About Child Trauma
Expertise in complex trauma in children
Introduction to Child Trauma
Childhood should be a time of growth and exploration, but for some, it is marred by traumatic events. Child trauma occurs when young individuals (0-18 years) experience or witness events that threaten their or others’ safety, such as accidents, natural disasters, violence, or significant loss. These experiences can lead to overwhelming distress, a sense of helplessness, and profound emotional impact, affecting their development and well-being.
Key Concepts in Child Trauma
A traumatic event encompasses any situation that is frightening, dangerous, or violent, posing an immediate threat to an individual or someone close to them. Such events can lead to significant injury or harm, triggering intense emotional reactions including fear, loss, or distress. Individuals might experience these profound emotions due to the direct impact of the event or from feeling powerless to prevent the harm from occurring. The aftermath of experiencing a traumatic event can profoundly affect a person’s daily life, potentially leading to possible changes in mental, physical, social, emotional, and spiritual health.
The list below illustrates some potentially traumatic events. This is a non-exhaustive list.
- Physical, sexual, or psychological abuse and neglect
- (including trafficking)
- Natural and technological disasters
- Family or community violence
- Terrorism, mass violence, and school shootings
- Discrimination, prejudice, and racism
- Sudden or violent loss of a loved one
- Substance use disorder (personal or familial)
- Traumatic separation (including as part of an immigration journey or incarceration)
- Refugee and war experiences (including torture)
- Serious accidents or life-threatening illness
- Military family-related stressors (e.g., deployment, parental loss or injury)
While many of the examples listed above may be more easily thought of or identified as traumatic, other events might be less obvious when considering the potential for traumatic impact. It’s important to recognize that what constitutes a traumatic event can vary widely. Not all experiences deemed traumatic for one individual will be perceived the same by another.
For example, many families might need to relocate due to job changes, financial hardship, or military involvement. While these are fairly common occurrences for some families, they could have a lasting traumatic impact. It is also important to remember that all youth in foster care, independent of why they might have entered foster care, have experienced changes in caregivers and living situations, and it is important to take into consideration how these events may have made an impact. This variance highlights the subjective nature of trauma, emphasizing that an event not listed as traditionally traumatic may still have a profound, distressing impact on an individual.
If you are a parent or caregiver, check out the NCTSN’s Resources for Parents and Caregivers webpage. Additionally, for more detailed descriptions of different traumatic events, click check out the NCTSN’s Definitions of Different Trauma Types document.
Another term that you may hear a clinician use when referring to difficult or scary experiences is Adverse Childhood Experiences or ACEs. The ACE study is an ongoing research study that explores the relationship between childhood trauma experience and long-term medical health and social consequences. Results show that approximately 65% of children experience at least 1 adverse event during their childhood and that nearly 40% of children experience at least 2 or more ACEs. This study further has repeatedly found that the greater number of ACEs a child has been exposed to, the greater their risk for developing physical and mental health challenges throughout their lifespan (e.g. heart and lung disease, alcoholism, risk for intimate partner violence, drug use, poor academic or work performance, depression, and suicide). ACEs include many traumatic experiences, but are broader in nature. The original ACEs study included the following 10 adverse childhood experiences:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Mother treated violently
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
Since the original study, the list has expanded to include additional types of adverse experiences. For more information about ACEs, please visit acestudy.org.
If a child exhibits reactions that significantly affect their daily life following a traumatic event, these behaviors are known as child traumatic stress. Such reactions can manifest in various ways, including noticeable changes in behavior (e.g., increased irritability, withdrawal, or regressing to behaviors typical of a younger age), difficulties in interacting with others, alterations in sleeping or eating habits, or declining school performance. The National Child Traumatic Stress Network (NCTSN) explains that child traumatic stress arises when children and adolescents exposed to one or more traumatic events or situations over the course of their lives that exceed their coping abilities.
These stress symptoms typically emerge involuntarily, as your child grapples with negative emotions, such as fear, triggered by memories of the traumatic event. Symptoms may appear immediately following the event or develop over time, and they can persist for days, weeks, or even months afterward. In some cases, symptoms may reemerge at various points throughout a young person’s life. It’s important to note that some children are more prone to experiencing traumatic stress reactions than others.
