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ECE 2650:

These assignments involved gathering a wide range of resources, many focused on supporting children with traumatic backgrounds. These resources provide valuable tools and information to help educators better understand trauma and implement effective strategies to support affected children.

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ECE 3310:

This assignment focuses on designing a classroom layout tailored to a specific learning environment. For children with trauma, creating a supportive and accommodating classroom space helps foster safety, predictability, and calmness, which are essential for their emotional regulation and healing.

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Engagement 8: Natural Environment Shopping List

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Engagement 8: Natural Environment Shopping List

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ECE 2650:

This activity involves creating a shopping list and designing a natural environment floor plan. For children with trauma, natural environments can promote calmness, reduce stress, and support healing by providing sensory-rich, soothing spaces that encourage exploration and connection to nature.

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ECE 2650:

This assignment involves reflecting on both my own practices and the school’s efforts to create a trauma-informed environment. It highlights the importance of being aware of how everyday actions and school-wide policies work together to support children’s safety, emotional well-being, and healing from trauma.

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Effectiveness of Reflective Teaching Practices

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Effectiveness of Reflective Teaching Practices

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ECE 3310:

This assignment explores how reflective teaching supports a positive classroom environment. For children with trauma, reflective practices help educators adapt their approaches to meet emotional and developmental needs, creating a more responsive and supportive space for healing and growth.

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ECE 3210:

In this assignment, I explored Game-Based Learning as a teaching strategy. For children with trauma, game-based approaches can offer a safe and engaging way to build trust, social skills, and confidence, while also reducing stress through play and positive interactions.

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ECE 2910:

This presentation focused on understanding and supporting families where grandparents are the primary caregivers. Children from these families may have experienced trauma or disruption, and recognizing their unique family dynamics helps create a more empathetic, inclusive, and supportive classroom environment.

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Conflict and Professional Communication Assignment 

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Conflict and Professional Communication Assignment 

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ECE 2910:

In this assignment, I addressed a scenario involving a child named Nicky who struggled with impulse control. I reflected on my experience communicating with his family, which is especially important when working with children who may have experienced trauma, as open, respectful communication builds trust and ensures consistent support between home and school.

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ECE 1650:

This assignment involved selecting a scenario and identifying assessment tools to support the child and their family. It emphasized the importance of building positive family relationships and creating a safe and supportive learning environment. These elements are especially important for children who have experienced trauma, as they rely heavily on stability and trust.

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ECE 1650:

This assignment involved selecting a child in my care and documenting their experiences, using assessments and screenings to track their progress. For children with trauma, closely monitoring development and behavior helps identify specific needs early and allows for targeted support that fosters growth and emotional well-being.

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What is Community Violence Intervention?

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What is Community Violence Intervention?

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Kati Morton explains that trauma is a strong emotional response to a painful event. She describes three types: acute trauma (one-time event), chronic trauma (repeated harm), and complex trauma (multiple ongoing events, often starting in childhood). Trauma can cause flashbacks, anxiety, and trouble sleeping. Healing often involves therapy like CBT or EMDR.

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What is Community Violence Intervention?

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The study looked at teens exposed to community violence. It found three groups based on risk and protection. One group had high violence exposure and low self-worth. Two groups had moderate violence exposure but more protection. The group with less protection had more depression. Parents being involved helped protect teens. Violence exposure did not predict aggression.

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Community Violence, Protective Factors, and Adolescent Mental Health: A Profile Analysis

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This study examined interrelationships among community violence exposure, protective factors, and mental health in a sample of urban, predominantly African American adolescents (N = 504). Latent Profile Analysis was conducted to identify profiles of…

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The Centre for Clinical Psychology explains that intergenerational trauma is passed through parenting, behaviors, and mental health challenges, leading to ongoing cycles of hardship. They promote trauma-informed, culturally sensitive care and offer therapy to support healing.

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Co-authored by Frieda Friedemann Intergenerational trauma is commonly misunderstood as a cycle that needs breaking, when really, there is no cycle to

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This article is very thorough on all the ins and outs of the development, the effects, the before and after, the studies, the statistics, the treatment options, different therapy options, and so much more. It goes into depth with a lot of words, but also visuals, too. It's helpful to see diagrams that truly put the words into eyesight to see where in the brain it's being affected the most.

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Abstract

Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors. Antidepressants have effets on the hippocampus that counteract the effects of stress. Findings from animal studies have been extended to patients with post-traumatic stress disorder (PTSD) showing smaller hippocampal and anterior cingulate volumes, increased amygdala function, and decreased medial prefrontal/anterior cingulate function. In addition, patients with PTSD show increased cortisol and norepinephrine responses to stress. Treatments that are efficacious for PTSD show a promotion of neurogenesis in animal studies, as well as promotion of memory and increased hippocampal volume in PTSD.

Keywords: positron emission tomography, depression, stress, post-traumatic stress disorder

Abstract

El estrés traumático surte efectos muy diversos sobre la función y la estructura cerebrales. Las regiones cerebrales implicadas en la respuesta al estrés son la amígdala (núcleo amigdalino), el hipocampo y la corteza prefrontal. Los sistemas neuroquímicos, como el cortisol y la noradrenalina, desempeñan una misión crítica en la respuesta al estrés. Estas regiones cerebrales influyen sobre la respuesta al estrés y sobre la memoria, lo que subraya la interrelación entre la memoria y la respuesta al estrés traumático. Los antidepresivos actúan sobre el hipocampo y contrarrestan el efecto del estrés. Los estudios sobre pacientes con trastorno por estrés postraumático (TEPT) revelan alteraciones en las regiones cerebrales implicadas en los estudios con animales como la amígdala, el hipocampo y la corteza prefrontal, así como en los sistemas neuroquímicos de respuesta al estrés, entre ellos el cortisol y la noradrenalina. Los tratamientos con eficacia frente al TEPT promueven la neurogénesis en los estudios con animales y también aumentan la memoria, y el volumen hipocámpico en el TEPT. Se requieren nuevos estudios para evaluar los mecanismos neurales de la respuesta terapéutica en el TEPT.

Abstract

Le stress traumatique exerce une grande variété d'effets sur la fonction et la structure cérébrales. Les aires cérébrales impliquées dans la réponse au stress comprennent l'amygdale, l'hippocampe et le cortex préfrontal. Les systèmes neurochimiques, incluant le cortisol et la norépinéphrine, jouent un rôle critique dans la réponse au stress. Ces aires cérébrales influent sur la mémoire et sur la réponse au stress traumatique, soulignant ainsi les interactions existant entre les deux. Les effets des antidépresseurs sur l'hippocampe compensent les effets du stress. Les études chez les patients atteints de trouble stress post-traumatique (ESPT) montrent des modifications des aires cérébrales impliquées au cours des études animales, telles l'amygdale, l'hippocampe et le cortex préfrontal, ainsi que des modifications des systèmes neurochimiques de réponse au stress comme le cortisol et la noradrénaline. Les traitements efficaces dans l'ESPT entraînent une activation de la neurogenèse chez l'animal de même qu'une amélioration de la mémoire et une augmentation du volume de l'hippocampe dans l'ESPT. Il faudra d'autres études pour évaluer les mécanismes neuronaux dans la réponse thérapeutique au cours de l'ESPT.

Effects of traumatic stress

Traumatic stressors such as early trauma can lead to posttraumatic stress disorder (PTSD), which affects about 8% of Americans at some time In their lives,1 as well as depression,2,3 substance abuse,1,4 dissociation,5 personality disorders,6,7 and health problems.8 For many trauma victims, PTSD can be a lifelong problem.9 The President's New Freedom Commission Report highlights the Importance of providing services for mental disorders related to early trauma.10-12 However, the development of effective treatments is limited by gaps in knowledge about the underlying neurobiological mechanisms that mediate symptoms of traumarelated disorders like PTSD. This paper reviews preclinical and clinical studies on the effects of traumatic stress on the brain.

Normal development of the brain across the lifespan

To understand how traumatic stress occurring at different stages of the life cycle interacts with the developing brain, it is useful to review normal brain development. The normal human brain undergoes changes in structure and function across the lifespan from early childhood to late life. Understanding these normal developmental changes is critical for determining the difference between normal development and pathology, and how normal development and pathology interact.

Although the bulk of brain development occurs in utero, the brain continues to develop after birth. In the first 5 years of life there is an overall expansion of brain volume related to development of both gray matter and white matter structures; however, from 7 to 17 years of age there is a progressive increase in white matter (felt to be related to ongoing myelination) and decrease in gray matter (felt to be related to neuronal pruning) while overall brain size stays the same.13-16 Gray matter areas that undergo the greatest increases throughout this latter developmental epoch include frontal cortex and parietal cortex.17,18 Basal ganglia decrease in size, while corpus callosum,19,20 hippocampus, and amygdala21-23 appear to increase in size during childhood, although there may be developmental sex-laterality effects for some of these structures.24 Overall brain size is 10% larger in boys than girls during childhood.24

During the middle part of life (from age 20 to 70) there is a gradual decrease in caudate,25 diencephalon,25 and gray matter,25,26 which is most pronounced in the temporal27 and frontal cortex,26 with enlargement of the ventricles26,27 and no change in white matter.25,26 Studies have not been able to document changes in hippocampal volume in normal populations during this period.27 After menopause in women at about the age of 50, however, there are changes in reproductive hormones, such as decreased levels of estrogen. Since estrogen promotes neuronal branching in brain areas such as the hippocampus,28 a loss of estrogen may lead to changes in neuronal structure. Although the effects of menopause on the brain have not been well studied, it is known that sex hormones also affect brain function and circuitry29; therefore, the changes in sex hormones with menopause will presumably affect brain function, as well as possibly structure. There is some evidence in super-elderly individuals (age >70) for modest reductions in hippocampal volume with late stages of aging.27,30 More robust findings have included increased ventricular volume and reduction in gray matter, temporal lobe, and cerebellum volumes with normal aging, that begins before the age of 70.

Therefore, trauma at different stages in life will presumably have different effects on brain development. The few studies that have looked at this issue do suggest that there are differences in the effects of trauma on neurobiology, depending on the stage of development at which the trauma occurs. Studies in this area, however, have been limited.

Neurobiology of PTSD

PTSD is characterized by specific symptoms, including intrusive thoughts, hyperarousal, flashbacks, nightmares, and sleep disturbances, changes in memory and concentration, and startle responses. Symptoms of PTSD are hypothesized to represent the behavioral manifestation of stress-induced changes in brain structure and function. Stress results in acute and chronic changes in neurochemical systems and specific brain regions, which result in longterm changes in brain "circuits," involved in the stress response.34-37 Brain regions that are felt to play an important role in PTSD include hippocampus, amygdala, and medial prefrontal cortex. Cortisol and norepinephrine are two neurochemical systems that are critical in the stress response (Figure 1.)

Figure 1. Lasting effects of trauma on the brain, showing long-term dysregulation of norepinephrine and Cortisol systems, and vulnerable areas of hippocampus, amygdala, and medial prefrontal cortex that are affected by trauma. GC, glucocorticoid; CRF, corticotropin-releasing factor; ACTH, adrenocorticotropin hormone; NE, norepinephrine; HR, heart rate; BP, blood pressure; DA, dopamine; BZ, benzodiazapine; GC, glucocorticoid.

