The Silent Struggle: Trauma and Communication in Young TBI Survivors
Unlocking Their Voices: A Guide for Families Navigating Childhood Brain Injury and Its Unseen Emotional Impact.
My own journey began at 15 years old with a severe TBI that left me in a coma for over a month. When I awoke, I had lost my speech and faced immense difficulties expressing myself. It took me 7 to 8 years, well into adulthood, before I could even begin to openly discuss my TBI and its effects. Before that, the thought of talking about what happened was incredibly uncomfortable.
Trauma in the context of childhood is defined as an event or series of events that threaten injury, death, or the physical integrity of oneself or others. These events evoke overwhelming feelings of horror, terror, or helplessness at the time they occur (American Psychiatric Association, 2013).
Such dangerous experiences can overwhelm a child's inherent capacity to regulate their emotions, leaving them in a persistent state of vigilance, constantly "on guard" for additional threats (Perry, 2009).
The ability to communicate effectively is often severely compromised after a TBI, particularly in the initial stages of recovery (National Institute of Neurological Disorders and Stroke, 2024).
Depending on the severity of the trauma, the very act of speaking may be impossible. In my case, I lost my speech completely, making any verbalization an insurmountable challenge. This isn't just about uttering words; it's about the fundamental capacity to convey thoughts, feelings, and needs.
While psychiatric treatments are often initiated with the expectation of facilitating a child's dealings with trauma, the outcomes lack significance, particularly when the child struggles with fundamental communication.
This is due to several factors: the inherent difficulty in assessing trauma in non-verbal or minimally verbal children; the reliance of many traditional therapies on verbal processing; and the limited research on adapting psychiatric interventions specifically for children with significant communication barriers post-TBI (Hyter, Y. D., 2024; National Autistic Society, 2022; SAMHSA, 2016).
What trauma feels like as a child?
For a long time (for 5 - 6 years after my traumatic accident) I could not talk about my trauma. Not even with a psychiatric therapist. While it was well intentioned and set up from the professional perspective, in accordance with whats referred to above I doubt where it helped me at that time. I didnt find any different feelings or understandings after these sessions, both short time and long term.
When a traumatic event occurs before a child develops the language skills necessary to encode the information or form coherent memories (which is often the case with very young children), making verbal recall difficult or even impossible later on (Teicher et al., 2016). Consequently, a child's distress is frequently expressed through their behaviors rather than through spoken words.
When a child experiences trauma, their body's innate "stress response" system—the "fight, flight, or freeze" mechanism designed for immediate danger—is activated and can become chronically dysregulated (Perry, 2009).
This is not merely a psychological phenomenon; it is a profound physiological experience. Children may describe or exhibit a racing heart, rapid breathing, or an overwhelming sense of terror, helplessness, or fear. In some instances, they may feel "frozen," too overwhelmed to regain a sense of calm.
These intense physical sensations can persist long after the traumatic event, manifesting as frequent complaints of stomachaches, headaches, nausea, or vomiting, for which no medical cause can be found.
They might also feel perpetually "on edge" or "jumpy," easily startled by sudden noises or movements, as if constantly anticipating the next threat.
Supporting Young TBI Survivors and Their Caregivers
Trauma often impairs executive functions, which are higher-level cognitive skills essential for planning, problem-solving, self-regulation, and working memory (National Institute of Neurological Disorders and Stroke, 2024).
These impairments can significantly affect a child's ability to process and articulate their traumatic experiences.
Alternative and Augmentative Communication (AAC)
For TBI survivors who experience significant speech loss or difficulty, exploring and implementing Alternative and Augmentative Communication (AAC) methods is vital. This can include picture exchange communication systems (PECS), communication boards, speech-generating devices, and even sign language.
To recover my speech, I have used PECS. Out from this experience, we are developing a program that empowers TBI patients and their caregivers in recovering and implementing speech strategies with a focus on the trauma and the consequently difficulty of feelings and understandings about the trauma. Follow, Subscribe and Donate when you want to hear more about this.
The Power of Play and Expressive Therapies
For children, especially those with limited verbal abilities, play therapy and other expressive therapies (art therapy, music therapy, drama therapy) can provide a safe and effective outlet for processing trauma. These approaches allow children to communicate their experiences symbolically and non-verbally.
Family-Centered Care and Education
Caregivers are on the front lines of supporting TBI survivors. Comprehensive, family-centered care models are essential, providing not only resources for the child but also education and psychological support for the entire family. This includes training caregivers to recognize non-verbal cues of distress, understand the neurobiological impacts of TBI and trauma, and develop effective communication strategies.
My own prolonged struggle to voice the impact of my TBI underscores a critical truth: for young survivors, particularly those with communication challenges, the journey through trauma is often a silent one.
The intertwined complexities of childhood trauma and brain injury can fundamentally alter a child's ability to express the profound physiological and psychological distress they endure. This highlights the urgent need for innovative, trauma-informed approaches that go beyond traditional verbal therapies, embracing methods like Alternative and Augmentative Communication (AAC) and expressive therapies to unlock their voices.
My experience with PECS, and the subsequent work to develop empowering speech recovery programs, stands as a testament to the potential of such tailored strategies.
Ultimately, truly effective support for young TBI survivors and their families hinges on recognizing these unique communication barriers, fostering a family-centered care environment, and continuously striving to understand and address the unspoken burdens of trauma.
Having suffered severe TBI myself, personal sources that helped me to become the best version of myself:
Follow my personal survivors story by clicking here, having suffered severe TBI and the remarkable life story that brought me to where I am today.
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Disclaimer
Everything written here is based on my own account, if not otherwise stated. I am not a physician, nor do I have a medical degree. I was patient with them and by following certain and consciously not following other advice from them I found my way to become the best version of myself. I am a TBI survivor and I am sharing my experiences. From my own perspective I know what works and what not. My own perspective is always well researched and I only use products and services that have worked for me. Having said that, TBI survivorship is dependent on the individual going through TBI and therefore each case is different. One size - Fits all solutions don't exist in this space.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
National Autistic Society. (2022). Post-traumatic stress disorder in autistic people.
National Institute of Neurological Disorders and Stroke. (2024). Traumatic Brain Injury: Hope Through Research.
Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14(3), 240-255.
SAMHSA (Substance Abuse and Mental Health Services Administration). (2016). Key Ingredients for Successful Trauma-Informed Care Implementation. HHS Publication.
SAMHSA (Substance Abuse and Mental Health Services Administration). (2024). Effective Strategies to Prevent and Address Adverse Childhood Experiences
Teicher, M. H., Samson, J. A., Anderson, C. M., & Ohashi, K. (2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17(10), 652-666.