Nine year old James had been in a car accident with his father. Shortly after the accident, James started experiencing negative intrusive thoughts.
James repetitively asks, “What if we’re driving and the car smashes into a tree, Dad?”
Or while James is in class, he is thinking, “If I don’t count in my head (mental ritual), my dad will crash his car and die?”
Traumatized, James is also ruminating about how things were before the accident. He can’t concentrate on his classwork and seems, at times, to disappear into a world of his own.
When pressed by his teacher, James jumped up and in a state of agitation, openly expressed that he wishes everything could go back to the way things were before the accident.
James cries out at night, not able to sleep and pleads for the negative thoughts to go away.
Obsessive Compulsive Disorder and Trauma in Children
Children and adolescents who have obsessive compulsive disorder (OCD) are often distracted by their obsessions and compulsions. If OCD is severe, children can spend a lot of time obsessing. This obsessing may present like inattentiveness. Children with OCD are trying to keep their rituals under control.
To compound all of that obsessing, children who have experienced trauma, lack the ability to concentrate. With trauma, behaviours might look like the symptoms seen in Attention Deficit Disorder with Hyperactivity (ADHD). Additionally, children may appear jumpy, fidgety and agitated.
In actuality, kids who have endured trauma are showing signs of Post Traumatic Stress Disorder (PTSD). Along with presenting as jumpy, fidgety and agitated, children with PTSD may demonstrate an exaggerated startle response, hypervigilance or appear spaced out.
The child may even start acting out. The parent or teacher may be concerned the child is showing signs of Oppositional Defiance Disorder (ODD). However, the child’s internal fears are seeping out.
While many traumatized children may demonstrate outward behavioural signs, other children may disappear into a world of their own giving the impression that the child is depressed. However, this child is thinking deeply over past traumatic events.
Analyze the Scenario for Trauma in Children
In the scenario with Jame’s car accident above, you can see:
(1) how intrusive thoughts appear as a result of a trauma
(2) how the symptoms of trauma can look like attention deficits, ODD or depression
(3) how OCD manifests or intensifies
Children, like James, may experience obsessions about future harm and feel an overdeveloped sense of responsibility to keep themselves and loved ones safe.
Trauma-Focused Cognitive Behavioural Therapy
Because PTSD becomes so complex, it is important that correct treatment is provided as soon as possible.
For OCD, the gold standard and psychological way forward is with cognitive behavioural therapy (CBT). Often Exposure Response Prevention (ERP) accompanies CBT.
In CBT, children learn strategies to examine this faulty reasoning. When children are able to identify erroneous beliefs, they are more likely to be able to resist giving into compulsions when faced with triggering situations.
Children learn to recognise and manage their OCD intrusive thoughts. In CBT, children learn strategies for understanding the low probability of occurance and how to live with uncertainty.
Explore more on ERP in Teachers: 5 Signs to Spot a Child’s Contamination Fears
However, when OCD symptoms are tied in with symptoms from a trauma, the more favourable treatment would be Trauma-Focused Cognitive Behavioural Therapy” (TF-CBT). A core feature of TF-CBT is to gradually expose the child to memories of their trauma in a gentle, therapeutic way.
Trauma Focused Cognitive Behavioural Therapy is an evidence-based psychotherapy that aims at addressing the needs of children and adolescents with Post-Traumatic Stress Disorder (PTSD) and other difficulties related to traumatic life events. It is suitable for children who have obsessive compulsive disorder when trauma is involved, as it targets the obsessions that run parallel with intrusive thoughts relating to the trauma, or other obsessions.
For James, TF-CBT would be helpful because he suffers from intrusive thoughts about the accident. Ironically, the best way to reduce intrusive thoughts is through exposure. As it goes with ERP, the more James faces his fears, the less fearful he will feel. The intensity and frequency of his obsessions will decrease.
Cope through Mindfulness for Trauma in Children
A further advantage of TF-CBT is that it teaches good coping skills and mindfulness techniques. Mindfulness can help the child find ways to relax their body.
Explore more >> Mindfulness: What is it and How can it Help?
The ultimate goal of TF-CBT is to help children maintain an overall view that while a traumatic event did happen, the likelihood of it happening again are slim and he is free to feel safe.
Explore more >> 3 Steps to Help a Child Overcome Irrational Fears
Children, who are living with OCD, may believe that their failure to complete rituals will have harmful consequences either to themselves or people they love.
Explore Rituals >> Compulsive Checking – Two Games to Help a Child Think Differently
James was referred to a child psychologist with experience in TF-CBT. Over time, James was able to face his fears through gentle re-exposure. His school put in place temporary accommodations while he received weekly therapy. Slowly, James became the focused and attentive child he was before the accident.