PTSD and Trauma in Children

Millions of students across the U.S. started the 2020–2021 school year online instead of in-person with their teachers and peers. Education is meeting head-on one of the largest upheavals in decades. Research coming in from the start of the COVID-19 pandemic in March until today points to increasing levels of distress in children, teenagers, and their families. 

District administrators, school psychologists, counselors, and social workers have heightened concerns about the immediate and long-term effects of trauma and Post-Traumatic Stress Disorder (PTSD) on students of all ages in their care. School districts are challenged to consider and employ new approaches to better support their students’ mental health. Many students with behavioral and mental health challenges struggle significantly with transitions and the unknown. The rapid transition in many districts to online learning and hybrid models adds additional pressures to ensure students are getting the help they need.

Trauma is an emotional response to terrible events. The word itself comes from the Greek trauma, “a wound, a hurt, a defeat.” Initially tied to physical events, over time the word trauma has come to be used in a psychological context. Related, but more specific, Post-Traumatic Stress Disorder (PTSD) is used to define the psychological reaction to emotional trauma. 

The American Psychiatric Association (APA) defines PTSD as: 

“a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury…PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age.”

Megan Gosling, PhD, a clinical psychologist and associate research scientist in the Yale Child Study Center, offers the following explanation for what makes experiences potentially traumatic from this article on the Yale School of Medicine website. 

Traumatic events involve the personal experience of danger that:

  1. Comes out of the blue, leaving little opportunity to prepare
  2. Is not in our control, leading to helplessness
  3. Includes the reality of chaos in the “real world” and the internal experience of feeling overwhelmed

Dr. Gosling continues:

“When pre-existing strengths, capacities, and coping strategies are outmatched by vulnerabilities brought on by the pandemic, when the level of impact is significant (for example, loss of a loved one or extreme financial distress), and/or when there is insufficient external support, individuals, including children, may become overwhelmed and traumatized.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places Post-traumatic Stress Disorder in the category Trauma- and Stressor-Related Disorders. For a more in-depth look at diagnostic criteria, refer to the DSM-5 or this document.

Examples of Common Traumatic Events

We don’t need to look far today to find examples of events that can lead to trauma in children and adolescents. Natural disasters such as widespread fires that have devastated communities on the West Coast in the summer of 2020, severe hurricanes in the Gulf states, acts of violence such as school shootings or police brutality, or illness and death related to the COVID-19 pandemic are a few examples. Other sources of trauma are widespread and prevalent and include bullying, accidents, serious illness, divorce, intimate partner violence, abuse (sexual, drug, alcohol), job loss, hunger, homelessness. Military-related stressors for families include deployment and parental or caregiver injury or death.

Extended school closures, social distancing restrictions, and distance learning due to the pandemic have contributed to feelings of loneliness and isolation, putting young people at increased risk for anxiety and depression. 

Black and Brown communities face even greater vulnerabilities due to the many legacies of structural racism. In a conversation about COVID-19 and trauma, Dr. Sarah Jerstad, associate clinical director of psychological services at Children’s Minnesota St. Paul hospital, explained: “Kids of color have long faced barriers to mental health care in areas of prevention, access to care, quality treatment and mental health outcomes. The onset of COVID-19 has only increased that burden on kids of color.” The CDC has reported how systemic health and social inequality clearly have put communities of color disproportionately at risk for increased exposure to illness and death from COVID-19. 

In addition, some students experience increased vulnerability to abuse during lockdowns and school closures due to a lack of daily contact with teachers, counselors, school staff who are trained to spot abuse. According to the CDC, extended COVID-19 school closures have removed an important layer of protection for children from “neglect as well as physical, sexual, and emotional maltreatment and abuse. A 2018 Department of Health and Human Services report found that teachers and other educational staff reported more than one-fifth of all reported child abuse cases—more than any other category of reporter.  During the COVID-19 school closures, however, there has been a sharp decline in reports of suspected maltreatment, but tragically a notable increase in evidence of abuse when children are seen for services. For example, the Washington, D.C. Child and Family Services Agency recorded a 62 percent decrease in child abuse reporting calls between mid-March and April 2020 compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms.”

Recognizing signs of trauma in children

The signs of trauma in children and adolescents can take many forms and will vary with age. Early recognition of signs and symptoms of trauma is critical for preventing long term physical, social, emotional, and cognitive effects that can lead to long term health problems, as well as behavior and learning problems.

Adam D. Brown, PsyD, clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone, lists these typical reactions to trauma that young children (ages 10 and younger) might exhibit:

  • Unwanted thoughts or images
  • Negative Feelings
  • Avoidance of Reminders and Problems with Attention
  • Arousal and Reactivity Symptoms

According to the National Center for PTSD at the U.S. Department of Veteran Affairs, children may show signs of trauma and PTSD in their play: “They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives…PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.”

Supporting Students with Trauma and PTSD 

The most common treatments for trauma-related PTSD are Cognitive-Behavioral Therapy (CBT), Psychological First Aid (PFA), and Eye movement desensitization and reprocessing (EMDR), typically provided by mental health providers. In other cases, medication might be prescribed. Selection of the most effective treatment will depend on the particular trauma a student has experienced and will be recommended by the diagnosing school psychologist or specialist. 

