Treatment for children with complex trauma doesn’t end with therapy appointments — an effective support plan accounts for all aspects of a child’s life, including their time at home, in school, and within their broader community. This comes from incorporating trauma-informed care into their day-to-day lives and recognizing how their trauma will influence the supports they need to thrive personally, academically, and socially.
To help us better understand complex trauma and how to incorporate trauma-informed care in their home, school, and social lives, we spoke to a range of experts: Daniel Hoover, PhD, clinical child and adolescent psychologist at the Center for Child and Family Traumatic Stress at Kennedy Krieger Institute and associate professor at the Johns Hopkins School of Medicine; Karen Yingling, parent advocate at Advocacy for Connected Education and parent of children with complex trauma; Kelly Rain Collin, EdM, educational consultant and founder and director of Healthy Minds Consulting; Emily J. Aron, MD, child, adolescent, and adult psychiatrist, associate professor of clinical psychiatry at MedStar Georgetown University Hospital, and founder of Looped-In Parenting; Margaret Blaustein, PhD, clinical psychologist, founder and director of the Center for Trauma Training, and co-creator of the ARC framework; and Kristine Kinniburgh, LCSW, director of the Trauma Services for Justice Resource Institute and co-creator of the ARC framework.
Recent strides in trauma research and childhood development have created a lens and framework for providing children and adults who have complex trauma with therapy and support to work through their experiences, called trauma-informed care. Trauma-informed care, Kinniburgh and Dr. Blaustein say, is not a treatment method in itself, but a way to reflect on how a child with complex trauma sees and moves through the world, to recognize the impact of their experiences, and to shape their treatment plan around that. Multiple approaches to trauma-informed care exist; for this article, we will be referring to the definitions and framework drawn from the work of Maxine Harris, PhD, and Roger D. Harris, PhD. It has five core tenets: safety, trust, choice, collaboration, and empowerment.
In this clip, Kinniburgh defines the trauma-informed care approach when treating children with complex trauma.
“People have defined trauma-informed care in many different ways,” says Dr. Blaustein. “The starting point is a recognition that trauma matters, that trauma has the potential to be relevant to the work that you do.” This can apply to the child’s household and their therapist, but also to broader environments and institutions, such as their school. Creating trauma-informed systems, on both a personal and a community level, helps create and maintain a baseline of care not only for children with complex trauma, but for their peers and caregivers. “There’s an emphasis on safety and on empowerment and on voice and choice; it’s creating a system in which we are not re-creating danger, but in which we’re building toward safety and empowerment and all those things that are sort of the antithesis of trauma.”
While many therapists and mental health professionals study trauma as part of their education, not all of them may be applying a trauma-informed lens in their practice, especially for children with complex trauma. The lack of comprehensive research and implementation across educational institutions may create situations where parents need to advocate for their children and their needs.
Dr. Blaustein advises that parents do their research on the treatment models a therapist has the training to provide. “All good trauma-informed and trauma-focused therapies have certain things in common and then certain things that make them slightly different. What I would say is learn about the treatment being offered and ask questions.” These questions aren’t just about how, say, TF-CBT differs from EMDR, but about how the family feels about the therapist. Questions may include:
In a perfect world, all the caregivers a child comes into contact with on a regular basis should be trained on trauma-informed practices. This includes not only parents and adult relatives, but also teachers, IEP and/or school teams, family friends, and medical and mental health providers. But Dr. Aron emphasizes what much of the research on trauma-informed care indicates: the number of children working through complex trauma far exceeds the number of teachers, family members, and providers who have trauma-informed care training. But, this doesn’t mean they can’t incorporate trauma-informed practices into their skillset when interacting with a child with complex trauma.
This can be as simple, Collin adds, as maintaining a sense of self-regulation around the child so they can model off you and feel grounded by your connection to them. “The adults around them have to be in a place of calm and connection and [foster] the ability to be in the space that we want the child to be in. We have to do that first, because they feed off of our nervous systems,” she says. “How do we, as adults, shift what we’re doing in order to make sure that student feels safe on a neurological level? Part of the conversation relies around reframing it as a trauma response and making sure that everybody on the team is really seeing it from that perspective. It’s not necessarily a behavior to be modified so much as a neurological response that the child is not in charge of.”
