Early childhood educators are constantly adjusting their practice to meet children where they are and help them reach challenging and achievable goals—core tenets of developmentally appropriate practice (DAP) (Copple & Bredekamp 2009). To provide a learning environment for children that embraces excellence and equity, teachers incorporate a thorough understanding of how children develop and learn, how to teach based on children’s unique characteristics and experiences, and what each child’s social, family, and cultural contexts mean for learning (NAEYC 2009; NAEYC 2019). This concept is critical; children don’t fit neatly into specific boxes, with one approach covering everyone’s needs.
This same mindset applies when you are striving to be aware of and sensitive to the needs of children who have experienced trauma and their families. Even knowing that a child has been in a traumatic circumstance, because you observed it firsthand or were told by a reliable source who has a relationship with the child, doesn’t give you the full picture or tell you what strategies would best support the child and family.
In addition, if you aren’t told directly about the circumstances, it is easy to fall into the trap of relying on guesswork, unconscious bias, a child’s behavior, and your own experience to assume that a particular child has experienced a traumatic situation. However, all of these can lead you to unfounded conclusions. Educating yourself on what trauma is, understanding potential sources, and learning what a traumatic response may look like in a child enables you to better recognize a child who needs support in the moment and partner with the family to find ways to ease the causes of the trauma. This lets you better individualize your response and care for the whole child rather than trying to address individual behaviors.
This chapter explores broad definitions of trauma and then looks more closely at different types and the presentation you may see in a child who has been exposed to that type of trauma. It is critical to keep in mind, as Ellen Galinsky notes, that “adversity is not destiny” and that a caring person can have an enormous impact on a child’s life (“From Trauma-Informed to Asset-Informed Care in Early Childhood,” Brookings, October 23, 2018). Later chapters will speak about effective strategies that you can use as you build relationships and provide healing-centered TIC in your environment.
Trauma is defined as “an experience that threatens life or physical integrity and overwhelms the capacity to cope” (NCTSN 2008b). There are two major categories of trauma: acute and complex. Acute trauma is “a single exposure to an overwhelming event” (Sorrels 2015), such as being involved in a car crash or experiencing an extreme weather event like a flood or tornado. It can also come from witnessing a violent incident.
Unlike acute trauma, complex trauma is not a one-time event. Complex trauma refers to chronic and ongoing harm or neglect at the hands of another, with far-reaching, long-term effects (see NCTSN, n.d. b). It also refers to trauma that occurs within a more finite period of time but has effects that linger, like extensive recovery from an injury or serious illness that leaves a child with trauma related to medical procedures. In young children, complex trauma usually happens within a family or caregiver relationship, because children are completely dependent on others to care for them. Complex trauma includes all forms of abuse (physical, emotional, sexual), neglect, and abandonment as well as living in an environment with domestic violence (Sorrels 2015).
Trauma can be experienced in different ways. Firsthand trauma refers to events that happen to a child or to the child’s family member in a way that directly influences the child’s experience. This could be an acute traumatic event or a complex, ongoing trauma.
Secondhand trauma, sometimes called secondary trauma, is defined by “indirect exposure to trauma through a firsthand account or narrative of a traumatic event” (Zimering & Gulliver 2003). A child might experience secondhand trauma through watching news footage of a terrorist attack, hearing about community violence from adults, or having a close, trusted adult who has experienced trauma. Although the child does not experience the trauma themselves, hearing the vivid recounting or seeing images of traumatic events can deeply affect them because of the connection they feel to adults closest to them and their perception of time, which may make them think that the event is happening at that moment.
People who work closely with children, including educators, social workers, and therapists, can also experience secondhand trauma. These professionals may find that their work takes an emotional toll and that they begin to have symptoms that parallel post-traumatic stress disorder (PTSD). In these scenarios, secondhand trauma is sometimes called compassion fatigue or vicarious trauma. This type of trauma is discussed in more depth in Chapter 10.
There are three key concepts to keep in mind when thinking about trauma and young children. The first is that the way an individual experiences trauma is completely dependent on that person’s perspective, no matter how an outside person views the experience.
Second, trauma is not only the event itself but the response to the stressful situation and the undermining of the person’s ability to manage. While a specific event may be the catalyst, what comes after is also significant. The emphasis on relationship-based and healing-centered approaches in early childhood programs is in direct response to this idea.
Third, trauma and its impact are subjective; a child’s worldview and previous experiences will determine how they interpret and respond to the event. For one child, having a parent who is hospitalized may be distressing while it is happening but not affect them long term. However, a different child may experience lasting negative effects from a similar event.
