Trauma Overview

To fully understand the negative role that  trauma can play within the child welfare system, one must first understand the impact of child maltreatment upon children who enter the system.  While states have varying legal definitions, the term "child maltreatment" typically refers to a child who is physically, sexually, or emotionally abused or neglected; exploited; or exposed to domestic violence by a parent or caregiver.  These types of maltreatment can lead to childhood trauma.

Trauma itself can be defined as "simple" or "complex." Simple trauma refers to a single, isolated, definable traumatic event.  Even a single incident of maltreatment can be traumatic and lead to a wide range of potentially negative short-term psychological and behavioral responses from the child that include fear, dissociation, inability to regulate emotions, loss of trust, attachment disorders, and many other issues.

However, evidence also suggests that different types of abuse and neglect rarely occur in isolation. In other words, maltreated children often experience multiple types of abuse or neglect, which in turn results in even greater maladjustment and negative outcomes.  Complex trauma, also referred to as “chronic interpersonal trauma,” refers to a child’s experience of multiple traumatic events or maltreatment that often occur within the context of the child’s caregiving situation.  This chronic maltreatment can result in a lack of secure bonding between the child and his or her primary caregiver, which in turn can cause significant negative effects across multiple well-being domains.  However, children vary enormously in how they are affected by complex trauma, due in large part to a variety of protective and coping factors that each child may or may not possess.

For years, child welfare agencies have provided treatments to maltreated children that focus primarily on a child's mental health.  However, these traditional therapeutic treatments are often ill-designed to deal with victims of trauma and often fail to provide needed long-term support and flexible approaches.  To be effective in their work with maltreated children, agencies must be aware of the differences between treatments traditionally focused on mental health and treatments that are truly part of a trauma-informed system

The Administration on Children, Youth, and Families (ACYF) has developed a Framework for Social and Emotional Well-Being that establishes four well-being domains across which a child’s functioning can be assessed.  This framework helps provide child welfare agencies with an understanding of how to more effectively work with children whose lives have been affected by trauma.

Impact of Child Maltreatment

There is a well-recognized relationship between child maltreatment and a variety of negative emotional, developmental, and health consequences.  However, relatively new evidence also indicates that childhood trauma can actually alter the physiology of a child’s brain, which may lead to significant negative impacts on the child’s neurological development and mental health, and thus the child’s social, emotional/behavioral, cognitive, and physical/developmental domains.  These effects can diminish a child's relational competence and lead to the development of behavioral problems, which together can diminish the child’s capacity to maintain effective interpersonal relationships, progress academically and vocationally, and become a productive member of his or her community.  Furthermore, psychotropic medications may be inappropriately used to treat these effects.

Neurological Development

To understand how maltreatment can affect a child's neurological development, it is important to first understand that the brain is organized into and develops within four distinct regions.  These regions range from least to most complex, and each region develops, organizes, and becomes fully functional at different stages of a child's development.

One of the more critical functions of the lower, or "micro-level," brain regions is the creation of neural networks that facilitate simultaneous communication across the regions.  Impairment of these neural networks can result in a myriad of dysfunctions that extend from the lower regions to the higher, or "macro-level," regions.  Thus, brain development in the higher regions that control functions like perception, reasoning, emotion, and problem-solving is dependent on development in the lower regions.

Many of the micro-level brain processes, including the critical development of neural networks, are dependent on an optimal level of activation, which in part comes from the environment or experience of the child.  When the child has adverse experiences, such as loss, threat, neglect, or abuse, the brain’s developmental processes can be disrupted in the micro-level areas and the neural connections can wither.  This, in turn, can have a cascading negative effect on the macro-level regions of the brain.  Depending on the degree and duration of the adverse experience, these effects can be significant and hamper the child’s functioning well into adulthood.

Early childhood, during which neurons are organized to form the complex workings of the brain, is a critical time for brain development.  This development includes essential neurological processes that establish patterns of behavioral and emotional functioning during subsequent stages of life.  Since a child's early experiences and environment can significantly affect the development of specific areas of the brain, the impact of neglect and the impact of abuse on a child's brain can seriously affect his or her ability to regulate emotions and become emotionally connected with others in the future.

