Healing from childhood trauma: What a child needs to feel safe again after abuse and adverse experiences
The first part last week was on how abuse, parents’ divorce and living with mentally unwell persons can affect a child’s lifelong health and relationships.
Please be advised that the articles delve into trauma-related topics that may be triggering to the reader.
- The behaviour and emotions of children and teenagers change after a traumatic event
- Acknowledging traumatic experiences, not evading or dismissing them, is an important first step to helping them recover
- Close bonds and the presence of safe, nurturing adults in a child’s life are vital in helping them rise above adversity
- In Singapore, there are various programmes to support traumatised children and mitigate the impact of a painful experience
SINGAPORE — Adverse childhood experiences are potentially traumatic events that occur in a child’s life before the age of 18.
Some of them are harmful and obvious when there is abuse and maltreatment. Others are less apparent but equally traumatic such as enduring pain from an injury or prolonged hospitalisation, not fitting in among peers and emotional neglect from parents.
In children and teenagers who are still growing physically, cognitively and emotionally, these early adverse experiences can leave a negative imprint on their development, behaviour and health right into adulthood.
In an ideal world, every child will grow up safe, loved and supported. Yet, painful and distressing experiences are sometimes unavoidable, and not every child has the inner resources and capacity to bounce back on their own from the shock or hurt.
So what are the signs to watch for in children and teenagers who are traumatised? And what can be done to help them recover from an adverse childhood experience or traumatic event?
However, an important step is to first acknowledge the occurrence of a traumatic experience, because healing cannot begin in silence or denial.
Adjunct Associate Professor Daniel Fung, chief executive officer of the Institute of Mental Health (IMH), said: “We need to recognise that there was a potentially traumatic event and help the child to deal with it.
“There’s a saying that a burden shared is a burden halved.
“I’ve seen a number of children where the parents are really in denial of something that has happened in the family when it’s clear that there was abuse. And that’s painful for the child.”
WHAT ARE THE SIGNS OF CHILDHOOD TRAUMA
Although different children may process a traumatic event differently, some tell-tale signs to pay attention to are:
- Unexplained disruptive behaviour
- Unexplained, intense outbursts of anger and aggression
- Becoming withdrawn
- Loss of interest in activities they used to enjoy
- Loss of focus and concentration on tasks
- Psychosomatic symptoms such as stomach upsets, fatigue and headaches
- Intrusive thoughts
- Being easily frightened or scared
- Showing sadness, fear or crying frequently
- Changes in appetite
- Having sleep difficulties
- Regressive behaviour where the child returns to an earlier stage of development such as bedwetting
- Exhibiting reckless and risky behaviours such as substance misuse and inappropriate sexual activity
WHY SUPPORTIVE ADULTS OR CAREGIVERS ARE IMPORTANT IN HEALING FROM TRAUMA
In the absence of parents, these adults may be other family members, family friends, school counsellors, teachers, befrienders, mentors or neighbours.
“There’s a need for love, but love is not something that I can prescribe, though I wish I could.Dr Daniel Fung, chief executive officer of the Institute of Mental Health, on the most important thing that children need”
What if parents or immediate family cannot provide support or continue to be the source of trauma, for example, in cases of child abuse or ill-treatment?
Senior clinical psychologist Jeremy Heng said that in such cases, professional agencies such as Family Service Centres and the Child Protective Service under the Ministry of Social and Family Development will work with other adults in the child’s life to establish safety.
He added: “Having someone who trusts in you, who tells you that whatever negative things that have happened is not your fault, that you are safe, are loved and wanted, that you belong, are good enough and that the future is hopeful.
“These messages help ground a child and give them an opportunity to develop healthily and thrive in spite of their adverse childhood experiences.”
Mr Heng is the deputy head of Sunbeam Place at Singapore Children’s Society, a residential home for abused and neglected children.
There, for example, the residential care workers are parental figures for many of the young residents. Not only do they provide care, they also gently guide them to correct their mistakes using “teachable moments”.
Mr Heng illustrated how it often takes a village to support traumatised children: An eight-year-old was referred to Sunbeam Place after prolonged harsh physical punishment and emotional rejection by her parents.
