Trauma and Adversity

What is trauma?

A response to a discreet or prolonged circumstance; which at some point is perceived by the person to be an uncontrollable serious threat to physical or psychological integrity and which overwhelms emotional resources.

What has this got to do with my care?

Health care professionals will aim to take your life experiences, including trauma, into account when planning your care. They will co-ordinate the appropriate help and services to meet your needs. This may include a crisis team for out of hours support, outside agencies, psychological therapy. They will also aim to support you in your distress around the trauma related issues which are relevant to you currently.

What treatment could this involve?

• Helping to ensure your safety.
• Helping you to understand your difficulties.
• Helping you with your current mental health difficulties.
• It may be useful for some people to address their trauma in therapy.
• It is important to focus on the future and build on your strengths.
• Your care is tailored to meet your needs.
• Recovery may mean different things to different people.

Trauma & Recovery: Free online course

Our free online course ‘Trauma & Recovery’ aims to provide education about the impact of trauma for anyone with personal experience or an interest in this area. This course can support trauma informed care, trauma therapy or trauma informed peer support.

The intention of this course is to make information about trauma available in an online learning format so that everyone can benefit from a greater understanding of the impact of trauma, with the hope that this understanding will form part of their recovery, or help with someone else’s. This course may be recognised as CPD for staff by your organisation.

To explore this resource, and more, look under the courses at the top of this page.

Trauma Informed Care: Online Resource

This course provides an overview of trauma and how care should be shaped by this. It is aimed people living with mental health problems or people supporting them.

To explore this resource, and more, look under the courses at the top of this page.

Developmental Trauma

Developmental trauma describes repeated traumatic experiences or unmet attachment needs during childhood that led to developmental problems. Until relatively recently, there was very limited understanding of developmental trauma and children affected were given a wide range of labels. For example, ‘maladjusted’. Different organisations refer to developmental trauma in a range of ways. Most diagnoses in the UK are based on the International Classification of Diseases (ICD-11).

The ICD-11 does not use the phrase ‘developmental trauma’, but it does refer to the ‘developmental presentations’ of complex post-traumatic stress disorder. Beacon House, a leading organisation in the study and treatment of childhood trauma in the UK, uses the phrase ‘developmental trauma’. In the USA, the National Child Traumatic Stress Network uses the phrase ‘complex trauma in childhood’. It is also very common to hear professionals using the phrase ‘attachment difficulties’ in this context. Attachment issues in childhood and developmental trauma are closely related. ‘Attachment’ refers to children’s early experiences of nurture and is based on the theories of developmental psychologists Bowlby and Ainsworth.

Common causes

The most common causes of developmental trauma are neglect and abuse in childhood. When children do not receive the care and nurture they need, this affects their development. Some children who experienced trauma very early in their childhood experience profound developmental difficulties which affect them throughout life, even if the rest of their childhood did not involve trauma. Developmental trauma can affect a child before birth, for example, through high levels of stress in the mother which affects the baby’s physiology and in turn, brain development. The period of an infant or child’s development that the trauma took place influences the developmental difficulty the child experiences. Other factors also influence how child are affected. A great deal of human brain development takes place after birth during infancy, and primary care-givers have a central role in this process.

Examples of adverse experiences

There are many different adverse experiences which can be traumatic for children and can affect their development. Here are just a few examples:

• If a child in distress does not receive the soothing from adults that they need repeatedly or over an extended period during their childhood, this may mean that they do not develop a capacity to self-soothe, and they may go on to develop difficulties in regulating their own emotions. The additional stress may impact physiological, emotional and cognitive development.

• A child that does not experience enough interaction with adults in early childhood may experience difficulty in developing language.

• A child that misses out on early play opportunities because of neglect may experience difficulties in sensory and cognitive development.

• A child who experiences physical or emotional abuse from family members may need to try to protect themselves from the adults around them by withdrawing trust or by being very wary of them and learning to predict their behaviour. This ‘hypervigilance’ and tendency to be wary of others can lead to problems in developing trusting relationships throughout life. 

Other difficulties

It is worth remembering that difficulties which are unrelated to neglect or abuse and have nothing to do with parenting can also make it hard for adults to meet the attachment needs of small children. This can lead to developmental issues. A well-known example of this is an undiagnosed hearing difficulty or repeated medical interventions as a small child. Long term physical health conditions experienced as traumatic may lead to developmental trauma.

A further point is that when child neglect does take place, the care-givers who have failed to meet the needs of the child and are therefore responsible for the neglect may have experienced developmental trauma themselves. The developmental trauma of the care-giver may therefore have contributed to their inability to meet the needs of their own child. This situation is known as ‘intergenerational trauma’.

The areas children can experience difficulties as a consequence of developmental trauma include:

• Sensory processing.
• Mood and emotional regulation.
• Behaviour.
• Language acquisition.
• Self-esteem and relationships.
• Memory and cognition.

Given that all the examples in the list above are a part of learning, it is clear that developmental trauma can have a profound impact on a child’s education.

Recovery

Children can and do make up for developmental deficits in a range of ways. For most children where there are strong relationships, parents and family members are likely to have the greatest therapeutic impact and advice and support is available through a range of different organisations (for example, children’s charities and organisations such as YoungMinds, NHS services and local authority education services).

A range of professionals and organisations are involved in supporting children with developmental trauma. Therapists working with adults have a far better understanding of the possible impact on their adult clients of traumatic experiences in childhood and an appreciation of the knowledge and skills their client has developed throughout their life. Professionals that may work directly with children affected by developmental trauma include counsellors and psychotherapists, play therapists, occupational therapists, social workers, educational and clinical psychologists, speech and language therapists and others.

Support for children

Support for children affected by developmental trauma will depend very much on the needs of the child and on their age / developmental stage and the context (for example, whether in the home, an education setting or in a clinical setting). Enabling the child to voice their needs allows for a bespoke approach. For example, for a teenager who has missed out on opportunities for messy play in childhood, creative art or baking could be effective alternatives as they involve similar sensory processes. For other children, an assessment by a highly specialist psychologist may be more appropriate, followed by a period of intensive work.

There is now greater understanding of the brain, and neuroplasticity. The brain continues to develop through childhood and adulthood so there is always the opportunity for recovery. This is particularly relevant to children who experienced traumatic circumstances throughout their whole childhood.

Certain developmental opportunities are only available at certain points in child development. If it doesn’t happen at that point, it may need to happen in a different way later. Children who have experienced developmental trauma may need to develop their own unique work arounds later. Those around them need to be sensitive and open to this. Many adults who are aware that they experienced developmental trauma will be able to identify the things that they did to develop and grow, despite the difficulties which they experienced as children, for example developing coping strategies and building resilience. There are connections between developmental trauma in childhood and problematic behaviours in adulthood (for example, substance misuse). There are links to positive behaviours and character traits (like self-reliance and tenacity) are examples of post-traumatic growth.

Adults who have experienced developmental trauma

The most recent version of the ICD-11 recognises the importance of complex PTSD in childhood. It shows the similarity of the presentation of PTSD with conditions previously identified as personality disorders. This is relevant to adults who experienced developmental trauma and have a mental health diagnosis. Though there are differences between the two diagnoses people with a personality disorder diagnosis might now be diagnosed with complex PTSD.

Videos

In the video below carers describe how it can be difficult for children who’ve experienced trauma to describe how they feel.

Strong, safe and trusting relationships with adults and specialist therapy can help children to recover. It is also important that schools understand the effects of developmental trauma in order to support children in their education.

In the video below listen to some carers describing how they talk to their children about their developmental trauma.