Selected Podcast
Trauma and Adverse Childhood Experiences in Kids and Teens
In this episode, CHOC psychologist Sheila Modir, PhD, MSW, addresses the topic of trauma in kids and teens, including the warning signs parents should look for.
Featuring:
Sheila Modir, PhD, MSW
Dr. Sheila Modir is a pediatric psychologist at Children's Health of Orange County (CHOC). She obtained a combined doctoral degree in clinical, counseling, and school psychology at the University of California, Santa Barbara and her master’s degree in social welfare at University of California, Los Angeles (UCLA). Prior to coming to CHOC, Dr. Modir completed her doctoral internship at the UCLA Semel Institute for Neuroscience and Human Behavior where she worked at the UCLA Stress, Trauma, and Resilience Clinic, and then completed her fellowship year at CHOC. Her research interests include understanding risk and resilience factors in the context of adverse childhood experiences, and she has presented at conferences and published articles on this topic. Transcription:
Melanie Cole (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy.
I'm Melanie Cole, and I invite you to listen as we discuss trauma and adverse childhood experiences in kids and teens. Joining me today is Dr. Sheila Modir. She's a pediatric psychologist with Children's Health of Orange County. Dr. Modir, it's a pleasure to have you join us today. Before we get into this very important topic, can you tell us just a little bit about yourself and your expertise on this subject?
Dr Sheila Modir: Yes, of course. Well, it's so great to be here and thank you so much for having me here, Melanie. I'm excited to be able to talk about a topic that's especially really important right now with everything going on in this pandemic. To introduce myself, I am Dr. Sheila Modir. I have a combined doctoral degree in Clinical Counseling and School Psychology at the University of California, Santa Barbara, and my master's degree in Social Welfare from UCLA.
Prior to coming to CHOC, I completed my doctoral internship at the UCLA Semel Institute for Neuroscience and Human Behavior, where I really specialized in working with stress, trauma and resilience. And I've completed a number of research studies and presented at conferences and published articles on the topic of risk and resilience and adverse childhood experiences.
Melanie Cole (Host): Thank you for sharing that. And, you know, building resilience in our kids, that's a hot topic right now. I hope you'll come back on and join us and we can talk about that. So let's get into this topic. How do you define trauma, Dr. Modir? And what types of trauma may children be experiencing? What are we talking about here?
Dr Sheila Modir: Definitely. So trauma is an emotional response to a terrible event that has occurred like a car accident or a natural disaster or, currently in our case right now for many people, this pandemic. And immediately a traumatic event, people experience a number of emotional reactions. And at times, the emotional reaction might be short-term and sometimes the emotional reaction can last longer and that's really when we see children in our practice, is when the emotional reaction of a traumatic event has caused impairment in their daily lives.
Melanie Cole (Host): So tell us a little bit about the difference between adverse childhood experiences and childhood trauma. Is it important that we understand the difference between these two?
Dr Sheila Modir: I think that's a really great question because adverse childhood experiences really stemmed from a study between Kaiser and CDC that was done that studied 10 specific adverse childhood experiences or traumatic events in childhood that had occurred such as looking at different types of abuse and neglect for a child. And they really based data off of this research study. And what it found was between the ages of zero to eighteen, many people have experienced trauma. And I think that was one of the first studies that really demonstrated that trauma is not something that is for one community or one type of group. It's really widespread and it's much more widespread than people had considered before. It's widespread across socioeconomic statuses, across diversity and it really helped people pay attention to it. So you hear adverse childhood experiences a lot more lately because it's what the research articles are about and it's what a lot of presentations and data is collected on it. But it is another way of saying childhood trauma. It's just measuring 10 specific types of childhood trauma.
Melanie Cole (Host): Thank you for clarifying that. What an important distinction. So tell us about signs and symptoms of childhood trauma. What might a caregiver or a parent or a teacher, somebody in that child's life notice that would send up some red flags?
