Jana Pressley, Psy.D. & Joseph Spinazzola, Ph.D.
The Foundation Trust
During stressful and uncertain times, children and adolescents often feel increased anxiety, just as we do as adults. Depending on the age and stage of development, children often do not have a clear sense of how to articulate their worries. Fear can present in a variety of ways such as angry, oppositional behavior, or overdependent, panicked distress. This is especially true for a particular group of youth: those with a history of complex trauma. As we find ourselves navigating the Coronavirus (COVID-19) pandemic, there are many who are caretakers for children and adolescents with histories of complex trauma. If you are a parent, foster care provider, residential program worker, educator providing online instruction, or health care professional, you are likely caring for youth who will be dealing with increased vulnerability to stress right now.
Complex Trauma: How the Past is Relevant in the Present
Complex trauma exposure comes in many forms. Some of these include experiencing childhood neglect or abuse, witnessing or experiencing domestic or community violence, removal from home or family of origin, or enduring racial, cultural, religious, or gendered oppression. Growing up in chaotic, unpredictable living situations in which caregivers are overwhelmed by serious mental health issues, addiction, or health crises can also be experienced as a form of complex trauma.
Youth with histories of chronic interpersonal trauma tend to struggle with ongoing internal experiences of anxiety or panic that can be easily triggered in the present, even if these youth are currently living in a nurturing environment. For those who have been persistently navigating adversity throughout their childhood, it is common for the body’s stress response system to be activated frequently, and at a level beyond the capacity that the autonomic nervous system was designed to manage on a day-to-day basis. We now know from decades of research on complex trauma, neurobiology, and adverse childhood experiences (ACES) that a chronically elevated stress response leads to cumulative negative health consequences, and also is often connected to risky coping behaviors such as substance use, problem eating, and self-harm. As troubling and, at times, dangerous as some of these risk behaviors can be, they are often best understood as survival-based adaptations to complex trauma that evolved to help children and youth “disappear” in the face of inescapable violence or abuse, soothe intense distress, combat chronic numbness, or attain relief from emotional pain.
Trauma-impacted youth have often learned to navigate physical and psychological danger by being highly attuned to the mood or stress level in their immediate surroundings: their homes, neighborhoods, and schools. This is known as hypervigilance, and it is a powerful instinct that supports survival in the midst of threat. If a child lives in a home with risk for relational violence, he may adapt by learning to read the nonverbal cues of his parents, detecting subtle shifts in their mood in order to interact with them in a way that keeps the peace. Another youth may learn to fight to protect herself, or become invisible, or become numb to feelings of fear or even physical pain.
Fast Forward to the Present
For youth who have experienced past trauma, this same hypervigilance often lives on in the body far beyond the initial trauma exposure. Essentially, the stress response system stays in a survival-based state of alertness. Often without the conscious awareness of their minds, children’s bodies can react to triggers reminiscent of past traumatic experiences such as a loud and startling sound, the fear of feeling trapped, or a facial expression that looks threatening or rejecting. In these instances, youth can suddenly find themselves transported momentarily to the past and fall into a state of panic. This can occur without a clear understanding of why it is happening or what specifically set it off.
Another common characteristic of complex trauma is that it often leaves youth coping with a sense of constant unpredictability and loss of control. Past experiences of helplessness or powerlessness associated with chronic trauma can carry into the present day. These states of being can then be triggered in the present at times when the surrounding environment or larger culture is experiencing threats to safety or disruptions to daily life routine.
In this time of global crisis, most children are likely feeling justifiably concerned or worried at some level. Children with histories of complex trauma may demonstrate even more intense emotional or behavioral responses. They may feel helpless or frozen, or behave in an impulsive, reckless, or enraged manner. Other youth may return to former symptoms that were present at a younger age and had previously subsided, such as bedwetting, tantrums, or clingy behavior. Paradoxically, intense anxiety associated with major life stressors such as the COVID-19 pandemic may also manifest in some youth as apparent indifference or exaggerated denial of safety concerns.
Some of the ways a child or adolescent with a complex trauma history may already experience the world (prior to a global crisis) might include:
- My body feels tense or painful
- My emotions are hard to understand or regulate, and extremely difficult to express
- My feelings are too big for others to handle
- My head is spinning with fears, worries, self-doubts
- The world feels unsafe, unpredictable
- People have used me or let me down in the past, so I probably shouldn’t trust them
- I feel really alone, but I don’t know how to ask for help
When a present-day threat emerges, all the above feelings, thoughts, or fears tend to intensify, but can lead to a wide variation of manifestations. Consider these scenarios:
- A child with a tendency toward physical manifestations of anxiety might become hypersensitive to any shift in bodily sensations, and immediately panic at subtle signs of a cough or sore throat.
