ídhood traumas rttngr wfcírff ÍB ñ&atítAf and Impact A car acddent an

íitsf^
ihquake or flood, being attacked bj*óog, iñiJeiyáng; a frightening medical
• I ment—«II are distinctly diflercBt cvcñlsjct afl provoke common symptoms of
. hologkal tooma. Tríese symptoms stay indode fearftdness, nightmares, and
ma He behavioral or personalty changr* And pamrtaíaroóety over changes in
,ild can. In turtv eotfipiidtc «be neanng process*
Qi Udrtn and 7hnñM tepache» parents and professionals about the effects of
i ordeals on children and offers a blueprint for restoring a child's sense of
ty and balance. Cynthia Monahon, a chad psychologist who specializes in
treatment of psychological taniia,offei9 hope and reassurance for parents.
suggests straightforward ways to help lads through tough times, and also
ribes in detail the warning signs that Indicate a child needs professional
< Monahon helps adults understand psychological trauma from a child's
•f of view and explores the ways both parents and professionals can help
hen heal.

tisefor Children and Trauma

•nls reading this sensitive, comprehensive book will be well nourished...
•ped in a warm comforter, soothed, educated, and given the hope and practical
r they need to hetp their children and themselves cope wilh traumatizing
''enees. Professionals trill treasure this book."
wily James, author. Treating Traumatized Children

CO
atih'tit, comprehensive, and authoritative guidclnvk. An essential reference for
•is of traumatized children.'
.ttles Schacícr, Ph.D., cofoiinder, Association for Ptoylherapy

'hia Monahon has written a < fair and comprehensive guide to understanding the
(MEN
en •mat aftermath of ehUdluwd crises. 77n"¡¡ hook is a must read for parents and
earegiveis who live or work with children."
tiene A. Young, Ph.D., J.IX, executive director,
liona! Organization for Victim Assistance AND
TRAUMA
\ulhor
M.I Monahon is director of a children's menial he.illh clinic in
¡.iinpton, Massachusetts.

^fCE «9.85
"ILDfiEH h rRflUflrt-ED2 NFT Psychology

en
I5BN 0-7H73-1071-G
<r> 90000
JHM-WC ttK t M r i Pitch
•?J-TOt CC?IÍ?0?2 , ...» . •

In. h .i ii ni 11 in ii HI >•! 1^ p-jii ni iv f.i^li.ni-.iiniit.

CYNTHIA MONAHON
-—T'T" !I!lHlli:iBBii
 TABLE NO. 1
Developmental Guidelines: Children's Reactions to Trauma
(Infancy to Two and a Half Years)
General Trauma Reactions Sexual Abuse—Specific Memory for Trauma Parental Support
Reactions*

Disruption of sleeping and toilet- Unusual concern/attention Memory of trauma may Maintain child's routines around sleep-
ing to own or others' private be evident in behavior ing and eating
Startle response to loud/unusual parts or play Avoid unnecessary separations from
noises; hypervigilance Demonstration of adult Snatches of incomplete important caretakers
"Freezing" (sudden immobility of sexual behavior or knowl- memory .or visual Provide additional soothing activities
body) edge through behavior images may remain in
Maintain calm atmosphere in child's
Sudden, intense masturba- memory and be given
Fussiness, uncharacteristic crying, presence
tion verbal description by
and neediness Avoid exposing child to reminders of
toddlers
Loss of acquired speech and Inappropriate private trauma
motor skills touching of others
Expect child's temporary regression;
Separation fears and clinging to Genital pain, bruising, don't panic
care takers inflamación, bleeding, dis-
Help verbal child to give simple names
charge, or diagnosis of sex-
Withdrawal; lack of usual respon- to big feelings; talk about event in simple
ually transmitted disease
siveness terms during brief chats
Avoidance of or alarm response to Give simple play props related to the
specific trauma-related reminders actual trauma to a child who is trying to
involving sights and physical sen- play out the frightening situation (a doc-
sations tor's kit, a coy ambulance, toy dog, etc)
'These behaviors and symptoms are not in themselves condusivc evidence of sexual abuse but are frequendy noted in sexually abused children of this age.