Discussions of trauma often include the mention of adverse childhood experiences (ACEs)—potentially traumatic events that occur in childhood. This term comes from a landmark study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente from 1995 to 1997 that measured ten types of childhood trauma (Felitti et al. 1998). Individuals participating in the study marked the adverse experiences they had been exposed to as children, which were then tallied to give them an overall ACE score. The childhood traumas listed included five personally experienced traumas and five involving family members:
❯ Physical abuse
❯ Verbal abuse
❯ Sexual abuse
❯ Physical neglect
❯ Emotional neglect
❯ A family member who was a substance abuser
❯ A mother who was a victim of domestic violence
❯ A family member who was incarcerated
❯ A family member with a severe mental illness
❯ Parents who were separated or divorced
Researchers found that a higher ACE score put individuals at increased risk for later negative outcomes in health and well-being, including mental illness, risky behaviors such as substance use disorders, and diminished professional and educational opportunities (Sacks & Murphey 2018). Nationally, 1 in 10 children have experienced three or more ACEs and just under half of all children in the United States have experienced at least one ACE (Sacks & Murphey 2018).
Understanding potential sources of trauma in a child’s life helps you keep in mind the big picture of how home, family, and community have an impact on a child’s response to traumatic events. It also allows you to access support strategies more quickly and to individualize them. The ACE study (Felitti et al. 1998) greatly helped shape discussion of potential traumatic events. However, as the knowledge of trauma and trauma-informed care has progressed, the understanding of what constitutes an adverse experience has also developed. Noting that the “body’s stress response does not distinguish between overt threats from inside or outside the home environment, it just recognizes when there is a threat, and goes on high alert,” the National Scientific Council on the Developing Child “expanded its definition of adversity beyond the categories that were the focus of the initial ACE study to include community and systemic causes—such as violence in the child’s community and experiences with racism and chronic poverty” (Center on the Developing Child, n.d. a).
With that in mind, potential traumas are discussed here within four broad categories.
❯ Household and family: Trauma that arises from within a child’s household, family, or primary care situations, including physical, emotional, and sexual abuse; neglect; severe or chronic illness; family discord; and financial insecurity and poverty
❯ Loss: Reactions to death experienced by a child, including the loss of someone important to the child and traumatic grief
❯ Family separation: Trauma that occurs when a child is separated from their family or a particular family member; includes situations in which families are refugees or migrants or a family member is incarcerated or deployed
❯ Violence and disaster: Violent events that affect children, including gun violence, natural and human-made disasters, car crashes, personal injury and witnessing violence, and terrorism
Young children are dependent on their family for their physical and emotional safety; thus, it is more likely that complex trauma will arise from within the household. However, there are many ways this can manifest.
Physical abuse is committing an act that results in physical injury to the child, including bruises, burns, and broken bones.
Physical abuse from a parent or guardian is especially toxic because a child’s natural instinct is to run to that person for protection, but when abuse is occurring, their stress response will tell them to run away instead (Sorrels 2015). This leaves the child with no clear person to turn to and keeps them in a heightened state of fear and alarm.
Physical abuse may have many lasting behavioral effects. Children may have difficulty forming relationships, because they learned early on not to trust anyone or to default to aggression to solve conflict. They also can feel like they deserved the abuse and have a sense of worthlessness. Some children show hypervigilance—being abnormally alert to the potential of danger and threat, demonstrating increased aggression or instances of acting out, and experiencing a constant state of alarm. Hypervigilance may also be related to a higher incidence of ADD and ADHD diagnosis among children experiencing trauma, because the symptoms are similar (Sorrels 2015). Later in this chapter there is further discussion of misdiagnoses that often occur.
Children who experience physical abuse also may turn to risky behaviors or substance use disorders later in life as a means of coping. If you suspect physical abuse or any other type of abuse discussed below, you must follow your state’s reporting requirements immediately.
Emotional abuse does not have a single, accepted definition, and it can be difficult to detect. It is characterized by behaviors that are meant to diminish someone’s feelings of dignity, confidence, and self-worth. It may be inflicted by family members intentionally taunting or humiliating a child or creating a climate in which the child feels frightened. Children can also experience emotional abuse when they feel overpressured or isolated from normal social experiences.
Children who have experienced emotional abuse may develop a paralyzing sense of shame and humiliation, seeing themselves as unworthy of love or affection and trying to remain unnoticed. They may be developmentally delayed or show physical manifestations such as frequent stomachaches or headaches and fluctuating weight. Socially, they may have difficulty forming relationships or be aggressive and cruel or withdrawn. They may also demonstrate behaviors that seem inappropriate for their age, such as an older child continuing to suck their thumb or rock their body.
Sexual abuse is when a child is used for another person’s sexual stimulation. It can happen between a child and an adult or between a child and another child. Sexual abuse can include witnessing sexual activity or pornography or being used for sexual exploitation for pornographic purposes as well as inappropriate bodily contact like fondling, kissing, or intercourse (Sorrels 2015).
Children who have experienced sexual abuse may have no personal boundaries and initiate or accept inappropriate bodily contact. They may also have sexual knowledge, behaviors, or language beyond their age. In addition, they may experience behavior changes like being depressed and withdrawn or having angry outbursts. Their sleep may be affected or they may express fear of being left alone with particular individuals. Educators may also observe a child re-enacting the experience through play or talking about their body as being hurt or dirty (NCTSN, n.d. c).
