Trauma in Young Minds: PTSD, Complex PTSD, and ACEs

By: Missy Lloyd, LCMHC

As a therapist who works with all ages, I’ve sat beside children navigating anxiety that didn’t seem to match their experiences, teens paralyzed by anger they couldn’t name, and parents who carry guilt for patterns they never meant to pass down. Through it all, one truth rings clear: trauma does not have a time stamp. Trauma doesn’t just live in past memories—it lives in present bodies, in difficult behaviors, and even in the smallest of genes.

PTSD and Complex PTSD in Children

While many are familiar with Post-Traumatic Stress Disorder (PTSD)—often associated with singular, life-threatening events like car accidents, natural disasters, or assaults—Complex PTSD (C-PTSD) tells a quieter but deeper story. C-PTSD results from chronic, prolonged exposure to trauma, often in early caregiving relationships. Neglect, emotional abuse, domestic violence, or growing up in unpredictable environments can shape a child’s entire sense of self, safety, and worth.

Children with C-PTSD may not always have flashbacks or nightmares. Instead, they might show up in your office with:

• Difficulty trusting others
• Explosive outbursts or shutdowns
• Chronic anxiety or depression
• Somatic complaints (e.g., stomachaches, headaches)
• A profound sense of shame or “badness”

This nuanced trauma presentation may go misdiagnosed as ADHD, ODD, or even bipolar disorder. But when we pause to consider what a child has survived, the behaviors often begin to make sense.

The Science of Trauma: How the Body Keeps the Score

In his seminal work, The Body Keeps the Score, Dr. Bessel van der Kolk outlines how trauma is not just “in the past”—it’s stored in the body. Neuroimaging shows that traumatic memories can deactivate parts of the brain responsible for language and logic while lighting up fear centers like the amygdala.

For children, this means trauma is not always remembered in words—it may be remembered in:

• Night terrors without context
• Hypervigilance or startle responses
• Difficulty concentrating in school
• Intense reactions to perceived rejection or separation

When we approach children with curiosity rather than correction, we begin to see that what looks like defiance is often defense. The child isn’t being “bad”—they’re doing their best to survive with the nervous system they’ve inherited and shaped through experience.

ACEs: The Roots Beneath the Surface

The Adverse Childhood Experiences (ACEs) study, one of the largest investigations into childhood trauma, illuminated a stark truth: early adversity doesn’t just affect mental health—it impacts lifelong physical health. Children or adults with high ACE scores are at increased risk for heart disease, diabetes, substance use disorders, and more.

But ACEs are not destiny. They are a call to action.

Knowing a child’s ACE score helps us ask not, “What’s wrong with you?” but “What happened to you?” and more importantly, “What strength have you shown to survive this far?”

ACEs is self-reportable, accessible and free online, and assesses abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (mental illness, mother treated violently, divorce, incarcerated relative, substance abuse).

It Didn’t Start With You: The Inheritance of Trauma

Mark Wolynn’s book, It Didn’t Start With You, expands our understanding of trauma even further. He explores intergenerational trauma—the way unhealed wounds are passed down, not just through behavior and environment, but even through epigenetics.

Children may be impacted by:

• Family members who experienced war, poverty, or systemic oppression
• Unspoken grief in the family lineage
• Repeated patterns of abandonment, addiction, or anxiety

Wolynn’s work invites us to look at trauma not only through a personal lens but through a systemic and familial one. This helps children and their caregivers recognize that their pain is real, even if they can’t always pinpoint its origin.

What Healing Looks Like

Healing trauma is not about fixing children. It’s about co-regulating with them, helping them feel safe, and rebuilding a sense of agency and connection.

Effective trauma treatment often includes:

• Play therapy, where children can process trauma symbolically
• EMDR (Eye Movement Desensitization and Reprocessing) or TF-CBT (Trauma-Focused Cognitive Behavioral Therapy)
• Somatic work, helping children listen to and regulate their bodies
• Family therapy, supporting caregivers to respond with attunement rather than punishment

To work with trauma is to sit with the sacred: the unspeakable pain children have endured, and the unwavering courage it takes to heal. As therapists, educators, and caregivers, we can be witnesses to resilience—not by pushing children to “move on,” but by inviting them to move through.

Because trauma may shape the beginning of their story, but it doesn’t have to write the end.

Suggested Reading for Further Exploration

For Adults

• The Body Keeps the Score by Bessel van der Kolk
• It Didn’t Start With You by Mark Wolynn
• What Happened to You? by Dr. Bruce Perry and Oprah Winfrey
• The Deepest Well by Dr. Nadine Burke Harris

For Teens

• Trauma: The Invisible Epidemic by Dr. Paul Conti
• Be You by Peter H. Reynolds (illustrated, for younger teens)
• Healing the Heart: A Journey Through Grief and Trauma by Mindy R. Neher
• Stuff That’s Loud by Ben Sedley & Lisa Coyne (ACT-based, helpful for trauma-related anxiety)

For Children

• A Terrible Thing Happened by Margaret Holmes
• Once I Was Very Very Scared by Chandra Ghosh Ippen
• The Invisible String by Patrice Karst
• Breathe Like a Bear by Kira Willey (mindfulness for emotional regulation)

If you’re a parent, therapist, or educator reading this—thank you. Your presence in a child’s life is a healing force all its own.