Parts of this interview with Ginny Sprang, Ph.D., Executive Director of the University of Kentucky Center on Trauma and Children appeared in Healing Childhood Trauma: A KET Special Report.  It has been lightly edited.

Renee Shaw:  Dr. Sprang, I know this is your life’s work, so I’d like you to talk about how a child who has gone through traumatic experiences or has suffered from toxic stress may exhibit behaviors either in the classroom, at home, in the community or with their friends. What would it look like?

Dr. Sprang: The first thing that usually we see is some alteration in the regulation of affective impulses. These are kids that just have trouble regulating their moods and their anger and they can be very self-destructive. So, in the classroom or in the community, they may be doing things to destroy property, fighting, engaging in bullying. And quite often in this category of poor regulation of affective impulses, we see a lot of negative behaviors like addiction and self-harming behaviors. Paradoxically these are also the kinds of things that can be lifesaving to them because they bring them to the attention of law enforcement, of hospitals, of child protection and these are intervention points. We see that disruption of the ability to regulate these strong feelings.

There are also some alterations in self perceptions. There could be this chronic sense of guilt and responsibility. A lot of times they feel intense shame, and they incorporate that into their sense of self-worth. So if you’re trying to be in a relationship with a child who is having trouble with affect regulation and has these disturbances of self, then you can imagine that you’re going to have some difficulty in the relationship because they don’t feel particularly connected to other people. They have learned that intimacy is associated with betrayal and a violation of trust in the most intimate form. The people that they counted on that should be trusted were people that disappointed them, that hurt them, that violated that trust, so they begin to equate intimacy with harm and danger. And so that can also activate their stress response.

Renee Shaw: What is the treatment that would be most beneficial to help them be able to establish relationships as they mature and get older?

Dr. Sprang: Part of the reason why we want people to understand the impact of trauma on behavior and relationships is not to create some kind of pejorative situation where a child is labeled, it’s really so that we can channel them into the right resources. We do have a number of evidence-based treatments for children that have been proven to be very effective, especially with kids who have chronic and complex forms of trauma – things like Trauma-Focused Cognitive Behavioral Therapy; TARGET, which is Trauma Affect Regulation: Guide for Education and Treatment; Child- Parent Psychotherapy for the little ones five and under that incorporates the caregiver as the vehicle for delivering the treatment; and Cognitive Behavioral Intervention for Trauma in Schools, CBITS is what we call it. It is a nice intervention that we have been able to train folks in the educational system to deliver at school which involves the parent, the teacher, and the child. It creates this new support system, and takes kind of a three-pronged approach at addressing trauma. It is also an evidence-based treatment. But we always want to do a good trauma assessment first so that we are actually getting kids into the treatments that meet their symptom profiles. There is really no one treatment that is right for all kids. It has to do with how they present. Are they more of an externalizer or are they more of an internalizer?

Renee Shaw:  I know that you’re very familiar with the old adage that “hurt people hurt people.” How much of what a child endures by trauma or child abuse that was delivered by an adult is because that adult has unresolved traumatic experiences of their own?  And how do you break that intergenerational cycle?

Dr. Sprang: Prevalence rates vary because we don’t always know when children have been abused, we only know what’s reported – but we know about a third of children who have this experience of maltreatment will go on to perpetrate harms against their own children. Some of that is social learning because these are the behaviors that have been modeled for them. But there’s also a disturbance in systems of meaning where they begin to have altered perceptions of the perpetrator. So even though they despise them, and this person is responsible for hurting them, they begin to incorporate some of those behaviors and those beliefs into their own life like it’s their destiny. They may think “this is what people like me do”. And so that’s part of that complex trauma phenomenon that we need to keep an eye on.

Renee Shaw: There are so many tensions in our society right now.  A lot of people are on edge because of uncertainty with the pandemic, with their jobs, with schools – and sometimes we see a lot of anger going on. I am curious how you perceive where we are emotionally as a society right now, and what would you advise so that we don’t unintentionally harm our most precious gift – our children?

Dr. Sprang: I would say two things. First, pay attention to the first part of this series that really talked about what we as human beings do when our stress response is activated. It is our human tendency to survive no matter what we are facing. And the uncertainty of the pandemic certainly presents us with a threat of sorts. Will we get COVID-19? Is life over as we knew it? Will the recovery take place? Will I get sick or will I get someone else sick? So understand that when we react to COVID-19, we’re reacting with our own stress response and we need to pay attention to how we self-regulate and use our good adaptive coping skills to down regulate when we feel the stress and recognize that’s a normal thing. It is our body and our mind’s way of saying pay attention, this is important.

The second piece I would say is pay attention to the kids in your life. Pay attention to your neighbor’s kids. Pay attention to the kids that are in the store. These are kids that do not have as many eyes on them because there are not as many monitors out there paying attention to them. Reach out, give some respite to parents who may be doing this 24/7 and need a little bit of a break.  And understand that we are all trying to figure out the best ways to keep ourselves and our loved ones safe and that we need to think about this from a community perspective.

Renee Shaw: Dr. Sprang, thank you so much for your time and expertise.

Healing Childhood Trauma: A KET Special Report was funded, in part, by a grant from the Foundation for a Healthy Kentucky.