This literature review examines the impact of trauma on children and their ability to show empathy. Empathy is defined as “an effective response that is more appropriate to or congruent with someone else’s situation than to one’s own situation” (Wilson & Ray, 2018, p. 400) whereas trauma is “an exposure to an extraordinary experience that presents a physical or psychological threat to oneself or others and generates a reaction of helplessness and fear” (Levenson, 2017, p. 105). Eighty to 97% of youth are exposed to trauma, and children who have been exposed to trauma can have unstable emotional regulation and externalize their behaviors, such as showing acts of aggression (Hall & Jones, 2018, p. 588). This topic is important because of the inherent vulnerability children experience from the exposure to trauma, which may result in children internalizing this aggression. In addition, if early intervention is absent, a lack of empathy toward others can remain throughout adolescent and adulthood (Wilson & Ray, 2018, p. 400). This literature review will explore whether children who have experienced trauma are more likely to be empathetic if acts of kindness are modeled by others in a supportive environment than children who have experienced trauma and do not have acts of kindness modeled by others.
Trauma primarily impacts a child’s ability to regulate emotion and behavior (Amendola & Oliver, 2013, p. 57). Youth exposed to trauma lack the interpersonal and social skills to recognize the expression of emotion and often display acts of aggression, mistrust, and impulsivity (Amendola & Oliver, 2013, p. 57). Emotional neglect stimulates hyperarousal in children which activates the fight-flight-freeze bodily response (Levenson, 2017, p. 107). This overproduction of neurochemicals can “destabilize emotional regulation, social attachment, impulse control, and cognitive processing” (Levenson, 2017, p. 107). When a child encounters stressors, they may cope through negative behaviors, such as aggression, due to this bodily instinct (Levenson, 2017, p. 107).
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Aggression is a natural human response, but children who show persistent aggression are at risk for behavior problems, such as poor interpersonal functioning and trouble forming and maintaining relationships. Toddlers represent the peak of physical aggressiveness, so early intervention is necessary to minimize a child’s aggressive behavior (Wilson & Ray, 2018, p. 401). Empathy and self-regulation are components of aggression that are directly related; when children display empathy through interpersonal processes, aggressive behavior decreases (Quas, J., Dickerson, Richard, Harron, & Quas, C., 2018). Hence, children who lack emotional regulation impulsively display aggression, and if not addressed during childhood, empathic and self-regulatory processes will be impaired (Quas et al., 2018).
Aggression Replacement Training (ART) was used to combat the impact of trauma on children through skill streaming, which incorporated the modeling of behavior to instill the skills being taught, role play to practice skills, and positive feedback when children displayed emotional control (Amendola & Oliver, 2013, p. 58). ART placed an emphasis on carry-over by people who were directly involved in the youth’s life, including staff or employers, who could understand and reinforce prosocial behavior. Participants showed an increase in interpersonal and social cognitive skills and a significant decrease in aggression scores (Amendola & Oliver, 2013, p. 60). These findings validate that aggression can be unlearned through prosocial modeling as being emotionally nurtured can refashion a child’s brain that has previously been exposed to trauma (Amendola & Oliver, 2013, p. 60).
Childhood is an important developmental stage for fostering empathy, as empathy is an effective response that results from comprehension of others emotional states (Taylor, Eisenberg, Spinrad, Eggum, Sulik, 2013, p. 822). Empathy is naturally linked to a child’s prosocial behavior, which is intentional behavior intended to benefit another (Taylor et al., 2013, p. 822). Empathetic children are more likely to act in prosocial ways, but prosocial behaviors depend upon socialization experiences and relationships in a child’s life (Taylor et al., 2013, p. 822). Environmental factors, such as the presence of supportive relationships, contribute to changes in empathy levels (Taylor et al., 2013, p. 823).
Children who are exposed to trauma often suffer from inconsistent parenting patterns, and this lack of a supportive role model results in disorganized attachment patterns, distorted cognitive schema, and emotional dysregulation (Quas et al., 2018). When caregivers are inconsistent in the lives of children and do not adequately model emotional regulation, children develop a heightened sensitivity to emotions and are unable to recognize emotional cues (Quas et al., 2018). A child’s well-being is largely influenced by the perception of social functioning in their environment; growing up in a highly stressful or traumatic environment has a severe impact on a child’s mental health by impairing functions (Scrimin, Osler, Pozzoli, Moscardino, 2018, p. 887). A study investigated whether trauma exposure in youth was associated with reduced empathy and deficits in emotion recognition, and concluded that youth who experienced chronic hardship show different patterns of emotion recognition such that it alters their level of empathic concern (Quas et al., 2018). Results showed that trauma exposed youth perceive more anger and less sadness in images, which aligns with the notion that youth in adverse environments have a heightened sensitivity to the perception of anger. This bias to anger can result in children having a reduced empathic concern for others due to a lack of emotional recognition (Quas et al., 2018).
