Understanding Complex Trauma:
Strengthening Supporting Learning
Environments through a Trauma Sensitive
Lens
Washington PBIS Conference
May 21st, 2011
“Exposure to extremely stressful conditions that
one can’t change or escape from can have
profound effects on anyone, regardless of age. It
can alter how we see the world, how we see
others, and how we perceive our own worth.”
(Mark Katz. (1997). On Playing a Poor Hand Well, p. 5)
Copyright 2007 WSU Area Health
Education Center
Complex trauma defined
Both the process of exposure and the process of
adjustment to terrible stress
 As a common defining concern, complex trauma
originates in the child’s family
 But, community violence, racism, and the profound
stressors of poverty also contribute to the complexity
of trauma
 Often occurs early in the child’s life
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◦ Occurs at most rapid period of development
◦ Occurs when thought and action by the child aren’t options
◦ Trauma effects the basic biology of responding to stress
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The experience of traumatic events often involves
chronic exposure to trauma
Exposure to multiple trauma types is common.
Exposure to one trauma type is a marker for risk of
exposure to others
Copyright 2010 WSU Area Health
Education Center
Trauma is an existential threat to
children, families, and communities.
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Family factors are among principal dropout risks
◦ Maltreated children have 3 times the drop out rate of the
general population
◦ At least half of all child maltreatment victims will experience
serious school problems, especially conduct issues.
But…
◦ Community risks- violence and racism
◦ School culture and school actions are equally predictive
Nationally, children with emotional and behavioral disorders
who are also in special education classes have the highest
school drop out rate (50%).
Trauma is the defining common denominator in students
entering the juvenile justice and treatment systems.
Only one in 10 children with severe behavior and emotional
distress ever engage in formal treatment.
“Complex Trauma Outcomes are most likely to
develop and persist if an infant or child is
exposed to danger that is unpredictable and
uncontrollable because the child’s body must
allocate resources that are normally dedicated
to growth and development instead to survival.”
(Focal Point, 2007, p.4)
Copyright 2007 WSU Area Health
Education Center
What Does Trauma Look Like?: The
Identified Primary Domains Of Impairment
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Attachment
Biology
Self Regulation
◦ Emotional & Behavioral Regulation
Cognition
Self-Concept
Copyright 2007 WSU Area Health
Education Center
How Complex Trauma May/Can
Disrupt Attachment:
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Problems with boundaries
Hesitant to look towards adults for attention or
support—suspiciousness and distrust
Sense of security and safety can be
compromised or destroyed
Uncertainty about the reliability and
predictability of the world
Difficulty forming trusting relationships with
others—hesitant to enlist others as allies
Trouble interpreting emotional signals
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Education Center
The Still Face Experiment
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C:\Documents and Settings\naturner\My
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“Children are like wet
cement. Whatever falls on
them makes an impression."
– Hiam Ginott
Copyright 2007 WSU Area Health
Education Center
Brain Development And Trauma
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Trauma’s risk to development has a biological
foundation
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The most developed areas of the brain are the areas
most frequently used
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Ongoing development of the brain throughout
childhood and adolescence
◦ Critical periods for definition of structure, function,
and coordination of the brain
Copyright 2007 WSU Area Health
Education Center
Copyright 2007 WSU Area Health
Education Center
Trauma And Biological Response To
Trauma
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Brain and hormonal systems are a single unified
system
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Central nervous system appraisal of threat and
triggering of threat response
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Direct neural and hormonal responses to prepare
fight/flight survival responses
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Activation of cognition for planning and problemsolving
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Education Center
Trauma’s Potential Effects On
Biological Threat Management
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Elevated stress hormone levels (Particularly Adrenaline and
Cortisol)
Sustained stress hormones correlated with
◦ trauma-related reductions in brain function of limbic system,
hypothalamus, hippocampus (involved in threat appraisal, stress
regulation, memory, cognition, and learning)
◦ Impaired regulation in the overall system
Cerebral cortex (prefrontal and frontal lobes) function reduced
with resulting problems of verbal skills, memory, and problem
solving
Underdeveloped Corpus Callosum – structure that allows for
communication between the Left and Right hemispheres
Copyright 2007 WSU Area Health
Education Center
Threat-arousal response in
traumatized individuals
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Three interacting ways trauma can lead to ineffective
behaviors and risk of high and persistent emotional distress in
response to threat
◦ Learned responses of fear that are not matched to
objective risk (hyper-vigilance and anxiety/terror)
◦ Heightened arousal as a trait (hyper-arousal)
◦ Risk of incomplete development of integrated brain
function for mastery of new situations and response to
threat
Threat Appraisal and Detection in
Traumatized Children
Copyright 2007 WSU Area Health
Education Center
Implications Of Trauma On Biological
Threat Response System
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If we are responding to trauma-related reactions
recognizing the biological basis of behavior in a child
or adult means blame has no place.
