Trauma-Informed Care for Children Exposed to Violence

Tips for Staff and Advocates Working With Children:

Polyvictimization

What is polyvictimization?

Polyvictimization refers to having experienced multiple victimizations such as sexual abuse, physical abuse, bullying, 

and exposure to family violence. The definition emphasizes experiencing different kinds of victimization, rather than 

multiple episodes of the same kind of victimization.1

Polyvictimization usually occurs during transitions when children are most vulnerable, such as the beginning of grade 

school and/or high school. It is often associated with children experiencing a cluster of adverse life circumstances 

such as living in a family with domestic violence, growing up in a distressed and chaotic family, living in a violent 

neighborhood, or experiencing mental health problems.

What happens when children are exposed to multiple types of victimization?

Children are very resilient—but they are not unbreakable. No matter their age, children are deeply hurt when they are 

physically, sexually, or emotionally abused or when they see or hear violence in their homes and communities.

Each child and situation is different, but exposure to violence can overwhelm children at any age and lead to 

problems in their daily lives. 

Because children who experience repeated victimizations of several types are found to have more life adversities, 

they are at greater risk of developing intense and persistent symptoms such as anxiety, depression, anger, and 

posttraumatic stress disorder (PTSD). These children are more distressed than those who experienced frequent 

victimization of a single type.

What are some of the warning signs of exposure to violence?

Children’s reactions to exposure to violence can be immediate or may appear much later in life. Reactions differ in 

severity and cover a range of behaviors. People from different cultures may have their own ways of showing adverse 

reactions. How a child responds also varies according to age. Some of the symptoms associated with early exposure 

to violence (for example, distraction, changes in eating or sleeping patterns, and impulsivity) can be associated with 

Young Children (5 and younger) 

Young children’s reactions are strongly influenced by their caregivers’ reactions. 

Children in this age range who are exposed to violence may:

■ Be irritable, fussy or have difficulty calming down

■ Become easily startled

■ Resort to behaviors common to when they were younger (for example, 

thumb sucking, bed wetting, or fear of the dark)

■ Have frequent tantrums

■ Cling to caregivers

■ Experience changes in level of activity

■ Repeat events over and over in play or conversation
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many other conditions. In adolescence, these may be 

typical of the developmental stage. Furthermore, as 

the child grows and is confronted with multiple types of 

violence, these symptoms may have been misdiagnosed 

as attention deficit/hyperactivity, oppositional defiant 

behavior or conduct disorders, among others. It is critical 

to consider each symptom for its severity, chronicity, 

and its impact on the child ́s functioning within the 

context of the victimization history of the child. (For more 

information, see Identifying Polyvictimization and Trauma 

among Court Involved Children and Youth)

Post-Traumatic Stress Disorder (PTSD) 

Post-traumatic stress disorder (PTSD)symptoms are 

generally grouped into three types: intrusive memories, 

avoidance and numbing, and increased anxiety or 

emotional arousal (hyperarousal).

Symptoms of intrusive memories may include: 

■ Flashbacks, or reliving the traumatic event for 

minutes or even days at a time

■ Nightmares (related to traumatic event)

Symptoms of avoidance and emotional numbing may 

include: 

■ Trying to avoid thinking or talking about the 

traumatic event

■ Feeling emotionally numb

■ Hopelessness about the future

■ Trouble concentrating

Teenagers (13–18 years)

Older children may exhibit the most behavioral changes as a result of exposure to 

violence. Depending on their circumstances, teenagers may:

■ Talk about the event constantly or deny that it happened

■ Refuse to follow rules or talk back with greater frequency

■ Complain of being tired all the time

■ Engage in risky behaviors

■ Sleep more or less than usual

■ Demonstrate increase in aggressive behavior

■ Want to be left alone, not want to spend time with friends

■ Experience frequent nightmares

■ Use drugs or alcohol, run away from home, or get into trouble with 

the law

Elementary School-Age Children (6–12 years)

Elementary and middle school children exposed to violence may show problems 

at school and at home. They may 

■ Have difficulty paying attention

■ Become quiet, upset, and withdrawn

■ Be tearful or sad and talk about scary feelings and ideas

■ Fight with peers or adults

■ Show changes in school performance

■ Want to be left alone

■ Eat more or less than usual

■ Get into trouble at home or at school
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Symptoms of anxiety and increased emotional arousal 

may include: 

■ Self-destructive behavior, such as drinking too 

much

■ Being easily startled or frightened

■ Hearing or seeing things that aren’t there

What can we do?

