‘Childhood trauma.” We hear these words so often that they’ve lost any kind of concise meaning. Virtually all children confront disturbing experiences, and rates of their diagnosed mental struggles have increased significantly, but not every one of them is traumatized. So, what does it mean for a child to live with trauma?

Known formally as post-traumatic stress disorder (PTSD), approximately 3-4% of children are diagnosed at any one time. Those numbers likely have risen at least to some extent as a result of the pandemic.

I’ve worked in this clinical area for a long time. In 1978, I was an intern at a Bangladeshi refugee clinic in a struggling immigrant section of London. The children I saw had come to England some years earlier to escape the civil war between Pakistan and Bangladesh. Many of them were profoundly withdrawn.

Interestingly, I found that music was the most effective way to reach some who at other times seemed to dissolve inwards. They communicated with their hands what pace I should play my different instruments. It was the only time I ever saw some of these children smile. For others, it was the only time I saw any emotion at all.

This is one way trauma can reveal itself, and it’s where I first came face-to-face with how powerful the impact can be.

The children I’ve seen over the years have nightmares and terrifying thoughts that intrude into their consciousness. No matter how hard they try, most struggle to maintain any kind of balanced mood or inner calm and find themselves paying attention to the wrong things — rather than, say, a teacher’s instructions — to make sure there’s no danger lurking.

They usually have trouble sleeping, can be jumpy, irritable and impulsive, and avoid anything that reminds them of whatever it is they experienced. Sadly, one child told me, “It’s hard to avoid your own horrible thoughts.”

Some of these children look like they have ADHD because of their inattention and hyperactivity. Mental health professionals refer to them as “externalizers.” They’re described as “defiant” or “oppositional.” They act out to communicate the depths of their pain for everyone to see. Once, I met with a 10-year-old boy sent by juvenile court who blasted out the most impressive stream of curses and threats I’d ever heard and, believe me, I’ve heard them all. We hadn’t yet left the waiting room.

You could consider this all a matter of stress, but it is stress powered by rocket fuel. For instance, I saw a child who, rather than act out, shut down to the point where she couldn’t move, stared in front of her without blinking her eyes, and appeared as though she was barely conscious. This is known as “dissociation” and can be seen in children with histories of complex trauma.

These children are referred to as “internalizers.” Like the Bangladeshi children I worked with many years ago, they disappear inside of themselves amid the crush of what is unbearable.

One of the hallmarks of childhood trauma, which also shows up among some children with anxiety, is “avoidance.” This is especially challenging because the more one avoids a specific task or activity, the harder it gets to do whatever it is —  like going to school. In other words, the fear spirals upward, making it tough to overcome. The way to address this is to help the child go toward what frightens them rather than support them in steering clear of it. Easier said than done, but it’s only in recent years that mental health practitioners have adopted this stance.

Another aspect of avoidance is the tendency to worry repeatedly about the past while fearing the future, which leaves limited mental energy and attention for living in the present moment. I recently heard a school principal refer to a severely traumatized sixth grader as “unfocused” and “joyless.” Hearing the child’s history, it shouldn’t be hard for anyone to understand why. He avoids the here and now, but not intentionally.

Not every hurting child has trauma, but I certainly won’t minimize the astounding numbers dealing with anxiety, depression, and various self-harming behaviors. We only have to look at the data showing us how many children are seeking help from maxed-out outpatient centers, overburdened crisis centers, and overflowing emergency departments to grasp the degree of suffering happening around us.

Their pain is real and sometimes debilitating. For many, developing the skills to tolerate normal levels of discomfort and frustration is the primary goal, especially after their learning-at-home during COVID, when they could shut down their computers as soon as any of the typical academic and social challenges of school appeared. For children with PTSD, there are usually additional challenges.

The good news is that I’ve seen many children learn to thrive in spite of their traumatic history. We hear the terms resilience and grit a lot these days. To me, they signify the importance of helping children learn how to turn things around when they start to get overwhelmed by negative moods, thoughts and emotions.

I use this language almost as a mantra: You can turn it around. Rather than plummeting to a dark place, many find that they can interrupt that descent and learn how to cope in much healthier and happier ways. It has always been a joy for me to witness when this happens.

The pendulum can swing. We can help caregivers, schools, police and legal systems understand childhood trauma and share ways to support these children in very real ways. We’ve taken small steps in this direction, but we need to do much more. Additional services must be put in place to meet their needs. These are children who have suffered enough.

James Levine has written two full-length books on the subject of childhood trauma and is working on a third for parents and other caregivers. He is the founder and former director of James Levine & Associates, a behavioral health organization in South Hadley. 

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