Vol. 18, No. 1 • November 2013

Parenting Children Who Have Experienced Trauma

by Laura Phipps, MSW

Thanks to trauma, some children see the world as an unsafe place. That's why, for those of us who support children and families impacted by trauma, one idea is paramount: help kids feel safe!

Unfortunately, this isn't simple. True, it's not hard to move a child from a dangerous setting to one that is objectively safer. But physical safety is only half of the issue. We also need to help children feel psychologically safe.

Psychological safety is feeling safe, and it is based on each individual's experiences and understanding of what has happened to them in the past and what will happen in the future. Achieving psychological safety for children can be challenging because what's safe to one person may not feel safe to someone else. Unsafe feelings can be triggered by many different kinds of things: sights, sounds, smells, people, time of day, etc.

What's more, these feelings can be triggered without conscious awareness of it. This can be very confusing to caregivers because trauma histories can lead children to exhibit behaviors and emotions that don't make sense to us, and may be the exact opposite of what we think they should be doing.

Consider the child who comes in from playing outside and is very wet and dirty. You run a nice big bubble bath with toys and a fluffy white towel and call the child. She runs away screaming. Many of us would find that bath soothing and comforting, but for some children bath time reminds them of past trauma, so they react in a way we don't expect.

So, how can we help kids feel safe when it may not even be clear what "safe" means for them?

It is helpful to think about psychological safety as having three parts: we feel psychologically safe when we feel safe, capable, and lovable (NCTSN, 2010). Parents must act in a way that sends a clear message in each area.

1. You Are Safe

• Reassure children things have changed and that everyone is working to keep them safe.
• Be aware of trauma reminders; remove them when possible.
• Maintain children's contact with loved ones, friends, and siblings to reassure them the people who matter to them are still in their lives.
• Use compassion and understanding when addressing challenging behaviors.

2. You Are Capable

• Taking into account their developmental level, give children control over as many aspects of their lives as possible.
• Help them learn skills to manage overwhelming emotions.
• Make it clear you're sure they'll succeed in managing their emotions and behaviors.
  Build on children's existing skills and strengths.

3. You Are Lovable

• Show unconditional positive regard for the child as frequently as possible.
• Separate what children do from who they are--make it clear that they can make bad choices but still be a good person.
• Be excited to see them when they come home from school or have been separated from you.
• Express interest in what they think, feel, and are interested in; talk to them and ask their opinions about things.

Managing Challenging Behaviors While Promoting Psychological Safety
Trauma reminders can trigger intense reactions and are often at the root of many behavior challenges. It can be difficult to figure out how to balance (1) the need to address problem behaviors and hold kids accountable for their actions with (2) helping children feel psychologically safe.

Yet how can you show unconditional positive regard when behaviors are causing stress and frustration? How can you communicate confidence in their ability to master challenges while challenges are still occurring?

The answer is in how we understand and respond to children's behavior.

Understanding Problem Behavior
All behavior meets needs. When children experience trauma their most pressing need is survival. Many behaviors we would label as "bad" or "difficult" were necessary at one point for the child to survive.

We need to reframe our thinking about this behavior. Rather than seeing it as negative and hostile, we need to see it as a previously necessary survival skill that isn't working for their current environment. If hiding in the closet helped a child stay out of the way of an angry and abusive parent, that is a survival skill. But if the same child is hiding in the bathroom at school to feel safe, that same survival skill is getting in the way of them being successful in a different situation.

One helpful strategy is to remind yourself that it isn't about you. It may feel like the behavior is aimed at you, but we have to remember that the child is behaving the way they are based on a situation from their past. This can be very difficult when a child is doing or saying things that are hurtful or dangerous, but it will help you respond in a way that will be more likely to work. It can help to keep a Q-Tip in your pocket as a reminder to "Quit Taking it Personally."

Responding to Problem Behavior
No matter how well we understand challenging behavior, it can still be incredibly difficult to change. It helps if you recognize that all behavior operates in a pattern; behavior is a reaction to certain triggers and is influenced by the reactions of others and the environment. If we break this pattern down, it becomes much easier to build a comprehensive plan that will help the child learn new, more appropriate behaviors over time.

There are three general strategies for responding to children's problem behaviors.

1. Prevent: Be a behavior detective. Look for clues about when behaviors happen and what is going on in the environment around the child. Once you see a pattern, make changes that prevent the problem from occurring in the first place. Eliminating trauma triggers is the most important prevention strategy for maintaining psychological safety.