Dr Sheila Modir: That's a great question because childhood trauma really presents differently across the developmental lifespan. So when we're talking about younger kids like preschool and young child, they don't really have the language to be able to express their feelings after a traumatic event has occurred. So what you would see more often is an increase in crying, screaming, tantrums, difficulty falling, asleep, and increase in nightmares. And then they might have a lot more separation anxiety from their caregivers. And finally, they engage in more regressive behavior. So you might've just accomplished, you know, potty training, but now they are having difficulty with their toileting skills or they might not be able to eat independently when before you had just gotten through that milestone.
So with younger kids, you do see a lot more of that non-verbal emotional reaction. But then as they get older, so when you have the school-aged children, their emotions start getting a little bit more complex. So they have feelings of anxiety, sadness they're worried and fearful. They might be a little bit more clingy, so now that separation anxiety has manifested into clinginess and then they might have a harder time with sleep and concentrating at school. And finally, for them, you see a lot more somatic complaints, so they might have a lot more stomach aches or headaches. And first signs, usually parents tend to go to the doctor because like the stomach ache really isn't going away, and so they're going to go see their pediatrician and the pediatrician after doing like a full assessment will inform the parents, you know, this could be something that's happened and they're having an emotional reaction to it.
And then finally for our teenagers, they have much more complex emotions where they're really feeling that depression, anxiety, loneliness, and they might act out and engage in risky behaviors. So you might have your teen engage in self-harming, using substances, restrictive eating, engaging in more fights or physical aggression at school. They might isolate and withdraw or sleep too much or sleep too little, and they might be more on edge and more irritable. So as they go through these developmental stages, you see that trauma does impact them in different ways and elicits different emotional reactions across the developmental lifespan.
Melanie Cole (Host): So, what do we do, Dr. Modir, if we notice in our little kids some backtracking of those milestones or some risky behavior in our teens, what are at least three things that we can do to support them, to find out what's wrong? What language do we use? Who do we call? What do we do?
Dr Sheila Modir: I know it's such a big question and it's such an important one, and I'm going to kind of push it a little bit and ask if I could talk about five different things to help navigate the emotional aftermath of a traumatic event. And I talk about it by talking about five E's, like the letter E. So the first E that parents could do is really explore what the child already knows. So let's say a traumatic event has occurred at school or even in the context of this pandemic, right? It's constantly changing. People are talking about it at school, hearing different things. So really exploring with your child, what do they know in a very gentle and calm manner and starting that conversation, asking about, you know, how was your day? Did anything happen at school? Did you hear anything?
And then the next E is explaining, so then explaining in a way that your child can understand, again, with developmentally appropriate language. And while you're explaining, you want to make sure that you are trying to provide information to the questions that your child had asked you and you're not really overwhelming them with a ton of information. You want to also address any misinformation that they might've picked up at school, any sort of rumors that they've heard. and at the same time, you are reassuring their sense of safety. So you could remind them of all the protocols that are in place at school to help keep them safe if it's related to, let's say there's a lot of COVID-19 anxiety right now, like all the things the school is doing to keep them safe, all the things you're doing at home to help keep them safe.
Then you want to express. The next E is to express to your child that these feelings are normal and it's okay to feel sad, mad, angry when something that's tragic or traumatic occurs. We also want to make sure during this time that we are reducing any sort of media exposure after traumatic event, because repeated exposure to the event has actually been associated with psychological distress and intensifying already heightened emotions. We also want to emotionally model for your child the healthy expression of feelings as children tend to take their cues from their parents, so you can talk about how you are coping with the stressful situation. For example, you could say, "When I feel scared that something's going to that I might go out and if a family has experienced like a car accident, you know, when I get into a car, I take three deep breaths and really help calm myself. I wonder if we can take three deep breaths together." So you're modeling for them how to cope with the stress that they're experiencing.
And finally, the last E is to ensure stability because you really want to make sure that there is a routine during a chaotic time and you really want to make sure that there's structure and stability and predictability. It doesn't mean that we're trying to ignore the trauma that's happened, but for a child, they need to know that as the world is maybe really chaotic and overwhelming, that they have something that they can master and understand and be able to have a reassurance of that sense of safety.
