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Trauma and Treatment in Early Childhood: A Review of the Historical and Emerging Literature for Counselors



Young children are especially susceptible to exposure to trauma. Rates of abuse and neglect among this population are staggering. This article presents a review of relevant literature, including research findings specific to early childhood vulnerability to trauma, symptoms associated with traumatic events, diagnostic validity of early childhood trauma, and treatments for young children. In the past, misconceptions about the mental health of young children have hindered accurate diagnosis and treatment of trauma-related mental illness. Due to the prevalence of trauma exposure in early childhood, counselors are encouraged to become familiar with ways that clients and families are impacted and methods for treatment. Implications for future research also are presented.
Kristen E. Buss, NCC, is a counselor at Hope-Thru-Horses, Inc. in Lumber Bridge, NC. Jeffrey M. Warren, NCC, is an Assistant Professor at
the University of North Carolina-Pembroke. Evette Horton is a clinical instructor at the UNC OBGYN Horizons Program at the University
of North Carolina-Chapel Hill. Correspondence can be addressed to Jeffrey Warren, The University of North Carolina-Pembroke, P.O. Box
1510, School of Education, Pembroke, NC 28372,
Kristen E. Buss
Jeffrey M. Warren
Evette Horton
Trauma and Treatment in Early Childhood:
A Review of the Historical and Emerging
Literature for Counselors
Young children are especially susceptible to exposure to trauma. Rates of abuse and neglect among this population
are staggering. This article presents a review of relevant literature, including research ndings specic to early
childhood vulnerability to trauma, symptoms associated with traumatic events, diagnostic validity of early
childhood trauma, and treatments for young children. In the past, misconceptions about the mental health of young
children have hindered accurate diagnosis and treatment of trauma-related mental illness. Due to the prevalence
of trauma exposure in early childhood, counselors are encouraged to become familiar with ways that clients and
families are impacted and methods for treatment. Implications for future research also are presented.
Keywords: early childhood, trauma, treatment, mental health, mental illness
Children from birth to age 5 are at a particularly high risk for exposure to potentially traumatic events
due to their dependence on parents and caregivers (Lieberman & Van Horn, 2009; National Child Traumatic
Stress Network, 2010). Traumatic events are incidents that involve the threat of bodily injury, death or harm
to the physical integrity of self or others and often lead to feelings of terror or helplessness (National Library
of Medicine, 2013). The American Psychological Association (APA) Presidential Task Force on Posttraumatic
Stress Disorder (PTSD) and Trauma in Children and Adolescents (2008) indicated that traumatic events
include suicides and other deaths or losses, domestic or sexual violence, community violence, medical trauma,
vehicle accidents, war experiences, and natural and manmade disasters. With more than half of young children
experiencing a severe stressor, they are especially susceptible to accidents, physical trauma, abuse and neglect,
as well as exposure to domestic or community violence (National Child Traumatic Stress Network, 2010).
Over 20 years ago, Straus & Gelles (1990) estimated that three million couples per year engage in severe
in-home violence toward each other in the presence of young children. The Administration on Children, Youth,
and Families (2003) reported that in 2001, 85% of abuse fatalities occurred among children younger than 6
years of age, and half of all child victims of maltreatment are younger than 7. More recently, the Child Welfare
Information Gateway (2014) indicated that 88% of child abuse and neglect fatalities occurred among children
7 years of age and younger. Often, there is an overlap between domestic violence and child physical and sexual
abuse (Osofsky, 2003). In addition to domestic violence, young children also are vulnerable to community
A study conducted by Shahinfar, Fox, and Leavitt (2000) suggested that the majority of young children
enrolled in Head Start experienced violence in their communities. Young children also are exposed to traumatic
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Volume 5, Issue 2, Pages 225–237
© 2015 NBCC, Inc. and Affiliates
stressors such as accidental burns or falls resulting in hospitalization or death (Grossman, 2000). It is common
for children to experience more than one traumatic event (APA Presidential Task Force on PTSD and Trauma in
Children and Adolescents, 2008).
Young children birth to age 5 are especially vulnerable to adverse effects of trauma due to rapid
developmental growth, dependence on caregivers and limited coping skills. However, despite decades of
statistical data, counselors generally have limited knowledge of the impact of traumatic events on younger
children in comparison to older children and adolescents (De Young, Kenardy, & Cobham, 2011). Reasons for
this disparity in knowledge include a historical resistance to the notion that early childhood mental health is
important and concerns about diagnosing young children with mental disorders.
Research in early childhood mental health has developed rapidly over the past 20 years. Practitioners and
researchers who work with this population continue to contribute to the understanding of trauma and early
childhood mental health. However, the broader counselor population seems less informed which hinders
referrals for this vulnerable population of young children. For example, a counselor may work with a victim
of domestic violence who has young children. However, due to the counselor’s limited knowledge of early
childhood trauma and the impact of domestic violence, the counselor may not consider support services for the
children. The present article examines the history and diagnostic validity of trauma-related mental illnesses in
young children, the symptoms of trauma in early childhood, the longitudinal impact of early childhood trauma,
the protective and risk factors associated with trauma in early childhood, and current and emerging treatments
for this vulnerable population.
Mental Health, Trauma and Young Children: A Historical Perspective
Historically, researchers have spent little time and energy researching the effects of trauma exposure in early
childhood. A widely held misconception has been that infants and young children lack the perception, cognition
and social maturity to remember or understand traumatic events (Zeanah & Zeanah, 2009). Additionally, mental
health counselors have been hesitant to diagnose trauma-related mental illness as a result of the associated
stigmas that plague young children. In some cases when a child is diagnosed with mental illness, society focuses
on the diagnosis and not the child.
