Trauma’s Impact in Middle Childhood: Clinical Implications

1. Trauma’s Impact in Middle Childhood: Clinical Implications Esther Deblinger, Ph.D. CARES Institute UMDNJ-SOM May 11, 2006

2. Middle Childhood (5-12 years) • Stage of life filled with many firsts that can be stressful, but optimally lead to feelings of mastery and increasing social competence • Natural developmental processes may be disrupted and/or altered by traumatic experiences that can impact on overall growth and adjustment

3. Cognitive Development in Middle Childhood • Ability to process information in a systematic/logical manner develops BUT • Characterized by concrete operational thinking • Interpretations are still very literal and concrete • Tendency to over generalize and see things in good/bad terms

4. Trauma and Cognitive Processes in Middle Childhood • Natural tendency to over generalize may lead to highly dysfunctional beliefs • School age children’s tendency to rely on the most parsimonious concrete explanations for events can be problematic • Limited ability to consider alternative explanations on their own

5. Social Development During Middle Childhood • Normative research suggests decreased self esteem during first years of school • Increased concern for social approval and acceptance from teachers and peers • Increased tendencies to make social comparisons • Beliefs and expectations about relationships develop • Secrets have social value

6. Trauma and Social Processes in Middle Childhood • School age children more likely to engage in sexually reactive behavior in secret • Exposure to interpersonal violence may lead to distorted relationship expectations • Social concerns may inhibit disclosure and encourage avoidance

7. Emotional Development in Middle Childhood • Emotions may guide/dominate behavior more than abstract reason • Increase awareness of others’ emotions • Increased recognition that one can experience different emotions at the same time • Begin to develop more complex emotions

10. Trauma and Emotional Processes in Middle Childhood • Acceptance of perpetrators’ simplistic, concrete rationales for violence • Heightened vulnerability to feelings of embarrassment, guilt and shame • Potential to isolate and avoid to minimize distress and avoid social fears

11. Impact of Trauma on Fears in Middle Childhood • Normative school age fears (e.g. bodily harm, bad storms, burglars, etc.) are typically concrete, specific, realistic and transient • Fears may be intensified and longer lasting • Concrete behavioral reactions may be utilized to cope with trauma-related fears • Parental reactions may inadvertently reinforce children’s trauma-related fears

12. Developmental Implications for Treatment • Provide age appropriate education and emotional skill building exercises • Continuously assess children’s understanding and retention by asking questions and listening carefully • Incorporate concrete behavioral exercises and role plays • Utilize concrete language and images to convey and discuss abstract issues

15. Encourage humor and fun to motivate school age children In laughter there is always a kind of joyousness that is incompatible with contempt and indignation Voltaire If you’re not laughing – you’re not doing it right! Barbara Bonner (2005)

16. TF-CBTWeb www.musc.edu/tfcbt TF-CBTWebis sponsored by: TF-CBTWebwas developed and is maintained through grant No. 1-UD1-SM56070-01 from the Substance Abuse and Mental Health Services Administration.