Excerpt: Listening to Fear: Helping Kids Cope, from Nightmares to the Nightly News

When Things Go Wrong: Trauma and Our Youngest Children

Our children's nightmares are filled with the dangers and fears that span development from infancy into adulthood. These bedrock fears -- of losing our lives or the lives of those we love and upon whom we depend, of losing the love of others and the love of ourselves, of damage to our bodies and impairment of functioning, of losing control of our urges, feelings, and rational thought, and of losing the order and structure in our worlds -- are also the ones that we try to keep as far away from conscious thought as we possibly can. Even if our efforts are not as successful as we would like, as we get older our capacity to feel and respond to signals of anxiety increases, helping us to watch for, prepare for, and take protective action against danger.

Growing up, unfortunately, does not free us from vulnerability to the fears of previous phases. In fact, we are most acutely and intensely affected and overwhelmed by fundamental fears from the past when they are reawakened and materialize in unexpected events in the present. We are most frightened when internal threats and real external dangers converge. With nightmares, our fear diminishes as we awaken and latch on to our immediate surroundings to counterbalance the dreaded aspects of our imaginations. A very different situation emerges when, in traumatic situations, we are unable to anticipate or avoid real dangerous events. We are clobbered by nightmares that have come true.

For children and adults alike, traumatic situations are similar to earlier times in our lives when we had no words for our worst fears and when our cognitive resources were not yet up to the task of ordering and making sense of complex experiences. Regardless of age and phase of development, psychological trauma can interfere with our established intellectual, emotional, and physiological patterns. At the most acute and intense moments, traumatized children and adults, awash in hard-to-identify feelings and chaotic thoughts, are unable to recognize or explain their experience. In these circumstances, anyone feels confused, disoriented, and terrified.

Traumatized children and adults alike may be unable to control their bodies. They may shake uncontrollably, weep, sweat, or feel nauseated and jumpy. Alternatively, and in exception to many people's expectations, traumatized individuals may look as if they aren't fazed by the horror or danger they have just experienced. In fact, their detachment and emotionally frozen look may be an indication that they are disconnecting or dissociating from their own experiences. This automatic response is one way in which their minds are able to digest the breadth of what has occurred. In truly traumatic events, the capacity to pull together strands of information and experience that are essential for making decisions and protecting ourselves are effectively knocked out of commission.

Well after the traumatic events, children and adults may involuntarily and suddenly reexperience their original loss of control. Their bodies are more vulnerable; they are more apt to be startled and experience rapid changes in heart rate and breathing. These so-called post-traumatic symptoms are especially distressing when we are unable to consciously locate what triggered them or identify the reminders that set such uncomfortable, isolated bodily sensations in motion.

While children and adults share many of the disorganizing effects of trauma, the adult capacity to adapt, figure out defensive strategies, and call on internal resources is vastly different from what is available to our children. Moreover, the self-protective mechanisms that they acquire through normal development are especially vulnerable to traumatic disruptions. A child's experience of helpless surrender to overwhelming circumstances threatens to undermine recently attained developmental capacities. In a regressive slide, traumatized children are apt to return to earlier ways of expressing their needs, fears, conflicts, and anxieties, as well as to previously reliable ways of negotiating them. As a result, young children who have been traumatized show a wide range of symptoms. These include:

Increased clinginess and difficulties separating from parents

Disrupted sleep, with increased nightmares, waking, and panic

Increased worries and hypervigilance

Avoidance of new or previously identified sources of danger (phobias about animals, noises, monsters under the bed, etc.)

Toileting problems and physical complaints (headaches, stomachaches, or other aches and pains with no medical cause)

Eating problems with increased fussiness, lack of interest, or insatiability

Increased irritability and oppositional behavior with increased aggressiveness, angry outbursts, and inability to be soothed

Emotional upset with unusual and frequent tearfulness and expressions of sadness

Withdrawal of interest in pleasurable activities and interactions

Dramatic changes in or inability to play; playing less creatively; repeatedly reenacting a traumatic event, such as a car crash or a fire

Blunted emotions with no show of feelings; disconnection, as though going through the motions of regular activities

Unusual distractibility

Refusal to engage in previous age-appropriate behaviors (self-feeding, washing, brushing teeth, self-dressing, etc.)

Return to more babyish speech patterns

While all children may be vulnerable to symptoms of trauma when real dangers converge with their worst fears, it is not surprising that children whose development is already fragile may be at greatest risk for continued long-term effects after sudden overwhelming events. Parents and caregivers fail children when they do not recognize that they have been overwhelmed by trauma and need help.

Excerpted from the book Listening to Fear: Helping Kids Cope, from Nightmares to the Nightly News by Steven Marans, Ph.D. Copyright © 2005 Steven Marans. (Published by Owl Books; January 2005; $15.00US/$20.95CAN; 0-8050-7604-2)