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Take a moment to think about a time that you have struggled when working with a child. Perhaps the child was irritable, wasn’t paying attention, or argued and fought with other children. Think about how a child that exhibits these behaviors can be labeled as a “difficult child” or a “bad kid” and how that label can influence the way they think or feel about themselves, their abilities, and how others view them.

As a caregiver, you play an important role in shaping a child’s initial experiences outside of the home environment. While it can be difficult to work with a child that exhibits challenging behaviors, it’s important to take a step back and consider other factors that may be contributing to the behaviors you experience in your settings. For more information about working with children that exhibit challenging behaviors, review the �Թ��� Focused Topics course, �Թ���ing Children with Challenging Behaviors.

Recently, you may have read about or heard the term “trauma-informed care” or “trauma-sensitive schools.” Trauma-informed care is especially relevant for individuals working with young children. The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) defines “trauma-informed care” as an approach that is grounded in understanding and responding to the impact of trauma in a way which focuses on the strengths of the survivor and prioritizes the physical, psychological, and emotional safety for all involved (2014).

Trauma-informed care seeks to help survivors of trauma feel safe and secure in their settings and to encourage and construct opportunities for survivors to rebuild a sense of control and empowerment in their lives. In order to incorporate a trauma-informed approach, it’s necessary to understand trauma and how survivors of trauma may process their experiences.

What is Trauma?

SAMHSA defines trauma as a single event, a series of events, or a set of circumstances that have a lasting and harmful effect on an individual’s functioning and overall well-being (2014). Approximately 1 out of every 4 children in the United States have experienced at least one form of trauma (NCTSN, 2008), which suggests that trauma is a common experience for young children. These statistics reveal that you will inevitably be working with children, families, or communities that have endured or are currently enduring trauma.

The following are just some of the possible traumatic experiences that young children may experience, according to the National Child Traumatic Stress Network: 

• Physical, sexual, psychological, or emotional abuse.
• Witnessing domestic violence in the home.
• Witnessing community violence.
• Experiencing a natural disaster.
• Traumatic grief (the sudden loss of a caregiver or loved one).
• Medical injury or illness.
• Experiencing a robbery or break-in.
• Experiencing chronic homelessness.
• Military-related stressors, such as parental deployment or injury.

We may think of trauma as affecting an individual child or family, however, it’s important to consider trauma that occurs on a community level. The Johns Hopkins Urban Health Institute says that whole communities endure trauma through experiences of oppression, racial discrimination, pervasive poverty, or neighborhood violence. Because trauma occurs at these various levels and in a multitude of environments, trauma-informed care is starting to appear in areas such as the criminal justice system, schools, and health-care settings (2013).

Another assumption we may have regarding trauma is that it occurs as a single, one-time event that a survivor has witnessed or experienced. However, trauma is complicated and can be experienced in several ways. Trauma can be acute, appearing as a single one-time event such as a home burglary or a serious car accident, or it can be chronic, occurring repetitively and over an extended period of time. Chronic trauma may include exposure to war, repetitively witnessing community violence, or extended displacement from a natural disaster.

Complex trauma adds an additional layer to traumatic experiences and is considered to be especially invasive and disruptive to a child’s development. Complex trauma consists of varied and multiple traumas and often stems from experiences with trusted caregivers in early childhood. Children that have been neglected, or emotionally, sexually, or physically abused may be dealing with complex trauma.

Complex trauma can be especially harmful for young children because it occurs within the caregiving system, or with the individual that is supposed to be a source of safety and stability in a child’s life. Complex trauma in early childhood can interfere with a child’s ability to form a secure attachment to a caregiver. Attachment theory suggests that children’s early experiences with their primary caregivers are critical and have a lasting impact on children’s lives (Bowlby, 1969). Children that struggle to form a positive secure attachment to their caregivers within the first few years of life due to complex trauma may have difficulties forming healthy intimate relationships or establishing and maintaining healthy boundaries in adulthood. For more information on attachment theory in early childhood, see these �Թ��� lessons in the Infant-Toddler track: Cognitive Development Lesson Three and Self and Cultural Understanding Lesson One.

