Let’s say you wake up one morning with a sore throat. You go to the doctor, and they give you a physical exam and ask you some questions. Hopefully, those questions will give the doctor an understanding of the “root cause” of your sore throat.

For example, perhaps you were singing loudly at a concert the night before. Or, maybe it is springtime and your seasonal allergies are acting up. Or maybe you caught the strep virus. Knowing the cause of your sore throat is helpful, because the most effective treatment will be quite different depending on the cause. A throat lozenge won’t cure strep throat, and an antibiotic won’t treat allergies.

The same principle holds true when thinking about emotional and behavioral problems as well. One symptom can have different root causes. And similar to a sore throat, if the root cause is missed, the recommended intervention may not be effective. Childhood trauma is one root cause that is notorious for being missed.

Why Traumatic Stress Is Commonly Misunderstood

Human brains are wired for self-protection. When we encounter danger, our body goes into a “fight, flight, or freeze” state, which is designed to help us survive. When a child experiences chronic or repeated trauma, the nervous system becomes chronically activated, and the “fight, flight, or freeze” response is constantly being activated, even when there is no threat or danger.

This can look different from one child to another, depending on the nature of the trauma (for example, sexual abuse vs. neglect), the child’s current environment, and their biological temperament. Some children may be constantly “on the lookout” and hypervigilant to perceived danger. Other children may tend toward frequently shutting down or freezing, kind of like a turtle going into its shell. Other children may be quick to anger and have frequent aggressive episodes.

Without knowing the “root” of these reactions, these behaviors can be confusing, scary, and very frustrating. And, because trauma is often not disclosed, these behaviors or often misattributed to other causes by well-intending caregivers, teachers, doctors, and mental health professionals.

Take, for example, a child who is easily distracted in class, often forgets instructions, wanders around the classroom when he is supposed to be in his seat, and is fidgety throughout the day. These problems look a lot like the genetically influenced Neurobiological Developmental Disorder known as Attention Deficit Hyperactivity Disorder (ADHD). Similarly, if a child in your classroom is aggressive, throws frequent temper tantrums, often seems angry or annoyed, it may seem like a diagnosis of Oppositional Defiant Disorder (ODD) is warranted. However, both of these children could also fit the description of a child with traumatic stress.

Research shows that children with a history of trauma show more oppositional behaviors than children without exposure to trauma, and children who have experienced four or more adverse childhood events are 3x more likely to use ADHD medication than non-trauma exposed children.

Commonly Misunderstood Trauma-Related Problems

See below for a list of commonly misattributed trauma-related emotional or behavioral problems.

Traumatic Stress Reaction:

Commonly Confused With:

If Trauma Is the Root of the Problem:

Difficulty concentrating, forgetfulness, or being easily distracted

ADHD

Being constantly on the lookout for possible danger can make it difficult to pay attention to the teacher or focus on completing an assignment.

Fidgeting or restlessness

ADHD

A chronically activated fight/flight system can make a child jumpy or easily startled by noise, movement, or trauma reminders. This can look like restlessness.

Daydreaming, non-compliance, or “not listening”

ADHD

Dissociation is a common freeze response the brain uses to avoid trauma memories or reminders.

Impulsivity or acting without thinking

ADHD or ODD

A quick “survival” reaction to an intrusive trauma memory or trauma reminder may look like impulsivity.

Frequent temper tantrums or “meltdowns”

ODD, Autism Spectrum Disorder

Children learn to calm and soothe themselves through the help of their caregivers. Trauma in the form of abuse or neglect can lead to an underdevelopment of self-regulation capacities and difficulty processing sensory inputs.

 

Children with an overactive fight or flight system also experience a reduced activation of the prefrontal cortex, which is the part of our brain that thinks through problems. Having constant difficulty problem solving can be very frustrating and emotionally overwhelming.

Irritability and easy to anger

ODD

Children who have experienced chronic trauma may learn to believe that everyone is out to get them. This is called a “hostile attribution bias.” This means that neutral interactions may be interpreted as hostile, leading to anger and being ready to fight back at any moment.

Finding the Root of the Behavior

Noticing and being curious about these behaviors is the first step to understanding the problem — and understanding is an essential step in finding the most effective intervention. Additional steps include:

1. In your curiosity, try to notice if there are any noticeable patterns in the child’s behavior.

  • Do they act up when the classroom gets noisy? Or really quiet?
  • Do they “space out” when interacting with teachers or other authority figures?
  • Do they become angry at the end of the day before getting on the bus?

2. Provide the child warmth and kindness, even if it’s not necessarily “earned.”

  • This doesn’t mean they don’t get consequences for negative behavior, but even consequences can be delivered with calm energy and kindness. This sends the signal that you are a safe and approachable adult.
  • In the same vein, invite them to chat and ask how they are doing, without pressure to disclose anything in particular. Let them know that you are there and welcoming.

3. Connect the child with a school psychologist or other mental health provider trained in conducting trauma-informed assessment.

  • Share your observations, including patterns you have noticed regarding triggers to their symptoms.

With an accurate diagnosis and treatment plan, which may include trauma-informed intervention and support both at home and at school, the child has the best chance of getting what they need to heal from trauma or manage their mental health disorder.


Vanessa Jacoby, Ph.D., is an Assistant Professor and Licensed Clinical Psychologist with a child specialization in the Division of Behavioral Medicine at the University of Texas Health Science Center. She is member of the STRONG STAR Multidisciplinary Research Consortium and the Consortium to Alleviate PTSD, whose mission is to alleviate and prevent posttraumatic stress disorder (PTSD) and other deployment-related problems in active-duty service members and their families. In her work at STRONG STAR, Dr. Jacoby conducts prevention and supportive programs with military families with young children experiencing deployment.

The opinions, representations, and statements made within this guest article are those of the author and do not necessarily reflect those of One in Five Minds or Clarity Child Guidance Center. Any copyright remains with the author, and any liability with regard to infringement of intellectual property rights remains with them. One in Five Minds and Clarity Child Guidance Center accepts no liability for any errors, omissions, or representations.