Kinniburgh adds, “Acknowledgement and awareness of the impact of trauma and using that lens. If we’re going beyond some of the core values of trauma-informed care, it’s really looking at treatment planning and goal setting. Goals across a child’s care team, school team, and at home should all contribute to the same outcomes: a happy, healthy, and regulated child. Are you really understanding the case and establishing goals that are child- and family-friendly, using language that people can understand? Are you establishing goals for care that are realistic and based on what we understand to be the impact of developmental trauma?”
Sources interviewed for this article all agree that children with complex trauma and their families can explore far more options now than they could a generation ago. Each of the most researched and long-standing therapy options has different parameters and degrees of flexibility depending on the child’s needs, age, and cognitive ability. For some kids, a talk-based approach suits them better, while others may need something more physically engaging or tactile. Finding the best method will depend on a lot of factors beyond simply the child’s trauma origins.
In this clip, Dr. Hoover discusses the importance of treatment options and understanding which one will benefit a child with complex trauma:
Thankfully, the primary question families need to ask themselves about finding the right therapy for their child is a matter of ‘which one?’, not ‘is there a way to help child?’ Many approaches now exist that can accommodate a child’s age, communication style, and cognitive ability.
“Some of those treatments are designed for young children, like 0–6 years old,” says Dr. Hoover. “Child-parent psychotherapy, parent-child interaction therapy, those have been adapted for or tailored to treat little kids who have intellectual developmental disorders and autism. For older kids, trauma-focused CBT — it has quite a range. It can help kids from the cognitive age of sometimes 4 to 6, all the way up to 21 or 22 years old. We’re coming up with new adaptations and tailoring for TF-CBT so it fits well for kids with autism and IDD. EMDR — eye movement desensitization and reprocessing — there’s some research that’s coming out that’s showing it’s a gold-standard treatment for trauma, and there are some really nice adaptations that are being done for EMDR for kids who have autism and IDD.”
What these all have in common is what they are meant to help instill in the child. The journal Psychiatric Annals identifies six core components that measure the scope and efficacy of complex trauma interventions and therapies:
In short, effectively addressing and treating a child’s complex trauma requires a safe environment that allows for deep and nonjudgmental self-reflection, effective strategies for working through traumatic events, and creating both positive attachments with others and a healthy self-image. The ideal therapy for each family will vary, and it may require a combination of different therapies or modifications to implementation, depending on the child’s age and needs.
Trauma-focused cognitive behavioral therapy (TF-CBT): an exposure-based therapy that can be modified for children and young adults primarily up to 21 years old. Like traditional cognitive behavioral therapy, it provides a structure to discuss and work through mental health challenges, but with a trauma-informed lens. “The basic format is you help educate the person about trauma, what it is, [and] what their particular trauma is. You help them learn relaxation and coping skills and teach them how to identify feelings . . . by talking through their traumatic experiences,” Dr. Hoover adds. “The more they gradually expose themselves to those facts and memories, the less hold those memories have on them. It’s a package of steps that really fits anybody, and what we’re doing is trying to scaffold the treatment for the particular cognitive age of the child and help them to be able to engage in those treatments and help them to remember the skills for coping and help them learn how to apply those skills.”
Dialectical Behavior Therapy (DBT): a talk-based therapy that focuses on building life skills, establishing coping mechanisms, and managing intense, harmful emotions, such as suicidal ideation.
Eye Movement Desensitization and Reprocessing (EMDR): a form of psychotherapy specified for helping patients process trauma and PTSD. Rather than using standard talk therapy and focus on emotions, this therapy works on desensitization with eye movement and other physical and vocal stimuli to identify and work past traumatic memories.
Somatic approaches: somatic therapy options focus on body-mind connection, breathing techniques, and physical movement rather than a stationary talk-focused approach. The physicality allows children to expel tension held in the body and learn grounding techniques that mitigate their trauma symptoms; this can also provide a sensory outlet for younger children or children with higher support needs.
Attachment, Regulation, and Competency (ARC) framework: more so than as a type of therapy or treatment, Dr. Blaustein and Kinniburgh designed the ARC framework as an intervention model to help children with complex trauma. “Because it’s formulation-driven, it sort of opens the door to creativity around fully understanding who a child and caregiver are, what they’re interested in, what they’re motivated by — all kinds of things that we can use to center our treatment, to make it more accessible,” says Kinniburgh.
