Childhood trauma is a difficult topic to navigate. We don’t like to think or talk about children being hurt.
But if we’re working with clients who may have been traumatized, we really need to understand it — what it means, how it manifests, and how to identify it.
Accurate childhood trauma tests are an important part of the therapeutic process if we suspect that trauma may have occurred.
In this article, we highlight examples and signs of childhood trauma. We also provide a list of proven childhood trauma tests for clinical practice and research. We end with a look at post-traumatic growth and positive psychology strategies to work with trauma and to foster resilience and positive growth.
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Childhood trauma can take many forms and have lasting effects on an individual’s emotional, psychological, and even physical wellbeing (Van der Kolk, 2003).
Below are just a few examples of childhood trauma; each individual’s experience is unique.
1. Abuse
Abuse is defined by its intention to harm and can be physical, emotional, or sexual in nature (Terr, 2003). Abuse involves various forms of harm inflicted upon children by caregivers, significantly impacting their wellbeing (Legano et al., 2009).
2. Neglect
Childhood neglect refers to the failure of caregivers to provide for a child’s basic needs, including food, shelter, supervision, and emotional support (Gould et al., 2012; Young & Widom, 2014).
Childhood neglect, which also includes emotional neglect, can lead to significant developmental, emotional, and psychological consequences, including difficulties forming healthy relationships, low self-esteem, and increased vulnerability to mental health issues later in life (Legano et al., 2009).
3. Witnessing violence or trauma
Children who witness violence or trauma, such as domestic violence, accidental injury, car crashes, or the death of a loved one, can experience feelings of fear, helplessness, and confusion resulting in trauma, even if they are not directly abused themselves (McCloskey & Walker, 2000).
4. Separation or loss
Loss of a parent through death, divorce, abandonment, or other circumstances can have severe traumatic effects for a child (Benz et al., 2004).
5. Natural disasters
Children who experience or witness natural disasters such as an earthquake, flood, fire, or hurricane may develop trauma-related symptoms, including anxiety, nightmares, and fear of similar events occurring again (Kousky, 2016).
6. Severe illness or hospitalization
Children who experience chronic illness or frequent hospitalizations may experience trauma related to their medical experiences, separation from family, and fear of their own mortality (Stuber & Shemesh, 2006).
7. Bullying
Being exposed to bullying at school, online, or within the community can be traumatic for children, leading to feelings of isolation, low self-esteem, and depression (Vanderbilt & Augustyn, 2010). Interestingly, the findings of this study also suggest that children may be traumatized by bullying even if they are involved in perpetrating or witnessing the bullying.
Understanding childhood trauma and abuse - Tanya Waymire
Tanya Waymire’s TEDx talk about understanding childhood trauma and abuse provides a detailed personal perspective.
6 Signs of Childhood Trauma
Signs of childhood trauma are varied, subtle, and nuanced (Terr, 2003). Just as every child is unique, so is their response to adversity and their experience of trauma. Some of the more obvious signs of childhood trauma include:
1. Behavioral changes
Aggression, withdrawal, regressive behaviors (such as baby talk, bed-wetting, or thumb-sucking), acting out, or excessive compliance and clinginess may indicate that a child has experienced some kind of trauma (Milot et al., 2010).
However, more subtle changes, such as changes in appetite, sleeping patterns, ability to concentrate, school performance, and avoidant behaviors, may also indicate that a child may have experienced something traumatic (Perry, 2003).
2. Nervous system dysregulation & hypervigilance
Childhood trauma can dysregulate the nervous system, leading to heightened reactivity to stressors and alterations in brain structure and function, particularly in regions involved in emotion regulation such as the amygdala and prefrontal cortex (Elbers et al., 2018).
This dysregulation can result in hypervigilance, difficulties in managing emotions, increased sensitivity to triggers, and a heightened risk of mood swings, depression, anxiety, panic attacks, hypervigilance, or emotional numbness (Elbers et al., 2018).
3. Difficulty trusting others
Childhood trauma can affect a child’s ability to trust others, as it disrupts the development of secure attachment bonds and may lead to a pervasive sense of fear, betrayal, or fear of abandonment (Beaton & Thielking, 2020).
This difficulty in trusting others may manifest as guardedness, avoidance of intimacy, and/or clinginess, resulting in challenges in forming and maintaining healthy relationships (Beaton & Thielking, 2020).