Melanie Cole (Host): What an excellent comprehensive list that was Dr. Modir. I just don't remember having this kind of strife in our lives as kids. And as you said, with social media and the news, these kids are inundated with all of this, and they're so much more worldly and they're getting this from all parts and all sides. So it is really difficult for them to separate that. You just gave us some great advice. Now, what about some warning signs that there needs to be a specialist brought in?
Dr Sheila Modir: Definitely. So I think that parents are aware of their child's emotional cues. So being really attuned to them, knowing what their baseline is and what they're experiencing beyond their baseline is the first step that maybe something's going on with my child. The second thing is understanding that some signs and symptoms of distress are a normal part of adjusting to any sort of transition or trauma such as changes in your sleep or appetite. Let's say a family pet passed away and your child is having a hard time sleeping at night, so this could take a while as they adjust to this sadness and they're grieving. But if you start seeing that this isn't subsiding and your child is not adapting and it's beginning to really interfere with their ability to function, go to school, talk to people, see friends, that's when I would consider contacting a mental health professional. So to summarize, really being aware of those emotional cues of your child and being able to see if the symptoms are starting to impair their daily functioning.
Melanie Cole (Host): Dr. Modir, this is a bit off topic, but before we wrap up, there really is a mental health crisis in this country right now for our kids and teens. Can you give parents listening any advice about helping all of our right now where we can look for help to support our child? Really what words we can use, things we can say? Because it is overwhelming for all of us, but as adults, we learn some coping mechanisms, but these kids not so much just yet.
Dr Sheila Modir: Definitely. I think that what we really want to do as adults right now is be able to really emotionally model for them how to react appropriately and in a healthy manner towards a tragic or traumatic event. Kids are always watching adults around them and they're emulating them. Even when you don't think they're watching you, they are watching you and they learn from how you react to things. So really what I'd like to talk to parents about is co-regulating. So when you're regulated as a parent, your child can take your emotional cues and internalize them. So talking about coping skills openly as a family is a huge way to build resilience in a child because then you're teaching them what to do in the face of a traumatic event.
And being able to also contact a therapist during difficult times is really important, so we reduce that mental health stigma and really go talk to a professional when we feel like we've gotten to a point that either as a parent, you need to talk to somebody about how to be able to help your child navigate these symptoms or for your child to have a space to help process those symptoms.
Melanie Cole (Host): Really great advice, Dr. Modir. Thank you so much for joining us today. For more pediatric health and wellness tips, you can visit choc.org/mentalhealth for more information and to get connected with one of our providers.
Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. Please also remember to share on your social channels as we're all learning from the experts at CHOC together. I'm Melanie Cole.
Melanie Cole (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy.
I'm Melanie Cole, and I invite you to listen as we discuss trauma and adverse childhood experiences in kids and teens. Joining me today is Dr. Sheila Modir. She's a pediatric psychologist with Children's Health of Orange County. Dr. Modir, it's a pleasure to have you join us today. Before we get into this very important topic, can you tell us just a little bit about yourself and your expertise on this subject?
Dr Sheila Modir: Yes, of course. Well, it's so great to be here and thank you so much for having me here, Melanie. I'm excited to be able to talk about a topic that's especially really important right now with everything going on in this pandemic. To introduce myself, I am Dr. Sheila Modir. I have a combined doctoral degree in Clinical Counseling and School Psychology at the University of California, Santa Barbara, and my master's degree in Social Welfare from UCLA.
Prior to coming to CHOC, I completed my doctoral internship at the UCLA Semel Institute for Neuroscience and Human Behavior, where I really specialized in working with stress, trauma and resilience. And I've completed a number of research studies and presented at conferences and published articles on the topic of risk and resilience and adverse childhood experiences.
Melanie Cole (Host): Thank you for sharing that. And, you know, building resilience in our kids, that's a hot topic right now. I hope you'll come back on and join us and we can talk about that. So let's get into this topic. How do you define trauma, Dr. Modir? And what types of trauma may children be experiencing? What are we talking about here?
