An overview of complex trauma: causes, symptoms and treatment

By Daphne Boucher, MScOT, OT Reg. (AB), Doctoral student NYU OT Reviewed by Unyte Clinical Team

Complex trauma results from chronic or ongoing exposure to events, such as abuse, neglect, separation from primary caregivers, exposure to violence or substance abuse, and poverty (Cook et al., 2003).

These events are especially impactful in early childhood, a sensitive time during which important brain connections are established. They expose the developing brain to excess stress chemicals that alter its physical structures in a way that desensitizes it to danger. If not supported effectively, these impacts affect a child’s ability to regulate emotions and behavior, form relationships, and cope with stress during childhood and in later life. Additionally, genetic and environmental factors can play a role in the experience of complex trauma.

In this blog, we’ll explore the symptomatology associated with complex trauma, treatment from an occupational therapy lens, and how providers can assess clients experiencing complex trauma.

Symptoms of Complex Trauma

Complex trauma can manifest in many ways. The most common and easily identifiable include emotional and behavioral regulation difficulties, as well as physical symptoms, such as delayed milestones throughout childhood, chronic pain complaints, and gut issues.

Complex trauma can also have significant effects on cognitive development, leading to difficulties in attention, memory, and executive function, creating immense difficulty in school functioning (van der Kolk, 2005).

Treatment Options for Complex Trauma from an Occupational Therapy Lens

Occupational therapy (OT) offers a multifaceted approach to help children who have experienced complex trauma regain a sense of control, safety and well-being. These treatment modalities are tailored to the unique needs of each child, and aim to address their physical, emotional and cognitive challenges.

1. The Safe and Sound Protocol (SSP) is a non-invasive listening protocol designed to support the regulation of the autonomic nervous system, leading to increased social engagement, improved regulation and decreased sensory sensitivities.
2. Sensory integration therapy, a core component of OT, helps children regulate their responses to sensory stimuli, aiding in emotional regulation and reducing hyperarousal.
3. Play Therapy, often incorporated into OT sessions, provides a safe space for children to express their feelings, develop social skills and rebuild trust in relationships.

Additionally, activities promoting fine and gross motor skills enhance physical development and help children regain a sense of mastery and self-esteem. Collaborative work with families and caregivers is also crucial to create a supportive environment for healing and growth.

OT modalities for children affected by complex trauma are holistic and compassionate, striving to empower these young individuals on their path to recovery and resilience.

Other treatment options include evidence-based therapies, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Although OTs less commonly use these therapies, TF-CBT and EMDR have demonstrated effectiveness in treating complex trauma (National Child Traumatic Stress Network, 2017; American Psychological Association, 2018).

Assessing Complex Trauma

A comprehensive evaluation by a mental health professional, including a detailed history of adverse childhood experiences (ACEs), can help identify these types of experiences in a child’s history.

OTs may use family interviewing or trauma-specific screening tools or questionnaires designed to identify trauma symptoms and their impact on daily life. Examples include the Child Behavior Checklist (CBCL), the Trauma Symptom Checklist for Children (TSCC), and the Child Trauma Screening Questionnaire (Ford & Courtois, 2013).

I hope this overview of complex trauma has helped you gain a better understanding of this topic as it relates to occupational therapy! Please watch out for our next blog post, which will delve deeper into how to identify symptoms and how occupational therapists can help.

For suggestions on blog topics or questions about the material, please reach out to [email protected]!

References

American Psychological Association. (2018). Play therapy. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/play-therapy

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., … & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European

van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408.