Child-Parent Psychotherapy (CPP): this is a talk-therapy option recommended for younger children up to six years old that involves both the child and parents and offers a flexible environment for working through trauma and its effects. As Dr. Aron explains, “[For] younger children, more relational approaches to therapy are really helpful. Parents should really always be involved [with] children and adolescents who have experienced trauma in one way or another. [These approaches] are really fluid and adjustable based on what’s happening in one’s life.” However, she adds, this is a long-term therapy that will not necessarily yield immediate, demonstrable results for the child’s treatment.
Other trauma-informed therapies: depending on the child’s age and need, many elements of these therapies can be incorporated into activities the child enjoys. This includes art therapy (painting, drawing), dance therapy, and forms of play therapy like Lego building and floor time. “Play therapy in general is lovely, which can include sand tray therapy and a lot of other things where the kids are not having to just sit there and talk. If you’re looking at a child with disabilities where language is not their area of strength, you’ll definitely want to try to find other types of activities that are kinesthetic or tactile or somehow — visual or movement-oriented — in order to help the child connect with those more,” says Collin.
Occupational therapy: Yingling suggests that occupational therapy can also serve as a complementary practice for children with complex trauma. But instead of focusing on fine motor skills, an OT can work with a child to develop their sensory processing skills and means of understanding their sensory needs and triggers.
Medication: not all children with developmental trauma and CPTSD require medication, though some may find that options like Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) help alleviate symptoms related to anxiety, depression, and sleep disorders. In her practice, Dr. Aron sees medication as a potential tool within a child’s treatment plan rather than as a primary solution, and she feels it should always come from an informed conversation with parents. “I follow the lead of the parents and what they’re looking for, and start there,” she says. Depending on the child’s level of needs and symptoms, therapy and treatment may suit them just fine; if the child is exhibiting behaviors and symptoms that directly and consistently interfere with big aspects of their life, such as school, relationships, and their mental health care, then medications can help mitigate the challenges. “[For] severe symptoms, I think it makes sense to add medication, and I would recommend that to families. If symptoms are impairing the child’s ability to even access therapy, then it’s going to be really hard to make any gains. It doesn’t mean they need to be [on it] forever. If you make good progress, then there should always be a time when you say, ‘Let’s see if we can taper off the medications,’ and see if this progress is sustained without them.”
No two children respond and adapt to trauma in the same way, so it follows that each child’s treatment plan is equally unique and based upon their experiences. However, this doesn’t necessarily mean that a specific treatment option works better based on the child’s ACEs or trauma origins.
As Dr. Blaustein explains, “Something that I think we've moved away from as a field is linking interventions to specific types of exposure, other than in thinking about, for instance, acute disaster exposure versus a more chronic developmental [exposure]. But within the world of chronic exposures, there’s a lot of nuance for everyone and what their experience is. Broadly, kids who experience chronic trauma are exposed to either or both: too much danger or not having their needs met.”
The emphasis, then, should be on efficacy and compatibility with a child’s needs. “It’s really important to carefully match children and families into the type of treatment that’s most likely to be the most help to them, for mental health treatment, for trauma,” says Dr. Hoover, “so they’re actually going after the cause of the trauma and trying to get the kid better from the trauma.”
Rather than origin, Dr. Aron adds, the therapy should constantly be shaped to how the child’s relationship with their trauma is changing. “You have to adapt to people’s interests . . . not just use a standard protocol.” Creating a therapeutic pathway requires a foundation: “what the person’s needs are and where their strengths are, so that they have an ability to receive the information and express themselves in whatever way they feel most comfortable. You have to be flexible in how you provide the treatment based on who the person is.” This can be especially helpful for younger children or children who are nonspeaking.
In some cases, the child may not be able to manage and treat their trauma through services available to them at home, at school, or through their care providers. Some hospitals and universities host more involved day programs, such as Columbia’s Day Treatment Program, Rutgers’ Day School or UCLA’s Family STAR Clinic, where children have more direct access to mental health professionals and therapy options integrated with their learning. These programs are meant to complement, not override, the IEP or 504 plan a child has in place at their current school. (More on this later!)
According to Yingling, these programs should not disrupt the child’s IEP eligibility, and in fact, the child’s IEP can be a wonderful tool for helping shape the supports and services a child gets at the day program.