The corticotropin-releasing factor (CRF)/hypothalamic-pituitary-adrenal (HPA) axis system plays an important role in the stress response. CRF is released from the hypothalamus, with stimulation of adrenocorticotropic hormone (ACTH) release from the pituitary, resulting in glucocorticoid (Cortisol in man) release from the adrenal, which in turn has a negative feedback effect on the axis at the level of the pituitary, as well as central brain sites including hypothalamus and hippocampus. Cortisol has a number of effects which facilitate survival. In addition to its role in triggering the HPA axis, CRF acts centrally to mediate fear-related behaviors,38 and triggers other neurochemical responses to stress, such as the noradrenergic system via the brain stem locus coeruleus.39 Noradrenergic neurons release transmitter throughout the brain; this is associated with an increase in alerting and vigilance behaviors, critical for coping with acute threat.40-42

Studies in animals showed that early stress has lasting effects on the HPA axis and norepinephrine. A variety of early stressors resulted in increased glucocorticoid response to subsequent stressors.43-45 Maternally deprived rats had decreased numbers of glucocorticoid receptors in the hippocampus, hypothalamus, and frontal cortex.46 Stressed animals demonstrated an inability to terminate the glucocorticoid response to stress,47,48 as well as deficits in fast-feedback of glucocorticoids on the HPA axis, which could be related to decreased glucocorticoid receptor binding in the hippocampus.49 Early postnatal adverse experiences increase hypothalamic CRF messenger ribonucleic acid (mRNA), median eminence CRF content, and stress-induced glucocorticoid50 and ACTH release.46 These effects could be mediated by an increase in synthesis of CRH mRNA following stress.51 In nonhuman primates, adverse early experiences resulted in long-term effects on behaviors, as well as elevated levels of CRF in the cerebrospinal fluid.52 Exposure to chronic stress results in potentiation of noradrenergic responsiveness to subsequent stressors and increased release of norepinephrine in the hippocampus and other brain regions.42

Preclinical and clinical studies have shown alterations in memory function following traumatic stress,53 as well as changes in a circuit of brain areas, including hippocampus, amygdala, and medial prefrontal cortex, that mediate alterations in memory.54 The hippocampus, a brain area involved in verbal declarative memory, is very sensitive to the effects of stress. Stress in animals is associated with damage to neurons in the CA3 region of the hippocampus (which may be mediated by hypercortisolemia, decreased brain-derived neurotrophic factor (BDNF), and/or elevated glutamate levels) and inhibition of neurogenesis.55-60 High levels of glucocorticoids seen with stress were also associated with deficits in new learning.61,62

Antidepressant treatments have been shown to block the effects of stress and/or promote neurogenesis.58,63-66 Animal studies have demonstrated several agents with potentially beneficial effects on stress-induced hippocampal damage. It has been found that phenytoin blocks the effects of stress on the hippocampus, probably through modulation of excitatory amino acid-induced neurotoxicity.67 Other agents, including tianeptine, dihydroepiandosterone (DHEA), and fluoxetine have similar effects.63,64,66,68-73 These medications may share a common mechanism of action through upregulation of cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) that may lead to regulation of expression of specific target genes involved in structural modeling of the hippocampus. Such treatment effects on BDNF and trkB messenger ribonucleic acid (mRNA), can have long-term effects on brain structure and function. There is new evidence that neurogenesis is necessary for the behavioral effects of antidepressants,74,75 although this continues to be a source of debate.72,76

The hippocampus demonstrates an unusual capacity for neuronal plasticity and regeneration. In addition to findings noted above related to the negative effects of stress on neurogenesis, it has recently been demonstrated that changes in the environment, eg, social enrichment or learning, can modulate neurogenesis in the dentate gyrus of the hippocampus, and slow the normal age-related decline in neurogenesis.77,78 Rat pups that are handled frequently within the first few weeks of life (picking them up and then returning them to their mother) had increased type II glucocorticoid receptor binding which persisted throughout life, with increased feedback sensitivity to glucocorticoids, and reduced glucocorticoid-mediated hippocampal damage in later life.79 These effects appear to be due to a type of "stress inoculation" from the mothers' repeated licking of the handled pups.80 Considered together, these findings suggest that early in the postnatal period there is a naturally occurring brain plasticity in key neural systems that may "program" an organism's biological response to stressful stimuli. These findings may have implications for victims of childhood abuse.

Long-term dysregulation of the HPA axis is associated with PTSD, with low levels of Cortisol found in chronic PTSD in many studies81-86 and elevations in CRF.82,87 Not all studies, however, have found lower Cortisol levels in PTSD.88-91 Exposure to a traumatic reminder appears to be associated with a potentiated release of Cortisol in PTSD.92 The few studies of the effects of early stress on neurobiology conducted in clinical populations of traumatized children have generally been consistent with findings from animal studies. Research in traumatized children has been complicated by issues related to psychiatric diagnosis and assessment of trauma.93 Some studies have not specifically examined psychiatric diagnosis, while others have focused on children with trauma and depression, and others on children with trauma and PTSD. Sexually abused girls (in which effects of specific psychiatric diagnosis were not examined) had normal baseline Cortisol and blunted ACTH response to CRF,94 while women with childhood abuse-related PTSD had hypercortisolemia.95 Another study of traumatized children in which the diagnosis of PTSD was established showed increased levels of Cortisol measured in 24-hour urines.96 Emotionally neglected children from a Romanian orphanage had elevated Cortisol levels over a diurnal period compared with controls.97 Maltreated school-aged children with clinicallevel internalizing problems had elevated Cortisol compared with controls.98 Depressed preschool children showed increased Cortisol response to separation stress.99 Adult women with a history of childhood abuse showed increased suppression of Cortisol with low-dose (0.5 mg) dexamethasone.100 Women with PTSD related to early childhood sexual abuse showed decreased baseline Cortisol based on 24-hour diurnal assessments of plasma, and exaggerated Cortisol response to stressors (traumatic stressors101 more than neutral cognitive stressors).102 We also found that patients with PTSD had less of an inhibition of memory function with synthetic Cortisol (dexamethasone) than normal subjects.103 Adult women with depression and a history of early childhood abuse had an increased Cortisol response to a stressful cognitive challenge relative to controls,104 and a blunted ACTH response to CRF challenge.105 These findings show longterm changes in stress responsive systems. Early in development, stress is associated with increased Cortisol and norepinephrine responsiveness, whereas with adulthood, resting Cortisol may be normal or low, but there continues to be increased Cortisol and norepinephrine responsiveness to stressors. In addition, early stress is associated with alterations in hippocampal morphology which may not manifest until adulthood, as well as increased amygdala function and decreased medial prefrontal function.

Cognitive function and brain structure in PTSD

Studies in PTSD are consistent with changes in cognition and brain structure. Multiple studies have demonstrated verbal declarative memory deficits in PTSD.53,106-108

Patients with PTSD secondary to combat109-113 and childhood abuse114,115 were found to have deficits in verbal declarative memory function based on neuropsychological testing. Studies, using a variety of measures (including the Wechsler Memory Scale, the visual and verbal components of the Selective Reminding Test, the Auditory Verbal Learning Test, Paired Associate Recall, the California Verbal New Learning Test, and the Rivermead Behavioral Memory Test), found specific deficits in verbal declarative memory function, with a relative sparing of visual memory and IQ. These studies have been conducted in both patients with PTSD related to Vietnam combat,109-113,116,119-121,123 rape,117 the Holocaust,124-126 adults with early childhood abuse,115 and traumatized children.118 One study in adult rape survivors showed that verbal declarative memory deficits are specifically associated with PTSD, and are not a nonspecific effect of trauma exposure.117 Another study of women with early childhood sexual abuse in which some, but not all, of the patients had PTSD, showed no difference between abused and nonabused women,127 while another study was not able to show a difference between Vietnam veterans with and without PTSD.128 Other types of memory disturbances studied in PTSD include gaps in memory for everyday events (dissociative amnesia),129 deficits in autobiographical memory,130 an attentional bias for trauma-related material,131-140 and frontal lobe-related impairments.141 These studies suggest that traumas such as early abuse with associated PTSD result in deficits in verbal declarative memory. It is not clear if cognitive deficits in early abuse survivors are specific to PTSD and are not related to the non-specific effects of abuse.

These effects were specific to verbal (not visual) memory, and were significant after controlling for IQ. Some of these studies used neuropsychological tests of declarative memory, such as the Wechsler Memory Scale (WMS) and Selective Reminding Test (SRT), that have been validated as sensitive to loss of neurons in the CA3 region of the hippocampus in epileptics who underwent hippocampal resection.142,143 Vietnam veterans with PTSD were originally shown by us to have 8% smaller right hippocampal volume based on magnetic resonance imaging (MRI) relative to controls matched for a variety of factors such as alcohol abuse and education ( P<0.05); smaller volume was correlated with deficits in verbal declarative memory function as measured with the Wechsler Memory Scale.144 A second study from our group showed a 12% reduction in left hippocampal volume in 17 patients with childhood abuse-related PTSD compared with 17 case-matched controls, that was significant after controlling for confounding factors.145 Smaller hippocampal volume was shown to be specific to PTSD within the anxiety disorders, and was not seen in panic disorder.146 Gurvits et al147 showed bilateral hippocampal volume reductions in combat-related PTSD compared with combat veterans without PTSD and normal controls. Combat severity was correlated with volume reduction. Stein et al148 found a 5% reduction in left hippocampal volume. Other studies in PTSD have found smaller hippocampal volume and/or reductions in iV-acetyl aspartate (NAA), a marker of neuronal integrity.149-153 Studies in childhood154-156 and new-onset157,158 PTSD did not find hippocampal volume reduction, although reduced NAA (indicating loss of neuronal integrity) was found in medial prefrontal cortex in childhood PTSD.159 In a recent meta-analysis we pooled data from all of the published studies and found smaller hippocampal volume for both the left and the right sides, equally in adult men and women with chronic PTSD, and no change in children.160 More recent studies of holocaust survivors with PTSD did not find a reduction in hippocampal volume, although PTSD patients who developed PTSD in response to an initial trauma had smaller hippocampal volume compared with those who developed PTSD after repeated trauma, suggesting a possible vulnerability of smaller hippocampal volume.161 Two independent studies have shown that PTSD patients have deficits in hippocampal activation while performing a verbal declarative memory task,149,162 although it is unclear if this is a deficit in activation or higher hippocampal blood flow at baseline. Both hippocampal atrophy and hippocampal-based memory deficits reversed with treatment with the selective serotonin reuptake inhibitor (SSRI) paroxetine, which has been shown to promote neurogenesis (the growth of neurons) in the hippocampus in preclinical studies.163 In addition, treatment with the anticonvulsant phenytoin led to an improvement in PTSD symptoms164 and an increase in right hippocampal and right cerebral volume.165 We hypothesize that stress-induced hippocampal dysfunction may mediate many of the symptoms of PTSD which are related to memory dysregulation, including both explicit memory deficits as well as fragmentation of memory in abuse survivors. It is unclear at the current time whether these changes are specific to PTSD, whether certain common environmental events (eg, stress) in different disorders lead to similar brain changes, or whether common genetic traits lead to similar outcomes.

The meaning of findings related to deficits in memory and the hippocampus in PTSD, and questions related to the relative contribution of genetic and environmental factors, has become an important topic in the field of PTSD and stress research. There are three possible models, taking into account genetic or environmental factors, which have been proposed to explain smaller hippocampal volume in PTSD: Model A (Environment), Model B (Environment and Genetic), and Model C (Genetic).166-169 In Model C (Genetic), smaller hippocampal volume represents a premorbid risk factor for PTSD. In support of this model Pitman and colleagues170 have demonstrated that lower premilitary IQ is associated with combat-related PTSD, as well as finding a correlation between PTSD symptoms and hippocampal volume in twin brothers.151 Model A (Environment) states that stress leads to damage or inhibition of neurogenesis via hypercortisolemia, decreased BDNF, or increased glutamate. Model B (Environment/Genetic) states that a combination of environmental and genetic factors leads to deficits in hippocampal function and structure. Showing that an intervention like medication changes hippocampal volume and cognition would provide support for at least a partial contribution of the environment to the outcomes of interest.

