Karen Blumberg,
MA, LCMHC
Karen Blumberg, MA, LCMHC holds a Master’s degree in counseling psychology and is licensed as a psychotherapist. She has an extensive background working with children, teenagers and trauma. Karen is trained in several clinical modalities including couples counseling, family systems counseling, Emotionally Focused Therapy, Internal Family Systems, Hypnotherapy, and Narrative therapy.
More than two-thirds of students experience some form of trauma by age 16. It could be witnessing or experiencing violence to the illness or loss of a loved one. We know that trauma rewires children’s brains and interrupts neural pathways. We know that the impacts of childhood trauma can resonate well into adulthood. It can disrupt learning and social relationships. It can lead to substance abuse and repeating cycles of violence.
But we also know that while these effects can profound, they also can be reversible. Caring adults can help children to feel safe again. They can help them heal and they can rewrite the trajectory in the lives of traumatized children. Here’s how schools, parents, and the community are helping children who have experienced trauma in their lives, and how you can help them, too.
Facts About Trauma in Children and Young People
There is a lot to unpack about childhood trauma and adverse childhood experiences. Parents, teachers, and childcare professionals may feel overwhelmed by it, especially when they come to realize the devastating and long-term consequences trauma can have on the developing brain.
A good starting point is understanding what constitutes childhood trauma and teasing out the facts from the myths.
What Is Child Trauma?
The National Child Traumatic Stress Network defines trauma as any event a child experiences or witnesses that causes them to feel threatened. So, what does that mean?
Generally speaking, there are three kinds of trauma.
- Acute trauma: A single incident that may be direct, like being the victim of a violent crime or natural disaster, or indirect, like witnessing the events of an actual tragedy unfolding on television.
- Chronic trauma: Repeated, prolonged exposure to a single type of event as in ongoing domestic violence or medical trauma. Chronic trauma can also be insidious, meaning that it is tied to the child’s environment such as wars or mass migrations.
- Complex trauma: Multiple events, usually over a period of time and may involve a direct caregiver. Complex trauma often begins between the ages of 0-6.
There are traumas that you can see like the bruises and broken bones of physical violence, the malnourished, unwashed bodies and filthy clothes of neglect. Each year enough children to fill 9 stadiums receive hospital treatment due to physical assault. Then, there is the trauma that occurs from mental and emotional abuse without obvious outward signs.
It is so important to understand that trauma is not relegated to certain communities or cultures. Childhood trauma can’t be dismissed as simply a problem of poverty or inner cities, of refugees or foster children. In fact, one of the seminal studies on the long-term effect of ACEs came from a white, middle-class, and largely college educated community.
Types of Trauma
Childhood trauma doesn’t always look like you expect it to. The unifying factor of childhood trauma is that it puts a child in a frightening, violent, or dangerous situation that is out of the child’s control. Though, that doesn’t mean a child won’t feel in some way responsible for being in that situation.
While by no means an exhaustive list, these are some triggers of trauma and traumatic stress in children and adolescents:
- Abuse: physical, sexual, or emotional harm
- Neglect: failure to provide for a child’s basic health and welfare needs
- Domestic violence: perpetrating violence against a family member
- Household dysfunction: substance misuse, divorce, displacement, or homelessness
- Community violence: school or gang shootings, riots or acts of terrorism
- Loss or grief: sudden or unexpected death or death of a close family member
- Natural disasters: tornados, hurricanes, flood, or drought
- Medical: accident, injury, or life-threatening illness and resulting treatment
Karen Blumberg, a licensed psychotherapist with an extensive background working with children, teenagers and trauma, takes care to clarify that not all stressful experiences are traumatic. “We are not talking about a parent who is just working a lot and preoccupied,” she says. Blumberg notes that children’s responses to a traumatic event aren’t universal. Siblings removed from a home might interpret that experience very differently. Certain factors can increase the impact of traumatic events, like whether the child has experienced trauma in the past. Family, caregivers, and community also play a role in how children process traumatic events. Supportive environments can act as buffers for trauma. Also, when children feel like they are being listened to and believed, they are less likely to develop toxic stress reactions to traumatic events.
“Two people can go through the same experience and they come out very differently,” Blumberg explains. “Some people are just naturally more resilient than others or have more resources, including inner resources.”
Recognizing the Symptoms and Effects of Child Trauma
According to Dr. Bruce Perry, a leading voice in the field of child trauma, more than five million U.S. children experience a traumatic event every year. 40% of those children will go on to develop “some form of neuropsychiatric problem that can significantly impair their emotional, academic, and social functioning.” If left unresolved, the effects will continue to reverberate well into adulthood.