Some children with complex trauma may exhibit behaviors that require further intervention than a public or private school or even a day program can provide. As we discussed in our article about emotional disabilities and alternative school placements, residential schools can also provide a more structured and therapeutic environment for children to both learn and have their mental health needs met. However, we recommend that parents take time to deeply research all the options available to them, as these placements can greatly limit parents’ contact with their child and cannot guarantee that they can address the child’s trauma.
As we note in our article Pediatric Developmental Trauma 101, there can be overlap between complex trauma and disability that makes it harder to diagnose and treat children with co-occurring conditions.
Unfortunately, there is no guarantee that all the pediatric providers for a child’s health and trauma care will understand how impactful their trauma can be to their disability and vice versa. Per an article published in the journal Perspectives on Behavior Science, “Despite high risks of both exposure to adverse events and trauma, people with intellectual disability (ID) face a lower likelihood of finding accessible services to address stress-related disorders. Increased exposure to adverse events and low likelihood of access to appropriate services combine to result in very low chances of full recovery following traumatic experiences for people with ID.”
Parents, Collin says, will likely need to advocate for their child and be prepared to both answer and ask questions about trauma-informed care. Not all providers may have the background on trauma and disability or the psychological readiness and confidence to take on a new approach and adapt it to a particular family.
“I think a lot of it ends up falling on the shoulders of the parents, with regard to educating others about what’s going on and what’s needed, and even being a model for others and how they interact with their child,” says Collin.
Dr. Aron adds that before embarking on treatment with a particular provider, parents should discern how prepared the professional is to both learn and adapt to the child’s needs, from both a trauma and a disability lens. Asking to be present during treatment and incorporating the parent’s or another caregiver’s participation can mitigate potential obstacles or reactions from the child.
Dr. Aron, Dr. Hoover, Dr. Blaustein, and Kinniburgh all recognize that children who are nonspeaking and/or have higher support needs do not show their trauma in the same way as neurotypical kids do, and there are fewer options for treatment and communication.
But many of the treatment options can still be adapted and applied to their long-term treatment plan. They, as with any child with complex trauma, need to first feel safe and supported before they can begin. The same tenets of trauma-informed care apply, but on an adapted scale: centering the child’s comfort and focusing on building a strong child-caregiver relationship to support them through further options and interventions.
Both Dr. Hoover and Dr. Aron believe that most available therapy options can be tailored to fit a child’s needs. “I wish there was more to guide our thinking,” says Dr. Aron, “so you really have to take note of who the person is in front of you and what they’re capable of and what would be best for them. In the past, we thought of therapy as talk therapy. You expect the person to express things, and you kind of sit there and listen. But that doesn’t work for a lot of people, and certainly individuals with autism can really struggle with that random generation of the thoughts of the day. And so a lot of times, I like to use cognitive behavioral therapy in those situations, something that’s a little bit more prescriptive.”
Providers can also incorporate more visual aids and somatic practices, such as breathing or movement.
The field of Applied Behavioral Analysis (ABA) has changed a lot since its inception in the 1960s, including how practitioners respond to the child’s more intense behaviors. The intention for ABA today is to help children with autism and other developmental disabilities learn life skills and improve their reactivity and behaviors across various settings. However, both advocacy groups like the Alliance Against Seclusion and Restraint (AASR) and academic research have raised concerns about how ABA is applied to children with complex trauma.
Broader concerns about ABA center around the use of methods to minimize or eliminate certain behaviors and around creating goals that follow protocol rather than the individual child’s needs. The AASR has published articles about how ABA may lead to a child masking their trauma rather than working through it; similarly, they raise the idea that eliminating behaviors that may help a child process their emotions can compound their trauma, creating a conflict with the main tenets of trauma-informed care.
This does not mean that a child may not benefit in some way from ABA, or that there is a guaranteed retraumatization. Rather, parents need to be aware of how trauma and disability interplay in ways that make it impossible for one aspect to be addressed without consideration for the other.
School is one of a child’s primary domains, and it’s where they will spend a majority of their developmental life. Working on an IEP that incorporates trauma-informed care as early as possible sets a child up for support across multiple spheres of their development. In some cases, Dr. Hoover and Collin say, school itself can be a site of trauma, making intervention crucial.
