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Trauma in young children can prevent the normal development of areas of the brain involved in specific functions such as access to memory, affect and impulse regulation, integration of brain functions and language, it can also produce alterations in attention and consciousness, organizational skills, somatizations and biological regulation and result in distortions in self-perception and meaning of the world around them. All of these alterations negatively impact children’s interpersonal relations with adults and peers and also learning and handling of new experiences. The long term effects are correlated to the areas of the brain being developed at the time of the trauma.  This will impact the cognitive, social and emotional functioning of the child in ways that become more resistant to change the younger the child is at the time of trauma. This is particularly severe when the child is exposed for a prolonged time to developmentally adverse interpersonal trauma and maltreatment, such as emotional abuse, neglect, attachment disruptions, physical abuse and sexual abuse. These effects are long term and can affect the individual into adulthood masquerading at times as mental illnesses like for example bipolar disorder or ADHD.

 Child in pain

One of the leading world authorities on the study, research and treatment of complex trauma in children and adults for the last twenty years is Dr. Bessel Van Der Kolk, MD.  He is a professor of psychiatry at Boston University and director of the Trauma Center at JRI in Brookline Massachusetts. One of the programs in his center is the SMART therapy program for traumatized children. A greatly successful treatment option, the SMART therapy program of Sensory Motor interventions was created to help traumatized children develop arousal regulation (1) It has been based on an integration of three sources: the first one comes from Attachment Theory and Treatment, utilizing the protective healing properties that secure attachment provides against trauma through co-regulation by a caring adult that provides a calming and safe relationship to stimulate and calm the child into keeping them inside their own window of tolerance to stress. In this the caretaker is included and plays a role in learning how to touch, hold and hug to calm down the child, and all those activities that come naturally to an effective and caring parent, such as providing a stuffed toy animal “to protect them” among others. The second source comes from activities from the sensory-motor realm, associated usually with physical, occupational and sensory integration therapy, such as crawling through a play tunnel, or pushing against a pillow or,  wrapping the child in a soft warm blanket, or rocking and rhythmic activities. The third source comes from sensory motor psychotherapy activities, bringing the body into focus and applying mindfulness of sensory body sensations and also labeling them and connecting them with feelings, as a road to increase cognition, or even a state change, through simple movement activities such as standing up, rocking or jumping which aid to calm the child. In this way the child can develop over time some thoughtful and adaptive responses to traumatic triggers.  As these therapists have observed, children, as they feel safer, often begin to narrate their trauma experience with great clarity, thus allowing the adult to continue to help them to heal, or in younger children this appears in their dramatic and symbolic play where therapy can also intervene. Slowly then the child builds an ability to calm himself down when arousal rises to the upper limits of their window of tolerance, or to stimulate oneself, when arousal drops to the lower limits causing disengagement and shut down as in dissociative reactions.

 angry child

Thus, just like discussed previously when discussing trauma in general, trauma therapy  with small or school age children is not done through attempting to have the child relieve the trauma scenario and narrate it. This would risk re-traumatization of the child and usually the child is unable to put the experience into words, as it is often impossible for adults as well, because many of these memories are stored as dissociated images and sensations. The road taken by the therapist is by slowly building safety first, through teaching body activities that give them the ability to calm down the stressful body responses triggered by sensory memories and flashbacks. All of this within the safety of a caring relationship and with great care to observe their window of tolerance before moving to the next activity, or to assess how the child is handling the present one. This method is actually done in very similar fashion with adults and teens in the sensory-motor psychotherapy of trauma, on which this program is based.  Based on the same principles, this is one of many therapies utilizing the body and the understanding of its connection to the brain in stimulating and fostering greater integration of different areas affected by trauma, as researched in the last few years of neuroscience studies.

(1) Taken from a presentation by the SMART Program director and therapists at the International Trauma Conference in Boston, MA 2009

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