Learning Outcomes
After this course, participants will be able to:
- Describe ways exposure to trauma affects cognitive and language development.
- Describe how abuse and neglect play an important role in language development.
- List at least 3 prevention strategies that can help avert more serious developmental outcomes over time.
Introduction and Overview
I am going to talk with you about trauma and its effects on language development. I recently attended an all-day summit about adverse childhood experiences (ACEs) sponsored by a division within the American Psychological Association. It’s a very important topic and we need to learn more about ways to integrate it within our thinking, as well as how it relates to policy, which is also very important. I am sure that many of you are familiar with trauma, and how it impacts development in different ways. Today, we are focusing on language. Here is our roadmap for today’s course: I will first do a general review of the impact of trauma on development, and then look specifically at how trauma exposure can affect language development. Finally, we will look at the clinical implications related to language development, and the kinds of things that we can do to help parents and teachers help children in this area.
If young children (ages 0-6) are exposed to trauma, there are a number of different ways that can affect their development. It is very important to realize when working with very young children, problems with speech and language delay start very early and if the family goes somewhere for help – for example to a clinic or a primary care doctor - in general, they will be told that nothing can be done for those very young children. Nothing is done, and then they get into school, and there are more problems.
So, I want to raise awareness about the fact that we can do something early.
Effects of Trauma on Young Children
Here are some symptoms that very young children exposed to trauma may exhibit. You can find poor verbal skills, with delayed language or reduced intelligibility. When we talk about trauma - maltreatment, abuse, and neglect - it is important to recognize that the majority of trauma we see with young children is due to neglect. Neglect, of course, plays a very important role in the lack of language skills in these children.
If there is speech or language delay with trauma exposure, there are many things we need to look at. Obviously, we need to look at hearing. But we also see learning disabilities, which I am sure many of you are familiar with. With trauma, children have much more difficulty focusing on learning in school. They have much more difficulty being still and paying attention. And if they experience neglect or maltreatment, they often do not feel very good about themselves. That comes into play in the first four years of life. I know that other speakers in this virtual conference have talked about brain development, which plays an important role. So, how a young child feels about himself is incorporated into cognitive development and language development.
How does trauma impact a child's development in general? You have heard already, in this conference, about the neuroscience and the neurobiological effects on the brain. One of the references listed at the end of the course is from the Harvard Center for the Developing Child. They have taken on translating the complex science of early childhood development into very understandable material related to stress, trauma, and toxic stress. I am not a neuroscientist, and I depend on their translation of that material, which is really useful for those of us who are not neuroscience specialists.
Trauma obviously impacts the early attachment relationships, and early relationships have an impact on all later relationships; therefore, how attachments develop early on is very important. One of the effects of trauma exposure in a child is dysregulation, both in emotions and in behaviors.
I like to think about trauma impacting young children using the following analogy. I am sure all of you are familiar with the book, The Little Engine That Could, where the train is trying to make it up the track. If you conceptualize trauma as an event that can push that train off the track, then our role as clinicians is to help that child get back on track. Essentially, trauma derails the normal developmental trajectory, and can contribute to developmental delays, which is obviously what we are talking about today. It can also contribute to a negative sense of self, and difficulty in forming attachments in both early and later years of life.
Red Flags
It is important to be aware of the red flags that may indicate the emotional needs of a baby or very young child are not being met. A child in the first year of life should have a whole range of emotions, from clear attention, to sadness, to smiling. With the baby who has been exposed to trauma, you often see bland affect. You look at the baby and think, "Is this baby depressed?" My colleagues in the field of mental health do not like us to use the word “depression” in relation to a young baby, but you can think of it as withdrawn behavior. For example, the baby who lacks responsiveness and does not show eye contact, particularly with the primary caregiver. There is a problem with attachment to the caregiver, though the child may be friendly to strangers. We know that some young children are friendlier than others, but they really should not show preference for a stranger over a familiar caregiver. Another red flag is a baby who really does not want to be held close and cuddled in any way.
When children get a little older, to toddler or preschool age, that is when you start to see the aggressive behavior, dysregulation, difficulty sitting still and paying attention. There is no question that while a young child may be hesitant to be with you at first, over time, they become more comfortable with you because you pay a lot of attention to them. But if you get indiscriminate attachment where the child really prefers a stranger to the primary caregiver, that is of great concern.
You can also see feeding problems or sleep problems. There are many behaviors that are part of toddlers’ normal development that are not pleasant for parents or teachers. Toddlers will hit, they will bite, and they will throw tantrums. The question is whether these behaviors occur beyond what seems to be normal in terms of development. Those are things that we need to look at.
The Impact of Trauma on Adults
We also need to consider that trauma exposure not only impacts the child, but also affects parents, caregivers, and teachers. All of the people who are caring for the child may also be impacted by the trauma. When you are impacted by trauma as an adult, it may be difficult for you to be what we call “emotionally available” to the child. You may be there physically, but not really emotionally available to them.