“If a child has some neurological vulnerabilities already, and then they’ve had some experiences like domestic violence or witnessing community violence, or [they] see [someone] being beaten or physically restrained [or are beaten or restrained themself] in school, it’s undermining their ability to cope and pay attention,” says Dr. Hoover. “They go to school and they’re trying to sit in class and learn difficult concepts. They might be reminded of trauma right there in the classroom; they might be overwhelmed by fear that something’s going to happen, and then they can be really distracted and disorganized and upset easily and have meltdowns in the classroom. A lot of that is because of this combination of the disability [and] trauma on top of it.”
Trauma-informed care in an IEP means taking a holistic lens to every aspect of a child’s life and recognizing how complex trauma has impacted their development and engagement with the world. This is particularly relevant to their life at school and how they build relationships with both peers and adults outside their family. Creating an IEP for a child with complex trauma must take this all into consideration as early as possible, because, Yingling says, “a child who doesn’t feel safe can’t learn.”
First, we must clarify: trauma is not considered a disability under IDEA, and is thus not one of the 13 IEP-qualifying categories a family can pursue. Yingling adds, however, that there are other ways that trauma can sometimes qualify a child for an IEP or 504 plan. In some cases, Yingling says, the impact of trauma may manifest in ways that do warrant IEP eligibility; for example, in California, FASD and its symptoms can now qualify a child under Other Health Impairment (OHI).
“Trauma is not one of the 13 categories,” she says, but “that doesn't mean there are not ways that trauma presents that are.” In her experience, many children with complex trauma may appear to have clinical symptoms related to ADHD or autism. In a white paper Dr. Hoover contributed to on trauma-informed IEPs, students who have experienced trauma may qualify for special education services in different ways.
Who qualifies for an IEP?
Some children may qualify because they have a diagnosis connected to the effects of trauma, such as an emotional disability, speech and language impairment, traumatic brain injury, or other health impairment. If a child with trauma is being assessed for an IEP, their assessments should be conducted by a proctor aware of their trauma; additionally, their psychological assessment can also include a specific trauma assessment.
Other students may already qualify under a separate disability category, but their trauma may still affect multiple aspects of their cognitive, academic and social skills at school, including “learning behaviors, social skills, speech and language, reading, and self-management.”
Yingling advises that parents “not get too hung up” on the IEP eligibility category. Whether a child is getting their first IEP or adapting a pre-existing IEP that didn’t previously address their trauma, trauma-informed care and practices can be added in a number of ways. However, experiencing trauma alone does not automatically make a student eligible for special education services. To qualify under the IDEA, a student must have a disability that affects their ability to access their education and creates a need for specialized instruction and related services.
504 plan
If a child does not qualify for services under the IDEA, schools should also consider whether the student may be eligible for supports and accommodations under Section 504 of the Rehabilitation Act. Children with trauma can still receive accommodations within and beyond the classroom that give them access to a safe space or safe person, teach them self-regulation, and give them trauma-informed goals to work toward.
Is trauma an emotional disability?
As we mention in our article on emotional disability, trauma is not the same as an emotional disability (ED) even if the symptoms manifest in similar ways, and what works for a child with ED will not yield the same results in a child with complex trauma. As Sarah Pelangka, PhD, BCBA-D, special education advocate and owner of Know IEPs explains in that article, many schools are not well-versed in how to address a student’s mental health needs. Behaviors that educators may perceive as ED-related may manifest as a coping mechanism from traumatic events or temporary hardships in a child’s life that cannot necessarily be addressed by the same services that help students with ED.
“Oftentimes they like to peg trauma as an emotional disability,” she says. “Trauma is not the same as emotional disability, but schools don’t recognize that. So when they see young kids coming in that might have been homeless or adopted or had in-utero exposure, they definitely like to explore emotional disability. But it’s really hard to label kids that young, because typically students who fall under that category . . . it’s more about mental health needs.”
Students who may have experienced trauma before or during their time at school can still access general counseling services with a school psychologist, even if they do not meet the criteria for special education. They are also still eligible for lower-level, school-wide accommodations, which you can find more information on in this article.
In this clip, Yingling explains how to adapt a child’s IEP or 504 plan to suit their trauma needs:
Discuss trauma history and triggers
Before parents can begin working with their child’s school team on creating or adapting a trauma-informed IEP, Collin recommends the family notify the school personnel — such as the counselor or school psychologist — of their child’s trauma history. It doesn’t have to be a comprehensive explanation, she says, but it will help all adults contextualize the appropriate accommodations and services for the child.