In addition to the hippocampus, other brain structures have been implicated in a neural circuitry of stress, including the amygdala and prefrontal cortex. The amygdala is involved in memory for the emotional valence of events, and plays a critical role in the acquisition of fear responses. The medial prefrontal cortex includes the anterior cingulate gyrus (Brodmann's area [BA] 32) and subcallosal gyrus (area 25) as well as orbitofrontal cortex. Lesion studies demonstrated that the medial prefrontal cortex modulates emotional responsiveness through inhibition of amygdala function. Conditioned fear responses are extinguished following repeated exposure to the conditioned stimulus in the absence of the unconditioned (aversive, eg, electric shock) stimulus. This inhibition appears to be mediated by medial prefrontal cortical inhibition of amygdala responsiveness.

Animal studies also show that early stress is associated with a decrease in branching of neurons in the medial prefrontal cortex.171 Rauch and colleagues found smaller volume of the anterior cingulate based on MRI measurements in PTSD172; we have replicated these findings in women with abuse and PTSD.160 An important question is whether these effects are reversible with treatment.

Neural circuits in PTSD

Brain imaging studies have shown alterations in a circuit including medial prefrontal cortex (including anterior cingulate), hippocampus, and amygdala in PTSD. Many of these studies have used different methods to trigger PTSD symptoms (eg, using traumatic cues) and then look at brain function. Stimulation of the noradrenergic system with yohimbine resulted in a failure of activation in dorsolateral prefrontal, temporal, parietal, and orbitofrontal cortex, and decreased function in the hippocampus.173 Exposure to traumatic reminders in the form of traumatic slides and/or sounds or traumatic scripts was associated with an increase in PTSD symptoms, decreased blood flow, and/or failure of activation in the medial prefrontal cortex/anterior cingulate, including Brodmann's area 25, or subcallosal gyrus, area 32 and 24, as measured with positron emission tomography (PET) or functional MRI (fMRI).174-183 Other findings in studies of traumatic reminder exposure include decreased function in hippocampus,176 visual association cortex,176,180 parietal cortex, and inferior frontal gyrus, and increased function in amygdala,181,184 posterior cingulate, and parahippocampal gyrus.174,176,178 Shin and colleagues found a correlation between increased amygdala function and decreased medial prefrontal function with traumatic reminders,181 indicating a failure of inhibition of the amygdala by the medial prefrontal cortex that could account for increased PTSD symptoms with traumatic reminders. Other studies found increased amygdala and parahippocampal function and decreased medial prefrontal function during performance of an attention task,182 increased posterior cingulate and parahippocampal gyrus and decreased medial prefrontal and dorsolateral prefrontal function during an emotional Stroop paradigm,185 and increased amygdala function with exposure to masked fearful faces.186 Retrieval of emotionally valenced words187 (eg "rape-mutilate") in women with PTSD from early abuse resulted in decreases in blood flow in an extensive area which included orbitofrontal cortex, anterior cingulate, and medial prefrontal cortex (BA 25, 32, and 9), left hippocampus, and fusiform gyrus/inferior temporal gyrus, with increased activation in posterior cingulate, left inferior parietal cortex, left middle frontal gyrus, and visual association and motor cortex.188 Another study found a failure of medial prefrontal cortical/anterior cingulate activation, and decreased visual association and parietal cortex function, in women with abuse and PTSD relative to women with abuse without PTSD, during performance of the emotional Stroop task (ie, naming the color of a word such as "rape").189 We recently found increased amygdala activation with classical fear conditioning (pairing a shock and a visual stimulus), and decreased medial prefrontal cortex function with extinction, in abuse-related PTSD.190 The findings described above point to a network of related regions mediating symptoms of PTSD, including medial prefrontal cortex, anterior cingulate, hippocampus, amygdala, posterior cingulate, parietal, visual association, and dorsolateral prefrontal cortex.191

Fewer brain imaging studies have been performed in children with PTSD. Several studies have shown alterations in electroencephalogram (EEG) measures of brain activity in children with a variety of traumas who were not selected for diagnosis compared with healthy children. About half of the children in these studies had a psychiatric diagnosis. Abnormalities were located in the anterior frontal cortex and temporal lobe and were localized to the left hemisphere.192,193 Two studies have found reductions in brain volume in children with trauma and PTSD symptoms.154,155 One group did not find reductions in hippocampal volume, either at baseline or over a longitudinal period,154,156 while another group found an 8.5% reduction in hippocampal volume that was not significant after controlling for smaller brain volumes in the PTSD group.155 One study used single-voxel proton magnetic resonance spectroscopy (proton MRS) to measure relative concentration of NAA and creatinine (a marker of neuronal viability) in the anterior cingulate of 11 children with maltreatment-related PTSD and 11 controls. The authors found a reduction in the ratio of NAA to creatinine in PTSD relative to controls.159 Studies have also found smaller size of the corpus callosum in children with abuse and PTSD relative to controls.154 as well as larger volume of the superior temporal gyrus.194 In a study of abused children in whom diagnosis was not specified, there was an increase in T2 relaxation time in the cerebellar vermis, suggesting dysfunction in this brain region.195 The reason for differences in findings between adults and children are not clear; however, factors such as chronicity of illness or interaction between trauma and development may explain findings to date.

In summary, dysfunction of a circuit involving the medial prefrontal cortex, dorsolateral prefrontal cortex, and possibly hippocampus and amygdala during exposure to traumatic reminders may underlie symptoms of PTSD. These studies have primarily assessed neural correlates of traumatic remembrance, while little has been done in the way of utilizing cognitive tasks as probes of specific regions, such as memory tasks as probes of hippocampal function.

MRI assessment of brain abnormalities in PTSD and trauma spectrum disorders

Findings of smaller hippocampal volume appear to be associated with a range of trauma related psychiatric disorders, as long as there is the presence of psychological trauma. We have used MRI to show smaller hippocampal volume in PTSD, depression,197 depression with early abuse,198 borderline personality disorder (BPD) with early abuse,199 and Dissociative Identity Disorder (DID) with early abuse.200 The greatest magnitude of difference was seen in the DID patients, who had unusually severe early childhood sexual abuse histories. We did not find changes in hippocampal volume in patients with panic disorder without a history of abuse (suggesting that findings are not generalized to other anxiety disorders).201 We found smaller amygdala volume in BPD with early abuse199 and increased amygdala volume in depression.197,202 Patients with depression had smaller orbitofrontal cortex volume with no changes in anterior cingulate (BA 32) or medial prefrontal cortex (BA 25).203 More recently, we found smaller anterior cingulate volume in women with abuse and PTSD relative to controls.204

Neural circuits in women with abuse and PTSD

We have used PET to study neural circuits of traumarelated disorders in women with early abuse and a variety of trauma spectrum mental disorders. Initially we studied women with abuse and PTSD.54,205-208 We initially measured brain activation with a paragraph-encoding task in conjunction with PET 0-15 water measurement of brain blood flow. Women with abuse and PTSD showed a failure of hippocampal activation during the memory task relative to controls.149 Women with abuse and PTSD in this study also had smaller hippocampal volume measured with MRI relative to both women with abuse without PTSD and nonabused non-PTSD women. The failure of hippocampal activation was significant after controlling differences in hippocampal volume as well as accuracy of encoding. In another study we measured neural correlates of exposure to a personalized script of childhood sexual abuse. Women with abuse and PTSD showed a failure of medial prefrontal and hippocampal activation relative to abused women without PTSD.176 Women with abuse and PTSD also showed a failure of medial prefrontal and hippocampal function during recall of paired word associates with traumaticemotional content (eg, "rape-mutilate"),188 and decreased medial prefrontal function during an emotional Stroop task with trauma-content words.209 Other studies showed a failure of medial prefrontal activation in women with BPD and early abuse during an abandonment script.210 Women with BPD and abuse had increased psychophysiological responses to abandonment scripts relative to trauma scripts, while women with PTSD and abuse had the opposite pattern,211 indicating differential responding in those two disorders in spite of the common exposure to early abuse.

In another project we studied 19 physically healthy women including women with a history of severe childhood sexual abuse and the diagnosis of current PTSD (N=8) and women without childhood abuse or PTSD (N=11).212 All subjects underwent PET measurement of cerebral blood flow and psychophysiology measurement of heart rate and skin conductance during habituation, acquisition, and extinction conditions, on a single day, with scanning during a control condition on another day separated by 1 week from the active condition. Subjects were randomly assigned to undergo either the active condition or the control condition first (ie, active-control or control-active). Subjects were told at the beginning of the study that they would be exposed to electric shocks and viewing images on a screen during collection of PET and psychophysiology data. During habituation subjects were exposed to a blue square on a screen (conditioned stimulus [CS]), 4 seconds in duration, followed by 6 seconds of a blank screen. CS exposure was repeated eight times at regular intervals over 80 seconds in two separate blocks separated by 8 minutes. One PET image of brain blood flow was obtained starting from the beginning of each of the blocks. During active fear acquisition exposure to the blue square (CS) was paired with an electric shock to the forearm (unconditioned stimulus [UCS]).Subjects had 8 paired CS-UCS presentations at 10-second intervals for each of two blocks. With extinction subjects were again exposed to the blue squares (CS) with out shock ("active" extinction). On a second day subjects went through the same procedure with electric shocks delivered randomly when the blue square was not present (unpaired CS-UCS) (an equal number as on day 1) during scans 3 and 4, which served as a control for active fear acquisition.

PTSD subjects had increased symptoms of anxiety, fear, dissociation, distress, substance use disorders (SUDs), and PTSD at all time points during both study days relative to non-PTSD. Acquisition of fear was associated with increased skin conductance (SC) responses to CS exposure during the active versus the control conditions in all subjects. There was increased SC for PTSD during the first CS-UCS presentation. Extinction of fear was associated with increased skin conductance (SC) responses to CS exposure during the active versus the control conditions in all subjects. When PTSD and non-PTSD subjects were examined separately, SC levels were significantly elevated in non-PTSD subjects undergoing extinction following the active compared with the control condition during session one.

PTSD subjects showed activation of the bilateral amygdala during fear acquisition compared with the control condition. Non-PTSD subjects showed an area of activation in the region of the left amygdala. When PTSD subjects and control subjects were directly compared, PTSD subjects showed greater activation of the left amygdala during the fear conditioning condition (pairing of US and CS) relative to the random shock control than healthy women. Other areas that showed increased activation with fear acquisition in PTSD included bilateral superior temporal gyrus (BA 22), cerebellum, bilateral inferior frontal gyrus (BA 44, 45), and posterior cingulate (BA 24). Fear acquisition was associated with decreased function in medial prefrontal cortex, visual association cortex, and medial temporal cortex, inferior parietal lobule function, and other areas. Extinction of fear responses was associated with decreased function in the orbitofrontal and medial prefrontal cortex (including subcallosal gyrus, BA 25, and anterior cingulate BA 32), visual association cortex, and other areas, in the PTSD subjects, but not in the controls. Amygdala blood flow with fear acquisition was negatively correlated with medial prefrontal blood flow with fear extinction (increased blood flow in amygdala correlated with decreased blood flow in medial prefrontal cortex) in all subjects ( r=-0.48; P<0.05). Increased amygdala blood flow with fear acquisition was positively correlated with PTSD ( r=0.45), anxiety ( r=0.44) and dissociative ( r=0.80) symptom levels in PTSD (but not non-PTSD) subjects. There was a negative correlation between medial prefrontal blood flow during extinction and anxiety as measured with the Panic Attack Symptom Scale (PASS) during extinction in the PTSD group only, which was significant after correction for multiple comparisons ( r=-0.90; P=0.006).190 This study was consistent with increased amygdala function with fear acquisition, and decreased medial prefrontal (anterior cingulate) function during extinction in PTSD. This is consistent with the model of an overactive amygdala and a failure of medial prefrontal cortex to extinguish, or shut off, the amygdala, when the acute threat is no longer present.