Impact of Neglect

Whether it is a lack of emotional or physical nurturance, neglect can negatively affect the child's neurological development.  If a caregiver is depressed, chronically stressed, inconsistent, or absent, this can adversely affect the brain’s neural networks that help the child to regulate stress and benefit from healthy, nurturing support.  Essentially, these early experiences between the caregiver and child create a template for the child’s brain, setting up associations that help determine the child’s balance between resilience and vulnerability.  Bonding and healthy caregiver/child interaction are critical in ensuring normal brain development; thus, the negative impact of neglect on the developing brain, beginning in the lower regions and expanding into the higher regions, can significantly impede a child’s ability to develop socially and emotionally, and to meet developmental milestones.

For example, one of an infant's primary tasks is to determine how to have his or her needs met.  Infants constantly assess whether their cries for comfort and food are answered or ignored.  When infants feel safe and secure and their needs for food and soothing are met, their brains are free to explore, focus on the objects and people in the world around them, and develop socially and cognitively.  If, however, responses to them are inconsistent or harsh, infants will concentrate their energy and brainwork on survival or ensuring that their needs are met.  As a result, it becomes increasingly difficult for them to interact with surrounding people and objects, as their mental and emotional resources are focused on other tasks and their brains shut out the stimulation needed to develop healthy cognitive and social skills.

Impact of Abuse

Abuse, like neglect, can severely affect a child's neurological development.  While mild or moderate levels of stress for a child within a supportive and nurturing environment can promote adaptive coping skills, abuse or severe neglect can expose children to chronic and abnormal levels of stress, which in turn can lead to elevated levels of cortisol, a stress hormone.  These levels can become toxic and stunt the tissue growth of the hippocampus, an area of the brain that affects the child’s ability to respond to future stress, regulate emotion, and retain memory.

Heightened stress can also impede the development of the prefrontal cortex, a part of the brain that controls critical functions like focusing, planning, self-regulation, and decision-making.  All of these functions are essential for children to successfully navigate their way later in life, academically, in relationships, and in the workplace. 

Mental Health

Children who have been maltreated, particularly those who have experienced complex trauma, may experience higher rates of mental health issues and more mental health diagnoses than other children.  Some of the most common diagnoses of maltreated children include:

  • Post-traumatic stress disorder (PTSD)
  • Attention deficit/hyperactivity disorder (ADHD)
  • Major depressive disorder (MDD)
  • Conduct disorder (CD)/oppositional defiant disorder (ODD)

Since many of the children entering the child welfare system meet the diagnostic criteria for mental health disorders before they enter foster care, it is important that child welfare agencies promote mental health screening and assessment early in the child’s involvement with the system.  It is equally important to remember that there is currently no single diagnosis for the full range of issues that can be experienced by children affected by complex trauma.  Behavioral health specialists may instead use one or several mental health diagnoses in an attempt to categorize the array of difficulties shown by many traumatized children.  However, traditional mental health treatments may not aid traumatized children to better control behaviors and improve social relationships.

For example, in a comprehensive analysis of trauma-informed assessments administered to children who entered foster care in Illinois between 2005 and 2011, the researchers found that it was possible for children to have a mental illness and, at the same time, display trauma symptoms.  The primary concern identified was that children did not receive trauma-focused treatment when they were either misdiagnosed with a mental illness or did not meet the criteria for PTSD.  In both cases, the critical need to effectively address the trauma symptoms was neglected.

Child welfare agencies must focus on developing effective trauma-based screenings and assessments to capture trauma history and symptoms in children whom they serve, rather than relying solely on mental health screening and diagnoses to pinpoint behavioral and mental health needs.  To be effective in this task, the relationship between trauma and mental health, and how decisions about treatment are affected by this interplay, must be understood.  Otherwise, a traumatized child's condition may be treated in isolation, thereby ignoring the disarray of the traumatized child’s condition as a whole. 

