Trauma Informed Care: What Lawyers Representing Children and Teens Need to Know

by Kirstie MacEwen, MSW, LCSW

Practice Tips

Introduction

Modern social work principles present trauma informed care (TIC) as the most effective and safe way to work with clients of any age. TIC is approaching every person you meet as though he or she has experienced some kind of trauma, and doing your best to be sensitive to whatever those traumatic experiences may have been. It is working with intentionality, being grounded in empathy and empathic responses. TIC is vital when working, in any capacity, with children and adolescents, because their brains are still growing and developing. An adolescent brain is malleable. This plasticity allows the brain to readily learn and adapt, which helps the adolescent develop strategies, skills, and habits. If a child is exposed to traumatic experiences, the habits and strategies he or she is taught can significantly influence his or her ability to cope with the trauma. It is therefore critical that adults provide the support children and adolescents need to develop positive habits and strategies instead of allowing negative ones to take root.

Research has proven that trauma and traumatic experiences significantly impact brain structure. Specifically, a brain that has experienced trauma has significantly diminished frontal lobe structure. The frontal lobe is the executive of our brain. This region is the command center that helps us control our impulses, regulate our emotions, and make thoughtful decisions. Because the frontal lobe plays such a key role in both behavior and functioning, children who have experienced trauma display a wide variety of symptoms. Not surprisingly, many children who exhibit trauma symptoms are misdiagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation disorder (DMDD), as well as many others. Discussing trauma and misdiagnosis, Bessel van der Kolk states,

Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.

Bessel van der Kolk, M.D., The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma 159 (2014).

While the symptoms of trauma can present in a variety of ways that make proper diagnosis difficult, misdiagnosis can be very detrimental to a child’s treatment. Take, for example, the distinction between hyperactivity and hypervigilance.  Hyperactivity (e.g., the inability to sit still or focus) is more closely associated with ADHD. Hypervigilance (including enhanced sensory sensitivity, increased arousal, and high responsiveness to stimuli) can appear the same as hyperactivity but has an added component of anxiety and is more closely associated with post-traumatic stress disorder (PTSD). The symptoms of these disorders can look very similar, but it is important for a child to have access to a clinician who is careful and cognizant of nuances so the child can receive the most appropriate treatment and support.

Why, you may be asking, is this discussion pertinent to lawyers? Children with “behavioral” symptoms are often labeled as problem kids. Because of the punitive nature of our systems of school discipline, these students often receive suspensions or are arrested by school resource officers instead of receiving therapeutic interventions. This is true even when therapeutic interventions are laid out in a legal document such as an Individualized Education Plan or 504 Plan. Punishment for school related behavior is often the cause of a student’s first interaction with the juvenile justice system, but it most likely won’t be the last. Juvenile offenders are at much greater risk of becoming adult offenders. Even on an individual level, working to disrupt this pattern by providing therapeutic support over punishment can start a trend for changes in the larger system.

Tips for Lawyers Representing Children and Teens

1. Remember that trauma significantly impacts brain structures that are meant to help with impulse control, decision making, and emotional regulation.
2. Always approach clients using TIC practices.
3. Look for therapeutic supports that are trauma informed.

• Justice Resource Institute (including SMART team, Trauma Center, Boston GLASS, My Life My Choice, and many other trauma informed programs)
• Diversion Program through Suffolk County District Attorney’s Office
• ROCA
• The Louis D. Brown Peace Institute

4. Advocate for mental health support as opposed to punitive measures whenever possible.
5. Work collaboratively with mental health, physical health, school, and justice system providers.
6. Do some reading about trauma!

• The New Jim Crow, Michelle Alexander
• Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, Laura van Dernoot Lipsky with Connie Burk
• The Boy Who was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook – What Traumatized Children Can Teach Us About Loss, Love, and Healing, Bruce D. Perry, M.D., Ph.D., and Maia Szalavitz
• The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der Kolk, M.D.
• Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, Judith Lewis Herman

Kirstie MacEwen is a graduate of Simmons College School of Social Work.  She is an In Home Therapist for the Justice Resource Institute SMART Team.  In this capacity, Ms. MacEwen serves children and families who are engaged in the juvenile justice system.  She is passionate about juvenile justice reform and disrupting the school to prison pipeline.