Question
What behaviors may be seen in pre-teens and teenagers who have experienced trauma?
Answer
Pre-Teens
The behaviors often seen in pre-teens are almost the same as for school-age children. They also have anxiety, fear, and worry about the safety of themselves and others. They worry about recurrence or consequences of violence. They often have a decrease in attention and concentration and an increase in activity level. You may see changes in academic performance. They may be more irritable with friends, teachers, and events, sometimes having angry outbursts and/or aggression. They may withdraw from others and activities and be absent from school. They also might have increased somatic complaints such as stomach aches, headaches, or chest pains. Pre-teens may have discomfort with feelings, such as troubling thoughts of revenge. This is important to keep an eye on because that falls into a completely different category if they want to harm somebody else. We don't want anyone to ruin their lives because they're focused on revenge. Revenge will not help them heal from their feelings.
You may hear repeated discussions of the event focusing on specific details of what happened. This is also important to look for because a pre-teen might be focused on what they think they did wrong. That might be the only thing they focus on, but certain things happen out of our control. For example, the teen that was sexually assaulted might solely focus on, I accepted the date, and it's my fault. I'm the one that did that. As professionals, we need to be there and correct that information because while they may have accepted the date, they did not accept being assaulted. They may over- or underreact to bells, physical contact, doors slamming, sirens, lightning, and sudden movements. Just like school-age children, they may re-experience the trauma through nightmares or disturbing memories throughout the days, which are usually flashbacks.
A pre-teen with a flashback might be able to articulate things a little better than a preschool-age or school-age child. Sometimes they still don't know that the movie is playing in their head every time someone slams the door because slamming the door is the trigger. Again, you may see hyperarousal, including sleep disturbances and being easily startled. They too, will often display avoidance behaviors as they resist going to places that remind them of the event. They will also have emotional numbness. As I said with school-age children, it's just not being able to process what they're feeling because once they process what they're feeling, it just becomes too painful. No one wants to sit there willingly and feel pain. When something is painful, you want to hide and not feel it. Emotional numbness is where people go to. It's like their safe place in their mind.
Teenagers
Teenagers often display the same behaviors as pre-teens. You will see some you've heard about before, as well as some new ones below.
- Anxiety, fear, and worry about the safety of self and others
- Worry about recurrence or consequences of violence
- Withdrawal from others or activities
- Irritability with friends, teachers, events
- Angry outbursts and/or aggression
- Change in academic performance
- Decreased attention and/or concentration
- Increase in activity level
- Absenteeism
- Increase in impulsivity, risk-taking behavior
- Discomfort with feelings (such as troubling thoughts of revenge)
- Increased risk for substance abuse
- Discussion of events and reviewing of details
- Negative impact on issues of trust and perceptions of others
- Over- or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements
- Repetitive thoughts and comments about death or dying (including suicidal thoughts, writing, art, or notebook covers about violent or morbid topics, and internet searches)
- Heightened difficulty with authority, redirection, or criticism
- Re-experiencing the trauma (e.g., nightmares or disturbing memories during the day)
- Hyperarousal (e.g., sleep disturbance, tendency to be easily startled)
- Avoidance behaviors (e.g., resisting going to places that remind them of the event)
- Emotional numbing (e.g., seeming to have no feeling about the event)
A teen's increased activity level could be a red flag because they are trying to stay busy, so they don't think about what happened. They can be running from if I stop, I'm going to think about X, Y, and Z. In my experience, many people abuse substances because they have some level of trauma. They don't want to deal with their feelings, so they numb it. They numb the feeling, and even if it's just for 30 minutes, they're not thinking about X, Y, and Z, which makes them feel horrible.
This Ask the Expert is an edited excerpt from the course, Collective Trauma and Building a Trauma-Informed Culture, presented by Nadia Tourinho, MSW, LICSW, LCSW-C.
