Introduction

Child trauma, or adverse childhood experiences (known as ACEs) have been frighteningly wide-spread in the U.S.: according to the statistics, 64% of the country's population have had at least one ACE in their lives. But what exactly stands behind these letters? What is the definition to childhood trauma and how does it impact one's further life?

Child traumatic stress is a an emotional response to a deeply distressing or disturbing experience, often leading to long-term psychological and physical consequences. A trauma does not necessarily mean dangerous or life-threatening events took place; chronic stress or persistent emotional neglect can be the harmful factors to cause tghe negative reaction, too. Usually, this type of event causes strong fear and can result in long-term negative consequences. However, it is good to remember that trauma in itself is not an even that happened, but the human's reaction to it, it is how a person responds to it and processes it with time. ACEs vary in types as there are many events that can be considered traumatic.

Some say that children forget things too fast, and therefore, a stressful affair in their early years would not put a child in any danger, especially if they were not a victim, but a witness to it. However, this is a wrong opinion as some of the ACEs cause life-long issues that need serious treatment.

Childhood trauma affects people both on physical and mental levels, may cause relationship problems and have a lot of other impacts. So, to not underestimate the importance of childhood trauma and its consequences, let's probe deeper into the topic and find out what kinds of ACEs there are and how we can help to treat them right.

What Is a Childhood Trauma?

To better understand what hides behind the term 'childhood trauma', let's clarify some of its details step by step.

1. One has to experience traumatic events at the age of 0-17 for it to be called a childhood trauma. The stress an adult undergoes after having some traumatic experience has a different name depending on the kind of event and their reaction to it.
2. A child does not have to be influenced directly by these events. They can have an experience of witnessing violence or simply know that something like that happened to their close friend, classmate, or other person they find important. Seeing or hearing about such an experience can make a child upset, overwhelmed, and frightened.
3. Traumatic events can happen to anyone at any time, there is no particular age that is at risk.
4. Not all of the negative things that happen to children are traumatic, and not all of them will have a long-term impact.

Traumatic Experiences: Examples and Explanation

Now that we are more aware of the childhood trauma definition, let's look through the list of experiences that are often named potentially traumatic events.

1. Family or community violence;
2. Mass violence, terrorism, and school shootings;
3. Natural disasters;
4. Discrimination and racism;
5. Physical, psychological, and sexual abuse;
6. Neglect;
7. Refugee and war experiences;
8. Bullying and cyberbullying;
9. Substance abuse (familial or personal);
10. Sudden or violent loss of a loved one.

These are the situations that often make a child fear for their lives, and therefore, they have a huge negative effect on them. Not all, but some children develop the symptoms of child traumatic stress after a hard experience, that, in turn, may lead to PTSD.

Types of trauma

As for the types of trauma a child can experience at some point of their life, they vary in time and the effect they have on a child. This classification is pretty conditional as one event can have different effects based on the context and a children's different nature.

• Acute trauma is caused by a violent event that happens once, is single and isolated. However, it does not make the consequences less serious. A natural disaster, a major car accident, a serious injury, or exposure to a crime—these are the examples of adverse experiences that bring acute trauma.
• Chronic trauma is brought on by repeated events that hurt a child physically or mentally (or both). Here, the reason might be domestic violence, continuous school bullying, community conflict, an ongoing war experience, or any other traumatic events that have a repetitive nature. Also, chronic trauma is usually based on an event that has a pattern to it.
• Complex trauma is led by multiple events at once. They possess an invasive nature and a child is often exposed to them simultaneously, forced to undergo a bigger stress. It can be abandonment, neglect, abuse, etc. Complex trauma usually appears in early childhood, causing problems in child's development. That is why this kind of issue is also called a complex developmental trauma. It deprives a child of secure attachment, causing difficulties in feeling safety and stability, which, in turn, results in numerous physical and mental issues later.

Understanding a type of trauma a child has is vital for finding the best way to help. Surely, each case is special and requires personal treatment, but still, there are some common methods that are usually applied in these cases.

Common Causes of Childhood Trauma

Although the list of reasons for childhood trauma is rather big, there are some very wide-spread causes that can and do provoke traumatic stress symptoms in children of different age. Let's have a closer look at them.