Relational Competence

Relational competence refers to a child’s ability to engage in beneficial caregiver and peer relationships, and navigate other social interactions.  Trauma-affected and vulnerable children frequently have difficulty forming and sustaining relationships.  This may be due to the absence of an early nurturing relationship with their primary caregiver.  Nurturing relationships provide the context within which a child learns about reciprocal relationships.  Also, in early adolescence, the neurological development of the brain areas most crucial to successfully forming interpersonal relationships may be hindered by traumatic stressors.

If, however, children in the child welfare system are able to form and sustain supportive relationships with peers and adults, and other protective and coping factors are strengthened, their ability to cope with trauma can be greatly enhanced.  Child welfare agencies should strive, through effective trauma-based screenings and assessments and trauma-informed systems, to strengthen the child’s capacity to successfully build meaningful relationships with others, including the child’s caregivers, by emphasizing the development and employment of critical interpersonal skills like cooperation, seeing another’s perspective, boundaries, and empathy.

While this skill-building is taking place, agencies, caregivers, and others must continually strive to enhance the child’s protective and coping factors by surrounding the child with caring, supportive adults; listening to the child; keeping the child’s world as predictable as possible; and ensuring that the child has a secure attachment relationship.  The goal is not only to enhance the child’s self-esteem, but to make the child feel as psychologically and physically safe as possible.

Behavioral Problems

The National Survey of Child and Adolescent Well-Being (NASCAW) study showed that behavioral problems warranting mental health or behavioral services are common in children who have been maltreated or traumatized.  Many of these children lack sufficient ability to regulate their emotions or impulsivity and may also have difficulty describing their feelings.  They may be unable to articulate their wishes and desires in a socially acceptable way, and may manifest behavioral problems externally through bullying, fighting, or opposition; or internally through withdrawal, anxiety, or fear in the face of non-threatening events, or crying easily.

Caregivers of traumatized children with behavioral issues in the child welfare system frequently have difficulty coping with these children in the home.  They do not understand why a child fails to respond to their affection, support, and structure with improved behaviors.  The caregiver may eventually ask for the removal of a child with behavioral problems, particularly if the child is defiant and aggressive.  This may further compound the child’s social and emotional difficulties, and make permanency even more elusive.

Psychotropic Medications

The use of psychotropic medications for children has risen over the past 10-15 years, although there is currently no definitive, comprehensive information that shows the prevalence of psychotropic medication use among children in the child welfare system.  However, published studies do indicate that there are higher rates of psychotropic medication use among children involved in child welfare than in the general population; older children, males, and children in residential or group settings are the most likely to have psychotropic medications prescribed.

Unfortunately, the full effect of these medications on a child's growth, development, and maturing neurological system remains unknown.  What is known is that psychotropic medications can have a variety of side effects, including lethargy, withdrawal, weight gain, poor appetite, irritability, and sleep disturbances.  They can also cause hallucinations, intrusive thoughts, and paranoia.

There are growing concerns that some children in foster care are prescribed too many psychotropic medications, that their dosages exceed approved recommendations, and that they are being prescribed psychotropic medication at too young an age.  There has, in fact, been a dramatic rise over the past 20 years in the use of antipsychotic medications with foster children.  A seven-state study found that the rate of antipsychotic medication use among foster children was almost nine times that of other Medicaid-covered children, even though foster children made up only three percent of the population of children on Medicaid.  An additional concern is that because there is no clear diagnostic label for complex trauma, a default to a mental health diagnosis is resulting in the inappropriate over-use of psychotropic medication for traumatized children.

Despite these concerns, the high rates of psychotropic medication use among children in foster care may indicate, at least in part, the high level of emotional and behavioral needs of this population.  Psychotropic medication may be necessary to effectively treat children or adolescents struggling with a mental illness, and can be helpful when children are so overwhelmed by their own behavior that their symptoms cannot be managed in other ways.  However, if untreated emotional trauma underlies the presenting symptoms, use of medication as a primary treatment may be ineffective or even exacerbate existing problems, and the stabilization needed to effectively support growth and healing will not occur.