TABLE N O . 2
Developmental Guidelines: Children's Reactions to Trauma
(Two and a Half Years to Six Years)
General Trauma Reactions Sexual Abuse—Specific Memory for Trauma Parental Support
Reactions*

Repeated retelling of traumatic Sexualized play with toys

Memory of at least Listen to and tolerate child's retelling of
event. or other children some visual images from event
Behavioral, mood, and personality Unusual concern about or traumatic event is likely Respect child's fears; give child time to
attention to own or others' for youngest children; cope with fears
changes
private parts many demonstrate recall
Obvious anxiety and fearfulness Protect child from reexposure to fright-
in words and play
Sudden, intense masturba- ening situations and reminders of trau-
Withdrawal and quieting At the older end of chis
tion ma, including scary T.V programs,
Specific, trauma-related fears; age range, children are movies, stories, and physical or locarion-
Inappropriate and/or
general fearfulness more likely to have last- al reminders of trauma
aggressive touching of oth-
Post-traumatic play often obvious ing, accurate verbal and
ers or sexualized relating Accept and help the child to name strong
Involvement of playmates in trau- piaorial memory for
feelings during brief conversations (the
central events of trauma
ma-related play ac school and day child cannot talk about these feelings or
care the experience for long)
Regression to behavior of younger Expect and understand child's regression

Developmental Guidelines: Children's Reactions to Trauma
General Trauma Reactions
Loss of interest in activities
Sleep disturbances: nightmares,
night terrors, sleepwalking, fear-
fulness of going to sleep and
being alone at night
Confusion and inadequate under-
standing of traumatic events most
evident in play rather than discus-
sion
Unclear understanding of death
and che causes of "bad" events
Magical explanations to fill in
gaps in understanding
Complaints about bodily aches,
pains, or illness with no medical
explanation
Visual images and unpleasant
memories of trauma that intrude
in child's mind but will seldom be
discussed spontaneously
General Trauma Reactions
Hyperarousal/hypervigilance
Loss of energy and concentration
at school
Fear of trauma's recurring
Increased need for control
Vulnerable to anniversary reac-
tions set off by seasonal
reminders, holidays, and other
events
¿s
TABtS NO . 2 ( c o n t l n u t d )
(Two and a Half Years to Six Years)
Sexual Abuse—Specific Memory for Trauma Parental Support
Reactions*
Physical indicators: genital Set firm limits on hurtful or scary play
pain, bruising, bleeding, and behavior
inflammation, discharge, Avoid nonessential separations from
diagnosis of sexually trans- important caretakers with fearful chil-
mitted disease dren
Maintain household and family routines
that comfort child
Avoid introducing new and challenging
experiences for child
Provide additional nighttime comforts
when possible: night lights, stuffed ani-
mals, physical comforting after night-
mares
Explain to child that nightmares come
from the fears a child has inside, that
they aren't real, and that they will occur
less and less over time
Provide opportunities and props for
trauma-related play
TABLE NO. 2 (eofitlnu«d)
(Two and a Half Years to Six Years)
Sexual Abuse—Specific Memory for Trauma Parental Support
Reactions*
Use detective skills to discover triggers
for sudden fearfuiness or regression
Monitor child's coping in school and day
care by communicating with teaching
staff and expressing concerns
Listen for child's misunderstandings of a
traumatic event, particularly those that
involve self-blame and magical thinking
Gently help child develop a realistic
understanding of event
R i f i

General Trauma Reactions
Repeated retelling of traumatic
event
Obvious anxiety and fearfulness
Specific post-traumatic fears
Post-trauma tic rcenactments of
traumatic event that may occur
sectetly and involve siblings or
playmates
Fear of trauma's recurring
Intrusion of unwanted visual
¡mages and traumatic memory
that disrupt concentration and
create anxiety, often without par-
ents' awareness
Loss of ability to concentrate and Verbal or behavioral indica
attend at school, with lowering of tions of age-inappropriate
performance
"Spacey" or distracrible behavior
These behaviors and symptoms are not ín themselves conclusive evidence of sexual abuse bur are frequently noted in sexually abused children of this age.
General Trauma Reactions
Behavior, mood, or personality
changes
Regression to behavior of younger
child
Toileting accidents
Withdrawal and quieting or
excesses of aggression and limit
testing
Loss of interest in previously plea
surable activities
Sleep disturbances: nightmares,
sleepwalking, night terrors (rare
for this age), difficulties falling or
staying asleep
TABLE NO. 3 i i
Developmental Guidelines: Children's Reactions to Trauma
(Six Years to Eleven Years)
Sexual Abuse—Specific Memory for Trauma Parental Support
Reactions*
Engages in explicit sexual Child is likely to have Listen to and tolerate child's retelling of
behaviors with other chil- detailed, long-term event
dren or attempts to engage memory for traumatic Respect child's fears; give child time to
older children or adults event cope with fears
sexually Factual accurate memo-
Increase monitoring and awareness of
Verbally describes experi- ry may be embellished child's play, which may involve secretive
ences of sexual misuse by elements of fear or reenactments of trauma with peers and
Excessive concern or preoc- wish; perception of siblings; sec limits on scary or hurtful
cupation with private parts duration may be dis- play
torted
and adult sexual behavior Permit child to try out new ideas to cope
Sexualized relating to* with fearfulness at bedtime: extra read-
adults ing time, radio on, listening to a tape in
Hinting about sexual expe- the middle of the night to undo the
rience . residue of fesr from a nightmare
Reassure the older child that feelings of
fear or behaviors that feel out of control
knowledge of adult sexual or babyish (e,g^ night wetting) are nor-
behavior mal after a frightening experience and
that the child will feel more like himself
or herself with time
TABLE NO. 3 (continuad)
(Six Years to Eleven Years)
Sexual Abuse -Specific Memory for Trauma Parental Support
Reactions*
Encourage child to talk about confusing
feelings, worries, daydreams, mental
review of traumatic images, and disrup-
tions of concentration by accepting the
feelings, listening carefully, and remind-
ing child that these are normal but hard
reactions following a very scary event
Maintain communication with school
staff and monitor child's coping with
demands at school or in community
activities
Expect some time-limited decrease in
child's school performance and help the
child to accept diis as a temporary result
of the trauma

