he immediate and long-term consequences of children's exposure to maltreatment and other traumatic experiences are multifaceted. Emotional abuse and neglect, sexual abuse, and physical abuse, as well as witnessing domestic violence, ethnic cleansing, or war, can interfere with the development of a secure attachment within the caregiving system. Complex trauma exposure results in a loss of core capacities for self-regulation and interpersonal relatedness. Children exposed to complex trauma often experience lifelong problems that place them at risk for additional trauma exposure and cumulative impairment (eg, psychiatric and addictive disorders; chronic medical illness; legal, vocational, and family problems). These problems may extend from childhood through adolescence and into adulthood (see van der Kolk, page xxx). DIAGNOSTIC ISSUES The diagnosis of posttraumatic stress disorder (PTSD) does not capture the developmental effects of complex trauma exposure. Children exposed to maltreatment, family violence, or loss of their caregivers often meet diagnostic criteria from the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV), 38 for depression, attention-defi cit/hyperactivity disorder (ADHD), oppositional defi ant disorder (ODD), conduct disorder, anxiety disorders, eating disorders, sleep disorders, communication disorders, separation anxiety disorder, and reactive attachment disorder. Each of these diagnoses captures a limited aspect of the traumatized child's complex self-regulatory and relational impairments. A comprehensive review of the literature on complex trauma suggests seven primary domains of impairment observed in exposed children: attachment, biology, affect regulation, dissociation (ie, alterations in consciousness), behavioral regulation, cognition, and self-concept. 1 Sidebar 1 (see page xxx) provides a list of each domain, along with examples of associated symptoms.

In this article, operational definitions of resiliency used in previous studies are reviewed. Data from a sample of 56 maltreated school-age children are then explored to highlight how variations in the source, type, and number of assessments obtained affect the rates of children classified as resilient. Assessments were obtained in three domains: academic achievement, social competence, and clinical symptomatology. Two sources of information were used to assess each domain, and three different data integration procedures were used to calculate rates of resiliency in the maltreated cohort. It is concluded that the most appropriate definition of resiliency to be used in future investigations depends on the aims of the study. If the goal of the study is to assess overall functioning, there is an advantage to using more broad, multidimensional assessments. If, in contrast, the goal of the study is to determine why some high-risk children develop particular types of problems, to identify underlying etiological processes associated with different outcomes, there is an advantage to using narrower definitions.

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Complex trauma (i.e., exposure to chronic, interpersonal trauma in childhood) has been associated with structural and functional alterations in brain development, which in turn can result in cognitive and neuropsychological deficits. The goal of combining neuropsychological assessment with standard trauma specialty evaluation is to gain a comprehensive understanding of each child's unique set of cognitive strengths and weaknesses and associated behavioral manifestations within a trauma-informed framework. This process can be a vital aide in diagnosing, conceptualizing, and designing effective interventions for traumatized youth and avoiding the common misdiagnoses that lead to ineffective treatment. This paper presents a trauma-informed approach to neuropsychological assessment, using two case studies to illustrate the process of integrating neuropsychological testing with trauma specialty evaluation.Complex trauma refers to the dual problem of children's exposure to traumatic events and the impact of such exposures on their development and long-term outcomes (Cook, Blaustein, Spinazzola, & van der Kolk, 2003;Cook et al., 2005). Complex trauma exposure is the experience in early childhood of chronic, developmentally adverse traumatic events, typically of an interpersonal nature, occurring within the child's caregiving system. These exposures include sexual, emotional, and physical abuse; neglect; loss; and witnessing domestic and community violence. Research and clinical observation have demonstrated impairment in the regulatory capacities of children with complex trauma exposure in the affective, cognitive, behavioral, physiological/ biological, relational/interpersonal,

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