Children and adolescents who have experienced complex trauma have been exposed to multiple, ongoing traumatic events. These are usually interpersonal in nature, involving violent, abusive, or otherwise harmful relations between persons. This might include neglect or abuse at home, war, or community violence.
Complex trauma often develops within a young person’s family or caregiving system. It can involve child maltreatment, but also other conditions that prevent caregivers from being able to meet a child’s needs. For example, war, displacement, the loss of a parent, and mental health problems within the family can contribute to early life trauma.
Complex trauma deeply impacts young people’s emotional, cognitive, and social development. The effects of complex trauma are usually much broader than the symptoms of PTSD (post-traumatic stress disorder). Alongside PTSD symptoms, survivors of complex trauma often experience symptoms related to anxiety, mood, eating, attention and concentration, substance abuse, dissociation, and medical problems.
The term complex trauma can refer to both the traumatic events experienced and the symptoms that it causes.
Most definitions of complex trauma only include ongoing trauma that has been experienced in childhood or adolescence, and not later on in life. They emphasise the developmental impact of complex trauma and the consequent symptoms that emerge. Some definitions of complex trauma specify that these traumatic events should be interpersonal and intended, and not include accidental or natural events.
Defining Traumatic Events
Traumatic events are often defined as exposure to threatened or actual death, serious injury, or sexual violence (DSM-V). But research suggests that post-trauma symptoms also arise after events that do not fulfil these criteria. In particular, interpersonal trauma, including emotional abuse and exposure to family violence, is consistently associated with trauma symptoms.
This has led many experts to use a wider conception of traumatic events that includes interpersonal adversities. This is particularly important in relation to complex trauma: in the United States, interpersonal adversities are the most common form of trauma experienced by children with complex trauma symptoms.
What Is Developmental Trauma?
Developmental trauma is a term used to describe complex trauma experienced by children and adolescents that disrupts the development of cognitive, emotional, and social functions. It has multi-faceted, long-lasting, and significant consequences for a young person’s life that often continue into adulthood.
Children typically have fewer mechanisms to cope with trauma than adults, who may have developed strategies and resources to cope with stress and mitigate the harm. This means that they can be impacted more profoundly and in more aspects of their being. At a time of rapid neurological and biological development, interpersonal traumas shape how they process social situations, regulate emotions and behaviours, and form attachments to others.
Developmental trauma is caused by exposure to traumatic events. However, the presence or lack of a secure attachment relationship is also crucial. While a secure attachment with a caregiver may be able to protect a child against the developmental harm caused by trauma, young people who lack secure attachments are most likely to experience profound disruptions to their development and the way they perceive the world.
How Does Complex Trauma Impact Young People’s Development?
When children and adolescents experience ongoing exposure to threats, they use neural networks in the brain associated with survival. These networks often bypass reflective processes, involving stress responses to triggers that enable fast reactions to avoid the perceived danger.
However, overusing these networks may limit opportunities for the development of other mental capacities, particularly executive functions, which allow young people to thrive in everyday life. Limited self-reflection can disrupt social and emotional learning processes, such as regulating emotions and understanding other people’s intentions and mental states. This can have a deep impact on their interpersonal relationships, ability to cope with stress, and overall mental well-being.
Neuroimaging studies have found that complex trauma is associated with the underdevelopment of pathways in the brain that are required for self-reflection. Complex trauma is also linked to the dysregulation of stress response systems, including the HPA axis.
Rather than taking decisions guided by self-awareness and the integration of experiences, adolescents who have experienced complex trauma may be driven by ‘fight or flight’ reactions, not only to threatening situations but also other aspects of everyday life. Young people may experience persistent anxiety, distrust in others, and feelings of hopelessness and despair. They may develop aggressive behaviours to preempt perceived threats, leading to conduct problems and oppositional behaviours.
The symptoms of complex trauma can also be linked to attachment and early-life relationships. Children who experience interpersonal trauma, particularly by parents or caregivers, experience disruption to their core sense of self, perceptions of other people, and the world around them. This can lead to distrust of others and an understanding of the world as unsafe and threatening. A lack of secure and trusting relationships also limits young people’s social and emotional learning, preventing the development of important social-emotional skills.
What Is Toxic Stress and How Does It Relate to Complex Trauma?
Toxic stress happens when someone experiences excessive, prolonged activation of their stress response systems in the brain and the body. When children experience toxic stress, it can prevent the healthy development of neural connections that support more complex skills, like decision-making and attention, as well as wider biological processes.
Toxic stress often occurs when caregivers don’t or are unable to soothe a child after a stressful event. This can happen in instances of maltreatment or neglect, but also because of a child’s social environment. For example, a caregiver experiencing homelessness, displacement, or economic hardship may struggle to meet their child’s emotional needs.
Toxic stress and its impact can be one of the key processes at play in experiences of complex trauma. Ongoing interpersonal threats may lead to toxic stress, which underpins the development of many complex trauma symptoms. On the other hand, caring relationships early on in life can help to protect against toxic stress and the harm it causes, even when a child is exposed to stressful and distressing events.
How Can We Treat Complex or Developmental Trauma in Children or Adolescents?
There are several different treatment approaches that can support young people living with complex or developmental trauma. These interventions will look different depending on a young person’s age.