Today it is widely accepted that children have the capacity to perceive and remember traumatic events. From
birth, the tactile and auditory senses of a child are similar to those of an adult, which suggests that a child can
experience stressful events (De Young et al., 2011). At 3 months of age, a child’s visual sensory development
increases exponentially. A study by Gaensbauer (2002) suggested that infants as young as 7 months of age
can remember and reenact traumatic events for up to 7 years. By 18 months of age, children begin to develop
autobiographical memory; however, it is unlikely that memories from before that age can be recalled verbally
(Howe, Toth, & Cicchetti, 2006). Researchers have demonstrated that infants and young children have the
perceptual ability and memory to be impacted by traumatic events (De Young et al., 2011; Howe et al., 2006).
While research ndings have conrmed that traumatic events can impact children, clinicians without proper
training in early childhood mental health may have difculty diagnosing trauma-related mental illness in
childhood. Children younger than 5 years of age typically experience rapid developmental changes that often
are misinterpreted or not fully accounted for which hinders proper diagnosis and intervention (Zero to Three,
2005). Given time and insurance reimbursement constraints, there can be difculties observing children’s
behaviors across settings (Carter, Briggs-Gowan, & Davis, 2004). Although verbal skills develop rapidly in
early childhood, children may lack the communication skills necessary to accurately express their thoughts,
The Professional Counselor/Volume 5, Issue 2
emotions and experiences (Cohen, 2010). When conducting assessments, mental health professionals rely on
parental feedback, inventories and reports from multiple sources, thus increasing the accuracy of the assessment
(Carter, Briggs-Gowan, Jones, & Little, 2003).
There is a lack of psychometrically sound diagnostic tools for directly assessing trauma symptoms in
children (Strand, Pasquale, & Sarmiento, 2011). Those tools currently available do not appropriately consider
the developmental levels of young children (Carter et al., 2004; Egger & Angold, 2006; Strand et al., 2011).
However, there are well-designed instruments for early childhood that utilize indirect assessments such as
clinician observations and parent/teacher reports (Yates et al., 2008).
Diagnostic tools and assessments developed for children over age 5 are not suitable for assessing young
children. For example, young children may not fully understand the directions or the vocabulary used in certain
assessment tools. Furthermore, the diagnostic criteria for specic mental health issues (e.g., PTSD) are not
developmentally appropriate for children younger than 5 (Scheeringa & Haslett, 2010). The APA Presidential
Task Force on PTSD and Trauma in Children and Adolescents (2008) argues that children are not being
appropriately identied or diagnosed as having trauma histories and do not receive adequate help.
From a historical perspective, mental health counselors as well as society as a whole have hesitated to
acknowledge the plight that young children face in terms of trauma exposure. Several historical factors have
contributed to counselors’ general lack of knowledge and expertise regarding this population. However, recent
advances in research and in the counseling profession, such as the new American Counseling Association
division, the Association for Child and Adolescent Counseling, have begun to broaden counselor knowledge in
this area.
Symptoms of Trauma in Early Childhood
Trauma reactions can manifest in many different ways in young children with variance from child to child.
Furthermore, children often reexperience traumas. Triggers may remind children of the traumatic event and a
preoccupation may develop (Lieberman & Knorr, 2007). For example, a child may continuously reenact themes
from a traumatic event through play. Nightmares, ashbacks and dissociative episodes also are symptoms of
trauma in young children (De Young et al., 2011; Scheeringa, Zeanah, Myers, & Putnam, 2003).
Furthermore, young children exposed to traumatic events may avoid conversations, people, objects, places
or situations that remind them of the trauma (Coates & Gaensbauer, 2009). They frequently have diminished
interest in play or other activities, essentially withdrawing from relationships. Other common symptoms
include hyperarousal (e.g., temper tantrums), increased irritability, disturbed sleep, a constant state of alertness,
difculty concentrating, exaggerated startle responses, increased physical aggression and increased activity
levels (De Young et al., 2011).
Traumatized young children may exhibit changes in eating and sleeping patterns, become easily frustrated,
experience increased separation anxiety, or develop enuresis or encopresis, thus losing acquired developmental
skills (Zindler, Hogan, & Graham, 2010). There is evidence that traumas can prevent children from reaching
developmental milestones and lead to poor academic performance (Lieberman & Knorr, 2007). If sexual trauma
is experienced, a child may exhibit sexualized behaviors inappropriate for his or her age (Goodman, Miller, &
West-Olatunji, 2012; Pynoos et al., 2009; Scheeringa et al., 2003; Zero to Three, 2005).
The symptoms that young children experience as a result of exposure to a traumatic event are common to
many other childhood issues. Many symptoms of trauma exposure can be attributed to depression, separation
anxiety, attention-decit/hyperactivity disorder, oppositional deant disorder or other developmental crises (see
American Psychiatric Association, 2013). It is important for counselors to consider trauma as a potential cause
of symptomology among young children.
Long-Term Consequences of Early Childhood Trauma
Recently, researchers have focused on how trauma during early childhood impacts mental and physical
health later in life. Symptoms of mental illness can manifest immediately after a trauma, but in some cases
symptoms do not emerge until years later. PTSD, anxiety disorders, behavior disorders and substance abuse
have all been linked to traumatic events experienced during early childhood (Kanel, 2015). The types and
frequencies of traumatic events and whether they were directly or indirectly experienced also can have various
effects on physical and mental health later in adulthood. In a review of literature, Read, Fosse, Moskowitz and
Perry (2014) described support for the traumagenic neurodevelopmental model. This model proposes that brain
functioning changes following exposure to trauma during childhood. These biological factors often lead to
psychological issues and physical and mental health concerns in adulthood.