Neglect is defined by an inadequate response to a child’s needs. This can include lack of basic survival needs like access to food, shelter, and medical care; lack of supervision; and lack of experiences or sensory stimulations.
A child who is neglected may develop medical problems like malnutrition and chronic physical pain as well as headaches or stomachaches. Children who are neglected may also have an over- or undersensitivity to pain, touch, smells, sounds, and light.
Beyond the risks to a child’s physical health, neglect carries risks for learning deficits and language and other developmental delays; the constant stress on a child’s body and brain from neglect affects growth and development. Neglected children may have difficulty forming relationships, and there may be an increase in anxiety or other mental health issues. Emotional responses can be unpredictable and explosive.
Identifying neglect can be difficult. A child may seem constantly tired, hungry, unclean, or not dressed appropriately for the weather. They may need medical care or be frequently absent from the program. The child may also make comments about no one being home to provide care. In addition, the parent may seem apathetic or indifferent to the child or be depressed or irrational.
Other sources of instability in a child’s life may contribute to adverse experiences. A family member with mental health issues may exhibit abusive or neglectful behaviors, or their interactions may create a chaotic and unpredictable household environment. As explained at the beginning of this chapter, trauma occurs not only when life and physical integrity are threatened but also when an individual’s capacity to cope is overwhelmed (Sorrels 2015). Baseline chaos in a child’s home, like not knowing who will be there to care for them or having irregular meals or disrupted schedules, diminishes a child’s resilience and capacity for response when traumatic events occur on top of what the child is already trying to manage.
Children thrive on predictability and routines, and having a family member with a chronic or severe illness, even if it is generally well managed, can make their life feel erratic. Often the people who serve as the caregiver for the ill individual are worried and anxious and may be taking on different roles and responsibilities in the family. There might be changes in the family’s financial situation or daily routine. Disruptions for medical procedures, times when the ill person is unavailable to the child, or sudden changes in the health of the person can create uncertainty and concern.
If a child is the one who is ill, then they are dealing with all of the unpredictability, uncertainty, and anxiety related to disruption of routine as well as the physical symptoms of their illness. Invasive medical procedures can spark lifelong anxiety and medical trauma. Very young children do not understand that the pain, surgeries, needles, or tubes are lifesaving; their bodies and brains interpret the situations as the people around them causing them pain (Sorrels 2015). Children react to how frightening the event is for them rather than responding objectively to the severity of the problem.
Family discord is a general term for anything that creates instability and uncertainty in a household. This can include, but is not limited to, substance use disorders, substance use happening in the home, family members experiencing severe mental illness, or family members thinking about or planning suicide.
Family discord can affect social development and make it difficult for children to form relationships. It is not only a risk for trauma in its own right, but it can also lead to other types of abuse or neglect if it is not addressed. Children may have insufficient supervision or lack stimulation. Their basic needs may not be taken care of or the family member may be physically abusive.
Children living with family discord may show a variety of symptoms, such as hypervigilance, withdrawal, or anxiety and clinging behavior with trusted adults. Some children take on caregiving roles or try to constantly be a peacemaker.
Nearly 1 in 5 children in the United States—12.8 million in total—live in poverty, which at the time of this writing is defined as having an annual family income of less than $25,000 a year for a family of four (Children’s Defense Fund 2019). While poverty isn’t an automatic catalyst for trauma in children, it is considered by some to be a source of trauma on its own (Menschner & Maul 2016) and often causes conditions that factor into other sources of trauma.
Families who are living at or below the poverty line can experience extreme stress because of tight budgets and the disparities between income and cost of living. They may lack necessities like food, safe housing, and health care and live in areas with environmental hazards, a lack of safe play spaces, and increased violence. Children’s education may be interrupted frequently or of low quality. For some families, the stressors may lead to abuse, neglect, and other types of trauma.
Children living in low-income communities face significantly more ACEs and environmental risk factors than children from higher-income families: 13 percent of children living at or below the poverty line have had three or more ACEs, compared with 5 percent of children in households with income more than twice the poverty level (Child Trends 2019). It is estimated that 50 to 80 percent of children living in poverty have experienced trauma (NEA 2016). In addition, children in poverty are less likely to overcome these traumas because there is rarely a break in their exposure to ongoing ACEs and other types of trauma (Collins et al. 2010). Children of color are significantly more likely to be poor compared with White children (Children’s Defense Fund 2019; Jensen 2016) and thus are disproportionately affected by poverty-related traumas.
Many children living in these conditions of instability and upheaval experience chronic or toxic stress, which is long-term stress that has been linked to physical and developmental delays (see Chapter 3 for more on toxic stress). The hormone cortisol and other stress markers are continually elevated—a sign of toxic stress—in children who live in poverty (Blair & Raver 2016), and this can cause changes in brain architecture. These changes adversely affect executive function and emotional regulation, which in turn impacts children’s ability to thrive in school (Blair & Raver 2016).
