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How to Assess for Developmental Trauma / ACEs

Young girl with doctor

Children and youth with developmental trauma present with symptom clusters in emotions, behaviour, cognition, physical health and relationships. Below we list some examples of symptoms which may arise from traumatic experiences.

Please see the Screening Questionnaires and Checklists for a downloadable quick screening tool, and the Conducting a Quick Screen for Trauma videos below for modeling of how to conduct a clinical trauma screen.

Emotions & Behaviours

Trauma creates emotional dysregulation, which can look like increased outbursts and aggression, or excessive withdrawal. Trauma significantly increases the risk of anxiety disorders, depression and substance use disorders.

Cognition

Trauma impairs concentration and memory, making it hard for children and youth to succeed in school.

Physical Health

Trauma alters children's physiology well into adulthood, for example giving them a significantly elevated risk of developing heart disease, diabetes, stroke, and cancer, among other leading causes of death. It also makes them more likely to die by suicide.

Relationships

Children who experience trauma in their caregiving relationships may show inappropriate attachments, including early sexuality or high-risk relationships. They may also show inappropriate rejection or clinging to other adults in their lives, such as teachers or health care providers.

Conducting a Quick Screen for Trauma - Parent Interview

 

Conducting a Quick Screen for Trauma - Child Interview

 

When assessing for Developmental Trauma:

1. Inquire from child and parent about the child's history of traumatic events and the developmental stage in which they occurred. For a quick screen, use the ACEs screening tool.

2. After the quick screen, you may also screen for the following signs and symptoms at this or a following appointment:

  • Emotional Regulation Difficulties
    • Developmental regression (emotionally acts like a younger child)

    • Frequently crying or crying in inappropriate situations

    • Flat or numb emotional expression

    • Excessive worry, nervousness, fear, or shyness

    • Frequently feels depressed or down

    • Negative sense of self (e.g., helplessness, worthlessness)

    • Frequent intense emotional outburst or irritability

    • Lack of coping skills to deal with stress or adversity

  • Social/Relationship Difficulties
    • Frequent conflict (e.g., distrust, defiance)

    • Lack of empathy, compassion and remorse

    • Engages in inappropriate relationships with peers (e.g., early sexual behaviours, bullying, dysfunctional peer group)

  • Behaviour Difficulties
    • Poor impulse control

    • Self-injury behaviour (head banging, cutting, etc.)

    • Aggression towards others

    • High risk behaviour (examples for children: climbing, running into the street; examples for teens: drug or alcohol use, early sexual behaviour)

  • Physical Problems
    • Unexplained physical complaints (e.g., headache or abdominal pain)

    • Sleep disturbance

    • Eating disturbances (e.g., hoards, gorges, or hides food; refuses to eat; eats strange things)

    • Unexplained weight gain or loss<

    • Failure to thrive

    • Enuresis, encopresis, or constipation

    • Hair loss

    • Poor control of chronic disease (e.g., asthma or diabetes)>

  • Cognitive/Academic Difficulties
    • School failure or absenteeism

    • Difficulty thinking clearly, reasoning, or problem solving

    • Struggles to plan ahead, anticipate the future, and act accordingly

    • Struggles to sustain attention or interest in a task or activity (may be distracted by trauma reminders)

    • Speech and language problems

    • Memory deficits 

Obtain information using a variety of methods and informants when possible (e.g., clinical interviews, standardized measures, physical examination, behavioural observations).

Ideally, involve a multidisciplinary team in the assessment (e.g., pediatrician, mental health professional, educational specialist) and to plan the treatment.


What is Developmental Trauma / ACEs?

How to Treat Developmental Trauma / ACEs

Clinical Tools