Traumatic stress reactions are common, and it is heartbreaking and distressing when caregivers see their child continuing to struggle long after the traumatic event has passed. Knowing that there is still a long road ahead of their child, many caregivers are eager to see their child recover swiftly, overcome the adversities, bounce back to their usual self, and carry on with life despite the negative events.
Caregivers may take heart in knowing that, much like a caterpillar transforming into a butterfly after a tough but necessary struggle of breaking through its cocoon, children may be able to experience post-traumatic growth (PTG) after struggling through adversities, with the right support [1, 2]. PTG represents the silver lining that trauma can result in positive changes in these five ways: help individuals discover new possibilities, improve relationships, develop new personal strengths, facilitate positive spiritual changes and foster a stronger appreciation of life .
Factors related to Post-Traumatic Growth
Trauma can challenge and alter an individual’s understanding and fundamental beliefs about themselves, others, and the world in positive ways. What determines whether and how much growth is experienced depends on an individuals’ subjective stress experience and subsequent stress reactions, not the objective nature of the traumatic event. While the PTG research in children and adolescents is relatively nascent compared to that in adults, there is some emerging evidence of factors that contribute to PTG in children and adolescents.
A commonly proposed mechanism for PTG is productive rumination, which is a cognitive process through which individuals deconstruct their pre-existing beliefs, come to terms with their new reality and makes sense of what has happened and what that means for life moving forward . Social support, especially from parents and other trusted adults, may contribute to PTG in children by restoring a sense of safety and belonging, promoting a positive sense of self and facilitating self-disclosure of emotions, which in turn creates opportunities for adults to guide the younger ones in productive rumination, reframing adversities in a constructive way, and coping adaptively .
Conversely, parents’ difficulty in taking care of themselves and maintaining normal functioning post-trauma may potentially impede their children’s PTG . It should be noted that age may also play a part in how PTG unfolds. Unlike adolescents and adults, very young children (e.g., preschool-aged) are unlikely to have adequate life experiences or the cognitive maturity to establish a thorough understanding of the world. Hence, PTG in young children is thought to be part of a continuous integration of experiences, rather than a reconstruction of a pre-existing mental framework .
Post-traumatic stress reactions are not only normal reactions to an abnormal event, but also opportunities for potential growth and new possibilities.
Differences between Resilience and Post-Traumatic Growth
PTG is often confused and used interchangeably with the concept of resilience. While these may share some similar features (e.g., positive responses to negative events), they are distinct concepts.
Resilience represents an individual’s ability to bounce back from adversities quickly and maintain his or her normal level of functioning. Individuals who are resilient may go through adversity without strong traumatic stress reactions, be less likely to engage in positive meaning-making, and thus emerge from trauma relatively unchanged. In contrast, PTG typically refers to positive changes and growth beyond an individual’s previous level of functioning that result from his or her effort to process what happened and cope with the distress. It is believed that PTG is more likely to occur when a person experiences some level of post-traumatic stress, which may be both a catalyst and a by-product of, the process of developing new, positive perspectives on self, others and the world [7, 8]. In fact, some studies suggest a possible inverted U-shaped relationship between the levels of post-traumatic stress symptoms and PTG, where moderately strong symptoms were related to more growth . It is therefore helpful to recognise that post-traumatic stress reactions are not only normal reactions to an abnormal event, but also opportunities for potential growth and new possibilities.
In other words, while resilience can be seen as the deep, sturdy roots that anchors a tree firmly in the ground through the harsh weather, PTG is the rainbow that comes after a storm.
Supporting Development of PTG for Children as their Caregivers
Children’s response to trauma, understanding of what happened, and coping skills can be influenced by their caregivers. Hence, caregivers are instrumental in shaping the course of the children’s recovering and helping them to develop PTG. Here are somethings to consider when you are supporting a child through trauma:
First and foremost, take care of yourselves and manage your own distress: It is important that caregivers take care of ourselves and manage our own distress, as a way of teaching their children how to handle to difficult feelings adaptively. This also prevents us from adding our own stress to our child’s. Importantly, it also increases our capacity to provide assurance, love and protection, which are essential in helping children to develop new, positive outlook in life.