Treatment of PTSD

Intervening soon after the trauma is critical for long-term outcomes, since with time traumatic memories become indelible and resistant to treatment.213 Early treatments are not necessarily effective. For instance, studies have shown that Critical Incident Stress Debriefing (CISD) can be associated with a worsening of outcome relative to no treatment at all.214 Pharmacological treatment of chronic PTSD has shown efficacy originally for imipramine,215 amitriptyline,216 and phenalzine,215 and later for brofaramine,217 paroxetine,218,219 and sertraline.220 Selective serotonin reuptake inhibitors (SSRIs) and tianeptine are now recommended as first-line treatment for PTSD.221-226

The utility of early treatment is also demonstrated by animal studies showing that pretreatment before stress with antidepressants reduces chronic behavioral deficits related to stress.227,228 Antidepressants, including both norepinephrine and serotonin reuptake inhibitors, as well as gabapentine and phenytoin, promote nerve growth (neurogenesis) in the hippocampus, while stress inhibits neurogenesis.63,64,66,69,71,75,229 This is important because hippocampal neurogenesis has been shown to be required for antidepressant response.74

Few studies have examined the effects of pharmacological treatment on brain structure and function in patients with trauma-related mental disorders. We studied a group of patients with depression and found no effect of fluoxetine on hippocampal volume, although there were increases in memory function230 and hippocampal activation measured with PET during a memory encoding task. Depressed patients with a history of childhood trauma were excluded, and we subsequently have found hippocampal volume reductions at baseline in women with early abuse and depression but not in women with depression without early abuse;198 this suggests that the study design of excluding patients with early trauma may account for the negative result. Other studies in depression showed that smaller hippocampal volume was a predictor of resistance to antidepressant treatment.231 Smaller orbitofrontal cortex volume is associated with depression; one study in geriatric depression found smaller orbitofrontal cortex volume, while length of antidepressant exposure was correlated with larger orbitofrontal volume.232

Several studies have looked at functional brain imaging response to antidepressants in depression. Single photonemission computed tomography (SPECT) blood flow studies in depression showed that antidepressants increased anterior cingulate, right putamen, and right thalamus function.233 SPECT Xenon-133 studies showed reduced prefrontal function at baseline in depression, with treatment responders showing reduced perfusion in prefrontal cortex compared with non-responders after treatment.234 In a fluorodeoxyglucose (FDG) PET study of brain function patients with depression treated with fluoxetine who had a positive response to treatment had limbic and striatal decreases (subgenual cingulate, hippocampus, insula, and pallidum) and brain stem and dorsal cortical increases (prefrontal, parietal, anterior, and posterior cingulate) in function. Failed response was associated with a persistent 1-week pattern and absence of either subgenual cingulate or prefrontal changes.235 Sertraline resulted in an increase in middle frontal gyrus activity in depression measured with PET FDG, as well as increased function in right parietal lobe and visual association cortex.236 Successful paroxetine therapy of depression was associated with increased glucose metabolism measured with PET in dorsolateral, ventrolateral, and medial aspects of the prefrontal cortex, parietal cortex, and dorsal anterior cingulate. Areas of decreased metabolism were noted in both anterior and posterior insular regions (left) as well as right hippocampal and parahippocampal regions.237 In another PET FDG study, at baseline, subjects with depression had higher normalized metabolism than controls in the prefrontal cortex (and caudate and thalamus), and lower metabolism in the temporal lobe. With treatment with paroxetine, subjects with depression had metabolic changes in the direction of normalization in these regions.238 A PET FDG study of patients with depression and controls showed that at baseline, the mean metabolism was increased in the left and right lateral orbital cortex/ventrolateral prefrontal cortex (PFC), left amygdala, and posterior cingulate cortex, and decreased in the subgenual anterior cingulate cortex (ACC) and dorsal medial/dorsal anterolateral PFC in depressives relative to controls. Following treatment with antidepressants, metabolism significantly decreased in the left amygdala and left subgenual ACC. The metabolic reduction in the amygdala and right subgenual ACC appeared largely limited to those subjects who both responded to treatment and remained well at 6 months' follow-up.239 Another study showed that antidepressant treatment of depression resulted in a decrease in amygdala activation with emotional faces as measured with fMRI.240 In summary, studies show changes in limbic and prefrontal cortical regions with successful antidepressant treatment of depression.

Fewer studies have looked at the effects of pharmacological treatment on the brain in anxiety disorders. One PET FDG study showed that caudate function decreased with treatment of obsessive compulsive disorder with antidepressants.241 Paroxetine resulted in a decrease in glutamate/glutamine measured with magnetic resonance spectroscopy (MRS) in children with obsessive-compulsive disorder (OCD).242 Patients with PTSD were shown to have an increase in hippocampal volume and memory function with paroxetine,163 and increased right hippocampal and right cerebral volume with phenytoin.165 No published studies have looked at the effects of pharmacological treatment on brain function in PTSD, or on sensitive markers of brain chemistry like NAA.

Figure 2.

Figure 2. Neural correlates of fear conditioning in women with abuse and PTSD. There was increased amygdala activation with fear acquisition using a classical conditioning paradigm relative to nonPTSD abused women. PTSD, post-traumatic stress disorder.

Brain biomarkers like NAA represent an objective marker of neural plasticity. To date psychiatry has relied on subjective reports as the gold standard. However, this is limited by self-reporting and the subjective interpretations of symptoms and response to treatment. Brain markers of antidepressant response may provide a complementary approach to assessing response to treatment, as well as providing insight into the mechanisms of treatment response. Our group is trying to look at mechanisms in the brain underlying treatment response in PTSD.

Effects of pharmacotherapy on brain function and structure in PTSD

We have begun to assess the effects of pharmacotherapy on brain structure and function in PTSD.243 We recently assessed the effects of phenytoin on brain structure and function. Studies in animals show that phenytoin, which is used in the treatment of epilepsy and is known to modulate glutamatergic function, blocks the effects of stress on the hippocampus.67 We studied nine patients with PTSD in an open-label function before and after treatment with phenytoin. Phenytoin resulted in a significant improvement in PTSD symptoms.164 Phenytoin also resulted in increases in both right hippocampal volume and right hemisphere volume.165 These findings indicate that phenytoin has an effects on PTSD symptoms as well as brain structure in PTSD patients.

We have assessed the effects of open4abel paroxetine on memory and the hippocampus in PTSD. Male and female patients with symptoms of PTSD were medication-free for at least 4 weeks before participation in the study. Twenty-eight patients were found to be eligible and started the medication phase. Of the total patient sample five patients did not finish due to noncompliance; 23 patients completed the study.

Before patients started the medication phase, neuropsychological tests were administered, including the Wechsler Adult Intelligence Scale - Revised, WAISR (arithmetic, vocabulary, picture arrangement, and block design test), two subtests of the Wechsler Memory ScaleRevised.WMS-R, including logical memory (free recall of two story narratives, which represents verbal memory) and figural memory (which represents visual memory and involved reproduction of designs after a 6-second presentation); and the verbal and visual components of the Selective Reminding Test, SRT.

Paroxetine was prescribed in the first visit after the pre-treatment assessments. All patients started open-label with a dose of 10 mg daily and were titrated up to 20 mg in 4 days.

Paroxetine treatment resulted in a mean 54% reduction in PTSD symptoms as measured with mean changes from baseline on the CAPS total score ( P<0.005) among study completers. Improvement was equally strong on all symptom cluster scores (Reexperiencing, Avoidance/Numbing, Hyperarousal). Treatment also resulted in significant improvements in verbal declarative memory as measured with the WMS-R paragraph recall for delayed recall ( P<0.005) and percent retention (80.2 to 91.1; P=0.003), but not immediate recall. Improvements were significant on all subscales of the Verbal Component of the SRT; including long-term recall and delayed recall.

Repeated measures ANOVA with side as the repeated measure showed a main effect for treatment related to a 4.6% increase in mean hippocampal volume (1857.3 mm ³ [SD 225.6] to 1906.2 mm ³, [SD 243.2]) with treatment (F=8.775 df=1.36; P=0.005). Increased hippocampal volume was seen for both left (5.6%) (1807.6 mm ³ [SD 255.5] to 1909.3 mm ³ [SD 236.9]) and right (3.7%) (1906.9 mm ³ [SD 195.8] to 1976.7 mm ³ [SD 249.6]) hippocampus. There was no change in whole brain volume with treatment. Increase in hippocampal volume was significant after adding whole brain volume before and after treatment to the model.

Discussion

Traumatic stress has a broad range of effects on brain function and structure, as well as on neuropsychological components of memory. Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Neurochemical systems, including Cortisol and norepinephrine, play a critical role in the stress response. These brain areas play an important role in the stress response. They also play a critical role in memory, highlighting the important interplay between memory and the traumatic stress response. Preclinical studies show that stress affects these brain areas. Furthermore, antidepressants have effects on the hippocampus that counteract the effects of stress. In fact, promotion of nerve growth (neurogenesis) in the hippocampus may be central to the efficacy of the antidepressants. Studies in patients with PTSD show alterations in brain areas implicated in animal studies, including the amygdala, hippocampus, and prefrontal cortex, as well as in neurochemical stress response systems, including Cortisol and norepinephrine. Treatments that are efficacious for PTSD show a promotion of neurogenesis in animal studies, as well as promotion of memory and increased hippocampal volume in PTSD. Future studies are needed to assess neural mechanisms in treatment response in PTSD.

Selected abbreviations and acronyms

ACTH

adrenocorticotropic hormone

BDNF

brain-derived neurotropic factor

BPD

bipolar disorder

CRF

corticotropin-releasing factor

CS

conditioned stimulus

FDG

fluorodeoxyglucose

HPA

hypothalamic-pituitary-adrenal

MRI

magnetic resonance imaging

mRNA

messenger ribonucleic acid

NAA

N-acetyl aspartate

PET

positron emission tomography

PTSD

post-traumatic stress disorder

US

unconditioned stimulus

REFERENCES

Articles from Dialogues in Clinical Neuroscience are provided here courtesy of Taylor & Francis

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Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and ...

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This article does cover a lot of topics, however, the topic I am referring to is started on page 64/84 in the PDF (labeled as 162).

This article talks about the Neuroanatomy behind it all, as well as the similarities between psychosis and PTSD. It highly talks about psychosis and the effects of emotional trauma in that aspect. It gives sensitization treatment mechanisms, as well as more clarification on the effects of childhood trauma.

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I chose this article because it briefly, yet thoroughly, talked about the effects of emotional trauma on a child's brain development. It also emphasizes a lot on PTSD which is a result from said trauma, and is very important to be recognized. There is also a part in this article that talks about the neuroimaging studies that they have found which was interesting to read on.

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Neurobiology of emotional trauma - PubMed

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An emotional trauma may induce a cascade of neurobiological events that have long-lasting consequences even altered gene expression. Early abuse and neglect can deregulate the child’s developing neurobiological system by reducing its resistance to stressful events, leading to later problems of emoti …

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This article introduces the concept of systemic trauma, which recognizes how environments, such as family systems, institutions, cultural norms, and social structures, can create, maintain, and influence trauma responses. Rather than focusing solely on individual experiences, it emphasizes the importance of considering broader societal and ecological factors like racism, institutional policies, and community dynamics in understanding trauma.

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Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-con …

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Systemic trauma is described as harm caused or sustained through institutions, policies, or cultural systems, often affecting groups over time. This page defines the concept clearly and connects it to related issues like intergenerational trauma and collective trauma. The website also offers additional resources, including a glossary, toolkits, and educational materials to support trauma-informed care and understanding.

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Practices and procedures implemented by institutions or their leaders that directly or indirectly cause psychological, emotional, economic, spiritual, physical or sexual harm to particular individu…

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The video explains that attachment trauma happens when our emotional needs weren’t consistently met as kids, which can lead to insecure relationship patterns later on. But the good news is, with self-awareness and support, like therapy or safe relationships, healing is totally possible, and we can learn to form healthier, more secure connections.