Fortunately, there are things that adults can do to help mitigate and heal the effects of trauma. Knowing the signs and symptoms is the first place to start.
Symptoms and Signs of Trauma
When children experience trauma, their brains immediately go into fight, flight, or freeze mode. Trauma then raises their “baseline” reactions. How this looks to adults may be a kid who routinely overreacts to situations that to others don’t seem stressful. These overreactions lead to kids feeling angry, scared, overwhelmed, exhausted, or all of those feelings at once. And it manifests differently in children depending on age:
In young children
Young children who have experienced trauma may appear to be overly fearful. They may cry a lot, be hard to console, have nightmares, or seem irritable or angry. Weight loss, poor eating, or regular stomach aches may be signs that they are carrying around toxic stress.
Elementary school
In elementary school, trauma-related stress may look a little different. Like younger children, they may exhibit fearfulness and anxiety. Adults may notice these kids have difficulty concentrating and difficulty sleeping. They may seem hypervigilant or exhibit behavior problems in school. Internally, they may be dealing with feelings of guilt and shame.
As teens
As they become teenagers, the stress response to trauma becomes more heightened. Teenagers begin to “play out” their stress. This can look like cutting or self-harming, eating disorders, substance abuse, or risky sexual behavior.
Blumberg advises that trauma can present with a range of behaviors. She suggests looking for clusters of clues. Look for how they act towards teachers and peers. Do they seem over anxious or depressed? Do they come to school unkempt?
Extreme abuse can lead to dissociation, these are the kids who will appear incredibly withdrawn or shut down. Other kids respond to trauma with aggressive, defiant behavior. They’ll be disruptive and disrespectful, especially with authority figures.
Don’t overlook the overly compliant kid, Blumberg advises. Over compliance can be a fear reaction and an indication of trauma. It can be a reaction of “if I don’t do what this adult says, I’m not going to be okay,” as opposed to being positive and helpful because that makes you feel good. Kids who won’t break any rules, are A++ students, are great in sports, seem overly positive, and make sure everyone likes them, sometimes those are kids to worry about.
While trauma may present in different ways, the effects of trauma-related stress are uniformly negative. “Children suffer greatly when their needs aren’t met or when they are witnessing or experiencing abuse of any kind,” says Blumberg. “It can have incredible ramifications on their self-esteem and self-outlook.”
This is especially true for the youngest victims of trauma, from birth through age 6. “Kids need adults for survival. They can’t really say ‘wow, I’m in an abusive situation and my adult is really unhealthy and doesn’t express their anger in healthy ways.’ So, what they do is they take it on and they make it about them. They don’t feel like they are good enough, because if they were good enough, their parent wouldn’t treat them this way.”
The Effects and Impact of Child Trauma
Adverse childhood experiences (ACES) activate chemical and stress hormones, cortisol, and adrenaline. Children’s hearts race, their eyes dilate, and blood pressure spikes. When children are soothed and comforted after a trauma, their little bodies are able to relax. On the flip side, if there is no comforting response or children are exposed repeatedly, their baseline for distress changes and the damage is compounded.
Toxic Stress
Unresolved or repeated exposure to trauma can develop into what is known as toxic stress. Toxic stress changes the developing brain. It over-activates regions of the brain connected to fear and impulsivity. It under-develops areas of the brain connected to reasoning and impulse control. Toxic stress disrupts a child’s ability to learn and is linked to learning disabilities, attention deficit disorders, and memory impairment. They may struggle with behavioral challenges in school and family settings. As they grow into adults, children who experience toxic stress are more likely to experience substance abuse, mental health issues, justice system involvement, troubled interpersonal relationships, and career hurdles and lower wages.
Over the long term, toxic stress has physical effects, too. It can lead to asthma, heart disease, diabetes, obesity, and other chronic health conditions. It’s like driving a car too hard and too fast over a long period of time. The parts are more likely to show wear and tear.
Is it Trauma, or Something Else?
It can be difficult for adults, even those trained in psychology or social work, to tease out whether a child’s behavior stems from abuse, trauma, or something else entirely.
Sometimes, childhood trauma is obvious, like the death of a parent. Reactions to trauma can mimic and mirror intense behaviors that are completely unrelated. Blumberg provides the example of a young elementary student who has trouble transitioning from the playground back to school work. There could be something related to trauma that triggers this child’s stress response. Maybe another child always trips him or pushes him on the way inside from recess. Or, he might have an emotional or behavioral challenge that makes transitions difficult. Or, it could be as simple as maturity, because some kids simply do not develop the skill of shifting cognition at the same time as their peers.
