Childhood trauma comes in many different forms. Child trauma may represent a single acute event, like a motor vehicle accident, and/or more ongoing chronic forms of complex trauma.
This page focuses on Complex trauma.
Complex trauma is described as arising from interpersonal experiences that often involve betrayal, and are repetitive or prolonged. Averse childhood experiences that are associated with Complex Trauma include childhood abuse, neglect and family dysfunction. Abuse includes sexual, physical and verbal and/or emotional abuse. Family dysfunction may include exposure to parental or family alcohol or drug abuse, mental illness in family members or domestic violence.
The National Child Traumatic Stress Network defines complex trauma "as exposure to multiple traumatic events that occur within the family and community systems.
These might include maltreatment or bullying by a peer or sibling, or harsh aggressive punishment by a parent or caregiver, or ongoing domestic or sexual violence. Other family stressors, like alcoholism or mental illness in a parent, or various forms of ongoing abuse (sexual, psychological/emotional and physical), are also examples of Complex Trauma.
So too are neglect or abandonment by primary caregivers and others in positions of trust, or traumatic losses in those relationships.
As many as 50 % of children will experience some from of trauma before their 18th birthday. Yet few of these children will receive psychological services to address their trauma symptoms. The psychological needs of these children remain largely unrecognized. Few are likely to receive the trauma based psychological assessments that are needed to determine the extent of the child's trauma symptoms, and appropriate treatment options.
Childhood trauma symptoms, whatever the cause, comprise a range of behavioral, social and emotional concerns that are often associated with Post Traumatic Stress Disorder (PTSD).
However, trauma has long been recognized as a risk factor for a range of other psychological disorders.
One trauma expert who has explored the effects of child abuse noted that when psychiatrists and psychologists see these children as young adults “they may come up with all kinds of diagnoses, when in fact what they’re simply doing is clumping together some of the outcomes from the pervasive early trauma.”
Children who suffer from complex trauma and/or chronic relationship stress , often show various psychological problems and concerns. They may be diagnosed with a range of disorders, such as depression, anxiety or ADHD, and various other impulse control or executive function issues.
Some in the trauma field have suggested that a more precise diagnosis for children with complex trauma histories is needed. They have conceptualized a new diagnosis, provisionally called “Developmental Trauma Disorder.” This proposed diagnosis is organized around issues of triggered dysregulation in response to trauma reminders/memories, stimulus generalization to internal and/external symptoms that may in some way, however minor, trigger a trauma reminder, and the anticipatory organization of behavior to prevent the occurrence of the feared trauma impact.
Those who have proposed this new diagnosis report that children who have experienced multiple exposures to interpersonal trauma such as abandonment, neglect, abuse and so on, show affects in various domains of functioning. These include:
· Intense affects such as rage, betrayal, fear, resignation, defeat and shame.
· Efforts to ward off the recurrence of those emotions by avoiding experiences that trigger them, or engaging in behaviors that help the child develop a sense of control when they perceive a potential threat.
stress disorder (PTSD) is not the most common psychiatric diagnosis in children
with histories of chronic trauma. The most common diagnoses in order of
frequency are separation anxiety disorder, oppositional defiant disorder,
phobic disorders, PTSD and ADHD. Traumatized children show problems with
unmodulated aggression, impulse control, attention and dissociative problems
and difficulty negotiating relationships with caregivers and peers.
Children who have endured relationship
trauma may behaviorally re-enact trauma either in acting out or aggressive
behaviors, or in frozen avoidance reactions. They may deal with feelings of
helplessness through defiant and/or compliant behaviors.
These children can show persistent sensitivity to reminders of various trauma experiences that can interfere with the development of emotional regulation and causes long-term problems with the ability to regulate emotions. These children often show high levels of physiological arousal, which is manifested on multiple levels: emotional, physical, behavioral, cognitive and relational. They have fearful, enraged or avoidant emotional reactions to minor stimuli that would have no significant impact on secure children. When these children feel stressed and aroused they experience difficulty restoring homeostasis and returning to a more calm and stable state. Self-insight and understanding about the origins of their reactions apparently has little effect.
In addition to conditioned physiological and emotional responses to trauma reminders, these children may also develop a worldview that incorporates their betrayal and hurt. They may anticipate and expect that the trauma will reoccur and/or mistakenly perceive that it has, and respond with hyperactivity, aggression, defeat or freeze responses and/or avoidant behaviors to minor stresses.
Trauma triggers, or reminders of the trauma may also affect their cognition, and they may show confusion, dissociation, and disorientation when faced with stressful stimuli. They easily misinterpret events in the direction of a return of the trauma, and the helplessness they felt around it. This causes them to be constantly on guard, frightened and over-reactive. They organize their relations around the trauma, and the expectation or prevention of further abandonment or victimization. This can be expressed in excessive clinging, compliance, oppositional defiance and distrustful behavior and they may be preoccupied with retribution and revenge.
The presentation of childhood trauma symptoms varies across individuals.
Some children, for example, may show largely fear based or anxious
behaviors. Other children may show depressive states or negative
perceptions or verbalizations. Still others will show high levels of
arousal and reactive externalizing behaviors, such as aggressive and
angry behaviors, and sudden and extreme emotional outbursts.
In addition, traumatic triggers or reminders in maltreated children are interpersonal in nature (e.g., the tone of a voice, the look on a face, what the child may mistakenly perceive as rejection or criticism). As a result children who suffer from complex trauma are likely to experience significant difficulty at school, where social interactions with teachers and peers are almost constant. Such social cues may trigger PTSD or trauma symptoms of hypervigilance, and problems with emotional and behavioral regulation.
Dr. O'Connor offers trauma based psychological assessments. Children who suffer from childhood trauma are likely to benefit from a trauma based psychological assessment to determine the nature and extent of the child's trauma related symptoms, and their impact on her functioning at home, at school and in the community.
A full trauma based assessment combines elements of both a clinical and/or school neuropsycological assessment. This is often needed when the child is showing symptoms of childhood trauma.
To learn about Dr. O'Connor's psychological assessments, including her trauma based assessments for children and adolescents, click here.
Dr. O'Connor's trauma based psychological assessments lead to evidence based treatment strategies to address the child's trauma symptoms.
Learn more about Post Traumatic Stress Disorder and its association with mental health disorders, like substance abuse. This is a problem that plagues millions of families, and the children and adolescents who are growing up in them.Resources Used in this Report
· Children’s Aid Society (Nippissing and Perry Sound) (2014). The brain behind the behavior (workshop presentation).
· Van der Kolk: Developmental trauma disorder. Psychiatric Annuals, May 2005.