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    Objectives
    • Learn to identify various traumatic experiences.
    • Understand the symptoms a child may exhibit following exposure to trauma.
    • Consider the long-term impact of adverse childhood experiences across an individual’s lifespan.

    Learn

    Learn

    Know

    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 Virtual Lab School Focused Topics course, Supporting 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 Virtual Lab School 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:

    Britney is a 6-year-old child in your program. She lives with her mother, father, and 18-month-old brother. Britney’s family has struggled with finances over the years and have been in and out of homelessness. Typically, Britney’s family rotates from home to home, staying with friends of the family for a week or two at a time. Occasionally, Britney’s family has to resort to living out of their car for several days or weeks until they can find a place to stay.

    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.

    Symptoms of Childhood Trauma Across Developmental Stages

    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

    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 VLS Focused Topics Courses: Supporting 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.

    Severity of the eventHow serious was the event? How badly was the child or someone they love hurt? Did anyone go to the hospital? Were police involved? Was the child separated from a caregiver? Did a family member die?
    Proximity to the eventWas the child actually at the place where the event occurred? Did they see the event happen to someone or were they a victim? Did they watch the event on TV? Did they hear someone talk about the event?
    Caregivers’ reactionsDid the family believe the child was telling the truth? How did caregivers respond to the child’s needs, how did they cope with the event themselves?
    Prior history of traumaChildren repetitively exposed to trauma are more likely to develop traumatic stress reactions.
    Family and community factorsCulture, race, and ethnicity of children, their families and communities can be a protective factor.

    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: 

    Maria, one of the children in your care, recently lost her mother to cancer. While this experience was clearly a traumatic experience for Maria, her close-knit family and community came together to help support her and encourage healthy coping. Maria’s neighbors and members from her faith community showed their support by assisting the family with immediate needs. Maria’s father created a safe environment for Maria to express her feelings and even signed the family up for counseling services. Maria’s father has communicated with you so that you are aware of the situation at home.

    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).

    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.

    Laci's Story

    Take a few moments to read about Laci’s adverse childhood experiences in early childhood and the effect these experiences had on her development and behaviors later in life. The figure below outlines how Laci’s ACEs affected her neurodevelopment, social emotional and cognitive development, adopted health risk behaviors, social problems, and early death. Remember, although a child may have experienced several ACEs, it doesn’t necessarily mean that they will follow the same trajectory.

    • Age 3:

      When Laci was 3-years-old, her father began physically and sexually abusing her on a regular basis; this abuse lasted for several years throughout her childhood. Laci also frequently saw her father physically and emotionally abuse her mother. Her father struggled with alcoholism for as long as she could recall, and her mother began drinking heavily as well. 

    • Age 5:

      The trauma and the chronic stress Laci experienced during early childhood affected the development of her brain. When Laci was in preschool, her teachers noted that she was more impulsive than typical and had difficulty learning to interact with peers. She also needed more time and help to learn self-help skills such as toilet training. Laci was identified as a student with a disability and entered kindergarten with an Individualized Education Program (IEP).

    • Age 13:

      Over the years, Laci grew to become unhappy at school; she found learning in that environment difficult and would skip school altogether at least once a week. In class, Laci had trouble connecting with her peers. Often, they found it difficult to work with her because she would get upset over small things and yell at her classmates, threaten to hurt them, and sometimes start physical fights in the classroom. At this time, Laci's father was arrested and was incarcerated for the remainder of her teen years.

    • Age 16:

      In high school, Laci adopted several unhealthy behaviors. She began smoking cigarettes and marijuana on a daily basis. By the end of 10th grade, she ventured into harder drugs such as cocaine, and she regularly engaged in unprotected sex.

    • Age 29:

      In adulthood, Laci had difficulty maintaining close relationships and employment. People seemed to float in and out of her life, and she was never able to keep a job for very long. By the time she was in her late 20s, Laci developed an addiction to heroin and experienced several near fatal overdoses. Laci often felt lonely, as she didn’t have any close significant connections with family or friends.

