Language Acquisition and Trauma

¶ … treatment of any victim of trauma can be circuitous and nebulous at times due to the many factors, implications and issues involved. Even with that being the case, there are ways to do it, with time and directed effort being the key item to focus on. When it comes to the subject of children, however, a good amount of care, diligence and alternative methods, at least as compared to adults, is necessary to heal and address the aftereffects and results of trauma. What follows in this document is a summary of fifteen different sources that all focus on cognitive therapy for children after the latter has been exposed and subjected to trauma, whether it be acute or prolonged.

Annotated Bibliography

Chae, Y., Goodman, G. S., Eisen, M. L., & Qin, J. (2011). Event Memory and Suggestibility in Abused and Neglected Children: Trauma-Related Psychopathology and Cognitive

Functioning. Journal Of Experimental Child Psychology, 110(4), 520-538.

• There are several important aspects about trauma-related cognitive therapy and the functioning that is studied and altered as a result. Two of those are event memory and suggestibility. This is a particular realm of interest when it comes to children that are actively abused or neglected by parents, other family members or caretakers, whomever the problem person (or people) happen to be. As a general rule, dissociation tends to be much more prevalent with children whose trauma is sexual or otherwise physical in nature as compared to children that endure other forms of abuse or neglect. Beyond that, post-traumatic stress rates of diagnosis are much higher with sexually abused children. Even so, trauma disorders and the associated treatments are present from all forms of abuse, albeit with different prevalence and frequency. It is important to know and understand this when trying to get a child to recount memories and such that are physical and eyewitness in nature.

Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2016). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research: Journal Of The Society For

Psychotherapy Research, 1-11.

• There are two sub-layers of cognitive behavioral therapy when it comes to the use of the tactic with children. First, there is the fact that there is indeed a subsection of cognitive behavioral therapy that is trauma-focused. It is often labeled as Trauma Focused Cognitive Behavioral Therapy, or TF-CBT. The other wrinkle, of course, would be how CBT would differ between children and adults. As is the normal case with the selection of tactics and methods, there is a large premium placed on what has been proven and used in the past with strong results, known as evidence-based therapy. There are absolutely methods of trauma-focused CBT for children that fall into this realm and they are extremely effective when they are selected and used properly by the practitioners involved. Not only is this true in the general sense, it is also true when speaking about any number of cultures, populations and societies

Deblinger, E. D., Pollio, E., Runyon, M. K., & Steer, R. A. (2017). Improvements in personal

resiliency among youth who have completed trauma-focused cognitive behavioral

therapy: A preliminary examination. Child Abuse & Neglect, 65132-139.

• There are obviously some poor patterns and trends that can be seen and observed from any patients with trauma-related mental illness, let alone just children. With children or otherwise, one of the biggest things that is looked for in terms of positive results and development is what is known as resiliency, the ability to adapt to challenges before, during and after therapy has run its course. This research is so entrenched that there are models and frameworks out there that are specifically meant to measure resiliency. One such model is known as Resiliency Scores for Children and Adolescents (RSCA). There has been concern that the RSCA tracking would show moderation and tempering of results but that actually was not the case according to this study. Instead, there actually seemed to be sustained progress over time after treatment had ceased, so as to indicate that the children involved continued to recover and learn on their own.

Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length. Depression & Anxiety (1091-4269), 28(1), 67-75.

• When it comes to therapy, cognitive or otherwise, for children who have been subject to trauma, there are a number of details and factors that need to be considered. Of course, the trauma narrative and how much treatment, in terms of frequency and overall time horizon, that are needed is very important to consider. As other sources have and will suggest or assert clearly, there is little debate as to the fact that TF-CBT is effective for the victims of trauma. However, the amount of therapy that is needed and over how long a time period when the therapy should happen is much more in debate and subject to opinion from one clinician to another. The type of trauma, of course, will dictate some of this, without question. For example, elementary-age children that are subjected to sexual abuse will need longer and more intensive treatment than children who are just subject to care neglect or lack of supervision. Even with the variances involved, an eight-session pattern seems to work out well for most situations but more or less can be done based on the patterns and results that are seen from such a batter of sessions.