When she was first admitted, her intense emotional and behavioural outbursts often meant that she was biting, punching and scratching the staff members.
A group people were roped in to give the necessary support: A psychologist, residential care workers, a child development team and social workers.
“Currently, the teenager (now aged 14) is thriving in secondary school and is vice-captain for her sports co-curricular activity. She copes well with distress and relational conflicts, using her preferred emotional regulation strategies,” Mr Heng said.
“Most importantly, she is going home to her family in the next few months because both the professionals and her family have expressed confidence in a safe and stable reunification.”
Referring to Singapore Children’s Society’s research, Mr Heng said that when children who perceived that they had no one or only a few people whom they can turn to for emotional support, those who were exposed to more adverse childhood experiences had more of what is known as “internalising problems”, which are the feelings that develop internally such as anxiety, social withdrawal and depression.
When they perceived that they had more people to turn to, they were less likely to experience these feelings.
WHAT IS INVOLVED IN TRAUMA-FOCUSED CARE FOR CHILDREN
Mr Heng said that receiving the appropriate intervention after a traumatic event is critical. This is to ensure that the child feels safe and is not in immediate danger or harm.
It helps the child make sense of what has happened and reduce the likelihood of psychological troubles later.
“No other intervention may be effective if the harm continues,” he added.
Clinical psychologist Claire Ng from IMH said that trauma-focused work with children often involves working closely with families and communities.
“A large part of the work is helping children and families understand the impact of trauma on children,” she said.
“This helps families develop empathy for the child who may have difficulties regulating their emotions and behaviour after experiencing trauma.
“Another important part of the work is also helping caregivers understand how to help the child feel safe, both physically and emotionally.”
Ms Ng is with IMH’s department of developmental psychiatry and the forensic rehabilitation, intervention, evaluation and network development services (Friends).
“If a child can rely on safe, reliable caregivers to meet their needs, they develop a mental model of the world as a safe place… (this) allows them to explore the world with confidence, develop healthy relationships, manage setbacks effectively.Ms Claire Ng, clinical psychologist with the Institute of Mental Health”
- The first phase of treatment is to ensure that the child’s immediate environment is “safe enough”, which is defined as removing triggers that may potentially destabilise the child
- Next, the child and caregivers are taught skills on how to manage strong emotions
- Processing trauma begins once safety and regulation skills are established. This is because discussing past difficult experiences tends to be highly triggering and it is important to set the child to process these memories in a safe way
- Creative and expressive therapies such as art, play, music and drama may also help children who cannot verbalise their trauma due to pain and shock
An approach called Trauma-informed Positive Behavioural Interventions and Supports (TI-PBIS) is used in the residential care setting at Sunbeam Place under the Singapore Children’s Society.
It is a system of care that equips children with adaptive behaviours that help them regulate their emotions and form positive social connections.
To promote social connections, each of its six dormitories is set up to resemble a typical Singaporean household, with a living room, study room and bedrooms.
The residents have daily routines and activities that are mundane but critical in promoting positive behaviour and social interaction, Mr Heng said.
For example, having meals together and sharing about their day, deciding on activities to do as a group and studying together.
Besides letting the residents feel they are safe and loved, can trust others and have control, the recurring positive interactions allow them to “unlearn” maladaptive interaction patterns such as being aggressive to protect themselves, and to learn healthier ways to relate to others.
“They also learn skills to tolerate distress and regulate themselves using more effective and healthier methods.
“This is why having one or more consistent safe and trusted adult attachment figures is so critical to scaffold, guide and promote the learning of necessary skills to support the recovery of these children and youth,” Mr Heng explained.
WHAT OTHER PROGRAMMES OR HELP ARE AVAILABLE
In Singapore, various programmes are in place to support traumatised children. The following are just a few of them.
