Trauma-Exposed Infants and Toddlers: A Review of Impacts and Evidence-Based Interventions
Keywords:trauma, infant mental health, early childhood, attachment, development, intervention
Infants and toddlers are exposed to abuse and neglect at disproportionate rates compared to other children, setting a trajectory for disrupted developmental processes and increased vulnerability to future traumatic exposure. Social workers encounter trauma–exposed young children across a number of systems, including but not limited to early childcare, family physical and mental health, court, and child welfare. It benefits social workers to have a working understanding of current research related to the bio–psycho–social impact of trauma on infants and young children and an awareness of current, research-driven interventions that can support young, at–risk children and families. This article reviews trauma-impacted development throughout the first two years of life with a discussion of current research exploring attachment and brain development and then discusses caregiver–child based interventions that work to repair disrupted attachment patterns, repair impaired regulatory processes, and return the caregiver–child relationship to a healthy developmental path.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., & Blaustein, M. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4(1), 34-51. doi: https://doi.org/10.1080/19361521.2011.545046
Bergeron, M. Y. (2017). Factors that support the use of child-parent psychotherapy as an intervention for child-parent dyads exposed to pediatric medical traumatic stress. Clinical Social Work Journal, 45(1), 77-87. doi: https://doi.org/10.1007/s10615-016-0585-2
Berlin, L. J., Shanahan, M., & Carmody, K. A. (2014). Promoting supportive parenting in new mothers with substance-use problems: A pilot randomized trial of residential treatment plus an attachment-based parenting program. Infant Mental Health Journal, 35(1), 81-85. doi: https://doi.org/10.1002/imhj.21427
Bernard, K., Hostinar, C. E., & Dozier, M. (2015). Intervention effects on diurnal cortisol rhythms of Child Protective Services-referred infants in early childhood: Preschool follow-up results of a randomized clinical trial. JAMA Pediatrics, 169(2), 112-119. doi: https://doi.org/10.1001/jamapediatrics.2014.2369
Bernard, K., Simons, R., & Dozier, M. (2015). Effects of an attachment-based intervention on child protective services-referred mothers’ event-related potentials to children’s emotions. Child Development, 86(6), 1673-1684. https://doi.org/10.11111/edev.12418
Brand, S. R., Engel, S. M., Canfield, R. L., & Yehuda, R. (2006). The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant. Annals of the New York Academy of Sciences, 107(1), 454-458. doi: https://doi.org/10.1196/annals.1364.041
Caron, E. B., Weston-Lee, P., Haggerty, D., & Dozier, M. (2016). Community implementation outcomes of Attachment and Biobehavioral Catch-up. Child Abuse & Neglect, 53, 128-137. doi: https://doi.org/10.1016/j.chiabu.2015.11.010
Cicchetti, D., Cowell, R., Rogosch, F., & Toth, S. (2015). Childhood maltreatment and its effect on neurocognitive functioning: Timing and chronicity matter. Development and Psychopathology, 27(2), 521-533. doi: https://doi.org/10.1017/S0954579415000139
Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child & Adolescent Psychiatry, 34(5), 541-565. doi: https://doi.org/10.1097/00004583-199505000-00008
Cordón, I., Pipe, M., Sayfan, L., Melinder, A., & Goodman, G. (2004). Memory for traumatic experiences in early childhood. Developmental Review, 24(1), 101-132. doi: https://doi.org/10.1016/j.dr.2003.09.003
DeBellis, M. D. (2001). Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13(3), 539-564. doi: https://doi.org/10.1017/S0954579401003078
DePrince, A. P., Weinzierl, K. M., & Combs, M. D. (2009). Executive function performance and trauma exposure in a community sample of children. Child Abuse & Neglect, 33(6), 353-361. doi: https://doi.org/10.1016/j.chiabu.2008.08.002
DeVoe, E. E., Klein, T., Bannon, W., & Miranda-Julian, C. (2011). Young children in the aftermath of the World Trade Center attacks. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1), 1-7. doi: https://doi.org/10.1037/a0020567
Dong, M., Anda, R. F., Dube, S. R., Giles, W. H., & Felitti, V. J. (2003). The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse & Neglect, 27(6), 625-639. doi: https://doi.org/10.1016/S0145-2134(03)00105-4
Dozier, M., Bick, J., & Bernard, K., (2011). Attachment-based treatment for young, vulnerable children. In J. D. Osofsky (Ed.), Clinical work with traumatized young children (pp. 75-95). New York: Guilford Press.
