Video Notes:
Here are 7 areas of potential impairment that might take place as a result of developmental trauma. You might recognise some of these in yourself, and it might help explain why that is, or if you are working with children who have experienced developmental trauma then this might help you understand some of their presentation.
And in this video we are going to cover quite broadly what these domains are and then we can dive deeper into each area in later videos, and we can talk about how to support someone who may be having these difficulties.
And lets not forget that children obviously grow into adults. So although this is generally focussed on children and adolescents, we quite often see these presentations in adults as well.
The first domain we see problems is within the domain of Attachment.
Domain number one. Attachment.
To a child, arguably the greatest source of danger and unpredictability is the absence of a caregiver who reliably and responsively protects and nurtures the child. This early caregiving relationships provides the context within which children learn about themselves, their emotions, and their relationships with others and how they fit in the world.
This helps to support the child’s development in a lot of key areas such as being able to regulate physical and emotional states, the sense of safety (so a secure base to return to after exploring the environment), and early capacity for communication.
This is also where children develop what is often referred to as an internal working model, or a framework of how they see the world and how they and other people fit in it. This is where, you may have heard some of these terms, things like core beliefs come from, or schemas or narratives. And over time these get learned over and over again and reinforced if they keep happening.
As you can probably guess these experiences influence the way we interact with other people and the world. I don’t want this to turn into an attachment theory video, because thats a massive subject in itself and because we have plenty to cover in the other domains but somewhat briefly there are different attachment styles.
Secure
We have a style called secure, which some research states is about 55-65% of the population, and that is the result of receptive and sensitive caregiving. This is where the caregiver has responded appropriately to the child’s cues. When the child feels overwhelmed or distressed the caregiver co-regulates with them to soothe them. The child doesn’t know how to do it themselves so the caregiver does it with them, thats called co-regulation. I still do this with a lot of the adolescents I work with I co-regulate with them. Children are then able to internalise these co-regulation strategies for later use by themselves.
The child has the caregiver as a safe base where they can go out and explore the world, and learn and then if they come across something that is a threat or scares them, or makes them anxious they can return to this safe base for support, for protection, for empathy, for kindness and for co-regulation. Its also said that this builds up qualities like self compassion, they are more likely to feel deserving and accepting of love, care, trust and the co-regulation they are receiving.
However, if this relationship becomes a source of trauma, so if a parent or a caregiver responds to a child in a way that is abusive, dismissive, rejected, shaming, threatening, causes the child fear, or is disconnected, unavailable, unpredictable, incongruent with the childs needs, then this attachment relationship becomes severely compromised and thats one reason that we start to see the other attachment styles of avoidant, ambivalent and disorganised.
And if that caregiver is behaving that way, how does the child know that others will or won’t respond in the same way? This is a far less secure and safe base to be exploring the world from as we saw in the secure attachment pattern. Think about the internal working model or core beliefs that these children might have. “The world is unfair and lonely. The world is dangerous and threatening. Relationships are unpredictable. People wont protect me. I am unsafe, I am unlovable, I am nothing, I am a mistake, I am bad, i am worthless.”
So what happens? Well this leads to a wide range of difficulties. There is uncertainty about the reliability and predictability of the world. Some people go on by learning to cope, and to protect themselves by keeping others way and not forming relationships.
We also see that this causes difficulties in understanding other peoples feelings, and intentions and being able to act appropriately in a social context. Children quite often have poorer social judgement, lower levels of empathy, and have difficulty with perspective taking. And people who have come from this sort of background self report difficulties with social rejection, poor stranger danger, inappropriate friendships, intense relationships, mistrusting relationships, and social withdrawal.
Domain number two. Biology
Next we have the second domain which is biology.
Toddlers or preschool aged children with trauma histories are at risk for failing to develop brain capacities necessary for regulating emotions in response to stress. To put it simply at the risk of dumbing down neurobiology, trauma interferes with the integration of left and right hemisphere brain functioning, such that a child cannot access rational thought in the face of overwhelming emotion. This leads to children reacting with extreme helplessness, confusion, withdrawal, or rage when stressed.
In middle childhood and adolescence, the most rapidly developing brain areas are those that are crucial for executive functioning and success in forming interpersonal relationships and solving problems. Traumatic stressors or deficits in self regulatory abilities impede this development, and can lead to difficulties in emotional regulation, behavior, cognition, and identity formation.
