When “Bad Behavior” Is Actually a Nervous System Crying Out: Complex Trauma, Children, and Why Play Therapy Heals
By: Samantha Long, PhD. LPC, RPT, NCC
There is a question I keep coming back to in my work with children:
Why is it that one child is sent to the principal’s office, while another child with the same behavior is sent to the school counselor?
The answer, if we’re honest, often has less to do with the behavior itself and more to do with the child, their skin color, their zip code, how their distress looks on the outside. That question sits at the heart of why we need to talk about complex trauma: what it actually is, how it shows up in children’s bodies and behaviors, and why the intervention we choose matters enormously.
What Is Complex Trauma?
We talk a lot about trauma in mental health spaces, but complex trauma is something specific. It refers not to a single frightening event, but to chronic, repeated experiences of adversity, often within the very relationships a child depends on for safety.
Adverse Childhood Experiences (ACEs) give us a useful frame here. ACEs include abuse, neglect, household dysfunction, domestic violence, parental mental illness or substance use (Felitti et al., 1998), and community-level adversity like racism, neighborhood violence, foster care, and food insecurity (Cronholm et al., 2015). The original landmark ACEs study found that 64% of over 17,000 participants had experienced at least one ACE and more than half had experienced more than one (Felitti et al., 1998). The consequences follow a dose-response pattern:
The more ACEs, the greater the risk across physical, mental, and behavioral health.
Complex trauma doesn’t just happen to children. It happens inside their developing nervous systems, reshaping how they experience the world, other people, and themselves.
What Complex Trauma Actually Looks Like in Children
This is where I think we get it most wrong.
When a child has experienced chronic trauma, their nervous system has learned one primary lesson: the world is not safe, and I need to stay ready. The brain develops from the bottom up, the brainstem governs survival responses and physiological regulation; the limbic system handles emotion, attachment, and memory; and the cortex manages thinking, planning, and reflection (Gaskill & Perry, 2014; Siegal & Bryon, 2011). Trauma, especially early and repeated trauma, disrupts this development at the most foundational levels.
What this means in practice is that a child who has been chronically unsafe is often functioning from their lower brain, their survival brain, much of the time. Dr. Dan Siegel describes this as the “downstairs brain” going online while the “upstairs brain” (reasoning, empathy, impulse control, reflection) temporarily goes offline which is similarly discussed in Dr. Bruce Perry’s Regulate—Relate—Reason framework. This is not a choice. It is a neurobiological response to perceived threat.
So, what does this look like?
Externalizing behaviors: are the ones most likely to get a child in trouble: aggression, defiance, impulsivity, emotional outbursts, difficulty following directions, destruction of property. These behaviors are often read as “bad” or intentional. They are a dysregulated nervous system doing what it was wired to do: protect.
Internalizing behaviors: are quieter and often missed entirely: withdrawal, excessive worry, difficulty eating or sleeping, flat affect, dissociation, appearing “zoned out,” being overly compliant or people-pleasing. A quiet child is not necessarily a regulated child. Freeze is not fine…what looks like stillness may actually be dorsal vagal shutdown, the nervous system’s most ancient survival response.
Somatic symptoms: tell the story the body holds when words are not yet available: stomachaches with no medical explanation, headaches, heightened sensitivity to touch or sound, difficulty with feeding or eating, chronic muscle tension, hypervigilance to environmental cues. Research using wearable heart rate monitors during play therapy sessions has shown that a child’s body is constantly responding, even in a seemingly quiet playroom (Perryman et al., 2024), in ways that are invisible to the naked eye.
And then there is what trauma does to perception and this is just one example of how this shows up: Children who have experienced abuse become neurologically “tuned” to detect anger quickly, recognizing angry faces faster and more accurately than their peers, even when the image is still unclear. Their brains had to work much harder to ignore anger, requiring significantly more cognitive effort. Imagine trying to ignore a fire alarm while doing a math problem (Pollack, 2008). For these children, anger feels like that fire alarm, even when it isn’t relevant. This is not defiance. This is adaptation.
The Misdiagnosis Problem
Here is something that doesn’t get said enough: many children living with complex trauma are walking into offices and leaving with diagnoses that do not capture what is actually happening.
ADHD
ODD
Conduct Disorder
Bipolar Disorder
The externalizing, dysregulated, impulsive, emotionally reactive child can look like many things on a symptom checklist. When a child’s presenting symptoms are rooted in a sensitized stress response system, when the behavior that looks like inattention is actually hypervigilance, when what looks like defiance is actually a freeze response beginning to thaw, treating the symptom without treating the underlying dysregulation is unlikely to produce lasting change.
