Summary: Pynoos RS. "Traumatic stress and developmental psychopathology in children and adolescents," in Oldham JM, Riba MB, and Tasman A, American Psychiatric Press Review of Psychiatry vol 12: 205-238. Washington, DC, American Psychiatric Press. 1993.

Traumatic events and their aftermath have a profound impact on children's development in many and complex ways. This review considers that impact in the following areas: the trauma itself; traumatic reminders, later stresses, resistance, resilience, and vulnerability; adjustment; later development; and future stress-related psychological problems.

For example, traumatic reminders-the scar of an injury inflicted, the anniversary of a brother's suicide, even the presence in the home of a formerly abusive parent-are a source of ongoing stress for the traumatized child. They can increase the child's sense of helplessness, shame, anger, and sadness. Resilience and adjustment refer to the child's ongoing efforts to manage the consequences of the trauma. Here, the active involvement of therapists and parents in helping the child gain an understanding of the traumatic event is important to foster recovery. At the same time, caregivers need to avoid unrealistic expectations about how quickly recovery can occur. Trauma and its aftermath can affect the child's sense of self and his or her relationship with peers and family members. The child may turn anger inward, feel isolated, or act aggressively toward others. Later, the experience of a youthful trauma can shape reactions to future adversities and influence the course of sexual identity and behavior in adulthood.

While the course of reactions to trauma is complex, each of the factors described in this article represent opportunities for treatment and for prevention of further harm. The support provided to children by their families, schools, and mental health professionals can serve to arm traumatized children with the tools to deal with the adversities they have been forced to encounter.