Attachment theory explains that children must experience nurturing, consistent, and responsive interactions with supportive adults in order to develop secure attachments. Studies show that a warm, interested, and validating therapeutic environment facilitates supportive relationships (Levenson, 2017, p. 110). Adaptation by a child after exposure to trauma depends on the presence of protective factors to increase resiliency, such as a supportive family environment (Scrimin et al., 2018, p. 887). A study identified the presence of at least one caring adult, who is a constant and supportive presence in the child’s life, as a strong protective factor (Scrimin et al., 2018, p. 889). Findings showed a negative association between the number of family adversities and children’s physical/emotional wellbeing, whereas supportive resources provided by the family were positively associated with a child’s mental health. Thus, the presence of a caring support system is an important protective factor for child development and well-being; activities such as eating meals together, playing with, or listening to a child proved to be an emotional and psychological support and positively affects their emotional and social functioning (Scrimin et al., 2018, p. 889).
Specifically, youth in foster care who have histories of grief, loss, or trauma are predisposed to social and emotional impairments, as impermanence during childhood weakens the social functioning of youth and changes how they process information to regulate their emotions and behaviors (Hall & Jones, 2018, p. 590). However, caring relationships with supportive adults can overpower the damage of past trauma and grief. Youth in foster care often repress their feelings to protect themselves and need to learn how to express/regulate emotions; research shows that the presence of supportive adults in a child’s life improves mental well-being and decreases aggressive and violent behaviors (Hall & Jones, 2018, p. 594). This study implemented Intensive Permanence Services (IPS), a trauma-informed intervention model that engages family members and supportive adults who are important to the youth and willing to support them in their path to permanency (Hall & Jones, 2018, p. 592). Findings showed that consistency and transparency in supportive relationships helped rebuild trust in youth that had past relational trauma. Results also showed that the youth driven approach of IPS enhanced the youth’s socio-emotional development and growth while healing from trauma (Hall & Jones, 2018, p. 596).
Scientific research also establishes a link between children witnessing emotional expressions and then relaying those emotions. A study of 16 children analyzed the mirror neuron system (MNS), which plays an important role in social cognition as it provides a neural mechanism to understand the actions and emotions of others (Pfeifer, Iacoboni, Mazziotta, & Dapretto, 2013, p. 288). Specifically, this study examined the relationship between MNS activity and the development of empathy and interpersonal competence in children. Findings confirmed that the observation of emotional expressions stimulate activity in mirror neurons (Pfeifer et al., 2013, p. 290). Moreover, the neural mirroring of emotions by others enables children to display empathy consistent with those emotions. Overtly mirroring emotions displayed by others also leads to social functioning in children; social interactions sculpt the neurons so that children can replicate the emotions and behaviors of others (Pfeifer et al., 2013, p. 290). Hence, the neural damage caused by negative experiences during childhood can be reversed by neuroplasticity, which allows the brain to integrate new skills for emotional healing and cognitive development (Pfeifer et al., 2013, p. 290).
The development of social functioning early in life is an important consideration given the malleability of youth. Resolving early behavioral aggression in children subsequently helps the formation and maintaining of supportive relationships (Wilson & Ray, 2018, p. 400). A study that implemented Child- Centered Play Therapy (CCPT), an intervention that recognizes play as a child’s way to express themselves and uses this foundation to develop positive and empathic relationships focused on healing, recognized that a child’s externalized behaviors were an indication of internal struggle and emotions (Wilson & Ray, 2018, p. 401). Findings showed that children who were exposed to CCPT became less aggressive, more self-regulated and more empathetic (Wilson & Ray, 2018, p. 408). A supportive environment for children allowed them to convey empathy towards others; counselors in CCPT responded to acts of aggression with empathic understanding. Hence, the counselor’s empathetic responses and actions modeled to children increased their self-regulation and ability to display empathy. This concludes that a therapeutic and supportive relationship is a primary agent of change (Wilson & Ray, 2018, p. 408).
Attention and social functioning also directly affect self-regulation. A study implemented a 12-week mindfulness based Kindness Curriculum on social functioning, self-regulation and prosocial behavior at a public school with a sample of 68 preschool children (Flook, Goldberg, Pinger, Davidson, 2015, p. 46). The curriculum included mindfulness practice in order to cultivate attention and emotion regulation with an emphasis on kindness practices such as empathy, gratitude and sharing (Flook et al., 2015, p. 46). Findings showed that students who participated in the Kindness Curriculum improved social competence and acted less selfishly. Hence, mindfulness training promoted well-being and prosocial behavior in children (Flook et al., 2015, p. 49).
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Youth that are able to succeed after being exposed to a traumatic environment are described as resilient. Resilience is a “dynamic and interactive process between the individual and the environment in which the youth resides” (Richards et al., 2016, p. 1). Thus, prosocial organizations and supportive adults are environmental protective factors associated with resiliency. Resilience based intervention is a strengths based approach aimed to identify internal and external resources along with promotive and protective factors (Richards et al., 2016, p. 2). Findings showed that the resilience based intervention for children was successful in promoting positive development and socio-environmental relationships among peers and support systems (Richards et al., 2016, p. 3). A positive association was identified between a child’s empathy and parenting styles that were empathetic and supportive (Richards et al., 2016, p. 3). Moreover, promoting empathetic skills during childhood resulted in an increase of prosocial and kind behavior. These results recognized a child’s need for internal and external supports in order to develop resiliency and cope with past trauma (Richards et al., 2016, p. 4).