Abuse

Abuse is, unfortunately, a very common form of child maltreatment. 6 in 10 children under 5 years of age suffer from physical and/or psychological violence regularly, and the crimes like this are usually conducted by the closest people, like parents or caregivers. World Health Organization claims it to have life-long consequences and influence the kids heavily. Besides, there is still little to no info from many low- and middle-income countries because of the social, cultural, and economical reasons that complicate data collection. So, we can only guess how vast the problem actually is.

Yearly, 40 150 homicide deaths in children under 18 years of age happen. There is no exact number of how many of them are deaths due to child maltreatment, but the percentage is sure not small. Unfortunately, the total number is underestimated, too, as some of the cases are mistreated for accidents.

Among the types of abuse, we can highlight the following:

• physical abuse
• sexual abuse
• emotional abuse
• neglect.

Physical abuse

Physical abuse is a term for the actions that are performed to harm or intent to harm a child. An important notion: it does not only concern parents or caregivers; if anybody, including relatives, teachers, and other adults, engdangeres child's welfare, this crime also be specified as childhood abuse.

The actions usually recognized as abuse are:

• shaking
• kicking
• hitting (with hands or objects)
• scratching
• biting
• burning and scalding
• slapping
• punching
• throwing
• drowning
• poisoning

If one causes a child to feel sick, it is considered abuse, too. The list can continue with any action that hurts or harms a kid, be it a goal or a result of neglect or disregard.

Children hurt themselves unintentionally from time to time, and it is okay as their musculoskeletal system, as well as their brain, is only developing, and they don't have full control over it. But, if you notice that getting those injuries become a pattern, and the kid's explanations do not seem valid or do not seem to match the injuries, it is your duty to report this case.

What signs should you pay attention for? Bruises, scratches, burns, and broken bones are typical for physical child abuse. However, there can be much more other hints, like scars, or sleepiness and dizziness (as signs of concussion). In any case, attentiveness and care should be the first protective factors we provide to children around us.

Infants and toddlers suffer most as it is much easier for them to get head injuries. Their behavior, like wakefulness, colic, or temper tantrums, may leave their caretakers frustrated. Head and abdominal injury often occur in this age category.

It is dangerous not only because the harm to children's health can be really serious, but also because at this age, children can't tell about their experience and report abuse.

Sexual abuse

Sexual abuse is a type of behavior that includes manipulating, tricking or forcing a child into sexual activity, as well as using one's power and authority or the kid's credulity. It can be hard for younger children to understand that the thing happening to them is not normal or should be reported as they do not understand the concept of intimate interaction. School-aged kids and teenagers might realize the situation is wrong, but not have the courage to report it, or not even understand how to deliver this information to the adults. Sexual abuse can happen both online and offline, as not every form of it requires physical contact. Generally, sexual abuse is classified into two categories: non-contact and contact abuse.

Non-contact sexual abuse includes:

• exposing the child to sexual acts, activities, or conversations;
• showing pornography;
• making a child masturbate;
• exhibitionism;
• voyeurism.

Contact sexual abuse includes:

• making a child undress and/or sexually touch themselves or someone else;
• inappropriate sexual touching or forcing a child to engage in sexual acts, including kisses and oral sex;
• penetrating or raping a child with any body part or object.

The physical signs of sexual abuse can often be the same as of the physical abuse, but there are some more that signal about child sexual harassment: difficulty in walking or sitting (if they were not typical for the child), pain, discharge, or bleeding in the genital and/or anal area, and the symptoms of sexually transmitted infections.

Sexual play, however, is not considered sexual abuse as it is an activity normally performed by children as a part of their growing up and development process. This might result in viewing or touching each others' genital area, but won't include coercion. To not be treated as sexual assault, the game has to be voluntary, according to age, and not contain any elements of exploitation or coercion.

Emotional abuse

Emotional abuse of children is usually performed with words or actions that negatively influence children's mental health. Adults may traumatize kids emotionally in various ways, but here are some of those that regularly have negative impact on children:

• emotional neglect;
• persistent ignoring;
• not letting a child make acquaintances or have friends;
• depriving a child of praise;
• exposing a child to substance abuse or domestic violence;
• being absent regularly;
• not recognizing or ignoring child's limitations (=pushing too hard);
• manipulating.

These actions make children lose their self-confidence quite fast and drop their ability to establish meaningful contacts both with peers and adults. Also, emotional abuse can deprive the child's social skills development and emotional regulation.

