International Society for Traumatic Stress Studies

Book Review: Traumatized Children’s Behavior Explored and Interventions Suggested

Posted 1 July 2003 in StressPoints by Mary Beth Williams

A prospective adoptive parent walks excitedly toward a group of 4- to 6-year-old children. She sees two small girls dressed in faded tops and shorts, colored hats and shoes with the toes cut out so that each child’s feet will fit. One girl runs toward the woman and says “Momma.” The woman’s heart melts—she now has her daughters. The second child stands more hesitatingly behind, watching. The woman’s dreams seem to be realized; the two children know she is their new mother. She will take them away to America and all will be well and good and happy—but will it?*

What does the woman need to know, prior to adopting her children, about the impact of institutionalization on their lives? Is the task ahead of her, to become a parent, in any way influenced by those events and by chemical changes that her children’s brains have endured? Is her task similar to that of a parent of a child who has been witness to family violence prior to the mother’s escape from a brutal relationship, or to that of a foster care parent who has assumed custody of a child molested by a caretaker over the course of years, or to the parent of a child who witnessed the collapse of the World Trade Center on 9/11?

Traumatic Experience and the Brain: A Handbook for Understanding and Treating Those Traumatized as Children, by Dave Ziegler, offers help to all of these parents as well as to clinicians, pediatricians, school personnel and others who work with children damaged by trauma. I believe this small volume should be required reading in a variety of courses because the information it provides not only explains behaviors and reactions in all areas of a child’s functioning, but also offers suggestions for parenting, therapy, education and other interventions in a child’s life.

Some of the most relevant information from the book appears below:

  • With prolonged neglectful pasts, children can lose their receptivity to others, and attachment problems result (p. 19).
  • Attachment between mother and child directly influences the development of the right hemisphere of the infant’s brain (housing)...the neural networks of the developing stress response system...(controlling) the processing of social and emotional information (p. 20).
  • Dysfunction of the organizational system of the right hemisphere of the brain...affects attachment, affect regulation and stress management (p. 22).
  • Memories of past trauma are not stored in the neocortex where our reasoning functions can have an impact on these recollections (p. 29).
  • Recollections and associations of traumatic experience reside in the limbic system...trauma sensitizes the child’s system to the prime directive of the brain—survival (pp. 29, 31).
  • A child’s memory of trauma often is not about facts. The child’s inner experience or memory...is internal, personal and not logical (p. 33).
  • Overactivity in nonfunctional reactivity to stimuli associated with traumas (triggers) can lead to a lack of cognitive development (p. 47).
  • What the brain experiences, the rest of the body experiences with effects in emotions and behaviors such as frequent arousal to minor issues, hypervigilance, mood swings, attention problems and sleep disturbance (p. 49).

When explaining the impact of trauma on the child’s brain, the book looks at trauma’s impact on limbic systems, amygdala functions and hippocampus. This book provides easy-to-understand descriptions of brain structure and functioning that a lay person can read and digest. Understanding the impacts of neglect, trauma and abuse on the brain makes it easier to understand what Ziegler terms “the detrimental global effects” of those experiences on the child (p. 38).

A child stores traumatic memories primarily in the limbic system and brain stem, locations that make accessibility difficult in any organized way. Implications for treatment that arise from these realizations are listed clearly in bullet format at the end of each chapter. For example, Ziegler points out on page 50 that “nonverbal therapy methods will be needed to get to the best understanding of trauma memories.” In addition, he stresses that if information is known as to when trauma(s) occurred in the child’s lifetime, then treatment needs to address developmental issues and tasks missed during the traumatic exposure(s). In sync with the views of many others who work with traumatized children, Ziegler does not agree with restrictive holding therapies that can distract children from dealing with emotional pain and lead them to consider only the physical pain associated with holding. He also stresses the importance of play and helping children learn to play and use imagination. Forcing children to “be close to others, held until they accept love” has a “negative cost to true healing” (p. 87).

Ziegler repeats his message in many ways and under different topics. The message is the same. Traumatic exposure can have an impact on the brain of a child on a continuum from mild to extreme. Treating a traumatized child, let alone living with one, can be challenging and painful, as well as rewarding. The book confirms what the mother of the two adopted daughters soon learned: her children attempted “to get as much as they [could] while giving as little as they [could] as part of their power dance” (p. 92). She learned to set boundaries and expectations that were developmentally appropriate to the children’s experiences, not chronological age. She learned that her children’s frustration and upset over consequences actually were good signs in what Ziegler terms “the dominance struggle” (p. 97). This book helps therapists and others to be consistent, clear and safe figures as they try to help traumatized children talk about perceived present danger and threat, learn to delay gratification and learn to respond rather than react to the world around them. These and other techniques he suggests are designed to help the child’s brain develop new inner working models that slow the brain’s reactivity and include play, fun and being a child in a safe (as possible) world.

The book’s final chapter presents primary ingredients of trauma therapy. This discussion is more theoretical than experiential. The only shortcoming of this volume is that possible experiential interventions and strategies are not included. When Ziegler writes on page 150 that “talk therapy is of little initial value for the traumatized child,” it would be helpful to include specific nonverbal ways to explore trauma memories and associated responses (step 3), decondition harmful affective responses and replace problematic behavioral responses with adaptive behaviors (steps 4 and 7, respectively). The goal of any trauma work with children or adults is to build resilience and the ability to cope. Understanding what has made an impact on those tasks is the first step to gaining mastery over them. This book is a needed volume in building that understanding.

*The opening vignette serves as the reviewer’s introduction to the book review and is not taken from the book.

Mary Beth Williams, PhD, LCSW, CTS, Trauma Recovery Education and Counseling Center, Warrenton, Virginia, is a StressPoints contributing editor.