Enlow, M. B., Egeland, B., Blood, E. A., Wright, R. O., & Wright, R. J. (2012). Interpersonal

trauma exposure and cognitive development in children to age 8 years: a longitudinal study. Journal of Epidemiology & Community Health, 66(11), 1005-1010.

doi:10.1136/jech-2011-200727

• The research has made it clear that each point and milestone along the timeline of the general growth patterns, both physical and mental, for elementary-age children need to be looked at for their own reasons and merit. Indeed, a longitudinal study done with eight-year-olds was done and some interesting things were discovered. More specifically, eight-year-olds that were subject to interpersonal trauma were assed in terms of how they developed up to that point. The analysis started for them when they were two years (24 months) old and continued at intervals of a year to several years after that until they were eight years old. Items looked at included trauma, types of trauma, IQ levels as well as socioeconomic traits like race, affluence levels and so forth. One key finding of that study was that inter-personal trauma (IPT) that happens within the first two years of life can have negative effects and can be an antecedent for issues well into later childhood.

Goldbeck, L., Muche, R., Sachser, C., Tutus, D., & Rosner, R. (2016). Effectiveness of Trauma-

Focused Cognitive Behavioral Therapy for Children and Adolescents: A Randomized

Controlled Trial in Eight German Mental Health Clinics. Psychotherapy And

Psychosomatics, 85(3), 159-170. doi:10.1159/000442824

• This article states that TF-CBT with children and adolescents is effective and worthwhile when it comes to dealing with post-traumatic stress symptoms, or PTSS. However, there are some other options and considerations that people are wont to discuss in a clinical and research sense. One of those other options is waiting list, or WL. This is apparently something that happens within the German sphere of counseling and medicine for children that need mental health treatment for trauma, whether acute or prolonged. A single blind group was used to compare and contrast the effects and results for TF-CBT versus the waiting list method. As one might expect, the TF-CBT group did better in very many ways and was clearly superior to the use of waiting lists. The one caveat to that, although it makes sense, is that success rates and abundance can be blunted by situations where comorbidities exist.

Hamiel, D. (2005). Children Under Stress and Trauma: The Use of Biofeedback, Cognitive

Behavioral Techniques, and Mindfulness for Integrated and Balanced

Coping. Biofeedback, 33(4), 149-152.

• One important thing to know about the treatment for trauma is that while TF-CBT and CBT in general are heavily used, there are other things that are sometimes used instead or at least in conjunction with those more popular and prominent options. Indeed, Hamiel reflects upon and studies the fact that biofeedback and mindfulness are often integrated together as a means to provide a balanced coping environment. There are, of course, some caveats to that observation, and that would be that people studied for Hamiel's study often filled at least some of the requirement to be diagnosed as having PTSD, but not all of them. The other side of that coin is that even when PTSD is present (as well as when it is not fully present), CBT alone is often not enough and other treatment methods and styles could and should be coupled with the CBT so as to get the fullest and most advanced progress as is possible. This blended approach can be useful for many situations and trauma is just one of them.

Kaplan, I., Valibhoy, M., Stolk, Y., Tucker, A., & Baker, J. (2016). Cognitive assessment of refugee children: Effects of trauma and new language acquisition. Transcultural Psychiatry, 53(1), 81-109. doi:10.1177/1363461515612933

• Part and parcel of treating and handling children that are the victims of trauma is knowing what effects are rendered and what other things are slowed down. When it comes to refugee children in particular, language acquisition is critical for them and that does seem to be one of the things that is affected by the trauma that is brought upon them. This is no small thing considering more than 60,000 refugee children are housed with new nations within the Western part of the world every year. Indeed, there are concerns about many things within the cognitive function sphere of these refugee children and acquiring a new culture and language would certainly be complicated by the trauma that they experience. It is to the extent that the way in which teachers (even bilingual ones that are familiar with the culture of the refugees) as well as governments should bend and shape the relevant policy so that it is ensured that the full depth and breadth of needed treatment options are present.