Understanding the prevalence and impact of 

polyvictimization can help families, advocates and 

practitioners identify the most seriously victimized children 

and protect them from additional harm. It will also help 

target intervention and prevention to the full range of 

trauma-causing events that children are at risk of or have 

experienced to provide needed services and supports. 

Expand Assessment Beyond the 

 ̈Presenting ̈ Problem

Children exposed to violence enter service 

systems through different entry points 

i.e. school, child welfare, and juvenile 

justice. Typically they are assessed for 

the impact of a specific victimization 

such as sexual abuse or bullying. 

As mentioned above, many of the 

symptoms of exposure to violence 

can be associated with other 

conditions.

Agencies working with vulnerable 

children need to ensure that 

they are not responding only to 

the “presenting” issue (i.e., sexual 

abuse) because it is likely that they 

are also experiencing other types 

of victimization concurrently (i.e., 

bullying and physical assaults). 

It is critical to recognize the 

need for more comprehensive 

assessment to identify them as 

potential victims of violence and 

to ensure that their treatment 

accounts for this possibility.

Emphasize Prevention/

Early Intervention

It is generally acknowledged 

that not all children who are 

exposed to violence require 

mental health intervention. 

However, because of their 

higher vulnerability for mental health, behavioral, school 

performance and other problems, children who have been 

exposed to multiple types of victimization must be formally 

assessed and referred for intervention when needed. 

In addition to mental health interventions these children 

might receive to address their victimization experiences 

and associated symptoms, health professionals can 

take advantage of the opportunity to refer children and 

their families to preventive services. These can address 

individual, relationship, and community factors that predict 

and prevent future violence exposure.

Provide Comprehensive Services

Treatment for children who have been exposed to 

multiple types of violence should address the underlying 

risk factors for victimization. Strategies for reducing 

stigma or traumatic reminders also need to be applied to 

the full range of victimization exposures.

Develop Community-Based Partnerships

Services for children exposed to multiple kinds of 

violence must recognize that such children not only 

suffer from victimization trauma, but may also be 

trapped in families, circumstances or environments 

or that may increase the likelihood of repeated 

victimization. Agencies must work together with other 

community-based providers and families to assess 

environmental conditions and develop strategies—for 

example, teaching parenting and guardianship skills to 

parents and other adult caregivers—that address them.

Expand the Mission of Child Welfare

The traditional child protective services (CPS) approach 

might benefit from some broadening of its capacities. 

Only protecting children from child abuse and neglect 

alone may be too narrow. Although it is unrealistic to 

expand CPS to respond to reports of all forms of child 

victimization, children within the current CPS system may 

benefit if child protection workers are trained to assess 

them for exposure to multiple forms of victimization 

in the same way that police are trained to assess for 

multiple crimes. CPS systems could then design and 

implement service responses that are pertinent to the 

variety of threats children face. They have to be prepared 

to work with law enforcement, educators, and mental 

health professionals.
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Reference

1 Finkelhor, D., Turner, H., Ormrod, R., Hamby S. & Kracke, K. (2009) Children’s Exposure to Violence: A Comprehensive 

National Survey. U.S. Department of Justice, Office of Juvenile Justice and Delinquency Programs 

For more information and resources, please contact the Safe Start Center, 

a National Resource Center for Children’s Exposure to Violence:

http://www.safestartcenter.org

info@safestartcenter.org

Break the cycle

All agencies working with vulnerable families must help 

build the supervision and protection capacities of family 

members, legal guardians, caregivers, teachers, and 

other adults who may be in a position to intervene to 

help children, and thus stop the progression toward 

polyvictimization. Early intervention and primary prevention 

are always helpful, as are awareness of dangerous and 

disrupted families and violent neighborhoods. These 

environments are early warning indicators of current or 

future polyvictimization.