Neglect

Although it may not sound as shocking as substance abuse or other prominent issues, neglect can lead to serious risks for a child's health and well-being, including accidents and long-term developmental issues. When a child is neglected, it means they don't get a chance to meet their basic physical, medical, emotional, and educational needs. Due to a rather passive nature of neglect as a phenomenon, it does not always hold an intention to harm. Quite often, neglect happens because of the carelessness of responsible adults, their lack of knowledge or resources. However, there are cases of conscious ignoring of children's needs, which can be claimed purposeful harm.

Different forms of neglect are often connected and happen to a kid simultaneously: for example, educational and emotional neglect can go hand-in-hand, as well as emotional and physical ones. Still, they all influence the child very much and can be extremely traumatic and take years to cure.

Physical neglect is often a failure of child's caretakers or parents to provide decent nutrition, clothing, shelter, and protection from potential dangers and harm.

Medical neglect is failure to provide necessary medical care (this does include treatment for injures and both physical and mental conditions, and even dental care and vaccinations).

Emotional neglect means a child doesn't receive reasonable emotional support, attention and recognition, which are considered the basic emotional needs of a child. Parents or caretakers are usually very cold and distant in such cases and do not empathize with their children at all.

Educational neglect means a child doesn't get to study neither at school nor at home. If a child manages to visit school, but their family member or caretakers doesn't assure regular attendance, it is also considered educational neglect. This is an especially popular case in low-income countries.

Loss of a Caregiver and Traumatic Grief

It is a misconception that children quickly adjust to loss of a close person because of their young age. Grief interferes with kid's everyday life and causes difficulties in communication and even performing the basic activities, especially if the death was unexpected and sudden.

The National Child Traumatic Stress Network claims that traumatic grief in a child may result in anger, decreased concentration, headaches and stomachaches, and intrusive frightening thoughts and images of the significant person's death. In this case, physical pain are not the direct consequence of grief, but the feelings of a psychosomatic nature.

Even the happy memories of a caregiver often bring a child to negative states like fear, numbing, avoidance and denial.

Effects on Mental Health

Mental health is the first thing to suffer when a child gets maltreated. It is easy for a kid to develop emotional distress, anxiety, depression, or even a post traumatic stress disorder (PTSD).

The stress symptoms may last long after the traumatic events and PTSD, which, if not treated, can also have negative influence on the child's physical health. PTSD may include symptoms such as distressing flashbacks, sleep disturbances (e.g., nightmares and insomnia), emotional dysregulation, and memory impairments.

Some kids mentally separate themselves from their experience, like losing the memories of the traumatic event, or having an impression of watching it from the side. Such phenomenon is called dissociation and can be dangerous for a kid's psyche.

Effects on Physical Health

As children form 0 to 17 years of age are in their era of active physical development, the traumatic events can significantly influence their health causing negative changes or slowing some vital processes down.

The immune system suffers first, and so does the central nervous system as their respond to stress is rather fast.

The more adverse experiences a child has had, the higher are the chances they develop chronic illnesses. Diabetes, asthma, stroke, and coronary heart disease are among the wide-spread adult health conditions that form as a result of a childhood trauma. Traumatized kids are at increased risk of developing autoimmune diseases, too, as well as pulmonary disease, and even cancer.

Long-Term Impact on Relationships and Career

The ability to build strong and healthy bonds with their caregivers, be it parents, grandparents, or other close people who are responsible for a child, secure attachment forms the foundation of a child's emotional well-being. Thanks to these relationships, a child can learn to trust other people, effectively interact with them, and recognize their own emotions, as well as cope with these feelings.

Later on, it can be really hard for a kid who has lived through a traumatic experience, to establish and keep a romantic relationship as people around start to seem toxic and dangerous. According to a research conducted in 2017, child abuse does have marital outcomes: those who have been abused in their early years tend to be less satisfied with their marriages, even on the early stages.

It is not only personal life that suffers from experiencing trauma, but the career, too. Professional development in any area implies communication, and it becomes a real challenge for a person who has a low self-esteem and/or has trust issues. Avoidance coping, defensiveness, and anxiety are only a tip of an iceberg that appears in any interpersonal connections of a traumatized person.

Also, survivors of childhood abuse may encounter difficulties with executive functioning, including planning and organization, as a result of trauma's impact on cognitive processes, which can negatively impact their aptitude.

