DEE WILSON CONSULTING
Challenges to Trauma-Informed Care
(Originally published March 2026)
Deborah Gray’s book, Nurturing Adoptions: Creating Resilience after Neglect and Trauma (updated, 2012), is an outstanding resource for foster parents and adoptive parents of children who have experienced complex trauma in their early lives. Deborah Gray is a semi-retired therapist who lives in Washington State. She is the author of Attaching in Adoption (updated, 2012) and Promoting Healthy Attachments: Hands-on Techniques to Use with Your Clients (2019), also excellent resources for caregivers. What makes Nurturing Adoptions exceptional is Gray’s ability to combine theory, research findings and vast clinical experience to provide concrete guidelines for caregivers tailored to the developmental needs of children of different ages.
Gray asserts that “Trauma stuns, shatters, or shuts down a person’s ability to comprehend, feel, or process. In traumatic stress reactions, people describe feeling as if they are out of their bodies, as if time has slowed down, and as if they are watching and re-watching the traumatic event over and over. They note feeling powerless and helpless,” the hallmark of trauma when combined with terror and severe imminent threat to physical or emotional safety.
Gray quotes the definition of complex trauma provided by the National Child Traumatic Stress Network: “exposure to multiple traumatic events that occur within the family and community systems … that are chronic and begin in early childhood.” Gray maintains that children who have experienced complex trauma “are unlike children who may have had just one overwhelming event occur in an otherwise advantaged childhood …” Gray comments that an initial challenge to trauma informed care is helping caregivers to understand the long term and wide-ranging effects of complex trauma. She comments: “There is a popular myth that children somehow become “expert” at coping with trauma, or, that it does not bother them much because they experience it as a way of life. Trauma research does not support this. Rather than “becoming used to it” …children who are repeatedly exposed to the stress of trauma become more sensitized to it, becoming even more dysregulated by successive traumatic events.” Gray asserts that it is an “illusion that children get over and forget everything -- especially since they are so young. On the contrary, children are especially impacted -- because they are so young.”
Gray describes a cluster of trauma symptoms with four major components:
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Intrusive memories, night terrors, flashbacks
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Emotional numbness; dissociation (“a developmental catastrophe”)
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Emotional dysregulation, i.e. extreme mood swings, that includes vulnerability to “meltdowns”
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Somatization, i.e., “bodily distress that signals something is wrong” that may not have a physical cause.
Gray comments that this is an incomplete list of trauma symptoms. Traumatic experiences often compromise the capacity for friendship and intimate relationships and “contaminate the meaning of life” through beliefs such as “no one can be trusted” or “the cosmos is dangerous and hostile.”
Challenges associated with children’s need for safety
It is an axiom of trauma informed care that trauma victims must feel safe before they can begin to therapeutically engage with what happened to them. Traumatic experiences have profound impacts in part because (Gray states) “these children don’t have parents who are helping them with safety and calming before, during, or after trauma. And, in fact, the children are often traumatized by the very person who is to be providing safety.”
Young children may be placed in foster care after learning the lesson that caregivers cannot be trusted. However, to reestablish a sense of safety, young children need to learn to utilize caregivers and other adults to calm down. Gray comments: “Children who experience a sense of safety with a parent learn to calm with that person.” And “Adoptive parents must understand that they will have to teach their children soothing, calming and emotional regulation through their attachment relationship.” In a normal developmental trajectory, a child’s sense of safety depends on attachment. However, a traumatized child may be resistant to becoming attached to caregivers, leaving foster parents or adoptive parents to cope with a child’s “meltdowns” and other difficult behavior before the child trusts them and is able to reach out for help. In these instances, the development of the child’s attachment to her/his new caregivers, (which Gray asserts may take months) is likely to be greatly influenced by how caregivers respond to episodes of emotional dysregulation, e.g. “meltdowns,” or when a child is hurt, ill or otherwise exceptionally needy.