Trauma in Families

Trauma can occur on a variety of levels and is experienced by individuals, families, and entire communities. There is a wide-range of potential traumatic situations or experiences that some families endure. For example, parental divorce, incarceration of a family member, or the diagnosis of a terminal illness all have the potential to be traumatic experiences for families. Another pervasive traumatic experience that some families may be faced with is homelessness, with an estimated 1.3 million children experiencing homelessness at a given time in the United States. Chronic homelessness can be traumatic for young children and place them at risk for encountering other traumatic experiences, and it can adversely affect their development. For more information about how homelessness specifically can impact the children and families that you work with, review the References & Resources section at the end of this lesson. Consider Britney’s story:

Remember, families are incredibly resilient and can serve as a significant source of support for one another when experiencing trauma. Keep in mind that trauma can occur on various levels, and is experienced not only by individual children but may also affect families or communities as well.

Symptoms of Trauma

Each child uniquely experiences and processes trauma. Because there is no standard or expected way in which children process traumatic experiences, there is a wide range of cognitive, social, emotional, or physical symptoms that a child may or may not demonstrate.

To understand the range of symptoms that children may exhibit following exposure to trauma, it’s necessary to consider the developmental stage of the child. Children develop at an astounding rate during the first years of their lives, each with unique challenges and important developmental milestones. Some symptoms of trauma can affect children of all ages without regard to developmental stages. Examples include major changes in eating or sleeping, nightmares, anger or rage, unreasonable fear, or unusually strong startle reactions. Other symptoms may be tied to certain developmental stages.

The following list identifies common symptoms that children may exhibit following exposure to trauma, broken down by developmental stage. It’s important to note that not all children exposed to trauma will experience these symptoms and several of the symptoms listed can be part of typical development or unrelated to trauma. When considering the symptoms that survivors of trauma may experience, it’s important to consider the severity of the symptoms and the impact these symptoms can have on the everyday lives of children and their families.

Source: Mental Health Connection of Tarrant County, Texas.

While there is a range of symptoms that children may exhibit as a result of trauma, the most common symptoms that program staff see displayed by children are: clinginess, anxiety, irritability, impulsivity, difficulty concentrating, aggression and challenging behavior. Exposure to trauma can manifest itself as challenging behaviors that are overwhelming and frustrating to staff members. It is important for you to remember that children use behavior as a form of communication, and they may be expressing difficult or challenging behavior as a result of the trauma that they have experienced. Understanding the impact that trauma can have on children’s development and behavior is critical so that you can be sensitive and responsive to their needs. For more information on understanding and responding to challenging behavior, see the �Թ��� Focused Topics Courses: �Թ���ing Children with Challenging Behavior and Sexual Development & Behavior in Children and Youth.

Traumatic Stress

When we encounter a stressful situation, our bodies react to protect us from the perceived threat; you may have heard this referred to as the “fight or flight” reaction. It’s normal for our bodies to increase heart rate, begin to sweat, or become hyper-alert following a situation we believe to be dangerous. These immediate physiological reactions return to normal once we feel that the danger has passed. However, some children that have experienced trauma can have longer-lasting reactions that interfere with their daily lives and their physical and emotional development (NTCSN, 2003).

Children that have endured trauma are at an increased risk of developing childhood traumatic stress. The National Child Traumatic Stress Network describes traumatic stress as a response to trauma that significantly interferes with a child’s ability to function and complete daily activities. Children with traumatic stress may experience significant symptoms, such as intense emotional upset, depression or anxiety, severe behavioral changes, attention difficulties, and problems with eating or sleeping.

The pain associated with trauma can persist for years. Reminders of the trauma, such as persons, places, objects, smells, or anniversaries, may bring forth difficult or intense emotions associated with the trauma and can be expected to some extent. For example, an adult that experienced early childhood trauma by witnessing domestic violence in the home may experience intense anxiety when they are reminded of the past traumatic event in some way (e.g., adults yelling at one another or seeing an individual get hit).

While trauma can be a life-altering experience, not all children develop traumatic stress that interferes with their daily lives. In fact, there are several factors that can influence the severity of symptoms that children may experience. The National Child Traumatic Stress Network outlines several factors that may affect the way a survivor may process or experience the trauma.