“Looking at what types of accommodations might need to be in place, or if there’s certain sensory triggers for the student. Maybe loud noises are a trigger ... so having the team be aware of that and understand it from a trauma-informed point of view, instead of a behavioral perspective. What’s going on? What’s triggering that? Understanding it from that trauma perspective [can] change how the team perceives the behavior and how we [are] able to move forward in supporting [the child].”
Prioritize safety
Just as the six components of trauma treatment start with safety, Yingling says a child’s IEP must address the triggers, environments, and situations that influence their nervous system. “The biggest thing that I’m looking for when I’m building an IEP for a kid [with trauma] is, how do I maintain their felt safety? How do I make school a place where they’re safe and secure? If we don’t have ‘safe’ and we don’t have ‘secure,’ we can’t get to ‘successful,’” she says.
Services, goals, and supports for a child with both a disability and complex trauma should thus prioritize safety and security before focusing on academic achievement. When working with IEP teams for children with trauma, Yingling says, “The first question I ask is, who is this child’s safe adult? I want to know who the five-year-old thinks is their safe person. If they can’t tell me who the safe adult is and they don’t have access to that safe person, that’s where we start. Someone needs to establish a connection with this child [and] hold that container of safety for them. If they don’t have that in that school setting, they will not be successful.”
A safe adult for the child at school may not necessarily be their teacher; it could be the school nurse, the school psychologist, or any school personnel that helps the child feel prepared to regulate themself and continue with their school day.
Avoid focusing on behavior
Similarly, a child’s goals in an IEP should reflect their capacity and contextualize their behaviors and abilities. As we will discuss more in our sections about FBAs and BIPs, goals that simply aim to stop a certain behavior do not effectively address a child’s trauma. Both Yingling and Collin believe goals should reflect a trauma-informed approach — working to understand and address the trauma that may be causing behaviors that impact the child’s learning and socialization, rather than simply meeting a metric.
“I love goals that teach kids to read their body cues, that teach them to integrate what’s going on in their head, in their heart, with what’s physically happening for them and puts them in control. Then we give them a strategy to know what to do for it. Every kid’s going to be different,” says Yingling.
Beyond the goals a child may have in place for their disability, they should also have trauma-specific goals. These are often centered on a child’s communication behavior, Collin and Yingling say, because the nervous system of a child who has experienced trauma is often reacting in an outsized way to seemingly mundane stimuli or interaction. Helping them develop coping skills and strategies keep them feeling safe and naturally extend to keeping them present at school and on-task.
Some goals and considerations that both Yingling and Collin recommend implementing into an IEP for a child with complex trauma include:
“IDEA is written [such] that goals will be written in all areas of need, not all areas of eligibility,” Yingling adds. “So there can be needs outside of the area of eligibility. I believe every child who has an IEP should have a counseling goal. There is an emotional and social impact to their disability, and they need to learn how to deal with it.”
Conducting a functional behavioral assessment (FBA) and creating a behavior intervention plan (BIP) for a child at school can provide the child’s IEP team with information about how to address the child’s intense behaviors. The aim is not to modify or discourage the behavior coming from trauma, but to create a plan that reliably prevents the behavior from escalating.
Change adults’ behavior, not the child’s
Yingling emphasizes, “The behavior intervention plan is not about the child. A [BIP] should never be written to change a child’s behavior. It is only written to change the behavior of the adults who are supporting that child. You’re not asking the seven-year-old to change. If an adult is being cruel to a child and that child is reacting to it, that’s the adult’s fault, not the kid’s fault.”
In this clip, Collin explains how FBAs and BIPs can work for children with complex trauma:
Traditional BIP goals and interventions won’t serve children with complex trauma, especially if they have a developmental or intellectual disability. Behavior becomes, in many cases, a means of communication to express the child’s needs or emotions.
See behavior as a trauma response
For a child with a record of exhibiting intense behaviors at school — such as being combative with peers or teachers, self-harming, issuing verbal threats, or eloping — Collin says that creating an effective BIP requires that “the conversation relies around reframing [a behavior] as a trauma response and making sure that everybody on the team is really seeing it from that perspective. It’s not necessarily a behavior to be modified so much as a neurological response that the child is not in charge of,” she says. “Then we need to figure out how to support them through that process. [We need to ask] ‘How can we support their nervous system?’”