2. Teach: Just as the child learned a series of behaviors that kept them safe, they can also learn new behaviors that meet the same need and are a better fit for their new environment. The goal is to identify the need behind the behavior and then teach a new skill that allows children to get this need met in a different way.

Caution: we must never remove a coping strategy without replacing it with another equally or more effective strategy. We want to maintain the sense of safety that these behaviors have provided in the past. This takes practice and support, but if the need is being met you should see improvement over time.

3. Respond: To support children in using new skills we need to respond differently to the old behavior and spend the majority of our time and energy responding positively to the new behavior. When the problem behavior occurs we need to respond in ways that demonstrate why this behavior is not a good choice. Logical consequences that focus on helping children understand the impact of their behavior are the best way to help teach this. Logical consequences need to be respectful, relevant, and realistic. Consequences that don't meet these criteria are less likely to work.

Positive responses to the new behavior can be given in a wide variety of ways, including verbal and nonverbal praise, positive contracts, earning privileges or special activities, or tangible reinforcement. What is most important is the frequency of positive responses, not the method. (Ideally there will be at least four positive comments for every correction--though there are those who think this ratio should be much higher.) Especially when a child is trying to learn a new skill, positive feedback needs to be frequent and specific. This will help support the child in feeling capable and increase psychological safety.

Most importantly, we need to remember that we want children to feel lovable, even when they are demonstrating difficult behavior. Choose your words carefully. Avoid statements that imply blame or express anger or impatience. Focus on the behavior, not the child. Validate children's feelings. Communicate a desire to help them figure out what is going on and learn how to be successful.

Examples of Behavior Management Strategies

Strategy: PREVENT Eat dinner half an hour earlier to avoid meltdowns caused by hunger. Talk with the school about providing extra support for the child on mornings after parent-child visits. Give the child choices when seeking compliance ("you can do this or that"). Practice a difficult transition right before you do it. Plan times to give one-on-one attention and tell the child when that will be and how long they have to wait. Strategy: TEACH Teach a new skill to replace the problem behavior. So, if a child regularly starts fights with a sibling in the car, help her plan an activity such as listening to an audiobook to manage her boredom. New skills must meet the same need as the problem behavior. If the audiobook doesn't keep the child from getting bored, it won't eliminate the fighting. Effective teaching includes repeated modeling, practice, and feedback on use of the skill. To be used in a stressful situation, a skill needs to be "over taught." Example: you want the child to use a safe space instead of running away when overwhelmed. Model the skill by taking five minutes by yourself in your room when you're frustrated or angry, explaining to the child when you do so. Help the child create his own safe space with some favorite objects. Practice going there with him during different times of day and moods. With practice, the safe space will feel like a tool controlled by the child, not a punishment controlled by you. Feedback might include thanking and hugging the child for going to the safe space, or reminding him that the space is available when he forgets to use it. Don't try to teach skills during a crisis or highly emotional moment. Wait for a time when you and the child are calm. Strategy: RESPOND Support the Positive Behavior Contracts: Best for structured feedback to support a new behavior. Example: when a child uses his safe space a certain number of times instead of running away, he receives a privilege. Frequent, specific praise: Focus on praising the new, desired behavior. Privileges and responsibility: As a new behavior is being mastered, add special privileges and responsibilities to show you know the child can handle them. Reduce the Problem Behavior Logical consequences: These flow directly from the problem behavior. If a child has a meltdown about turning off video games, he loses use of the games for a period of time. Consequences need to be discussed in advance so everyone understands what will happen if the problem behavior continues. Loss of privileges: Privileges can be removed if the problem behavior returns. Disengage from conflict: Though difficult, do your best to stay calm and focused on what you want the child to do when the problem behavior occurs.

And remember: no one is perfect. We all make mistakes and say and do things we wish we hadn't. When this happens, the best thing you can do is model how to handle mistakes. Apologize for anything you feel was hurtful, and talk about your own feelings. Showing children that we all make mistakes and can try again is one of the most powerful ways to support them in doing it too.

Laura Phipps is a clinical instructor with the Family and Children's Resource Program, part of the UNC-CH School of Social Work.

To view references cited in this and other articles in this issue, click here.

~ Family and Children's Resource Program, UNC-CH School of Social Work ~