Pending Developments in Psychotropic Medication

Some States have made attempts to regulate, at least to some extent, the use of psychotropic medication for behavior and mood management among foster children, encouraging caregivers to become more skilled in dealing with children’s challenging behaviors. Agencies are promoting more effective, evidence-based treatments for these children, coupled with trauma-focused training and education for staff and foster parents about caring for and managing behaviors of children with significant emotional and behavioral needs. The issues surrounding psychotropic medication use for children in foster care are being addressed through several Federal initiatives outlined in the ACYF Information Memorandum, Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Case (ACYF-IM-12-03).

Complex Trauma

The National Child Traumatic Stress Network (NCTSN), located at www.nctsnet.org, has defined complex trauma, also called "chronic interpersonal trauma," as a child’s experiences of multiple and sequential traumatic events within the context of the caregiving system.  Typically, these traumatic events incorporate two or more types of child maltreatment that begin in early childhood. 

Complex trauma typically involves the lack of a secure bond, or attachment, between a child and his or her caregiver.  The relationship between complex trauma and attachment is complicated.  A disruptive attachment pattern can be the source of complex trauma; conversely, traumatic events can disrupt the normal attachment process.  Because a caregiver bond is normally the fundamental source of stability and security in a child’s life, the lack of a primary attachment can result in the child’s inability to self-regulate emotion and relate beneficially to others.

Children exposed to complex trauma often experience lifelong problems that place them at risk for multiple dysfunctions, including:

  • Substance abuse or other addictions
  • Psychiatric disorders
  • Chronic physical illnesses
  • Poor parenting of their own children
  • Relationship and workplace problems
  • Involvement with the criminal justice system

Needless to say, the impact of complex trauma can be severe, diverse, and persistent across several domains of functioning, with difficulties extending from childhood through adolescence and into adulthood.  It is also critically important to understand the negative impact that complex trauma can have upon a child's neurological development.  In his booklet, Effects of Traumatic Events on Children, Dr. Bruce Perry emphasizes the need for understanding how trauma affects brain development and subsequent cognitive, social, and emotional development, and the implications for assessment and treatment of maltreated children.

Protective and Coping Factors

While exposure to complex trauma can adversely affect child development across multiple domains of functioning, the degree of the trauma's impact can change as the child is exposed to different stressors and developmental challenges.  Various protective and coping factors, including the child’s supportive relationships, self-esteem, and social competency, will affect how each child fares when exposed to trauma.  These factors, whether they are individual factors or family and environmental factors, can help buffer the effects of trauma, strengthening the child’s resilience and competence across various domains of functioning.

Understanding these protective and coping factors is critical to the child welfare practitioner’s ability to respond appropriately to children exposed to trauma, and is key to implementation of trauma-informed practice.  It is the responsibility of caregivers, child welfare practitioners, and other professionals to instill and/or enhance these factors in trauma-affected children to the greatest degree possible and set them on a pathway to healing.

Individual Factors

There are a variety of critical individual protective and coping factors, or traits, that relate to a child’s resilience and ability to cope with adverse events such as maltreatment and trauma.  Many maltreated children possess some of these traits to some degree.  They include:

  • Social supports, or well-developed interpersonal skills, and the ability to secure and maintain a circle of nurturing, supportive adults. Research suggests that strong interpersonal relationships may provide the best defense in coping with stress or trauma.
  • Involvement in validating experiences. Children who participate in experiences such as art, music, outdoor activities, and volunteering, are provided opportunities for success and validation, which helps build feelings of worthiness and lessen the effects of trauma.
  • Healthy self-esteem. A good self-concept and regular experiences of positive emotions promote resistance and resilience to the effects of trauma.
  • Adaptability. Flexibility in perspective, beliefs, and emotions is a protective factor against adverse experiences.
  • Aptitude. Resourcefulness and intellectual mastery can help mitigate the effects of trauma.
  • The ability to think rationally. This ability, which enables children to make sense of the actions of others and brings logical, clear ideas about their experiences to the forefront, is a factor in mitigating trauma.
  • Positive temperament. A positive temperment provides the ability to see things in as favorable a light as possible and helps children cope with the effects of trauma.
  • Positive beliefs about the world. Children who perceive the world as fair, safe, and predictable are generally better able to withstand the effects of trauma.
  • Degree of mastery and autonomy. When children feel that they have a sense of power and control over their lives, they can better deal with traumatic events.