Dozier, M., Peloso, E., Lewis, E., Laurenceau, J., & Levine, S. (2008). Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care. Development and Psychopathology, 20(3), 845-849. doi: https://doi.org/10.1017/S0954579408000400
Feldman, R., & Vengrober, A. (2011). Posttraumatic stress disorder in infants and young children exposed to war-related trauma. Journal of the American Academy of Child & Adolescent Psychiatry, 50(7), 645-658. doi: https://doi.org/10.1016/j.jaac.2011.03.001
Fitzpatrick, C., McKinnon, R., Blair, C., & Willoughby, M. (2014). Do preschool executive function skills explain the school readiness gap between advantaged and disadvantaged children? Learning and Instruction, 30, 25-31. doi: https://doi.org/10.1016/j.learninstruc.2013.11.003
Ford, J. D. (2005). Treatment implications of altered affect regulation and information processing following child maltreatment. Psychiatric Annals, 35(5), 410-419.
Ford, J. D., Albert, D., & Hawke, J. (2008). Prevention and treatment interventions for traumatized children: Restoring children’s capacities for self-regulation. In D. Brom, R. Pat-Horenczyk, & J. Ford (Eds.), Treating traumatized children: Risk, resilience and recovery (pp. 51-70). New York, NY: Routledge.
Grasso, D., Ford, J., Dierkhising, C., Branson, C., & Lee, R. (2015). Developmental patterns of adverse childhood experiences and current symptoms and impairment in youth referred for trauma-specific services. Journal of Abnormal Child Psychology, 44(5), 1-16. doi: https://doi.org/10.1007/s10802-015-0086-8
Jimenez, M., Wade, R., Lin, Y., Morrow, L., & Reichman, N. (2016). Adverse experiences in early childhood and adult health outcomes. Pediatrics, 137(2), 1-9. doi: https://doi.org/10.1542/peds.2015-1839
Jones, A. (2006). Levels of change in parent–infant psychotherapy. Journal of Child Psychotherapy, 32(3), 295-311. doi: https://doi.org/10.1080/00754170600996820
Kaplow, J. & Widom, C. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology, 116(1), 176-187. doi: https://doi.org/10.1037/0021-843X.116.1.176
Lavi, I., Gard, A. M., Hagan, M., Van Horn, P., & Lieberman, A. F. (2015). Child-parent psychotherapy examined in a perinatal sample: Depression, posttraumatic stress symptoms and child rearing-attitudes. Journal of Social and Clinical Psychology, 34(1), 64-82. doi: https://doi.org/10.1521/jscp.2015.34.1.64
Lewis-Morrarty, E., Dozier, M., Bernard, K., Terracciano, S. M., & Moore, S. V. (2012). Cognitive flexibility and theory of mind outcomes among foster children: Preschool follow-up results of a randomized clinical trial. Journal of Adolescent Health, 51(2), 517-522. doi: https://doi.org/10.1016/j.jadohealth.2012.05.005
Lieberman, A. F. (2004). Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health. Infant Mental Health Journal, 25(4), 336-351. doi: https://doi.org/10.1002/imhj.20009
Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2006). Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 45(8), 913-918. doi: https://doi.org/10.1097/01.chi.0000222784.03735.92
Lieberman, A. F., & Van Horn, P. (2011). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: Guilford Press.
Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive intervention and outcome with anxiously attached dyads. Child Development, 62(1), 199-209. doi: https://doi.org/10.2307/1130715
Lojkasek, M., Cohen, N. J., & Muir, E. (1994). Where is the infant in infant intervention? A review of the literature on changing troubled mother-infant relationships. Psychotherapy Theory Research & Practice, 31(1), 208-220. doi: http://dx.doi.org/10.1037/0033-322.214.171.124
Markese, S. (2011). Dyadic trauma in infancy and early childhood: Review of the literature. Journal of Infant, Child, and Adolescent Psychotherapy, 10(2-3), 341-378. https://doi.org/10.1080/15289168.2011.600214
McKelvey, L. M., Whiteside-Mansell, L., Connors-Burrow, N. A., Swindle, T., & Fitzgerald, S. (2016). Assessing adverse experiences from infancy through early childhood in home visiting programs. Child Abuse & Neglect, 51, 295-302. doi: https://doi.org/10.1016/j.chiabu.2015.09.008
Miller, M., Nevado-Montenegro, A. J., & Hinshaw, S. P. (2012). Childhood executive function continues to predict outcomes in young adult females with and without childhood-diagnosed ADHD. Journal of Abnormal Child Psychology, 40(5), 657-668. doi: https://doi.org/10.1007/s10802-011-9599-y
Mongillo, E., Briggs-Gowan, M., Ford, J., & Carter, A. (2009). Impact of traumatic life events in a community sample of toddlers. Journal of Abnormal Child Psychology, 37(4), 455-468. doi: https://doi.org/10.1007/s10802-008-9283-z
Pynoos, R. S., Steinberg, A. M, Layne, C.M., Briggs, E. C., Ostrowski, S. A., & Fairbank J. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Trauma Stress, 26(1), 391-398. doi: https://doi.org/10.1002/jts.20450
Pynoos, R. S., Steinberg, A. M., & Piacentini, J. C. (1999). A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biological Psychiatry, 46(11), 1542-1554. doi: https://doi.org/10.1016/S0006-3223(99)00262-0
Qiu, A., Rifkin-Graboi, A., Chen, H., Chong, Y-S., Kwek, K., ..Meaney, M. J. (2013). Maternal anxiety and infants’ hippocampal development: Timing matters. Translational Psychiatry, 3(9), 1-7. doi: https://doi.org/10.1038/tp.2013.79
Scheeringa, M. S., Myers, L., Putnam, F. W., & Zeanah, C. H. (2012). Diagnosing PTSD in early childhood: An empirical assessment of four approaches. Journal of Traumatic Stress, 25, 359-367. doi: https://doi.org/10.1002/jts.21723
Streeck-Fischer, A., & Van der Kolk, B. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development. Australian & New Zealand Journal of Psychiatry, 34(6), 903-918. doi: https://doi.org/10.1080/000486700265
Thompson, R., Flaherty, E., English, D., Litrownik, A., Dubowitz, H., Kotch, J., & Runyan, D. (2015). Trajectories of adverse childhood experiences and self-reported health at age 18. Academic Pediatrics, 15, 503-509. doi: https://doi.org/10.1016/j.acap.2014.09.010
Toth, S., Rogosch, F., Manly, J., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006-1016. doi: https://doi.org/10.1037/0022-006X.74.6.1006
Tucker, J. (2006). Using video to enhance the learning in a first attempt at ‘Watch, Wait and Wonder’. Infant Observation, 9(2), 125-138. doi: https://doi.org/10.1080/13698030600810359
Twardosz, S., & Lutzker, J. (2010). Child maltreatment and the developing brain: A review of neuroscience perspectives. Aggression & Violent Behavior, 15(1), 59-68. doi: https://doi.org/10.1016/j.avb.2009.08.003
U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2015). Child Maltreatment 2013. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment
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.
Van der Kolk, B. A. (2006). Clinical implications of neuroscience research in PTSD. Annals of the New York Academy of Sciences, 1071(1), 277-293. doi: https://doi.org/10.1196/annals.1364.022
Van Horn, P., Gray, L., Pettinelli, B., & Estassi, N. (2012). Child-parent psychotherapy with traumatized young children in kinship care: Adaptation of an evidence-based intervention. In J. D. Osofsky (Ed.), Clinical work with traumatized young children (pp. 55-74). New York: Guilford Press.
Van Horn, P., & Lieberman, A. (2008). Using dyadic therapies to treat traumatized young children. In D. Brom, R. Pat-Horenczyk, & J. Ford (Eds.), Treating traumatized children: Risk, resilience, and recovery (pp. 51-70). New York: Routledge.
Yehuda, R., Mulherin Engel, S., Brand, S., Seckl, J., Marcus, S., & Berkowitz, G. (2005). Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. The Journal of Clinical Endocrinology & Metabolism, 90(7), 4115-4118. doi: https://doi.org/10.1210/jc.2005-0550