4. Low self-esteem
Children who have experienced trauma may experience feelings of worthlessness, self-blame, shame, or guilt, presenting as low self-esteem (Downey & Crummy, 2022).
5. Physical symptoms
Unexplained aches and pains, headaches, stomachaches, or other physical symptoms without medical cause may also indicate that a child is struggling to process trauma (Roelofs & Spinhoven, 2007).
6. Flashbacks or nightmares
Repeatedly experiencing the traumatic event through flashbacks, nightmares, or intrusive memories is a definite sign that a child is struggling to process a traumatic event (Tareen et al., 2007).
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Taking a Closer Look: The ACE Childhood Trauma Test
If you suspect that a child or client has been traumatized, you may want to look a little closer. One childhood trauma test, the Adverse Childhood Experiences (ACE) Test, is a widely used questionnaire that assesses individuals’ exposure to adverse experiences during childhood (Felitti et al., 1998).
The ACE Study, which used the ACE Test, revealed significant findings regarding the impact of childhood trauma on health outcomes later in life (Felitti et al., 1998).
This and further studies have found a strong association between childhood trauma as well as a wide range of health problems in adulthood (Felitti et al., 1998; Zarse et al., 2019). These may include mental health issues, a higher likelihood of engaging in risky behaviors, and struggling to form and maintain healthy relationships.
Felitti et al. (1998) and Zarse et al. (2019) further found that childhood trauma was associated with lower educational attainment, reduced job stability, and lower income levels in adulthood. Worryingly, there was also evidence to suggest that the effects of childhood trauma could be passed down to future generations, as individuals who experienced trauma in childhood were more likely to have children who experienced similar adversities.
Overall, there is compelling evidence of the long-term and wide-ranging impact of childhood trauma on physical health, mental health, social functioning, and overall wellbeing, highlighting the importance of early testing, intervention, and trauma-informed care to mitigate these effects.
4 More Childhood Trauma Tests & Quiz Options
There are several other childhood trauma tests and quizzes available that assess different aspects of childhood adversity and its impact on individuals.
Here are a few options.
1. Childhood Trauma Screener (CTS)
The CTS is a concise screening tool designed to identify individuals who may have experienced childhood trauma (Grabe et al., 2012).
It consists of a brief set of questions covering various types of childhood adversity. While it doesn’t provide detailed information, you can use it as an initial assessment in situations where you suspect abuse. You can download the CTS to use in your own practice.
It offers a quick assessment of childhood trauma exposure, making it suitable for initial screenings.
3. The Childhood Trauma Questionnaire—Short Form (CTQ-SF)
The CTQ-SF is a concise self-report measure that assesses childhood trauma experiences, including emotional, physical, and sexual abuse, as well as emotional and physical neglect (Hagborg et al., 2022).
It provides a brief yet comprehensive overview of childhood trauma exposure, suitable for initial screenings.
4. Childhood Experience of Care and Abuse (CECA) Interview
The CECA is a semi-structured interview used to gather detailed qualitative information about childhood experiences of care and possible abuse (Bifulco et al., 1994). It explores parental behaviors, family dynamics, and specific traumatic events, offering rich insights into the impact of childhood trauma on individuals’ wellbeing (Smith et al., 2002).
These are just a few examples of childhood trauma tests and quizzes available for assessing different aspects of childhood adversity and its impact. It is important to choose a tool that aligns with the specific therapeutic context of each client. Additionally, the interpretation of results should take context as well as all clinical and individual considerations into account.
Remember that your client is an individual person with unique experiences, so a person-centered approach is required.
4 Childhood Trauma Questionnaires for Research
If you’re undertaking childhood trauma research, you may need more in-depth childhood trauma tests and questionnaires that have been validated for research purposes. Here are a few options.
1. Childhood Trauma Questionnaire (CTQ)
The CTQ is ideal for researching childhood trauma due to its comprehensive assessment of various trauma types, including abuse and neglect (Bernstein et al., 1994).
Its structured format and reliability make it easy to administer, providing valuable data for understanding the prevalence, severity, and impacts of childhood trauma in research studies (Georgieva et al., 2021).