Mental health professionals are often challenged to accurately diagnose PTSD in early childhood, leading
to inconclusive reports of the actual prevalence of post-traumatic stress (De Young et al., 2011). Still, there is
a clear relationship between PTSD diagnoses and trauma experienced in childhood. For example, higher rates
of PTSD are reported among children residing in urban populations where neighborhood violence is prevalent
(Crusto et al., 2010; Goodman et al., 2012). Briggs-Gowan et al. (2010) found an association between family
and neighborhood violence exposure and oppositional deant disorder, attention-decit/hyperactivity disorder,
conduct disorder and substance abuse. Additionally, noninterpersonal traumatic events (e.g., car accidents,
burns, animal attacks) are associated with PTSD as well as anxiety, phobias, seasonal affective disorder and
major depressive disorder (Briggs-Gowan et al., 2010).
Violence exposure is associated with externalizing problems while nonpersonal traumatic events are
associated with internalizing problems (Briggs-Gowan et al., 2010). In a more recent study, Briggs-Gowan,
Carter, & Ford (2011) found that exposure to neighborhood and family violence in early childhood is associated
with poor emotional health and poor performance in school. Low socioeconomic status and traumatic events in
early childhood also are correlated with low academic achievement in school (Goodman et al., 2012). Similarly,
De Bellis, Woolley, and Hooper (2013) found maltreated children demonstrated poorer neuropsychological
functioning and aggregate trauma was negatively related to academic achievement.
According to Schore (2001a), children and adults who experienced relational trauma during infancy are
often faced with the struggles of mental disorder due to right brain impairment (p. 239). More recently, Teicher,
Anderson, and Polcari (2012) found exposure to maltreatment and other types of stress as a child impacts
hippocampal neurons leading to alterations in the brain and potential developmental delays. Additionally,
there is evidence of relationships between mistreatment, bullying and accidents in early childhood and
the development of delusional symptoms in later childhood (Arseneault et al., 2011). Young children who
experience trauma and later use cannabis in adolescence are also at a higher risk for experiencing psychotic
symptoms (Harley et al., 2010). Other studies have shown a correlation between early childhood trauma and
development of schizophrenia later in life (Bendall, Jackson, Hulbert, & McGorry, 2008; Morgan & Fisher,
2007; Read, van Os, Morrison, & Ross, 2005). Changes in the brain may mediate these relationships between
trauma exposure and mental health, as suggested by Schore (2001a, 2001b) and others.
Infants exposed to trauma are often inhibited by emotional and behavioral dysregulation in childhood and as
an adult (Ford et al., 2013; Schore, 2001a, 2001b). Dysregulation resulting from trauma is predictive and related
The Professional Counselor/Volume 5, Issue 2
to substance use and functionality (Holtmann et al., 2011). For example, ndings from a study by Strine et al.
(2012) suggested that early childhood trauma and substance abuse are directly correlated. Children who had
experienced more than one traumatic event were found to be 1.4 times more likely to become alcohol dependent.
Strine et al. (2012) noted that females who experience trauma are more likely than males to abuse or become
dependent on alcohol. The relationship between trauma and alcohol use and dependence often stems from
untreated psychological distress (Strine et al., 2012).
In addition, there is ample evidence that early childhood trauma impacts later physical health. Some of the
most well-known data on this topic come from the adverse childhood experiences study (Edwards et al., 2005).
Multiple studies have found that early childhood trauma is associated with autoimmune disorders (Dube et
al., 2009), headaches (Anda, Tietjen, Schulman, Felitti, & Croft, 2010), heart disease (Dong et al., 2004), lung
cancer (Brown et al., 2010) and other illnesses. In fact, these studies often have found that the more frequent
the exposure to early childhood trauma, the higher the risk of poor health outcomes in adulthood (Felitti et al.,
Researchers have found clear evidence that children who experience traumatic events in early childhood
are impacted well beyond their youth. Mental health disorders as well as alcohol and substance abuse emerge
intermittently with age. Changes in brain functioning and physical health issues are also associated with early
childhood trauma.
Risk and Protective Factors
Researchers have begun to explore factors that interact with trauma and the effects they may produce in
young children. Environmental and demographic factors as well as parent–child relationships signicantly
impact outcomes for young children exposed to traumatic events (Briggs-Gowan et al., 2010). These factors may
either insulate a child from adverse effects of trauma or increase the child’s risk for developing psychological
Briggs-Gowan et al. (2010) found that symptoms of psychopathology and trauma were related to factors such
as economic disadvantage and parent depressive and anxious symptoms. While ethnicity of the minor, parental
education level and number of parents were associated with violence exposure, those factors were not associated
with symptoms of mental illness. A more recent study found that young children exposed to a traumatic event
along with a combination of socio-demographic factors (e.g., poverty, minority status, single parent, parental
education less than high school, teenage parenting) are at greater risk for mental illness (Briggs-Gowan et
al., 2011). Additionally, Crusto et al. (2010) found that high levels of parental stress are associated with
adverse trauma reactions in young children. Parental dysfunction, family adversity, residential instability and
problematic parenting can increase the impact of traumatic events as well (Turner et al., 2012). Young children
exposed to chronic and pervasive trauma in addition to these risk factors are especially vulnerable to adverse
effects (APA Presidential Task Force on PTSD and Trauma in Children and Adolescents, 2008).
There are factors that may help protect young children from the negative impact of exposure to trauma.
