The following information about developmental trauma has been prepared to provide more detailed background on an area that is not widely understood. We have endeavored to frame this discussion in such a way as to honour the living experiences and perspectives of the wide array of individuals, families and communities that have been impacted by developmental trauma. Through our roundtables we are listening and learning to how best to frame what we hope is a ultimately a message of hope, healing and wellness. We are very interested in your feedback on our message as we work together as a community to Heal Childhood Trauma Together.
The DTAA uses the term developmental trauma to explain and capture the effect early life trauma has on a child’s development, and the inherent reliance that development has on a child's relationship with their primary caregiver. Some of the resources suggested below use other terms such as early life adversity, complex trauma or toxic stress to describe this. The DTAA is continuing to canvass and discuss the best approach to the terminology we use to ensure our initiative is easily understood by families and professionals, and the words we use are positive and focused on healing and wellness, and are not seen as pathologizing those impacted by developmental trauma.
Significant adverse childhood experiences, particularly in the first 3 years of life, can lead to profound changes in our brain and body that put people at risk. Our brains have evolved to respond and adapt to stressful experiences as a necessary survival mechanism. These adaptations can undermine healthy development and become damaging patterns or “blueprints” that determine lifelong relationships, mental and physical health, and learning, living and parenting. We call this process and its impacts developmental trauma.
Developmental trauma is not a formal diagnosis. We think of it as a “lens” or a perspective - a way of understanding the broad-based impacts early trauma and neglect have on a developing brain and the broader nervous system. Using a developmental trauma perspective makes it possible to more fully understand how early trauma and neglect affect all aspects of a person’s functioning and health across the life span. It also helps us know what to do to address and prevent developmental trauma.
The concept of developmental trauma came into being because more and more people began to recognize the diagnoses and clinical concepts we had for understanding the impacts of early trauma and neglect were not working. Children and youth with mental health issues and histories of significant abuse and neglect often ended up with huge numbers of different diagnoses. As a result, some children end up with an alphabet soup of labels, none of which adequately describes what we are dealing with. Also, therapy methods that were found to work with adult-onset PTSD did not work very well when the trauma started in childhood.
A key part of the developmental trauma lens is that it shifts the focus of what we are looking for and thinking about from the traditional medical model approach emphasizing PATHOLOGY. Instead of thinking mostly about what is WRONG with somebody, we are learning to think about what has HAPPENED to that person to affect the way they exist in the world.
In particular, to understand the impact of having significant adverse experiences early in one’s life, experiences such as loss, trauma and neglect, we have to recognize that these adverse experiences occurred during the most important periods of the developmental process. The interactions we have with the people we are dependent on in infancy and childhood create ‘relationship blueprints’ for all future relationships and build the brain systems that organize and regulate behaviour throughout our life. When babies do not consistently get their needs met early in life it can have huge impacts on how the architecture of their brains develops.
When caregivers struggle to meet children’s basic needs for a safe, predictable and loving environment, when children suffer neglect and abuse, separations from attachment figures, and other traumas, the experience can be intensely scary and painful and dysregulating. In such situations, instead of using the safety of the caregiver relationship as a secure base to explore the world and learn about themselves, biological survival mechanisms are activated and a child's brain and body adapts itself to their relational environment in order to reduce fear and pain. The impact such adaptations have is predictable and pervasively affects most critical brain/body systems. This process is referred to as developmental trauma.
In particular, developmental trauma affects all seven domains of development. It can impact a child’s sensory and somatic development, attachment development, emotional regulation, behavioural regulation, cognition, self concept and identity development and can create dissociation. Some may frame these impacts as disturbances, but in fact these adaptations become a part of a traumatized child’s brain and body development. These adaptations are not a conscious choice but an innate survival strategy common to all humans. When trauma happens the brain adapts in the moment. In the longer term, these adaptations can be maladaptive. Being aware of this helps us to understand why our children struggle in some situations. The developmental trauma perspective helps all of us understand that it was necessary for impacted children to adapt in this way because their environments actually were scary and possibly dangerous. If they had not adapted to be hyper alert to danger more bad things would have happened to them and they might not have survived.
By recognizing how children had to adapt to survive, the developmental trauma perspective helps children and the people supporting them understand why impacted children act and feel that way that they do, like reacting to situations using their brain’s threat system, even when they are in an environment we think is safe. The emphasis shifts from “What is wrong with you” to “What happened to you”, and promotes acceptance: acceptance of the children by the key people in their lives, and by the children towards themselves.
It is also important to understand that developmental trauma can be thought of as a spectrum from brain injury/adaptations to enhanced coping strategies and resilience. Ultimately, with acceptance and healing the goal is that "What happened to me, doesn't define me".
