Symptoms of Early Childhood Trauma
Young children's expressions of trauma symptoms are often more difficult to identify, as they may not be able to verbally communicate distress as older children and adults can. Therefore, it is important to carefully watch for symptoms of early childhood trauma, especially in early childhood education settings.
Headaches and stomachaches are common.
They are often related to hypervigilance and/or inattention.
Young children imitate trauma through play. Play is not enjoyable, but almost compulsion-like.
Behavior prevalent especially in novel situations.
They may revert to sucking their thumb, wetting the bed, and/or speaking in baby-talk.
They are often difficult to console.
Poor appetite can result in low weight.
It is important to look for changes in a child's normal functioning rather than simply the identification of these symptoms. However, children's behavioral changes are often non-specific, meaning they do not point directly to trauma, but rather a wide variety of developmental, temperament, and personality characteristics. This is why it is important to be aware of changes in children's behaviors and have open communication with parents and caregivers.¹
Possible DSM-5 Diagnoses
Not all children who experience trauma will meet criteria for a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) disorder. However, there are three main childhood trauma-related disorders. It is important to know the symptoms characteristic of these disorders in order to refer children for necessary assessment and treatment.
Reactive Attachment Disorder
RAD is characterized by attachment behaviors that aren't developmentally appropriate.
- lack of consistent seeking of the caregiver for comfort during times of stress
- lack of response of child to caregiver's attempts to comfort them
- lack of emotion regulation, often manifested as developmentally deviant fear, sadness, and/or irritability
It is not that these children are unable to form a secure attachment, but rather that they fail to do so as a result of insufficient care and a strained early relationship with the caregiver.
Possible Causes of Insufficient Relationship
- repeated changes in primary caregiver
- neglect
- being raised in unusual settings such as institutions that limit attachment relationships
RAD is thought to be extremely rare and must be diagnosed between 9 months and 5 years of age.
Symptoms often subside when a child is placed in a stable, caring household.
Disinhibited Social Engagement Disorder
DSED is characterized by a pattern of culturally inappropriate and overly familiar behavior with people who the child doesn't know.
- child may go off without checking in with the caregiver
- child may ask strangers personal questions, violate their personal space, and/or initiate personal contact
Possible Causes of Insufficient Relationship:
- repeated changes in primary caregiver
- neglect
- being raised in unusual settings such as institutions that limit attachment relationships
DSED is thought to be extremely rare and must be diagnosed between 9 months and 5 years of age.
Symptoms do not tend to go away after neglect stops.
Children often show language and cognitive delays.
DSED has not been identified in children who experience neglect after the age of 2.
Post-Traumatic Stress Disorder (under 6)
PTSD is characterized by anxious reactions to traumatic events that exceed the child's ability to cope, including:
- symptoms of intrusion, often in dreams
- avoidance of thoughts, feelings, reminders and/or memories of the event
- distorted thoughts or feelings
- extreme arousal or reactivity
Children's reactions to trauma differ from those of adults, so the DSM-5 includes a specific PTSD diagnosis for ages 6 and below. Key differences are:
- young children often use play enactment rather than words
- criteria are combined for avoidance and negative alterations in cognitions
- fewer symptoms needed for diagnosis
- experiencing trauma through repeated exposure to details was dropped
- reckless and self-destructive behavior are not included
Prevalence rates for PTSD are between 3-6%, but 25-52% of children who experience a single traumatic event will develop PTSD.²
¹ https://www.nctsn.org/what-is-child-trauma/trauma-types/early-childhood-trauma/effects
² Mash & Wolfe, 2017