Don't ignore behavior
What should not be part of an effective BIP for children with complex trauma, both Yingling and Collin say, is ignoring a child’s behavior or refusing to engage with it. “If a kid from trauma needs attention, give it to them. Nothing gets me crazier than when I see a behavior intervention plan where it says we’re going to plan to ignore this. No, we’re not,” Yingling says. “We don’t have to feed the behavior, [but] we are not ignoring the child, ever.”
Ask questions
Collin adds that attention-seeking behavior, while not unique to children with complex trauma, can often provide the school with information that the child may not be able to express. By engaging with the behavior, the team is able to glean what led to it. “Why are they trying to get your attention? Are they trying to communicate a need? Are they having difficulty communicating that need? What need are they trying to communicate?” Collin adds.
“There’s a lot of deeper questions that I would want to ask around those types of things. Same thing with avoiding a task. If the student’s avoiding a task . . . okay, why? Why are they avoiding that task? There’s a reason behind that, and it’s rarely, ‘I just don’t want to do it.’ There’s always something behind that. There’s a reason why that student doesn’t want to do it in that moment, or doesn’t feel like they’re engaged or connected.”
As with the broader IEP, “There are many times when we can ask the student and get relevant feedback. It has to be phrased in a certain way or supported, but if possible, getting feedback from the student can be very valuable as well.”
A child with complex trauma benefits from a number of interwoven accommodations, services, and environmental supports. Creating a sense of safety, as our interviewees and research sources have noted, is paramount before the child can reap the benefits of therapy and education.
“Looking at accommodations, with regard to the environment itself, are some of those things we could change? If it’s another kid moving around, you might not be able to change that, right? But if it’s how loud the teacher is speaking, that might be something that could be changed. Or if it’s the tone, you know, there’s a difference between ‘sit down’ and ‘sit down!’ and our nervous system feels that difference,” says Collin.
Some applicable accommodations and services to incorporate into a child’s IEP are:
As your child develops the language and means of communicating their trauma needs and feelings, you and the IEP team may want to give them the opportunity to contribute to IEP meetings and the scope of their services. Even if your child is nonspeaking, adults can ask guiding questions to help determine what strategies and services will keep the child’s academic and treatment trajectories on track.
“It would start with the family and the school being able to have a dialogue about how much is appropriate to share,” says Collin. “There might be some things that need to be kept private, but the family can share the child’s reaction to certain things. If there can be a dialogue around [how] the student reacts to certain types of triggers, this is important for the school to be aware of. Many times, [the child is] going to be able to identify that they react in certain ways to certain types of environments or experiences.”
For example, if the child is particularly sensitive to loud noises, they can be accommodated with noise-canceling headphones, or the team can create a plan for the child to be notified in advance of fire drills. “For a student who’s able to communicate that effectively, I think those can be very powerful conversations, to have them involved in the process.”
It’s possible that a child may not meet eligibility for an IEP as they start school, and may not have resources under IDEA to address both their disability and trauma needs. Both Collin and Yingling advise parents to seek out all avenues for support; 504 plans can also provide classroom accommodations and goals that serve the same purpose of keeping the child safe and supported at school.
“There is a narrative in the world that says that all it takes is love,” says Yingling, which is both true and not. Love and presence are huge counterparts to the medical, psychiatric, and academic supports a child with complex trauma needs to work through their trauma, but they can’t supersede complex trauma alone.
Beyond creating a safe space for children with complex trauma at home and accommodating them at school, children also need the means to engage with the world and communities around them. Fostering communal connections through communal activities and hobbies helps children with trauma feel less alone, which is one of the hardest feelings for them to let go of.
“Even in the face of adversity or traumatic experiences, there are things that, if they’re in place, people don’t have long-term bad outcomes. One of the biggest things is feeling a sense of belonging,” Dr. Aron says. “Being in the community, having people, having groups — it’s important. Kids feel good when they know that their parents have a place in the world, that they have people, that they have friends, that they’re a part of the community.”