We also see in this domain this idea of implicit memories. These are pre verbal memories that while the child cannot later recall and talk about them, because they have no language stored with them, their body has stored the memories in its sensory systems. Think about this idea of the body keeps the score, which I’m sure you have come across. This can cause what some might refer to as a sensory flashback where they re experience the bodily feeling of immediate danger, with no way to make sense of it or be able to communicate it verbally as the memory has no language attached to it.
And we see difficulty with sensory development, which might look like struggling to know how much force to press on things, struggling with certain textures or with food and certain textures of food, struggling with balance and co-ordination and difficulty knowing when they are too hot or too cold, or difficulty knowing if they are hungry or full up.
Domain number three. Emotion Regulation
Emotion regulation and emotion expression is often impacted in the context of developmental trauma. Usually children learn these skills in their early childhood and by around the age of 10 or so, they know how to notice they are having an emotional reaction, they know what emotion it is they are experiencing, they can express it in a healthy and clear way and manage the emotion well so that they start to feel calm.
We talked about this a bit in the attachment domain, and that is that babies and young children rely on their caregiver to co-regulate. The caregiver responds to the child’s emotions and regulates the emotions for them which teaches them how to respond for themselves later. Then they start to get the message of ‘my feelings are okay’, ‘i can manage these’, ‘people still come to me when i feel this way’, and ‘my emotions aren’t something to be scared of.’
And what can happen through developmental trauma is we may see a child that may not have had their own experiences noticed, labelled or responded to, for a variety of reasons.
And this doesn’t intend to blame the caregiver or parent, there are many many reasons why this may have happened, or the parent may have responded in this way, but these are the impacts of that.
Children struggle with identifying internal emotional experiences. They can’t effectively differentiate emotions such as happy, excited, scared, anxious, and they cant label them as such because they don’t have a framework to do so. That framework most often comes from the caregiver, but if the caregiver doesn’t model this well, for example the child might see a smile but its paired with being hurt, or rejected. Or if a child is experiencing an upsetting or sad emotion (but doesnt know thats what is is yet) and is met with an anger response it really struggles to interpret what is going on. The child might learn that emotions and feelings are dangerous, and when they feel a certain way they get hurt in return. Or they might believe their feelings aren’t important, or acceptable, or valid in some way.
They might have had to find their own ways to work through these confusing emotions such as trying to push them down, bottle them up, avoid them, ignore them, distance themselves from them. Maybe its gone the other way and instead of trying to shut them out they’ve learned that big behaviours like lashing out makes them heard. Maybe it swings between the two, and we can end up in a situation where there is constant activation of the fight, flight, freeze systems with no real workable coping system. Some times this can look like children are attention seeking, or are referred to as being naughty, but thats not really the case, they are trying to communicate in the only way they know how to.
Domain number four - Dissociation
This is a big topic and dissociation comes in many forms and guises, so its going to warrant its own video at some point. I like to think of it as a spectrum that runs from normal kinds of dissociative experiences such as getting caught up in a really good book and you don’t notice whats going on around you, all the way to dissociative disorders such as dissociative identity disorder.
And its thought that dissociation begins as a protective defense mechanism in the face of overwhelming trauma, however it can sometimes develop into its own disorder that then requires its own specific treatment. The DSM identifies specific dissociative disorders as depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder that I mentioned a few moments ago.
Imagine a baby or a toddler who is being physically abused by a parent. Whilst that is happening, so at that specific moment that that is taking place, the child cannot fight back, they cannot run away, so fight or flight is unavailable, but they can retreat into their mind to try and protect themselves from the pain. Sometimes this is referred to as psychologically running away.
So what dissociation looks like is this separation or a disconnection between thoughts, feelings and behaviours. This may look like a child remembering a traumatic experience but not having any feelings attached to it, thinking back to our biology domain this may look like having a stomach ache but having no actual feeling of anxiety underneath it.
There can be flashbacks to memories, feelings, behaviours or physical pain with no understanding of why they are having that or what has triggered it because those memories are fragmented by the dissociation at the time. Imagine how confusing this must be, to have these feelings of immediate danger, this sense of impending danger but not being able to understand why this is happening.