Blumberg encourages adults to tread cautiously, but at the same time to trust their gut. She recommends that when an adult becomes concerned about a kid, it is important to pull back and look at the larger context. Some ways to do this are to observe a child across environments. Is the same concerning behavior playing out in other situations? Be inquisitive without cross-examining a child or their parents.
When confronting challenging behaviors, Blumberg suggests naming the behavior using phrases like “I noticed that when you were sitting next to Suzy, you grabbed her book.” Describe its impact with phrases like “Suzi got really upset.” The key, says Blumberg, comes with the prompting question. “Help me understand what was going on for you.” This approach offers kids the opportunity to share their feelings without feeling shamed. It provides you the opportunity to discover the reasons behind the behavior.
Lastly, Blumberg reminds us that you can always turn to professionals like school counselors and social workers for advice.
Support Systems for Students and Families Affected by Trauma
Schools and organizations that work with children can use the principles of trauma-informed care that help to heal the effects of trauma and build resilience. Trauma-informed systems can provide those buffers that ameliorate the negative long-term health and societal outcomes of trauma on children.
What is Trauma-Informed Care and Why Does it Matter?
Put simply, trauma-informed care means creating environments where kids and families feel safe and respected. Using a trauma-informed approach does not mean the professionals need to be informed of the specifics of the trauma. Professionals do need to be aware of how trauma presents. They must teach in social-emotional skills that help kids build resilience.
Schools and organizations looking to integrate trauma-informed care into their practice can access the U.S. Department of Health & Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) framework for the trauma-informed approach.
SAMHSA has boiled down their comprehensive recommendations within the Concept of Trauma and Guidance for a Trauma Informed Approach. They call their approach to trauma-informed care The 4 Rs:
1
Realizes the widespread impact of trauma and understands potential paths for recovery.
2
Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system.
3
Responds by fully integrating knowledge about trauma into policies, procedures, and practices.
4
Resists re-traumatization.
(Source: SAMHSA-HRSA Center for Integrated Health Solutions, Trauma)
Professional Help and Support for Trauma
Who are the professionals that help with this?
When a child’s needs extend beyond school and family support, families can enlist the help of mental health professionals. Child psychologists, psychotherapists, and licensed clinical social workers can provide counseling support for your child.
How is child trauma treated by professionals?
The range of treatment modalities can read like alphabet soup to families. NCTSN has a useful tool that explains the treatment options.
How can you find a trusted professional to help with child trauma?
If you are looking for help for your child, a good place to start is with professionals you already know. Ask your pediatrician, school counselor, or school social worker for recommendations. You can also use the provider locator tools below:
Why and when should you seek professional help for trauma?
It is natural and normal for children to react with symptoms of stress after a trauma. Some children will heal with just the support of their family. Needing the help of a professional does not mean that parents have ‘failed’ to heal their child’s trauma. Trauma is complex. Professional counseling or therapy is simply another tool to help your child regain a sense of control and normalcy. If your child’s stress symptoms last for weeks or if they seem to be getting worse over time, it’s time to call in professional help.
Dealing with Immediate Trauma and the Aftermath in the Classroom
Teachers often have the most sustained contact with children outside their own families. Sadly, it means teachers have a front row seat to the trauma and neglect that some children suffer. In 47 states, teachers are bound by statutes on mandatory reporting. This means that if a teacher has seen or has a legitimate reason to suspect abuse or trauma, they are both legally and morally obligated to report it.
It’s important for teachers to understand that while they have the responsibility to report, they do not have the responsibility to investigate. In fact, pushing kids to disclose abuse may create additional harm for that child.
Teachers who begin to have a feeling that there is something happening to a child should begin by reaching out to trusted professionals in their school community like administrators, school counselors, or social workers. They should try to build a complete picture of the kid, to understand their hunch in a larger context. They should be advised however that simply reaching out to an administrator does not constitute a mandated report. Also, if a teacher sees direct evidence, or suspects with reason that a child is being harmed, the state may require immediate reporting. That means not waiting until the end of the day, or even the end of a class period to report.
11 Ways to Create a Supportive Classroom
Teachers are uniquely positioned to create safe, supportive environments where kids feel valued and successful. They can be powerful allies for traumatized kids. Here are 11 things teachers can do to create positive spaces for all our kids.
1
Empathy is the best tool you can employ for any child who is struggling with behavior in school. It is undeniably hard to teach kids who are acting up, but it is really hard to be a kid who is acting out of pain and fear.
2
Create predictable classroom routines and boundaries. Emphasize the idea of consent around peer-to-peer interactions.