Low impulse control is treated negatively in professional environment, too. That's why it might occur as a problem for those, who have higher impulsivity as a part of their stress response.

Seeking Help for Childhood Trauma

Any type of childhood trauma needs treatment, and an early intervention is the best any person can do to break the toxic and dangerous pattern and save a child's life. A hands-off policy deprives children who got traumatized of a chance for treatment; they don't have the opportunity for resolving the issues (both physical and psychological) that arise together with traumatic stress. Trying to prevent any negative consequences of this terrible experience can be hard, especially of the changes happen on the biological level. But, in fact, many of them can be mitigated or avoided thanks to Early Intervention.

If you know someone in need for help with their childhood trauma, consider turning to Substance Abuse and Mental Health Services Administration. Apart from that, here are some kinds of therapy to pick from and begin the healing journey..

Types of Therapies Available

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

In this kind of treatment, parents/caregivers and children participate equally. They both get exposed to the childhood trauma reminders gradually, and so they have to learn to overcome this together. Such an approach ensures a child is provided with more parental support on the way to healing, and makes them use the skills they have already mastered in other sessions to emotionally overcome the reminders and triggers. At first, a mental health professional spends 30 minutes with a kid, and then 30 minutes with a parent, separately. With time, joint sessions begin.

Cognitive Processing Therapy (CPT)

This approach is also a cognitive behavioral kind of treatment that focuses on helping patients whose thoughts are firmly stuck on a childhood trauma.

The main idea of this type of therapy is to figure the so-called 'stuck points': those are the points where patient's pre-trauma and post-trauma beliefs collide. For an abused child, these beliefs might be:

pre-trauma: 'Adults care for me and can't do me any harm';

post-trauma: 'They hurt me and I can't feel safe anymore'.

CPT brings patients awareness of their feelings, teaches useful skills to manage their thoughts, and helps to reduce distress.

Attachment-Based Therapy

This approach focuses on the person's inability to build strong, healthy, and meaningful bonds in their adult life. Often the reason for that is a childhood trauma, but this kind of therapy may work for people with different negative emotional background. As you can guess, it is usually performed on older children or adults and addresses their early attachment patterns.

Dialectical Behavior Therapy (DBT)

It is a mix of mindfullness and cognitive-behavioral approaches created by Marsha Linehan. Having started as a way to treat borderline personality disorder (BPD), today Dialectical Behavioral Therapy is used in a wider range of mental conditions. For example, it is often performed to work with self harm and suicidal thoughts, which are quite typical in children exposed to child traumatic stress. Generally, DBT teaches people to regulate their emotions, deal with stress, and live in the moment.

Prolonged Exposure Therapy

Prolonged Exposure therapy generally means the patient has to gradually face their fears remembering and analyzing the traumatic events and the feelings it brought. The thing is, many child trauma survivors tend to avoid any memories of the negative events they have gone through. PE helps eliminate those fears and make the trauma less overwhelming emotionally.

Eye Movement Desensitization and Reprocessing (EMDR)

A patient undergoing EMDR experiences bilateral stimulation thorough guided eye movements. Bilateral here means involving alternating stimulation of the right and left hemispheres of the brain.

To put it simple, a person focuses on the trauma, but that focus is brief, and they are involved in other activity (like eye movement) at the very same time. This way, the emotions and memories associated with a childhood trauma get less vivid, and the patient gets a new perspective of their negative experience.

Somatic Experiencing (SE)

SE guides a patient through the memory of their traumatic experience separated into small doses, focusing on the bodily sensations. This gradually eases trauma symptoms and reduces the stress on a physical level, promoting self-regulation.

Internal Family Systems (IFS)

An inventor of this type of therapy, Dr. Richard Schwartz, viewed a person's mind as an inner family consisting of different members, or sub-personalities. Some of them might hold on to traumatic experiences, prolonging the suffering. The goal of IFS is to empathize with those wounded parts, heal them, and bring all sub-personalities together to find harmony and self-awareness.

Narrative Therapy

Narrative therapy is based on an idea of viewing a person as an expert of their own life. The problems are externalized to help patients distinguish between their identity and their challenges. Such diversification gives the patient a chance to rethink their experience and view it from a new perspective. Narrative therapy can be really empowering and help children believe in themselves again, showing them they are in more control of their life than they have thought after the traumatic incident. Yet, this kind of therapy might work better for older children as they are more capable of analyzing their previous experience and behavior than toddlers or early schoold-aged kids (5-8 years old).