And what are other signs of this that we may see when observing the child? It might appear as if the child isn’t listening to parents or caregivers, or other adults or at school it might look like daydreaming and lack of focus. There may be rapid regressions to previous states like suddenly acting like a baby or suddenly seeming very young for their age. Voice hearing is known as a form of dissociation, so that is worth keeping in mind.
Domain number five. Behavioural Control
Quite often we see this association with under controlled behaviour and over controlled behaviour. So over controlled are rigidly controlled behaviour patterns, compulsive compliance with adult requests, resistance to changes in routines, rigid control of food intake, or hoarding Or undercontrolled behaviour such as aggression and what is sometimes diagnosed as conduct disorder or oppositional defiance disorder.
We may see behaviours that represent children’s defensive adaptations to overwhelming stress such as reenacting behavioural aspects of their trauma through aggression, or sexualised, or self injurious behaviours. Because there might be a lack of coping skills we might see drug or alcohol use to avoid feeling distressing emotions, and because there might be difficulty in knowing how to form or understanding healthy relationships we might see sexual behaviours as a way to try and achieve acceptance and intimacy.
This is also where we often see this idea of window of tolerance being used. So when a child is in their window of tolerance they find their inner world and their outer world tolerable and bearable, and are in more of a position to think, learn, and to relax, and to have fun.
However, for traumatised children quite often small things can push them outside of their window where they either become hyper aroused so hyper meaning too much, so too much arousal so you may see running away, hitting, screaming, shouting, biting, saying horrible things, avoiding things, what might be seen as disruptive behaviours, these are all fight flight behaviours that they are doing to try and get away from the perceived threat to bring them back into their window of tolerance.
Or they can become hypo aroused, hypo meaning not enough, beneath or below. And what we might see here are children feeling numb, feeling dead inside, zoning out, feeling empty, that have difficulty in connecting with others and difficulty thinking clearly. These are those collapse type behaviours you sometimes here about in the fight, flight, freeze, collapse framework.
Domain number six. Cognition
In children, especially children who have had abusive and neglectful caregivers, then that deprivation of sensory and emotional needs appears to really impact cognitive development.
By early childhood, maltreated children demonstrate less flexibility and creativity in problem- solving tasks, children and adolescents demonstrate deficits in attention and abstract reasoning.
By early elementary or primary school, maltreated children are more frequently referred for special education needs. We see lower grades and lower overall academic achievement. We see higher rates of drop out from education. And as time goes on we see this widening effect between peers because as they meet critical points in their lives they don’t have the foundations to build upon.
Having said that, and this is why all of this can get a bit hard to unpick, we sometimes see the other side of this where children appear bright, focussed and achieve academically. Well those children might actually be pre occupied with success and achievement because they feel that being seen and being loved is dependent on those outcomes, but quite often they really struggle with emotional literacy so difficulty with articulating emotions and making decisions about their lives as we’ve seen in the other domains.
Domain number seven. Self concept
If you expose a child to repeated forms of verbal abuse from people who should be there to look after them, such as “you ruined my life”, “you are nothing to me”, and shamed and blamed. Or “you are so stupid”, or being rejected, neglected and having your emotional needs minimised, or having limited or conditional opportunities to be or to feel appreciated, praised or receive positive attention. And spending large amounts of time in survival mode and having a disconnect between your thoughts, your feelings and your body, then its quite easy to think that this will have an impact on self identity or self concept.
There is a quote and I'm not sure who originally said it so I apologise if they happen to watch it, but it is “If you abuse, abandon or neglect a child, the child doesn’t stop loving the parent, they stop loving themselves”.
Children often end up with this sense of being ‘bad’ or ‘unwanted’ and that then becomes their template of how they see themselves fitting within the world. And it doesn’t matter how much you try to tell them that they arent bad or that they are wanted they really struggle to connect with that, to make a genuine emotional connection with that.
This then has issues that come with it such as being vulnerable to exploitation, not knowing what group they belong with, not even knowing things like what they like, what they enjoy and what they want to do, and thats in the present moment never mind trying to think about future plans.
Outro
So something that you might have noticed is that there is a massive overlap between some of these domains and the presentations within those domains and other diagnosis, or disorder, or presentations, and it can be really difficult to pick them apart. So coming up there are going to be videos about the overlap between trauma and ADHD, trauma and ASD, trauma and personality disorder so if you want to know more about that then please consider subscribing to this channel, help it grow, and get this information out there.
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