Turner et al. (2012) found that nurturing familial relationships can insulate children from psychological distress
associated with traumatic events. Other factors such as safety and stability also might serve as protective
factors. Safety implies that the child is free from harm or fear of harm, both physically and socially. Stability
indicates consistency in the family environment, while nurturing suggests availability, sensitivity and warmth of
caregivers or parents. Well-established, secure parent–child relationships are likely to provide protection from
negative effects of trauma experienced by young children. A secure parental attachment has been shown to help
children effectively regulate emotional arousal (Aspelmeier, Elliot, & Smith, 2007). Emotional regulation may
be a mechanism that protects young children from extreme trauma reactions (De Young et al., 2011). Similarly,
Crusto et al. (2010) found that caregiver support and healthy family functioning reduce the risk of psychological
distress in young children after a traumatic event.
Early intervention and treatment can minimize the social and emotional impact of a child’s exposure to a
traumatic event. Professional counselors should consider making referrals to counselors trained in providing
early childhood mental health support. If the professional counselor has difculties nding a referral source,
the counselor’s basic counseling skills can provide the foundation for a safe, secure and trusting relationship
between the counselor, family and child. Demonstrating empathy, genuine care and acceptance also fosters
rapport among stakeholders (Corey, 2009). Mental health counselors can emphasize strengths and resources for
the child and family.
Incorporating existing coping strategies can serve to minimize family stress and foster rapport with the child.
Providing information about community support groups or other mental health agencies and resources also can
help support and encourage the family. Informing parents and caregivers about symptoms common to young
children exposed to traumatic events can foster awareness and allow for adequate support during the treatment
process. Counselors can help the family establish or reestablish routines that begin to restore stability for the
child, minimizing the adverse effects of the trauma (APA Presidential Task Force on PTSD and Trauma in
Children and Adolescents, 2008; Clay, 2010).
There are several evidence-based methods available to counselors treating trauma symptoms in young
children. Evidence-based approaches are rooted in theory, evaluated for scientic rigor and tend to yield
positive results (National Registry of Evidence-Based Programs and Practices, 2012). Trauma-focused
cognitive behavioral therapy (TF-CBT) is a popular evidence-based treatment used with children aged
3–18. Based on cognitive behavioral therapy, humanism and family systems theory, TF-CBT includes many
therapeutic elements for children and caretakers (Child Welfare Information Gateway, 2012). This form of
therapy helps children develop different perceptions and a more adaptive understanding of the traumatic event
(APA Presidential Task Force on PTSD and Trauma in Children and Adolescents, 2008). Caretakers learn
parenting and communication skills as they play active roles throughout the TF-CBT process. Multiple studies
demonstrate the effectiveness of TF-CBT in reducing symptoms of trauma in early childhood (see Cohen &
Mannarino, 1996, 1997; Deblinger, Stauffer, & Steer, 2001).
While TF-CBT is an established treatment for children and adolescents, there are evidence-based treatments
developed specically for treating trauma in children between birth and 6 years of age. Child–parent
psychotherapy (CPP), one of the most widely used interventions for young children, was created to address
exposure to domestic violence, although it can treat a variety of traumatic experiences (Lieberman & Van Horn,
2008). In this form of dyadic therapy, the child and the caregiver reestablish safety and security in the parent–
child relationship (Lieberman & Van Horn, 2008). CPP is one of the few early childhood treatments validated
for use with ethnic minorities (Lieberman & Van Horn, 2008). The primary goal of CPP is to equip parents to
meet the psychological needs of their child and maintain a secure relationship after treatment has ended.
Attachment and biobehavioral catch-up (ABC) is another treatment option that is designed primarily for use
with young children who have experienced neglect (Dozier, 2003). This approach was developed specically for
low-income families and later adapted for use with foster families. ABC is based on the neurobiology of stress
and attachment theory. The goal of ABC is to foster the development of the child’s optimal regulatory strategies
by equipping parents with tools for effective response (Dozier, 2003; Dozier, Peloso, Lewis, Laurenceau, &
Levine, 2008).
The Professional Counselor/Volume 5, Issue 2
Counselors also can utilize parent–child interaction therapy (PCIT) when working with traumatized youth.
PCIT is a structured technique for children ages 2–8 years in which the counselor teaches the parent or caregiver
how to interact with the child and set effective limits (Chafn et al., 2004). In this form of therapy, the counselor
often assumes the role of coach, instructing the client on specic skills. Counselors frequently use PCIT when
working with children abused by a caregiver. PCIT has been implemented successfully with various populations
including Hispanic and Latino clients (Chafn et al., 2004). The focus of PCIT is on improving the quality
of the parent–child relationship as well as child behavior management (Chafn et al., 2004; McCabe, Yeh,
Garland, Lau, & Chavez, 2005).
The treatment interventions previously mentioned are geared toward very young children, all incorporating
play as a treatment modality. Since young children do not have extensive vocabularies, they often communicate
information about themselves, their trauma and relationships with their caregivers through play (Landreth,
2012). Play therapy intervention research using samples with children between birth and 5 years of age is
scant; however, several case studies indicate that play therapy is effective with trauma in early childhood. For
example Dugan, Snow, and Crowe (2010) utilized play with a 4 year old exhibiting PTSD symptomology after
experiencing Hurricane Katrina in 2005. Anderson and Gedo (2013) provided a case study in which play was
used to treat a 3 year old with aggressive behaviors who was separated from his primary caregiver. There also
are intervention examples of using play therapy with young children exposed to domestic violence (Frick-
Helms, 1997; Kot, Landreth, & Giordano, 1998).
