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Preventing Post-Traumatic Stress in Children Through Attachment

Let's talk about trauma. What is it? Our Trauma-Informed Systems of Care team at the Wichita State University Community Engagement Institute likes to define it as any event or experience that overwhelms an individual's internal resources (or resiliency) leaving him or her feeling powerless or hopeless. It can be a single event or a reoccurring event. It can be life-threatening, frightening, stressful, neglectful, overwhelming, and more. Trauma is universal. It is also deeply personal and individualistic. What is traumatic to one person may not have any traumatic meaning for another. The meaning, or story, that we create around life experiences impacts all of us in different ways.

This is particularly true for children. When a little one experiences a traumatic event, he creates a story around what that event means about his world, his family system, and himself. These stories often dig themselves deep into the fabric of a child's psyche. They are called internal working models. The earliest stories that children make about the world are based firmly upon the attachment that they have to primary caregivers. If a child's caregiver is responsive to his needs, smiles and coos, makes eye-contact, and is emotionally present, they develop a secure attachment. This is called a secure base from which the child views the world and is able to explore their own place in the world. They internalize positive stories about themselves such as, "I am valuable. I am loved. I am worthy."

What happens when there is a break in that attachment pattern? What if the caregiver does not respond to the child's needs? Or if the home is full of chaos, neglect, violence, and addiction? So often, the child creates a pretty sad story about themselves and their place in the world.

Let's think about these two kiddos: If a traumatic event happens to the child with a secure attachment base, he or she has a foundation of resilience that will help them overcome some of the effects of the trauma. Most likely, they will be able to bounce back a little better after experiencing pain. The opposite is also true for a child without a comforting caregiver.

The good news is that a child can develop secure attachment with any caring adult that has their best interest in mind. For this reason, health care professionals, mental health providers, educators, faith-based youth workers, etc. are so critically important to a child's resiliency.

You may have heard about the Adverse Childhood Experience (ACE) study conducted in the 1990s. It was a partner study between the CDC and Kaiser Permanente. They evaluated over 17,000 HMO members—wanting to explore the link between childhood trauma and later-life general health and well-being. What they found was staggering. Over two-thirds of those surveyed had experienced some kind of traumatic event in childhood. One in five had experienced three or more traumatic events. They also found a striking link between childhood trauma and later-life addiction, risky behaviors, mental illness, chronic disease, and early death (About the CDC, 2016).

Child maltreatment is a serious social problem. It can have long-term impact on a child's emotional, behavioral, social, and cognitive development (Moss, Dubois-Comtois, Cyr, Tarabulsy, St-Laurent, & Bernier, 2011). It costs our country millions of dollars each year (About the CDC, 2016). There is a link between children that experience trauma, insecure attachment, and developing post-traumatic stress disorder (PTSD) later in life. Remember how children create stories about themselves based upon their attachment to caregivers? Without intervention, those stories remain long into adulthood. If a child believes that interpersonal relationships are dangerous, threatening, or unreliable, they carry those beliefs into adult relationships.

But, trauma is not destiny. There is a large body of research suggesting secure attachment as one of the key preventative measures against trauma symptoms as the child grows into adulthood. Ogle, Rubin, & Siegler (2015) found that there is a correlation between PTSD diagnosis and attachment security. Individuals that experienced insecure attachment patterns in interpersonal relationships were more likely to display hyper-vigilance, emotional avoidance, and flashbacks. Individuals with secure attachment patterns were more likely to display less severe PTSD symptoms, more resiliency and coping, and overall less time spent in recovery.

So what is secure attachment and how can it be utilized to prevent severe PTSD symptoms in children? A secure relationship is one where the child feels that their physical and emotional needs will be met. The adult is emotionally present for them, listening with compassion, respecting the child's emotion, engaging with them in a way that lets them know their needs are being heard. The adult is able to see underneath the child's behavior to the deep need for safety and love. Children want to know: Am I safe? Am I unconditionally acceptable? Am I loveable?

As stated above, secure attachment does not have to come from primary caregivers alone. Have you ever heard stories about children that survived abuse because of that one teacher that believed in them unconditionally? Or about a child whose grandparent sent encouraging letters of support to help them through their chaotic home life? Or in movies such as Good Will Hunting, Freedom Writers, The Blind Side. A child needs at least one caring, sensitive adult whom believes unconditionally in their ability to overcome adversity and struggle. A child needs to know that someone thinks they are worth it.

This is how children survive, grow through, and grow from traumatic experiences.
Just one unconditionally caring adult.

About the CDC-Kaiser ACE Study. (2016). Retrieved June 24, 2016, from http://www.cdc.gov/ violenceprevention/ acestudy/ about.html

Mosier, S., & Skidmore, B. (2016). Adverse Childhood Experiences Among Kansas Adults: 2014 Kansas Behavioral Risk Factor Surveillance System (Rep.). Topeka, KS: Kansas Department of Health and Environment.

Moss, E., Dubois-Comtois, K., Cyr, C., Tarabulsy, G. M., St-Laurent, D., & Bernier, A. (2011). Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: A randomized control trial. Development and Psychopathology, 23, 195-210.

Ogle, C. M., Rubin, D. C., & Siegler, I. C. (2015). The relation between insecure attachment and post traumatic stress: Early life versus adulthood traumas. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 324-332.

Brittney Hauck, MS, LMFT, CPS