Q

My daughter is 11 years old. She has been having a lot of meltdowns recently, and I’m worried that there might be something going on at school that is upsetting her emotionally. I’ve asked her, but she says that nothing is bothering her. Should I send her to a therapist who might be able to dig deeper and get to the root of her issue?

A

Let’s examine the three main assumptions behind your question before we answer it. The first is that emotional distress leads to disturbed behavior, and thus disturbed behavior is caused by emotional distress. The second is that therapists, through artful “digging,” can get to the root cause of a child’s disturbed behavior. The third is that getting to the root cause of disturbed behavior will lead to improvement in the child’s behavior.

Where do these assumptions come from? One source is the trauma literature. We know that when a child has been traumatized, defensive and protective brain processes take over automatically to reduce overwhelming psychic pain. These processes can include avoidance mechanisms such as numbing (forgetting, self-harming), distracting (drug usage, overeating, compulsive activities like excessive studying, developing pain syndromes, etc.), attaching (becoming clingy, dependent, or overly pleasing), and “fighting” processes such as becoming argumentative, combative, aggressive, and otherwise emotionally dysregulated.

Because traumatized children may not consciously understand what has happened to them, therapists can use techniques to help strengthen and stabilize them to the point where it’s possible to recall and talk about overwhelming events. Trauma-based therapies form a good foundation for making progress, along with other specific interventions that directly target addictive, impulsive, compulsive, self-harming, and other destructive behaviors. Targeted interventions for each of these “dysfunctions” are necessary because the dysfunctions don’t automatically disappear just because the child has emotionally processed the trauma. For instance, if overeating was a trauma-related protective “dysfunction” following abuse, obesity doesn’t automatically diminish once the abuse has been healed. Rather, dietary changes will also be necessary. Similarly, acquired patterns of emotional dysregulation will still need their own treatment even after traumatic material has been resolved.

But — and this is a big “but” — it’s important to understand that trauma-related “acting out” is a very rare phenomenon. It’s the least likely explanation for a child’s tantrums. It does occur, but only rarely, just as most headaches are due to stress or food sensitivities, rather than due to brain tumors. All of the common reasons for tantrums should be explored before sending a child for therapy to see if there is something “deeper” causing the emotional dysregulation. Only when the common culprits have been explored and addressed with appropriate but ineffective interventions, would you want to consider other, “deeper” causes.