Understanding Child and Adolescent Trauma to Stop the Cycle

Traumatic events that overwhelm a child's or adolescent's coping skills and lead to a functional impairment can result in debilitating coping mechanisms that hinder social function, academic performance and success in life. Because trauma so often factors into the diagnosis, treatment and complexities of behavioral health conditions, Northwell Health's behavioral health service providers work to identify underlying traumatic events plaguing their patients.

"Trauma-informed care always factors into the treatment of our child and adolescent patients," said Patrice Reives-Bright, MD, director of child and adolescent psychiatry at South Oaks Hospital

"As a result of severe trauma, children often develop destructive behaviors that may include aggression and self-harm. During adolescence, these may morph into other behaviors such as substance abuse or delinquency."

Although the advantage of youth can permit some patients to recover more easily than adults, one-time traumatic events, such as the death of a loved one, or chronic trauma via ongoing emotional or physical abuse, can lead to debilitating lifelong consequences. 

"While most children and teenagers can be resilient following a distressing event, there are risk factors that make some more vulnerable to the effects of trauma," Dr. Reives-Bright said. "Exposure to trauma has the potential to affect the developing brain and lead to long-term effects and need for intensive treatment. A child may also become predisposed to continued victimization."

Identifying patients dealing with a traumatic experience and referring them for treatment is critical for reducing the likelihood that patients suffer deleterious long-term effects.

Effective Treatment Modalities

"A key aspect in all our service areas is that counselors are knowledgeable and sensitive to the potential effects of trauma," Dr. Reives-Bright said. "Our service provides a safe environment for children to discuss their experience. Traumatized or abused children will often feel guilt and shame. It's a great relief for them to process this in treatment and see they're not defined by their trauma."

The safe environment at South Oaks incorporates primary aspects of the Sanctuary Model, a paradigm that informs care for trauma patients and their support systems. This framework promotes calming techniques instead of restraint and seclusion, which can retraumatize children. Allowing children an escape when conversations get frightening is an important part of making them feel safe.

Each patient receives a safety bag, which he or she decorates and fills with familiar, comforting items. If patients become overwhelmed during therapy, safety bags can help them remember they are in a safe place and prevent them from self-harming or becoming aggressive.

Therapeutic Strategies

South Oaks and Zucker Hillside Hospital providers use group dialectical behavior therapy (DBT) to develop alternate coping skills for patients. During DBT sessions, patients learn ways to regulate intense emotional experiences. They may also learn how to construct a trauma narrative that eliminates distortions and addresses any associated guilt or shame. In the group setting, the facilitator's experience and skills are instrumental in breaking through unhealthy patterns and recovery.

"A tenet of DBT is that people are doing the best they can, and they need this to be recognized in order for them to do better," said Peter D'Amico, PhD, director of child and adolescent psychology at Zucker Hillside.

"This is really important for teenagers, especially those who come from situations that are not validating for them. Validating their emotions without judgment is key to disclosure — and therapists and clinicians already have this skill as part of their professional code of ethics."

Because trauma-related conditions are typically complex, behavioral health care professionals deploy a number of techniques, such as noncoercive behavioral modification and psychoeducation about stress and trauma, to deliver highly personalized care that increases the efficacy of treatment.

Focus onHealth TV

Watch Focus onHealth, Northwell Health's TV show. It's the healthy way to stay informed!