Poverty does not automatically mean a child will experience long-term effects from trauma, however. Many families can draw on cultural and spiritual resources to provide a buffer from the adverse effects of trauma (Christian & Barbarin 2001; NCTSN, n.d. a; Wethington et al. 2008). And educators, as discussed in Chapter 4, play an important role in mitigating these effects.
Being confronted with death is an experience that almost every child will have in one form or another. Whether it is a loved one or family pet or even seeing a dead insect or bird, being able to cope with these upsets is foundational to children’s emotional and mental health. Death can happen suddenly or be a planned-for transition. There may also be outside influences like long illness or substance use that affect how children and the adults in their life cope with death. In addition, the myriad personal, societal, and cultural norms surrounding death influence how it is experienced by the child and the process they learn for dealing with it. Trusted adults are critical in helping children process what has happened and guiding them through healthy ways to cope.
Although any death may affect a child, the loss of someone important to them will bring up a complex array of emotions. They may feel anger and confusion along with their grief, and depending on their age and developmental level, they will have an evolving understanding of what death means. Preschool-aged children may also think their actions have the power to change reality and if they thought or said bad things about a person, it might have caused that person to die.
In many cases, children can grieve a loss while still maintaining routines and achieving developmental milestones. Sometimes, though, a child will develop what the NCTSN refers to as a “traumatic grief response” (NCTSN, n.d. d), which occurs when they are unable to cope with the changes that resulted from the death and move forward with healthy patterns of living. Traumatic grief response usually occurs following the loss of a primary attachment figure (such as a parent or sibling) or another important person in the child’s life, such as a relative, friend, or classmate (NCTSN, n.d. d).
Children who are experiencing traumatic grief may
❯ Withdraw and avoid any reminders or triggers of the loss
❯ Experience distress when reminded of the person—even of happy times
❯ Be irritable and angry
❯ Complain of headaches or stomachaches
❯ Be overly vigilant about their safety and the safety of others
❯ Have guilt or blame themselves for the death of the person
❯ Have nightmares (NCTSN, n.d. d)
In most cases, children who are experiencing traumatic grief require intervention from a mental health professional to help them work through the grief and learn to cope.
For young children, who rely entirely on their families to take care of them, family separations can be incredibly traumatizing. Children may experience separation in a number of ways.
Children who leave their country of origin with their families as refugees or migrants experience a variety of events that may be traumatic. They may have witnessed violence and war, including torture and assault, or may have lost loved ones. They also may have lacked necessities like food and shelter or been injured and ill and had their schooling disrupted. Often, they have left familiar surroundings and family and friends.
Hardships may continue after arriving in a new country, including the difficulties of making a new life and building a community of support and resources. Children often pick up on the anxiety and stress of their family members. They may have difficulty fitting in at school or in their family child care program. For young children who are learning to speak both English and their home language, known as dual language learners, the burdens of trauma become heavier than they might ordinarily be if children can’t communicate effectively with the people around them (K. Nemeth, personal communication). If educators do not speak the home languages of the children in their care, the ability to form a strong bond is weakened at a time when children need to connect the most.
Children who are refugees also risk being separated from their families and communities. For young children, who build their entire identity on the people in their lives who take care of them, losing their main ties to their family and community makes them vulnerable to trauma and traumatic response.
For the estimated 1 million undocumented immigrant children living in the United States (APA, n.d.), this status predisposes them to open-ended stress. In addition to the traumas they likely experienced in their country of origin or at the border, they may experience the possibility of immigration raids in their communities, arbitrary stopping of family members to check their documentation status, and the threat of deportation.
Any of these stressors may have a strong impact on a child, and when multiple stressors are layered on top of each other, as is often the case with refugee and migrant children, it can affect a child’s physical and mental health, including difficulty eating and sleeping, withdrawal, and anxiety (APA, n.d.). A growing awareness of the potential for these stressors and more resources being shared among educators and other professionals means that the circumstances of refugee and migrant children are being recognized, with the goal of specific supports being put in place.
Over 1.5 million children in the United States have at least one parent incarcerated. Black children are overwhelmingly affected: 1 out of 9 have an incarcerated parent, compared with 1 in 28 Latino children and 1 in 57 White children (National Resource Center on Children & Families of the Incarcerated 2014). These situations may create uncertainty in many aspects of a child’s life, including disrupted day-to-day routines, financial hardship or changing care arrangements including foster care, permanent separation from family, or frequent changes in where the child lives.
There may be limited contact between an incarcerated parent and child and potentially a repetition of these disruptions if the parent is in and out of prison. Children may experience the stress response of abandonment, including trust issues or being wary of creating relationships (La Vigne, Davies, & Brazzell 2008).
Children may also have a social stigma or feel shame because of parental incarceration. There may be social backlash from peers or a lack of understanding from adults and service providers in their life (La Vigne, Davies, & Brazzell 2008). There may be additional sources of trauma if children witness the incident that led to the arrest or the arrest itself or are exposed to violence or drug and alcohol use in the community (Youth.gov, n.d.).