It is important to remember that these protective factors interact differently in different children, and that some trauma-affected children can function fairly competently in some social and emotional areas but not in others.

Family and Environmental Factors

Unlike a child's individual factors, which are protective and coping factors intrinsic to the child, family and environmental protective and coping factors refer to factors that are generally outside of the child's control, such as the available extended support network.  These factors, which relate to a child’s resilience and ability to withstand trauma, include:

  • Positive attachment and connections to emotionally supportive and competent adults within the family or community. Parents or other significant adults who can provide emotional support and understanding can significantly increase a child's ability to cope effectively with trauma.
  • Socioeconomic resources. Children from families with adequate resources are much more likely to have fewer stressors than children from families with inadequate resources, and it is also likely that parents with adequate resources will be more able to provide support and resources that children need to mitigate trauma.
  • Ties to extended family. These ties can provide a child with additional supportive resources from a trusted network of adults and help mitigate the effects of trauma.
  • Caregiver/parental capacity to provide the child with a secure base and a secure attachment relationship. A child with a secure attachment will have more cognitive and emotional resources for dealing with trauma than a child with insecure attachments.
  • Caregivers/parents who are able to effectively manage their own response to the child’s trauma. Caregivers who stay calm, supportive of the child, and focused on meeting the child’s needs rather than their own provide an important defense against the negative effects of the child's trauma.
  • Caregivers/parents who believe and validate the child’s experience. Knowing that someone understands and cares about what has happened to them greatly increases the child’s ability to cope with adversity.
  • Availability of community supports. Accessible community social organizations that promote healthy child development are valuable resources to children dealing with adverse situations.
  • Communities that send a clear message of behavior and events that are acceptable. Children and caregivers who recognize clear boundaries of acceptable and non-acceptable behavior feel more supported in dealing with trauma.

These family and environmental protections help mitigate the effects of maltreatment and trauma experiences for a child.  However, like individual protections, the family and community supports are present in different degrees for different children, and their interplay in a specific child is complex and varied.

ACYF Framework for Social and Emotional Well-Being

There are various constructs, or frameworks, that have been designed to present, in an easily understood fashion, how both healthy and impaired functioning affects children across multiple domains of their lives and relates directly to how they interact with others and function on a daily basis.  Many of these frameworks describe "domains of functioning" that have some commonality or overlap with other constructs.

The framework developed by the Administration on Children, Youth, and Families (ACYF) focuses on social and emotional well-being.  The framework, which is adapted from the research of Lou, Anthony, Stone, Vu, & Austin (2008), establishes four well-being domains across which a child's functioning can be assessed, and provides for flexibility and refinement, depending on the age and developmental level of the child.  For instance, independent living skills are indicators of well-being only for older youth.  The framework’s purpose is to present a way for child welfare agencies to understand and promote well-being that is aligned with ACYF’s overall focus on system change, and, as such:

  • Engages in continuous quality improvement (CQI) of child/youth functioning
  • Takes a proactive approach to social and emotional needs
  • Uses developmentally specific interventions
  • Focuses on child and family outcomes
  • Promotes healthy relationships for children and youth

In their research, Lou et al. found that some of the existing well-being frameworks were either too focused on deficits or did not account for the child’s resilience or environmental supports.  ACYF’s framework addresses these concerns, incorporating two intermediate outcome domains, “environmental supports” and “personal characteristics,” into the overall framework to illustrate factors that may influence a child’s ability, positively or negatively, to cope with trauma.  Environmental supports include family income, family social capital, and community factors such as neighborhood.  Personal characteristics include the child's temperament, cognitive ability, identity development, and self-concept.  The various factors within these two intermediary domains are related to the child’s protective and coping factors.

