“We tend to think of trauma as the result of a frightening and upsetting event. But many children experience trauma through ongoing exposure, throughout their early development, to abuse, neglect, homelessness, domestic violence, or violence in their communities. And it’s clear that chronic trauma can cause serious problems with learning and behavior.”1
When children are profoundly hurt before they’re able to ask for help, in ways that deter them from doing so, it’s up to the adults in their lives to recognize the distress signals. To explore how trauma can affect child development and learn what to look for, keep reading.
Expand Your Practice
Professor Lisa A. Henshaw, of Yeshiva University, explores what trauma is and how to identify it, and shares strategies for supporting high-risk students in the classroom.
Understanding What Constitutes Trauma
The United States Department of Health and Human Services (HHS) and the National Child Traumatic Stress Network (NCTSN) have published similar lists of experiences that could be traumatic. While neither list is comprehensive, each presents a significant range of possibilities. Collectively, they include:2,3
- Physical, sexual, or psychological abuse and neglect, including trafficking
- Natural and technological disasters or terrorism
- Family or community violence
- Sudden or violent loss of a loved one
- Personal or familial substance use disorder
- Refugee and war experiences, including torture
- Serious accidents or life-threatening illness
- Military family-related stressors (e.g., deployment, parental loss or injury)
Recognizing the Signs of Trauma in Children
Some signs of trauma are distressingly easy to see. In an article updated in March 2023, the Substance Abuse and Mental Health Services Administration (a division of HHS) published these grim survey results:2
- At least one in seven children have experienced child abuse and/or neglect in the past year, and this is likely an underestimate; in 2019, 1,840 children died of abuse and neglect in the United States
- Each day, more than 1,000 youth are treated in emergency departments for physical assault-related injuries
- In 2019, about one in five high school students reported being bullied on school property in the last year
- Eight percent of high school students had been in a physical fight on school property one or more times during the 12 months before the survey
- Each day, about 14 youth die from homicide, and more than 1,300 are treated in emergency departments for violence-related injuries
Sometimes, though, signs of trauma in children are less immediately apparent. A February 2023 article by the Child Mind Institute’s Editorial Director, Caroline Miller, notes, “Trauma is particularly challenging for educators to address because kids often don’t express the distress they’re feeling in a way that’s easily recognizable—and they may mask their pain with behavior that’s aggressive or off-putting.”1 She quotes Dr. Nancy Rappaport, a psychiatrist who treats children and adolescents and focuses on mental health issues in schools: “They are masters at making sure you do not see them bleed.”1
According to the NCTSN, children who have feared for their lives, believed that they would be injured, witnessed violence, or tragically lost a loved one may show signs of traumatic stress.3 Educators who can recognize these signs are better equipped to understand the confusing behaviors associated with them. Further, by accurately identifying signs of trauma—which can mimic signs of Attention Deficit/Hyperactivity Disorder (ADHD) and other challenges—therapists are more prepared to avoid misdiagnosis.1
Behavioral Signs of Trauma in Children
When young children experience trauma—when recognizing and responding to threats becomes a priority—it can delay their brains’ development. Trauma affects the limbic system, which regulates much of what the body does; the hippocampus, which is deeply involved with learning and memory; and the prefrontal cortex, which is responsible for emotional regulation, attention, cognition, executive function and impulse control.4
Behavioral signs of trauma in children include:5
- Having a low tolerance for frustration
- Showing signs of dissociation, being withdrawn, closed-off, shut down or not present
- Having problems focusing or concentrating on schoolwork, projects, tasks and/or conversation
- Regressive behavior in which they return to an earlier stage of development, such as wetting the bed and/or thumb-sucking
- Refusing to go to school
- Crying frequently
- Having difficulty sleeping
- Gaining or losing weight suddenly
- Changing their eating habits or showing signs of disordered eating or an eating disorder
- Exhibiting reckless and risky behaviors such as substance misuse and inappropriate sexual activity
- Showing signs of self-harm such as cutting or suicidality
- Expressing extreme concern about their safety
- Especially in younger children: reenacting the traumatic event
Physical Signs of Trauma in Children
There are physical signs of trauma that are apparent even to a casual observer. In addition, however, childhood trauma can also damage the immune system by causing it to activate inflammatory responses for long stretches of time. This can make children more susceptible to illnesses such as metabolic syndrome, asthma and infections. Constant stimulation of the immune system can cause the so-called “sick syndrome,” which can present as lethargy, headaches and stomachaches.4
Trauma can also cause body dysregulation, in which the system over- or under-responds to sensory stimuli. This can be recognizable when a child:5
- Is hypersensitive to noise, touch, light or smells
- Complains about pain in body parts where there is no physical cause
- Is unaware of experiencing touch or pain, which can lead to injury without the child’s realization of it
Emotional Signs of Trauma in Children
Emotion-based signals that children have lived through trauma can include:1
Trouble Forming Relationships
Neglect and abuse deter children from forming relationships with teachers and other adults. Having been betrayed and otherwise hurt by people on whom they relied, these young survivors have learned to distrust even seemingly dependable adults. Without a model for adult behavior that recognizes and responds to their needs, they often don’t know how to ask for help.