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This video quickly summarizes PTSD as a whole. It is very quick, yet extremely informative. It talks about the neurocircuits and the way the activity affects our emotions and ability.

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This article talks about the survival reflexes that are builty based on fear, trauma, and things of that nature. It gives examples of dissociation, which is a common one talked about. Some people have responses of "fight or flight" and things like that. It gives an idea of these likely chose responses. There is also a very long video tied to this explains the process towards sexual assault, too.

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Neurobiology of Trauma helps to explain many of the common behaviors and experiences of survivors of gender-based violence. Having an understanding of how trauma affects the brain helps to dismantle common misconceptions and victim-blaming statements about sexual violence. Please read the Myth vs Fact document below to learn more!

Key Concepts

The prefrontal cortex is the decision-making/choice-making part of the brain; it's the part of the brain responsible for rational thinking, planning effective responses, remembering important information, etc. When a person is experiencing a traumatic event or experiencing extreme fear, their " Fear Circuitry" may kick in and the prefrontal cortex begins to function less effectively. This means that in the midst of trauma, a person may not be able to think through the situation and make decisions such as calling for help. It is not a matter of choice--their brain is in survival mode and the fear circuitry is bypassing their prefrontal cortex entirely.

Many people are familiar with the concept of "fight or flight," but research shows that there is a third response called " freeze." A common example is a deer in the headlights, and humans have this same fear response--in fact, freezing is the most common reaction to trauma or fear, rather than fighting back or running away.

In addition to freezing, some survivors may experience extreme survival reflexes such tonic immobility or collapsed immobility. If you've ever seen a possum go limp when it is scared, you are familiar with this brain response. Going limp, feeling "sleepy" or passing out, or being completely unable to move or speak are survival mechanisms hard-wired into our brains--even apex predators like sharks have these responses! It is not a sign of weakness, nor is it a choice the person is making.

Survivors may also experience dissociation, which is a survival reflex where someone may feel disconnected from their body or may go into " auto-pilot" mode. In auto-pilot mode, a person is not using their prefrontal cortex to make decisions, but is instead relying upon habitual modes of being. Habitual responses are rooted in socialization--for example, women are socialized to be polite and pleasing, to "save face" or placate. This means that during an assault, a person might engage in sexual acts, say polite things, even smile, but they are not consenting; they are actually experiencing extreme fear and their brain is operating on auto-pilot as a survival mechanism.

Memories are encoded differently during a traumatic event. The brain does not encode memories in chronological order, there are gaps in memory, and whatever the "fear circuitry" in the brain focused attention on during the assault is more likely to be encoded into memory than periphery details. For example, a survivor may have a very clear memory of the smell of the perpetrator's cologne, but not have any memory of what the room looked like. Contextual information (e.g., the layout of a room) and time‐sequence information (e.g., the order in which sexual acts occurred) are often poorly encoded. Again, this is not a conscious choice a survivor is making about what to focus on or remember during an assault; it is a common impact on the brain when the "fear circuitry" survival response kicks in.

These are all based in normal brain processes that occur during extremely
stressful and traumatic situations. They can happen to police officers, soldiers - anyone who is attacked or fears for their life.

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Information about how trauma impacts the brain of victims and survivors, both during and after a traumatic event.

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This video talks a lot of what it does to your body, your predictability, and your genetic make up. It talks about being able to break the cycle and change it using effective methods. The treatments are heavily promoted and talked about during this video. It refers to the predictions to be able to react and allow it to affect you in that way.

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The CTS is a free, 10-item screening tool designed to help professionals identify children aged 6–17 who may have experienced trauma. It’s easy to use, available in multiple languages, and can be administered by both clinical and non-clinical staff. The goal is to spot potential trauma early, so kids can get the support they need before problems deepen. The CTS is part of a broader initiative called Trauma ScreenTIME, which offers free training to help professionals conduct trauma screenings effectively.

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The Child Health and Development Institute of Connecticut, Inc.

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The National Network for Youth (NN4Y) provides a comprehensive toolkit to help youth-serving organizations implement trauma-informed care. Their Trauma Screening and Assessments section offers a curated list of standardized tools suitable for children and families affected by complex trauma. These resources assist professionals in identifying trauma exposure and its impacts, ensuring that interventions are both effective and sensitive to the needs of youth.

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Introduction What Is Trauma? Stress vs. Trauma Adverse Childhood Experiences (ACES) Complex Trauma Impact on Youth Experiencing Homelessness Trauma-Informed Care 101 Trauma Screening and Assessments Organizations must ensure that individuals have an inclusive space to heal. TRAUMA SCREENING AND ASSESSMENTS
The

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ISTSS offers several free and easy to use tools to help identify trauma and PTSD symptoms in kids and teens. These include questionnaires for children and caregivers plus detailed clinician assessments. The goal is to catch trauma early and guide the right support.

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Child/Adolescent Trauma Assessments | International Society for Traumatic Stress Studies

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Michigan’s MDHHS provides easy-to-use tools and training to help professionals spot and support kids affected by trauma. They offer screening tools for all ages, from babies to teens, plus resources to help organizations become more trauma-informed.

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This review highlights trauma-informed programs in early childhood settings, mainly focused on teacher training and support. These programs improved classroom interactions and children's emotional and behavioral outcomes, though long-term effects need more research.

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Trauma-informed Interventions in Early Childhood Education and Care Settings: A Scoping Review

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Trauma in early childhood is a significant public health concern. Early Childhood Education and Care (ECEC) services are uniquely positioned to buffer the negative impact of early childhood trauma on children. This scoping review synthesized studies…

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This page lists evidence-based trauma interventions for children and families. It offers summaries, fact sheets, and training info for each model to support informed treatment choices.

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The National Child Traumatic Stress Network

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The intervention fact sheets linked from this page offer descriptive summaries of some of the interventions developed and/or implemented by members of the National Child Traumatic Stress Network.

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This article from ZERO TO THREE talks about how important it is for early childhood educators to understand and use trauma-informed care. It explains that knowing about trauma helps teachers better support kids who’ve been through tough experiences so they can heal and be ready to learn.

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Trauma-Informed Practices in Early Childhood Education

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Implementing trauma-informed care in early childhood education can increase the chances that young traumatized children recover, thrive, and enter kindergarten ready to learn.

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WestEd’s Developmentally Informed Trauma Practices (DITP) program equips early childhood professionals (prenatal through age 8) with trauma-sensitive skills. It offers training and communities of practice to help educators recognize adversity, support resilience in young children and families, and promote provider self-care.

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Developmentally-Informed Trauma Practices in Early Childhood (WestEd DITP)

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Learn how to support young children who may have experienced trauma in order to support their health, healing, resilience, and well-being.

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Brookes highlights nine practical strategies to create trauma‑responsive early learning environments. These include identifying and minimizing sensory and emotional triggers, setting clear, positive expectations, teaching healthy boundaries, coaching social-emotional skills (like empathy), embedding mindfulness or self‑regulation routines, and fostering a strong sense of belonging and connection.

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9 Ways to Support Trauma-Sensitive Classrooms

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Children who have experienced trauma or are under chronic stress can have trouble identifying and appropriately expressing emotions, concentrating on lessons and activities, and forming healthy peer relationships. Use the nine strategies outlined in this brand-new feature article to help all children feel safer, more emotionally regulated, and ready to learn.

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This article explains five ways trauma-informed care supports children’s development. It highlights how recognizing trauma responses and providing consistent support helps children regulate behavior and access needed services. Understanding this helps caregivers and educators create trauma-sensitive environments that promote healing and positive growth.

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5 Ways Trauma-Informed Care Supports Children’s Development - Child Trends

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This page explains trauma-specific therapies designed to help children recover from trauma and improve emotional regulation. It shows how these therapies can reduce harmful behaviors, highlighting their potential to support healing and prevent future issues. Understanding this helps guide effective trauma-informed treatment choices.

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What is it?

Trauma occurs when an event or set of circumstances causes physical or emotional harm which leads to lasting adverse effects on health and wellbeing. Research suggests a link between experiencing trauma and increased risk of involvement in crime and violence.

Trauma-specific therapies, also known as trauma-focused interventions, aim to support children to recover from trauma. They typically involve forms of psychological therapy where a therapist provides support to individuals or small groups. They can work with children who have experienced trauma but have not been involved with the criminal justice system, or with children who are already in the system. These therapies are distinct from trauma-informed practice or trauma-informed training, which seek to improve practitioners' understanding of and approach to trauma within day-to-day services such as policing or education. We have a separate Toolkit strand for trauma-informed training and service redesign.

A range of different therapies are included in this summary:

Trauma-focused Cognitive Behavioural Therapy (TF-CBT), which aims to modify thoughts, behaviours, and emotions.

Cognitive Processing Therapy (CPT), a specific form of CBT that focuses on modifying unhelpful and faulty beliefs related to a traumatic event.

Various other psychotherapies, such as humanistic therapy, psychodynamic therapy and safety seeking therapy.

Eye Movement Desensitisation and Reprocessing (EMDR), which aims to reduce the vividness and the emotional response associated with memories of trauma.

A range of different practical activities were used by the interventions above. Therapists might work with children to develop coping skills, make sense of traumatic experiences, set personal goals, and plan for the future.

Theories suggest that trauma-specific therapies can support children and young people to cope with trauma and adverse childhood experiences (ACEs). This could disrupt the link between trauma and negative behaviours that are associated with later involvement in crime and violence.

Is it effective?

On average, trauma-specific therapies are likely to have a high impact on preventing crime and violence for children and young people at-risk of involvement in the criminal justice system.

Our estimate is based on only four studies which suggest on average trauma-specific therapies reduced crime and violence for children and young people at-risk of involvement by 45%.

Findings from 19 studies suggest that trauma-specific therapies also had a high impact on externalising behaviours, such as aggression.

It is important to note the effect may vary depending upon the characteristics of children and young people supported. Six studies assessed impacts on offending, of which four focused on children and young people at-risk of involvement in crime and violence, and two focused on children and young people already involved in the justice system. The latter two studies did not find that trauma-specific therapies were effective for children and young people already involved in the justice system. However, the very low number of studies means we have very low confidence in these findings.

How secure is the evidence?

We have very low confidence in our estimate of the average impact on violent crime.

Our confidence is very low because the estimate is based on only four studies and there is a lot of variation in the impacts they found. Some studies suggested that the impact was higher and others suggested it was lower. Studies have generally used very small sample sizes, typically between 21 and 30 children.

Most studies were conducted in the USA and the review didn't find any studies from the UK or Ireland.

How can you implement it well?

The review suggests that programmes that include techniques to change the way we think may have a larger effect for children and young people at-risk of involvement with the criminal justice system. This involves:

Becoming aware of the thoughts we regularly have

Evaluating our thoughts and deciding what could be changed

Replacing unhelpful or unhealthy thoughts with more rational thoughts.

Programmes that include 'trauma narrative therapy' may have a larger effect for children and young people at-risk of involvement with the criminal justice system compared to those that don't include it. This type of therapy involves creating a chronological narrative of the person's life story, remembering and talking through traumatic experiences and related thoughts and feelings. This gives opportunity to re-evaluate and reconstruct memories, modify fear reactions and develop healthy processing of memories.

What programmes are available?

Below is a list of programmes found in the Early Intervention Foundation's (EIF) Guidebook. The Guidebook summarises the research on programmes that aim to improve outcomes for children and young people.

Trauma-Focused Cognitive Behavioural Therapy

A CBT intervention for children and their parents who have been exposed to a traumatic event.
EIF Guidebook entry

Child-Parent Psychotherapy

Child-Parent Psychotherapy (CPP) is a psychoanalytic intervention targeting mothers and preschool children (aged three to five) who may have experienced trauma or abuse (eg domestic violence), or are otherwise at risk of an insecure attachment and/or other behavioural and emotional problems.
EIF Guidebook Entry

How much does it cost?

