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Trauma’s Impact Trauma’s Impact in Middle Childhood: in Middle Childhood:

Clinical ImplicationsClinical Implications

Esther Deblinger, Ph.D.Esther Deblinger, Ph.D.CARES InstituteCARES InstituteUMDNJ-SOMUMDNJ-SOMMay 11, 2006May 11, 2006

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Middle Childhood Middle Childhood (5-12 years)(5-12 years)

Stage of life filled with many firsts that Stage of life filled with many firsts that can be stressful, but optimally lead to can be stressful, but optimally lead to feelings of mastery and increasing feelings of mastery and increasing social competencesocial competence

Natural developmental processes may Natural developmental processes may be disrupted and/or altered by be disrupted and/or altered by traumatic experiences that can impact traumatic experiences that can impact on overall growth and adjustmenton overall growth and adjustment

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Cognitive Development Cognitive Development in Middle Childhoodin Middle Childhood

Ability to process information in a Ability to process information in a systematic/logical manner develops systematic/logical manner develops BUTBUT

Characterized by concrete operational Characterized by concrete operational thinkingthinking

Interpretations are still very literal and Interpretations are still very literal and concrete concrete

Tendency to over generalize and see Tendency to over generalize and see things in good/bad termsthings in good/bad terms

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Trauma and Cognitive Trauma and Cognitive Processes in Middle ChildhoodProcesses in Middle Childhood

Natural tendency to over generalize Natural tendency to over generalize may lead to highly dysfunctional beliefsmay lead to highly dysfunctional beliefs

School age children’s tendency to rely School age children’s tendency to rely on the most parsimonious concrete on the most parsimonious concrete explanations for events can be explanations for events can be problematicproblematic

Limited ability to consider alternative Limited ability to consider alternative explanations on their ownexplanations on their own

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Social Development During Social Development During Middle ChildhoodMiddle Childhood

Normative research suggests decreased Normative research suggests decreased self esteem during first years of schoolself esteem during first years of school

Increased concern for social approval Increased concern for social approval and acceptance from teachers and peersand acceptance from teachers and peers

Increased tendencies to make social Increased tendencies to make social comparisonscomparisons

Beliefs and expectations about Beliefs and expectations about relationships develop relationships develop

Secrets have social value Secrets have social value

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66 Trauma and Social Trauma and Social Processes in Middle Processes in Middle

ChildhoodChildhood School age children more likely to engage School age children more likely to engage

in sexually reactive behavior in secretin sexually reactive behavior in secret

Exposure to interpersonal violence may Exposure to interpersonal violence may lead to distorted relationship expectationslead to distorted relationship expectations

Social concerns may inhibit disclosure and Social concerns may inhibit disclosure and encourage avoidance encourage avoidance

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Emotional Development Emotional Development in Middle Childhoodin Middle Childhood

Emotions may guide/dominate behavior Emotions may guide/dominate behavior more than abstract reasonmore than abstract reason

Increase awareness of others’ emotionsIncrease awareness of others’ emotions

Increased recognition that one can Increased recognition that one can experience different emotions at the experience different emotions at the same timesame time

Begin to develop more complex Begin to develop more complex emotionsemotions

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1010 Trauma and Emotional Trauma and Emotional Processes in Middle Processes in Middle

ChildhoodChildhood Acceptance of perpetrators’ Acceptance of perpetrators’

simplistic, concrete rationales for simplistic, concrete rationales for violenceviolence

Heightened vulnerability to feelings Heightened vulnerability to feelings of embarrassment, guilt and shameof embarrassment, guilt and shame

Potential to isolate and avoid to Potential to isolate and avoid to minimize distress and avoid social minimize distress and avoid social fears fears

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1111 Impact of Trauma on Impact of Trauma on Fears in Middle Fears in Middle

ChildhoodChildhood Normative school age fears Normative school age fears (e.g. bodily harm, (e.g. bodily harm,

bad storms, burglars, etc.)bad storms, burglars, etc.) are typically are typically concrete, specific, realistic and transient concrete, specific, realistic and transient

Fears may be intensified and longer Fears may be intensified and longer lasting lasting

Concrete behavioral reactions may be Concrete behavioral reactions may be utilized to cope with trauma-related fears utilized to cope with trauma-related fears

Parental reactions may inadvertently Parental reactions may inadvertently reinforce children’s trauma-related fearsreinforce children’s trauma-related fears

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1212Developmental Developmental Implications for Implications for

TreatmentTreatment Provide age appropriate education and Provide age appropriate education and emotional skill building exercisesemotional skill building exercises

Continuously assess children’s Continuously assess children’s understanding and retention by asking understanding and retention by asking questions and listening carefullyquestions and listening carefully

Incorporate concrete behavioral Incorporate concrete behavioral exercises and role playsexercises and role plays

Utilize concrete language and images Utilize concrete language and images to convey and discuss abstract issuesto convey and discuss abstract issues

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Encourage humor and fun to Encourage humor and fun to motivate school age childrenmotivate school age children

In laughter there is always a kind of In laughter there is always a kind of joyousness that is incompatible with joyousness that is incompatible with

contempt and indignation contempt and indignation Voltaire Voltaire

If you’re not laughing – you’re not If you’re not laughing – you’re not doing it right!doing it right!

Barbara Bonner (2005)Barbara Bonner (2005)

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