1. INSTITUTE OF MENTAL HEALTH
- Friends at the Child Guidance Clinic works with schools, the police, social service organisations, the Ministry of Social and Family Development and other agencies to support children and youth. They include young offenders, youth-at-risk, child abuse victims and families involved in complex custody and access disputes
- The Resilience Programme workshops help children with parents who have a psychiatric illness develop resilience and understand what mental health is. They also learn skills to manage the everyday challenges they face at home
2. SINGAPORE CHILDREN’S SOCIETY
- The society makes a concerted effort to use a trauma-informed approach to support children with adverse childhood experiences and their families
- Its practitioners are trained to carry out a psychosocial programme called Be The Light, developed by psychosocial trauma support services at KK Women’s and Children’s Hospital (KKH) to support children and caregivers after a traumatic event
Ms Ang Jia Yi, a counsellor at Yishun Family Service under the Singapore Children’s Society, said: “The aim is to reduce the likelihood of individuals developing more severe distress and trauma symptoms. The majority of them return to normalcy with adequate support.”
3. KK WOMEN’S AND CHILDREN’S HOSPITAL
- In 2019, KKH started a home visitation pilot programme called Anchor with the partnership of Temasek Foundation to support children under the age of four who are exposed to adverse childhood experiences. As of February this year, more than 160 children have been enrolled in the programme
- The programme is fully funded by Temasek Foundation, the charitable arm of state investor Temasek Holdings, and is also voluntary, which means that parental consent is obtained before a child is enrolled
- Children are referred to the Anchor programme if they are:
– Under the age of four and seen in KKH for suspected non-accidental injuries
– The child’s sibling who is also under the age of four and living in the same household
Dr Yeleswarapu Padmini, senior consultant with KKH’s department of child development, said: “(Information on) the history of non-accidental injuries could come from one of the parents, community agency supporting the family or from preschool if they have identified any signs and symptoms suggestive of any non-accidental injuries.
“At the same time, a detailed evaluation of the child and information gathered by the medical social worker as part of the social evaluation would also be considered.”
Dr Padmini added that children who are exposed to adverse childhood experiences often come from families that have competing needs. These may include financial concerns or the child’s caregiver could have mental health ailments.
One of the advantages of receiving help through the Anchor programme is that the interventions are carried out in the family’s home.
For example, children exposed to a significant traumatic event will get support from a psychologist who can provide more trauma-focused interventions.
For children with health or developmental problems, they will be supported by paediatricians and allied health professionals.
WHY SUPPORTING CHILD’S FAMILY IS ALSO IMPORTANT
Ms Ng from IMH said that humans are innately wired to seek connection and learn about themselves, others and the world through the eyes of their early caregivers.
“If a child can rely on safe, reliable caregivers to meet their needs, they develop a mental model of the world as a safe place.
“This perception of a secure base allows them to explore the world with confidence, develop healthy relationships, manage setbacks effectively and so on,” she explained.
Understanding the impact of adverse childhood experiences and the struggles that families face spurred Morning Star Community Services to launch a free evening “drop-in” service in 2016.
The child may be dropped off at the centre where it runs its CareNights programme, which supports lower-income families in need who require care for their children on weekday nights.
This gives parents time at night for work or to take courses to improve their skills. This also allows them to get a respite for families going through a difficult time such as those undergoing divorce or attending to critically ill family members.
“Supporting parents is crucial in addressing and mitigating adverse childhood experiences because parents play a vital role in shaping a child’s environment and experiences.Mr Lemuel Yanos Baculanta, assistant manager of the CareNights programme under Morning Star Community Services”
CareNights also conduct parenting workshops and organise parent-child bonding activities such as outings and birthday celebrations for children who attends CareNights and their families.
A large proportion of families that place their children with CareNights are single-parent households. It currently supports 63 children across four centres.
Mr Lemuel Yanos Baculanta, the programme’s assistant manager, said: “Supporting parents is crucial in addressing and mitigating adverse childhood experiences because parents play a vital role in shaping a child’s environment and experiences.”
A recent case that Mr Baculanta encountered is an eight-year-old girl, whose father was put up at a nursing home due to deteriorating dementia. He had shown verbally violent behaviour.
The mother, the sole breadwinner in the family, works extra hours at night and during weekends to make ends meet.
