Understanding Child Trauma Exposure
By Kylie Evans
Chelsea* was a quiet 6-year-old when she arrived at the shelter with her mom, Sheila*. A police officer brought them to the shelter after an incident between Sheila and Chelsea’s dad, which left Sheila with bruised ribs and a gash across her forehead. I first met with Chelsea in the small attic playroom that doubled as an office I shared with another case manager. Sitting on the floor together as we played, Chelsea was silent, keeping her tattered stuffed bunny tucked tightly under her arm. She was understandably disinterested in small talk, and unresponsive to my inquiry about whether she felt like talking about what happened last night. Eventually, she stood up without a word, sat down at our snack table and laid her head down on her arms. At that moment, she spoke a thousand words, without saying anything at all.
Children are exposed to traumatic events with alarming frequency in the U.S., placing them at increased risk for a variety of challenges in social-emotional, behavioral, physical and cognitive functioning. Helping this group of vulnerable young people is not a job reserved only for mental health practitioners or social workers. Rather, supporting trauma-exposed youth on their path to healing is the responsibility of all child-serving professionals and volunteers. Children faced with experiences like Chelsea’s can be found sitting in classrooms, after-school programs, Scout meetings, worship services and everywhere in between. This article provides a starting point for those who work with children, offering a brief overview of key information on traumatic exposure and resources for further reading on the topic.
What is child trauma exposure?
Decades ago, our understanding of trauma was limited to acute incidents such as sexual assault or war combat. Today, research has brought us to understand trauma as a much broader scope of experiences, including anything that a child perceives as a dangerous threat to their life and safety, or to the life and safety of someone they love. Examples include:
Physical, emotional, and/or sexual abuse or neglect
Witness to family violence (e.g., observe violence between parents, siblings, etc.)
School violence (e.g., direct victimization or witness)
Community and neighborhood violence exposure
Sudden or violent death of a loved one
Natural disaster
Life-threatening illness or injury
Historical and intergenerational trauma
What factors influence how a child will respond to traumatic exposure?
Numerous factors impact how a child reacts to traumatic experiences—two children from the same family can have vastly different responses to the same incident. Thorough assessment of traumatic exposure will account for how the individual circumstances of each child influence their risks, protective assets and path to healing.
Relationship to perpetrator: The closer a child’s relationship is to the perpetrator of trauma, the more significant the betrayal of trust and safety. For this reason, interpersonal trauma, particularly those that are prolonged--such as chronic abuse-- pose the most significant risks to children.
The developmental age of exposure: Prolonged traumatic exposure in early childhood can shape a child’s rapidly-developing neuro-archaeology. Between birth and age three, the brain is rapidly organizing key regulatory functions related to emotion regulation, attention and impulsivity. Chronic activation of a child’s stress response system can disrupt this process, resulting in lasting impacts on a child’s self-regulatory capacities that can persist into adulthood if untreated.
Duration and chronicity: Children exposed to prolonged traumatic experiences are at higher risk for social-emotional, behavioral, and physical consequences, as compared to children who experience single incident traumas.
Relational health: Children’s connection to a robust network of attuned, supportive, and caring adults have been identified as one of the most powerful predictors of child well-being in the aftermath of trauma. Consistent adults who are compassionately invested in a child can serve as a protective buffer from the effects of trauma, significantly enhancing children’s path to healing.
Previous victimization experiences: Experiencing a traumatic incident increases a child’s risk of subsequent traumatic victimizations. For example, adolescents exposed to violence at home have an increased likelihood of dating violence victimization.
Individual and family factors: Gender, cultural background, systematic oppression, and the presence of other traumatic stressors in the household (e.g., economic insecurity, unstable housing, caregiver mental illness, etc.) can impact a child’s response to trauma exposure.
What types of traumatic reactions are commonly seen in the aftermath of child trauma exposure?
For many years it was assumed that traumatic reactions fit neatly under the label of “post-traumatic stress disorder (PTSD).” While this certainly does apply in some cases, we now know that children’s reactions to trauma can expand far beyond the scope of traditional diagnostic criteria for PTSD, and often vary significantly based on a child’s age developmental stage. This is particularly true in cases of complex trauma, when a child experiences prolonged exposure to interpersonal trauma, such as chronic abuse or neglect. Researchers collaborating with the National Traumatic Stress Network have identified seven domains of child functioning that can be impacted by complex traumatic exposure:
Attachment: Ability to develop healthy, supportive relationships with others
Physical: Somatic complaints (headache, gastrointestinal issues)
Emotion regulation: depressed and/or anxious feelings, difficulty managing “big” feelings (e.g., anger, fear)
Behavior regulation: Aggression, destructive, violent behavior, developmentally inappropriate self-soothing (e.g., head-banging, excessive rocking)
Self-concept: Low self-esteem, feelings of guilt or shame
Cognition: Poor attention span, difficulty staying on task, inability to focus and complete work
Dissociation: Appears to daydream or “zone out” for extended periods of time
What can I do next?
Be a consistent, caring and supportive adult in the lives of young people you work with! Prioritize safety, and refer families to trauma-informed resources and professionals for additional support. Consult community and county-based online resource directories to learn about helping agencies in your community, including the Ohio United Way’s 211 network. Consider deepening your knowledge on this topic even further. The list below is a sampling of educational resources that can help you learn more about child trauma exposure:
National Child Traumatic Stress Network (NCTSN): Offers numerous webinars, online courses, printable resources, and more.
SAMHSA’s National Child Traumatic Stress Initiative: Resources on evidence-based practices for treating traumatic stress, practitioner training, and educational resources for caregivers and practitioners.
Further reading on child trauma exposure:
The Boy Who Was Raised as a Dog by Bruce Perry
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk
The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris
Trauma & Recovery by Judith Herman
Born for Love by Bruce Perry
*Names have been changed to protect client confidentiality.
References
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., & van der Kolk (2017). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398.
Gerrity, E., & Folcarelli, C. (2008). Child traumatic stress: What every policymaker should know. Retrieved from National Child Traumatic Stress Network website: http://www. nctsn. org/nctsn_assets/pdfs/PolicyGuide_CTS2008. pdf.
Greeson, J. K., Briggs, E. C., Layne, C. M., Belcher, H. M., Ostrowski, S. A., Kim, S., Lee, R.C., Vivrette, R.L., Pynoos, R.S., & Fairbank, J. A. (2014). Traumatic childhood experiences in the 21st century: Broadening and building on the ACE studies with data from the National Child Traumatic Stress
Hambrick, E. P., Brawner, T. W., Perry, B. D., Brandt, K., Hofmeister, C., & Collins, J. O. (2019). Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children. Archives of Psychiatric Nursing, 33(3), 238-247.
Price, M., Higa-McMillan, C., Kim, S., & Frueh, B. C. (2013). Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity. Journal of Anxiety Disorders, 27(7), 652-660.
Turner, H. A., Shattuck, A., Finkelhor, D., & Hamby, S. (2016). Polyvictimization and youth violence exposure across contexts. Journal of Adolescent Health, 58(2), 208-214.
Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38(3), 323-330.
van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics, 12(2), 293-317.