- An adolescent with a history of physical neglect and food deprivation might feel particularly panicked that their family will run out of food and may begin stealing or hoarding items.
- A youth with a history of sexual abuse might feel triggered by the threat of feeling trapped during quarantine or shelter at home conditions.
- A teenager who experienced past emotional deprivation and neglect as a child might feel extremely anxious at the idea of social distancing in general, and struggle with feelings of perceived rejection or abandonment if asked to isolate from others for an extended period. This youth might particularly struggle with the temporary reduction in opportunities for healthy touch with peers, or lack of physical access to a boyfriend or girlfriend.
- A child who can easily pick up on the stress level of adults might react in ways that appear extreme or inappropriate to the present situation, as their body’s alarm system “goes off” and they automatically shift into a fight, flight, freeze, or submit survival mode. For example, some youth may shut down and withdraw, while others might escalate into a tantrum or aggressive stance.
- A youth appears indifferent to cautions around social distancing, and when confronted with the concern states, “Whatever, I’m not scared. I’ve faced way scarier situations than this. Life always sucks; this is no different.”
With the current state of uncertainty in our world, it helps to be aware that a child’s or adolescent’s historical experience can get triggered in a manner that heightens present day reactions. While an entire community might be feeling anxiety in response to a global crisis like COVID-19, a complex trauma survivor might experience intensified reactions to particular details that are most pertinent to their own past experiences.
Connecting the Dots Between Past and Present
Given the resilience of the human spirit and the various ways in which healing occurs, many youth with a history of early trauma have found nurturing homes and are coping or thriving in healing environments. Therapy, family and school support, mentors, faith communities, athletics, and the arts have served as powerful aids for many young people who have experienced trauma. For most complex trauma youth survivors, however, there are still particular scenarios that can stir up troublesome feelings or sensations related to earlier trauma.
As caregivers for complexly traumatized youth, this may also feel like a particularly challenging time. Children in your care may have symptoms that are re-emerging, or old coping patterns that are re-activated. Youth in out-of-home placements who had been starting to respond positively to and feel comforted by the structured routines of new living environments may now be “acting out” or grappling for control in the midst of disrupted weekly rituals and outside activities put on hold. All youth - and their caregivers – need nurturing a community and routines that support self-care and sustain health. There are many variables out of our direct control as caregivers during this global health crisis. Nevertheless, it can still be useful to find tangible daily practices to aid youth in managing anxiety.
Resource Ideas and Anxiety Management Strategies for Youth and Caregivers Facing Acute Stress
We are all different as far as what feels most helpful during a triggered moment or extended period of distress. What follows is a list of ideas and suggestions that might help create moments of re-centering and calming for youth and caregivers. We recommend that you consider gently experimenting with these or other coping techniques to find the ones that work best for you.
For Parents and Caregivers of Youth with Histories of Complex Trauma
- First of all, care for yourself. The best resource for an overwhelmed child or adolescent is a calm, regulated adult. And…it is not easy to consistently remain calm and regulated in a season of broader anxiety in society. Remember to be gentle with yourself in the inevitable moments when you lose your patience, allow too much of your own fear to show, or respond in other ways that are less helpful than you would like to be able to offer youth in your care during this stressful time.
- As much as possible, stay connected to your own community throughout this pandemic. Consider carving out time to connect online with supportive friends and family members, particularly if you have others who understand the needs of caring for youth with trauma histories. If you are a foster/adoptive parent, a residential program staff member, or a teacher or therapist providing online support for trauma-impacted youth, this is a time to come together in virtual forums to share experiences, strategies, and support with other adults in your sphere.
- If you are feeling shame or pressure by social media posts or messages prescribing a one-size-fits-all daily routine or that are publicly degrading others, consider restricting unhelpful content from coming into your social media feed.
- If you are a caregiver who also struggles with your own history of painful past experiences, we recommend that you review the detailed list of recommended coping strategies suggested in our companion resource guide for adults, also available in Spanish, French, and Portuguese: Coping Strategies for Complex Trauma Survivors Contending with the Coronavirus (COVID-19) Pandemic
- When youth demonstrate reactions and behaviors that may be intensified by the current global crisis, begin with curiosity. Ask yourself, “how might my child’s current behaviors be triggered by their past experiences and coping patterns?” When we can allow ourselves space to pause and be curious about our children’s responses, we can better understand, soothe, and support their needs. Further, we can teach and cue youth to be curious about their own responses.
Strategies for Supporting Trauma-Impacted Youth:
- Maintain a daily routine that helps support a sense of predictability and control, with the caveat that you can give yourself permission to be flexible if taking breaks or temporarily altering routine is most comforting to your child. There is no perfect one-size-fits-all daily routine. Find what works for your family or residential program during this unique time in all our lives.
