By Matthew Oransky, PhD, Rachel Colon, LCSW & Susann Cortes, LMSW
Trauma is increasingly recognized as a major public health issue, but we still have a lot of work to do. For example, foster care alumni are diagnosed with Post-Traumatic Stress Disorder (PTSD) at twice the rates that military veterans are. Yet, instead of being met with empathy and understanding, young trauma survivors are often disciplined or expelled from school.
As mental health care providers at Mount Sinai Adolescent Health Center, we know that many of our patients have experienced trauma. Previous doctors have often diagnosed them with anxiety or ADHD, without working to understand the root cause of their behavior.
We are almost always the first to ask about their trauma history.
For the most part, health care providers still neglect to screen teens for trauma. In order to adequately serve young people, this needs to change.
1. Trauma is more common than you think.
As we’ve discussed before, trauma is our nation’s hidden public health crisis. Two-thirds of young people experience at least one type of trauma before they turn 18. Eighty-seven percent of those who have experienced one type of trauma have experienced at least one additional type.
Many people find these statistics surprising, partly because their conception of trauma is limited. But trauma can include:
- Physical, emotional, or sexual abuse
- Physical or emotional neglect
- Physical or sexual assault
- Having a parent or caregiver addicted to drugs or alcohol
- Witnessing violence, including domestic abuse or neighborhood violence
- Incarceration of a family member
- The severe mental illness of a caregiver
- Car accidents
- Natural disasters
- Experiences of extreme poverty, such as frequently not having enough to eat
- Human trafficking
- The death of a loved one
Some of these traumas are more common in certain populations. LGBTQ young people are especially at risk for homelessness. Low-income youth are more likely to be exposed to neighborhood violence and poverty. People of color are more likely to have an incarcerated caregiver.
2. Trauma impacts every part of life.
After experiencing trauma, the brain and body change. Sometimes, these changes are temporary. Other times, they have a long-lasting impact on young people’s ability to thrive.
This is especially common if the trauma is prolonged, such as with childhood abuse. In these cases, the body’s stress response system fundamentally changes. Chronic anxiety and fear cause the body to produce constant, elevated levels of cortisol, adrenaline and other stress chemicals. This is called toxic stress. It increases the chances of developing chronic health problems later in life, such as autoimmune diseases, diabetes, heart disease, cancer, and more. Toxic stress can also fundamentally alter young people’s brain architecture, affecting the development of their prefrontal cortex. This is the area of the brain that regulates executive functioning, impulsivity, learning, organization, and the ability to focus.
This means that young trauma survivors may have trouble managing their time, sitting still, and keeping track of assignments—the skills they need to succeed in school. This is why many of our patients who have experienced trauma are diagnosed with ADHD.
Survivors may also have trouble appropriately expressing themselves. They may talk back to teachers, get into fights, yell, steal, or otherwise “act out.” Instead of responding with compassion and understanding, schools often punish these young people (especially if they’re youth of color), making the situation worse.
Survivors of trauma are also at risk for anxiety, depression, and attempting suicide.
3. Adolescence is a key time to intervene.
Teen brains are still developing, which means that they are particularly susceptible to the effects of toxic stress. This makes it critical for medical providers to identify trauma early.
Youth who have been through trauma are more likely to engage in risky behaviors, which often begin in adolescence. Trauma survivors are four times more likely to get a sexually transmitted infection (STI) or inject drugs, and people who have experienced at least four traumas are twice as likely to smoke cigarettes, and seven times more likely to develop an addiction to alcohol.
When they’re teens, survivors may begin to repeat traumatic relationships. If they’ve been abused or witnessed domestic violence, teens may act out similarly violent and destructive relationships—either as victims, or abusers themselves.*
4. Providers don’t screen for trauma—but they should.
Despite all this, few medical or mental health providers screen adolescents for trauma. Many are afraid of re-traumatizing their patient—so they just don’t ask. But if providers don’t ask, they’re still communicating—that their patient’s trauma should not be spoken out loud.
It’s time this changed.
At Mount Sinai Adolescent Health Center, we screen young people for trauma during their very first visit. This helps our patients understand that therapy is a safe space where they can process their trauma without judgment.
5. We can make a difference.
More so than other mental illnesses, PTSD has a reputation for being “untreatable.” But that’s just not true. Trauma-Focused Cognitive Behavioral Therapy, Attachment, Regulation and Competency, and other forms of talk therapy have been effective at helping young trauma survivors heal and build resilience. There is hope.
The more we talk about trauma, the more we can chip away at its stigma. Stigma keeps young people from speaking their truth and getting the help they need. Survivors and the people who love them need to understand that PTSD and other trauma responses are normal reactions to an abnormal event. These responses do NOT make you weak or crazy.
Of course, screening requires skill and sensitivity. Providers need to be culturally sensitive, understand how to not re-traumatize patients, and know what next steps are appropriate. But with training, providers can give survivors the tools they need to not only heal, but thrive.
The Substance Abuse and Mental Health Services Administration discusses trauma-informed approaches to care, and includes links to info about several trauma-specific interventions. More research about childhood trauma and resilience can be found here and here.
*This does NOT mean that survivors of abuse are destined to become abusers.
Matthew Oransky, PhD is the Director of Psychology Training at Mount Sinai Adolescent Health Center, oversees the integration of mental health services into the medical clinic and co-coordinates services for transgender and gender non-conforming youth.
Rachel Colon, LCSW is a primary care social worker with over 10 years of experience working with survivors of domestic violence.
Susann Cortes, LMSW is a social worker who provides individual short-term and long-term therapy for adolescents at the Mount Sinai Adolescent Health Center. Susann is passionate about exploring and maximizing individuals’ inner strengths and talents while validating their life experiences, including trauma, and genuine motivation for change. She specializes in trauma, PTSD, and behavioral therapies.
The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.