We now know that early childhood adversity has long-term consequences on mental and physical health, and overall individual and family well-being. We also know that adverse childhood experiences are fairly common and the more adverse experiences a person has experienced, the greater impact it can have on their health. From a big picture perspective, if the causes and effects of early life trauma are not recognized and addressed, the economic costs to society as a whole are very significant.
Recognizing and healing developmental trauma in children is crucial to addressing the needs of many of the most complex and behaviourally challenging children and youth in our province, especially those who, through no fault of their own, are or have been in the care of our child welfare system; adopted children; refugee children; and children in families and communities where developmental trauma has become intergenerational.
A developmental trauma perspective is also necessary to understand and address many adult mental health issues. Studies such as those using the Adverse Childhood Experiences (ACES) model have found that traumatic experiences in childhood such as neglect, abuse (physical, emotional, sexual), household dysfunction (a parent has a mental illness, substance abuse issue, parent incarcerated), or divorce, strongly predict key mental health problems such as substance abuse and depression, but also many problems traditionally seen as physical health issues such as heart disease and stroke.
One Canadian study by Dr. Tracie Afifi of the University of Manitoba found that adults who reported significant abuse as children were 8 times more likely to have a mental disorder than individuals who did not report abuse, were 10 times more likely to have substance abuse disorders, and were 27 times more likely to have reported making a serious suicide attempt.
From a societal and community perspective, developmental trauma helps explain how it is that many families and communities have repeated contacts with the child welfare system across generations, and what can be done to change that pattern.
Traditional approaches are not often effective. Significantly, studies have shown that the treatments developed to treat trauma first experienced in adulthood (i.e., PTSD) are not effective when used to address trauma that occurs in childhood (i.e., developmental trauma).
And, in particular, developmental trauma is a critical concept for understanding and addressing the intergenerational impacts of colonialism such as the “Sixties Scoop”, the residential school system and the current over-representation of indigenous children in the child welfare system, on indigenous people and their communities.
A developmental trauma lens provides a way of thinking where everyone can work together to address the intergenerational impacts of trauma so all our children can live, love and parent in a healthy way.
Developmental trauma, like trauma and post-traumatic stress can be experienced as flashbacks: intrusive thoughts, feelings and memories that make it difficult to regulate emotional, intellectual and physical responses. Coping strategies include avoidance of experiences that trigger these responses; numbing that may include self-medicating with alcohol or drugs and distraction through highly stimulating or extreme pleasure seeking activities.
Unlike trauma and post-traumatic stress, developmental trauma is the result of repeated, early childhood exposure to traumatic events such as abuse and neglect. These events change the way the brain develops, disrupting the normal patterns of attachment, emotional development and learning. Because these experiences often occur before a child has developed language and reasoning skills, the inability to make sense of these experiences frequently leads to unpredictable behaviours, relational difficulty, emotional dysregulation and learning problems that do not respond to traditional forms of therapy, teaching and parenting.
The behaviour of children with developmental trauma is varied. For some it can be temper tantrums that appear to come out of nowhere, are intense and last for extended periods of time. Attempts to soothe and comfort can appear to make things worse, with parents left feeling frustrated, helpless and hopeless. For other children there may be episodes of withdrawal, non-communication and shutting down. At its most extreme, this can result in infants with Failure to Thrive (FTT) that may lead to the death of a child. Attempts to draw the child out can feel futile. Some children may engage in both types of responses.
In adolescence and adulthood the adaptations to the developing brain shows up in an under-developed ability to regulate emotions. This can result in significant problems with anger and aggression, withdrawal and depression. When these problems are a result of developmental trauma, traditional, talk-based therapy is unsuccessful. As a result, people with developmental trauma are at greater risk for mental illness and the associated challenges of learning difficulties, unemployment, social isolation and involvement with the criminal justice system. These problems in turn make parenting increasingly difficult.
Developmental trauma impacts parenting. In addition to the direct impact of repeated, early childhood exposure to trauma on the brain our ability to parent is influenced by the parenting we received. How we were parented becomes the template for how we parent. This intergenerational effect impacts individuals, families and communities. The ACEs study and other research identify the negative consequences for physical and mental health, socialization, learning and life expectancy. While we believe people do the best they can, we know the costs of adaptation are great and take a human toll including substance abuse, addictions and incarceration all of which can negatively impact our ability to provide the secure, stable environment infants and children need to develop into healthy members of society.
Recognizing developmental trauma is the first step to healing. Healing developmental trauma helps prevent future developmental trauma.
There is an effort in the United States to have a Developmental Trauma Disorder diagnosis in the DSM. At this time, developmental trauma has not been formally accepted as a diagnostic category by the American Psychiatric Association. As a result, mental health professionals are sometimes forced to use inappropriate diagnostic categories to explain and address the behaviour of children and youth that families and schools find most challenging. Current diagnostic categories also pathologize the emotional experiences and patterns of behaviour such children show, even though we know they were developed to help the children tolerate harmful early experiences. Because the current system does not include a developmental trauma perspective it reinforces the message people impacted by adverse childhood experiences often received as children - that they are “bad” and that the problems the systems around them are having are their fault.
