Childhood trauma

Childhood trauma has profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being. Colloquially referred to as adverse childhood experiences (ACEs), childhood trauma ranges from sexual abuse to neglect to living in a household where a parent or sibling is treated violently or there is a parent with a mental illness. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises.[1] Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

Health outcomes

Lasting effects of Adverse Childhood Experiences
Lasting effects of Adverse Childhood Experiences

Traumatic experiences during childhood causes stress that increases an individual’s allostatic load and thus affects the immune system, nervous system, and endocrine system.[2][3][4][5] Childhood trauma is often associated with adverse health outcomes including depression, hypertension, autoimmune diseases, lung cancer, and premature mortality.[2][4][2][6][7] Effects of childhood trauma on brain development includes a negative impact on emotional regulation and impairment of development of social skills.[4] Research has shown that children raised in traumatic or risky family environments tend to have excessive internalizing (e.g., social withdrawal, anxiety) or externalizing (e.g., aggressive behavior), and suicidal behavior.[4][8][9] Recent research has found that physical and sexual abuse are associated with mood and anxiety disorders in adulthood, while personality disorders and schizophrenia are linked with emotional abuse as adults.[10][11]

Psychological impact

Childhood trauma can increase the risk of mental disorders including posttraumatic stress disorder (PTSD), attachment issues, depression, and substance abuse. Sensitive and critical stages of child development can result in altered neurological functioning, adaptive to a malevolent environment but difficult for more benign environments.

Epigenetics

Child abuse can leave tracks, not only physically and emotionally, but also in the form of epigenetic marks on a child's genes. Although these epigenetic marks do not cause mutations in the DNA itself, the chemical modifications-including DNA methylation-change gene expression by silencing (or activating) genes. This can alter fundamental biological processes and adversely affect health outcomes throughout life. A 2013 study found that people who had experienced childhood trauma had different neuropathology than people with PTSD from trauma experienced after childhood.[12] Another recent study in rhesus macaques showed that DNA methylation changes related to early-life adversity persisted into adulthood.[13]

Socioeconomic costs of childhood trauma

The social and economic costs of child abuse and neglect are difficult to calculate. Some costs are straightforward and directly related to maltreatment, such as hospital costs for medical treatment of injuries sustained as a result of physical abuse and foster care costs resulting from the removal of children when they cannot remain safely with their families. Other costs, less directly tied to the incidence of abuse, include lower academic achievement, adult criminality, and lifelong mental health problems. Both direct and indirect costs impact society and the economy.[14][15]

Transgenerational effects

We can pass our epigenetic marks including de-myelinated neurons to our children. The effects of trauma can be transferred from one generation of childhood trauma survivors to subsequent generations of offsprings. This is known as transgenerational trauma or intergenerational trauma, and can manifest in parenting behaviors as well as epigenetically.[16][17][18] Exposure to childhood trauma, along with environmental stress, can also cause alterations in genes and gene expressions.[19][20][21] A growing body of literature suggests that children's experiences of trauma and abuse within close relationships not only jeopardize their well-being in childhood, but can also have long-lasting consequences that extend well into adulthood.[22] These long-lasting consequences can include emotion regulation issues, which can then be passed onto subsequent generations through child-parent interactions and learned behaviors.[23] (see also behavioral epigenetics, epigenetics, historical trauma, and cycle of violence)

Resilience

Resilience is the process of adapting well to trauma, adversity, tragedy, threats, or significant sources of stress.[24] It strives on supportive, responsive relationships and capabilities that allow children to respond and adapt to adversity in healthy ways, turning toxic stress into tolerable stress.[25] Resilience can be impacted by a variety of risk or protective factors that either enhance or mitigate the risk of negative outcomes.[26] Establishing a secure attachment to caregivers has been identified as a significant protective factor that can buffer against the negative outcomes of childhood trauma.[27]

Prognosis

Trauma affects all children differently (see Stress in early childhood). Some children who experience trauma develop significant and long-lasting problems, while others may have minimal symptoms and recover more quickly.[28] Studies have found that despite the broad impacts of trauma, children can and do recover, and that trauma-informed care and interventions produce better outcomes than “treatment as usual”. Trauma-informed care is defined as offering services or support in a way that addresses the special needs of people who have experienced trauma.[29]

Types

Medical trauma

Medical Trauma, sometimes called "pediatric medical traumatic stress" refers to a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Medical trauma may occur as a response to a single or multiple medical events.[30]