A child with an incarcerated parent will most likely feel stress, sadness, or fear and may develop depression or other anxieties. There may be short-term behavioral changes like withdrawal or increased aggression as well as long-term risk for social, emotional, and physical changes.
Research continues to show the importance of strong relationships between children and trusted adults and the role that resilience can play in positive outcomes for children (Joseph & Strain 2010; McNally & Slutsky 2018). Resources created from these findings are used to support children with incarcerated parents. In addition, a continuing pushback against mass incarceration and continued efforts to disrupt the prison pipeline will provide more systemic change.
Approximately 1.7 million children in the United States have at least one parent serving in a branch of the military (DMDC 2019). As with any group, not all children in military families have the same experiences, and the impact of their experiences can be very different. In many ways, the stressors are similar to those faced by all young children. However, when a parent is deployed or sent from the place where they are stationed (their home installation) to a specific location for a particular mission, the military service member is separated from their family. Deployment can occur with little notice, making it difficult for children to adjust to the situation. There is also anxiety and fear that the person who is deployed may be in danger since deployments are often for combat operations where it can be difficult to maintain regular contact with them. Changes in the family’s living situation during the deployment can upend routines even more.
Even though the military provides a wide support system for the families of deployed service members, the stress on a family is immense. Stress on the parent or guardian who remains can cause trauma for the young children of deployed service members. The more overwhelmed and stressed the parent or guardian feels, the more severe the impact on the child (Cooper & Sogomonyan 2010). Maltreatment severity and risk increase during deployment as well. Neglect rates are two times higher than among families without a family member deployed (James & Countryman 2012), which puts children at risk for additional trauma and traumatic response.
Young children are the most vulnerable to the effects of parental deployment, with those ages 3–5 having the highest reported number of behavioral problems. Military spouses report that children’s problem behaviors, anxiety, and stress increase in response to deployment (James & Countryman 2012). These behaviors may include aggression or acting out and anger toward the deployed parent. Other children may withdraw and have intense anxiety and fear related to the person who is away. Children are at greater risk for negative outcomes when a family member has been deployed multiple times or for long stretches, when two parents are deployed, or when the deployed parent is a single parent.
While a substantial number of children experience trauma due to parental deployment, there are many excellent support systems available to military families. Families who feel supported in these ways experience less deployment stress (Cooper & Sogomonyan 2010), and most children in military families do not experience negative outcomes.
Violence and disasters are a reality for children no matter their age or where they live. Looking at a few broad examples can help you understand the effects on children and adjust to better meet their needs.
Gun violence is not a new issue, although it has received more mainstream media coverage attention with the rise in mass shooting events in the United States. Communities have been grappling for years with how to prevent gun violence and support survivors, and the problem is only growing. Early childhood educators need to be a part of the discussion since children are intimately affected by gun violence. An average of 96 people, including 7 children and teens, will die from gun violence every day (Everytown, n.d.). In addition, numerous children and teens die by firearm-related suicide each year or are killed each year in unintentional shootings when a child accesses an unsecured gun and kills themselves or someone else (CDC 2015; Everytown, n.d.).
The effects of gun violence are experienced by relatives, friends, community members, and society as a whole, and the loss, fear, safety concerns, and other emotional response can last for a long time.
Phenomena such as hurricanes, earthquakes, tornados, floods, and wildfires can cause children to be displaced, their normal routines to be disrupted for long periods of time, and the loss of home or personal items. With entire communities being affected, there can be a loss of community support, creation of economic hardships, and injury and loss of life.
Global pandemics, such as the spread of COVID-19 in 2019–2020, are another form of widespread disruption that affects entire communities and leaves an impact on children. These include economic and social impacts such as loss of work, extended school closures, isolation, and severe illness and loss of life.
The unpredictability of such events—often coming with little warning or chance to prepare—means that children can become extremely fearful of events repeating themselves and want to have as much control over their situation as possible. They may try to keep loved ones or precious belongings close at all times and take extreme preparation measures, like always having emergency kits with them or never playing out of sight of an adult.
Children may regress in behaviors such as having toileting incidents or exhibit changes in sleeping and eating patterns. They may also be clingy and need extra reassurance or have fear and anxiety triggered by reminders of the event. For example, a child who witnessed a wildfire may react when they smell smoke or see a campfire.
Crashes and their aftermath can be extremely frightening, and injury or death is a very real possibility. Traffic collisions are distressingly common; motor vehicle crashes are one of the top three leading causes of unintentional death for children in the United States (Johns Hopkins University, n.d.). Plane and train crashes, while not as frequent, can also be catastrophic and terrifying to those involved and their families since they often happen on a much larger scale and the risk for serious injury or death is high. Children who have been involved in any collision, even a relatively mild car crash, may experience symptoms of PTSD (see).
Violence affects children when they are either personally injured or assaulted or witness violence in their home and community. About 51 percent of children report being physically assaulted over their lifetime, and 37 percent report having witnessed violence at some point in their life (Child Trends 2016). This may include experiencing or witnessing maltreatment, sexual assault, or nonfatal assaults or witnessing homicide or intimate partner violence.