Well-Being Domains

The four Well-Being Domains of the ACYF framework are:

  • Cognitive functioning, which includes competencies such as language development, approaches to learning, problem-solving skills, academic achievement, school engagement, and school attachment
  • Physical health and development, which incorporates the normative standards for growth and development, gross and fine motor skills, overall health, and risk-avoidance behavior related to health
  • Emotional/behavioral functioning, which includes competencies such as self-control, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms, self-esteem, emotional intelligence, self-efficacy, motivation, prosocial behavior, positive outlook, and coping
  • Social functioning, which is defined by social competencies, attachment and caregiver relationships, social skills, and adaptive behavior

The components that make up these domains directly relate to how children live their day-to-day lives, or how they deal with frustrations, cope with tasks and responsibilities, and interact with others.  In addition, the ACYF framework assesses functioning across the domains according to the child’s age and developmental stage, as per these four stages:

  • Infancy (0-2)
  • Early childhood (3-5)
  • Middle childhood (6-12)
  • Adolescence (13-18)

Cognitive Functioning

The effects of maltreatment can linger long after the neglect or abuse occurs.  Because caregivers have such a critical role in fostering children’s cognitive development, the sensory deprivation caused by caregiver neglect appears to be particularly detrimental to the cognitive development of young children.  Many neglected infants and toddlers demonstrate delays in language development, as well as deficits in overall intellectual ability.

Research has consistently found that maltreatment increases the risk of low academic achievement and problematic school performance.  School performance is also significantly associated with a child's ability to regulate emotional responses and interact competently with peers and authority figures, abilities that are adversely affected by complex trauma.  This may be manifested in the child as over-reliance on teachers for completion of tasks, reluctance to try challenging or new tasks, and poor relationships with classmates.

In early elementary school, maltreated children may show short attention spans and an inability to concentrate and organize thoughts or conform to the structure of the school setting.  In middle school, children affected by complex trauma are more likely to face disciplinary actions.  By adolescence, maltreated children may show problems with abstract reasoning and problem solving.  Also, because of their ongoing behavioral issues, they may experience more frequent disciplinary action.  Consequently, they may disengage academically.

Physical Health and Development

Aside from the obvious effects of serious injuries, like broken bones or brain injuries, and possible resulting disabilities from physical abuse, the physical pain from other types of abuse will eventually pass.  However, maltreated children frequently experience additional kinds of physical issues, such as failure to thrive (delayed weight gain and growth) and even brain damage, stunted growth, and mental retardation from chronic malnutrition.  Because neglected and emotionally abused children must focus their mental energies on having their primary needs met, they cannot spend adequate time in motor activities and explorations.  Consequently, delays in their physical development are not uncommon.

report completed by the U.S. Department of Health and Human Services indicated that maltreated children from birth to 36 months are at substantial risk of experiencing developmental problems.  The level of risk for developmental delay remains high even years after the initial maltreatment.  Infants and toddlers who are neglected may exhibit poor muscle tone, delays in fine and gross motor skills, poor coordination and muscle control, and delays in reaching developmental milestones.  They may be difficult to soothe and may have small stature.  They may also be chronically ill; many have upper respiratory infections and digestive problems.

Trauma-affected children, particularly preschoolers, may also regress in their development and lose skills they had previously mastered.  For example, toilet-trained children may suddenly lose their ability to control their bladders and have to re-learn toileting control.  Maltreated children of school age may show general delays in physical development, with awkward gait and motor movement, poor coordination and muscle tone, speech and language difficulties, and low levels of strength as compared to their peers.  They may also lack the coordination and skills necessary for perceptual-motor activities, such as playground activities or sports.  As maltreated children enter their adolescent and teen years, they may begin to participate in risky behaviors such as smoking, promiscuous and/or unsafe sex, picking fights, and substance abuse, all of which may further affect their well-being.

