Complex trauma occurs when people experience trauma at multiple developmental stages of childhood and adolescence and/or repeatedly at any age.
Gabriel is having a hard time keeping up in school. He falls asleep in class, struggles to focus on his schoolwork, and lashes out at others. What his teacher and classmates don’t know is that Gabriel has been through a lot of adversity during his life. He is tired because he has nightmares about his father, who gets violent when he is angry. He can’t concentrate because images of the car crash that he was in last year keep popping up in his mind. He is alert and on-edge because he has been bullied by peers. Gabriel’s behaviors at school are likely aftereffects of his complex trauma. Unfortunately, he is not alone.
What is Trauma?
It is estimated that more than two- thirds of children in the United States experience at least one traumatic event by the age of 16. Events are considered traumatic when they pose a threat to someone’s physical safety. Examples of singular traumatic events include mass shootings, serious accidents and natural disasters. Directly experiencing a traumatic event is frightening but witnessing or hearing about it can also be traumatic.
How children respond following trauma varies widely from child to child. Some experience involuntary reminders of the traumatic event (e.g., nightmares, flashbacks), while others avoid all reminders of the event and withdraw from the world. Other responses include changes in thoughts (e.g., self-blame), negative mood, inability to experience positive emotions, angry outbursts, sleep disturbance, problems with concentration, hypervigilance (increased alertness in anticipation of danger), and reckless behavior. It is normal to experience distress following a traumatic event. Children who experience many of these symptoms for an extended period of time might meet clinical criteria for a stressor- or trauma-related disorder such as Post Traumatic Stress Disorder (PTSD).
The Impacts of Complex Trauma on Child Development
Any single traumatic event can have long-lasting impacts on a child. But when children are exposed to multiple traumatic events in their lifetime, the effects can be even more widespread and devastating. This phenomenon—known as complex trauma—occurs when people experience trauma at multiple developmental stages of childhood and adolescence and/or repeatedly at any age. Examples of complex traumatic events include physical, verbal, emotional, and sexual abuse; exposure to interpersonal violence; and physical and emotional neglect.
Children with complex trauma histories face a number of developmental challenges. For example, these children might have difficulties forming a secure relationship with a caregiver. Without a warm and stable caregiver relationship, children don’t feel safe and protected in the world and they struggle to control and express their emotions or trust others. This can weaken their ability to form close, stable relationships later in life (e.g., romantic relationships, friendships). Complex trauma also impacts the body’s biological systems. When children are under chronic stress, their brains are in survival mode, even in situations where they might not have to be. As a result, children exposed to complex trauma might have problems with attentional, reasoning, or problem-solving skills. Additionally, the body’s stress response systems and immune system may not develop typically. Adults with histories of complex childhood trauma are more likely to have physical health problems, including substance use, obesity, heart disease, and cancer.
Hope and Healing
Even though long-term effects of complex trauma are well-established, not every child is doomed to a life of hardship and sorrow. Each child’s journey is different and is largely dependent on the support of the adults and systems that surround them. As such, it is important that caregivers and child-serving professionals (e.g., mental health providers, educators, pediatricians) understand the potential warning signs of complex trauma on child development and behavior.
Importantly, trauma-informed mental health treatment can be particularly effective in reducing the distress and dysfunction associated with children’s trauma responses. Several therapies have been developed that specifically address complex childhood trauma. One of the most well researched trauma therapies for children is trauma-focused cognitive behavioral therapy, or TF-CBT. The primary focus of TF-CBT is for the child to write a personal narrative about their trauma(s)—what they remember about the incident(s) and what meaning they have made of their experiences. The child then shares their narrative with a supportive adult figure in their life, often a custodial parent. In addition to creating a trauma narrative, TF-CBT focuses on providing psychoeducation to both the child and the caregiver about the ways that trauma impacts children, learning how to cope with emotions in healthy ways (e.g., learning how to relax their body when activated), and identifying strengths within the child and family to promote resilience in the future.
Although TF-CBT is perhaps the most widely studied trauma-focused mental health treatment for children with complex trauma, many other effective treatments are used by clinicians. Attachment, Self-Regulation, and Competency—as its name suggests—focuses on strengthening the attachment relationship, helping the child to develop self-regulation skills (e.g., ability to manage strong negative feelings), and develop a sense of competency in their life (e.g., building problem-solving and decision-making skills). Another example is Bounce Back, a school-based group intervention for elementary school students to learn skills to cope with their traumas in a supportive peer setting. All share the common outcome of reducing children’s trauma-related symptoms and setting children up for the best futures possible.
Tips for Supporting Children with Complex Trauma
It is highly recommended that families impacted by complex trauma work with a mental health provider to receive support. However, there are many things that parents, caregivers, and other supportive adults can do to help a child with a history of complex trauma:
- Let the child know when they are safe. Children who experience repeated traumas tend to sense constant danger, even when there is none. Explain what measures you are taking to make sure that they are safe now and in the future.
- Help them to label what they are feeling in the moment. Complex trauma might cause a child to react strongly to trauma triggers without knowing why, or even become numb to strong negative emotions. Children need help to slow down and connect their thoughts, feelings, and behaviors. They need to “name it to tame it!”
- Find a quiet, calm, and safe space to relax when the child is emotionally dysregulated. Breathing exercises and meditation are common methods used to calm the body.
- Remind the child that they are not their trauma and that they are not to blame for the things that have happened to them.
- Foster positive emotions, increased self-esteem, and a sense of competency. This can be done through several ways—reminding them of their strengths (e.g., “you are such a good painter!”), praise (e.g., “thank you for clearing the dinner table, you are a big help”), and/or participation in extracurricular activities that they enjoy.
The National Child Traumatic Stress Network (https://www.nctsn.org/; provides resources for caregivers and clinicians)
CDC-Kaiser Adverse Childhood Experiences (ACE) Study (https://www.cdc.gov/violenceprevention/aces/index.html; provides information on the cumulative effects of early traumas on physical and mental health)
Center on the Developing Child at Harvard University – A Guide to Toxic Stress (https://developingchild.harvard.edu/guide/a-guide-to-toxic-stress/; discusses the impacts of chronic stress on child development and how to foster resilience)