Trauma-Informed Care is DYM Childcare!

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. Approximately 1 out of every 4 children in the United States have experienced at least one form of trauma, 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.

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 Virtual Lab School lessons in the Infant-Toddler track: Cognitive Development Lesson Three and Self and Cultural Understanding Lesson One.

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.

Infants and young toddlers - (birth-2 years)

• Tantrums that do not stop within a few minutes
• Inability to be soothed or comforted
• Easily startled
• Loss of skills (use of toilet or speech, for example)
• Aggression
• Sleeplessness
• Withdrawal from previously trusted adults
• Avoidance of eye contact or physical contact

 Older toddlers and preschoolers - (3-5 years)

•  Poor skills development
• Difficulty focusing
• Inability to trust others or make friends
• Stomachaches and headaches
• Unusual clinginess
• Bedwetting
• Sleeplessness
• Eating problems
• Lack of self-confidence
• Acting out in social situations

School-age children - (6-12 years)

•  School problems
• Suicidal thoughts or actions
• Imitating the traumatic event
• Verbal abuse toward others
• Overreaction to situations
• Fear of being separated from caregiver
• Stomachaches, headaches, other physical complaints
• Loneliness
• Lack of self-confidence
• Fear of adults who remind them of the trauma
• Sexual knowledge beyond the child’s age
• Hoarding of food

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.