Play Therapy

This approach implies taking game as a major instrument for treating childhood trauma. As plays is one of the easiest ways for a child to express themselves and develop in communication with other players, it can be easier for them to open up, realize what really happened, and figure out the ways to cope with the mental consequences. Of course, a therapist has to equally play with a kid and make them comfortable in a usual child's environment.

Psychodynamic Therapy

This kind of therapy analyzes some past issues that have not been completely resolved and the feelings that lie in subconsciousness, and, thanks to that, gives a clearer vision of the current state. This method can be effective some time after the traumatic events; if the impressions are still fresh, it is preferable to chose another type of therapy that is not so focused on unconscious.

Basic Helping Techniques to Apply

Surely, every case of child traumatic stress has to be treated by a mental health professional. Still, the treatment doesn't have to be limited by specialized help only. You, as a parent, or friend, or a close person, can help the child who has got through a rough experience. Here are some things you can do to support the healing process:

1. Be patient and understanding. Remember that everyone recovers at their own pace. You wouldn't put any pressure on an adult in a hard situation, so treating a child should go twice as thoughtful and careful.
2. Be there for them. Make sure the kid trusts you and understands that you can do anything to keep them safe.
3. Eliminate the guilt. Explain the child that they are not to blame, and they are not guilty of anything. Children tend to think they are the reason for the bad things that have happened, and it is vital to make a clear reassurance to save their mental health.
4. Create a daily routine. Implement simple, understandable patterns in the child's daily life and, what's most important, follow these routines strictly. This creates a safe space for a child to feel that they are in control and know what to expect from their life.
5. Encourage the child to speak. Make sure the kid can express their feelings and learns to describe and recognize their emotions. Talking about the lived experience helps to process and realize it better, and when a responsible guiding adult is around, it is easier for a kid to not start fantasizing but keep the real image of what happened and went to the past. However, too much pressure from the adults may be harmful, so, to ensure the kid feels safe and ready to tell you everything, be supportive and soft.
6. Give the kid honest answers. If they start asking you about the traumatic events, make your answers clear and straightforward, but as soft as it is possible. Remember, a kid sometimes cannot percept everything they've been through, so your job here would be to use simple terms, but not create any illusions. The more lies and uncertainly there is, the harder it will be in the future to overcome this problem; besides, a child has to trust you, and how can they do that if you lie?

So, as you see, there are some simple ways to support children who have experienced childhood trauma, as well as professional ones. Consult a doctor to choose the most suitable type of therapy so that it works best for your kid and remember to do what it takes to give them a necessary safe surrounding full of love and support.

Conclusion

Childhood and trauma can have a really strong bond that can influence a person during their whole life, even in their adulthood. Childhood trauma is a completely negative experience any person can have in their early years. The list of potentially traumatic events is not too long, but their varieties are numerous. The traumatic stress reactions can haunt childhood trauma survivors for years after the events that caused mental and/or physical health problems.

Young people of age 0 to 17 can be assaulted physically, sexually, emotionally, or neglected. They can suffer from natural disasters, war of refugee experience, bullying, mass violence or discrimination.Traumatic events can happen once, or be a continuous experience, or even cause a complex trauma if a child suffers from different kinds of abuse simultaneously.

Adverse childhood experiences may cause life-long consequences if therapy is not applied. Doctors offer many kinds of treatment, so caregivers can choose what works best for their child. Besides, it is important for people who surround a child to be attentive and supportive and create a safe space for a kid who has been assaulted.

Neglecting therapy might provoke both psychological and physiological responses to childhood trauma. Post traumatic stress disorder (PTSR) is among the most obvious consequences, but there are more, like depression, anxiety, developmental issues, and physical injuries. Mental health problems occur, too, depriving a child of ability to trust people, communicate effectively, and build healthy relationships.

If you suspect that a child you know is being exposed to adverse childhood experiences, don't hesitate to ask them and, if necessary, repost the abuse. Provide maximum care and support, and if it is your kid who suffered, ask seek support and use medical assistance, be it mental health services or other forms of help.

Take care of young people around you and try to make the world a safer place for them!