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We have lived with childhood trauma since Biblical times, hence the quote from Genesis, where Abraham was about to sacrifice his son, Isaac. We have become used to it. That is why helping people with childhood trauma needs preparation. That includes more than simply being well-informed about trauma and its effects on children and their development. It also includes our ongoing self-care.
During the International Forensic Psychiatry Lecture Series on October 3, Dr. Vincenzo Di Nicola discussed the effects of Adverse Childhood Experiences (ACEs) on lifelong health and mental health. Of particular interest to people working at the intersection of mental health and the law, he discussed planning trauma-informed care for child maltreatment. (You can watch a recording of the lecture online.)
A child’s self-portrait after experiencing trauma.
Trauma
The dramatic change in the healthcare field’s understanding of trauma is reflected in an update to the Diagnostic and Statistical Manual of Mental Disorders (DSM). Released in 1980, the DSM-III defined trauma as an event that was generally outside the range of normal human experiences. When the DSM-IV was released in 1994, the definition changed to an event involving actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
Trauma can take two forms.
- The first form is a single event that is dangerous, isolated, and sudden (e.g., a car accident, witnessing murder or suicide). People who experience this type of trauma typically have a vivid memory of the event, a faster recovery time, and a better health outcome.
- The second form has multiple, long-term, and repetitive events (e.g., physical or sexual abuse, war). People who experience this type of trauma typically have fuzzy memories, feel dissociation and helplessness, experience changes in their character, and have more long-standing problems.
Because of criticism that trauma was being too loosely applied or could not be used with preverbal children, some researchers draw connections between specific events and post-traumatic stress disorder (PTSD). DSM-IV’s requirements for a diagnosis of PTSD align with the first type of trauma.
Adverse Child Experiences
ACEs include physical, emotional, and sexual abuse, as well as neglect and household dysfunction. Research dating back to the 1990s shows a strong link between the number of ACEs and worsening health outcomes.
The effects of experiencing violence depend on the characteristics of the violence, developmental phase, the family and community context, and the response to the violence by family, school, community, and others.
ACEs derail children’s normal developmental trajectory, so the younger the child is and the earlier stage of their development, the greater their risk. Knowing the child’s developmental stage is crucial for mental health professionals to understand how the child experiences the violence and trauma.
Experiencing violence changes the way children think about themselves and the world around them. It affects how they view relationships as trustworthy and dependable, particularly if the perpetrator was a parent, relative, or teacher who broke their trust.
Protective factors include having a supportive person (e.g., parent, friend, teacher), a safe space (e.g., home, a safe haven in the neighbourhood), and resources to find better ways of coping (e.g., adaptive temperament, intelligence).
Relationships are the key ingredients of early experience. Nurturing and responsive relationships build healthy brain architecture, which provides a strong foundation for learning, behaviour, and health. When protective relationships are not provided, higher levels of stress hormones disrupt brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits.
Trauma-Informed Care
Whether parents or counsellors, caregivers are affected by the trauma experienced by the people they care for. To protect themselves from feelings of vulnerability and trauma, caregivers may have limited ability to hear the child’s distress.
A healing environment is needed, not only for the child but also for the caregiver. This includes our own self-care based on empathy for ourselves to hear the traumatic story. Dr. Di Nicola suggests having debriefs about the events and frequently looking at our responses, resistances, and tensions toward traumatic materials.
Treatment can include cognitive therapy (mentalization), critical incident stress management, eye movement desensitization and reprocessing, medications to treat symptoms, treatment of comorbidity (e.g., substance use), cultural family therapy, and combined therapies.
Written by Virginia St-Denis and approved by Dr. Vincenzo Di Nicola.