Malarbi, S., Abu-Rayya, H., Muscara, F., & Stargatt, R. (2017). Neuropsychological

functioning of childhood trauma and post-traumatic stress disorder: A meta-

analysis. Neuroscience & Biobehavioral Reviews, 7268-86.

doi:10.1016/j.neubiorev.2016.11.004

• There is obvious and unquestioned biological and physiological component to trauma, coming back from the same and the drugs that often go into treating trauma and anxiety. Even when looking at groups and samples of people as large as 1500 in size, there are certain neuropsychological patterns that cannot be ignored or set aside. Just a few examples include overall cognitive deficits, lower executive skills, lesser performance with learning and memory, poorer levels of general intelligence, lower visuospatial skills, learning speed, memory and so forth. All of this held true when comparing the progress or lack thereof of trauma-stricken children as compared to controls that were presumably normal and had not been exposed to such experiences. Even with all of that being said, children verifiably diagnosed with post-traumatic stress disorder (PTSD) were far worse than even the other abused children that had not reached the PTSD threshold. To be clear, all trauma-stricken children had some deficits but PTSD-stricken children were worse, on average.

Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012).

Trauma-Focused Cognitive-Behavioral Therapy for Children Sustained Impact of Treatment Six & Twelve Months Later. Child Maltreatment, 17(3), 231-241.

• One very important part of therapy for elementary-aged children that are subject to trauma is the follow-up that is done after a round of treatment is completed. Even with any firm and far advances when it comes to trauma-based therapy, there also stands to beat least some regression and loss of progress. Thus, the authors of this study assert that there should be follow-ups after about six and twelve months, or half a year and a full year. Even if progress is sustained and ongoing at the six and twelve month marks, it is still important to do the follow-up to just to be sure and thus be able to restart and reengage as needed to help the patient stay on track to recover or do even better than they would if no follow-up was done. There is always a small minority of children who continue to have problems even with a full battery of treatment.

Murray, L. K., Skavenski, S., Michalopoulos, L. M., Bolton, P. A., Bass, J. K., Familiar, I., &. ..

Cohen, J. (2014). Counselor and Client Perspectives of Trauma-Focused Cognitive

Behavioral Therapy for Children in Zambia: A Qualitative Study. Journal Of Clinical

Child & Adolescent Psychology, 43(6), 902-914.

• In contrast to the status of children in full and "normal" family structures and those that are orphaned and/or commonly subject to trauma, there is the "middle ground" of societies and groups where the concept of "therapy" among the community is less than what would be expected of commonplace in other parts of the society or world. An ostensible example of this would be the country of Zambia. A number of challenges are fairly present in that country including the aforementioned lack of a sense of what "therapy" is, engagement levels, attendance levels, availability and so forth. Even so, when it is present and done in an evidence-based way through the use of proper meetings, structures of those meetings and driving home the importance of all of the above, it can end up with very positive results. Just two positive results from TF-CFT or any variant thereof include better family communication and reduction of problem behaviors. Both of those lead to an increased ease in speaking about trauma, which leads to better results.

O'Donnell, K., Dorsey, S., Gong, W., Ostermann, J., Whetten, R., Cohen, J. A., & Whetten, K.

(2014). Treating Maladaptive Grief and Posttraumatic Stress Symptoms in Orphaned

Children in Tanzania: Group-Based Trauma-Focused Cognitive-Behavioral

Therapy. Journal of Traumatic Stress, 27(6), 664-671.

• As mentioned in other studies and examples, TF-CBT has seemingly been a boon to young patients with trauma issues. In many to most cases, the use of that therapy is very much one-on-one or very limited beyond that, such as a parent or small family. However, different approaches are needed and necessary when it comes to some victims of trauma. Indeed, there are a lot of child victims of trauma in countries like Tanzania that are orphaned and thus do not have the normal support networks and present family structures that is normal in other situations and countries. However, there are seemingly ways to address such outlier situations through the use of methods like group therapy. A study on the matter showed that twelve-week blocks of therapy for orphaned kids paid a huge number of dividends and benefits for the afflicted children in question. This seems to hold true even with the experience and training levels of the practitioners is less than normal or optimal.