Recognizing and Treating Childhood Trauma

Childhood trauma is an unfortunate reality for many young people around the world. It harms their brains, bodies, and hearts and ripples out into communities, causing too many people to live in a constant state of stress.But trauma can be treated, and people who have experienced it can and do survive and thrive.

How does childhood trauma present itself? And how can that inform our practices as behavioral health professionals?

Understanding Trauma

In the Connecticut Women’s Consortium training, “The Long Reach of Childhood Trauma,” our executive director Colette Anderson, LCSW, explores a topic that is near and dear to our hearts. 

Trauma is caused by an event or by the extreme stress of an event or circumstances that overwhelms a person’s ability to cope. Trauma threatens people’s physical or emotional health, and it can manifest in violence, hate crimes, sexual abuse, or anything that causes extreme stress.

It has an unequal impact on low-income people of color who live in under-resourced neighborhoods; racism and discrimination are forms of trauma.

How do we know if someone has experienced trauma? One of the most common tools that behavioral health professionals use to assess whether someone has experienced trauma is called the adverse childhood experience (ACE) study.

What Are the ACEs?

• Physical, sexual, or verbal abuse
• Physical or emotional neglect
• Witnessing your mother being abused
• Losing a parent
• Having a family member who is
  • depressed or diagnosed with another mental illness
  • addicted to alcohol or another substance
  • incarcerated

This long-term study shows us that more than half of adults in the US report having experienced at least one traumatic event, and many have experienced years of trauma. 

How Common Is Childhood Trauma?

Sadly, trauma often begins in childhood. According to the Centers for Disease Control (CDC), 61% of people report experiencing at least one type of ACE before age 18, with 1 in 6 experiencing four or more types of ACEs.

Our society has an unacceptable amount of childhood trauma. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that by the age of 16, more than two-thirds of children have experienced at least one traumatic event. For example,

• One in 7 children experience child abuse or neglect.
• Every day, more than 1,000 young people are treated in emergency rooms for injuries related to physical assaults.
• One in 5 high school students report being bullied at school.
• Every single day, 14 young people are murdered.

Trauma Affects the Brain

Our brains are the nerve centers of our bodies, and trauma has a number of negative effects on the human brain. 

• A reduced hippocampus diminishes our ability to tell the difference between the past and the present, affecting our interpretation of context.
• An overactive amygdala keeps us in a state of high alert, perceiving threats everywhere. People have a hard time knowing what is safe and what isn’t because stress reactions take over.
• We can experience flashbacks or intrusive memories of the traumatic event.

One important key for therapists is to recognize the difference between positive stress and toxic stress. “The reality is that we all need a certain amount of stress, a certain amount of anxiety to perform well.... But if all day, you feel like a truck is coming at you, day after day after day, that's gonna take a toll on the body," we learn in this clip from the documentary Resilience: The Biology of Stress & The Science of Hope.

How can behavioral health professionals learn to recognize and treat childhood trauma?

Symptoms of Childhood Trauma

Depending on the age of the child, the signs of trauma differ. 

• Preschool-aged children might cry or scream more often than their peers, have separation anxiety, have trouble eating, or have nightmares.
• Elementary school children could be anxious or afraid, express guilt or shame, or have trouble concentrating or sleeping.
• Middle and high school children might be depressed, develop eating disorders or self-harming behaviors, abuse substances, or engage in risky sexual behavior.

Effects of Childhood Trauma

When children experience a traumatic event, they learn adaptations to respond to situations that don’t feel safe. Children who have experienced abuse or neglect may have difficulty forming healthy attachments to caregivers. They may have trouble expressing or regulating their emotions. Brain development is affected by trauma, and children can have physical issues related to trauma like stomach issues or headaches. 

Sometimes children with trauma histories experience dissociation, where they feel like they are separated from their own bodies, watching themselves. Maybe this looks like daydreaming or inattentiveness, but it is another way that the brain and body react to the toxic stress.

Treating Childhood Trauma

There are many approaches to treating childhood trauma. Trauma-informed treatment incorporates knowledge of trauma while treating substance use disorder, mental health disorders, or other challenges that are related to a person’s trauma history.

Trauma-specific treatment is just as its name implies: It is specifically designed to address trauma.

It is critical for behavioral health professionals to establish safety for clients and to take their needs into account when choosing an appropriate treatment avenue. Some trauma survivors benefit from group therapy, while others do better in individual therapy sessions. 

Resources and Approaches

Treatment options for children and adolescents include some of the following approaches:

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
• Attachment, Self-Regulation, and Competence (ARC)
• Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
• Attachment and Biobehavioral Catch Up (ABC)
• DBT Skills Training for Emotional Problem Solving for Adolescents (CBT STEPS-A)
• Child First (home-based intervention for prenatal to age 5)
• Voices (Stephanie Covington)
• Miss Kendra Program
• Girls Circle/The Council for Boys & Young Men

The National Child Traumatic Stress Network provides excellent resources for recognizing and treating various types of trauma, including bullying, community violence, intimate partner violence, sexual abuse, and more. 

The Connecticut Women’s Consortium offers many trainings in trauma-informed practices. “The Long Reach of Childhood Trauma: Using the ACE Study to Inform Practice” provides an overview of adverse childhood experiences and the ways they can inform behavioral health practice. 

When we gain a fuller understanding of the ways that trauma begins in childhood and repeats itself in adulthood, we can provide better care for the children, youth, and adults who are growing up in the grip of trauma.