M4 - Posttraumatic Growth in Children
In this discussion, we will address the possibilities of posttraumatic growth. As you know, most of the attention of researchers, health care providers, and parents is focused on the long term negative impacts of trauma and how to help the child resolve them. However, there is growing research interest in the long term growth that can derive from trauma – often alongside the negative impacts.
Child trauma researcher, Eva Alisic and her team have asked those of us in the trauma field to "look beyond posttraumatic stress disorder" in children, to consider also the posttraumatic growth (PTG) and the child's quality of life after trauma (Alisic, van der Schoot, van Ginkel, & Kleber, 2008). Sadly, there is still little research to date that documents PTG in children.
Before posting to the discussion, please read the short discussion sections in the two studies below that asks children about their growth – one after a natural disaster and the other after a car accident:
· Cryder, C. H., Kilmer, R. P., Tedeschi, R. G., & Calhoun, L. G. (2006). An exploratory study of posttraumatic growth in children following a natural disaster. American Journal of Orthopsychiatry, 76, 65–69.
· Salter, E., & Stallard, P. (2004). Posttraumatic growth in child survivors of a road traffic accident. Journal of Traumatic Stress, 17, 335–340.
Then, read the article that considers posttraumatic growth – as well as the harm – that can influence our interventions with children:
· Kilmer, R. P., Gil-Rivas, V., Griese, B., Hardy, S. J., Hafstad, G. S., & Alisic, E. (2014). Posttraumatic growth in children and youth: clinical implications of emerging research literature. The American Journal of Orthopsychiatry, 84(5), 506–518.
After you have completed the readings, please post your responses to the following four questions:
1. What were the strongest areas of growth that children reported? Which areas were surprising to you?
2. What additional questions might you have liked to ask the children in these studies? Explain your answer, please.
3. How do you think taking PTG into account can change a counselor's interventions with a child and family?
4. How and when would you imagine raising the issue of PTG with a child and family to be respectful of their experience of crisis?
Posttraumatic Growth in Children and Youth: Clinical
Implications of an Emerging Research Literature
Ryan P. Kilmer and Virginia Gil-Rivas
University of North Carolina at Charlotte
Brook Griese
Judi’s House for Grieving Children and Families,
Denver, Colorado
Steven J. Hardy
Children’s National Medical Center, Washington, DC
and The George Washington University School of
Medicine
Gertrud Sofie Hafstad
Norwegian Centre for Violence and Traumatic Stress
Studies, Oslo, Norway
Eva Alisic
Monash University
Posttraumatic growth (PTG), positive change resulting from the struggle with trauma, has
garnered significant attention in the literature on adults. Recently, the research base has begun
to extend downward, and this literature indicates that youth also evidence PTG-like changes.
Researchers have sought to assess the construct, examine its co
elates, and understand the
factors that contribute to PTG in youth. Drawing from this work, this article considers clinical
implications for youth. After
iefly describing the PTG construct, its hypothesized process, and
its distinction from resilience, the article focuses on key themes in the literature and, with those
findings as backdrop, ways in which professionals can facilitate growth in youth who have
experienced trauma. This discussion situates PTG within the
oader trauma literature and
includes specific applications used to date as well as the role of cultural factors. Future
directions—salient to practitioners and researchers alike—are considered.
W ith its emphasis on the transformative elements ofone’s reactions and response to adversity, posttrau-matic growth (PTG), defined as positive change
experienced as a result of the struggle with trauma, has received
considerable attention in the adult clinical and research literatures
(e.g., Calhoun & Tedeschi, 2006; Helgeson, Reynolds, & Tomich,
2006; Joseph & Linley, 2008; Knaevelsrud, Liedl, & Maercker,
2010). In the last several years, this research base has begun to
extend downward, with researchers exploring the degree to which
children and adolescents evidence PTG. Indeed, an emerging
literature supports that youth demonstrate a PTG-like phenom-
enon (Meyerson, Grant, Smith Carter, & Kilmer, 2011), and
ecent efforts have sought to develop means to better assess the
construct in youngsters (Kilmer et al., 2009), examine its cor-
elates (Cryder, Kilmer, Tedeschi, & Calhoun, 2006), and un-
derstand the factors that contribute to PTG (Kilmer & Gil-
Rivas, 2010a). Subsequently, researchers have begun to
articulate possible clinical applications of this work to youth
populations. This article draws on recent findings to build on
and extend two contributions (Clay, Kni
s, & Joseph, 2009;
This article was published Online First August 11, 2014.
