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My stepson has experienced trauma and now he's acting out. Is it from the trauma, or something else?

Answered by Erika Rooney, PsyD

Q My stepson has been through some traumatic events, and I don't know how to tell if he is struggling with those or if he has some other disorder. He is currently home schooled because of a couple situations that happened in school. One including knocking everything off the principal’s desk and barricading himself in a classroom. He gets angry so quick and to the extreme over just about anything and especially when he feels like he is being singled out, picked on or embarrassed. This breaks my heart because he is a good kid with a big heart. I have mentioned to his dad and other family members my concern and they want to chalk it up to how rough he has had it. But is that the entire issue? Does he just need love and patience and understanding? Please help me decide if I should insist that he be tested for mental health problems or therapy or just continue to work with him, reassuring him that he is safe and loved.

It can be difficult for parents to know the best course of action to take when they see their child struggling, and differing opinions within the family can further muddy the waters. The behaviors and emotional distress you describe are in fact concerning and seem to be escalating, so I’m glad you are reaching out for some help. Without knowing more details it’s hard to provide specific guidance, so here is what I’d like you to know.  

Post-traumatic stress disorder is a complex range of symptoms that are the aftereffects of either a singular traumatic event or chronic exposure to something traumatic. A traumatic event might be real or perceived threats of harm/death, neglect, or frightening periods of separation from caregivers. Some of the emotionally reactive, defensive behaviors you describe could be a sign of hypervigilance and impulsivity, two of many symptoms that comprise a post-traumatic stress disorder diagnosis. But they could also be signs of something else.

Whether your stepson’s current behaviors are due to trauma exposure or a combination of other factors, it’s clear that he is in fact struggling with significant emotional distress in multiple areas — particularly school and family, which are two primary areas of his life. This means professional intervention is important. While having family members who understand that past trauma exposure can affect one’s life later on can be supportive, we want to be careful not to explain his distress away just by knowing his history. You can help other family members know that understanding his past experiences is a good first step in a multi-step process for supporting him.

Because your stepson is showing signs of significant distress and there is a history of trauma exposure, my advice would be to pursue a comprehensive psychiatric evaluation. An evaluation will collect information from multiple sources to help tease all of these concerns apart in the context of his developmental history and provide a diagnosis. That information will then inform an evidence-based treatment plan that would be most effective to target his specific needs.

Whether the outcome is trauma-related or not, there are great evidence-based cognitive-behavioral treatments for children that teach kids effective coping skills to manage emotional reactivity to help them feel more in control and improve their overall functioning. These treatments will frequently involve caregivers, to help kids learn to use these skills in everyday life. Providing the love, patience and understanding you describe above is always important and will be a strong a foundation for supporting him throughout treatment — and beyond.