PresenceLearnings Solutions for Trauma and PTSD

Recognizing the urgent need for new solutions for school districts to respond to a mental health crisis, PresenceLearning now offers two types of live, online groups to support students’ behavioral and mental health. Finding Your Power in Uncertain Times is a 6-week program designed to help students who are struggling with life’s current stressors including those related to COVID-19. And, Behavior Intervention Groups are 12-week programs, each designed to support a specific skill area.

Having an online solution enables schools to serve more students than is possible when limited to in-person, onsite therapy. Working with online therapists using familiar technology can put students at ease and help them talk more openly about their problems, while at the same time, reducing the stigma often associated with onsite therapy.

Finding Your Power in Uncertain Times

Finding Your Power in Uncertain Times has been developed for PresenceLearning by Dr. Isaiah Pickens, founder and CEO of iOpening Enterprises. iOpening Enterprises helps schools across the country by delivering trauma-informed and culturally-responsive programs that promote students’ behavioral and mental health needs while supporting their academic achievement.

Finding Your Power in Uncertain Times is a psychotherapeutic program designed to help middle and high school students navigate current stressors including the impact of COVID-19, economic uncertainty, and recent civil unrest. Offered as a 6-week program for small groups of 3–5 students, attendees of the program will gain:

  1. Trauma-informed, cognitive-behavioral, mindfulness-based, and culturally-responsive tools that will help them manage unhealthy responses to current events
  2. Techniques to navigate pervasive anxiety, depressed mood, and interpersonal functioning challenges
  3. Skills to better understand themselves through bolstering resilience-based strategies and their ability to find meaning and growth during difficult life experiences

This program has been designed exclusively for PresenceLearning providers to conduct online.

Behavior Intervention Groups

PresenceLearning’s live online Behavior Intervention Groups are designed to help schools meet the growing need for behavioral skill building in school settings, whether on site, in the home, or in a hybrid model—for all students. Students are identified by the school district and can be added to groups where they have a skill-based deficit.

Behavior Intervention Groups focus on 6 topics:

  • Anxiety
  • Emotional Regulation
  • Coping Skills
  • 21st Century Stress Management
  • Social Skills
  • Prevention & Active Depression

Each program is 12-weeks long and includes three students, ideally at the same grade level or stage of learning and development. Students do not need to attend the same school to be grouped together, giving districts flexibility to support students wherever they are.

PresenceLearning works closely with onsite school counselors, social workers, and/or school psychologists to assign students to the appropriate group, each of which is led by a highly trained school psychologist or licensed clinical social worker from PresenceLearning’s network of licensed clinicians with school-based experience.

What is a trauma-informed, culturally sensitive approach and why does it matter?

Now more than ever, students are experiencing traumatic events. According to the CDC, 1 in 5 students suffer from behavioral or mental health challenges. School districts are under increased pressure to develop culturally-responsive, trauma-informed programs for their students but often don’t know where to begin. According to Dr. Isaiah Pickens, a trauma-informed approach involves understanding what’s at the heart of challenging behaviors and allows young people who have been harmed and injured to reach their full potential. A trauma-informed approach provides evidence-based strategies to deal with invisible injuries that we don’t see but impact how people deal with the world, keep themselves safe, and eventually heal. And a system that is trauma-informed allows educators to be able to recognize when those invisible injuries like abuse or neglect have impacted somebody and then to respond in a way that helps them heal, not only heal themselves but eventually heal the community. A culturally-responsive approach to trauma infuses those strategies for healing with the values that undergird the communities being served.

Conclusion

Education is facing unprecedented challenges in supporting students’ well-being. Research coming in from the 2019–2020 school year shows increasing levels of distress in children, teenagers, and their families. The traumatic effects of COVID-19 coupled with economic impacts from widespread job losses will impact students for months to come. School districts are struggling to provide behavioral and mental health solutions that meet the pressing needs of students wherever they are—onsite, online, or in hybrid settings.

PresenceLearning offers two types of live, online groups to support students’ behavioral and mental health. Finding Your Power in Uncertain Times is a 6-week program designed to help students who are struggling with life’s current stressors including COVID-19. And, Behavior Intervention Groups are 12-week programs, each designed to support a specific skill area.

We partner with schools by connecting our network of 1,300+ licensed clinicians to students, whether they are currently onsite in school or doing distance learning at home. Services are delivered on PresenceLearning’s proprietary platform built by clinicians for clinicians specifically to serve K-12 students.

With 11 years of experience delivering more than 2.5 million teletherapy sessions on-site at schools, and in the home, PresenceLearning is the leading provider of live online special education related services—and behavioral and mental health services for all students, not just those with an IEP—for K-12 students nationwide. 

To learn more, request a consultation to make sure your students have the support and skills they need.  

Additional Resources on Childhood Trauma and PTSD

The National Child Traumatic Stress Network—COVID-19 Resources and more 

Trauma Informed School Strategies During COVID-19

Halladay Goldman, J., Danna, L., Maze, J. W., Pickens, I. B., and Ake III, G. S. (2020). Trauma Informed School Strategies during COVID-19. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.

UCLA Brief COVID-19 Screen for Child/Adolescent PTSD, a resource provided by the International Society for Traumatic Stress Studies (ISTSS)

COVID-19 and trauma: Mental health struggles among black teens by Alexandra Rothstein, July 16, 2020.

National Center for PTSD, U.S. Department of Veteran Affairs

Triaging for Trauma During Covid-19 by Sarah D. Sparks, Education Week, September 2, 2020

PresenceLearning Behavior and Mental Health Groups