Experiencing or witnessing violence has effects that can last well beyond the event itself. Even a single event can undermine children’s sense of trust and safety. They may worry about the security of their environment and whether they will be protected at home, in their early childhood program, and in the community. They also may fear for the safety of loved ones or be less willing to trust adults after seeing someone they know and care about being violent. If children feel they are no longer safe, they may switch into survival mode, living with a heightened sense of fear or readiness to protect themselves (NCTSN, n.d. b).
Symptoms can mimic those of PTSD. Children may have behavior changes like being more withdrawn or aggressive. They may try to avoid situations that remind them of the violent event or be more easily startled and have physical complaints like stomachaches and headaches. Some children may also feel responsible for what happened and feel guilty for not taking action or for being safe when others were harmed.
Terrorism is a very particular type of assault rooted in using violence, fear, coercion, or intimidation to achieve a political, economic, religious, or social goal (National Consortium for the Study of Terrorism and Responses to Terrorism [START] 2018). It may be an act of mass violence like a shooting or bombing or a more targeted hate crime designed specifically to hurt or intimidate parts of the population because of prejudice toward their race, cultural background, religion, sexual orientation, or gender identity.
How children are affected by terrorism varies widely depending on the type of event, how much they or their families were personally affected, their understanding of what happened, and what the recovery afterward looks like. For children directly affected by a terrorist attack, the potential for trauma is linked to the other causes we have discussed. They may be personally injured or assaulted or may potentially witness violence in their community. Friends and loved ones may have been hurt or killed, shattering their general sense of safety and security.
Easy access to descriptions, photos, videos, and accounts of terrorist attacks from television, the internet, and other sources means children may view graphic content over and over again. Young children do not have a secure grasp on time and distance, so they may interpret every image as a separate attack or think that faraway events are happening in their neighborhood. This fear is very real and may manifest in trauma symptoms similar to those seen in children who have personally experienced violence.
PTSD is a specific mental health problem linked closely to all types of traumatic events. Although it was first associated with combat veterans, it may occur in anyone who is exposed to a trauma. People may develop PTSD at any age after experiencing or witnessing a life-threatening event (US Department of Veterans Affairs 2019). It is estimated that 39 percent of preschoolers who have been exposed to trauma will develop PTSD (Fletcher 2003). In fact, since 2013, there is a designated subtype of PTSD known as PTSD for preschool, which describes how the disorder affects children ages 6 and under.
PTSD is characterized by anxiety-related symptoms that develop after exposure to trauma, that worsen over time, last longer than one month, and interfere with day-to-day functioning (US Department of Veterans Affairs 2019). PTSD can last for a brief time or go on for months, years, or the rest of the person’s life depending on the severity of the traumatic event and the person’s reaction to it.
PTSD symptoms in young children include being irritable or hyperalert, having trouble sleeping and concentrating, being more clingy to trusted and familiar family members, reverting to behaviors they had outgrown like bedwetting and thumb sucking, and re-enacting the trauma or aspects of it through play (Mayo Clinic 2018).
Discussion of trauma and young children would be incomplete without specific attention paid to the role of racism in trauma and child health. Racial trauma, or race-based traumatic stress, occurs when people experience or witness racism, whether as microaggressions (see the sidebar), as threats of harm, or as blatant hate crimes and physical assaults (Comas-Díaz, Hall, & Neville 2019; Sue et al. 2007; Williams 2015).
Racism often plays a major role in trauma. Indeed, racism has been identified by the Surgeon General as a cause of trauma (Carter 2006). Children of different races are exposed to trauma at different rates. A 2018 study (Wamser-Nanney et al.) found that Black children are more likely to be exposed to multiple types of trauma, experience more community violence, and be placed in protective custody more frequently than White children. Black and Latino children are at higher risk for child maltreatment, chiefly witnessing domestic violence (Roberts et al. 2011).
ACEs, too, vary by race and ethnicity. In the United States, 61 percent of Black children and 51 percent of Latino children have experienced at least one ACE, compared with 40 percent of White children and 23 percent of Asian children (Sacks & Murphey 2018). ACEs do not exist in isolation; they often occur because of systems in place that perpetuate cycles of disadvantage, oppression, and violence.
Statistics on incidence and reaction to trauma are just part of the picture. Racism can affect children on many levels. These include structural disadvantages through ongoing neighborhood and school segregation, which unevenly distribute resources (Reskin 2012). Discrimination puts Black, Latino, and Native Americans at a greater risk of either being poor or living in poor neighborhoods because of factors related to racist practices in housing and the job market. Living in poor neighborhoods likewise opens families up to ACEs linked to poverty (Child Trends 2019).
Racism also exists on a personally mediated level where a child’s abilities and motives are assumed because of their race (Trent, Dooley, & Dougé 2019). In early childhood education this can be seen explicitly through studies such as the one conducted at Yale Child Study Center that showed that preschool teachers already had an implicit bias against young Black boys that was evident in their interpretation of challenging behaviors and the expectations they had for the children (Gilliam et al. 2016).