Finally, there are emerging approaches specically for treating young children exposed to trauma. Tortora
(2010) developed Ways of Seeing, a program combining movement and dance therapy with Laban movement
analysis to create a sense of regulation and homeostasis for the child exposed to a traumatic event. The Ways of
Seeing program does not yet have empirical evidence of its effectiveness. However, it is rooted in attachment
theory, multisensory processing, play and sensorimotor psychotherapy. Counselors can use this program to
determine how a parent and child experience each other, implement creative interventions for healthy bonding,
and renew a sense of efcacy for the parent and child. While much more research is needed, this program
appears to be a promising approach to treating trauma in early childhood (see
Another emerging treatment, known as Honoring Children, Mending the Circle (HC-MC), is based on TF-
CBT. The HC-MC approach was developed to address the spiritual needs of young Native American and Alaska
Native children exposed to trauma. This method emphasizes preestablished relationships, wellness and healing
during the treatment process. Spirituality is a critical component of healing and is integrated throughout the HC-
MC approach. The goal of HC-MC is to help the traumatized child attain and reestablish balance (BigFoot &
Schmidt, 2007, 2010). Additional research is needed on the efcacy of the HC-MC approach in working with
Native American and Alaska Native youth.
A third emerging treatment, Trauma Assessment Pathway, is an assessment-based treatment that focuses
on providing triage to young children exposed to traumatic events (Conradi, Kletzka, & Oliver, 2010). In
this approach, the counselor uses assessment domains to determine the focus of treatment, provides triage to
identify an appropriate pathway for intervention and establishes referrals to community resources if needed
(Chadwick Center for Children and Families, 2009). The trauma assessment pathway method, which includes
the trauma wheel, is a versatile mode of treatment available for the child and family. However, in many
instances counselors may determine that an evidence-based practice, such as CPP, is the most appropriate mode
of treatment (see Chadwick Center for Children and Families, 2009).
Each method of treatment offers specic strategies for working with traumatized young children and
their families. However, ndings from most studies investigating the effectiveness of these treatments are
inconclusive (Forman-Hoffman et al., 2013). The strength of evidence for these and many other interventions
are relatively low while the magnitudes of treatment effects are small (see Fraser et al., 2013). Common to the
treatment models presented is the emphasis on system support, the importance of relationships in the recovery
process and developmentally appropriate intervention modalities. These factors likely will serve as integral
components of future methods focused on the treatment of traumatized young children.
Discussion and Implications
Young children are at high risk for exposure to traumatic events and are particularly vulnerable for several
reasons. They are dependent upon caregivers and lack adequate coping skills. Children also experience
rapid development and growth, leaving them particularly impressionable when faced with a traumatic event.
Young children benet from preventive psychoeducation aimed at teaching parents and caregivers about child
development and parenting skills (McNeil, Herschell, Gurwitch, & Clemens-Mowrer, 2005; Valentino, Comas,
Nuttall, & Thomas, 2013). Counselors who work with this population endeavor to increase protective factors
and decrease risk factors while exploring preventive methods, which may reduce young children’s exposure to
traumatic events. Similarly, legislators can inuence public policy related to enhancing childhood mental health.
For example, legislation can address prevention and offer incentives to parents participating in psychoeducation
focused on enhancing protective factors and reducing childhood trauma exposure.
In recent years research has emerged that provides an understanding of how trauma impacts young children.
Researchers and clinicians know that infants, toddlers and preschoolers have the capacity to perceive trauma
and are capable of experiencing psychopathology following a traumatic event. Although these children can
experience mental illnesses often associated with older children, adolescents and adults, the symptomology can
manifest in various ways. Additionally, professional counselors working with children in a variety of settings
should consider the residual impact of traumatic events experienced in early childhood. School-aged children
may experience behavioral problems and have difculty learning and forming relationships as a result of early
childhood trauma (Cole, Eisner, Gregory, & Ristuccia, 2013; Cole et al., 2005). A number of studies indicate
that trauma is a strong predictor of academic failure (Blodgett, 2012). Therefore, school counselors serving
as mediators between academics and wellness should explore ways to advocate for and support students with
known or suspected exposure to traumatic events in early childhood. For example, the trauma-sensitive schools
initiative provides school counselors with a framework for fostering schoolwide awareness and creating a safe
and supportive environment (Cole et al., 2013). School counselors can easily embed these types of preventive
measures as part of a comprehensive school counseling program. These efforts will presumably result in
increases in student success, wellness and awareness, three outcomes that will benet all children exposed to
traumatic events.
While great strides have been taken recently in understanding and treating early childhood trauma, there are
clear gaps in the dissemination of information to counselors. Professional counselors should receive training
in specically designed interventions and attempt to raise public awareness of early childhood trauma in hopes
that young children will receive necessary treatment. The ndings of this literature review suggest that various
methods of treatment might effectively reduce symptoms experienced by traumatized children. Parent–child
relationships and other environmental factors also can have signicant inuence on children’s reaction to
The Professional Counselor/Volume 5, Issue 2
A major purpose of this article is to educate counselors about the impact of trauma in early childhood and
advocate for appropriate assessment and treatment of these traumatic exposures. While not all counselors choose
to work with this vulnerable population, they often work with clients who have extended families with young
children. Counselors who work with adult clients can provide psychoeducation about this important issue and
initiate referrals to counselors trained to work with early childhood trauma. There is a body of information about
trauma in early childhood available for further review. Sources include the National Child Traumatic Stress
Network (, the California Evidence-Based Clearinghouse for Child Welfare (, and the
Association for Child and Adolescent Counseling ( Counselors interested in learning more about
this issue can review these online resources.
Conict of Interest and Funding Disclosure
The authors reported no conict of
interest or funding contributions for
the development of this manuscript.
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... B. Buss, Warren & Horten, 2015;Johnson-Reid & Wideman, 2017). Buss et al. (2015) und Johnson-Reid und Wideman (2017) ...
