Survival as Intelligence: How Trauma Therapies Unlock Adaptability in Children with PTSD

Overview: We examine how redefining intelligence as one’s ability to adapt to change has significant implications for approach to educating future clinicians serving children with trauma histories. The paper destigmatizes trauma survival by offering a strengths-based definition of intelligence, and underscores implications for curricular and pedagogical approaches for MSW students.Proposal text: Background and Rationale: MSW coursework provides students with an entry point to understanding child biopsychosocial development, including intelligence and trauma. Intelligence has been studied for many years among adults but has only recently begun to be examined among children . Unlike past approaches and definitions, current research considers how intelligence is more developmentally dynamic and might be linked to the child’s social environment.
One possible experience that children might have in their social environment is surviving traumatic stress. Historically, researchers and clinicians have used instruments that measure the severity of impacts of traumatic stress on children, such as the Adverse Childhood Experiences (ACEs) scale and MSW students learn about it in many courses. While understanding these impacts can be helpful for conceptualizing treatment and study design, researchers and clinicians have begun shifting focus from this deficit framework toward helping children embrace their learned and epigenetic resiliency to traumatic stress.
Resiliency to traumatic stress among children is most often elicited in the context of the therapeutic process. Therapeutic modalities help children gain mastery over their sense of self after the traumatic event(s), regulate their emotions, and adapt more effectively in distressing and changing scenarios. Conversations about children becoming more adaptable and resilient to traumatic stress very rarely include the topic of intelligence. In fact, intelligence is most often identified as a challenge area regarding children with PTSD. This framework of intelligence within the scope of trauma survival has the potential add to the debilitating stigmatization that child trauma survivors already face. Current courses on development, trauma and pedagogical approaches to training future clinicians can be enhanced by introducing alternative and more strengths-based understanding of trauma responses and intelligence.

Methodology: We performed a systematic review of the literature around trauma therapies for children and adaptability using the Boston College Libraries, MEDLINE, and PubMed databases (n=55). Articles for our review sample were collected using a PRISMA flow chart model. Articles were excluded that 1) did not focus on children with PTSD, 2) did not address TF-CBT, DBT, or EMDR as a primary mode of treatment, and 3) did not measure adaptability as a treatment outcome (final n=16). We used inverse scoring of UCLA Child/Adolescent PTSD Reaction Index for DSM-5 (CAPRI) to measure adaptability among studies. We subjected our sample to statistical analyses using histograms for frequency measurement and a one-way ANOVA to measure variance of adaptability between groups. All analyses were performed using Microsoft Excel and SPSS.

Results: TF-CBT showed the greatest initial frequency of adaptability from CAPRI scores (n=22), while DBT presented the lowest initial frequency (n=5). There was also a statistically significant relationship between TF-CBT and adaptability promotion at n < 0.05.

Conclusions: TF-CBT appears to be the most effective at promoting adaptability to traumatic stress among children with PTSD. This study serves as a jumping off point for further discussion about to reconceptualize treatment for children with PTSD as well as intelligence within the matrix of development and traumatic stress. Implications for curriculum, training, and instruction introduced.