Confused and frustrated by the changes, the girl confided in a CareNights mentor that she had thoughts of self-harm and was curious about a “happy pill” (presumed to be a drug) that she had discovered while watching content fromYouTube.
The mentor immediately advised the child’s mother to limit the girl’s access to such online content. After learning about her daughter’s thoughts of self-harm, the mother also communicated the self-harm concerns to the school counsellor.
Emphasising the importance of having trusted adults in the child’s life to buffer the impact of adverse childhood experiences, Mr Baculanta said: “Currently, the child is thriving and starting to express joyfulness despite her family situation. She feels more confident and secure, knowing that there are people (CareNights’ mentors and volunteers) aside from her family who are concerned for her well-being.
“There’s a need for love, but love is not something that I can prescribe, though I wish I could,” the child psychiatrist added.
HOW A CIRCLE OF SUPPORT HELPED MY CHILD
In 2021, a traumatic injury left my daughter with mobility issues for over a year and a chronic pain condition.
From a fit, healthy and cheerful teenager, my girl who was 14 then could not walk, run, jump or write without experiencing muscle spasms and pain.
The unrelenting pain she experienced was more than physical; it took over every aspect of her life, weighing her down mentally and emotionally.
Post-traumatic stress symptoms set in: The cold sweats, being easily startled and flashbacks of the incident that led to her injury. Her sleep was disrupted either by pain or nightmares.
In school, she struggled to make sense of the jeers and taunting from some classmates who labelled her “disabled” after seeing her hobble around using a crutch.
One day, she told me, “Something in my brain tells me to kill myself. It is too painful”.
It is the worst thing any parent could hear their child say.
But I was also glad that my daughter, with whom I had a close bond, let me in on her innermost thoughts. They reflected how traumatised she was by her experiences.
What I did after she disclosed her thoughts of suicide changed how she processed her traumatic experiences.
I immediately raised the alarm with her medical team and asked for extra support from a psychologist. Therapy sessions were stepped up to help her cope with her pain flares.
Instead of hushing up her mental health issues, I rallied extended family and friends. They took turns to visit, hang out, chat and prayed with her.
With support, care and love, things improved over two years.
My daughter developed a better understanding of herself and how to cope during times of stress, by using techniques such as deep-breathing and visualisation.
She now aspires to work in healthcare to support other children and youth in need.
Ms Claire Ng, a clinical psychologist from the Institute of Mental Health, said that there is consistent evidence to show that a child can thrive even after exposure to trauma — provided they have supportive, safe and nurturing environments.
The brain, she explained, has the capacity to change and develop over a lifetime.
“Just as negative experiences can affect brain development, corrective therapeutic experiences can have a profound impact on how a child develops after trauma,” Ns Ng added.
WHERE TO GET HELP
- Youth centres under the Singapore Children’s Society
– RoundBox@Children’s Society (Toa Payoh): 6259 3735 (Mon to Fri, 9am to 6pm)
– Vox@Children’s Society (Chai Chee): 6443 4139 (Mon to Fri, 9am to 6pm)
– JYC@Children’s Society (Jurong): 6566 6989 (Mon, Wed and Fri, 8.45am to 5.45pm)
– The Fort@Children’s Society (Radin Mas): 6276 5077 (Mon to Fri, 8.30am to 5.30pm)
- Fei Yue’s Online Counselling Service: eC2.sg website (Mon to Fri, 10am to 12pm, 2pm to 5pm)
- Institute of Mental Health’s Mental Health Helpline: 6389-2222 (24 hours)
- Samaritans of Singapore: 1800-221-4444 (24 hours) / 1-767 (24 hours)
- Singapore Association for Mental Health: 1800-283-7019 (Mon to Fri, 9am to 6pm)
- Silver Ribbon Singapore: 6386-1928 / 6509-0271 (Mon to Fri, 9am to 6pm)
- Tinkle Friend: 1800-274-4788 (Mon to Fri, 2.30pm to 5pm)
- Touchline (Counselling): 1800-377-2252 (Mon to Fri, 9am to 6pm
BY
EVELINE GAN
Published April 20, 2024
Updated April 27, 2024