How racism intersects with trauma is not limited to firsthand experiences. Historical trauma is a form of trauma that affects an entire community across multiple generations. It is often linked with racial and ethnic population groups that have experienced major intergenerational losses and assaults on their culture and well-being. This includes the legacy of enslaved Africans who were forcefully relocated to the United States, Native Americans who were displaced and murdered, and Jews who were exterminated or survived the concentration camps of the Holocaust (ACF, n.d. b; NCTSN 2017).
Historical trauma has a psychological and emotional response that is felt by descendants, families, and communities. In addition, researchers have found that descendants of those who experienced group genocide and experiences like slavery have inherited biological changes in response to trauma, such as heightened stress responses (NCTSN 2017). This then changes the way the body interprets and responds to stressful incidents. Historical trauma can negatively affect the physical, psychological, and social health of individuals and entire communities that share a past history of racial hatred and genocide (Resler 2019).
In addition, groups continue to be the target of persecution and hate in a way that is directly linked to the historical targeting. Ongoing discrimination in the labor market, policing, and education, for example, motivates many parents to prepare their children for the risk of experiencing discrimination. The day-to-day stress of living with discrimination can have significant physical effects (Chatterjee & Davis 2017).
Families affected by historical trauma often have personal, cultural, and community strengths that enable them to be resilient. However, historical trauma is an important perspective when considering how children, families, and educators are affected by traumatic incidents, and it is critical that early childhood educators understand what they can do to provide a welcoming, fair environment for all children and families (see Chapter 6).
Microaggressions
Microaggressions are “daily verbal, visual, behavioral, or environmental indignities” toward people of color that “communicate hostile, derogatory, or negative racial slights and insults” (Sue et al. 2007, 271). A microaggression might involve name calling, such as “colored,” “Oriental,” or “you people.” It conveys rudeness or insensitivity, for example, telling a job applicant of color, “I believe the most qualified person should get the job, regardless of race” or a White teacher ignoring children of color when listening to children at group time. Microaggressions exclude or nullify the feelings and experiences of a person of color, such as occurs when complimenting a person on their English or saying, “When I look at you, I don’t see color.”
In early childhood education, microaggression is often manifest in a learning environment where books, materials, room decorations, and photos reflect only the dominant culture and where children of color, especially Black boys, are unfairly targeted as disruptive or the perpetuators of anything that goes wrong (Friedman & Mwenelupembe 2020).
What makes this type of racial trauma particularly insidious is that microaggressions often operate below the surface. They may be inflicted unintentionally by those unaware that their words are causing offense and pain. But as early childhood teacher Bret Turner (2019) notes, “At their core, [microaggressions] are coded messages of disapproval that are based in identity: comments and actions that echo larger, structural bigotry, telling marginalized people they don’t belong, that they are less than. Children start internalizing these messages while they are still developing their identities.”
Other factors that intersect with trauma in addition to race and poverty include culture, disability, and gender.
Culture includes the set of behaviors, values, and traditions shared by a group of people. It is a lens that frames children’s understanding of events and shapes their processing of trauma as well as their reactions to it (Caspi et al. 2013). Culture also influences children’s ability to show resilience in the face of trauma.
People of different cultures may define trauma differently and use different expressions to describe their experiences (NCTSN 2013). Each child has unique experiences and cultural expectations, and educators need to understand children’s ways of expressing their experiences. Families in some cultures may avoid disclosure of abuse and other ACEs because it would prove embarrassing if known (Collin-Vezina, Daigneault, & Hébert 2013) and would make the families negatively stand out within their communities. Children in these cultures may learn to internalize their feelings. In some cultures or communities, people are less likely to actively pursue treatment related to trauma recovery (NCTSN 2010). Children in these cultures may be reluctant to share their feelings and may even be shamed by family members if they react to trauma. Still other children are from cultures that work to upend ACEs.
Culture influences how each child reacts to the same trauma. Consider this pre-K classroom:
Four-year-old Jae-Joong, who is Korean American, believes that to be respectful to his teacher, he should not express his feelings and fears concerning the recent shooting in his neighborhood that killed a 14-year-old Latino boy. Instead, he withdraws into himself and shows little interest in classroom activities.
In contrast, his 4-year-old classmate Darius, whose family is from Trinidad and Tobago and who lives in Jae-Joong’s neighborhood, has always been encouraged to express his feelings. With wide eyes and expressive hand gestures, Darius relates everything he knows about the shooting to his teacher. During the next several days, he repeats his tale and re-enacts the incident, focusing on little else.
While Darius’s teachers may readily understand that Darius is dealing with the aftereffects of trauma, they may not be as insightful about Jae-Joong. It may take careful observation and skill to see that he too is in need of immediate attention. Both boys are dealing with trauma in the only way they know how. Both need assistance from their teachers to come to terms with what they have experienced. Until then, neither child will be able to focus on learning.