There is evidence in support of the stated hypothesis: children who have experienced trauma are more likely to be empathetic if acts of kindness are modeled by others in a supportive environment than children who have experienced trauma and do not have acts of kindness modeled by others. Trauma presents challenges with personal, interpersonal, and social-cognitive skills along with impulsive and aggressive emotions (Amendola & Oliver, 2013, p. 56). Children exposed to trauma have an increased possibility of experiencing social, emotional, and cognitive impairments throughout development and need external supports to demonstrate emotional regulation in order to learn empathetic behavior (Richards et al., 2016, p. 1).
A child’s ability to overcome trauma is determined by the presence of environmental protective factors. A strong relationship exists between supportive resources and children’s social functioning (Scrimin et al., 2018, p. 890). A supportive environment nurtures a child’s empathy related skills during childhood and improves emotional regulation (Taylor et al., 2013, p. 829). Additionally, evidence suggests that supportive relationships are therapeutic to a child with trauma exposure as it allows a child to self-regulate emotions (Flook et al., 2015, p. 44).
Evidence validates the important role that the mirror neuron system has in children understanding and replicating the emotions and behaviors of others (Pfeifer et al., 2013, p. 287). Moreover, the emotions that youth perceive in others is directly related to a child’s ability to feel empathic concern for others. This concludes that emotion recognition plays a major role in children displaying empathy (Quas et al., 2018). Evidence highlights the importance of establishing a safe environment for children where adults are aware of the damaging impact of trauma and prioritize the demonstration of empathy (Levenson, 2017, p. 109). Youth directly benefit from relationships with adults that possess the qualities of empathy and kindness (Hall & Jones, 2018, p. 596). Thus, treating children with compassion and respect is crucial for enabling change in their emotional functioning (Levenson, 2017, p. 109).
Further research is needed to assess whether youth exposed to other forms of adversity, such as chronic health problems or war exposure, influence emotion recognition and empathic concern similar to childhood impermanence. The relationship between a child’s resiliency and dispositional empathy is understudied, and research is needed about the growth of empathy in children and prosocial behavior in later childhood. Further research should also be done on how to strengthen emotion regulatory resources in a foster care setting.
- Amendola, A. M., & Oliver, R. W. (2013). Aggression replacement training and childhood trauma. Reclaiming Children & Youth, 22(2), 56–61. Retrieved from http://online.library.marist.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=afh&AN=89922678&site=ehost-live
- Flook, L., Goldberg, S., Pinger, L., & Davidson, R. (2015). Promoting prosocial behavior and self-regulatory skills in preschool children through a mindfulness-based kindness curriculum. Developmental Psychology, 51(1), 44-51. doi:http://dx.doi.org.online.library.marist.edu/10.1037/a0038256
- Hall, S., & Jones, A. (2018). Implementation of intensive permanence services: A trauma informed approach to preparing foster youth for supportive relationships. Child and Adolescent Social Work, 35(6), 587-598. doi: https://doi.org/10.1007/s10560-018-0550-8
- Levenson, J. (2017). Trauma-informed social work practice, Social Work, 62(2), 105-113. doi: https://doi.org/10.1093/sw/swx001
- Pfeifer, J., Iacoboni, M., Mazziotta, J., & Dapretto, M. (2013). Mirroring people: The science of empathy and how we connect with others. Partner Abuse, 4(2), 287-291. doi:http://dx.doi.org.online.library.marist.edu/10.1891/1946-65126.96.36.1997
- Quas, J. A., Dickerson, K. L., Richard, M., Harron, C., & Quas, C. M. (2017). Adversity, emotion recognition, and empathic concern in high-risk youth. PLOS One, 12(7), e0181606. doi:http://dx.doi.org.online.library.marist.edu/10.1371/journal.pone.0181606
- Richards, M., Lewis, G., Cornelli-Sanderson, R., Deane, K., & Quimby, D. (2016). Introduction to special issue: Resilience-based approaches to trauma intervention for children and adolescents. (2016). Journal of Child, 9(1), 1–4. doi: https://doi.org/10.1007/s40653-016-0081-4
- Scrimin, S., Osler, G., Pozzoli, T., & Moscardino, U. (2018). Early adversities, family support, and child well‐being: The moderating role of environmental sensitivity. Child: Care, Health, and Development., 44(6), 885–891. doi:https://doi.org/10.1111/cch.12596
- Taylor, Z. E., Eisenberg, N., Spinrad, T. L., Eggum, N. D., & Sulik, M. J. (2013). The relations of ego-resiliency and emotion socialization to the development of empathy and prosocial behavior across early childhood. Emotion, 13(5), 822-831. doi:http://dx.doi.org.online.library.marist.edu/10.1037/a0032894
- Wilson, B. J., & Ray, D. (2018). Child-centered play therapy: Aggression, empathy, and self-regulation. Journal of Counseling and Development, 96(4), 399- 409. doi: http://dx.doi.org.online.library.marist.edu/10.1002/jcad.12222
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