Child with finger paints

An overview of Complex Trauma: Causes, Symptoms, and Treatment

Causes of Complex Trauma

Complex trauma results from the chronic or ongoing exposure to events such as abuse, neglect, separation from primary caregivers, exposure to violence or substance abuse, and poverty (Cook et al., 2003). These events are especially impactful in early childhood which is a sensitive time period when important brain connections are being established. These experiences expose the developing brain to excess stress chemicals, which in turn alter the physical structures in a way that becomes sensitized to danger. These impacts affect the child’s ability to regulate emotions and behaviour, form relationships, and cope with stress during childhood and in later life if not supported effectively. Additionally, genetic and environmental factors can also play a role in the experience of complex trauma.

Symptoms of Complex Trauma

Complex trauma can manifest many ways, however the most common and easily identifiable include: emotional and behavioural regulation difficulties, as well as physical symptoms such as delayed milestones throughout childhood, chronic pain complaints, and gut issues. Complex trauma can also have significant effects on cognitive development, leading to difficulties in attention, memory, and executive function creating immense difficulty in school functioning (van der Kolk, 2005).

Treatment Options for Complex Trauma from an OT Lens

Occupational therapy (OT) offers a multifaceted approach to help children who have experienced complex trauma regain a sense of control, safety, and well-being. These treatment modalities are tailored to the unique needs of each child and aim to address their physical, emotional, and cognitive challenges. The safe and Sound Protocol (SSP) is a non-invasive listening protocol designed to support regulation of the autonomic nervous system, leading to increased social engagement, improved regulation, and decreased sensory sensitivities. Sensory integration therapy, a core component of OT, helps children regulate their responses to sensory stimuli, aiding in emotional regulation and reducing hyper-arousal. Play therapy, often incorporated into OT sessions, provides a safe space for children to express their feelings, develop social skills, and rebuild trust in relationships. Additionally, activities promoting fine and gross motor skills not only enhance physical development but also help children regain a sense of mastery and self-esteem. Collaborative work with families and caregivers is also crucial to create a supportive environment for healing and growth. OT modalities for children affected by complex trauma are holistic and compassionate, striving to empower these young individuals on their path to recovery and resilience. Some other options for treatment include evidence-based therapies like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), which are less commonly utilized by OTs, however, they have shown effectiveness in treating complex trauma (National Child Traumatic Stress Network, 2017; American Psychological Association, 2018).

Assessing Complex Trauma

A comprehensive evaluation by a mental health professional, including a detailed history of adverse childhood experiences, can help identify these types of experiences in a child’s history. OTs may use family interviewing or trauma-specific screening tools or questionnaires designed to identify trauma symptoms and their impact on daily life. Examples include the Child Behavior Checklist (CBCL), the Trauma Symptom Checklist for Children (TSCC), or the Child Trauma Screening Questionnaire Ford & Courtois, 2013).

I hope this overview of complex trauma has helped you to gain a better understanding of this topic as it relates to occupational therapy! Please watch out for our next blog post that will delve deeper into how to identify symptoms and how OTs can help. For suggestions on blog topics or questions about the material, please reach out to [email protected]!


American Psychological Association. (2018). Play therapy. Retrieved from

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., … & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European

van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408.

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