Trauma and Clusters of Children’s Disturbed Behaviours

Research shows that when children become distressed, they often exhibit two types of disturbed behaviour that have been called internalizing behaviours and externalizing behaviours. A child who exhibits internalizing behaviours appears anxious and depressed, and this elicits support from most parents. A child who exhibits externalizing behaviours appears to be defiant and misbehaving, and this elicits a disciplinary response from many parents. A proportion of children exhibit both internalizing and externalizing behaviours when distressed, and this makes it difficult for parents to decide how to manage the child’s behaviour. Research shows that a proportion of children who have been traumatized, including by being traumatized from having been removed from the care of their parent, display a complex presentation where the child exhibits both externalizing and internalizing behaviours. This chapter distinguishes between the stress response and the trauma response, and explains the need for careful therapy for children who have been traumatized and who display complex behavioural patterns. The chapter discusses the pattern of attention-deficit/hyperactivity behaviour that is often observed in vulnerable children, and discusses optimal treatment for children who display this complex condition.