What if caregivers praise the independence or apparent stoicism of a toddler who has fallen and hurt himself but does not come to them for reassurance, or (worse) punish a child for having a tantrum in a public place? These responses of caregivers may increase a child’s feelings of isolation and/or threat, and in doing so, increase the obstacles to forming a secure attachment to caregivers. Adoptive parents may conclude that the child is incapable of attachment when their responses to her/his dysregulated behavior are undermining its development.
Gray comments: “Often adoptive parents of previously traumatized children complain that their children only listen when yelled at, threatened, or when highly stressed. These methods of stressful confrontation give short-term gains at the expense of longer-term health. While high stress, coercive methods may appear to work initially, they inevitably backfire as children deteriorate over time.”
For this reason, it is crucial that foster parents and adoptive parents receive therapeutic guidance in how to build connection and trust with a traumatized child who cannot be calmed in usual ways, e.g. through touch or verbal reassurance. Nurturing Adoptions has a wealth of concrete suggestions to assist in this process, including skills that children (including young children) can learn to self-soothe.
Gray, like most trauma experts, emphasizes the central role of children’s capacity for affect regulation in developmental repair. Gray states: “High stress kills children’s brain cells, making them even more vulnerable to stressful events.” In addition, vulnerability to extreme “meltdowns” is frightening to both peers and adults and makes it difficult for a child to cope in school and sustain supportive relationships of all types. It is also a source of placement disruptions.
Furthermore, Gray asserts, “until children have the ability to calm down, they should not move on to trauma work. It is too over-arousing. When people are over-aroused, they cannot think through what has happened without feeling like they are in the throes of it again. When they are flooded with emotion … they feel as if they are re-experiencing the traumatic event, or as if they are being revictimized.” Gray believes children need to “learn to calm with their parents and look to their parents for assistance in calming” before being asked to remember and talk about experiences which traumatized them.
Safety, routine and expanding children’s comfort zone
Foster parents and adoptive parents of children with symptoms of trauma are likely to quickly discover that a predictable routine helps children to feel safe and makes them easier to manage. The course of least resistance is to stick to a rigid routine. Gray states: “Parents can feel constantly torn between trying to maintain stability and trying to stretch their children’s ability to tolerate more excitement. I encourage parents to gradually vary the experiences available to their children. This process usually requires parents to temporarily increase their own level of discomfort.”
Gray comments that caregivers are often resistant to changing routines in ways that may cause a child to be overstimulated and more likely to have emotional outbursts. “However, the goal is not for the children to get better at living in their parents’ homes, but for them to develop the abilities required to cope successfully with life’s richness - life outside of their parents’ homes.” Caregivers may need additional support and guidance in how to vary routines in a way that does not undo a fragile child’s equilibrium and sense of emotional security. It’s easy for caregivers to overestimate the changes in routine a child can tolerate, and even easier to underestimate the capacity for novel experiences. These are tough decisions which caregivers of traumatized children face on a daily basis.
The importance of routine and structure is a lifelong need for some survivors of trauma. There are dysfunctional ways of feeling safe. One of them is to avoid novelty and uncertainty whenever possible, even when the cost is social isolation and narrowing of life’s possibilities to an extreme degree.
Executive function, agency, initiative, dissociation and neglect
One of the strengths of Nurturing Adoptions is its emphasis on the developmental harms of child neglect, along with Gray’s discussion of how severe neglect in early childhood compromises the development of personal agency, initiative and impulse control. Gray comments: “While it is often abuse that institutes removal from the home, neglect causes the most long-term destruction. It drives home messages like, “You can depend on no one,” and “It would be better if you did not exist.”
Gray (unlike some mental health experts) regards severe neglect as a form of trauma. Chronic and severe neglect has a wide range of developmental effects; one of the most consequential is that a pattern of neglect in early childhood undermines a child’s belief that they can influence the world around them. Gray asserts: “Children who have been neglected learn to expect that their actions will have little to do with what happens in their lives.” Gray states that new parents of neglected children are likely to expect their children to show initiative and hope, however “these expectations constitute a radical cultural change for these children.”