... B. kognitiven Elementen) konkret untersuchen (Dismantling-Studien). Die Ergebnisse der aktuellen und der früheren Übersichten (Buss et al., 2015;Johnson-Reid & Wiedemann, 2017) betonen die bedeutungsvolle Rolle der Bezugspersonen für die Therapie von Vorschulkindern mit trauma tischen Erfahrungen. Das Elternverhalten wurde als ein wichtiger Faktor in der Ätiologie und Aufrechterhaltung der psychosozialen Folgen traumatischer Erfahrungen erkannt. ...
Traumatic exposure can lead to symptoms of posttraumatic stress disorder or further psychosocial consequences in preschool children. The aim of this review is to systematically analyze international evidence-based interventions for young children (0 – 6 years old) exposed to traumatic events. We systematically searched the literature in the data bases PsycInfo, Psyndex, Web of Science as well as registers for evaluation studies. In a next step, we analyzed the efficacy of interventions to reduce symptoms in children and the quality of the included studies. The systematic review identified 13 interventions for treatment of young children exposed to traumatic events. Quality of evaluation studies was moderate to low. Effective interventions were based on heterogeneous methods – trauma-focused cognitive behavioral therapy, EMDR as well as expressive methods. The findings show that less cognitive challenging methods as well as trauma-focused cognitive behavior therapy can successfully reduce symptoms of young children exposed to traumatic events. Furthermore, interventions that involved parents in the therapeutic process had good efficacy. The results of the literature review emphasize the necessity of further high-quality studies of the efficacy and effectiveness of trauma treatments for preschool children.
... According to Buss et al. (2015), researchers have spent little time and energy researching on the effects of traumatic exposure in early childhood with the misconception that infants and young children lack the perception, cognition and social maturity to remember or understand traumatic events. Trauma is physical or psychological threat or assault to a child's physical integrity, sense of self, safety or survival or to the physical safety of significant other to the child. ...
Psychological trauma is a type of mental damage due to exposure to or experiencing of a traumatic event. Sending children to boarding schools early when they are still under age has been classified as form of traumatic event with undesired outcomes. Guided by Erik Erikson’s theory of psychosocial development, this study set out to establish the psychological effects of early enrolment to boarding schools on pupils’ academic performance in Malava Sub-County in Kakamega County, Kenya. The total study population was 1479 respondents comprising of 1139 pupils, 103teachers, 228 parents, an education officer and 8 head-teachers. Using descriptive research design, the study sampled 381 respondents from the 8 schools within the sub-county comprising of pupils, teachers and parents. The data was collected using questionnaires and interviews schedules. The study employed test-retest reliability method to pilot study instruments in two schools. The collected data was cleaned, coded and analyzed using SPSS 20.0. Study findings indicate that pupils who were enrolled to boarding schools before attaining 12 years of age performed poorer in general terms compared to those pupils who joined after attaining 12 years. The study concluded that early enrolment to boarding schools is associated with psychological effects which may affect academic performance. The study therefore recommends that pupils be enrolled to boarding schools after 12 years of age.
... Çocukluk çağına ait olumsuz yaşam olaylarının kapsamı, doğumdan on sekiz yaşına kadar olan sürenin tamamını içermektedir (12). Çocukluk yaşamını olumsuz etkileyen önemli olayların başında ihmal ve istismar gelmektedir. ...
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Objective: The aim of this study is to examine the relationship between substance abuse and childhood traumas and attachment styles in adults. Method: The study group consists of 279 participants. In the study, 55 data were collected from patients hospitalized in Balıklı Rum hospital by face to face survey method and 224 data were collected through online survey method and Google Forms. In this study, Demographic Information Form, Alcohol Cigarette and Substance Involvement Screening Test (ASSIST), Chidldhood Trauma Scale (CTS) and Three-Dimensional Attachment Styles Scale (SUBBS) were used. Results: The scores obtained from the physical abuse and anxious attachment subscales predicted the tobacco risk scores. Physical neglect, emotional neglect, sexual harassment subscale, and scores from the CTQ total and scores from the three-dimensional attachment styles subscales predicted alcohol risk scores; scores from physical abuse, physical neglect and overprotection subscales and scores from three-dimensional attachment styles were found to significantly predicted the risk scores of cannabis origin. Conclusion: Adults with substance addiction were generally exposed to trauma in their childhood and that childhood traumas and attachment styles predicted substance addiction. Öz Amaç: Bu araştırmanın amacı madde bağımlılığı olan yetişkinlerde madde bağımlılığı ile çocukluk çağı travmaları ve bağlanma stilleri arasındaki ilişkiyi incelemektir. Yöntem: Çalışma grubu 279 katılımcıdan oluşmaktadır. Çalışmada 55 veri Balıklı Rum hastanesinde yatan hastalar ile yüz yüze anket yöntemi ve 224 veri çevrimiçi anket yöntemi ile Google formlar aracılığıyla toplanmıştır. Bu araştırmada, Demografik Bilgi Formu, Alkol, Sigara ve Madde Tutulumu Tarama Testi (ASSIST), Çocukluk Çağı Travmaları Ölçeği (ÇÇTÖ), Üç Boyutlu Bağlanma Stilleri Ölçeği (ÜBBSÖ) kullanılmıştır. Bulgular: Elde edilen bulgulara göre fiziksel taciz ve kaygılı bağlanma alt ölçeklerinden alınan puanların tütün riski puanlarını yaradığı; fiziksel ihmal, duygusal ihmal, cinsel taciz alt ölçek ve ÇÇTÖ toplamından alınan puanlar ile üç boyutlu bağlanma stilleri alt ölçeklerinden alınan puanların alkol riski puanlarını yordadığı; fiziksel taciz, fiziksel ihmal ve aşırı koruma alt ölçeklerinden alınan puanlar ile üç boyutlu bağlanma stilleri alt ölçeklerinden alınan puanların hint keneviri kökenliler riski puanlarını anlamlı şekilde yordadığı bulunmuştur. Sonuç: Araştırma sonucuna göre madde bağımlılığı olan yetişkinlerin çocukluklarında çoğunlukla travmaya maruz kaldıkları ve çocukluk çağı travmaları ile bağlanma stillerinin madde bağımlılığını yordadığı tespit edilmiştir.