Applying the tenets of the ARC framework, for example, can also help foster positive attachments with people beyond the child’s daily life. “When we designed the framework, we did that in a very intentional way, in terms of research on traumatic stress and resilience and development. One of the things that we really wanted to honor with this framework [is] we’re looking at a range of settings, so we had to look at how we define caregivers, right? You know, in terms of looking at attachment support, who were we going to be working with and supporting around doing that for kids?” says Kinniburgh.
No more surprises
No child is born expecting to experience ACEs or find themselves experiencing long-term trauma. Consistency and routine, as Yingling mentioned, are huge structural supports that allow children to feel safe and regulated — so no more surprises, no matter how small or insignificant. “Before you deliver bad news to a child with trauma,” says Yingling, “tell them they’re not going to like it. Take the element of surprise out. Good or bad, it shocks their nervous system. And we don’t want to shock their nervous system.” This applies not only to potential changes in their home routine, but also to their school environment. Having an unexpected substitute teacher, for example, can create unforeseen stress and impact the child’s learning and behavior for the day.
Incorporate their care into your daily routine
“It’s not fancy and it’s not something that only lies within a professional,” says Dr. Aron. “Many of the tools that we talk about with caregivers are tools that they’re already using. What are the tools that you have at your disposal, and what are the things that you’re doing, and how does that support certain skills in your child?” This can include basic daily functions like watching a program with your child and asking about the characters and how the program makes them feel, or checking in with them at dinner.
Maintain an open and respectful dialogue with their care and school team
As a child gets older, depending on their needs, they may want to participate more in their IEP meetings and share insights about their therapy services. Keeping in touch with their IEP team outside of scheduled meetings helps all adults involved in the child’s care stay in the loop about their evolving needs, treatment plans, and progress.
Don’t forget about your own regulation
Seeing your child traumatized can have rippling effects on parents and caregivers on top of the responsibility of their child’s disability-related needs. Dr. Blaustein recommends that caregivers make time and room in their routines for recognizing their own needs. “We talk a lot about kids’ feelings making sense, but caregivers’ feelings also make sense, and their responses make sense. Understanding those and tending to those and using the tools they need to build themselves up as a regulated caregiving system is one of the most critical things [caregivers] can do for their child, because we are all better at caregiving when we are in a regulated place. We have to put effort and energy into it, and that’s not taking away from the energy you’re giving to your child. It’s additive.”
Enjoy the child you have
Many parents, whether they are the child’s birth parents, resource family, or adoptive parents, feel guilt about the trauma their child has experienced on top of the disability they may have. Kinniburgh encourages parents to let go of guilt they may be holding onto and to move forward with an intersectional approach to their child’s needs. “Every day is a new day.”
Let your child’s interests guide their treatment plan
Another recommendation Kinniburgh has for parents is to try and incorporate your child’s interests in how you respond to their behaviors on a daily basis. Therapy alone oftentimes does not move the needle without allowing the child to invest and find motivation in treatment.
It may sound scary to hear that there is no way to perfectly predict a child’s treatment path for their trauma, or how their needs will evolve as they age. But as our sources have reiterated, children want to feel safe, trust those around them, and participate in their own lives. How they live with their trauma only has to make sense to them and their family if it means they get to live a happy and healthy life.
The National Child Traumatic Stress Network (NCTSN): The National Child Traumatic Stress Initiative (NCTSI) raises awareness about the impact of trauma on children and adolescents as a behavioral health concern.
Pediatric Trauma Society: an organization for healthcare providers and parents to improve and share developmental care guidelines and outcomes for injured and/or children with trauma through education, research and advocacy. They also have a podcast, regular literature reviews, and an annual meeting.
Look Through Their Eyes: This online resource hub provides families with information about lesser-known sources of trauma, including community violence, bullying, and trauma for children under 5 years old. It also gives families access to a network of over 80 institutions across research, advocacy, medical, public, and private sectors devoted to childhood trauma and improving children’s outcomes.
Circle of Security International: Circle of Security provides training and educational resources for healthcare professionals, school personnel, and parents, including various levels of online courses, content and resources to better understand how to address a child’s trauma and build secure attachment. One resource our sources recommend is the attachment parenting book Raising a Secure Child by Kent Hoffman, Glen Cooper, and Bert Powell.
The Brazelton Touchpoints Center: A nonprofit founded on the principles of notable pediatrician Thomas Berry Brazelton, creator of the Neonatal Behavioral Assessment Scale, that focuses on young child attachment and healthy development.
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