Separation trauma

Separation trauma[31] is a disruption in an attachment relationship that disrupts neurological development and can lead to death.[32][33] Chronic separation from a caregiver can be extremely traumatic to a child.[34][35]

References

  1. ↑ "The Adverse Childhood Experiences (ACE) Study". Centers for Diesase Control. Retrieved 6 June 2017.
  2. 1 2 3 Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, Giles WH (January 2010). "Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study". BMC Public Health. 10: 20. doi:10.1186/1471-2458-10-20. PMC 2826284. PMID 20085623.
  3. ↑ Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB (February 2009). "Cumulative childhood stress and autoimmune diseases in adults". Psychosomatic Medicine. 71 (2): 243–50. doi:10.1097/PSY.0b013e3181907888. PMC 3318917. PMID 19188532.
  4. 1 2 3 4 Taylor SE, Lerner JS, Sage RM, Lehman BJ, Seeman TE (December 2004). "Early environment, emotions, responses to stress, and health". Journal of Personality. 72 (6): 1365–93. CiteSeerX 10.1.1.324.5195. doi:10.1111/j.1467-6494.2004.00300.x. PMID 15509286.
  5. ↑ Motzer SA, Hertig V (March 2004). "Stress, stress response, and health". The Nursing Clinics of North America. 39 (1): 1–17. doi:10.1016/j.cnur.2003.11.001. PMID 15062724.
  6. ↑ Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF (October 2004). "Adverse childhood experiences and the risk of depressive disorders in adulthood". Journal of Affective Disorders. 82 (2): 217–25. doi:10.1016/j.jad.2003.12.013. PMID 15488250.
  7. ↑ Murphy MO, Cohn DM, Loria AS (March 2017). "Developmental origins of cardiovascular disease: Impact of early life stress in humans and rodents". Neuroscience and Biobehavioral Reviews. 74 (Pt B): 453–465. doi:10.1016/j.neubiorev.2016.07.018. PMC 5250589. PMID 27450581.
  8. ↑ Aron EN, Aron A, Davies KM (February 2005). "Adult shyness: the interaction of temperamental sensitivity and an adverse childhood environment". Personality & Social Psychology Bulletin. 31 (2): 181–97. doi:10.1177/0146167204271419. PMID 15619591.
  9. ↑ Norman RE, Byambaa M, De R, Butchart A, Scott J, Vos T (2012). "The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis". PLoS Medicine. 9 (11): e1001349. doi:10.1371/journal.pmed.1001349. PMC 3507962. PMID 23209385.
  10. ↑ Sachs-Ericsson NJ, Sheffler JL, Stanley IH, Piazza JR, Preacher KJ (October 2017). "When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders". Journal of Clinical Psychology. 73 (10): 1403–1428. doi:10.1002/jclp.22444. PMC 6098699. PMID 28328011.
  11. ↑ Carr CP, Martins CM, Stingel AM, Lemgruber VB, Juruena MF (December 2013). "The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes". The Journal of Nervous and Mental Disease. 201 (12): 1007–20. doi:10.1097/NMD.0000000000000049. PMID 24284634.
  12. ↑ Mehta D, Klengel T, Conneely KN, Smith AK, Altmann A, Pace TW, Rex-Haffner M, Loeschner A, Gonik M, Mercer KB, Bradley B, Müller-Myhsok B, Ressler KJ, Binder EB (May 2013). "Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder". Proceedings of the National Academy of Sciences of the United States of America. 110 (20): 8302–7. doi:10.1073/pnas.1217750110. PMC 3657772. PMID 23630272.
  13. ↑ Provençal N, Suderman MJ, Guillemin C, Massart R, Ruggiero A, Wang D, et al. (October 2012). "The signature of maternal rearing in the methylome in rhesus macaque prefrontal cortex and T cells". The Journal of Neuroscience. 32 (44): 15626–42. doi:10.1523/JNEUROSCI.1470-12.2012. PMC 3490439. PMID 23115197.
  14. ↑ "Social and Economic Consequences of Child Abuse and Neglect". Child Welfare Information Gateway. U.S. Department of Health and Human Services. This article incorporates text from this source, which is in the public domain.
  15. ↑ "The Estimated Annual Cost of Child Abuse and Neglect". Prevent Child Abuse America.
  16. ↑ Fox M (2 May 2016). "Poor Parenting Can Be Passed From Generation to Generation". NBC News. Retrieved 2017-03-16.