As noted above, the DTAA is committed to promoting the use of a developmental trauma “lens” or perspective in all sectors working with individuals – children, youth and adults who have experienced adverse childhood experiences. In particular, we are committed to facilitating a focus on recognizing and addressing developmental trauma in mental health services, especially those services working with individuals, families and communities who have experienced adverse childhood experiences and the impacts of intergenerational trauma.
Many children and youth are receiving labels and diagnoses that do not reflect the impact of their early life or developmental trauma. As a result they are not being well served by the systems they interact with – health, mental health, education, child welfare and the justice system. As a result, many are not getting what they need to heal. The DTAA believes that a developmental trauma lens or perspective is needed in order to better understand what is truly going on with children, youth and adults who have experienced it. They need to be understood by the people and systems around them, but even more importantly, they need to FEEL understood. It is then that healing, primarily in the context of healthy relationships, can begin.
With a developmental trauma lens:
Only with greater awareness and understanding, will we get to:
With increased attention and awareness on developmental trauma it is natural to ask, what can we do to help? The answer to this question, like the topic itself, is multifaceted and evolving. In the areas of developmental trauma, prevention, intervention and healing efforts are interwoven.
Let’s look at the entry points:
Prevention of Developmental Trauma
To help most, we want to prevent developmental traumas that are within our control.
Attuned parents who understand the basic needs of emotional development and attachment will be best suited to provide an environment that reduces risk of developmental trauma.
Parents’ emotional wellbeing and emotional availability are interrelated. A parent who is taking steps to ensure their optimal wellness will likely be more emotionally available and attuned to their child.
Preventing developmental trauma and intervening early is important to not only support the growing child/family, but is also important for reducing subsequent challenges that may build on the earlier experience.
One situation that leads to trauma for the developing child happens before birth. Substance exposure (alcohol, nicotine, drugs and so on) is known to cause traumatic birth defects, some which are visible and some, which are not. Stress & abuse in pregnancy is also known to impact the developing child.
Recognizing high-risk families and responding with attachment-focused interventions to respond to their specific needs is critical. Timely recognition and healing of parents who experienced early childhood adversity themselves is a key part of this.
For children in care, understanding the impact of multiple caregivers and systemic moves is essential. Each change creates the potential for trauma through loss. Transition plans that take the child’s experience and readiness into account are important tools for easing changes and reducing risk for trauma.
Education and awareness about developmental trauma for all family members and the service community will help caregivers and service providers develop both prevention and intervention options.
A variety of programs are available in most communities throughout Canada supporting families beginning in the prenatal period. Specialized programs that are designed for child & family mental health can offer intervention to enhance trust and wellbeing. Developmental services are available to assist in remediating early learning needs. Determining the best intervention depends on the child’s age (chronologically, developmentally & emotionally) in combination with their identified needs.
When we understand the nature of early developmental trauma, we also begin to understand the capacity for change and growth in the developing brain and body. Our medical system is a reactive one responding once problems emerge. When looking at developmental trauma and early development needs, the very opposite is required. Rapid and adaptive brain growth in the early years means that instead of waiting for problems to emerge, we using our working knowledge to build skills that are incompatible with potential difficulties. In this way, we are responding to an ‘established’ developmental risk, and aligning with the framework for developmental services. As a result, early childhood intervention also serves as prevention for secondary issues that may develop in response to early trauma.
Emotion focused and trauma informed practices are challenging long held beliefs and practices understood as behavioural management. Trauma informed care requires looking ‘under’ a child’s behaviour to understand the emotional experiences that inform their behaviour. We move from ‘what did you do’…to ‘what happened’ and ‘what did it mean’. Trauma informed care requires empathic and emotional attunement. It is more concerned with the functional analysis of the behaviour (aka what purpose/function it serves).
Healing Developmental Trauma
Healing developmental trauma is a personal and a family journey that is dependent on the developmental age, life experience and identified presenting needs. Everyone experiencing developmental trauma experiences it in their own individual way and so the journey to healing is unique to them.
From the perspective of lived experience, in most cases, it involves reworking the relationship with the self and learning to be our best friend. It requires opening up to the self and to the shadows that exist within, in a compassionate and non-judgmental way. It requires a commitment to self-discovery and growth.
From a professional perspective, the process is influenced by client engagement and motivation, insight, awareness and skills in reflection.
Healing often happens in stages across the lifespan. Our level of openness to ourselves will impact our journey.
The good news is that our brains are resilient.
Preventing and healing childhood trauma needs to be an individual, family, and community-based effort. As noted by the UK’s Beacon House, “Relationships heal relationship trauma.”
Let’s Heal Childhood Trauma - Together.