There are many types of traumas that effect children and adolescents, and there is a great deal of variation in what different people find upsetting. What is a trauma for one might not upset another person at all. Traumas can range from the dramatic (such as witnessing violent death, or being sexually assaulted) to the subtle (experiencing an incident of emotional abuse, or being bullied) and everything in between. I find it is important not to judge whether or not a child "should" be upset by an experience. If a memory is disturbing him or her, trauma treatment may help.

Children who are suffering from disturbing memories or a full diagnosis of PTSD may exhibit different symptoms than adults. These symptoms may be confusing to the parents or caregiver, and might include:

• Post-traumatic play. Children use pretend play or toys to recreate and act out their upsetting memories. They play looks very serious or frightening to the child, and may scare other children.
• Post-traumatic reenactment. A child may do to others what has been done to them, or encourage others to do the upsetting thing again. For example when a sexually abused child initiates sex acts with others, or a child who has been frightened by a fire plays with matches or engages in arson.
• Frequent frightening nightmares, or difficulty sleeping. May begin trying to sleep in parent's bed.
• Appear to "zone out" or freeze up suddenly.
• The child may do well (or even improve) at school and when busy, but act disturbed at home or when given free or quiet time.
• Sudden clinginess.
• New anxiety or fears.
• Sudden jumpiness or exaggerated startle response.
• Refusal to participate in previously enjoyed activities, including a sudden hatred for school.
• Phobias.
• Make negative statements about one's self ("It was my fault", "I'm bad", "I'm not safe", "I am ugly/stupid/worthless").

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a scientifically proven treatment that cures problems caused by trauma quickly and effectively. EMDR is particularly efficient at treating trauma in children and teenagers. The young brain is constantly growing and changing which enables children to use EMDR extremely successfully and unbelievably quickly. Whereas an adult will usually take 2 hours to process a traumatic incident, a child will process in 5-15 minutes, and a teen 30-40 minutes. I often see dramatic symptom reduction immediately after the first EMDR processing session.

Children (ages 18 months-12 years) follow a special EMDR protocol that looks quite different from the adult procedures, but covers the same basic elements of desensitization and reprocessing. The therapist makes a game out of the bi-lateral stimulation and tells the child the story of the trauma beginning with the child being safe, and ending safe having learned something. An individualized story is used because children do not desensitize or reprocess on their own as adults usually do. When the child's trauma story is known to the parent/guardian/caretaker, the adult(s) are seen alone for 1-3 sessions for the therapist to gather history and information, and explain the procedures. Then the child and parents are seen together for one session of introduction and preparation. One or 2 EMDR treatment sessions per trauma are needed, usually with the parent present, followed by one follow-up/goodbye session. This direct EMDR method works well for both adjunct therapy work and short term treatment.

When the adult(s) do not know the trauma story, are extremely low functioning, perpetrated the trauma, or are new to the child (i.e. foster parent) the therapist may find play therapy to be safer and more effective for the child in building rapport and determining the trauma story(ies). EMDR techniques can then be incorporated into the play. The play therapy/EMDR hybrid approach takes significantly longer, but has been equally effective in my experience. The hybrid approach is possible as an adjunct therapy, but can be more complicated and difficult. I have found that it works best when the long term therapist has witnessed extensive post-traumatic play or the child has told the therapist the trauma story, and the long-term therapist can describe the trauma story to the EMDR therapist. In these instances the long-term therapist fulfills the role of the parent and the EMDR treatment progresses more similarly to the direct EMDR method.

In some cases the parent or caretaker has been traumatized as well. It may be a multigenerational type trauma, such as abuse, or an incident that impacted multiple family members, such as a robbery. In these circumstances I have found that when the parent completes EMDR treatment first, they are more able and willing to provide the necessary safe-base and an accurate and clear EMDR story for the child. The old metaphor applies of putting on one's own oxygen mask before helping a child.

Adolescents (ages 13-21) follow the same protocol as adults, moving through 8 phases of treatment, and are typically seen without the parents. However, while teens desensitize very rapidly, they do not usually reprocess on their own. The therapist can assist the teen in logically thinking about the event, and preparing for the future. Teens can expect a minimum of 3 preparation sessions and approximately one session per trauma, plus one follow-up/goodbye session.

What parents have said about their children:

• "She is sleeping in her own bed now, with no nightmares. It's a miracle!"
• "He doesn't talk about the bad man anymore. He is happy--normal, he can play again."
• "She has not gotten in trouble at school since the EMDR session. I didn't think she was paying attention, but it worked, she has stopped all of those behaviors" (from the parent of a child who had been sexually acting out at school).

For more information about EMDR, check out the EMDR International Association website www.emdria.org. There are many excellent books on using EMDR with children. I most enjoyed reading Small Wonders: Healing Childhood Trauma with EMDR by Joan Lovett, M.D.

---

About the Author

Alexandra Phillippe, MFT has 18 years of experience caring for and working with children. She has 7 years experience as an art and play therapist and has been practicing EMDR with children for 5 years. Alexandra is fully trained in EMDR and child EMDR and is working toward her EMDRIA certification. Alexandra has a private practice in Oakland and is currently accepting clients with approved Victim Compensation claims, Blue Shield insurance, or private pay. Alexandra is also experienced at providing adjunct EMDR treatment for children, adolescents and adults who are in long term therapy or groups elsewhere.