Treatment Approaches for Young Children
Child-Parent Psychotherapy
Child-parent psychotherapy supports parents in nurturing a sense of attachment and safety in their child and improving their child’s emotional management, cognitive skills, and behaviours. Therapists also work with parents to identify triggers of trauma in a child’s environment and remove them or find ways to manage them. This might involve exposure therapy or other desensitisation techniques.
Child-parent psychotherapy often incorporates play therapy, supporting a child to develop a coherent trauma narrative through drawings, toys, and other creative methods. In this context, children can express intense emotions in a safe and supported environment, alongside their parents. They can also learn ways to manage the anxiety that results from trauma.
Therapy sessions are adapted depending on a child’s age. For infants, therapy focuses primarily on parenting skills and understanding of how their child may be affected by trauma. For older children, play therapy takes on a bigger role.
Treatment Approaches for Young Children and Adolescents
Attachment, Self-Regulation, and Competency Model (ARC)
The ARC model was specifically developed for children and adolescents who have experienced complex trauma. The model presents a framework from which clinicians can design a specific treatment for each child. These adaptations depend on the age of a young person and their individual characteristics.
The ARC model focuses on four areas:
- Caregiver-child relationships, including how caregivers manage their emotions and how responsive they are to their child
- Children’s emotional management
- Children’s cognitive skills
- Children’s integration of traumatic memories
ARC interventions can involve both individual and family settings. They may include group therapies, family therapy, parenting workshops, and home visits. ARC approaches are grounded in attachment theory, development theory, trauma stress theory and resilience theory.
Intergenerational Trauma Treatment Model
ITTM focuses on supporting caregivers to respond therapeutically to their child and play a key role in their recovery from trauma. It emphasises building parenting skills to respond directly to trauma symptoms. These skills are grounded in cognitive-behavioural therapy techniques, including exposure therapy and cognitive processing.
ITTM also considers the impact of parents’ own traumatic experiences. Using CBT techniques, therapists support parents to identify and reconstruct false beliefs about their experiences and understand how these traumas may affect their child.
ITTM is designed for children and adolescents aged three to eighteen.
Treatment Approaches for Adolescents
Trauma Focused Cognitive Behavioural Therapy
TF-CBT is probably the best-known treatment for children and adolescents who have been exposed to trauma. It’s recently been adapted to address complex trauma specifically.
In TF-CBT treatment, therapists work with child-parent dyads, as well as parents and children individually. It involves several different components or ‘phases’, namely:
- Psychoeducation for parents and children, and parenting skills
- Relaxation techniques
- Emotional regulation
- Cognitive coping and processing
- Trauma narratives
- Navigating trauma reminders
- Child-parent sessions
- Nurturing a child’s future safety and development
TF-CBT sessions focus on building anxiety coping skills and cognitive coping mechanisms before addressing and processing trauma narratives. These skills enable teenagers to process traumas safely, integrating narratives into their memories, conception of themselves, and other experiences. Therapists also support adolescents in challenging false or unhelpful beliefs related to their traumas.
TF-CBT for adolescents with complex trauma may involve a longer treatment program than for other kinds of trauma. It may focus even more on the therapeutic alliance between a young person and the therapist, as adolescents often reproduce their traumatic relationship in the therapeutic one. It may also spend more time on coping skills, as teenagers with complex trauma often struggle to tolerate and manage their emotions.
Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
SPARCS is a group therapy intervention specifically designed for adolescents with complex trauma. It’s intended for adolescents living in stressful environments, focusing on how past traumas impact their feelings and behaviours today. Using techniques from cognitive-behavioural therapy and dialectical-behavioural therapy, SPARCS builds on adolescents’ existing strengths, developing skills such as mindfulness, distress tolerance, problem-solving, and meaning-making.
Seeking Safety
Seeking Safety (SS) focuses on building safety in relationships, ways of thinking, and behaviours. It centres around learning safe coping mechanisms and offering psychoeducation. SS emphasises the connection between trauma and addiction, but can be used as a treatment for either alone.
SS is a flexible program that can be offered in group or individual settings, in residential or outpatient treatment. The program includes 25 topics, each involving a different safe coping skill, such as compassion, grounding, and asking for help.
Seeking Safety doesn’t involve a trauma-narrative component, focusing instead on the links between trauma and present behaviours. It can be effective for adolescents who are still living in stressful – or even traumatic – environments.
Treating Complex Trauma at The Wave Clinic
The Wave Clinic offers specialist mental health support for young people and families. Our residential and outpatient programs deliver exceptional clinical care, combining individual, family, and system approaches. Our team draws on expertise from around the world, with decades of cumulative experience in child and adolescent psychiatry.
Our programs for complex trauma combine individual and group talk therapies, somatic therapies, and experiential therapies, including:
- Trauma-focused cognitive behavioural therapy
- Somatic experiencing
- Mentalisation-based therapy
- Family therapy
- Parenting skills training
Young people who have lived through complex trauma often experience a lack of meaning or purpose in their lives. Through education, vocational learning, and social responsibility projects, our programs support young people in creating new memories and ways of being, discovering new life paths, and finding their place in the world.
If you’re interested in our programs, reach out to us today.
