Child Trauma

“A child’s history isn’t only in the past. It affects the present and the future.”
—Gregory Keck & Regina Kupecky

What Is Child Trauma?

All children experience stressful and upsetting events from time to time. Usually they recover fairly quickly, especially if a parent or other trusted adult is available to help them calm down and feel safe.   By contrast, traumatic experiences in childhood have a much greater impact than ordinary stressful events, putting a child at risk of serious mental health problems. Trauma can disrupt the child’s developmental momentum and compromise the safety and security of the child-parent relationship.

A traumatic stressor is an unpredictable and uncontrollable event that threatens the physical or psychological integrity of the child.  In the moment of trauma, a baby or child experiences overwhelming fear, horror, or helplessness far beyond their developmental capacity to manage. Trauma also causes intense, automatic physiological responses such as a surge of stress hormones, increased heart rate, rapid breathing, dizziness, and trembling.  These overwhelming psychological and physical reactions occur whether the child experiences trauma directly (as in abuse, abandonment, or neglect) or indirectly (as a witness to violence, war, or natural disaster).

Complex trauma in early childhood—also known as developmental trauma—describes the experience of “multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature” caused by the actions or inactions of adults responsible for the child’s care and protection (see Bessel van der Kolk, MD). Domestic violence is a common cause of complex trauma, as is chronic abuse, abandonment, neglect, and institutional care.

Chronic neglect doesn’t have to be intentional to cause complex traumatic stress.  Most orphanage caregivers, for example, mean well, but staffing and training constraints limit their ability to respond to babies’ physical and emotional needs. Day after day, being left for hours in a wet, dirty diaper, experiencing hunger pains and lack of response to crying can feel life threatening to an infant.

Not all children respond to the same experience in the same way. Age and stage of development can make a difference, as can the child’s innate resilience, the availability of adults to soothe and protect, past experiences of safety or danger, and what happens to the child after the trauma.  While some children may bounce back and resume normal development, others may face a host of long-term challenges. They may find it difficult to trust other people, feel safe, understand and manage emotions, adjust to changes and transitions, or physically and emotionally adapt to stress.

Traumatized children show a wide range of stress reactions. They may have sleep problems or difficulty concentrating. They may be jumpy and hypervigilant, always watching out for possible danger. Distressing memories, dreams, sensations, or emotional states may make them feel as if past trauma were happening again right now. They may avoid people and places that remind them of the trauma, withdraw from social interactions, or feel numb or shut down.  They may overreact to benign events that they misperceive as threatening. These reactions in turn can lead to difficult, confusing, and sometimes alarming behaviors, such as aggression, dissociation, lying, stealing, and destructive or self-destructive actions.

Can Therapy Help?

Fortunately there are effective treatments for childhood trauma, such as the Attachment, Self-Regulation & Competency (ARC) framework, Child-Parent Psychotherapy, Dyadic Developmental Psychotherapy, EMDR, Sensorimotor Psychotherapy, and Trauma-Focused Cognitive-Behavioral Therapy.  When trauma  contributes to insecure attachment, I usually recommend family or child-parent therapy.  When individual child therapy for trauma is indicated, it usually works best when supplemented with parent-child and family sessions. For very young children,  at least one parent must participate in every session.

I work collaboratively with parents to:

  • Establish treatment goals and create an individualized treatment plan.
  • Provide guidance in expectations and strategies to help their children thrive.
  • Treat the mental health issues stemming from childhood trauma.
  • Enhance family relationships and family functioning.
  • Connect with teachers and other professionals as needed to support the whole child and family.

Would My Child Benefit from Treatment for Complex Trauma?

If your child has a history of trauma—even if only in infancy—and you recognize a number of the following symptoms that are not typical for the child’s age, your child may be struggling with the after-effects of complex trauma.

Attachment

  • Uncertainty about the reliability and predictability of the world
  • Distrust and suspiciousness
  • Avoiding comfort and affection from parents
  • Seeking comfort and affection from strangers
  • Social isolation
  • Interpersonal difficulties
  • Difficulty attuning to other people’s emotional states
  • Fear of intimacy

Biology

  • Sensorimotor developmental problems
  • Hypersensitivity to physical contact
  • Insensibility to pain
  • Problems with coordination, balance, body tone
  • Accident prone
  • Abnormal eating patterns
  • Expressing anxiety through physical symptoms without medical cause
  • Increased medical problems

Affect Regulation

  • Difficulty with emotional self-regulation
  • Difficulty describing feelings and internal experience
  • Difficulty communicating wishes and desires
  • Self-soothing when distressed while avoiding or dismissing comfort from parents
  • Difficulty self-soothing when the parent is not there (past age 3)

Behavioral Regulation

  • Poor impulse control
  • Self-destructive behavior
  • Aggression against others
  • Superficially charming
  • Little eye contact with parents unless angry
  • Sleep disturbances
  • Eating disorders
  • Alcohol or drug abuse
  • Excessive compliance (“too good”)
  • Excessive attempts to control interactions
  • Overly demanding and clingy
  • Excessive oppositional behavior
  • Difficulty understanding and complying with rules
  • Lying about the obvious
  • Stealing
  • Cruelty to animals
  • Preoccupation with fire

Cognition

  • Difficulties in attention and executive functioning
  • Lack of sustained curiosity
  • Problems processing new information
  • Problems focusing on and completing tasks
  • Difficulty planning and anticipating
  • Problems understanding their own contribution to what happens to them
  • Learning difficulties
  • Problems with language development
  • Problems with orientation in time and space
  • Acoustic and visual perceptual problems
  • Impaired comprehension of complex visual-spatial patterns

Self-Concept

  • Lack of a continuous, predictable sense of self
  • Poor sense of separateness
  • Disturbances of body image
  • Low self-esteem
  • Shame and guilt

List adapted from the National Child Traumatic Stress Network (NCTSN), Complex Trauma in Children and Adolescents, White Paper from the NCTSN Complex Trauma Task Force.