Also, if a young child or toddler has been traumatized, we see the child play out their trauma. Here is a quick example: After Hurricane Katrina, I played a role in the mental health response. We housed first responders who had lost their homes on cruise ships that were in the harbor because they had nowhere to live and had to work in the city. We felt it was important to get all the children to come back, and we got a lot of children onto the cruise ship. We had to set up childcare centers for them. The first thing many of these children did when they went into the childcare center was to play “hurricane.” Playing hurricane was very traumatic for the parents. They did not want the children to do that. We suggested the parents go walk around the boat, take a brief break, and have a bit of respite while the children were with us. Children who are traumatized replay whatever trauma they experienced. We also see that frequently with domestic violence, and that can be very traumatizing for the parent. The parents need to protect themselves because they feel vulnerable. So it is very, very important to pay attention to the adults if trauma has occurred as well. Of course, sometimes, we know that the adults are the perpetrators; we will talk a little bit about that later on.
Factors that Influence How Children Experience Trauma
What determines how much children are influenced by trauma, if they go through these experiences? The factors that seem to affect this are how many times they have been exposed to trauma, how severe it was, and how close they are to the event. What seems to be most important in terms of how much they will be impacted is the child’s relationship with either the victim or the perpetrator.
I have an example of children separated from parents during the London blitz. When they were concerned about the bombing, they would have the children go out to the country with relatives so they would be safe, while the parents stayed in London. But actually, when researchers followed the children over time, the children who stayed with their parents in London had fewer symptoms later on than the children who were separated. That speaks to the importance of the attachment relationship.
Other factors that influence children's exposure and the extent to which trauma will impact them are their age and developmental stage at time of the trauma, and how dangerous the situation is. I already mentioned that their relationship to the victim or perpetrator is also important. Is there someone there who can support them? There is no question about relationships being a critical factor for children who are impacted by trauma. Genetics can play a role as well.
Any previous history of trauma, as well as subsequent traumatic experiences, are very important in terms of how a child will be impacted by trauma. Our experience shows children who had a previous history of trauma and then were impacted by a disaster and had to evacuate and ended up losing their homes, or experienced a disaster and then had subsequent trauma, showed many more mental health symptoms than those who are more protected. So we need to look at chronicity of trauma and the numbers of traumatic experiences.
Additional Risk Factors for Speech and Language Delays
What are additional risk factors that relate to speech and language delays? This is the area that we are focusing on in this course. Children who grow up in poverty are more likely to have speech and language delays for a whole variety of reasons. They may not have as many resources available to them. They may be more stressed. Depending on how they were raised, the parents may not talk to the children that much because there are so many things in their lives that create stress. Other risk factors include not having social support, having parents with limited education, and having young parents. Having parents who are depressed is also a risk factor because parents who are depressed do not talk to their children and probably do not read to their children. You all know that talking and reading to a child is very important for language development.
If children are exposed to drugs prenatally - particularly fetal alcohol, but also other drugs - that can impact their development generally and language development specifically. Other risk factors during pregnancy, such as poor nutrition, and then low birth weight can play a role.
Abuse and neglect are very important risk factors related to language development. Children who are in foster care, especially those with multiple placements who do not have a steady attachment relationship and a stable environment, are also going to be at risk for not only speech delay, but other kinds of behavior problems as well. In doing research for this course, a number of other risk factors came up.
As we know, boys tend to develop a little bit slower, particularly in the area of language and speech, than girls, and are therefore more likely to have speech delays. Ongoing hearing problems are an obvious risk factor, but may not be picked up. Often, when a child is in preschool, either they are doing a hearing exam there or a teacher asks the parents to get the child a hearing exam if the child is three years old and is not putting together the numbers of words that is typical. So, hearing problems obviously play a role.
A child with a difficult temperament has additional risk factors because they have trouble sitting still and paying attention. They may not listen to other people. They may not be able to sit still and have books read to them. Those are additional risk factors.
Children with disabilities are at higher risk for language delays as well. Children with disabilities experience a higher rate of maltreatment. Almost three times the number of children with disabilities are maltreated as compared with normally developing children. If children are deaf or hard of hearing, they have a much greater risk for neglect and abuse than non-disabled children. Children with communication delays have five times the risk for neglect and abuse, and that is probably related to the fact that parents or caregivers do not have patience with them. These children do not have the receptive language to be able to follow directions, and that is probably much more frustrating for the parents trying to care for them. There are a whole variety of reasons that can lead to an increased rate of abuse for children with disabilities, but unfortunately, it does occur, and it does impact language.
Effects of Trauma and Maltreatment on Infants and Toddlers
What happens when an infant or toddler is maltreated? We know that lack of stimulation interferes with growth and development of the brain, and certainly the part of the brain that controls cognitive development. With maltreatment, there is also difficulty with attachment, and the attachment relationship is a protective factor related to trauma. So if there are difficulties with attachment, it can be very problematic for children’s language development. We often see that maltreated infants do not use speech and language.
Very often, maltreated infants and young children will exhibit aggressive behaviors. They will bring attention to themselves in ways that are negative because they cannot do it with language. One feeds into the other. It is always very important to know if the children are getting attention in ways that are negative as a result of not having language. Obviously, abuse and neglect co-occur with domestic violence, substance use, and other risk factors.
Effects of Trauma, Maltreatment, and Neglect on Speech/Language Development
There are some data related to the effects of exposure to trauma on speech and language. Thirty-five percent of children with speech and language delays have experienced maltreatment. Many children who are referred for speech therapy have experienced abuse and neglect. So, there would be a great benefit to having speech-language professionals be more educated and informed about the effects of trauma, abuse, and neglect on development.
