
traumatic life events.
• A traumatic event is one that
threatens injury, death, or the
physical integrity of self or others
and also causes the victim(s) to
feel horror, terror, or helplessness
at the time it occurs.
• Traumatic events can include sexual abuse, physical abuse,
domestic violence, community and/or school violence, medical
trauma, motor vehicle accidents, acts of terrorism, war experiences,
natural and human-made disasters, suicides, or other traumatic
losses.
Statistics
 In community samples, more
than two-thirds of children
report experiencing a traumatic
event by age 16 years.
 A child has a 39 to 85 percent
estimated rate of witnessing
community violence.
 The estimated rate of
victimization can be as high as
66 percent.
 A youths’ exposure to sexual
abuse is estimated to be
between 25 and 43 percent.
Statistics
 Children and adolescents
make up a substantial
proportion of the nearly 2.5
billion people affected
worldwide by disasters in the
past decade.
 It is more common than not for
a child or adolescent to be
exposed to more than one
single traumatic event.
 Children exposed to chronic
and pervasive trauma are
especially vulnerable to the
impact of subsequent trauma.
Signs and Symptoms
Children and adolescents vary in the nature of their responses to
traumatic experiences; however, nearly all children and adolescents
express some kind of distress or behavioral change in the acute
phase of recovery from a traumatic event.
Symptoms May Include:
– Preschoolers: Thumb sucking,
bedwetting, clinging to parents,
sleep disturbances, loss of
appetite, fear of the dark,
regression in behavior,
withdrawal from friends and
routines.
– Elementary-school children:
Irritability, aggressiveness,
clinginess, nightmares, school
avoidance, poor concentration,
withdrawal from activities and
friends.
– Adolescents: Sleeping and
eating disturbances, agitation,
increase in conflicts, physical
complaints, delinquent behavior,
poor concentration.
Recovery
 The majority of children and
adolescents manifest
resilience in the aftermath of
traumatic experiences. This is
especially true of singleincident exposure.
 Youths who have been
exposed to multiple traumas,
have a past history of anxiety
problems, or have experienced
family adversity are likely to be
at higher risk of showing
symptoms of posttraumatic
stress.
Recovery
 Research has provided evidence about
predictors of trauma recovery, although
there are no perfect predictors.
Recovery can be impeded by:
 Individual and family factors
 The severity of ongoing life stressors
 Community stress
 Prior trauma exposure
 Psychiatric comorbidities
 Ongoing safety concerns
 Poverty and racism
 Caretaker responses to trauma
Recovery
On a positive note, individual, family,
cultural, and community strengths can
facilitate recovery and promote resilience.
Social, community, and governmental
support networks are critical for recovery,
particularly when an entire community is
affected, as when natural disasters occur.
Treatment
• A substantial minority of
children develop severe acute
or ongoing psychological
symptoms.
• Most children and adolescents
with traumatic exposure or
trauma-related psychological
symptoms are not identified
and, consequently, do not
receive any help. Those who
do receive a wide variety of
treatments.
Treatment
• Literature has focused largely on adults until recently and limited
empirical data is available on the application of treatments with
children and adolescents with traumatic exposure.
• Cognitive–behavioral therapy (CBT) techniques have been shown to
be effective in treating children and adolescents who have persistent
trauma reactions.
• Most evidence-based, trauma-focused treatments include
opportunities for the child to review the trauma in a safe, secure
environment under the guidance of a specially trained mental health
professional.
Role of Mental Health
Professionals
Mental health professionals have an important role in facilitating the
recovery of children, adolescents, and families when traumatic events
occur. Opportunities include:
– Working with first responders and community organizations that
serve families with children
– Working with existing clients who experience trauma
– Reaching out to help children and families affected by trauma in
their community
– Developing and implementing research studies to determine
effective, evidence-based treatments
– Psychologists and other mental health providers can also
register with the American Psychological Association’s (APA)
Disaster Response Network or volunteer their services through
their local chapter of the American Red Cross
Role of Assessments
 Using standardized, wellestablished measures helps to
ensure efficient assessment and
diagnosis, as well as provides
critical information for treatment
design.