Dr Sheila Modir: Definitely. So trauma is an emotional response to a terrible event that has occurred like a car accident or a natural disaster or, currently in our case right now for many people, this pandemic. And immediately a traumatic event, people experience a number of emotional reactions. And at times, the emotional reaction might be short-term and sometimes the emotional reaction can last longer and that's really when we see children in our practice, is when the emotional reaction of a traumatic event has caused impairment in their daily lives.
Melanie Cole (Host): So tell us a little bit about the difference between adverse childhood experiences and childhood trauma. Is it important that we understand the difference between these two?
Dr Sheila Modir: I think that's a really great question because adverse childhood experiences really stemmed from a study between Kaiser and CDC that was done that studied 10 specific adverse childhood experiences or traumatic events in childhood that had occurred such as looking at different types of abuse and neglect for a child. And they really based data off of this research study. And what it found was between the ages of zero to eighteen, many people have experienced trauma. And I think that was one of the first studies that really demonstrated that trauma is not something that is for one community or one type of group. It's really widespread and it's much more widespread than people had considered before. It's widespread across socioeconomic statuses, across diversity and it really helped people pay attention to it. So you hear adverse childhood experiences a lot more lately because it's what the research articles are about and it's what a lot of presentations and data is collected on it. But it is another way of saying childhood trauma. It's just measuring 10 specific types of childhood trauma.
Melanie Cole (Host): Thank you for clarifying that. What an important distinction. So tell us about signs and symptoms of childhood trauma. What might a caregiver or a parent or a teacher, somebody in that child's life notice that would send up some red flags?
Dr Sheila Modir: That's a great question because childhood trauma really presents differently across the developmental lifespan. So when we're talking about younger kids like preschool and young child, they don't really have the language to be able to express their feelings after a traumatic event has occurred. So what you would see more often is an increase in crying, screaming, tantrums, difficulty falling, asleep, and increase in nightmares. And then they might have a lot more separation anxiety from their caregivers. And finally, they engage in more regressive behavior. So you might've just accomplished, you know, potty training, but now they are having difficulty with their toileting skills or they might not be able to eat independently when before you had just gotten through that milestone.
So with younger kids, you do see a lot more of that non-verbal emotional reaction. But then as they get older, so when you have the school-aged children, their emotions start getting a little bit more complex. So they have feelings of anxiety, sadness they're worried and fearful. They might be a little bit more clingy, so now that separation anxiety has manifested into clinginess and then they might have a harder time with sleep and concentrating at school. And finally, for them, you see a lot more somatic complaints, so they might have a lot more stomach aches or headaches. And first signs, usually parents tend to go to the doctor because like the stomach ache really isn't going away, and so they're going to go see their pediatrician and the pediatrician after doing like a full assessment will inform the parents, you know, this could be something that's happened and they're having an emotional reaction to it.
And then finally for our teenagers, they have much more complex emotions where they're really feeling that depression, anxiety, loneliness, and they might act out and engage in risky behaviors. So you might have your teen engage in self-harming, using substances, restrictive eating, engaging in more fights or physical aggression at school. They might isolate and withdraw or sleep too much or sleep too little, and they might be more on edge and more irritable. So as they go through these developmental stages, you see that trauma does impact them in different ways and elicits different emotional reactions across the developmental lifespan.
Melanie Cole (Host): So, what do we do, Dr. Modir, if we notice in our little kids some backtracking of those milestones or some risky behavior in our teens, what are at least three things that we can do to support them, to find out what's wrong? What language do we use? Who do we call? What do we do?
Dr Sheila Modir: I know it's such a big question and it's such an important one, and I'm going to kind of push it a little bit and ask if I could talk about five different things to help navigate the emotional aftermath of a traumatic event. And I talk about it by talking about five E's, like the letter E. So the first E that parents could do is really explore what the child already knows. So let's say a traumatic event has occurred at school or even in the context of this pandemic, right? It's constantly changing. People are talking about it at school, hearing different things. So really exploring with your child, what do they know in a very gentle and calm manner and starting that conversation, asking about, you know, how was your day? Did anything happen at school? Did you hear anything?
