Supporting Young Children Through Trauma

Recognising signs and symptoms of trauma in young children

Symptoms of trauma-induced stress include intrusive memories or dreams associated with the trauma, avoiding anything related to the traumatic event and significant changes to a child's reactions and behaviour (American Psychiatric Association, 2022).

These symptoms are common in both children and adults, however, they may be challenging to identify in very young children. Among preschool-aged children, trauma may result in the presence of the following behaviours (Phoenix Australia, 2020):

• Nightmares
• Emotional outbursts or tantrums
• Social withdrawal or increased clinginess with caregivers 
• Defiant behaviours
• Development of new fears and generalised anxiety
• Regressions in sleep or toileting behaviours
  

If you believe your child has experienced a traumatic event and is exhibiting any of these behaviours, one of the best ways you can support them is by seeking professional guidance from a child psychologist.

Professional support for children who have experienced trauma

When a child has experienced trauma, they need support from loving and trusted caregivers who can provide a feeling of safety for the child. However, caregivers are often at a loss for how to support children through such difficult experiences, particularly if the caregiver is also experiencing trauma or the event has caused rifts in their relationship with the child. In these situations, a child psychologist can assess the situation and implement an appropriate intervention to help the caregiver and the child through these experiences.

Before engaging in any intervention, a child psychologist should consider the relationship between the caregiver and the child as well as the child's capacity to engage in treatment. Children should be assessed according to their developmental level as opposed to their age, as trauma-exposed children differ widely in their language, cognitive and emotion regulation skills (Lieberman et al., 2011; Vanderzee et al., 2018). When looking for a child psychologist to support a child struggling with trauma, ensure that they are trained in at least one of the three methods below. A psychologist may suggest some of the following:

Trauma-focused cognitive behavioural therapy (TF-CBT)

TF-CBT uses cognitive behavioural theories and gradual exposure to reduce trauma symptoms. It also uses therapeutic strategies designed specifically for a child and caregiver (Cohen et al., 2016). Australia’s National Centre of Excellence in Posttraumatic Mental Health strongly recommends this cognitive behavioural strategy for use with children with post-traumatic stress disorder (McGuire et al., 2021; Phoenix Australia, 2021). 

TF-CBT uses several techniques summarised by the acronym PRACTICE (Cohen et al., 2017):

• Psychoeducation and parenting skills
• Relaxation
• Affective modulation
• Cognitive coping
• Trauma narration and processing
• In vivo exposure
• Conjoint child-parent sessions
• Enhancing future safety

When using this method with pre-schoolers, child psychologists will modify the way these techniques are taught to suit the child’s level of understanding. This can be done by using age-appropriate stories and art or play therapy (McGuire et al., 2021). Age-appropriate behavioural techniques, including active ignoring and reward systems, such as sticker charts, have also been found effective with this group, increasing children’s engagement with the therapy (Stiefel et al., 2024). 

TF-CBT emphasises both the child's and caregivers' role in overcoming traumatic symptoms. Sessions are usually split between child and caregiver, with the content mirroring each other so that caregivers can support children in practising the skills at home (Cohen et al., 2017). The sense of structure and consistency this method provides is extremely important for children and families who have been exposed to trauma. Whilst the intervention is child-focused, previous findings indicate that parents also experience improvement in depressive and traumatic symptoms in response to the treatment process (Cohen et al., 2017). It should, however be emphasised that caregivers supporting children through traumatic experiences should be aware of their own mental health needs, and seek individual support if necessary.

Parent-Child Interaction Therapy (PCIT)

PCIT trains parents to manage challenging behaviours among young children (Urquiza & Timmer, 2012). Research has found PCIT effective at reducing behavioural issues that arise after a child is exposed to trauma (Vanderzee et al., 2018). PCIT consists of two stages;

• Stage one focuses on the relationship between parent and child. This stage trains caregivers to notice and reinforce positive behaviours through child-led play. It begins with a parent-only session to teach the skills, followed by coaching sessions in which the child psychologist helps the parents practice these skills with their children (Stiefel et al., 2024). It is advisable to avoid commands, questions, criticism and sarcasm during this time. Instead, using specific praise, reflection, imitation, description and showing enjoyment is recommended (Allen & Kronenberg, 2014). These skills provide rewarding positive attention from the parents and, when given in response to appropriate behaviours, ensure that the child will continue to exhibit these behaviours in the future (Stiefel et al., 2024). 

