TABLE 2

National Child Traumatic Stress Network Core Concepts for Childhood Traumatic Stress

1. Traumatic experiences are inherently complex.
 a. Every traumatic event is made up of different traumatic moments, each of which includes varying degrees of objective life threat, physical violation, and witnessing of injury, or death. Children’s thoughts and actions (or inaction) during various moments may lead to feelings of conflict at the time and to feelings of confusion, guilt, regret, and/or anger afterward.
2. Trauma occurs within a broad context that includes children’s personal characteristics, life experiences, and current circumstances.
 a. The child’s own experience, personality, and environment affect his or her own appraisal of traumatic events and may act exacerbate the adverse effects of trauma.
3. Traumatic events often generate secondary adversities, life changes, and distressing reminders in children’s daily lives.
 a. Children’s exposure to trauma reminders can serve as additional sources of distress. Secondary adversities may significantly affect functioning in trauma survivors.
4. Children can exhibit a wide range of reactions to trauma and loss.
 a. Posttraumatic stress and grief reactions can develop over time into psychiatric disorders (eg, PTSD, separation anxiety, and depression), may disrupt major domains of child development, and reduce children’s level of functioning at home, at school, and in the community.
5. Danger and safety are core concerns in the lives of traumatized children.
 a. Lack of physical and psychological safety can be magnified in a child’s mind. Ensuring children’s physical safety is foundational to restoring the sense of a protective shield.
6. Trauma experiences affect the family and broader caregiving systems.
 a. Caregivers’ own concerns may impair their ability to support traumatized children. The ability of caregiver systems to provide support is an important contributor to children’s and families’ adjustment.
7. Protective and promotive factors can reduce the adverse impact of trauma.
 a. Protective factors buffer the adverse effects of trauma and its stressful aftermath, whereas promotive factors generally enhance children’s positive adjustment regardless of whether risk factors are present. The presence of these factors (ie, positive attachment to a caregiver, reliable social support, environment) can enhance children’s ability to resist, or to “bounce back” from adversities.
8. Trauma and posttrauma adversities can strongly influence development.
 a. Trauma and posttrauma adversities can profoundly influence children’s acquisition of developmental competencies and their capacity to reach important developmental milestones. Trauma and its aftermath can lead to developmental disruptions (regressive behavior, reluctance, or inability to participate in developmentally appropriate activities), and developmental accelerations such as leaving home at an early age and engagement in precocious sexual behavior.
9. Developmental neurobiology underlies children’s reactions to traumatic experiences.
 a. Children’s capacities to appraise and respond to danger are linked to an evolving neurobiology of brain structures, neurophysiological pathways, and neuroendocrine systems. Traumatic experiences evoke strong biological responses that can persist and alter the normal course of neurobiological maturation. Exposure to multiple traumatic experiences carries a greater risk.
10. Culture is closely interwoven with traumatic experiences, response, and recovery.
 a. Culture can profoundly affect the ways in which children and their families respond to traumatic events, including how they express distress and disclose personal information to others.
11. Challenges to the social contract, including legal and ethical issues, affect trauma response and recovery.
 a. Traumatic experiences often constitute a violation of expectations of the child, family, community, and society. The perceived success or failure of these institutional responses may exert a profound influence on the course of children’s posttrauma adjustment and on their evolving beliefs regarding family, work, and civic life.
12. Working with trauma-exposed children can evoke distress in providers that makes it more difficult for them to provide good care.
 a. Health care providers often encounter personal and professional challenges as they confront details of children’s traumatic experiences and life adversities. Proper self-care is an important part of providing quality care.