Published: May 5, 2021
Complex trauma occurs when children are exposed to multiple, severe and pervasive traumatic events or experiences. Complex trauma includes profound abuse, neglect or ongoing exposure to violence, typically involving a primary caregiver.
Traumatic experiences often overwhelm a child’s ability to cope. Children exposed to complex trauma can react in a number of ways, including lack of attention, hyperactivity, defiance, aggression, depression, anxiety and learning difficulties. They also can have difficulty developing and sustaining relationships.
In addition, children exposed to complex trauma are more likely to adopt risky behaviors as a way of coping. These include eating disorders, smoking, substance abuse, self-harm, sexual promiscuity and violence.
“It significantly disrupts a child’s physical, emotional and mental development, their sense of self, and, importantly, their ability to form secure attachments with caregivers,” said Katy Hopkins, Ph.D., HSP, pediatric psychologist with Norton Children’s Medical Group, affiliated with the UofL School of Medicine.
Children learn social skills from their environment. If they’re living in a chaotic home, they will have dysfunctional skills, according to Dr. Hopkins. Violence teaches withdrawal, anxiety, distress, overreaction, sometimes underreaction and/or aggression as coping behaviors.
Exposure to complex trauma can result in physical changes in the brain, and the effects of childhood trauma can last into adulthood.
Adults who experienced trauma as children are more likely to experience traumatic stress, as well as chronic health issues including heart disease, obesity, substance abuse, diabetes, suicide, emphysema and premature death. Also, the ability to form healthy relationships in adulthood depends highly on learning social skills in childhood.
Primary care physicians can screen effectively for complex trauma, which often appears like attention deficit hyperactivity disorder (ADHD), anxiety or other conditions, according to Dr. Hopkins.
Screening for complex trauma may involve asking a child simple questions or having the child fill out a more formal questionnaire. A primary care physician who thinks a child has been exposed to complex trauma will refer that child to a behavioral health provider for a formal diagnosis.
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A number of treatments exist that are designed to address complex trauma and help the child heal, according to Dr. Hopkins. These treatments all prioritize safety and stability, put a strong emphasis on relationships and use the strengths of a child and family as a springboard to recovery.
Other treatments not specifically designed to address complex trauma have been shown to work, according to Dr. Hopkins. These include child-parent psychotherapy, parent-child interaction therapy, eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavioral therapy (CBT).
Treatment should respect and prioritize patient choice and maximize collaboration, according to Dr. Hopkins, noting that children and teens are resilient and can bounce back from complex trauma.
“Human beings and especially children and adolescents are geared toward resilience,” she said. “Resilience has been called the ‘ordinary magic’ of childhood.”