Ryan P. Kilmer, Professor of Psychology, University of North Car-
olina at Charlotte; Virginia Gil-Rivas, Associate Professor of Psychol-
ogy and Director, Health Psychology Doctoral Program, University of
North Carolina at Charlotte; Brook Griese, Co-Founder and Executive
Director, Judi’s House for Grieving Children and Families, Denver,
Colorado; Steven J. Hardy, Assistant Professor of Pediatrics and Psy-
chiatry and Behavioral Sciences, Children’s National Medical Center,
Washington, DC; The George Washington University School of Med-
icine; Gertrud Sofie Hafstad, Senior Researcher, Norwegian Centre fo
Violence and Traumatic Stress Studies, Oslo, Norway; Eva Alisic,
Larkins Research Fellow, Monash Injury Research Institute, Monash
University.
An earlier version of this work was presented as a paper at the European
Conference on Traumatic Stress in Vienna, Austria in June, 2011. The
Hu
icane Katrina research referenced here was funded by National Insti-
tute of Mental Health Award R03 MH XXXXXXXXXXGil-Rivas and Kilmer).
Research and programs at Judi’s House are supported by private and
corporate sponsors, listed in annual reports at www.judishouse.org. The
authors would also like to acknowledge the contributions of key collaborators,
including Lawrence Calhoun, Arnie Cann, Louise Silvern, Kanako Taku, and
Richard Tedeschi.
Co
espondence concerning this article should be addressed to Ryan P.
Kilmer, Department of Psychology, The University of North Carolina at
Charlotte, 9201 University City Boulevard, Charlotte, NC XXXXXXXXXX.
E-mail: XXXXXXXXXX
T
hi
s
do
cu
m
en
t
is
co
py
i
gh
te
d
y
th
e
A
m
e
ic
an
Ps
yc
ho
lo
gi
ca
l
A
ss
oc
ia
tio
n
o
on
e
of
its
al
lie
d
pu
l
is
he
s
.
T
hi
s
a
tic
le
is
in
te
nd
ed
so
le
ly
fo
th
e
pe
s
on
al
us
e
of
th
e
in
di
vi
du
al
us
e
an
d
is
no
t
to
e
di
ss
em
in
at
ed
oa
dl
y.
American Journal of Orthopsychiatry © 2014 American Orthopsychiatric Association
2014, Vol. 84, No. 5, 506–518 http:
dx.doi.org/10.1037/ort0000016
506
http:
www.judishouse.org
mailto: XXXXXXXXXX
http:
dx.doi.org/10.1037/ort0000016
Kilmer & Gil-Rivas, 2008) regarding the practical applications
of the developing knowledge base.
The following sections: (a) introduce the PTG construct and its
hypothesized mechanisms and processes; (b) discuss its conceptual
and empirical differences from resilience; (c) summarize key
themes and findings in the extant research; (d) consider unan-
swered questions and gaps in the literature and their potential
implications; and (e) outline means by which professionals can
facilitate PTG in children and youth, including some specific
applications used to date.
What Is Posttraumatic Growth?
Although the term posttraumatic growth (and its present con-
notations) was coined fairly recently (Tedeschi & Calhoun, 1995,
1996), the notion of PTG has historical grounding in psychology,
philosophy, and other disciplines. In the last two decades, the
construct has spawned over 900 articles, chapters, special issues,
and volumes (Calhoun & Tedeschi, 2006; Joseph & Linley, 2006,
2008), including sources for practitioners (Calhoun & Tedeschi,
1999, 2013; Tedeschi & Calhoun, 2009; Tedeschi & Kilmer,
2005). These works largely focus on adults.
The scholarly literature is less well-developed for children and
adolescents, but researchers have documented PTG-like changes in
youth who have experienced natural disasters (Cryder et al., 2006;
Hafstad, Gil-Rivas, Kilmer, & Raeder, 2010; Hafstad, Kilmer, &
Gil-Rivas, 2011; Kilmer et al., 2009; Yang, Lin, & Qian, 2010; Yu
et al., 2010), te
orism (e.g., Laufer & Solomon, 2006; Levine,
Laufer, Hamama-Raz, Stein, & Solomon, 2008), traffic accidents
(Salter & Stallard, 2004), cancer (e.g., Barakat, Alderfer, & Kazak,
2006), parental loss and institutional deprivation (Kilmer, Cal-
houn, Tedeschi, McAnulty, & Gil-Rivas, 2006), and a range of
potentially traumatic events (e.g., Alisic, van der Schoot, van
Ginkel, & Kleber, 2008; Ickovics et al., 2006; Milam, Ritt-Olson,
& Unger, 2004; Taku, Kilmer, Cann, Tedeschi, & Calhoun, 2011).