 Enables tracking of symptom
progression in the recovery
process and return-to-baseline
functioning.
 Aids in the identification of comorbid conditions.
 Facilitates broad screening for
traumatic exposures upon intake
or in community and agency
settings.
Assessments of Trauma and
Child Abuse
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Trauma Symptom Checklist for Young Children™ (TSCYC™)
Trauma Symptom Checklist for Children™ (TSCC™)
Trauma Symptom Checklist™ Software Portfolio (TSC™-SP)
Checklist for Child Abuse Evaluation (CCAE)
Child Sexual Behavior Inventory (CSBI™)
House-Tree-Person and Draw-A-Person as Measures of Abuse in
Children: A Quantitative Scoring System (H-T-P/D-A-P)
Assessments of Depression
• Reynolds Child Depression Scale™-2nd Ed. and Short Form
(RCDS™-2 and RCDS™-2:SF)
• Reynolds Adolescent Depression Scale, 2nd Ed. and Short Form
(RADS-2™ and RADS-2™:SF)
• Clinical Assessment of Depression™ and Scoring Program (CAD™
and CAD™ SP)
• Adolescent Psychopathology Scale™ and Short Form (APS™ and
APS-SF™)
• Personality Assessment Inventory®- Adolescent (PAI®-A)
• Reynolds Depression Screening Inventory™ (RDSI™)
Assessments of
Anxiety/Irritability
• Adolescent Psychopathology Scale™ and Short Form (APS™ and
APS-SF™)
• Personality Assessment Inventory®- Adolescent (PAI®-A)
• Clinical Assessment of Behavior™ (CAB™)
Assessments of Behavioral
Disturbance
(Sleep disruption, acting out, loss of appetite, somatic complaints, etc.)
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Emotional Disturbance Decision Tree™ (EDDT™)
Eyberg Child Behavior Inventory™ (ECBI™)
Sutter-Eyberg Student Behavior Inventory-Revised™ (SESBI-R™)
Clinical Assessment of Behavior™ (CAB™)
Pediatric Behavior Rating Scale™ (PBRS™)
Personality Assessment Inventory®-Adolescent (PAI®-A)
Revised Behavior Problem Checklist-PAR Edition (RBPC)
Children’s Aggression Scale™ (CAS)
Reynolds Adolescent Adjustment Screening Inventory™ (RAASI™)
Assessments of Interpersonal
Relationships
• Parenting Stress Index™, 4th Ed. (PSI™-4)
• Stress Index for Parents of Adolescents™ (SIPA™)
• Clinical Assessment of Interpersonal Relationships™ (CAIR™)
Risk Assessments
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Psychosocial Evaluation & Threat Risk Assessment™ (PETRA™)
Structured Assessment of Violence Risk in Youth™ (SAVRY™)
Suicidal Ideation Questionnaire (SIQ)
Adolescent & Child Urgent Threat Evaluation™ (ACUTE™)
Firestone Assessment of Violent Thoughts™-Adolescent (FAVT™-A)
References and Resources
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2008 Presidential Task Force on Posttraumatic Stress Disorder and Trauma in
Children and Adolescents
– http://www.apa.org/pi/families/resources/children-trauma-update.aspx
Coping With a Disaster or Traumatic Event: Information for Individuals and
Families
– http://www.bt.cdc.gov/mentalhealth/general.asp
Post-Traumatic Stress Disorder (PTSD)
– http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorderptsd/index.shtml
Treatments That Work
– http://www.nctsnet.org/resources/audiences/parents-caregivers/treatmentsthat-work
Topic Specific Resources: Trauma and Justice
– http://www.samhsa.gov/children/earlychildhood_trauma.asp
How Children Cope With Trauma and Ongoing Threat
– http://www.nasponline.org/resources/crisis_safety/ongoingthreat.aspx