Trauma can mean different things to different people. Children and adolescents may experience trauma from an event, repeated events, or set of circumstances that are physically or emotionally harmful. Traumatic stress has a negative impact on a child’s mental, social, or emotional well-being and can have lasting adverse effects.
The National Child Traumatic Stress Network (NCTSN) has identified 13 different kinds of traumatic stress children may be exposed to. Although this is not an exhaustive list of the types of events than can cause trauma to a child, it gives you an idea of the most common types of traumatic events. The trauma is determined by the child's experience and interpretation of the event or conditions.
A child can experience traumatic stress from community violence in various ways, and either be a victim, a witness, or the perpetrator of the trauma.
Community violence can be defined as exposure to intentional acts of interpersonal violence committed in public areas by individuals who are not intimately related to the victim. Common types of community violence that affect youth include individual and group conflicts (bullying, fights among gangs and other groups, shootings in public areas such as schools and communities, civil wars in foreign countries or “war-like” conditions in U.S. cities, spontaneous or terrorist attacks, etc.). Although there are warnings for some types of traumas, community violence can happen with a sudden and terrifying shock. Consequently, youth and families that suffer from community violence often experience increased fears and feelings that the world is unsafe and harm could come at any time. In addition, although some types of trauma are accidental, community violence is an intentional attempt to hurt one or more people, including homicides, sexual assaults, robberies, and weapons attacks (bats, knives, guns, etc.).
Click here for more NCTSN resources on community violence.
Consult an NCTSN reading list of research on community and school violence.
The term complex trauma describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development.
Typically, complex trauma exposure involves the simultaneous or sequential occurrence of child maltreatment—including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence—that is chronic, begins in early childhood, and occurs within the primary caregiving system. Exposure to these initial traumatic experiences—and the resulting emotional dysregulation and the loss of safety, direction, and the ability to detect or respond to danger cues—often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood.
Consult an NCTSN reading list of research on complex childhood trauma.
Domestic violence is sometimes called intimate partner violence, domestic abuse, or battering. It includes actual or threatened physical or sexual violence or emotional abuse between adults in an intimate relationship.
This clinical definition is broader than the legal definition, which may be restricted to acts of physical harm. Domestic violence can be directed toward a current or former spouse or partner, whether they are heterosexual or same-sex partners.
Anywhere from 3 to 10 million children are exposed to domestic violence in the United States every year. Studies suggest that the majority of children who are exposed to domestic violence are under the age of 8.
Consult an NCTSN reading list of research on domestic violence and childhood trauma.
Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. These traumas can be the result of intentional violence—such as child physical or sexual abuse, or domestic violence—or the result of natural disaster, accidents, or war. Young children also may experience traumatic stress in response to painful medical procedures or the sudden loss of a parent/caregiver.
A growing body of research has established that young children – even infants – may be affected by events that threaten their safety or the safety of their parents/caregivers. Their symptoms have been well documented. Young children are affected by traumatic events, even though they may not be able to verbalize their reactions to threatening or dangerous events.
Consult an NCTSN reading list of research on early childhood trauma.
Pediatric medical traumatic stress refers to reactions that children and their families may have to pain, injury, and serious illness; or to "invasive" medical procedures (such as surgery) or treatments (such as burn care) that are sometimes frightening. Reactions can affect the mind as well as the body.
For example, children and their families may become anxious, irritable, or on edge. They may have unwanted thoughts or nightmares about the illness, injury, or the hospital. Some people may avoid going to the doctor or the hospital, or lose interest in being with friends and family and in things they used to enjoy. As a result, they may not do well at school, work, or home. How children and families cope with these changes is related to the person's own thoughts and feelings about the illness, injury, or the hospital; reactions can and will vary, even within the same family.
Consult an NCTSN reading list of research on medical trauma.
Childhood traumatic grief may occur following a death of someone important to the child when the child perceives the experience as traumatic. The death may have been sudden and unexpected (e.g., through violence or an accident), or anticipated (e.g., illness or other natural causes).
The distinguishing feature of childhood traumatic grief is that the trauma symptoms interfere with the child's ability to go through the typical process of bereavement. The child experiences a combination of trauma and grief symptoms so severe that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, and/or memories of how the person died.
Consult an NCTSN reading list of research on childhood traumatic grief.
Child neglect occurs when a parent or caregiver does not give a child the care he or she needs according to its age, even though that adult can afford to give that care or is offered help to give that care. Neglect can mean not giving food, clothing, and shelter. It can mean that a parent or caregiver is not providing a child with medical or mental health treatment or not giving prescribed medicines the child needs.
Neglect can also mean neglecting the child's education. Keeping a child from school or from special education can be neglect. Neglect also includes exposing a child to dangerous environments. It can mean poor supervision for a child, including putting the child in the care of someone incapable of caring for children. It can also mean abandoning a child or expelling it from home. Neglect is the most common form of abuse reported to child welfare authorities.
Click here to read Child Neglect: A Guide for Prevention, Assessment and Intervention, a publication from the Office on Child Abuse and Neglect within the US Department of Health and Human Services.
Physical abuse means causing or attempting to cause physical pain or injury. It can result from punching, beating, kicking, burning, or harming a child in other ways. Sometimes, an injury occurs when a punishment is not appropriate for a child's age or condition. Physical abuse can consist of a single act or several acts. In extreme cases, it can result in death.
Physical abuse is the second most common form of child maltreatment.