On average, the cost of trauma-specific therapies is likely to be moderate.

Most interventions for trauma consist of therapies which require a trained therapist and intensive and specialised support. A review of costs of trauma-specific therapies found that costs varied between around £500 and £1,500 for the various therapies used.

Topic summary

Trauma-specific therapies are targeted interventions which aim to support individual recovery from trauma.

Trauma-specific therapies on average have a high impact for children and young people at-risk of offending, although this is based on very weak evidence.

Further insights could be gained through evaluations of trauma-specific interventions conducted in the UK.

YEF have funded a pilot study of ASSIST Trauma Care, a project that employs experienced therapists trained to work with Post Traumatic Stress Disorder (PTSD) and the after-effects of trauma in line with current evidence-based practices.  Find out who we fund.

Take away messages

Invest in clinically-led provision of therapies for children with identified trauma who are at-risk or already involved in violence.

Fund therapeutic services that incorporate cognitive restructuring techniques, such as Cognitive Behavioural Therapy, Trauma-focused Cognitive Behavioural Therapy, and Cognitive Processing Therapy.

Ensure referrals and needs assessments take place quickly.

Put strategies in place to reach children from racially minoritised communities and to keep them engaged throughout the intervention.

Adverse childhood experiences: What we know, what we don't know, and what should happen next
EIF report about what we know about the impacts of trauma and the types of interventions used to treat trauma.
What have ACEs got to do with justice?
A research report by the Scottish Government outlining the relationship between ACEs and future outcomes.
Recognizing and Treating Child Traumatic Stress
Information sheet about the signs of traumatic stress, its impact on children, treatment options, and how families and caregivers can help.
Cost-effectiveness of psychological interventions for children and young people with post-traumatic stress disorder
This review of cost-effectiveness includes a table of average costs of various trauma-focused interventions delivered in the UK.

Downloads

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Trauma-specific therapies | Youth Endowment Fund

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Trauma-specific therapies, also known as trauma-focused interventions, aim to support children to recover from trauma.

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This document explains key practices for organizations to implement trauma-informed care effectively. It focuses on creating safe environments, training staff, screening for trauma, and engaging patients in their treatment. Knowing these practices helps improve compassionate care for people affected by trauma.

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This report explains how trauma impacts children, families, and early educators. It shares ways child care systems can become more supportive, like training staff, using trauma screenings, and involving families. These steps help create safe, caring learning environments for everyone.

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This guide explains how kids of different ages may react to disasters or trauma and gives tips to help them cope. It includes age-specific advice like keeping routines, encouraging play or talk, and offering support without pressure. It helps caregivers know what’s normal and how to support children after a crisis.

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This resource provides a comprehensive overview of trauma exposure and symptom assessment instruments used in clinical and research settings. It includes tools like the Brief Trauma Questionnaire (BTQ), Trauma History Questionnaire (THQ), Life Events Checklist (LEC‑5), Trauma History Screen (THS), and others—each designed to capture different aspects of trauma exposure efficiently and reliably.

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Trauma and Stressor Exposure Measures

Below is an alphabetical list of trauma exposure measures. These assessment instruments measure the types of trauma a person has been exposed to, or the degree of severity of the traumatic event someone experienced. For each measure, a brief description, sample items, versions, and references are provided. Information on how to obtain the measure is also provided.

Measure availability: We provide information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.

Other sources of information on measures and how to obtain them include:

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Apply for and manage the VA benefits and services you've earned as a Veteran, Servicemember, or family member-like health care, disability, education, and more.

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This page explains trauma screening tools and processes used across child-serving settings to identify children who have experienced traumatic events and may need further assessment. It details how these brief screenings assess exposure and symptoms (PTSD reactions, behavior concerns) using formats appropriate for different ages and respondents (child, caregiver, or provider).

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The National Child Traumatic Stress Network

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What is a Trauma Screening Tool or Process?

Trauma screening is designed to be able to be administered to every child within a given system (such as child welfare) to determine whether he or she has experienced trauma, displays symptoms related to trauma exposure, and/or should be referred for a comprehensive trauma-informed mental health assessment. Trauma screening can include a particular tool or a more formalized process. Trauma screening should evaluate the presence of two critical elements: (1) Exposure to potentially traumatic events/experiences, including traumatic loss, and (2) Traumatic stress symptoms/reactions.

Not all children who experience negative events suffer posttraumatic or trauma-specific reactions as a result. Trauma screening should measure a wide range of experiences and identify common reactions and symptoms of trauma (e.g., PTSD, dissociation), as well as other commonly reported difficulties (e.g., anger, behavior problems, depression, anxiety). With proper training, professionals or paraprofessionals from various child-serving systems-healthcare, schools, home visiting programs, and domestic violence shelters-can administer the screening.

Screening typically covers the following types of traumatic stress reactions:

Avoidance of trauma-related thoughts or feelings

Intrusive memories of the event or nightmares about the event

Hyper-arousal or exaggerated startle response

Irritable or aggressive behavior

Behavioral problems

Interpersonal problems

Other problems based on the developmental needs and age of the child

Types of Screening Tools

Providers may administer trauma screening in a number of ways depending on the age and developmental stage of the child and on the child's relationship with the caregiver and other collateral informants in his or her life. For example, with very young children, it is difficult to screen specifically for "trauma symptoms." Rather, a provider may screen for exposure to traumatic events and social and emotional difficulties, such as attachment difficulties or mood dysregulation. As the child gets older, it may be more appropriate to screen specifically for trauma symptoms.

Most screening tools are developed for use by professionals with a range of training and experience. Providers using a screening tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

Child-Completed Tool (Self-Report). Child-completed tools are appropriate for children, typically ages eight and above, who are able to read and complete the questions. These measures provide the child with an opportunity to verbalize his or her responses aloud or in writing.

Caregiver-Completed Tool. For infants, toddlers, young children (ages 0-8), or children with developmental delays, it is more appropriate to have a caregiver complete the trauma screening either by providing written responses to the items or through an interview by the provider.

Provider-Completed. The caseworker, clinician, or other professional can administer certain tools while reviewing and integrating available information on a child (e.g., court reports, interviews with caregivers and teachers, other questionnaires, and behavioral observations). These tools can be useful in consolidating a range of information in one place so that it is readily accessible.

Engaging Families in the Screening Process

To engage families in the screening process, the individual administering the tool should consider the following:

Explain the purpose and use of the screening tool and process. Say why you need to know this information, how you will use what you gather, how it may benefit the child and family, and who will have access to the information in the future. Emphasize that the information is confidential in most cases, unless the child endorses harm to self or others or the clinician has concerns regarding child abuse.

After the child or family has completed the trauma screening, share the results and show how you are using the information. For example, "It's clear from the forms that you filled out that your daughter is having a really hard time with nightmares and fear of things that remind her of her brother getting hurt. We call this Posttraumatic Stress. To help her, I would like to refer you to a therapist who specializes in treating children with these problems."

Make sure to thank the child for completing the tool or process, particularly if he or she disclosed a new trauma. Explain that the child's feelings and trauma reactions are normal and expected, given what he or she has lived through.

Consider the potential burden of the trauma screening to family members in terms of time and effort, and highlight the potential benefits, such as helping to link them to appropriate providers and services. Some families may be discouraged by the process; others may be comfortable with it. When providers explain the purpose and use of the screening tools and share the results, they enhance the benefits to families.

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Trauma screening should measure a wide range of experiences and identify common reactions and symptoms of trauma.

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This resource lists evidence-based tools used in pediatric healthcare to screen for trauma-related stress, psychosocial risk, immediate distress, and pain—guiding initial triage and deeper assessments. Highlights include the Psychosocial Assessment Tool (PAT) for evaluating family-wide risk and tools like the Acute Stress Checklist for Children (ASC‑Kids) and Child Trauma Screening Questionnaire (CTSQ) for pediatric trauma exposure and reactions.

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Find Screening & Assessment Tools

Find a tool to:

Evaluate traumatic stress symptoms

Evaluate psychosocial support needs

Guide needs assessment and care planning

Evaluate pain in pediatric patients

Tools are marked to denote those appropriate for use in screening (S) and/or as part of a more in-depth assessment (A).

Evaluate traumatic stress symptoms

Acute Stress Checklist for Children (ASC-Kids) (S) (A)

Purpose & Description: Evaluate acute stress reactions in children or teens. Available as 29 item self-report checklist, and as 3- or 6-item brief screening version.

Language: English, Spanish

Who can administer: Any member of the healthcare team; Child can complete as self-report.

Time to administer: 1-2 mins (brief screen versions); 5-10 mins (full version)

References: Kassam-Adams, 2006; Kassam-Adams et al., 2013; Kassam-Adams et al., 2016
Get a copy of the measure.
Child Trauma Screening Questionnaire (CTSQ) (S)

Purpose & Description: 10 item screening tool. Helps identify recently injured children at higher risk for later PTSD.

Language: English

Who can administer: Any member of the healthcare team. Child can complete as self-report.

Time to administer: 2-3 mins

References: Kenardy et al., 2006.

Get a copy of the measure.

For more information on the CTSQ, contact: Justin Kenardy, University of Queensland.

Acute Stress Disorder Scale (ASDS) (S)

Purpose & Description: Evaluate acute stress reactions in adults or older teens. 19 item self-report checklist.

Language: English

Who can administer: Any member of the healthcare team; Adult or teen can complete as self-report.

Time to administer: 5-10 mins
References: Get a copy of the measure. NOTE: CPTS has created an adapted version of the ASDS suitable for use with healthcare staff in the COVID19 pandemic. Bryant et al., 2000
Get a copy of the adapted ASDS measure.

Child Stress Disorders Checklist (CSDC) (A)

Purpose & Description: 35 item checklist completed by parent (or nurse). Assesses acute stress or PTSD symptoms in children or teens.

Language: English

Who can administer: Completed by parent or nurse about child.

Time to administer: 10 mins
Get a copy of the measure.
References: Saxe et al. (2003). Child Stress Disorders Checklist: A measure of ASD and PTSD in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42(8): 972-978.

Child Stress Disorders Checklist (CSDC) Short Form (S)

Purpose & Description: 4 item subset of CSDC to be completed by parent (or physician / nurse). Assesses acute stress of PTSD symptoms in children or teens.

Language: English

Who can administer: Completed by parent or nurse about child.

Time to administer: 1-2 mins

References: Bosquet Enlow et al,. 2010.

Get a copy of the measure.

Child PTSD Symptom Scale (CPSS) for DSM5 (A)

Purpose & Description: 27-item self-report checklist. Assesses PTSD symptoms (and impairment) in children or teens.

Language: English

Who can administer: Child can complete as self-report, or can be administered as interview.

Time to administer: 5-10 mins

References: Foa et al., 2018.

Get information on the measure from: Edna B. Foa, Center for the Study and Treatment of Anxiety, University of Pennsylvania.

PTSD Checklist for DSM5 (PCL-5) (S) (A)

Purpose & Description: 20 item self-report checklist. Assesses PTSD symptoms in older teens and adults.

Language: English, Spanish

Who can administer: Any member of the healthcare team; Adult can complete as self-report.

Time to administer: 5-10 mins

References: Blevins et al., 2015.

Scale available from the National Center for PTSD.

Evaluate psychosocial support needs

Psychosocial Assessment Tool (PAT) (S) (A)

Purpose & Description: Comprehensive questionnaire assessing psychosocial risk in families of children newly diagnosed with cancer. Helps identify children and families who would benefit from targeted psychosocial intervention.

Language: English, Spanish

Who can administer: Any member of the healthcare team.

Time to administer: 10-15 mins
Get information on the measure from: psychosocialassessmenttool@nemours.org
References: Kazak et al. 2018

Hospital Emotional Support Form (A)

Purpose & Description:: Brief clinical assessment tool to aid parents in providing coping assistance to child

Language: English

Who can administer: Any member of the healthcare team.

Time to administer: 5-10 mins

References: N/A

Get a copy of the measure.

Guide needs assessment and care planning

D-E-F Nursing Assessment Form (A)

Purpose & Description: Not just for nurses! Brief checklist completed by physician, nurse or social worker. Needs assessment and care planning with hospitalized children. Organized according to the D-E-F framework to assess Distress, Emotional support needs, and Family needs / strengths.

Language: English

Who can administer: Nurses, or any healthcare or psychosocial care provider

Time to administer: 10-15 mins

References: N/A

Get a copy of the measure.

Medical Trauma Assessment and Action Form for Child Welfare Professionals (A)

Purpose & Description: Brief questionnaire assessing psychosocial risk and medical traumatic stress in families of children in the child welfare system.

Language: English

Who can administer: Any child welfare professional.

Time to administer: 10 mins

References: N/A

Get a copy of the measure.

Evaluate pain in pediatric patients

Faces Pain Scale- Revised (S)

Purpose & Description: Well-validated self-report scale for children or teens. Assesses pain (disease-related, procedural, surgical/trauma, treatment-related).

Language: English, French, and 31 additional languages

Who can administer: Any healthcare provider.
Get a copy of the measure.
Time to administer: 1-2 min

References: Hicks et al., 2001.

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Find Screening & Assessment Tools | Patient Centered Care and Trauma Informed Care for Pediatric Patients - HEALTHCARE TOOLBOX

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Find a tool to: Evaluate traumatic stress symptoms Evaluate psychosocial support needs Guide needs assessment and care planning Evaluate pain in pediatric patients Tools are marked to denote those appropriate for use in screening (S) and/or as part of a more in-depth assessment (A).

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This resource explains various ways for health systems to screen children and adults for ACEs and other traumatic experiences. It reviews different approaches, like universal vs. targeted screening, timing (at intake vs. later), and whether to collect specific exposure details or just totals. Key considerations include having well-trained staff, minimizing re-screening to avoid re-traumatization, and ensuring there’s a clear follow-up care plan for anyone who screens positive.

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This page defines trauma screening as a brief, standardized process to identify children’s exposure to potentially traumatic events and early stress symptoms. It explains that effective screening helps tailor services from the start, informing eligibility and ensuring appropriate referral to trauma-specific interventions.

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Overview

Trauma screening involves the use of a culturally competent, standardized, and validated trauma screening tool. A trauma screener is designed to be administered to every child within a given system.

Trauma screening tools are brief and should evaluate the presence of two critical elements: (1) exposure to potentially traumatic events/experiences, including traumatic loss, and (2) traumatic stress symptoms/reaction.

A trauma screening typically covers the following types of traumatic stress reactions:

Avoidance of trauma-related thoughts or feelings

Intrusive memories of the event or nightmares about the event

Hyper-arousal or exaggerated startle response

Irritable or aggressive behavior

Behavioral problems

Interpersonal problems

Other problems based on the developmental needs and age of the child

Why Screen?

If you do not ask, they will/may not tell. Trauma-informed screening and assessment practices help providers identify children's and families' needs early in the intake/therapy process and to tailor services to meet those needs. Trauma exposure and its impact on a child can be varied and may occur over different developmental periods.

Trauma exposure has the potential to impact all domains of functioning, cognition, and emotional regulation. However not all children who experience a traumatic event(s) suffer posttraumatic or trauma-specific reactions as a result. Screening for exposure to trauma can help to gain a better understanding of what a child has experienced and identify or clarify other clinical presentations

The overall goal is for trauma to be factored into eligibility for services, service recommendations, and assessment and treatment planning. Screening for traumatic stress symptoms among those with a history of potentially traumatic experiences can identify children who may benefit from an evidence-based trauma treatment. Staff who administer the screening tool should be trained in the administration, scoring and interpretation of the results

For those mental health providers working in a CMHSP the MDHHS BHDDA Trauma Policy: Section IV states the following:

Screening for trauma exposure and related symptoms for each population. CMHSP, through direct service operations and provider network, shall use a culturally competent, standardized and validated screening tool appropriate for each population during the intake process and other points as clinically appropriate.

Trauma Screening is the first opportunity to normalize the effects of trauma. It is an opportunity for non-judgmental engagement and a transition to trauma treatment. The child and their caregiver can learn about common reactions to stress and normalize some of the reactions they may be experiencing. Trauma Screening can also provide a rationale for further trauma assessment and treatment.

Types of Trauma Screening Tools

What makes a good screening tool? The NCTSN states: providers using a screening tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of screening tools, below are a couple of examples:

University of Minnesota's Traumatic Stress Screen for Children and Adolescents (TSSCA)

Juvenile Victimization Questionnaire (JVQ-R2)

What is a Trauma Assessment?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment measure typically gathers information from both a child/youth and their caregiver.

Why is a Trauma Assessment Completed?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment evaluates the ways in which a child/youth's current functioning might have been affected by the experience of trauma. The assessment measure typically gathers information from both a child/youth and their caregiver.

There are three dimensions of the trauma assessment:

1. Has the child/youth been exposed to potentially traumatizing events?

2. Does the child/youth display symptoms associated with posttraumatic stress?

3. Determining if the youth meets the criteria for a formal diagnosis of Posttraumatic Stress Disorder (PTSD) as per the DSM-IV or ICD-10 diagnostic manuals.
It should be noted a PTSD diagnosis is not required to receive TF-CBT or CPP.

Trauma assessments can help to determine, trauma responses that are currently occurring, whether a child is developmentally on target in their social, emotional, and behavioral functioning; as well as, inform case conceptualization and drive treatment planning. Treatment goals can also be established from the assessment, specifically targeting ongoing trauma responses and identifying any barriers to treatment. A trauma assessment can also monitor progress over time as the child, youth and family proceed through treatment.

Types of Trauma Assessments

What makes a good trauma assessment tool? When reviewing assessment tools the NCTSN states: providers using a trauma assessment tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of trauma assessment tools, below are a couple of examples:

Young Child PTSD Checklist (YCPC) for children ages 1-6 years' old

UCLA Posttraumatic Stress Disorder Reaction Index for the DSM IV (UCLA-PTSD RI)

The NCTSN also has a database of searchable detailed reviews of screening and assessment measures utilized in the field of child traumatic stress, designed to allow comparison across measures.

Training Qualifications

Trauma Screening and Assessment Learning Collaboratives are provided on a regular basis throughout the year to Community Mental Health Services Programs (CMHSPs) and their provider agencies. To qualify for a Learning Collaborative in our Trauma Screening and Assessment program, you must be a licensed clinician employed by a CMHSP or provider agency.

Please speak with your agency supervisor if you are interested in participating in an upcoming Learning Collaborative.

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What is Trauma Screening and Assessment?

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Trauma screening involves the use of a culturally competent, standardized, and validated trauma screening tool. A trauma screener is designed to be administered to every child within a given system. Trauma screening tools are brief and should evaluate the presence of two critical elements: (1) exposure to potentially traumatic events/experiences, including traumatic loss, and (2) traumatic stress symptoms/reaction.

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This page outlines trauma screening and assessment tools used in Michigan for youth aged 13 to 21. It highlights tools like the Child Report of Post Traumatic Symptoms (CROPS), exploring exposure and symptoms consistently across youth populations.

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The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training.

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This article shares 10 easy ways to make classrooms more supportive for kids who’ve experienced trauma. Ideas include keeping routines, using calm lighting, offering choices, and helping with emotions and behavior. These tips help kids feel safe, stay regulated, and enjoy learning.

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10 Ideas for Creating a Trauma-Informed Classroom | MCH

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This article describes how educators and administrators can create trauma-sensitive classrooms by pairing technology-based behavior tracking with personalized support plans. It explains tools like dashboard systems that help identify and respond to students experiencing trauma-related behaviors. Knowing about these resources helps schools implement data-informed, trauma-aware strategies that support healing, consistency, and effective behavior intervention.

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Children act out all the time, but "naughty" behavior does not indicate naughty kids. When children deal with stress, their brains move into a fight-or-flight mode. All of our brains do this. It's the brain's way of saying, "you're in trouble, and you better do something about it."

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This article explains how trauma can affect student behavior and learning. It encourages teachers to see certain behaviors as signs of stress, not defiance. By creating safe, caring classrooms, educators can better support students who’ve experienced trauma.

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Developing Trauma-Informed Classrooms - NAfME

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Developing Trauma-Informed Classrooms: Helping Students Make Sense of What Hasn’t Made Sense By NAfME Member Lori Schwartz Reichl and Dr. Ramona Roberts “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and…

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This article shares several ways to design a classroom that supports students who have experienced trauma. It includes ideas like adding sensory-friendly spaces, using calming colors, and creating predictable routines. The goal is to help students feel safe, supported, and ready to learn.

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Designing Trauma-Informed Classrooms: Creating Safe and Supportive Learning Environments - Starr Commonwealth

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Picture this: you walk into a classroom that feels like a warm hug, where every corner whispers, “You belong here.” The walls aren’t just covered with posters but with reminders that every child is seen, heard, and supported. This is the heart of a trauma-informed classroom—a space where students learn, heal, and grow. Let’s dive […]

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This article presents a curated list of top books recommended for educators, parents, and professionals aiming to become more trauma-informed in their practice. It features titles such as The Trauma-Informed School, Lost at School, Building Trauma-Sensitive Schools, Teachers’ Guide to Trauma, and Reaching and Teaching Children Who Hurt, each offering strategies for understanding trauma’s impact and designing responsive, supportive environments.

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This resource compiles 37 recommended books focused on trauma-informed teaching, aimed at educators, parents, and school leaders. It includes titles that support understanding how trauma affects learning and behavior, offer strategies for classroom design, and promote emotional safety and resilience. The list also features tools like conversation cards to help adults and children navigate difficult topics together.

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31 Trauma-Informed Teaching Books plus one box of 48 Conversation Cards

Conversation starters

They help give language to both adults and children on difficult subjects.

They let the reader know they are not alone.

This list is intended to be helpful to directors, teachers, and parents.

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37 Trauma Informed Teaching Books | The Book Vine

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31 Trauma-Informed Teaching Books plus one box of 48 Conversation Cards Conversation starters They help give language to both adults and children on difficult subjects. They let the reader know they are not alone. This list is intended to be helpful to directors, teachers, and parents.

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This curated collection features books selected by educators and professionals to deepen understanding of trauma-informed approaches in classrooms. Titles include foundational works like The Trauma-Sensitive Classroom and Trauma-Informed Practices With Children and Adolescents, as well as guides on resilience-building, student behavior, and designing trauma-aware learning environments.

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Books shelved as trauma-informed-teaching: Dr. Melissa Sadin and Nathan Levy’s Teachers’ Guide to Trauma: 20 things kids with trauma wish their teachers…

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The article “The Powerful Role of Play in Early Education” (pp. 148–170) from the California Department of Education explores how play serves as a vital tool for young children, especially those affected by trauma, to process and heal from their experiences.

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This article explains 8 ways teachers can manage classrooms to support kids who have experienced trauma. It suggests making the classroom calm and organized, clearly teaching rules and routines, and watching students closely. It also recommends praising good behavior, using fair ways to handle problems, encouraging teamwork, and giving many chances for students to join in.

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This article talks about a model called ATRCM that helps teachers support students who have experienced trauma. It focuses on giving the right help at the right time based on what each child needs. The model is based on ideas about safety, self-esteem, and building strong relationships to create a caring classroom.

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Creating a trauma sensitive classroom - edpsy.org.uk

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Over the last 2.5 years I have held a specialist role in my Local Authority which centred upon supporting and imbedding trauma-informed practice with another service. This blog can also be read with the companion piece: Using the Applied Trauma Responsive Classroom observation schedule.