And then the next E is explaining, so then explaining in a way that your child can understand, again, with developmentally appropriate language. And while you're explaining, you want to make sure that you are trying to provide information to the questions that your child had asked you and you're not really overwhelming them with a ton of information. You want to also address any misinformation that they might've picked up at school, any sort of rumors that they've heard. and at the same time, you are reassuring their sense of safety. So you could remind them of all the protocols that are in place at school to help keep them safe if it's related to, let's say there's a lot of COVID-19 anxiety right now, like all the things the school is doing to keep them safe, all the things you're doing at home to help keep them safe.
Then you want to express. The next E is to express to your child that these feelings are normal and it's okay to feel sad, mad, angry when something that's tragic or traumatic occurs. We also want to make sure during this time that we are reducing any sort of media exposure after traumatic event, because repeated exposure to the event has actually been associated with psychological distress and intensifying already heightened emotions. We also want to emotionally model for your child the healthy expression of feelings as children tend to take their cues from their parents, so you can talk about how you are coping with the stressful situation. For example, you could say, "When I feel scared that something's going to that I might go out and if a family has experienced like a car accident, you know, when I get into a car, I take three deep breaths and really help calm myself. I wonder if we can take three deep breaths together." So you're modeling for them how to cope with the stress that they're experiencing.
And finally, the last E is to ensure stability because you really want to make sure that there is a routine during a chaotic time and you really want to make sure that there's structure and stability and predictability. It doesn't mean that we're trying to ignore the trauma that's happened, but for a child, they need to know that as the world is maybe really chaotic and overwhelming, that they have something that they can master and understand and be able to have a reassurance of that sense of safety.
Melanie Cole (Host): What an excellent comprehensive list that was Dr. Modir. I just don't remember having this kind of strife in our lives as kids. And as you said, with social media and the news, these kids are inundated with all of this, and they're so much more worldly and they're getting this from all parts and all sides. So it is really difficult for them to separate that. You just gave us some great advice. Now, what about some warning signs that there needs to be a specialist brought in?
Dr Sheila Modir: Definitely. So I think that parents are aware of their child's emotional cues. So being really attuned to them, knowing what their baseline is and what they're experiencing beyond their baseline is the first step that maybe something's going on with my child. The second thing is understanding that some signs and symptoms of distress are a normal part of adjusting to any sort of transition or trauma such as changes in your sleep or appetite. Let's say a family pet passed away and your child is having a hard time sleeping at night, so this could take a while as they adjust to this sadness and they're grieving. But if you start seeing that this isn't subsiding and your child is not adapting and it's beginning to really interfere with their ability to function, go to school, talk to people, see friends, that's when I would consider contacting a mental health professional. So to summarize, really being aware of those emotional cues of your child and being able to see if the symptoms are starting to impair their daily functioning.
Melanie Cole (Host): Dr. Modir, this is a bit off topic, but before we wrap up, there really is a mental health crisis in this country right now for our kids and teens. Can you give parents listening any advice about helping all of our right now where we can look for help to support our child? Really what words we can use, things we can say? Because it is overwhelming for all of us, but as adults, we learn some coping mechanisms, but these kids not so much just yet.
Dr Sheila Modir: Definitely. I think that what we really want to do as adults right now is be able to really emotionally model for them how to react appropriately and in a healthy manner towards a tragic or traumatic event. Kids are always watching adults around them and they're emulating them. Even when you don't think they're watching you, they are watching you and they learn from how you react to things. So really what I'd like to talk to parents about is co-regulating. So when you're regulated as a parent, your child can take your emotional cues and internalize them. So talking about coping skills openly as a family is a huge way to build resilience in a child because then you're teaching them what to do in the face of a traumatic event.
And being able to also contact a therapist during difficult times is really important, so we reduce that mental health stigma and really go talk to a professional when we feel like we've gotten to a point that either as a parent, you need to talk to somebody about how to be able to help your child navigate these symptoms or for your child to have a space to help process those symptoms.
Melanie Cole (Host): Really great advice, Dr. Modir. Thank you so much for joining us today. For more pediatric health and wellness tips, you can visit choc.org/mentalhealth for more information and to get connected with one of our providers.
Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. Please also remember to share on your social channels as we're all learning from the experts at CHOC together. I'm Melanie Cole.