Several decades ago, the Minnesota Longitudinal Study found that neglected children were the least likely group of maltreated children to persist in problem solving when given an unfamiliar task. Severely and chronically neglected children often lack self confidence in their ability to cope with novel difficulties and may be unwilling to ask for help. They learned at an early age that no one would respond to their cries or attend to their needs, however dire. In some extreme cases, neglected children have assimilated the message from caregivers, “don’t cry or complain” or even, “don’t be.” Marilynne Robinson’s novel, Lila, is about a young woman severely neglected and abandoned during infancy who, after her marriage to an elderly minister, feels shame at her very visibility. At a deep level, she is not sure she has a right to exist.
Dissociation, i.e., freezing in place during times of danger or becoming an observer of oneself in crisis rather than an agent who seeks to cope with events, undermines the ability to think about and emotionally process threatening experiences. Gray refers to dissociation as “a developmental catastrophe.” Gray asserts that children who have learned to stay alive through dissociation fail to recognize danger and take steps to protect themselves. Consequently, they are at elevated risk of subsequent victimization, both in childhood and as adults.
Gray asserts that dissociation involves “an uncoupling of the mind- body connection. … They simply do not know where their bodies are.” She quotes Bessel van der kolk (author of The Body Keeps the Score): “You just cannot get by in life without knowing where your body is in space.”
Gray comments that “Traumatized children are prejudiced toward using a dissociative defense in place of healthy, coping skills during highly charged emotional or physical life circumstances. This is one of the reasons why trauma work is essential to (their) future well-being… They need a lot of work, not just to treat the trauma, but also on a practical level.” Traumatized children must learn to give up their dissociative defenses and learn to act on their own behalf. Gray asserts: “The take home message … is that an increase in dissociation in a child is always balanced by a loss of true coping. The self has mortgaged the future to survive in the present. The balloon payment will come due – usually in teen years.”
Gray summarizes the conditions essential for developmental repair:
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Ample opportunities to work on calming and self-regulation
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“Parents who are sensitive, who are able to model and teach calming and self-regulation, and who are given enough support to keep connecting with difficult children (to) form the healing milieu at home.”
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Skilled professionals who can help parents overcome obstacles to attachment
It is also of the utmost importance that foster parents and adoptive parents receive support and guidance in responding to children’s “meltdowns,” fear of novelty and uncertainty and negative world views to which they may stubbornly cling, despite the misery these beliefs reflect. Hope, optimism, initiative, increased capacity for self- reflection and emotion regulation, the ability to simultaneously think and feel, the capacity for enjoyment and empathy are positive indicators of recovery.
However, the experience of complex trauma in early childhood can have lifelong effects on physical health and mental health across the life span. There is likely to be a heightened vulnerability among survivors to anxiety, depression and PTSD, and to subsequent victimization. Positive coping skills learned in childhood can help survivors of childhood trauma resist reverting to “hopeless/helpless” attitudes, beliefs and responses (e.g., paralysis) when faced with adversity.
References
Gray, D., Attaching in Adoption (updated 2012), Jessica Kingsley Publishers, Philadelphia, Pa.
Gray, D., Nurturing Adoptions: Creating Resilience after Neglect and Trauma, (updated 2012), Jessica Kingsley Publishers, Philadelphia, Pa.
Gray, D., Promoting Healthy Attachments: Hands-on Techniques to Use with Your Clients, (2019) W.W. Norton & Company, New York City, NY.
Robinson, M. Lila (2014), Farrar, Straus & Giroux, New York City, NY.
Stroufe, L.A., Egeland, B., Carlson, E. & Collins, W.A., (2005), The Development of the Person, The Minnesota Study of Risk and Adaptation Fron Birth to Adulthood, The Guilford Press, New York City, NY.
Van der kolk, B., Pelcovitz, A., Roth, S., Mandel, F., McFarlane, A. & Herman, J., (2002), “Dissociation, Affect Regulation, and Somatization: The Complex Nature of Adaptation to Trauma.”
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©Dee Wilson