3
Seat kids in ways that limit distractions and set up classrooms that are bright and cheerful and inviting.
4
Create sensory corners in the classroom that give kids a place to retreat when they need a break.
5
Allow kids to doodle. This is especially helpful for pre-teens and teens who have outgrown the sensory corner, but still need help focusing.
6
Be sensitive to potential “triggers”—sounds, smells, movements, behaviors, or even specific words—that can reactivate feelings of trauma.
7
Do “pre-work” with kids who regularly struggle with behavior. Set up proactive plans, including ways to take time out of the classroom when needed.
8
Author and educator Jessica Minahan suggests teachers provide “islands of competence for students swimming in a sea of inadequacy” by reinforcing or creating positive opportunities that build on their strengths.
9
Take care to address behaviors in ways that are not shaming. Reinforce that just because you may dislike the behavior, it doesn’t mean you dislike the kid.
10
Teach your students, not the material. It’s safe to assume that you will have traumatized children in every classroom, showing students you understand them and care for them is the first step to being able to teach them.
11
Seek out support and practice self-care. Being on the frontlines of teaching means you are often bearing witness to the effects of trauma. It is a heavy burden and it’s okay to ask for help.
Careers in Student Trauma and Counseling
Trauma-informed systems work best when everyone working within that system is educated in trauma-informed care. In a school, this may mean dedicated professional development for teachers, administrators, and staff including school nurses. In practice, it means creating a web of support throughout the entire school experience that weaves compassion into the curriculum. It also means clear expectations and effective communication.
When a student’s needs extend beyond the capacity of the school professionals, mental health counselors can provide direct support and treatment. Here is a snapshot of careers within that continuum of care.
School Counselor
School counselors provide acute and ongoing support to students. They work with groups to build social-emotional skills. They work one-on-one with students to de-escalate behavioral challenges or resolve specific emotional, behavioral, or academic problems. They collaborate with parents, administrators, and teachers to support student learning and provide access to mental health resources for families.
How can they help a child who has experienced or is experiencing trauma?
School counselors who identify students experiencing trauma may refer them to mental health services while providing continual support during the school day.
Where do school counselors work?
School counselors work in public and private schools from pre-K through 12th grade.
What education and degree programs are required to be a school counselor?
School counselors generally need at least a master’s degree in psychology or school counseling and state licensure. Some states require additional teaching experience or certification.
What skills are required to be a school counselor?
School counselors need to have strong analytical skills, be attentive and compassionate listeners, be effective communicators, and be willing to advocate for their students.
How much do school counselors earn?
Annual median wages for school counselors are $57,040.
Social Worker
Clinical and mental health social workers diagnose and treat mental and emotional disorders. School social workers collaborate with parents, teachers, and administrators to support academic and social-emotional learning. Child and family social workers protect vulnerable clients and connect them to social services like housing and food assistance.
How can they help a child who has experienced or is experiencing trauma?
Child and family social workers directly intervene in cases of abuse and neglect. School social workers address trauma as it presents in school through behavior interventions. Clinical social workers provide direct counseling to trauma victims.
Where do social workers work?
Local, state, and federal agencies as well as non-profit organizations employ social workers. Some also work in private practice.
What education and degree programs are required to be a social worker?
Caseworkers must have a bachelor’s degree in social work (BSW), some states require nonclinical licensure. Clinical social workers must have a master’s degree in social work (MSW), supervised clinical practice, and state licensure.
What skills are required to be a social worker?
Social workers must be active listeners, analytical problem solvers, critical thinkers, and effective communicators. They need to be socially perceptive and highly organized.
How much do social workers earn?
Annual median wages for social workers are $50,470.
Child Psychologist
Child psychologists assess, diagnose, and treat children who have experienced trauma and are experiencing trauma-related stress.
How can they help a child who has experienced or is experiencing trauma?
They may use modalities like Cognitive Behavioral Therapy to help them reframe the root of the trauma. This helps them change their thinking around the events. Child psychologists also provide healthy coping strategies to manage emotional triggers and stress.
Where do child psychologists work?
Child psychologists work in hospitals, clinics, group mental health practices, private practice, or as consultants for residential treatment facilities.
What education and degree programs are required to be a child psychologist?
Child psychologists need a PhD in psychology or a Doctor of Psychology (PsyD), supervised clinical practice, and state licensure.
What skills are required to be a child psychologist?
In addition to solid analytical skills, child psychologists need to be active and attentive listeners, creative problem solvers, kind and patient communicators, and careful observers.
How much do child psychologists earn?
Median annual wages for child psychologists are $75,090.