Consult an NCTSN reading list of research on child physical abuse .
Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person or alternatively between a child and another child/adolescent. Behaviors that are sexually abusive often involve bodily contact, such as sexual kissing, touching, fondling of genitals, and intercourse. However, behaviors may be sexually abusive even if they do not involve contact, such as of genital exposure ("flashing"), verbal pressure for sex, and sexual exploitation for purposes of prostitution or pornography.
Consult an NCTSN reading list of research on child sexual abuse.
A natural disaster is any natural catastrophe (for example, tornadoes, hurricanes, and earthquakes) or any fire, flood, or explosion that causes enough damage that local, state, or federal agencies and disaster relief organizations are called into action. Disasters can result from a man-made event (such as a nuclear reactor explosion), but if the damage is caused intentionally, it is classified as an act of terrorism.
School violence includes fatal and nonfatal student or teacher victimization, threats to or injury of students, fights at school, and students carrying weapons to school. Formal definitions of school violence range from very narrow to very broad. The Center for the Prevention of School Violence, for example, defines it broadly as "any behavior that violates a school's educational mission or climate of respect or jeopardizes the intent of the school to be free of aggression against persons or property, drugs, weapons, disruptions, and disorder." Click here for more information on community violence.
Terrorism is defined in a variety of formal, legal ways, but the essential element is the intent to inflict psychological damage on an adversary. The US Department of Defense defines terrorism as "the calculated use of violence or the threat of violence to inculcate fear, intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological."
Terrorism includes attacks by individuals acting in isolation (for example, sniper attacks) as well as attacks by groups or people acting for groups.
Refugee and war zone trauma include exposure to war, political violence, or torture. Refugee trauma can be the result of living in a region affected by bombing, shooting, or looting, as well as forced displacement to a new home due to political reasons. Some young refugees have served as soldiers, guerrillas, or other combatants in their home countries, and their traumatic experiences may closely resemble those of combat veterans.
Consult an NCTSN reading list of research on refugee and war zone violence and childhood trauma.
The Centers for Disease Control and Prevention and Kaiser Permanente have been collaborating for several decades to conduct research on the impact of adverse childhood experiences, or ACEs, on a person’s life. To find out your ACE score, or to see how adverse childhood experiences may affect a child you know, take the 10-question test.
Children suffering from traumatic stress symptoms generally have difficulty regulating their behaviors and emotions. They may be clingy and fearful of new situations, easily frightened, difficult to console, and/or aggressive and impulsive. They may also have difficulty sleeping, lose recently acquired developmental skills, and show regression in functioning and behavior.
Generally these reactions fall into three main categories: cognitive, behavioral and physiological.
When you’re trying to offer help to a child who experienced a traumatic experience, it’s not always easy to know the right thing to do. Here are some steps you can take to support children by opening communication, and offering emotional support.
If a child’s response to trauma becomes worse, instead of improving over time, it may be time to seek a referral to a trained and qualified mental health professional.
Sources: National Child Traumatic Stress Network (www.nctsn.org), American Psychological Association
The Trauma Informed Care Clinical Group is a subcommittee of the COACT Colorado System of Care, an initiative funded by the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The initiative is housed within the Colorado Department of Human Services, Office of Behavioral Health, in partnership with the Office of Children, Youth and Families. The Trauma Informed Care Clinical Group is comprised of licensed mental health professionals with extensive experience serving at-risk children and families. The group provides free consultation to organizations serving children and families who have experienced trauma.
Listen to Dr. Jerry Yager, Clinical Psychologist, talk about what educators and counselors should know about traumatic stress in children.
As part of the State’s effort to support an ongoing development of a trauma-Informed, integrated system of care to improve mental health and child welfare outcomes, the clinical group, which meets the third Tuesday of every month, is offering the following services free of charge:
The Trauma Informed Care Clinical Group is led by Dr. Jerry Yager, a clinical psychologist with more than 25 years of experience in the assessment and treatment of traumatized children and adolescents. He specializes in working with adolescents who exhibit self-destructive behavior and have severe mental illness such as clinical depression, bipolar mood disorder, post-traumatic distress disorder, and psychosis. Jerry is currently the Director of Programs at the Denver Children’s Advocacy Center. Prior to this, Jerry was the Executive Director of the Denver Children's Home, which shares a mission with DCAC to provide high quality mental health care for low-income children whose problems would otherwise go undiagnosed and untreated.
For a mental health evaluation that includes a trauma assessment, you can refer a child to a local mental health provider in their community. If you need assistance finding a mental health provider, use the COACT Colorado Community Resource Directory. Be sure to mention your concerns about trauma when making the referral.
Call 1-844-493-8255 (1-844-493-TALK) to reach the statewide 24/7 hotline with trained crisis clinicians and peer support specialists. You can also contact the Denver Children's Advocacy Center at 303.825.3850 or the Kempe Center at 303.864.5300.
If you or someone you know needs immediate help, go to Get Help Now. For information on Trauma Informed Care training for your agency, please contact Ashley Brock-Baca, PhD at the Office of Behavioral Health.
Mental health providers: click here to register for access to a Google form to enter your trauma screening data. Contact Patty Montoya for assistance with Google forms at firstname.lastname@example.org.
Click here to see the slides from the webinar on the Title IV-E Waiver screening, assessment, and treatment.
Click here for the Title IV-E Waiver screening, assessment, and treatment flow chart.