Developmental Trauma

Developmental trauma is the phrase used to describe repeated traumatic experiences or unmet attachment needs during childhood that led to developmental problems. Until relatively recently, there was very limited understanding of developmental trauma and children affected in this way have been given a wide range of labels (for example, ‘maladjusted’). Different organisations refer to developmental trauma in a range of ways. Most diagnoses in the UK are based on the International Classification of Diseases (ICD-11). The ICD-11 does not use the phrase ‘developmental trauma’, but it does refer to the ‘developmental presentations’ of complex post-traumatic stress disorder. Beacon House, a leading organisation in the study and treatment of childhood trauma in the UK, uses the phrase ‘developmental trauma’. In the USA, the National Child Traumatic Stress Network uses the phrase ‘complex trauma in childhood’. It is also very common to hear professionals using the phrase ‘attachment difficulties’ in this context. Attachment issues in childhood and developmental trauma are closely related. ‘Attachment’ refers to children’s early experiences of nurture and is based on the theories of developmental psychologists Bowlby and Ainsworth.

The most common causes of developmental trauma are neglect and abuse in childhood. When children do not receive the care and nurture they need, this affects their development. Some children who experienced trauma very early in their childhood experience profound developmental difficulties which affect them throughout life, even if the rest of their childhood did not involve trauma. Developmental trauma can affect a child before birth, for example, through high levels of stress in the mother which affects the baby’s physiology and in turn, brain development. The period of an infant or child’s development that the trauma took place influences the nature of the developmental difficulty the child experiences, however the way in which a child is affected is also influenced by many other factors. A great deal of human brain development takes place after birth during infancy, and primary care-givers have a central role in this process.

There are many different adverse experiences which can be traumatic for children and can affect their development. Here are just a few examples:

• If a child in distress does not receive the soothing from adults that they need repeatedly or over an extended period during their childhood, this may mean that they do not develop a capacity to self-soothe, and they may go on to develop difficulties in regulating their own emotions. The additional stress that children who are affected in this way experience may influence their physiological, emotional and cognitive development.
• A child that does not experience enough interaction with adults in early childhood may experience difficulty in developing language.
• A child that misses out on early play opportunities because of neglect may experience difficulties in sensory and cognitive development.
• A child who experiences physical or emotional abuse from family members may need to try to protect themselves from the adults around them by withdrawing trust or by being very wary of them and learning to predict their behaviour. This ‘hypervigilance’ and tendency to be wary of others can lead to problems in developing trusting relationships throughout life. 

It is worth remembering that difficulties which are unrelated to neglect or abuse and have nothing to do with parenting can also make it hard for adults to meet the attachment needs of small children. This can lead to developmental issues. A well-known example of this is an undiagnosed hearing difficulty or repeated medical interventions as a small child. Long term physical health conditions that are experienced as traumatic may also lead to developmental trauma.

A further point is that when child neglect does take place, the care-givers who have failed to meet the needs of the child and are therefore responsible for the neglect may have experienced developmental trauma themselves. The developmental trauma of the care-giver may therefore have contributed to their inability to meet the needs of their own child. This situation is known as ‘intergenerational trauma’.

The areas children can experience difficulties as a consequence of developmental trauma include:

• Sensory processing
• Mood and emotional regulation
• Behaviour
• Language acquisition
• Self-esteem and relationships
• Memory and cognition

Given that all the examples in the list above are a part of learning, it is clear that developmental trauma can have a profound impact on a child’s education.

Recovery

Children can and do make up for developmental deficits in a range of ways. For most children where there are strong relationships, parents and family members are likely to have the greatest therapeutic impact and advice and support is available through a range of different organisations (for example, children’s charities and organisations such as YoungMinds, NHS services and local authority education services).

Today, a wide range of professionals and organisations may be involved in supporting children who have experienced developmental trauma. Therapists working with adults have a far better understanding of the possible impact on their adult clients of traumatic experiences in childhood and an appreciation of the knowledge and skills their client has developed throughout their life. Professionals that may work directly with children affected by developmental trauma include counsellors and psychotherapists, play therapists, occupational therapists, social workers, educational and clinical psychologists, speech and language therapists and others.

Support for children affected by developmental trauma will depend very much on the needs of the child and on their age / developmental stage and the context (for example, whether in the home, an education setting or in a clinical setting). Enabling the child to voice their needs allows for a bespoke approach to be taken which meets them. For example, for a teenager who has missed out on opportunities for messy play in childhood, creative art or baking could be effective alternatives as they involve similar sensory processes. For other children, an assessment by a highly specialist psychologist may be more appropriate, followed by a period of intensive work.

There is now greater understanding of the brain, and neuroplasticity. The brain continues to develop through childhood and adulthood so there is always the opportunity for recovery. This is particularly relevant to children who experienced traumatic circumstances throughout their whole childhood.

It needs to be understood that certain developmental opportunities are only available at certain points in child development. If it doesn’t happen at that point, it may need to happen in a different way later. Children who have experienced developmental trauma may need to develop their own unique work arounds later. Those around them need to be sensitive and open to this. Many adults who are aware that they experienced developmental trauma will be able to identify the things that they did to develop and grow, despite the difficulties which they experienced as children, for example developing coping strategies and building resilience. While developmental trauma in childhood can be linked to problematic behaviours in adulthood (for example, substance misuse) it can also be linked to positive behaviours and character traits (for example, self-reliance and tenacity) which can be seen as examples of post-traumatic growth.

For adults who consider that they experienced developmental trauma and who already have a mental health diagnosis, the most recent version of the ICD-11 now recognises the importance of complex PTSD in childhood and the similarity of this presentation with conditions which have been identified in the past as personality disorders. Though there are differences between these two diagnoses today, it is possible that those who have been diagnosed with a personality disorder in the past, might today be diagnosed with complex PTSD.

Carers discussion

Carers describe how it can be difficult for children who’ve experienced trauma to describe how they feel:

Strong, safe and trusting relationships with adults and specialist therapy can help children to recover. It is also important that schools understand the effects of developmental trauma in order to support children in their education.

Listen to some carers describing how they talk to their children about their developmental trauma: