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.