Child Trauma Questions Answered by an Expert
Karen Blumberg,
MA, LCMHC
Karen Blumberg, MA, LCMHC holds a Master’s degree in counseling psychology and is licensed as a psychotherapist. She has an extensive background working with children, teenagers and trauma. Karen is trained in several clinical modalities including couples counseling, family systems counseling, Emotionally Focused Therapy, Internal Family Systems, Hypnotherapy, and Narrative therapy.
What is some advice you would give to someone working with kids who may have experienced trauma, especially if those kids are acting up or acting out?
I think requires a fundamental shift, a philosophical shift, from kids are being a problem, to kids are having a problem. So, the question becomes: what is the problem they are having and how can you help?
If you get focused on behavior only, you’re going to miss what’s really motivating it and what’s behind it. You really want to get to what’s motivating the behavior or you won’t get lasting change. You’ve got to figure out what is driving this.
What is something that a parent or teacher may not know to look for, but can be a sign that a child has experienced trauma?
If you have a kid who has pretty serious trauma, it’ll show up in their drawing. If you look at the drawing and it feels off or icky or weird, trust your gut. That’s your gut picking up on something going on with that kid. Kids will draw themselves or their parent, and the hands are enormous—not normally out of proportion—really large. Or, there are no windows on the house they draw. None. It’s not that it’s necessarily trauma, but you have to ask what that’s about. What is it they don’t want anyone to see?
What is something you really love about working with kids who have experienced trauma?
It’s very special and rewarding to be with another human being in their time of need. It’s a real privilege and an honor. I get to see these young people, who are these amazing sparkling souls. I get to help them retrieve that and connect to that again, that inner self, that true knowing. That is really special and it brings me so much joy. I feel really good about what I’m doing on a daily basis, that’s the upshot. It’s not always like that, of course.
And, being an ally, I love it. That really brings a lot to me. That makes me feel good about myself, my day, and that I’m doing something worthwhile.
What is some advice you would give someone going into the field?
Being a good therapist is a long journey, it takes a long time. You have to be where you are. Really be in the moment you are in, learning the skills you are learning.
What’s also really important is to know yourself and be able to identify what’s going on inside of you. That’s really important in the work. Things get triggered and come up for you as a therapist in sessions with clients. It’s really important to know the difference between what’s yours and what’s theirs.
It’s a long learning curve. And, the longer you do it, the better you get. You have to be patient with yourself.
Working with kids who have experienced trauma is hard. What are some ways you practice self-care?
I meditate every day. I exercise. I watch fun shows. I connect with my boys, my family, and my dog. My dog is good self-care and I love to go on long walks with her. I connect with friends. I love cooking.
And, I keep really good boundaries. That’s important as a therapist… When I come home, I change out of my work clothes. That’s a threshold for me. I envision when I leave work, closing that door for the day and not opening it until I’m back there. Unless there’s an emergency, of course!
Community Support Resources
Centers for Disease Control offer community resources for dealing with traumatic events.
Changing Minds is an initiative by the U.S. Department of Justice that explains the effects of trauma and how caring adults can help children build resilience and heal.
Child Welfare Information Gateway has parenting resources for families who have experienced trauma.
SAMSHA’s National Child Traumatic Stress Initiative offers resources and information around trauma and traumatic stress.
Youth Move National is a youth-focused, chapter-driven organization that supports and advocates for youth involved in education, mental health, juvenile justice, and child welfare systems.
School Resources
ACEs Too High provides ACE screenings tools and resources for lowering ACE scores in communities.
Child Trauma Toolkit for Educators was created by the National Child Traumatic Stress Network.
SAMSHA offers schools and mental health facilities guidance on practices of restraint and seclusion that can exacerbate childhood trauma.
Trauma and Learning Policy Initiative is a collaboration between Massachusetts Advocates for Children and Harvard Law School offers resources for building trauma sensitive schools.
Trauma-Sensitive Schools Training Package was developed by the National Center on Safe Supportive Learning Environments, contracted by the U.S. Department of Education and the Office of Safe and Healthy Students to the American Institutes for Research.
Professional Resources
The American Counseling Association provides its members with Trauma and Disaster Mental Health resources.
Center for Youth Wellness is a “national leader in the effort to advance pediatric medicine, raise public awareness, and transform the way society responds to children exposed to Adverse Childhood Experiences (ACEs) and toxic stress.”
Child Trauma Academy is an education, research, and advocacy organization.
The National Child Traumatic Stress Network supports frontline providers in trauma-informed care through research, best practices, training, and public awareness.
Trauma Resource List compiled by SAMSHA and HHS.