• Stage two focuses on increasing children's cooperation when given directions (Stiefel et al., 2024). In this stage, parents are taught the principles of effective commands and time-out procedures and allowed to practice these skills in session with the therapist. There are some objections to the use of time-out, particularly with children exposed to trauma, as it can affect the attachment between a child and their caregiver (Stiefel et al., 2024). There is, however, sufficient evidence that suggests that when done correctly, time-out can be used therapeutically with trauma-exposed children (Dadds & Tully, 2019). 

Building a positive relationship between child and caregiver is a central element of the PCIT method. This aspect is increasingly stressed, with early research showing promising outcomes for young children and their caregivers (Warren et al., 2021; Warren et al., 2024).

Child-Parent Psychotherapy (CPP)

CPP is a relationship-based therapy for children under six and their primary caregivers (Lieberman & Van Horn, 2009). This method highlights that a secure attachment between caregiver and child can buffer the effects of trauma (Lieberman et al., 2005; Stiefel et al., 2024). It aims to address trauma-related attachment issues by increasing the child’s sense of physical and emotional safety in their relationship with their caregiver (Hagan et al., 2017). As a result, children can better regulate emotions and physical sensations. 

CPP also aids in breaking negative behaviour patterns between children and their caregivers, provides education regarding traumatic responses and symptoms, and helps children process traumatic experiences (Allen & Kronenberg, 2014). The strong research base supporting CPP has shown it to be effective at reducing trauma-related symptoms, behavioural issues, emotion regulation issues and attachment disruptions (Lieberman et al., 2011; Vanderzee et al., 2019). 

CPP begins by evaluating both the child’s and caregiver’s trauma histories and symptoms, as well as observing how they interact (Lieberman et al., 2005).  Then, while ensuring the clients' safety, the child psychologist provides education about trauma and a safe space for the child to discuss their feelings and experiences (Stiefel et al., 2024). Child Psychologists then find “ports of entry”, naturally occurring moments in which they can introduce strategies to improve the relationship between caregiver and child (Allen & Kronenberg, 2014). 

These strategies commonly include: 

• crisis intervention
• modelling protective behaviour
• use of language
• play and physical contact
• providing emotional support 

Child psychologists help caregivers and children to recognise and manage behaviours triggered by trauma reminders. This often requires the clinician to translate behaviour from the young child into a narrative, which becomes a shared understanding of the trauma between the child and their caregiver (Lieberman et al., 2005). Play therapy can also be utilised to create a trauma narrative to enhance the processing of the trauma. 

Finally, CPP focuses on helping the child process the relationship's ending with the therapist and supporting them in viewing this as a natural progression rather than another trauma (Stiefel et al., 2024).

How parents can support children who have experienced trauma

Looking at the recommended strategies for supporting children through trauma detailed above, it is clear that establishing, repairing, or maintaining a positive relationship between a child and their caregiver is essential. When engaging in therapy, it is important that caregivers are very engaged in the therapeutic process (Phoenix Australia, 2020). This includes (Vanderzee et al., 2018): 

• ensuring strategies are practised at home 
• using the same language during therapy sessions, at home, and in any other environments 
• cultivating shared understanding and a sense of safety between themselves and their children

It is also important that parents and caregivers take care of their own emotional needs and are supported in therapy. Simply knowing that their child has experienced trauma can be a significant stressor for parents, let alone being present during the traumatic event (Vanderzee et al., 2018). With the right support, caregivers and children can learn to manage their trauma and thrive.

Book a session for clinical support with trauma today.