Childhood Trauma & Traumatic Stress
The National Child Traumatic Stress Network (NCTSN) defines a traumatic event as a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity.
Experiences that might be traumatic include:
- Physical, sexual, or psychological abuse and neglect (including trafficking)
- Natural and technological disasters and terrorism
- Family or community violence
- Sudden or violent loss of a loved one
- Substance use disorder (personal or familial)
- Refugee and war experiences or displacement
- Serious accidents or life-threatening illness
- Military family-related stressors (e.g., deployment, parental loss, or injury)
If a child is overwhelmed by or not adequately supported through a traumatic event, this may lead to traumatic stress. Child traumatic stress occurs when a child has experienced one or more traumatic events and continues to experience reactions after the event has ended (NCTSN, n.d).
Adverse Childhood Experiences, or ACEs, refers to traumatic events that occur before age 18. While trauma can happen across the lifespan, ACEs pertains to trauma that happens during childhood and adolescence that causes a profound effect on the developing brain and body. They are extremely common, with 67% of people reporting they had at least one ACE, while 13% had four or more ACEs.
The three primary types of ACES include:
- Abuse
- Neglect
- Household dysfunction/disruption
The original ACEs study was conducted by the Center for Disease Control and Prevention (CDC) and the Kaiser Permanente health organization between 1995-1997. It is one of the largest studies conducted about child abuse, neglect and household challenges and how they impact health later in life. There were over 17,000 Health Maintenance Organization members from Southern California included in this study who received physical exams and completed confidential surveys about their childhood experiences and current health behaviors. This study found a strong correlation between exposure to abuse and household dysfunction and health risk factors later in life (Felitti et al, 1998).
This study led to a rapid interest in understanding the relationship between ACEs and the development of chronic diseases later in life. Although there is still much to learn about the relationship between ACEs and their negative impact on human development, decades of research have shown that there is a dose-response relationship between the number of ACEs a child experiences and the likelihood that they have poor health outcomes and impaired social functioning later in life.
Some of the most common chronic diseases and poor social outcomes are associated with ACEs. These include:
| Chronic Health Conditions | Psychosocial/Behavioral Conditions |
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In addition to ACEs, there are Adverse Community Environments. These include experiences such as concentrated poverty, community violence, and systematic oppression, racism, and disenfranchisement that may worsen adverse childhood experiences. Adverse Community Experiences remind us that trauma not only happens at the individual level, but it also can happen at the community level.
Experiencing trauma at the community level makes ACEs more likely to occur, while at the same time, reducing the conditions that may be protective against the long-term impact of ACEs (Prevention Institute, 2017).
The signs of traumatic stress are unique to each child and vary based on a child’s age and developmental stage. Some common signs of traumatic stress in children based on age are:
Preschool Children
- Fear of being separated from their parent/caregiver
- Cry and/or scream a lot
- Eat poorly or lose weight
- Experience nightmares
Elementary School Children
- Become anxious or fearful
- Feel shame or guilt
- Have a difficult time concentrating
- Have difficulty sleeping
Middle and High School Children
- Feeling alone or depressed
- Eating disorders and/or self-harming behaviors
- Using alcohol or drugs
- Risky sexual behaviors (SAMHSA, 2023)
Fortunately, most children do recover quickly without any long-term consequences of post-traumatic stress. Approximately 1 in 6 children who are exposed to a traumatic event develop post-traumatic stress disorder (Alistic et al., 2014). Although it is unknown why some children do develop post-traumatic stress and others do not, there are factors that may play a role such as biology, the child’s temperament (CDC, 2023) and other individual and community protective factors.
- Sesame Street Online Resources - Caring adults can help kids learn coping and resilience-building techniques to help them face tough challenges like divorce, foster care, grief, and more
The Child and Adolescent Trauma Screen (CATS) questionnaire is a brief screening instrument based on the DSM-5 criteria for Posttraumatic Stress Disorder (PTSD)
Child & Adolescent Trauma Screening (CATS)
Adverse Childhood Experiences (ACEs) are traumatic events that occur before the age of 18. A landmark study found a significant relationship between the number of ACEs a person experienced and negative outcomes in adulthood, including poor physical and mental health, substance use, and risky behaviors.
The ACES Questionnaire can be taken here.