    • Age 31:

      At age 31, Laci overdosed on heroin, which took her life.

    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?

    An Introduction to Trauma-Informed Care

    An expert discusses how trauma may affect the behavior of children and youth and the tenets of trauma-informed care.

    Adverse Childhood Experiences and Traumatic Life Events

    An expert describes the ACE study and how adverse childhood experiences affect later health and social outcomes.

    Building Resilience Through Relationships

    An expert describes how nurturing relationships are a protective factor for children affected by trauma.

    Do

    CAPPD is an acronym developed by the Multiplying Connections Initiative that provides useful information for caregivers working with children who have survived trauma. The letters in CAPPD call for caregivers to be calm, attuned, present, predictable — and don’t let the child’s emotions escalate your own. Read through each of the elements of CAPPD below and refer to the Learn attachment for examples of caregivers using the CAPPD steps. 

    Calm: Regulating your emotions and returning to a calm state after being alarmed or shocked can be beneficial for you and the children you care for. Think about the healthy approaches you use to regulate your emotions and try to exhibit those behaviors in your environment.

    Attuned: Be attuned to children’s body language and nonverbal behaviors. These nonverbal indicators can help you determine how a child may be feeling or how they may be affected by the current activities or overall environment. Consider signals that may alert you to a child being uncomfortable or anxious in your environment. Also, consider what nonverbal behaviors you would see if a child were comfortable or engaged in your lesson.

    Present: Focus your attention on the children and the present moment. Showing children that you are engaged and present in the environment can be comforting and helpful in forming secure relationships. Consider what makes you feel like someone is listening to you and is present with you?

    Predictable: Provide children with a structured routine so that they can feel a sense of safety and stability. When children feel safe, they can focus on other cognitive tasks. Think about some of the routines you have in your room and how they provide stability to the children you work with.

    Don’t: Don’t let children’s emotions escalate your own emotions. When children become emotionally escalated, be aware of how you are experiencing the situation and if your reaction is calming or further escalating. Think about the last time that you felt frustrated when working with a child: How can you practice remaining calm and deescalating an emotional situation?

    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.

    Explore

    Explore

    What experiences in your childhood have made you who you are today? Have you encountered adverse childhood experiences? If so, how have you coped with these experiences? As a caregiver, it can be helpful to explore your own background and think critically about how your experiences may affect the way you relate to the children you work with. Review the What's My ACE Score? handout. Take a few minutes to familiarize yourself with the questionnaire, if you feel comfortable, you can respond to the questions and calculate your ACE score. This handout involves sensitive topics and it is up to your discretion whether you share. If, after completing this unit, you would like to speak to someone about your own experiences with trauma, speak with your coach, trainer, or administrator to identify counseling resources accessible in your area.

    Apply

    Apply

    Exposure to trauma can affect the way a child behaves in your program. Challenging behaviors such as resistance, disrespect, or negative attention-seeking may be related to a child’s attempt to cope with trauma. Review the Recognizing Trauma worksheet. Take a few minutes to read and respond to these questions. Then, share and discuss your responses with a trainer, coach, or administrator.

    Glossary

    TermDescription
    Acute TraumaA single traumatic event (e.g., burglary, natural disaster, house fire)
    Adverse Childhood Experiences(ACEs) A traumatic experience in an individual’s life that occurred before the age of 18 years of age.
    Attachment Theory A theory of early childhood development created by John Bowlby, which states that an infant's early attachment and bonding with a primary caregiver is important for forming healthy intimate bonds in adulthood.
    Chronic TraumaTrauma that occurs repetitively, or more than once (e.g., domestic violence, exposure to war).
    Complex Trauma Multiple or varied traumas that occur during early childhood and involves primary caregivers (e.g., sexual abuse, physical abuse, neglect).
    Protective FactorConditions or attributes in individuals, families, or communities that promote health and well-being.
    Trauma-Informed CareAn approach that is grounded in an understanding and responsiveness to the impact of trauma that is strengths-based and prioritizes the physical, psychological, and emotional safety for survivors of trauma as well as caretakers.
    Traumatic Stress When exposure to trauma results in a child’s inability to function normally. The child may feel intense symptoms related to their trauma exposure (e.g., depression, anxiety, behavioral changes).

