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In recent years, knowledge from trauma psychology and developmental psychology has been integrated. It has given us new concepts to understand the complex difficulties seen in children exposed to complex trauma.

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This is what Hanne Cecilie Braarud and Dag Nordanger from Uni Helse / RKBU Vest write in an article on the website of the Norwegian Psychological Association.

 

The vulnerable child brain

The rapid development of the brain early in life makes the child extra vulnerable both to intense and painful experiences, and to the absence of positive contact and stimulation, the authors write.

In parallel, trauma psychology has recognized that the most harmful stressors are those that persist over time, that occur in early life, and that are inflicted on the child in its care base. Such strains are often referred to today as complex trauma.





Examples of complex trauma can be neglect, abuse, sexual, physical or emotional abuse in the home, frequent separations, and violence between caregivers.

Such trauma experiences are not uncommon among children. The authors write:

NOVA's survey shows that 11 per cent of Norwegian young people during their upbringing have experienced serious sexual abuse, and that 8 per cent have experienced serious violence from a parent.





Prevalence rates may be different in other countries, but are not likely to deviate tremendously from these Norwegian estimates.

 

Too few positive and too many negative interaction experiences

An important point for Braarud and Nordanger is the understanding that traumatization can be explained as the absence of positive interaction experiences in combination with the presence of negative interaction experiences. When a child experiences this to a large enough degree, the child will be able to be strongly affected by this - or put into words: traumatized. 

The article emphasizes the importance of the child's early interaction with caregiver, attachment, and development of self-regulation. They write:

Based on the interaction experiences, the child develops inner work models that are generalized mental representations of both himself ("I am loved" or "no one loves me") and of the caregiver ("mother is available when I need her" or "no one comes when I need comfort").

Internal working models gradually become automated and unconscious expectations of other people, as well as perceptions of oneself and of how one masters social relationships.

With sufficient good care, the foundation is laid for the child to develop the ability for self-regulation. Braarud and Nordanger write:

Through positive interaction sequences with the caregiver, through experiences with activation of the attachment system and experiences of the caregiver as a safe haven for comfort and protection, the child learns to recognize bodily signals, distinguish between emotions, and understand what the emotions mean. In this way, a repertoire of ways to regulate intense emotions is also acquired.

 

Common symptoms of trauma

Braarud and Nordanger write about the characteristics that are common in children who have experienced complex traumatization:

Living with persistent fear, and at the same time being left to oneself in terms of regulating one's own behavior and emotional states, often leads to impaired self-regulation skills. 

Manifestations can be alternating and conflicting emotions and behaviors, such as experiences of emptiness, persistent sadness, dissociation and avoidant social behaviors on the one hand, and easily mobilizable anger, hypersensitivity to affective stimuli, difficulty calming down, and aggressive or dependent social behavior on the other hand.

They emphasize that children who live with neglect, violence and abuse have their brains kept in an emergency state where the focus is on survival. This can create changes in how the brain works, where the child is characterized by an overstimulation of the parts of the brain that are to identify danger and mobilize for self-defense. At the same time, the connections between these basic brain structures and prefrontal and other higher cortical areas that can link language and reasoning to what we do, feel and experience are understimulated and underdeveloped.

The result can be that the child has a reduced ability to self-regulate, a threat-oriented focus on attention, suspicion and distrust of others' intentions, and thus social insecurity.

 

Understanding trauma must be included in mental health care

Braarud and Nordanger write:

We believe it is important to work to ensure that the knowledge that lies in a newer developmental psychological trauma perspective is integrated into the assessments and interventions made in various services that meet children and families.

They refer to studies that have revealed a mismatch between how widespread traumatic experiences are and to what extent this is thematized in mental health care for children and young people: 

[A Norwegian survey] indicates that too little attention is paid to violence and abuse as causal factors [for child and youth mental illness]: Physical abuse was stated as a topic in the contact for only 0,4% of the clients who had been in the child and adolescent mental health care system in a given period, while as many as 33,9 % later stated that they had been exposed to this during their upbringing.

Important priority areas that are highlighted by the authors to improve the situation are that emphasis must be placed on systematic work to prevent children and young people from being exposed to this type of trauma. National strategy and action plans aimed at violence in close relationships and children of mentally ill and drug-abusing parents are important steps in the right direction, while home visits to pregnant women and parents of young children are emphasized as an effective measure. 

There is also a need for better reception of children who are exposed to violence and abuse.

 

The most important thing is to secure and stabilize the traumatized child

For children who have been exposed to complex trauma and who have been caught in this context, Braarud and Nordanger recommend:

The primary thing is to secure and stabilize the child, by meeting him in a way that regulates intense affective states. Eventually, the child must be helped to have their own concepts for the emotions and learn to recognize what triggers them, in order to develop their own self-regulation skills.

Acting constructively towards a child with severe affect regulation difficulties can be very demanding, and requires knowledge of the mechanisms behind the child's behavior. This knowledge should to a greater extent be made available to the relevant services.

 

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