... In the most general sense, the term stress is used to signify human states characterized by increased tension and emerging in response to various extreme influences (stressors). According to modern ideas (Buss et al., 2015) stress transforms into a psychological trauma when the impact of a stressor results in a disturbance in a person's mental sphere accompanied by somatic process disorders (Guterman et al., 2016;Garber, Flynn, 2011). In this case, the stressor is presented by a stressful event characterized by abruptness, destructive force, and high intensity (Berryhill et al., 2016). ...
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Children are one of the most vulnerable groups of the population that is particularly affected by traumatic events. In many of them, traumatic events significantly disrupt their life, bring severe losses, damage their health, and increase the likelihood of them developing stressful states. The goal of the present study is to analyze the effect of parenting style on stressful states in preschool children who have experienced a traumatic event. The article determines the specific characteristics of having experienced a traumatic event and the indicators of a stressful state in preschool children based on a theoretical analysis of scientific literature. The article presents the results of an empirical study determining the relationship between parenting styles and the manifestations of stressful states in preschool children who have experienced a traumatic event. In the conducted study, a preschool child’s anxiety and the style of parenting are revealed to be factors in the emergence of stressful states in preschoolers. In the future perspective, these findings substantiate the development of a psychological support program for preventing and fighting stressful states in children of preschool age. Received: 24 May 2022 / Accepted: 20 August 2022 / Published: 2 September 2022
... The age of the child experiencing parental incarceration is also essential to consider. For example, older children may process traumatic situations like those related to parental incarceration in a more productive way than younger children (Buss, Warren, & Horton, 2015). ...
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Over 2 million individuals are incarcerated in the US criminal justice system. More than half of incarcerated Americans are also parents of minors. Parental incarceration can lead to a higher risk of mental illness and enduring trauma in children, as well as other problematic cognitive, developmental, and educational outcomes. Examining parental incarceration through a racial equity lens is critical, as people of color make up 67% of the incarcerated population despite making up only 37% of the US population. Further, gender-related equity issues pose important challenges for families with incarcerated parents. Here, we discuss prison-based psychosocial interventions designed both to build parenting skills and to improve parent well-being within a racial and gender equity lens. We hypothesize that effective services in these areas are essential components in a broad strategy designed to mitigate the potential negative effects suffered by families and children of incarcerated parents of color as a result of their imprisonment.
... In addition to exposure variables, other risk factors for PTSD include: female gender, previous trauma exposure, preexisting psychiatric disorders, parental psychopathology, and low social support [19]. If one or more parents has manifested significant signs of PTSD themselves, children and adolescents will become more vulnerable to developing trauma and stress reactions [19,20]. How the family copes with trauma exposure will provide some protective forces or the contrary; increase the child's risk for developing their own set of subthreshold PTSD or PTSD symptomatology. ...
... While 85% of childhood trauma cases consist of children under 6 years of age, half of the victims of child maltreatment are known to be younger than 7 years of age. 88% of child abuse and neglect deaths occur in children aged 7 and under (Buss et al., 2015;Osofsky, 2003). ...
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The aim of this study is adaptation of Childhood Trauma Questionnaire to Turkish culture. For the validity of the scale, it was translated into Turkish. To evaluate the construct validity of the scale, KMO Test and Barlett's Test were used. In the study, CFA was performed for construct validity. Item statistics, halfway test and Cronbach's Alpha Coefficients were used as reliability methods. In order to test the invariance of time, the scale was applied to the same sample at three weeks intervals. The value of KMO was found to be .964 and Barlett to be 10652.579 and p=.000 When the model for CTQ consisting of 25 items and five sub-factors were examined, it was seen that the x 2 /sd, CFI, IFI, RMSEA, RMR and SRMR fit indexes were at an acceptable level and that PNFI and PGFI values achieved good fit. A positive correlation was found between item scores and total scale scores, and this relationship was statistically significant (r=.51 to .87 and p=.000). Total item correlation values of all items were found to be above .30. The Cronbach Alpha of CTQ was .970 and the Cronbach Alpha of the sub-dimensions ranged from .930 to .957. A positive linear correlation was found between pre-test and post-test measurements which were conducted to determine the invariance of CTQ (r=.809; p=.000). It was found that CTQ was valid and highly reliable and did not show any change in time. Öz Bu araştırmanın amacı Çocukluk Çağı Travma Ölçeğini Türk kültürüne uyarlamaktır. Ölçek geçerliliği için ölçek maddeleri Türkçe'ye çevrilmiştir. Ölçeğin yapı geçerliliğini değerlendirmek üzere KMO ve Barlett's Testi yapılmıştır. Çalışmada yapı geçerliliği için Doğrulayıcı Faktör Analizi (DFA) yapılmıştır. Güvenirlik yöntemlerinden madde istatistikleri, testi yarılama ve Cronbach Alpha Katsayısı'ndan yararlanılmıştır. Zamana karşı değişmezliğini test etmek için üç hafta arayla aynı örnkeleme ölçek uygulanmıştır. KMO değerinin .964; Barlett değerinin 10652.579 ve p=0.000 olduğu tespit edilmiştir. 25 madde ve beş alt faktörden oluşan ÇÇTÖ'ye ilişkin model incelendiğinde X 2 /Sd, CFI, IFI, RMSEA, RMR ve SRMR uyum indekslerinin kabul edilebilir düzeyde olduğu ve PNFI ve PGFI değerlerinin iyi uyum değerlerini yakaladığı görülmüştür. Madde puanları ile toplam ölçek puanı arasında pozitif yönde ilişki saptanmış olup bu ilişki istatistiksel olarak da anlamlı bulunmuştur (r=0.51 ile 0.87 arasında olup p=0.000). Tüm maddelerin madde ölçek toplam korelasyon değerleri 0.30'un üstünde bulunmuştur. ÇÇTÖ'nün Cronbach Alpha değeri 0.970 ve alt boyutların Cronbach Alpha değeri 0.930 ile 0.957 arasında değişmektedir. ÇÇTÖ'nün zamana karşı değişmezliğini belirlemek amacıyla yapılan ön test-son test ölçümleri arasında pozitif yönlü doğrusal bir ilişki olduğu istatistiksel olarak da anlamlı bulunmuştur (r=0.809; p=0.000). Sonuç olarak ÇÇTÖ'nün geçerli ve oldukça güvenilir olduğu, zamansal olarak değişim göstermediği saptanmıştır.