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The MI Kids Matter Community page offers resources to help Michigan families and communities promote children’s health, happiness, and success. It highlights local groups called Great Start Collaboratives and Family Coalitions that work together to improve early childhood services and support families. The page also features the Steps Initiative, which provides toolkits for families and trusted advisors with tips to support children’s development from birth through age five.

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The National Association for the Education of Young Children (NAEYC) provides a range of resources to support educators in creating trauma-sensitive classrooms. These resources include articles, books, and webinars that offer practical strategies for recognizing and addressing the impact of trauma on young children. For instance, the article "Creating Trauma-Sensitive Classrooms" discusses how various types of trauma can affect children's ability to learn and form healthy relationships, emphasizing the need for supportive and understanding classroom environments.

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Increase your understanding of young children's learning and development through our extensive selection of research-based books, articles, and journals (Teaching Young Children and Young Children).

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The Head Start Community Engagement page emphasizes the importance of collaboration among early childhood staff, families, and community agencies to build positive relationships that support parents in achieving their goals for themselves and their children. Community partners offer culturally and linguistically responsive services and resources, assisting families and early childhood providers in areas such as educational advancement, economic mobility, and overall family well-being. This collaborative approach promotes lasting, positive change for children, families, and communities, aligning with the Office of Head Start's Parent, Family, and Community Engagement Framework.

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The collaboration between early childhood staff, families, and community agencies builds positive relationships. These relationships support parents’ progress toward their goals for themselves and their children.

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The Macomb Intermediate School District (MISD) offers a variety of early childhood resources to support families, educators, and communities in Macomb County. These include Great Start to Quality, which helps families find and choose early childhood programs, and Early On Macomb, which provides services for infants and toddlers with developmental delays or disabilities. They also offer the Great Start Readiness Program (GSRP), a state-funded preschool for four-year-olds, and the Macomb Infant Preschool Program (MIPP) for children with special education needs from birth to about 33 months. MISD provides Child Find services to identify and assist individuals with special needs up to age 25.

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JoAnne Elkin Early Literacy/Early Childhood Consultant Email JoAnne Elkin 586-228-3480

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The "Resources for Families" page on Start Early's website offers a variety of tools and information to support parents and caregivers in fostering their children's development during the critical early years. Recognizing that parents are a child's first and best teacher, Start Early provides expert insights and practical resources to help families create enriching learning experiences at home. These resources include parenting tips, activity ideas, and information about Head Start and Early Head Start programs available in Illinois, which support each stage of a child's development.

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Parents are a child's first and best teacher. Discover early childhood resources from Start Early experts that give parents tools to help their children thrive.

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The article explains how educators and community groups can better connect families to helpful resources by understanding each family’s unique needs and culture. It stresses the importance of sharing clear, timely information and making access easy, such as providing materials in different languages. These strategies help ensure families get the support they need in a way that works for them.

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ParentPowered - Evidence-Based Family Engagement

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Get Community Resources to Your Families

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These tips will help you get community resources into families’ hands. And motivate families to access them, too.

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This Head Start Family & Community page emphasizes the importance of strong partnerships between families, educators, and communities to support children's school readiness and healthy development. It provides resources on community engagement, family engagement, family support and well-being, local early childhood partnerships, parenting, and pregnancy. These resources aim to help families and communities work together to create positive, enduring change for children and families.

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Family Support & Well-being Find tips and tools to support family well-being, which occurs when all family members are safe, healthy, and have chances for educational advancement and economic mobility. Explore Resources

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The Michigan Association for the Education of Young Children (MIAEYC) offers many resources for those pursuing early childhood education. They provide the TEACH Early Childhood Michigan Scholarship Program to help with financial support for degrees and credentials. MIAEYC also hosts a job board for early childhood positions across the state and offers partnership opportunities for educators and organizations. Additionally, they provide professional development through conferences, trainings, and a Knowledge Center to support growth and learning in the field.

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Michigan AEYC Administrator InstituteOctober 22, 2024LEARN MOREMichigan AEYCInfant Toddler ConferenceNovember 15, 2024LEARN MOREMichigan AEYC Annual Early Childhood ConferenceApril 13-15, 2025 Now accepting session proposalsLEARN MORECDA PD Specialist HubInformation for new and existing PD Specialists, CDA verification visit request board, PD specialist network, and incentive payment opportunities.LEARN MORENew Scholarship available as a project of Caring for MI Future:License Variance ScholarshipT.E.A.C.H. Early…

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The Zero to Three website offers a comprehensive range of resources aimed at supporting families in nurturing their children's development from birth through age three. Recognizing that parents are the primary experts on their children's growth, the organization provides evidence-based tools and information to help caregivers understand and respond to their child's needs. Key resources include guidance on developmental milestones, strategies for addressing challenging behaviors, and age-specific content covering prenatal development through 36 months.

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Our resources support families in developing their own ways to promote their children's growth and development.

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The Start Early website offers a variety of resources designed to support families in fostering their children's development during the critical early years. These resources include expert-backed parenting tips and activities that make learning enjoyable at home. Additionally, the site provides information about Head Start and Early Head Start programs, offering services such as prenatal and postnatal care, child care, and enrollment opportunities.

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Parents are a child's first and best teacher. Discover early childhood resources from Start Early experts that give parents tools to help their children thrive.

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The Administration for Children and Families (ACF) provides a comprehensive resource hub for parents and caregivers, emphasizing the importance of early childhood development and family well-being. Their offerings include information on Head Start programs, which support children's growth from birth to age 5 through services that address early learning and development, health, and family well-being.

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The article "Learning About Me: Activities & Resources for Parents & Caregivers" from Start Early provides engaging activities to support young children's social and emotional development. It emphasizes the importance of helping children understand their identity, express their feelings, and recognize their uniqueness.

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Tips & Resources for Parents & Caregivers: Learning About Me

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Resources from our partners at Big Heart World to support your child’s social and emotional learning around identity, belonging and emotions.

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The PBS Parents website offers a wealth of resources designed to support parents and caregivers in raising curious, kind, and resilient children. It provides expert-backed parenting tips, hands-on activities, and educational games that align with child development principles. The site covers a broad range of topics, including early childhood development, emotional health, creativity, and social competence.

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Explore parent resources to help you raise kind, curious and resilient children. Find parenting tips, hands-on activities, games, and apps featuring your child’s favorite PBS KIDS characters.

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The CDC's "Learn the Signs. Act Early." program provides resources to help parents track their child's developmental milestones from 2 months to 5 years old. The website offers free tools such as milestone checklists, the Milestone Tracker app, and videos to assist in monitoring development. If concerns arise, the site guides parents on steps to take and how to communicate with healthcare providers.

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Centers for Disease Control and Prevention

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Families: During COVID-19 you can still schedule appointments for well-child visits, developmental screening, and immunizations. Continue to monitor your child's development between visits.

As a parent, you already have what it takes to help your young child learn and grow. Watch your child's amazing progress by tracking his or her developmental milestones -how he or she plays, learns, speaks, acts, and moves - and sharing that progress with your child's doctor at every check-up.

Check out these free tools to help you track your child's milestones!

Milestone Checklists
Complete a milestone checklist for your child's age to track and celebrate the milestones that he or she is reaching.

Milestones in Action
See photo and video examples of important developmental milestones that children should reach from 2 months to 5 years of age.

Milestones Matter for Families!

If your child is not meeting milestones or if you have concerns about his or her development, talk to your child's doctor.

Amazing Books for Families!

Baby's Busy Day - Being One is So Much Fun!
Baby's Busy Day is the story of a one-year-old puppy who is having a very busy day! Keep an eye out for the paw prints to learn what one-year-old milestones to look for in your baby, and the hearts for tips on how you can help!
Read more about Baby's Busy Day
Order Baby's Busy Day

Where is Bear? - A Terrific Tale for 2-Year-Olds
" Where is Bear?" is a terrific tale for 2-year-old children and their parents! This interactive book encourages children to help Tiger and his forest friends in their search to find Bear.

Read more about Where is Bear
Order Where is Bear

Amazing Me - It's Busy Being 3!
In Amazing Me - It's Busy Being 3! Joey, a 3-year-old kangaroo, shows what he can do in one AMAZING day. This children's book teaches parents developmental milestones as they read to their young child.
Read more about Amazing Me

Resources to Support Developmental Screening

Ask your child's doctor about your child's developmental screening.

Links to Helpful Websites for Parents

HealthyChildren.org is a pediatrician backed parenting website that provides information and recommendations related to child health, guidance on parenting issues, and more from the American Academy of Pediatrics.

Just in Time Parenting (JITP)external icon
JITP features many resources that provide parents with the information they need to support and guide the growth of their child.

Family-to-Family is an organization dedicated to making one-to-one connections between families with 'enough to share' and American families struggling with the challenges of poverty.

Family Voices is a national network of families of children and youth with special health care needs and disabilities that promotes partnership with families in order to improve healthcare services and policies for children.
Positive Parenting Tips
As your child grows and develops, there are many things you can do to help your child. These links will help you learn more about positive parenting, safety, and health at each stage of your child's life. Find tips for positive parenting and child safety according to the age groups below.

Parent to Parent-USAexternal icon
Parent to Parent programs provide emotional and informational support to families of children who have special needs most notably by matching parents seeking support with an experienced, trained 'Support Parent'.

State Children's Health Insurance Program (SCHIP)external icon
Your children may be eligible for free or low-cost health insurance. Every state in the nation has a health insurance program for infants, children and teens. The insurance is available to children in working families.

Physical Developmental Delays: What to Look Forexternal icon
Physical Developmental Delays is a tool for parents concerned about the physical development of their child. The tool reinforces that parents know their child best and should trust their instincts.

Resources to Help Promote Your Child's Development

"Talking is Teaching: Talk, Read, Sing" is a public awareness and action campaign that helps parents recognize their power to boost their children's early brain and vocabulary development through simple, everyday actions.

Vroom has brain-building tips to support your child's development. Use these tips with your child during their first 5 years to help give them a strong base for lifelong learning.

Zero to Three has science-based information and tools designed to help parents and caregivers nurture their young children's development.

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free materials to track child development

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Families access CDC tools on child development

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Families: During COVID-19 you can still schedule appointments for well-child visits, developmental screening, and immunizations. Continue to monitor your child's development between visits. As a parent, you already have what it takes to help your young child learn and grow.

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GISP collaborates with partners to develop country-specific snapshots, highlighting key policies, stakeholders, and resources tailored to local contexts. These resources are designed to promote universal access to effective parenting support, ensuring that every child receives the care and guidance they need for healthy development.

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Global Initiative to Support Parents (GISP)

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Guidelines and Resources on Parent and Caregiver Support - Global Initiative to Support Parents (GISP)

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Guidelines, resources, and frameworks from across different sectors and outcomes and across the life course.

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The American Academy of Pediatrics (AAP) offers a comprehensive set of resources to support families in promoting the health and well-being of their children. These resources are designed to help parents and caregivers partner effectively with healthcare professionals. The Bright Futures Family Pocket Guide, 3rd Edition, provides families with guidance on child development, building resilience, and forming partnerships with others to improve policies, care, services, and support for all children and families.

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View resources which can help you protect and promote your child’s health by increasing your knowledge of children’s health issues, providing assistance on partnering with health care providers, and linking you to helpful organizations and tools. ​

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This page on supporting children's development offers a comprehensive overview of how children grow and develop from infancy through childhood. It provides resources to help parents and caregivers support their child's growth and development throughout these early years. The site emphasizes the importance of understanding developmental milestones and offers guidance on fostering a nurturing environment that promotes healthy development.

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Learn how children grow and develop from infancy through childhood. Find resources to help support your child’s growth and development throughout their childhood.

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The Born Ready Pre-K Parent Resources page offers a variety of tools and guidance to support parents and caregivers as they prepare their children for preschool. It features a video series designed to inform and empower families on their child's Pre-K journey.

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Ready to Help Parents and Children Learn