Dr. Mark Lerner 
Article Title
Post-traumatic stress and its manifestation in the young institutionalized child 
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Unfortunately, a significant number of young institutionalized children are exposed to traumatic events. These include, but are certainly not limited to, neglect, physical and sexual abuse and various degrees of abandonment. By having an understanding of traumatic stress and how it impacts young children, we can identify posttraumatic stress reactions and address the unique emotional and behavioral needs of these children. It's important to understand that traumatic stress, and posttraumatic stress, are not synonymous with Posttraumatic Stress Disorder (PTSD). The former are very normal human reactions that are experienced in the face of abnormal events. The latter, PTSD, it a mental disorder marked by a significant disruption in functioning over time (e.g., recurrent and intrusive distressing recollections of the event, distressing dreams, flashbacks, difficulty concentrating, hypervigilance, an exaggerated startle response, and a host of avoidance behaviors).

Traumatic stress typically refers to the emotional, cognitive, behavioral and physiological experience of individuals who are exposed to, or who witness, events that overwhelm their coping and problem-solving abilities. These events are often unexpected and uncontrollable. They compromise an individual's sense of safety and security and leave people feeling insecure and vulnerable. Traumatic stress disables people, causes disease, precipitates mental disorders, leads to substance abuse, and destroys relationships and families. In the case of the young institutionalized child, immature behaviors, behaviors that were typically abandoned in the past, are often manifested (e.g., thumbs sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties).

As these children become older, they may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc. Since preschool-age children do not yet possess the cognitive skills to understand a traumatic experience and since they lack the coping strategies to deal effectively with it, they look to adults in their environment for support and comfort. Unfortunately, the young institutionalized child may not find that comfort in their facility. They may not be exposed to adult figures who model an adaptive response in the face of adversity and who appropriately address their fears of abandonment. This experience only serves to reinforce feelings of aloneness.

It is critical to look beyond the physical and safety needs of young institutionalized children, and understand and address their emotional and behavioral needs. A mental health professional who is knowledgeable about traumatic stress, and how traumatic events impact young children, can be an invaluable resource in addressing the unique needs of the young institutionalized child.

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

Dr. Mark Lerner is a Clinical Psychologist and Traumatic Stress Consultant who focuses on helping people during and in the aftermath of traumatic events. He is the President of the American Academy of Experts in Traumatic Stress ( and the originator of the Acute Traumatic Stress Management intervention model ( Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience ( 
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