A screaming toddler commands the attention of everyone within earshot. Some have a fingernails-on-chalkboard response, others judge the parents. Everyone asks, "What is wrong with that kid?"
It's a fair question, but not necessarily the correct one—this behavior could be a reaction to something deeper. So maybe the question should be, "What has happened to this child?"
Children who have been exposed to adverse experiences, like domestic violence, emotional or physical abuse, even stress within the home, often suffer from trauma—an emotional response expressed through behavior. In Michigan, 28.5 percent of children are exposed to two or more adverse experiences, higher than the national average of 22.6 percent, according to the National Survey of Children's Health
"Trauma will look different for everyone," says psychologist Christina Grim, director of clinical and trauma services at Starfish Family Services
Some kids react with depression, others will have classic behavior problems, and some will be unfocused and distracted. The people most likely to witness these behaviors are teachers, librarians, school administrators, bus drivers, physicians, and many other adults in a child's daily life. It would be great if all adults who work with children were "trauma-informed," or skilled in recognizing and understanding trauma.
But experts say this is far from the case.
"We are not even at the starting line at this point," says Grim. "A lot don't understand the impact of trauma on children and what that means to their future. Without knowing what to do next, we are not doing a great service to children and communities."
Consider attention deficit hyperactivity disorder, or ADHD, which affects up to 12 percent of children
, according to the University of Michigan Health System. Experts now believe that many of these children are not experiencing ADHD, but trauma.
"We are all familiar with ADHD. What's happening in some of these cases is [the child] will have a trauma background, and is not sure how to channel their energy, or the thoughts in their minds," says Grim.
When physicians and therapists correctly identify the underlying cause, treatment follows a more appropriate path. "Instead, we give them strategies and coping skills to learn how to re-channel those behaviors and the intrusive thoughts that are causing them to act out."
Starfish, like other organizations in Michigan
, is working to become trauma-informed in every aspect of their work, and hope to spread trauma awareness throughout the region. "Ideally, we will all come in with a calmer voice and a caring response, so anybody who has a trauma background can feel supported or be in a judgment-free area," says Grim. "That is key."
Trauma-informed classrooms help kids thrive
Preschool classrooms are not immune to trauma-related outbursts. A little boy hears two children yelling, and responds by hitting and scratching. "He wants it to stop, but he's pre-verbal," says Michelle Smith, a teacher at Starfish Early Head Start Infant/Toddler in Inkster. "Instead of one fire to put out, we have two.
Physical outbursts or delayed social-emotional development are the most common responses in toddlers affected by trauma. Anxiety and insecurity can look a lot like stubbornness when kids feel unsafe and untrusting.
"Kids can be weepy, fall apart easily, and need a lot of support emotionally, or they use defense mechanisms and coping skills that show up in other ways," Smith says.
Michelle Smith reads to kids at Starfish Early Head Start in Inkster
A provider and child at Starfish Early Head Start in Inkster
Last year, Smith, an early childhood educator since 1995, and her colleagues spent 10 months undergoing Trauma Smart
, a program that provides skills to teachers that help children bond, attach, self-regulate, and build trust. In the classroom, they support activities to help rebuild brain pathways pruned as a result of repeated stress—damage which can be permanent for kids who don't learn coping skills and resilience.
Teachers validate students' feelings, and create refuge spaces in the classroom where kids can grab a blanket and a book and just calm down.
"To me, would you rather deal with a person who had trauma when they were three, or have them see a therapist when they are 20?" says Smith. "The time to help them and give them the coping skills is when they are young."
Early Head Start staff provides trauma-sensitive support to parents, too. "If mom is stressed out, so is her two-year-old, and it shows. For the parent who comes in the door and says she was late because they got evicted, well being on time is not on the priority list in that case," Smith says. "We are lucky enough to have services through Starfish, and a lot of parent support we can hook them up with."
Working to keep kids in school
The Student Advocacy Center of Michigan
is a trauma-informed nonprofit in Wayne, Washtenaw, and Jackson counties that helps students find success in school. Most of the youth helped here have experienced trauma or toxic stress
, which is the prolonged activation of the fight-or-flight response people feel when under threat. Their behavior often results in suspension or expulsion from school.
"We worked with a student who, because of his fight-or-flight response, needed to take a walk at times. It was a physical need, not an option, and his school suspended him," says executive director Peri Stone-Palmquist.
A toddler at Starfish Early Head Start in Inkster
The student moved to a trauma-informed school, where his needs were better understood.
A trauma-aware school moves away from blaming the student and the family, and recognizes there is a reason behind challenging behavior. Anger, for instance, is a common response for a student who is teased or belittled at home. But after regularly identifying a trigger, kids will hopefully be able to identify them on their own.
A plan to help kids cope with trauma can be a guard against repeated suspension, a measure that isn't necessarily the best action for kids who need to stay in school. "We have definitely seen what can happen when a school gets trauma training, or when kids switch to schools that have a more trauma-informed approach," says Stone-Palmquist. "The difference in their behavior is so profound. We know how impactful it can be."
This year, a new law
replaces Michigan's zero tolerance policies for student suspension and expulsion, giving districts more flexibility in cases of student misconduct. Schools can now consider many factors when determining appropriate disciplinary measures, which could pave the way for a more trauma-informed approach.
Still, trauma awareness trickles slowly into schools. "There may be individual people within schools, but some are just learning about it," says Stone-Palmquist.
Strength in self-healing
Mindfulness, the practice of paying attention to the present moment, often through breathing and yoga, is an innovative way to help trauma-affected kids build resilience and self-regulation. Since 2002, The Holistic Life Foundation
has worked with Baltimore's most underprivileged kids. The school-based mindfulness program has shown benefit in a randomized pilot trial
by the Johns Hopkins Bloomberg School of Public Health, and is currently in a second federally-funded research project.
"Children can use mindfulness as a tool to achieve some semblance of inner peace, a strength from inside they can always tap into," says Ali Smith, Holistic Life Foundation co-founder.
The program currently works with 7,500 children per week, and uses trauma-informed practices to help kids feel safe in their own bodies.
Michigan children, too, are expanding their social-emotional capacities through mindfulness with the help of Michigan Collaborative for Mindfulness in Education
"If we think about the symptoms of post-traumatic stress and how we experience life with ruminating thinking," says Ann Arbor Public Schools psychologist Mary Spence, "we consider focus and emotional regulation as a skill set that is of benefit to those who have the additional load of trauma on top of life."
Spence, who is on the board of MC4ME, works with educators, administrators, and children using the Mindful Schools Curriculum
. "I have worked with kids who have had terrible things happen to them, and it affects brain development. It does change how the body responds to the idea of threat and safety.
"We are working to give kids a space where they feel safe to develop a mindful practice."
This article is part of "Children of Michigan," a series on the importance of health and wellbeing for Michigan's children. It is made possible with funding from the Children's Hospital of Michigan Foundation.
All photos, except where mentioned, by Nick Hagen.