  17. ↑ "Childhood trauma compromises health via diverse pathways". The Blue Knot Foundation. Retrieved 2017-03-16.
  18. ↑ "Adverse Childhood Experiences (ACEs): Mental Illness of a Parent". Crow Wing Energized. Retrieved 2017-03-16.
  19. ↑ Roth TL (November 2013). "Epigenetic mechanisms in the development of behavior: advances, challenges, and future promises of a new field". Development and Psychopathology. 25 (4 Pt 2): 1279–91. doi:10.1017/S0954579413000618. PMC 4080409. PMID 24342840.
  20. ↑ Feder A, Nestler EJ, Charney DS (June 2009). "Psychobiology and molecular genetics of resilience". Nature Reviews. Neuroscience. 10 (6): 446–57. doi:10.1038/nrn2649. PMC 2833107. PMID 19455174.
  21. ↑ Tyrka AR, Ridout KK, Parade SH (November 2016). "Childhood adversity and epigenetic regulation of glucocorticoid signaling genes: Associations in children and adults". Development and Psychopathology. 28 (4pt2): 1319–1331. doi:10.1017/S0954579416000870. PMC 5330387. PMID 27691985.
  22. ↑ Kaplan SJ, Pelcovitz D, Labruna V (October 1999). "Child and adolescent abuse and neglect research: a review of the past 10 years. Part I: Physical and emotional abuse and neglect". Journal of the American Academy of Child and Adolescent Psychiatry. 38 (10): 1214–22. doi:10.1097/00004583-199910000-00009. PMID 10517053.
  23. ↑ "Maternal early-life trauma and affective parenting style: the mediating rol...: EBSCOhost". web.a.ebscohost.com. Retrieved 2017-10-04.
  24. ↑ "The road to resilience". www.apa.org. Retrieved 2017-03-16.
  25. ↑ "Resilience". Center on the Developing Child at Harvard University. Retrieved 2017-03-14.
  26. ↑ "Resilience". Center on the Developing Child at Harvard University. Retrieved 2017-03-16.
  27. ↑ Sciaraffa MA, Zeanah PD, Zeanah CH (2017-07-15). "Understanding and Promoting Resilience in the Context of Adverse Childhood Experiences". Early Childhood Education Journal. 46 (3): 1–11. doi:10.1007/s10643-017-0869-3.
  28. ↑ "Chapter 3, Understanding the Impact of Trauma.". Trauma-Informed Care in Behavioral Health Services. Trauma-Informed Care in Behavioral Health Services (Treatment Improvement Protocol (TIP) Series. 57. Rockville (MD): Center for Substance Abuse Treatment (US). 2014.
  29. ↑ SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2014.
  30. ↑ Marsac ML, Kassam-Adams N, Delahanty DL, Widaman KF, Barakat LP (December 2014). "Posttraumatic stress following acute medical trauma in children: a proposed model of bio-psycho-social processes during the peri-trauma period". Clinical Child and Family Psychology Review. 17 (4): 399–411. doi:10.1007/s10567-014-0174-2. PMC 4319666. PMID 25217001.
  31. ↑ Thomas C (2016). "Symbolization of early separation traumas and the formation of new representations. Experiences from the analysis of a former institutionalized child". Psyche. 70 (11). doi:10.21706/ps-70-11. ISSN 0033-2623.
  32. ↑ Ward MJ, Lee SS, Lipper EG (2000). "Failure-to-thrive is associated with disorganized infant-mother attachment and unresolved maternal attachment". Infant Mental Health Journal. 21 (6): 428–442. doi:10.1002/1097-0355(200011/12)21:6<428::aid-imhj2>3.0.co;2-b.
  33. ↑ Muñoz-Hoyos A, Augustin-Morales MC, Ruíz-Cosano C, Molina-Carballo A, Fernández-García JM, Galdó-Munoz G (November 2001). "Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development". Early Human Development. 65 Suppl: S145–52. doi:10.1016/s0378-3782(01)00216-x. PMID 11755045.
  34. ↑ Cook A, Spinazzola J, Ford J, Lanktree C, Blaustein M, Cloitre M, DeRosa R, Hubbard R, Kagan R (2005-05-01). "Complex Trauma in Children and Adolescents". Psychiatric Annals. 35 (5): 390–398. doi:10.3928/00485713-20050501-05.
  35. ↑ Kinzie JD, Sack WH, Angell RH, Manson S, Rath B (1986). "The Psychiatric Effects of Massive Trauma on Cambodian Children: I. The Children". Journal of the American Academy of Child Psychiatry. 25 (3): 370–376. doi:10.1016/s0002-7138(09)60259-4.
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