r6
General Trauma Reactions
Hyperarousa l/hype rvigilance
Acute awareness of parental reac-
tions; wish to protect parents
from their own distress
Frightened by intensity of own
feelings
Vulnerability to anniversary reac-
tions set oñ? by seasonal
reminders, holidays, or other
events
WM^iW^
Developmental Guidelines: Children's Reactions to Trauma
General Trauma Reactions
Trauma-driven acting-out behav-
ior: sexual acting out or reckless,
risk-taking behavior
Efforts to distance from feelings
of shame, guilt, and humiliation
Flight into driven activity and
involvement with others or retreat Running away from home
from others in order to manage
inner turmoil
6S
TABLB NO. 3 ( c o n t i n u e d )
Developmental Guidelines: Children's Reactions to Trauma
(Six Years to Eleven Years)
Sexual Abuse—Specific Memory for Trauma
Reactions*
TABLE NO. 4
(Eleven to Eighteen Years)
Sexual Abuse—Specific Memory for Trauma
Reactions*
Sexually exploitive or Acute awareness of dis-
aggressive interactions with tress with intrusive
younger children imagery and memories
of trauma
Sexually promiscuous
behavior or total avoidance. Vulnerability to flash-
of sexual involvement back episodes of recall
May experience acute
distress encountering
any reminder of trauma
Parental Support
Expect and understand child's regression
while maintaining basic household rules
Expect some difficult or uncharacteristic
behavior
Listen for a child's misunderstandings of
a traumatic event, particularly those that
involve self-blame and magical thinking
Gently help child develop a realistic
understanding of event
Remain aware of your own reactions to
the child's trauma
Provide reassurance to child that feelings
will diminish over time
Provide opportunities for child to experi-
ence control and make choices in daily
activities
Be mindful of the possibility of anniver-
sary reactions
Parental Support
Encourage younger and older adoles-
cents to talk about traumatic event with
family members
Provide opportunities for young person
to spend time with friends who are sup-
portive and meaningful
Reassure young person that strong feel-
ings—whether of guile, shame, em-
barrassment, or wish for revenge—are
 4 :-

Factors Influencing Children's

Reactions to Trauma

C hildren's reactions to trauma can be puzzling. Why does one

child quickly pick up the pieces and go on with her life, look-
ing relatively unscathed, while another becomes bogged down in
difficulties that seem to color her entire world? There are too few
solutions to this puzzle, although some tentative answers are
emerging from current research. There remains the very simple
fact, however, that children are impressively different from one an*
other in their reactions to all major life events.
It may be helpful to think of children's responses to entering
kindergarten, a high-stress event for even the most nonchalant
child. In any group of beginning kindergartners, there are those
who adjust by becoming quiet and withdrawn and others whose
level of overactivity threatens to disrupt the entire class. Some of
these children begin wetting their beds or sucking their thumbs
during their first few months of school. A number of them, how-
ever, are happy and secure within the classroom. Just as children
have very different reactions to routinely stressful events like start-
ing kindergarten, their reactions to trauma are similarly diverse.
Nevertheless, there are some protective factors—certain character-
istics of the child and family—that appear to insulate or buffer
children from the most disabling effects of exposure to severe
stress and some risk factors, that contribute to a child's vulnerabil-
ity." While the emerging research on children's resilience is not
based exclusively on traumatized children, the findings are helpful
in thinking about the forces that influence children's varied re-
sponses to trauma.
s