By Curtis Buzanski, LMFT, LAADC December 28, 2018 The Trauma Response: Re-Thinking Diagnosis When Trauma is Present Survivors of trauma often experience symptoms related to their trauma that are parallel to many of the diagnostic criteria of…
Marriage and Family Therapist
January 13, 2019
Youth, Trauma and The Brain
A fifteen-year-old youth that was adopted at the age of five years old out of foster care into an intact family has difficulty with sadness, anxiety and low motivation. The adoptive parents struggle, because while the youth has been in their care for ten years, the youth continues to exhibit symptoms of difficulty following directions, respecting authority, becoming overwhelmed with emotion and being destructive. The adoptive parents feel at a loss and frustrated, because this youth continues to have difficulty in school, with peers and at home. Prior to the adoption, they witnessed domestic violence in the home. After being removed from the home at age 3, they were in three foster placements until adopted.
This is an example of the trauma an individual can experience at a young age that may affect their ability to function in later years, despite being in a safe environment after the adoption. There is a common misconception that a diagnosis of PTSD is only appropriate with people that have experienced a traumatic event (car accident, war, natural disaster, etc.). The reality is trauma comes in all types of forms and environments and if untreated affects the development of the youth’s brain and their ability to utilize the rational part (Pre-Frontal Cortex) of their brain to make sound decisions.
The ACE study (Adverse Childhood Experiences) studied 17,000 participants and found there was a correlation between an individual’s health and the number of adverse events a person experienced before the age of 18. As the number of ACE’s increased, the number of complications with physical health, mental health and social health increased. The more complex and persistent trauma that a youth experiences, the more the development of the brain is interrupted and the youth continues to exist in a state of “Fight, Flight or Freeze”. Essentially, the brain of the youth is hijacked and the youth is unable to make sound decisions that would prevent them from having a healthy response to authority figures, soothing themselves, regulating their emotions, and following through with completing tasks. This study underscores the importance of early intervention. As a clinician, I have found that many youths in under served areas are diagnosed with ADHD, ODD, and unspecified disruptive behavior disorder, while also having significant trauma history.
Types of Trauma
The types of trauma a youth (or any person) can experience are:
Bullying, community violence, complex trauma, disasters, early childhood trauma, domestic violence, medical trauma, physical abuse, refugee trauma, sexual abuse, terrorism, and traumatic grief.
All of these types of trauma affect the youth differently and when trauma is continuous and pervasive, this can result in the brain developing in a way that protects the youth. The brain will over develop the limbic system and under develop the pre-frontal cortex. This results in hypervigilance, racing thoughts, flashbacks and other presenting symptoms indicative of Post-Traumatic Stress Disorder.
How to Help
If you know a youth that has been exposed to trauma, it is important to provide a safe and stable environment for them to connect and build healthy relationships. Work with the youth on making safety plans and support them in building a culture of safety and security. Identifying red flags is vital to supporting the youth. Additionally, remember that you can play a significant role for the youth in aiding their moving beyond their trauma.
Breathing through the nose (instead of through the mouth) activates the “rest and digest” physiological processes in the body and allows the Pre-Frontal Cortex to function at a higher level, allowing the youth to think rationally and alter their thoughts and behaviors that are a result of the trauma experienced.
Grounding in the moment of hypervigilance, panic or bouts of depression allows the youth to stand in the present moment and leave their racing thoughts and negative beliefs in their head for the time being. Encourage the youth to name colors, textures, sights, smells, etc. surrounding them to bring their attention into the present moment.
Mantras are essential to supporting the youth in your life that are struggling. For example, helping the youth recite “I am strong, I am safe, I am loved” will allow the youth to build new pathways in their brain (along with the grounding and breathing) to signal their brain when they are truly safe and secure.
Remind the youth (and yourself) to hold themselves kindly. Complex trauma does not happen overnight and does not go away overnight. Practice, practice, practice. Even when they are not anxious, depressed or distraught, practice in moments of peace; fortify the neural connections in the brain to signal the youth when they are truly safe. The brain is like a muscle and coping skills help strengthen it.
Remember, just like with exercise, we do not have a six-pack of abs after doing one or two sit-ups and once obtained, maintenance is needed to keep the abs (brain) strong and effective.
HOPE for You and Your Youth
There is hope. Time tested methods can aid youths in processing trauma experiences in a therapeutic setting and strengthen the bond between the youth and a safe caregiver. I always recommend therapy for the youth and the family. Healing is important and necessary to moving forward. Additionally, trauma focused cognitive behavioral therapy is an evidence-based practice that facilitates the healthy development of the brain and safe relationships to facilitate processing trauma experienced.
Things to Keep in Mind
Change your lens and perspective. This can be difficult, especially if the youth is being extremely defiant, oppositional or cannot complete school work or daily tasks. Remind yourself, “I am going to be their safe space and I will support them in progressing towards a secure attachment, healthier relationships and secure environment”. Treatment takes time and engagement that is consistent. Adjust expectations to aid in the support of the youth and celebrate the little victories (completing their homework and turning it in or that they showered and brushed their hair) with the youth. Let them know you are in their corner and hold appropriate boundaries to support safety and progress.
If there are concerns for safety for the youth (self-harm, suicidal thoughts, harm to others, caregivers harming the youth or others in the home or an unsafe environment), remember safety trumps your relationship with them. Wellness checks can be requested from the Sheriff, CPS can be contacted and safety plans can be made. Here are some numbers to utilize if you are concerned for the safety of the youth, yourself or others:
Again, there is hope. Commitment, consistency and stability allow the youth to process their trauma in a safe environment. When doing this, engage with a therapist who is trained in trauma-informed care. Trauma-Focused CBT is a particularly effective evidence based treatment that supports the relationship between the youth and the caregiver. As the youth’s support system, remember your significance and the positive impact you can have in their life.
About the Author
Stephanie Beermann is a Licensed Marriage and Family Therapist. She has worked with youth, trauma, depression and anxiety for over five years. She has training in Trauma-Informed Care, Adoption Competency and Trauma-Focused Cognitive Behavioral Therapy. Additionally, she incorporates art interventions and mindfulness to support the integration of trauma experiences so an individual can obtain balance and health. Stephanie has attended numerous mindful and art seminars to support this integration. She has a private practice in Natomas while currently working full-time in a county contracted non-profit agency. In her free time, she spends time with friends and family and enjoys reading, crochet and creating Mandalas.