The final factor in a child trauma framework is the effect of the event and its experience
on the person. 73 “There are powerful effects that may be obvious within a short time of the
event,” such as an extreme emotional reaction. 74 Such reactions are often transitory and will
dissipate over time. 75 Other effects may take longer to manifest, but will be sustained. 76
1. Clinical effects
The clinical effects of trauma77 are reflected in four DSM- 5 symptoms: intrusions,
avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and
reactivity. 78 Intrusions might include nightmares and flashbacks of the event. 79 Avoidance might
include refusing to attend activities that trigger reminders of the event or feeling detached from
significant others. 80 Negative alterations in cognition might include exaggerated beliefs (such as
the world is always dangerous) while negative alterations in mood might include continually
feeling estranged from others. 81 Altered arousal and reactivity might include the person having
difficulty concentrating, becoming easily agitated, or remaining hyper-vigilant. 82 The DSM- 5
PTSD definition requires that all these symptoms be present. 83
There are other, more long-term effects of trauma that are not included within some
diagnoses like PTSD. These other effects include the impact of trauma on the brain, the long-term impact on a person’s health, and the impact of trauma on epigenetics.
2. Brain development
The Roper, Graham, and Miller Courts were all concerned with research on brain
development. Research demonstrates how trauma can disrupt healthy brain development. 84 This
73 Cindy A. Crusto et al., Posttraumatic Stress Among Young Urban Children Exposed to Family Violence and Other Potentially
Traumatic Events, 23 J. TRAUMATIC STRESS 716, 717 (2010). See generally Daniel S. Schecter & Erica Willheim, The Effects of
Violent Experiences on Infants and Young Children, in HANDBOOK OF INFANT MENTAL HEALTH 197 (Charles H. Zeanah ed., 2009)
(discussing studies demonstrating how exposure to violence effects children).
74 GRIFFIN & STUDZINSKI, supra note 58.
75 For this reason, the effect does not result in “trauma.” See id. (explaining that lasting effects are an essential component of the
definition of trauma).
77 See DSM- 5, supra note 65, at 271-72 (describing PTSD symptoms). Clinical effects refer to those symptoms noted in PostTraumatic Stress Disorder. Karen Appleyard & Joy D. Osofsky, Parenting After Trauma: Supporting Parents and Caregivers in the
Treatment of Children Impacted by Violence, 24 INFANT MENTAL HEALTH J. 111, 114 (2003). This Article argues, however, for a
more expansive view and definition of trauma. See HELPING TRAUMATIZED CHILDREN LEARN, supra note 60, at 21 (“Bessel van der
Kolk [a leading trauma researcher] has proposed a new diagnosis for children with histories of complex trauma called ‘developmental
trauma disorder’ that attempts to account for the emotional, behavioral, neurobiological, and developmental consequences of
trauma.”) (citation omitted).
78 Appleyard & Osofsky, supra note 77; Schecter & Willheim, supra note 73, at 201; KATHRYN COLLINS ET AL., FAMILY-INFORMED
TREATMENT CTR., UNDERSTANDING THE IMPACT OF TRAUMA AND URBAN POVERTY ON FAMILY SYSTEMS: RISKS, RESILIENCE AND
INTERVENTIONS 11 (2010), http://nctsn.org/sites/default/files/assets/pdfs/understanding_the_impact_of_trauma.pdf.
79 Appleyard & Osofsky, supra note 77; Michael D. De Bellis, Developmental Traumatology: The Psychobiological Development of
Maltreated Children and its Implications for Research, Treatment, and Policy, 13 DEV. PSYCHOPATHOLOGY 537, 545 (2001).
80 See DSM- 5, supra note 65 (describing PTSD symptoms); Appleyard & Osofsky, supra note 77; CHILD WELFARE COMM., NAT’L
CHILD TRAUMATIC STRESS NETWORK, CHILD WELFARE TRAUMA TRAINING TOOLKIT: COMPREHENSIVE GUIDE 12-13 (2d ed., 2008),
81 See DSM- 5, supra note 65, at 271-72 (describing PTSD symptoms). This is a new criteria for PTSD that was not part of DSM-IV.
82 De Bellis, supra note 79, at 546 (explaining that hyperarousal symptoms include “persistent symptoms of increased physiological
arousal (difficulty falling or staying asleep, irritable mood or angry outbursts, difficulty concentrating, hypervigilance, and
exaggerated startle response)”); Vandervort et al., supra note 62, at 4.
83 DSM- 5, supra note 65, at 271-72. PTSD is given the code number of 309.81, and requires, among other things, one or more
intrusion symptoms; one or more avoidance symptoms; two or more negative alteration symptoms; and two or more marked arousal
and reactivity symptoms. Id.
84 See generally Patricia K. Kerig & Stephen P. Becker, From Internalizing to Externalizing: Theoretical Models of the Processes
Linking PTSD to Juvenile Delinquency, in POSTTRAUMATIC STRESS DISORDER (PTSD): CAUSES, SYMPTOMS AND TREATMENT 6
(Sylvia J. Egan ed., 2010), available at http://www.psych.utah.edu/people/files/kerig188a7.pdf (synthesizing research connecting
trauma and juvenile delinquency). There is more brain research available today because of technological advances, such as MRI and
PET scans. See Charles A. Nelson et al., NEUROSCIENCE OF COGNITIVE DEVELOPMENT 44-57 (2006). These technologies were not