- Provide opportunities for youth to experience moments of choice and control, which might feel particularly limited during this era. Even simple choices around what to have for dinner, which game to play, which movie to watch, or the order of academic tasks might make a difference toward helping youth feel like they can retain some sense of personal agency or control in their daily lives.
- Support youth efforts to maintain connection by phone or computer with peers as well as family members outside the home. If youth are feeling isolated from friends and loved ones, assist them in scheduling regular video, phone, online gaming or text chats with people who bring them joy and comfort. For youth in residential programs or foster care, prioritize efforts to enable them to sustain contact as appropriate with parents, guardians, and other important family members throughout a potentially extended period of sequestering.
- Limit news media input for young children as much as possible. For adolescents and older youth who naturally have more access to information and social media, have discussions about limiting news updates and assist in finding (and processing together) news only from credible sources.
- Incorporate closeness and safe physical touch as a comforting element of daily life, such as snuggling on the couch watching a movie or playing together with a pet.
- Recognize that for a variety of reasons, some youth do not like to be hugged or avoid other physical contact from parents or adult caregivers, whether due their particular trauma histories, personal preferences, or otherwise. For such youth, as well as for those living in residential programs with restrictions on physical contact, support and provide youth with alternative options such as curling up with a pillow, blanket or favorite stuffed animal.
- If your child or adolescent is exhibiting signs that they are feeling particularly triggered by a memory or emotion connected to past trauma, assist them in re-connecting to thoughts or activities that ground them to the present. Grounding is a strategy that connects us to the present moment. Support youth in connecting to their senses to focus on what they can see, hear, touch, smell, or taste in the moment as a reminder that panic/fear from past experiences is not happening in the present.
- Support youth in assessing if their body needs sensory input that helps to bring their energy up or down or that helps to expend restless energy. Sometimes when youth are distressed, energy feels too high (hyperarousal) and needs to be soothed, while other times energy leaves youth feeling shut down, withdrawn, and numb (hypoarousal). Still other times their natural energy has built up in their bodies and needs a healthy outlet such as aerobic exercise, lifting weights, stretching, or dancing (sensory satiation). Tending to sensory needs can include activities such as drinking hot tea or a cold drink, taking a warm bath or shower, wrapping in a heavy or weighted blanket, or using scented lotions or essential oils. Additionally, materials like playdoh, putty, sand, or fidget toys can be useful.
- Support youth in building a simple mindfulness practice into their routine and coping repertoire, such as deep breathing, meditation, stretching/yoga, or guided imagery. There are many good apps to guide these practices. For older youth, general apps such as Headspace; Calm; Stop, Think, & Breathe might be applicable, and many apps also have youth variations. Sesame Street has wonderful resources for younger children, including the “Breathe, Think, Do Sesame” app and various musical YouTube videos related to coping with and expressing difficult emotions.
- Whenever permissible, step outside with youth to take some deep breaths of fresh air, take a walk or hike, or go for a bike ride.
- Support youth in incorporating movement and exercise into their daily routine. Kicking or throwing a ball back and forth, engaging in brief vigorous exercise, living room dance parties, stretching/yoga, or strength training can assist the body in feeling stronger and more regulated. Sometimes simply shifting the body from a vulnerable position into a more powerful, active stance can adjust our physiology in a positive manner.
- Support youth in identifying personal sources of positivity, inspiration, comfort, and joy, and build these into the daily routine. Consider reading, listening to, or watching stories that inspire youth, stimulate laughter, nurture spirituality, or sustain core family or community values. For some families, this might work well together, while for others with older youth, merely encouraging adolescents to find what is useful to them individually might be a good start.
- Support youth in listening to music that lifts their spirits and connects with their interests and identity. If helpful, consider providing headphones or other tools to give youth access to music.
- Encourage youth to create things that bring them satisfaction. Drawing, coloring, painting, writing, collaging, making music playlists, and making photo albums and scrapbooks are all examples of creative tasks that can feel both calming and fruitful.
- Help youth ward off anxious thoughts by redirecting their thoughts and getting absorbed in light but focused problem-solving activities such as puzzles, board games, computer games, Legos, or other building activities.
- Consider how to best support youth of color in foster, adoptive, or residential placements who might be feeling disconnected from family, peers or mentors from their ethnic community. Check in with youth of color who might be at risk for isolation and assist youth in creating opportunities for maintaining communication with important connections.
- Consider how to best help LGBTQ youth during a time they may be feeling isolated from other LGBTQ peers and mentors and struggling to remain connected to a sense of community identity. Gently assess the social and emotional needs of LGBTQ youth in your care and promote opportunities for youth to link remotely to supportive individuals or organizations.