The Adverse Childhood Experiences Study (ACE), an ongoing, decade-long collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Department of Preventive Medicine, addresses the effects of childhood experiences on adult health.  Findings show that children who experienced adversity such as neglect, physical and sexual abuse, or exposure to domestic violence may likely have health problems in adulthood as a result.  The study states that there is “a powerful relationship between our emotional experiences as children and our physical and mental health as adults.”  In other words, the effects of childhood trauma and maltreatment that distort children's lives can last for a lifetime.

Behavioral/Emotional Functioning

Children affected by trauma may present a variety of emotional issues.  They may have experienced ongoing assault to their self-esteem from blaming or humiliating messages from a caregiver, or from lack of positive attention in a neglectful environment.  They may feel powerless, vulnerable, exploited, and unlovable.

Because capacities to safely express emotions and to regulate emotional experiences are linked, children exposed to complex trauma may show impairment in both of these skills due to neurological deficits and resort instead to maladaptive coping behaviors such as dissociation or emotional detachment to avoid further pain and anxiety.  Dissociation can occur to varying degrees; in its most intense form, children may emotionally separate from their bodies during a traumatic event and become unaware of their surroundings.  Following the trauma, memories of that experience may trigger the dissociative reaction.  Other maladaptive coping behaviors include avoidance, which is withdrawal from a stressor or situation, and substance use or abuse. 

Children exposed to trauma may also be “internally agitated" and display hyper-vigilance, an exaggerated startle response, a fast heart rate, and increased muscle tone.  They may also have great difficulty maintaining a state of internal calm.  Many traumatized children are diagnosed with Post-Traumatic Stress Disorder (PTSD), which may bring with it any number of these effects as well as panic attacks.  Other common emotional and psychological effects of trauma are attention problems, bed-wetting, concentration problems, sexual reactivity, and acting out.  The traumatized child may suffer from insomnia, depression, eating disorders, inability to concentrate, and self-mutilation.  Additionally, a maltreated child may experience excessive loneliness, paranoia, lack of interest in daily activities, and poor relationships with others.

Because trauma-affected children may have multiple emotional issues and deficits, behavioral problems are not uncommon.  Children who have experienced trauma may react with apathy, defiance, aggression, cruelty, and even rage in their day-to-day lives; they may appear unreceptive to treatment and efforts to intervene, and may be difficult for caregivers and teachers to manage.  These children tend to have more placement changes in care, and caseworkers may be inclined to blame them for taxing caregivers to the point that the child's removal is requested.  Many maltreated children exhibit emotional problems to the extent that a mental health diagnosis is made.  Thus, it is critical that child welfare agencies screen for and assess trauma, and employ evidence-based, trauma-focused treatments for children in care.

Social Functioning

Social functioning is yet another aspect of a child’s life that may be negatively affected by maltreatment.  The ability to become emotionally attuned to others and regulate emotions, otherwise referred to as "social competence," encompasses the capability to take another person's perspective, share experiences and learn from them, and apply that learning to further interactions with others.  This ability to communicate and relate effectively to others is the building block for future interactions with people in all walks of life.

Because of their early negative experiences and possible alterations in neurological development, many maltreated children lack the capacity for basic trust in others and find it difficult to form appropriate friendships.  The traumatized child may feel inferior and incapable around other children and may be overwhelmed by peer expectations of academic, social, and athletic performance.  This can lead to the child becoming detached and withdrawn.  Trauma-affected children may also be impulsive, have emotional outbursts, and experience difficulty in deferring gratification.  Schoolmates may view them with dislike and derision, and they may become scapegoats among peers. 

Some maltreated children, particularly those who have experienced complex trauma, have difficulty learning basic social skills and may either over-comply with or defy authority figures.  They may also be extremely shy and passive or, on the other hand, may employ aggression to solve interpersonal issues.  In addition to their social awkwardness, trauma-affected children may have low self-esteem and be easily victimized by both peers and adults.  These social difficulties, if left untreated, may affect children throughout their adult lives.