Indeed, sufficient research on PTG (and related constructs) in
children and adolescents has been conducted to justify a compre-
hensive, systematic review of the literature (Meyerson et al.,
2011), with recent additions since that review (Glad, Jensen, Holt,
& Ormhaug, 2013; Yablon, Itzhaky, & Pagorek-Eshel, XXXXXXXXXXThis
emerging literature provides the foundation for the present work,
laying needed groundwork for its applied emphasis and the rec-
ommendations put forth.
Hypothesized Key Elements of the
Posttraumatic Growth Process in Youth
Although the area is nascent in its development, theoretical and
conceptual writings related to PTG in children and adolescents
(e.g., Alisic, Boeije, Jongmans, & Kleber, 2011; Clay et al., 2009;
Kilmer, 2006; Kilmer & Gil-Rivas, 2010a) have drawn from the
larger trauma and adult PTG literatures (e.g., Calhoun & Tedeschi,
2006; Janoff-Bulman, 1992) to articulate the hypothesized growth
process. In many cases, trauma can shake a young person’s inter-
nal working model and basic assumptions about the world, influ-
encing and even altering central assumptions or core beliefs about
one’s self, others, one’s world, and the expected course of one’s
life (Cann et al., 2010; Janoff-Bulman, 1992; see Alisic et al., 2011
for an alternative view) and, in turn, stimulating attempts to cope
and adapt. As other authors have emphasized, growth is thought to
evolve as a result of this struggle with trauma and its aftermath, not
solely the experience of the trauma itself—that is, it is thought to
develop as one comes to grips with his or her new reality and
works to understand what has happened and its implications fo
life going forward (Calhoun & Tedeschi, XXXXXXXXXXIn fact, it is
thought that this continuing distress and efforts to reconcile one’s
posttrauma reality facilitate a constructive cognitive processing of
trauma, or what has been deemed productive rumination (Calhoun
& Tedeschi, 2006; Tedeschi, Calhoun, & Cann, 2007).
Through this deliberate and constructive ruminative process (see
Watkins, 2008), one may try to make sense of the event(s) and
integrate the trauma and its aftermath in a manner consistent with
prior internal representations, or working models. Subsequently,
this ruminative process is thought to yield schema change, which
consolidates changed perspectives on self, others, and one’s new
life and way of living (Calhoun & Tedeschi, 2006; Janoff-Bulman,
1992). Research suggests that the changes framed as PTG tend to
cohere in several main domains: a greater sense of one’s personal
strength; a different perspective on one’s relationships; a changed
philosophy of life, such as a greater appreciation for life and its
new possibilities; and spiritual growth (see Calhoun & Tedeschi,
2006; Kilmer, 2006 for descriptions).
The PTG Process: Some Caveats and
Developmental Considerations
Existing evidence suggests that, following trauma, the reactions
and responses of children and youth at different ages and stages
vary, in part because their cognitive and emotional capacities lead
them to understand and internalize the experience differently (Na-
tional Child Traumatic Stress Network [NCTSN], n.d.; Osofsky,
2004; see Kilmer & Gil-Rivas, 2010a for a detailed discussion). In
light of these realities, and because PTG appears to require the
cognitive capacity to allow both losses and gains to be recognized,
the extent to which the growth process in children accords with the
process observed among adults is unclear (Cryder et al., 2006;
Kilmer, XXXXXXXXXXRecent research, however, has uncovered some of
the key elements of this process, including some that appea
“active” for both youngsters and adults, such as ruminative pro-
cesses (Kilmer & Gil-Rivas, 2010a; Meyerson et al., 2011).
Nevertheless, it is imperative to acknowledge the variability in
children’s psychological mindedness or self-understanding and
awareness. That variation—and the fact that children’s internal
epresentations, basic assumptions, and working models are not
yet set—has implications for the degree to which a child has the
capacity to go through the process that yields PTG, and also points
to the potential role of caregivers and other important adults in the
child’s life in supporting the PTG process (Kilmer & Gil-Rivas,
2010a; Osofsky, 2004; Shahinfar & Fox, XXXXXXXXXXIndeed, a young-
ster’s response to trauma, understanding of what happened, and
coping repertoire will be influenced meaningfully by caregivers
(see below for a more detailed discussion)