- Finally, remind youth that asking for help is important, while perhaps validating that you know how difficult it might feel. Recognize that as much as you love or care for them, and as well as you normally get along, sometimes the youth in our care need a break from us, a momentary change in perspective, or even just someone else to vent to about our cooking and horrible taste in music! This may become truer than ever as we spend increasingly more time sheltered in close quarters with our immediate family members or the specific youth in our care. Consider getting ahead of this by helping youth identify additional supportive figures in their lives who are accessible by video, phone, or email or text. These could be family members who live apart from them, trusted adult mentors such as select pastors, rabbis, coaches or teachers, or safe friends and peers. Encourage youth to build regular communication with these relational resources into their weekly routines. This way we can help ensure that the youth in our care have options to reach out to when they need solace, encouragement, a good laugh, or non-judgmental listening.
A printer-friendly PDF of this resource is available to read and download in English, Spanish, French, and Portuguese
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., Andres, B., Cohen, C., & Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34-51.
Blaustein, M., & Kinniburgh, K. (2018). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency, 2nd edition. Guilford Publications.
Blaustein, M., & Kinniburgh, K. (2015). When age doesn't match stage: Challenges and considerations in services for transition-age youth with histories of developmental trauma. Focal Point, 29, 17-20.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Sprague, C., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K. Olafson, E.,& van der Kolk, B., (2007). Complex trauma in children and adolescents. Focal Point, 21(1), 4-8.
D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J. & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally-appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200.
Forrest, S., Gervais, R., Lord, K., Sposato, A., Martin, L., Beserra, K., & Spinazzola, J. (2018). Building communities of care: A comprehensive model for trauma-informed youth capacity building and behavior management in residential services. Residential Treatment for Children & Youth, 35(4), 265-285.
Habib, M., Machairas, K., & Spinazzola, J. (2019). MVP, surrogate parent, or mentor? The crucial role of front-line workers in building a unified trauma-informed residential services team for youth. New York State Trauma Informed Network Newsletter, August 15.
Hodgdon, H. B., Blaustein, M.B., Kinniburgh, K., Peterson, M., & Spinazzola, J. (2016). Application of the ARC model with adopted children: Supporting resiliency and family well-being. Journal of Child and Adolescent Trauma, 9(1), 43-53.
Kinniburgh, K., Hodgdon, H., Gabowitz, D., Blaustein, M. & Spinazzola, J. (2013). Developing and implementing trauma informed programming in two residential settings using the ARC framework. Journal of Family Violence, 28(7), 679-692.
Machairas, K., Habib, M., Labruna, V., & Spinazzola, J. (2019). Advancing inclusivity in trauma-informed residential services and staffing. New York State Trauma Informed Network Newsletter, October 15.
Pressley, J., & Spinazzola, J. (2018). The developmental consequences of exposure to complex trauma in childhood and adolescence. In J. Osofksy & B. McAlister Groves (Eds.), Violence and trauma in the lives of children (Vol 1.). Santa Barbara, CA: Praeger.
Spinazzola, J., van der Kolk, B., & Ford, J. (2018). When nowhere is safe: Interpersonal trauma and attachment adversity as antecedents of posttraumatic stress disorder and developmental trauma disorder. Journal of Traumatic Stress, 31(5), 631-642.
Spinazzola, J., Habib, M., Knoverek, A., Arvidson, J., Nisenbaum, J., Wentworth, R., & Pond, A. (2013). The heart of the matter: Complex trauma in child welfare. Child Welfare 360o. Special Issue: Trauma-Informed Child Welfare Pratice. Winter 2013, 8-9, 37.
Spinazzola, J., Hodgdon, H., Liang, L., Ford, J., Layne, C., Pynoos, R., Stolbach, B., & Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes in a national sample. Psychological Trauma: Theory, Research, Practice and Policy, 6(S1), S18-S28.
Spinazzola, J., Habib, M., Blaustein, M., Knoverek, A., Kisiel, C., Stolbach, B., Abramovitz, R., Kagan, R., Lanktree, C., & Maze, J. (2017). What is Complex Trauma? A resource guide for youth and those who care about them. National Child Traumatic Stress Network.
Spinazzola, J., A. Rhodes, D. Emerson, E. Earle & K. Monroe. (2011). Application of yoga in residential treatment of traumatized youth. Journal of the American Psychiatric Nurses Association, 17(6), 431-444.
Warner, E., Spinazzola, J., Westcott, A., Gunn, C., & Hodgdon, H. (2014). The body can change the score: Empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child & Adolescent Trauma, 7(4), 237-246.
 Several of these recommendations for youth and their parents and caregivers were informed by the Attachment, Regulation, and Competency (ARC) complex trauma intervention framework for children, families and systems (Blaustein & Kinniburgh, 2018).