... The Trauma felt by children are different from adults. Children victims of disasters tend to be more easily traumatized than adults because children do not yet have the maturity of selfidentity and the limited ability of coping (efforts of individuals to cope with stress) so if the psychic trauma occurs in children will arise the impact of the cessation of emotional development [3]. Research mentioned that the condition of early childhood experiencing post-disaster trauma, in general, shows the behavior of crying, whining, having sleep disorders, friendship problems, decreased concentration, irritability, health problems, excessive fear and feeling uncomfortable living in refuge [4]. ...
Adverse childhood experiences (ACEs) should be considered as context for assessment and diagnosis of depression, anxiety, and behavioral problems for youth aged 0–18. The researchers conducted a cross‐sectional study, using the public data set from the 2017–2018 National Survey of Children's Health, which represented 52,000 households of a nationally representative sample of children ages 0–17. The parent/caregiver participants reported their children aged 0–5 had higher odds than children aged 6–11 and 12–17 of a one‐unit increase in ACEs, resulting in anxiety, depression, and behavioral problems. Professional counselors can use the results as a basis to consider ACEs‐informed assessment and diagnosis practices when working with youth who present with mental health or behavior problems.
This chapter provides an overview of current interventions and psychotherapy treatments for childhood-related traumas. The implementation of evidence-based trauma-focused mental health services that are timely, effective, and developmentally appropriate is crucial in restoring psychological functioning and minimizing long-term negative effects after a traumatic event. We suggest a phase model of intervention comprised of three levels of response: (1) Psychological First Aid (PFA), a Level 1 intervention implemented during the first few hours, days, or weeks after a trauma; (2) Crisis Intervention/Skills for Psychological Recovery (SPR), a Level 2 intervention used weeks or months after a traumatic event where the goal is to restore psychosocial functioning and minimize psychological sequalae; and (3) Psychotherapy, a Level 3 response that includes use of evidence-based treatments. Within each phase, we review issues as well as therapeutic strategies that can be considered across different developmental periods. This chapter provides a framework for managing crises and providing psychotherapy to those who would benefit from more intensive treatment.
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Evidence that childhood adversities are risk factors for psychosis has accumulated rapidly. Research into the mechanisms underlying these relationships has focused, productively, on psychological processes, including cognition, attachment and dissociation. In 2001, the traumagenic neurodevelopmental model sought to integrate biological and psychological research by highlighting the similarities between the structural and functional abnormalities in the brains of abused children and adults diagnosed with schizophrenia'. No review of relevant literature has subsequently been published. The aim of this paper, therefore, is to summarize the literature on biological mechanisms underlying the relationship between childhood trauma and psychosis published since 2001. A comprehensive search for relevant papers was undertaken via Medline, PubMed and psycINFO. In total, 125 papers were identified, with a range of methodologies, and provided both indirect support for and direct confirmation of the traumagenic neurodevelopmental model. Integrating our growing understanding of the biological sequelae of early adversity with our knowledge of the psychological processes linking early adversity to psychosis is valuable both theoretically and clinically.
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Caregiver-child attachment results in a cognitive-emotional schema of self, other, and self-other relationships. Significantly disrupted attachments may lead to pathogenic internal working models, which may have deleterious consequences; this indicates the need for early attachment intervention. The authors consider the therapy of a 3-year-old boy with aggressive behaviors who had lacked consistent caregiving. Attachment theory can account for the child's psychotherapeutic gains, despite his insecure attachment style. The authors discuss discrepancies between treatment and current research trends.
Parent-Child Interaction Therapy (PCIT) is an empirically supported, parent-training program designed to teach parents specific techniques to manage the behavior of children between the ages of two and seven exhibiting extreme disruptive behavior. Over 30 published studies (see Herschell, Calzada, Eyberg, & McNeil, 2002b for a review) have lent support to the efficacy of this clinic-based program. The current paper will highlight the need for disruptive behavior disorder treatment for children in foster care, discuss the appropriateness of applying PCIT to children in foster care, and report on the effectiveness of and reported satisfaction with a modified procedure for training foster parents in PCIT skills.
The current manuscript describes the process of developing the GANA program, a version of PCIT that has been culturally adapted for Mexican American families. The adaptation process involved combining information from 1) clinical literature on Mexican American families, 2) empirical literature on barriers to treatment access and effectiveness, and 3) qualitative data drawn from focus groups and interviews with Mexican American mothers, fathers, and therapists on how PCIT could be modified to be more culturally effective. Information from these sources was used to generate a list of potential modifications to PCIT, which were then reviewed by a panel of expert therapists and clinical and mental health researchers. The resulting GANA program and ongoing research to evaluate its effectiveness with Mexican American families is described.