Diverse Outcomes After Trauma

Last month, I attended the online conference: Trauma Informed Practice Using Biopsychosocial Models to Promote Recovery organised by ICTC and IRCT. It was, once again, a very interesting and useful event, that provided much food for thought. In this blog, I want to address some of the points brought up by Matt Woolgar, one of the speakers, and next week I will write about Jane Herd’s contribution.

When people talk about children who have experienced trauma or adverse experiences, the discussion often focusses on an increased risk of this, high likelihood of that, and that is all perfectly true. However, the problem is that too often this is understood as ‘the child has experienced x adversity and will therefore have y problem’ and this is where things go wrong. Having a higher risk or likelihood of certain issues arising is not the same as knowing what the effects will be on an individual child.

As Matt Woolgar pointed out ‘early adversity breeds diversity’. In individual cases, you cannot predict what the outcomes will be, because there are so many different factors that have very significant influence on how a child copes and how her development is influenced. Some of these factors are the age at which the trauma was experienced, whether it was short-term or long-term, what protective and resilience factors where in place, what kind of support was offered and at what stage. And also the child’s temperament.

It was pointed out that even with very detailed information about the timing and circumstances, it still remains to be seen whether the child is a ‘dandelion’ or an ‘orchid’. Where dandelions are able to survive and even thrive under very difficult and harsh circumstances, while orchids can suffer significantly – with adverse outcomes – in circumstances that are only less than ideal. And these difference can sometimes even be seen in siblings, where almost all other factors were identical. While it is not known what makes one child able to shrug off almost unimaginable things, while another child is crushed under what seem to be relatively mild challenges, it is important to be aware of this and to take it into account.

Another important point that was made in this presentation was that the challenging behaviour and other problems that a traumatised child presents with are not signs of an illness or a defect. These behaviours were developed to adapt to very difficult circumstances, in order to be able to survive as well as possible. It is an adaptation, not damage. It is just that an appropriate adaptation to the harsh living conditions that the child survived is not appropriate in other settings. And these learned survival techniques are not going to disappear overnight, they are too deeply ingrained and were too essential for basic survival to just be able to let go of them from one moment to the next. Understanding this can help caregivers empathise with the child and be more patient.

This last point is something that comes close to what Jane Herd mentioned in her presentation, which I will mention in next week’s blog.

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