Learn to know the children’s families well and appreciate their cultural values and norms. This knowledge will help you to better understand how children who have gone through trauma may internalize the experience.
Children with some disabilities are more predisposed to experiencing ACEs than are their peers without these disabilities. For example, children with intellectual and developmental disabilities (IDD) are at greater risk for experiencing ACEs, such as abuse and neglect, than are children without these impairments (NCTSN 2016). Because these children are at high risk for trauma, “any behavior … could be an expression of trauma versus something that just comes along with their disability” (NCTSN 2016, 1).
There is great overlap in behaviors expressed by children who have experienced trauma and children with diagnosed disabilities or conditions such as autism, attention-deficit/hyperactivity disorder (ADHD), emotional disturbance, oppositional defiance disorder, sensory integration disorder, IDD, depression, and anxiety (Nicholson, Perez, & Kurtz 2019). This causes some children who have experienced trauma to receive such misdiagnoses as ADHD, and vice versa (Miller 2014). Children who have been neglected or abused often have difficulty forming relationships with teachers and other adults; have chronic dysregulation (that is, difficulty regulating their emotions and behavior); think negatively; are hypervigilant; and are inattentive, hyperactive, and impulsive (Miller, n.d.). These symptoms are also typically associated with ADHD. So while some children who have experienced trauma may actually have ADHD, many others have received incorrect diagnoses. To further exacerbate this, a child who receives an incorrect diagnosis of ADHD and the typical ADHD treatment of behavioral therapy and stimulant medication will not experience symptom relief since the root cause is trauma.
By addressing the role trauma has played in the child’s behaviors, the child’s evaluation team can determine whether or not trauma is at the root of the problem, thus preventing a misdiagnosis (Crecco, n.d.). At the same time, staff can make sure that a child with a history of trauma who also has an identifiable disability such as ADHD or IDD has a treatment plan that outlines both the socioemotional supports the child needs to address the roots of trauma and the supports needed to address the disability.
Gender also plays a role in how young children experience and are affected by trauma. Girls are more prone to experiencing ACEs in all categories than boys; sexual trauma and physical punishment are especially more common in girls than boys (Epstein & Gonzalez, n.d.). Boys are more likely to experience nonsexual assaults, traffic collisions, and injuries and to witness violence than are girls (Ziegler 2011). And while transgendered youth are not identified in studies at ages 3–6, young people who identify as transgender were found to be 28 percent more likely to experience physical violence than those who identify as cisgender (Treleaven 2018).
Researchers have also found gender differences in children’s reactions and resilience from trauma. Girls are more prone to internalizing their reactions through depression and anxiety following trauma, while boys show more anger and dissociation (Foster, Kuperminc, & Price 2004). Furthermore, boys have a stronger response to firsthand trauma than to secondhand trauma. Girls’ responses are equally strong when exposed to either firsthand or secondhand trauma (NCCD Center for Girls and Young Women, n.d.).
The experiences and events outlined in this chapter have the capacity to cause trauma response in children, but not all children who have these experiences will exhibit a traumatic response. Children respond to adverse events in different ways. Some will show signs of traumatic response as soon as the events occur, while others may act normally for a while and then show symptoms of traumatic response weeks or even months later.
The intensity and lasting power of the traumatic response in children depends on several factors. The nature of the traumatic event, for example, has great bearing on how deeply the effects of the trauma are felt. Being in a traffic collision where no one is seriously injured may not lead to behavioral symptoms. Indeed, most children have the resilience to bounce back from one traumatic incident and return to their normal level of functioning (Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents 2008). However, if the one-time trauma is horrific, such as a child witnessing a loved one being killed, it is more likely to leave deep scarring and serious ongoing symptoms.
Other factors such as the child’s temperament, their age when the trauma began or was experienced, how long the trauma persisted, whether the trauma was experienced firsthand or secondhand, the presence of other risk factors (for example, poverty, a parent’s mental health, community violence), and the child’s support system and level of resilience all influence how a child responds.
It is critical to not simply look at a list of potential triggers to decide whether a child has or has not experienced trauma. Take into consideration the severity of the problem; individual factors such as the child’s age, development, and disabilities or developmental delays; the child’s perception and emotional reaction, and whether family members recognize the source of the child’s distress and are actively seeking ways to alleviate the dysfunction.
It is also important to remember that although you play a vital role in supporting children and families and in providing nurturing environments that help children heal and thrive, you are not a specialist in diagnosing conditions or treating children who have been severely affected by trauma. Moreover, while the signs discussed in this chapter are often a response to trauma, a child may exhibit these behaviors because of another cause. Working closely with families, other primary support systems, and specialists is critical to ensure that children receive the care they need.
Creating a safe environment with consistent routines and establishing trusting, strong relationships gives educators numerous tools they can employ with the children they work with. Future chapters will talk in depth about these ideas and how they can be applied in your program. To lay the groundwork for those strategies, in the next chapter, we look at the ways trauma can affect children’s development. Combined with the information you have learned about types of trauma, this will help you to see how the physical, mental, and social consequences of trauma overlap.