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Understanding the biological risks points to some of
the actions we can take as caring adults
Copyright 2007 WSU Area Health
Education Center
How Complex Trauma Can/May
Disrupt Self-regulation:
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Constantly scanning the world
for warning signs
Focus on non-verbals of
others (facial expressions,
voice tone, body language)
constantly looking for signs of
anger or other potential
behaviors indicative that
abuse will happen
In a constant state of “survival
mode”
Difficulty describing feelings
and internal experiences
Difficulty communicating
wishes and desires
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Poor impulse control
Lack of mentoring for
appropriate behavior and
communication with others
Utilize aggressive behaviors to
regain control over
environment or to send
message regarding lack of
control
Self soothing behaviors
Sleep and eating disturbances
Difficulty complying with rules
Traumatic play
Copyright 2007 WSU Area Health
Education Center
How Complex Trauma Can/May
Disrupt Cognition:
Difficulty in their ability to
learn and process verbal
information
 Harder to use language
as a vehicle for
communication
 Difficulty in organizing and
remembering new
information
 Difficulty understanding
cause and effect
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Difficulty focusing on
tasks at hand
Difficulty planning and
anticipating
Problems with orientation
in time and space
Difficulty focusing on and
completing tasks
Tend to have poor
problem solving skills
Copyright 2007 WSU Area Health
Education Center
How Complex Trauma Can/May
Disrupt Self-concept:
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Feel incapable of having a positive impact on the
outside world
◦ Hopelessness
Difficulty in initiating play or having safety with
imagination and exploration
Low self-esteem--diminished sense of self worth
Disturbances of body image
Shame and guilt; self blame
Unsure of own needs and often lack capacity to
get needs met
Copyright 2007 WSU Area Health
Education Center
The Relationship Between Adverse Events and Academic Risk
in Elementary School Children (Spokane study)
(Percent of Students with One or More School Success
Problem)
100%
90%
90%
80%
70%
60%
60%
50%
53%
44%
40%
30%
20%
10%
0%
No Known Adverse Events
One Reported Adverse Event
Two Reported Adverse Events
Three or more Adverse Events
Copyright 2010 WSU Area Health
Education Center
In children not identified
in Special Education
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Compared to no known adverse events,
◦ Academic failure was X2 for students with two
adverse events and X3 for students with three or
more adverse events.
◦ Attendance problems increase X2 with one adverse
event, X3 with two adverse events, and X6.6 with
three or more adverse events.
◦ School behavior problems were X2, X3.6, and X4.4
with increasing adverse event exposure.
◦ With any adverse event, students have chronic health
problems X2.
ARC Model Components
Attachment
SelfRegulation
Competency
Caregiver Affect
Management
Affect
Identification
Developmental
Tasks
Attunement
Affect
Modulation
Executive Functions
Consistent Response
Affect
Expression
Self
Development
Routines and Rituals
Copyright 2007 WSU Area Health
Education Center
Trauma and Us
Each of us is a trauma survivor or will be
 We engage traumatized children through
the lens of our own trauma histories
 The foundation for change starts with
awareness of ourselves and understanding
the power of relationship
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“The world breaks everyone and
afterwards many are strong at the broken
places.”
~ Ernest Hemingway
Copyright 2007 WSU Area Health
Education Center
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Copyright 2007 WSU Area Health
Education Center