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Select which factor is likely to impact the way a survivor may process or experience trauma:

    Q2

    An important finding of the Adverse Childhood Experiences (ACE) study is that...

    Q3

    During a staff break, new teacher, Werner, tells fellow teacher, Javier, about a challenging day in his class with a new 2-year-old student. Werner says, “I can just tell Ronnie is going to be trouble. He won’t let the other kids get near him, and he won’t look me in the eye when I speak to him.” Javier, who is well-informed about trauma-informed care would be most likely to reply:

    References & Resources

    Bowlby, J. (1969). Attachment and Loss: Vol 1. Loss. New York: Basic Books.

    Centers for Disease Control and Prevention. (2016). About the CDC-Kaiser ACE Study. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/about.html

    Center on the Developing Child. (2020). A guide to toxic stress. Harvard University. Retrieved from https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/

    Child Savers. (2019). Trauma. Retrieved from: https://childsavers.org/trauma/

    ChildTrauma Academy. (n.d.). Retrieved from https://www.childtrauma.org/

    Child Welfare Information Gateway. (2015). Promoting Protective Factors for Victims of Child Abuse and Neglect: A Guide for Practitioners. Retrieved from https://www.childwelfare.gov/pubs/factsheets/victimscan/

    Missouri Association for Infant and Early Childhood Mental Health. (n.d.). Resources http://www.moaimh-ec.org/resources

    Johns Hopkins Urban Health Institute. (2015). Healing Together: Community-Level Trauma: It’s causes consequences, and solutions. In Brief 1: Introduction to “Trauma-Informed” Care: Important Components and Key Resources (2015). Retrieved from http://urbanhealth.jhu.edu/SDH_Symposium/2015.html

    Mental Health Connection of Tarrant County (Texas). (n.d.). Symptoms of Trauma. Retrieved from http://www.recognizetrauma.org/symptoms.php

    Merrill, S. (2020, September 11). Trauma is 'written into Our Bodies'-but educators can help. Edutopia. https://www.edutopia.org/article/trauma-written-our-bodies-educators-can-help

    Multiplying Connections. (2010). CAPPD Practical Interventions to Help Children Affected by Trauma. Retrieved from http://www.multiplyingconnections.org/become-trauma-informed/cappd-interventions-guide

    Nakazawa, D. J. (2016). Aces too high: Seven ways childhood adversity changes a child’s brain. Retrieved from https://acestoohigh.com/2016/09/08/7-ways-childhood-adversity-changes-a-childs-brain/

    The National Child Traumatic Stress Network (n.d.). About Child Trauma. Retrieved from
    https://www.nctsn.org/what-is-child-trauma/about-child-trauma

    The National Child Traumatic Stress Network. (2008). Child Traumatic Stress: What Every Policymaker Should Know. Retrieved from https://www.nctsn.org/sites/default/files/resources//child_traumatic_stress_what_policymakers_should_know.pdf

    The National Child Traumatic Stress Network. (2005). Facts of Trauma and Homeless Children. Retrieved from https://www.nctsn.org/sites/default/files/resources/facts_on_trauma_and_homeless_children.pdf

    The National Council for Behavioral Health. (n.d.). How to Manage Trauma. Retrieved from https://www.thenationalcouncil.org/wp-content/uploads/2013/05/Trauma-infographic.pdf

    Promising Futures Without Violence: Protective Factors and Resiliency. (n.d.). Retrieved from http://promising.futureswithoutviolence.org/what-do-kids-need/supporting-parenting/protective-factors-resiliency/

    SAMHSA. (2019). Trauma and Violence. Retrieved from https://www.samhsa.gov/trauma-violence