In this country, a standard school disciplinary practice removes attention and support from kids who act out and push others away—that is, disruptive students are often isolated in the hope that they’ll change their behavior. Instead, Dr. Rappaport urges educators to recognize and acknowledge the strong emotions that children are expressing, however inappropriately. Doing so can help children learn to express themselves in ways that “don’t alienate and drive away people who are trying to help them.”1
When infants and toddlers are attentively cared for, they learn to soothe and calm themselves from the adults who soothe and calm them. Not surprisingly, then, children who face trauma and neglect may have trouble managing their strong emotions. Educators can help them course-correct by working with them to manage their feelings. Through coaching and practice, kids can learn to handle the sense of being overwhelmed, and to defuse emotions that once would have taken over.
Children who have been traumatized often come to believe that they were at fault—that they’re ‘bad kids.’ As a result, they develop the expectation that they’ll be disliked, unsuccessful and treated poorly. Further, they may hold what clinical psychologist Jamie Howard, PhD, calls a “hostile attribution bias,” which is the belief that everyone is out to get them. Simple directions from teachers can register with them as attacks, which may lead to disproportionately irritable responses and/or a paralyzing fear of making mistakes in class and in life.
Educators and other supportive adults can help these young people rewrite their internal narratives. As students learn to recognize their own unhelpfully negative thinking, and to see that mistakes are helpful learning tools rather than inherent flaws, they can come to understand themselves in a more positive, productive light.
Trauma survivors are often overly alert to danger, with a fight-or-flight impulse that seems to be in overdrive. They may have trouble sleeping and/or be chronically irritable. These traits, combined with jumpiness and an exaggerated response to being startled, can lead to misdiagnosis of trauma as ADHD.
Children with these challenges can benefit from coaching that helps them recover when triggered, as they recognize the distinction between their larger emotions and the smaller situation of the moment.
Executive Function Challenges
Another overlap between trauma and ADHD—and, therefore, another set of causes for possible misdiagnosis—is that both do damage to executive function: the ability to focus, plan, think things through, communicate needs, complete tasks and act with intention rather than by impulse. Children who have experienced trauma can find it difficult not to know what the future, even the immediate future, holds. Adults can help these young people learn what to expect, and how to talk themselves through the actions they need to take, by coaching them through dry-runs of upcoming events.
Signs of Trauma in Children May Vary by Age
Human responses to experience, traumatic and otherwise, vary with age. SOS Children’s Villages, the world’s largest nonprofit organization dedicated to the care of vulnerable children, has published this list of age-related signs of traumatic stress:6
|Very young children (preschool)||Young children (elementary school)||Adolescents (middle school and high school)|
|Cry and/or scream more than typical for the child||Feel shame or guilt||Feel depressed|
|Feel under pressure or timid||Feel fear or anxiety||Feel alone, different from everyone else or like they’re “going crazy”|
|Develop new fears, including anxiety when separated from a parent or caregiver||Become clingy to adults they trust, like parents or teachers||Avoid going to places that bring up memories of their trauma|
|Experience nightmares||Have trouble sleeping||Have trouble sleeping|
|Wet the bed||Have difficulty concentrating||Engage in risk-taking behavior|
|Develop poor eating habits, which can result in loss of weight||Worry excessively about their own safety or the safety of others||Develop eating disorders|
|Revert to using “baby talk”||Startle easily||Engage in self-harming behaviors (ex: cutting, suicidal tendencies)|
|Recreate the traumatic experience while playing||Repeatedly tell people about the traumatic experience||Talk about the traumatic experience in detail|
|Ask questions about death||Feel afraid that the traumatic experience will happen again||Use or abuse drugs or alcohol|
|Display stunted developmental growth||Feel upset by minor injuries like bumps or bruises||Become sexually active/promiscuous|
|Decline in school performance||Say they don’t have feelings about the traumatic experience|
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- Retrieved on April 7, 2023, from childmind.org/article/how-trauma-affects-kids-school/
- Retrieved on April 7, 2023, from samhsa.gov/child-trauma/understanding-child-trauma
- Retrieved on April 7, 2023, from nctsn.org/what-is-child-trauma/about-child-trauma
- Retrieved on April 7, 2023, from publications.aap.org/pediatrics/article/148/2/e2021052580/179745/Trauma-Informed-Care
- Retrieved on April 7, 2023, from nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects
- Retrieved on April 7, 2023, from sos-usa.org/news/topics/ptsd-in-children/childhood-trauma-30-signs-your-child-is-trying-to