The comorbidity of neuropsychiatric diagnoses associated with childhood maltreatment is so pervasive that it encompasses nearly all diagnoses in the DSM-5 TR. Trauma-informed practitioners understand that the question isn’t “what is wrong with this child?” but “what happened to this child, and what is their nervous system responding to right now?”
Who Gets Sent to the Principal, and Who Gets Sent to the Counselor?
This question is not rhetorical.
Marginalized communities carry a disproportionate ACEs burden. Research consistently finds higher ACEs rates among children from racial and ethnic minority backgrounds, households below the poverty line, and those attending Title I schools. Experiencing racial or ethnic prejudice has been identified as among the strongest community-level predictors of reduced emotional regulation in children. If you are a data driven/research drive person, please check out the following:
Dr. Nadine Burke’s Harris TedTalk on ACEs
School to Prison Pipeline
Dr. Nadine Burke Harris Deepest Well
Chronholm et al. (2015) Adverse childhood experiences: Expanding the concept of adversity
Child Protective Services Statistics
Yet, the children most likely to have experienced complex trauma are also the children most likely to have their trauma responses criminalized rather than treated. The school-to-prison pipeline is not an abstraction. The behaviors that adults view as “misbehavior” are signs of dysregulation. Understanding brain development helps us respond with curiosity rather than correction. But curiosity is not equally distributed across all children. This is a systemic problem that requires systemic accountability: in schools, in clinics, and in training programs preparing the next generation of mental health practitioners.
Why Play Therapy and Why CCPT Specifically?
Children rarely process trauma through verbal narrative. Trauma often shows up through play themes (safety, protection, anxiety, control), behavioral dysregulation in the playroom, attachment disruptions, re-enactment of experiences, and somatic and sensory expression. Play becomes the child’s primary language for processing experiences that cannot yet be verbalized.
Child-Centered Play Therapy (CCPT), is among the most researched, widely taught, and commonly used forms of play therapy in the counseling field. Grounded in Carl Rogers’s person-centered principles, and carried forward by Virginia Axline, Dr. Garry Landreth, and Dr. Dee Ray, CCPT provides children with a therapeutic relationship characterized by genuineness, unconditional positive regard, and empathic understanding.
What makes CCPT different is its core assumption: children possess an innate capacity toward growth and healing. Given the right environment, children can move toward self-direction, emotional regulation, increased self-concept, and resolution of internal conflicts. The therapist’s role is not to fix, direct, or interpret, it is to provide safety, relationship, emotional attunement, and acceptance.
This matters enormously for trauma. Trauma often disrupts a child’s sense of control, safety, and trust in relationships. CCPT directly addresses each of these: it offers relational repair, emotional regulation through co-regulation, symbolic processing without requiring language, and a therapeutic space where the child has autonomy and control, perhaps for the first time.
All of the research backing, attachment, neurobiology points to one thing: the power of the relationship. What can help children heal is: safe, nurturing, consistent relational experiences where children can be seen as their full self, can feel heard, seen, feel worthy and important.
This is precisely what CCPT offers.
The goal is not to keep children calm or to teach them all these coping skills, or to force them into verbalizing their experiences... It is to help them move through their experiences and find their way back to connection on their own time. Regulation is not about never leaving calm… it is about flexibility, capacity, and return. For children who have spent years in survival mode, that return becomes possible only when they encounter a relationship that is genuinely safe and there is space for repetitions to re-wire the brain pathways.
Play is how children tell us what they cannot yet say. Our job is to listen, not just with our ears, but with our whole nervous system, our patience, and our willingness to follow.
References
Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., Harkins-Schwarz, M., Pachter, L. M., & Fein, J. A. (2015). Adverse childhood experiences: Expanding the concept of adversity. American Journal of Preventive Medicine, 49(3), 354–361. https://doi.org/10.1016/j.amepre.2015.02.001
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Gaskill, R. L., & Perry, B. D. (2014). The neurobiological power of play: Using the Neurosequential Model of Therapeutics to guide play in the healing process. In C. A. Malchiodi & D. A. Crenshaw (Eds.), Creative arts and play therapy for attachment problems (pp. 178–194). Guilford Press.
Perryman, K.L., Robinson, S., Schoonover, T.J., & Conroy, J. (2024). Psychophysiological insights into child-centered play therapy for trauma: A case study. Trauma Care, 4, 208–218. https://doi.org/
10.3390/traumacare4030019
Pollak, S.D. (2008). Mechanisms linking early experience and the emergence of emotions: Illustrations from the study of maltreated children. Curr Dir Psychol Sci, 17(6), 370-375. doi:10.1111/j.1467-8721.2008.00608.x
Siegal, D.J., & Bryson, T.P. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. Delacorte Press.