While there are several factors that may increase a child’s risk for developing traumatic stress symptoms, there are also various protective factors that serve to encourage healthy coping and buffer against developing harmful and lasting symptoms associated with trauma. Some important protective factors within the family or community that can help promote resilience or healing in children that have survived trauma include a strong cultural identity, stable housing, economic stability, access to health care, affiliation with a supportive faith community, and connections to family and friends, according to the Futures Without Violence organization. Consider the protective factors for Maria and her family:

As a caretaker and educator, you play an important role in helping children develop resilience to better protect them from experiencing any harmful symptoms associated with exposure to trauma. By using trauma-informed care in your setting, you can help a child feel safe, build trust, and have voice and choice in your room, all of which support healthy coping and promote resilience following exposure to trauma.

Assessing Trauma: The ACE Study

One prominent study that has explored the far-reaching impact of exposure to trauma during childhood is The Adverse Childhood Experiences Study (ACE). The ACE study is one of the most expansive investigations to date and explores the connection between adversity in childhood and later-life health and well-being (Centers for Disease Control and Prevention, 2016). In 1995, the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente collected data from over 17,000 individuals in California. The participants of this study were asked to complete surveys about their childhood experiences as well as their current health statuses. Findings from this study suggest that adverse childhood experiences are common—nearly 2/3 of participants reported at least one ACE and more than 1 in 5 participants reported enduring three or more ACEs during childhood (CDC, 2016). A recent study also reported that children with special emotional, behavioral, or developmental health care needs are more likely to experience two or more ACEs (National Academies of Sciences, Engineering, and Medicine, 2019).

Although not a complete list of every ACE a child may experience, the adverse childhood experiences identified in the ACE study include the following examples of traumatic events:

• Physical abuse
• Sexual abuse
• Emotional abuse
• Physical neglect
• Emotional neglect
• Witnessing intimate partner violence
• Witnessing your mother being treated in a violent way
• Substance misuse within the household
• Household mental illness
• Parental separation or divorce
• Incarcerated household member

The Effects of ACEs Throughout the Lifespan

Findings from the ACE study suggest that the more adverse childhood experiences an individual endures, the higher their risk for health and social issues in adulthood. When children have ACEs it can create changes and outcomes including:

• Disrupted Neurodevelopment

  When children experience extreme stress from trauma without supportive relationships to buffer the effect, it alters how the brain develops. Stress causes the body to release more cortisol, a hormone that when elevated is associated with health issues.

• Social Emotional and Cognitive Impairments

  The parts of the brain that control decision-making, impulse control, and processing of emotions may develop differently in children who have experienced trauma. These children may need more help developing relationships with others and may require specialized strategies or more help and time to learn new skills.

• Adoption of Health Risk Behaviors

  People with a higher number of ACEs may be more prone to adopting health risk behaviors such as drug and alcohol abuse, physical inactivity, smoking, and unprotected sex.

• Disease, Disability, and Social Problems

  ACEs are also associated with more health and social issues including heart disease, cancer, depression, unintended pregnancy, and poor academic achievement.

• Early Death

  The number of ACEs a person has is associated with their age expectancy. This means people with a higher number of ACEs die younger when compared to people with less ACEs.

After learning about Laci’s story, it’s important to remember that although adverse childhood experiences can have significant effects on one’s life, strong relationships are an important protective factor. Children are resilient and although some may experience significant ACEs, family and community supports can help children better cope with these experiences and disrupt an otherwise negative trajectory. In the next lesson, you will learn more about the role you and your program play in supporting children and youth through adverse experiences to promote resilience.

See

Listen as experts on trauma-informed care discuss trauma and its effects on children and youth, adverse childhood experiences, and the importance of building resilience through relationships. Are there children and youth in your program who have experienced trauma? How does your program support the development of resilience?

Do

Completing this Course

Visit the Trauma-Informed Care Course Guide for more information on what to expect in this course, and a list of the accompanying Learn, Explore, and Apply resources and activities offered throughout the lessons. 

Please note the References & Resources section at the end of each lesson outlines reference sources and resources to find additional information on the topics covered. As you complete lessons, you are not expected to review all the online references available. However, you are welcome to explore the resources further if you have interest, or at the request of your trainer, coach, or administrator.