Recognition grows that children's behavior problems may be trauma related

Editor's Note: This is the first of three stories that looks at new ways professionals are responding to childhood trauma. 

Mental health professionals and educators are rethinking their approach to childhood trauma.

For years, children were considered resilient to the effects of stress. Recent research demonstrates, however, that chronic childhood trauma can literally change the structure of the brain, so much so that behavior and learning ability are affected.

"Our kids get a bad rap at times because we see and judge only the behavior," says Diane Marquess, Director of Behavioral Health Services at Family & Children's Services of Kalamazoo and Battle Creek. "But children show us how they think and feel through their behavior."

Diane MarquessPreviously, what were labeled as behavioral and learning-related issues, such as non-compliance, learning disabilities, depression, oppositional disorder and even Attention Deficit Disorder, are undergoing a reexamination as the understanding of the effects of traumatic stress on a child's brain grows.

"The over-activity of fear centers affect the limbic system, which is constantly aroused in a fight or flight freeze, or in a fearscape," says Connie Black-Pond, Clinical Director and Co-Founder of the Childhood Trauma Assessment Center at Western Michigan University, established in 2000 as one of the first trauma assessment centers in the state. "The results might be a child who exhibits behavioral issues or a child who is shut down, depressed, emotionally numb, or disassociated."

The trauma assessment itself can bring tremendous relief to the child and family, and also direct the type of resources used to help the child regain resiliency, says Black-Pond. Unfortunately, the demand for assessment at CTAC is so great that clients are often put on a six-month waiting list. For that reason, CTAC has addressed these growing needs by training others at various facilities locally and statewide to provide assessments, including Easter Seals and Kalamazoo Community Mental Health.

"Assessment can make a huge difference in understanding what has happened to a child. Naming an issue as trauma helps a child and the caregivers make sense of their reaction," says Black-Pond. "That assessment, by itself, can be extremely de-stigmatizing. The child, parents, teachers and therapists can then act from a place of understanding rather than one of judging the behavior."

Instead of asking what's wrong with the child, Black-Pond says, we need to be asking what happened to the child and how can that child be helped?

"With this new model, we understand these behaviors may be a reaction to trauma," says Marquess. "We're educating ourselves more and more. How do we as a community recognize that these behaviors are coming from a different source other than willfulness?"

When children are exposed to repeated trauma, whether through a drug or alcohol-addicted caregiver, domestic violence, mental illness or witnessing criminal activity, to recover they must learn to manage their flight or fight responses and trust again.

Identifying trauma early can assist in healing, not only because the child can be directed toward the appropriate resources, but because the brain is more plastic and receptive to change in childhood. 

Many current therapies exist to address the building of coping skills, such as Trauma-focused Cognitive Behavioral Therapy, a multifaceted approach that focuses on 10 components, including relaxation skills and identifying triggers, to build resiliency. 

Cricket Leigh, a home-based therapist with Elizabeth Upjohn Community Healing Center, uses Trauma-focused Cognitive Behavioral Therapy, which is taught to both the children and their caregivers to help families regain balance and monitor reactions to fear-triggering situations.

Cricket Leigh"Home-based therapy is very different from regular office therapy. You're actually a part of the family, which means you have to be careful with the boundaries," Leigh says. "I'm in their home when they are having screaming matches. I get all-access. I go to doctor's appointments. I'm in the school. I talk to teachers, go to meetings. I have to advocate in every position. There is so much coordinating it's almost like case management mixed in with actual therapeutic techniques."

Those techniques are as varied as the clients Leigh treats, and include play, art, and movement-based therapies such as yoga.

But whatever Leigh uses in addition to TF-CBT, the success of any treatment depends largely on trust, which Leigh carefully cultivates over months before she offers advice and suggestions. 

Leigh, who manages a caseload of 12 children (ages 7 to 17), plus three transitional clients whom she meets with once a month, says that she sees a lot of positive outcomes, which she attributes to the proven success of TF-CBT, a modality that boasts an 80 percent success rate in improvement and the highest level of empirical support, according to the U.S. Department of Justice.

"In terms of healing, I have seen kids stop acting out, lying, having nightmares, stealing, being sexually inappropriate, and a host of other behaviors," says Leigh. "I see kids bond to the caregiver in a new way and they then are able to develop trust for others instead of constant fear or mistrust."

Early assessment and knowledgeable treatment offer the best outcomes, says Black-Pond. "When traumatized children learn to regulate and manage and self-calm and speak out appropriately, that helps them with resiliency," Black-Pond says. "When they get connected with people who can understand their behavior, who can be thoughtful, patient and caring, it helps them build these skills."

Connie Black-PondUnaddressed childhood trauma, however, can increase the likelihood of substance abuse, emotional issues, and even employment and health problems in adulthood. If caregivers or professionals suspect a child is suffering from repeated trauma, a free online screening is provided by Easter Seals Michigan called Look, Uncover, Nurture and Act (LUNA) found here. 

The Easter Seals Michigan website also provides useful tools and tips for dealing with trauma, as well as providing resources.

Local mental health professionals, such as Black-Pond, Marquess, and Leigh, are promoting a cultural shift in the way we think about childhood trauma, much like the one that has occurred over the past several years related to traumatic brain injury due to repeated concussions.

"We need to learn to target trauma in a way that is non-judgmental, then help children to learn the skills they need to feel good about themselves," says Black-Pond. "Children who experience trauma often think something is wrong with them, that they deserved it, and that no one is ever really going to love them. When they have been assessed, they can get the help they need to feel successful."

Theresa Coty O'Neil is a Kalamazoo area freelance writer. Her articles have appeared in many local publications and her short stories have been published in Alaska Quarterly Review and West Branch, among others. 

Marty Blackwell is a freelance illustrator and designer in the metro Detroit area. Her work can be found here.

This article is part of Michigan Nightlight, a series of stories about the programs and people that positively impact the lives of Michigan kids. It is made possible with funding from the W.K. Kellogg Foundation. Read more in the series here.