2. Traumatic Events Screening Inventory for Children (TESI-C)
The TESI-C is a self-report measure designed to assess trauma exposure in children and adolescents aged 7 to 18 (Ford et al., 2002). It covers various types of traumatic events, such as accidents, disasters, and interpersonal violence.
3. Trauma Symptom Checklist for Children (TSCC)
The TSCC is beneficial for research due to its ability to assess trauma-related symptoms in children and adolescents, providing valuable insights into their psychological wellbeing (Briere, 1996).
It reliably measures various symptom clusters, including anxiety, depression, post-traumatic stress, sexual concerns, and dissociation, aiding in comprehensive analysis (Wherry & Herrington, 2018).
4. Trauma History Questionnaire (THQ)
The THQ is a comprehensive questionnaire that assesses exposure to various types of traumatic events across the lifespan, including childhood trauma (Hooper et al., 2011).
It covers a wide range of traumatic experiences beyond those typically included in ACE assessments. So, if you’re looking for more depth in your assessment, this may be a good option for you.
Explaining Test Scores & Questions
When interpreting childhood trauma test scores and questions on childhood trauma questionnaires, it is crucial to understand the context and implications of each assessment (Sparta, 2003).
You should also read up on the use of the questionnaire, as different childhood trauma tests may have specific guidelines for interpreting scores.
Scores usually reflect the severity or frequency of traumatic experiences reported by the individual, with higher scores indicating greater exposure to adversity during childhood. It is important to interpret scores cautiously, considering individual differences, cultural factors, and the potential for underreporting due to stigma or memory biases.
When explaining test scores to clients or parents, offer a clear and understandable interpretation. Start by discussing what the test measures and why it is relevant to their situation. Then, provide a breakdown of scores, emphasizing strengths and areas for improvement.
Offer support, answer questions, and discuss next steps or interventions based on the results. Use plain language and examples to ensure comprehension and foster trust in the assessment process.
Childhood Trauma & Post-Traumatic Growth
Beyond the profoundly negative impact of childhood trauma, there is an opportunity for post-traumatic growth (PTG). PTG can manifest in various ways, such as increased resilience, greater appreciation of life, enhanced relationships, new perspectives, and increased inner strength (Quan et al., 2022).
It is important to note that PTG is not a simple or linear process, and it does not negate the challenges or negative effects of trauma. It represents a complex and multifaceted process of adaptation and growth in response to adversity.
Some individuals may naturally experience PTG in response to trauma, wherein they undergo positive psychological changes and personal development because of their traumatic experiences (Vloet et al., 2017).
Many, however, will need support and therapy to achieve growth, and the extent of growth can vary greatly among individuals (Henson et al., 2021). Factors that may influence PTG include coping strategies, social support, personality traits, and the nature of the trauma itself (Tedeschi et al., 2004a).
Supporting PTG in therapy involves fostering a therapeutic environment that encourages acceptance, exploration, reflection, and resilience building (Zoellner & Maercker, 2006).
Positive psychology strategies, such as mindfulness and acceptance, a strengths-based approach, cultivating gratitude, and meaning making, can be instrumental in supporting these elements of PTG in therapy (Linley & Joseph, 2004). These strategies foster resilience, promote personal development, and cultivate a sense of meaning and purpose, all of which are necessary for PTG (Tedeschi et al., 2004b).
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Childhood trauma encompasses a range of adverse experiences, including abuse, neglect, witnessing violence, and separation, which can have a profound and lasting effect on a child’s wellbeing. Understanding the signs and effects of trauma is crucial for providing appropriate support and intervention to affected clients.
Identifying and implementing appropriate childhood trauma tests to recognize the signs of trauma, such as behavioral changes, nervous system dysregulation, and difficulty trusting others, is essential for clinicians and caregivers to be able to intervene early and effectively to mitigate the impact of trauma and promote healing.
Employing positive psychology strategies can further support the process of post-traumatic growth, foster resilience, and promote wellbeing. Strategies such as mindfulness and acceptance, strengths-based approaches, cultivating gratitude, and promoting meaning making can empower individuals to navigate their trauma experiences, find purpose and meaning in their journey, and ultimately thrive despite adversity.
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About the author
Susan McGarvie, Ph.D., is a writer, researcher, and therapist in private practice. With more than twenty years' experience working in the health and NPO sectors, her research, writing, and work have focused on supporting practitioners to better manage stress and create a balanced sense of wellbeing.