Ignore, minimise, judge or stigmatise feelings and stress reactions: Trying to talk children out of these feelings and reactions might lead to more stress, which further impedes recovery. This also reduces children’s willingness to engage in open conversations, limiting opportunities for caregivers to provide guidance. Instead, encourage children to experience and express these normal emotions in these abnormal and stressful situations. It will be important for caregivers to, first, model expressing feelings in a healthy way before a child can feel safe enough to express his or her own.
Encouraging open conversations about your child’s feelings and experiences, when both you and your child are ready: Many caregivers are worried that talking about the trauma might bring up unpleasant memories, and prevent the child from moving on from the event. However, avoiding talking may, in fact, backfire and maintain excessive fears. Although it can be stressful, especially at the start, having the opportunity to think and talk about hard events and feelings helps the child to better process them and integrate them into his or her lived experience. This also frees up more mental space for the child to be more present and engaged in daily life and important relationships.
Impose unrealistic expectations for recovery or compare progress with others: Everyone’s reactions after a traumatic experience are different, and so is the recovery process. Recovery is not a linear progression; it is common to experience ups and downs along the way and some children find that it gets a bit harder before it gets better. Some children might feel pressured to recover in a certain way or by a certain timeframe, which might be unrealistic and result in undue stress and reinforce negative beliefs about themselves. Instead, it will helpful for caregivers to provide reassurance, moderate expectations, redirect their children to focus on the process instead of the result, and continue to encourage and support active coping and problem-solving through setbacks.
Here are some resources for you to learn more about PTG:
- https://www.echoparenting.org/the-promise-of-post-traumatic-growth/; https://www.echotraining.org/the-promise-of-post-traumatic-growth-part-ii/
- Laceulle, O. M., Kleber, R. J., & Alisic, E. (2015). Children’s experience of posttraumatic growth: Distinguishing general from domain-specific correlates. PloS One, 10(12), e0145736.
- Vloet, T. D., Vloet, A., Bürger, A., & Romanos, M. (2017). Post-traumatic growth in children and adolescents. Journal of Trauma Stress Disorder Treat 6, 4(2).
- Tedeschi, R. G., Calhoun, L. G. (1995). Trauma and Transformation: Growing in the Aftermath of Suffering, SAGE Publications, CA, USA.
- Calhoun, L. G., & Tedeschi, R. G. (2006). The foundations of posttraumatic growth: An expanded framework. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practice (pp. 1–23). Mahwah, NJ: Erlbaum.
- D’Urso, A., Mastroyannopoulou, K., & Kirby, A. (2017). Experiences of posttraumatic growth in siblings of children with cancer. Clinical Child Psychology and Psychiatry, 22(2), 301-317.
- Hafstad, G. S., Gil-Rivas, V., Kilmer, R. P., & Raeder, S. (2010). Parental adjustment, family functioning, and posttraumatic growth among Norwegian children and adolescents following a natural disaster. American Journal of Orthopsychiatry, 80(2), 248-257.
- Kilmer, R. P., Gil-Rivas, V., Griese, B., Hardy, S. J., Hafstad, G. S., & Alisic, E. (2014). Posttraumatic growth in children and youth: clinical implications of an emerging research literature. American Journal of Orthopsychiatry, 84(5), 506-518.
- Clay, R., Knibbs, J., & Joseph, S. (2009). Measurement of posttraumatic growth in young people: A review. Child Clinical Psychology and Psychiatry, 14, 411–422.
- Shakespeare-Finch, J., & Lurie-Beck, J. (2014). A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder. Journal of Anxiety Disorders, 28, 223–229.
This article is contributed by KK Women’s and Children’s Hospital. This article was first published on Trauma Network for Children’s Quick Bytes Newsletter and is republished with permission.
The Stay Prepared – Trauma Network for Children (TNC) programme is a joint collaboration between KK Women’s and Children’s Hospital (KKH) and Temasek Foundation. It aims to enhance the psychosocial capability of the Singapore community to support children and youth after crises or traumatic events. For more resources, visit the Trauma Network for Children Website at www.childtraumanetwork.sg.