Many children in Grant County suffer from post-traumatic stress disorder due to maltreatment, according to Brett Boswinkle, a mental health counselor and clinical administrator at Family Service Society Inc.
The problem is statewide. Child Protective Services receives 108.2 referrals for every 1,000 children in Indiana, compared to the national average of 55.1 referrals, according to the Child Maltreatment 2016 survey, published in February. Only Vermont and the District of Columbia have higher rates.
Any traumatic event a child goes through can cause PTSD, Boswinkle said. PTSD can affect mood, inhibits a child's ability to learn, form social connections and attacks their very basic sense of safety, he added.
"In our practice a lot of the things we're encountering are physical abuse, sexual abuse and child neglect," Boswinkle said.
"One bad thing in Grant County right now is the opioid epidemic and other drugs," he added. "Parents living that type of lifestyle can cause harm."
Another culprit is sex abuse that has been occuring within some families for decades, he continued.
PTSD affects every domain of a child's life. Symptoms often mimic anxiety disorders, attention deficit hyperactivity disorder and depression among other manifestations according to Boswinkle.
"One of the terrible things about PTSD is it attacks a person's very basic sense of safety, if (their PTSD is) really severe or complex they can't feel any sense of safety," he said.
Without a sense of safety, children may be easily triggered by events around them because they are unable to determine if something is a threat, he added.
Traumatic symptoms also affect a child's ability to learn in the classroom.
“(The challenge with trauma is) leaving baggage and trauma behind,” said Isaac McClung, a social worker at Frances Slocum Elementary.
“We use multiple strategies, but breathing is the most important thing one can learn, not just breathing, but breathing properly,” McClung added.
Breathing exercises help students to be present in the moment, so they focus less on their traumatic experiences, he said.
McClung also uses meditation, stretching and visualization practices to help a child's brain adapt and overcome traumatic symptoms, he said.
Numerous studies, such as the Centers for Disease Control and Prevention's ACEs study, show that children who go through a traumatic event often suffer a negative effect in the brain. These damaged areas of the brain do not develop at normal rates, Boswinkle said.
PTSD manifestations can last well into adulthood, too. The ACEs study discovered children who experience trauma are more likely to abuse substances, become sexually active at a younger age, resulting in higher rates of STDs and teen pregnancies, and contributes to higher rates of heart disease and cancer.
Common PTSD symptoms include bruising, showing fear in situations where a child had not before, becoming withdrawn or clingy when the child had not been before, experiencing flashbacks or nightmares and harboring intrusive thoughts, Boswinkle said.
"If you're not really doing an investigation into what that child's experience is, you may be missing something that's trauma related and not something (considered) classical ADHD," he added.
While reducing or removing a child's traumatic symptoms can often be a complex process, there is one treatment in particular showing promise, according to Ryan Davis, a mental health counselor at Family Services Inc.
Much of Davis's work is devoted to helping children persevere over traumatic conditions. Davis has been working with eye movement desensitization and reprocessing therapy, known as EMDR, since the spring of 2017.
EMDR therapy takes an average of six to nine sessions. At the end of these appointments, Davis said, children often return back to their pre-trauma state with no lingering symptoms.
"In general, EMDR uses fewer sessions (compared to other therapies) and needs less follow-up, if at all," he said.
EMDR targets the brain’s central nervous system. Davis has the patient recount their traumatic experience while a machine generates rapid eye movements over the center of the patient's central nervous system.
These eye movements last for roughly 30 seconds and help the brain process the data from the traumatic event, Davis said.
But EMDR is not magic, he added. The treatments are generally meant for those who have only experienced one traumatic event.
In the case that a child has been subject to multiple traumatic incidents, every therapist has a grab bag of therapies to help children, Davis said, such as cognitive behavior therapy and play therapy.
"A good competent therapist can make a good assessment on what type of counseling services might be needed," Boswinkle said.
While the numbers for child maltreatment across the state are exceptionally high, this may be because systems like Family Services, the Indiana Department of Child Services and law enforcement have improved in detecting child abuse, Boswinkle said.