Understanding and defining trauma can be aided by the “Three E’s of Trauma,” a concept developed by the Substance Abuse and Mental Health Administration (SAMHSA). These “Three E’s” are: Event, Experience, and Effect.
Event
The “Event” constitutes any occurrence of threat or actual harm that your child might experience once or multiple times. Examples of such events include abuse, neglect, the death of a loved one, or bullying.
Pause and Reflect: Has an event of this nature occurred in the life of a child you know or care for?
Experience
The “Experience” relates to how your child personally perceives and processes the event. It’s crucial to recognize that what is overwhelming or frightening for one child may not be the same for another. This stage is about understanding your child’s individual response to the event, which could involve feelings of shame, isolation, betrayal, or fear.
Pause and Reflect: How might the child feel about what happened? Are they experiencing any specific emotions as a result? How does this event potentially alter their view of themselves, others, or the world?
Effect
The “Effect” looks at the consequent impact of the event and experience on your child, which can be either short-term or long-term and may appear immediately or develop over time. This impact can lead to changes in social or family relationships, sleep patterns, eating habits, mood, and can cause difficulties in thinking, concentration, and expressing emotions.
Pause and Reflect: In what ways has the child’s behavior, mood, or relationships changed since the event? Are there any noticeable changes that might indicate they are struggling?
For more information on the Three E’s of Trauma, click HERE.
When a child experiences traumatic stress, their behavior may change in ways that are unusual or not typical for them. These reactions can persist for days, weeks, or even months after the traumatic event and may even begin weeks or months following the incident. It’s important to understand that such reactions are normal responses to having endured an overwhelming life experience.
The signs and symptoms of traumatic stress can vary widely among children and may differ depending on the child’s age. To assist family members in recognizing these symptoms, a diagram is available that outlines traumatic stress symptoms by age group. This diagram is recreated based on information from the “Understanding Trauma” webpage on the National Child Traumatic Stress Network (NCTSN)’s Resources for Parents and Caregivers.
Children who are exposed to traumatic events may experience a wide variety of consequences that can include intense and ongoing emotional distress and behavioral problems, difficulties with attention, academic failure, problems with sleep, or illness. For some children, these reactions interfere with daily life and their ability to function and interact The cost of these problems is felt not only in human terms across generations, but also in dollars and cents. As an example, the Centers for Disease Control and Prevention recently reported that the total lifetime estimated cost associated with just one year of confirmed cases of child maltreatment alone is approximately $124 billion. with others. These reactions sometimes develop into serious mental illnesses, including posttraumatic stress disorder (PTSD), anxiety, and depression. Exposure to traumatic experiences can also worsen preexisting mental health problems and disrupt children’s ability to form positive relationships and handle emotions and behavior.
Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (e.g., smoking, eating disorders, substance use, and high-risk activities). Research shows that child trauma survivors can be more likely to have long term health problems (e.g., diabetes and heart disease) or to die at an earlier age. Traumatic stress can also lead to increased use of health and mental health services and increased involvement with the child welfare and juvenile justice systems. Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships, and maintaining employment.
Untreated child traumatic stress can also contribute to many of the most pressing problems that individuals, families, and communities face, including poverty, crime, low academic achievement, addiction, mental health problems, and poor health outcomes.
Fortunately, there are evidence-based treatments and services that are highly effective for child traumatic stress. However, many children and families face barriers in receiving appropriate mental health care. Improving access to effective evidence-based treatments for children who experience traumatic stress can reduce suffering and decrease the costs of health care.
If you’ve observed a child who has experienced a traumatic event, or if you’ve noticed any concerning symptoms or behaviors, remember, seeking help can be a positive step forward. For more information on care and support available for children, adolescents, and families impacted by trauma, please explore the “Seeking Professional Help for Trauma” fact sheet.
Some material and content were adapted with permission from the National Center for Child Traumatic Stress, NCTSN Complex Trauma Collaborative Group. (2020). Complex Trauma. National Center for Child Traumatic Stress. https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma
