When Bad Things Happen to Children

What happens when bad things happen to young children? How does it affect their mental and physical health and social functioning? How often are they victims of or witnesses to traumatic events? Is there any way to soften the blow and help them to cope and recover?

A group of researchers recently explored these and other questions related to adverse experiences in childhood. Their findings suggest that the Incidence and Prevalence of trauma among children is disturbingly high. But they also suggest some strategies that can lessen the negative impact and offer both hope and guidance to those who care for and about children.

Childhood trauma has been associated with mental and physical health problems throughout life, including conditions such as asthma, attention deficit problems, and obesity, as well as developmental, behavioral, and social delays.

The findings suggest that childhood trauma is disturbingly common.

The economic and health impact of early traumatic experiences is so great that to improve health and contain health care spending, a better understanding of adverse experiences in early childhood should become a public health priority.

This approach requires more information about what’s happening and who the victims are, as well as what sorts of interventions might help reduce the effects of childhood trauma.

In order to provide some of this data, researchers from the Johns Hopkins University School of Public Health investigated traumatic experiences in the lives of over 95,000 U.S. children from birth to age 17. They questioned parents and guardians about children's exposure to nine types of incidents that occurred between 2011 and 2012.

The study looked at data from each state, including at least 1800 children per state. The experiences they tracked included:

Exposure to violence

Emotional, physical, or sexual abuse

Deprivation

Neglect

Family discord and divorce

Parental substance abuse

Mental health problems

Parental death or incarceration

Social discrimination

To understand the sorts of effects traumatic events like these can have, the researchers looked for medical and behavioral problems that may have come up in children who had been traumatized. They also reviewed the children's academic functioning, such as whether they were engaged in school or repeated grades.

The study found that 48% of U.S. children had at least one of the nine adverse childhood experiences. Twenty-two percent of children ages 0 to17 had experienced two or more of the nine adverse experiences. There were large variations among states and there were 18 states that had significantly higher rates of childhood trauma than the national rate of 48%.

The more negative events the child experienced, the more likely the children were to have special health care needs.

Older children (age 12 to 17) and those living in homes with lower average incomes were found to be at increased risk. And chronic health conditions and health risk worked both ways: not only did the likelihood of experiencing adverse childhood experiences increase if a child had health problems, children with adverse experiences were also more likely than those without them to suffer from chronic health conditions.

There also appeared to be a dose-response relationship of adverse childhood events such that the more negative events the child experienced, the more likely the children were to have special health care needs.

“This study tells us that adverse childhood experiences are common among U.S. children and, as demonstrated in adult studies, have lifelong impacts that begin early in life,” said Christina D. Bethell, the study leader and a professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, in a statement.

It's probably no surprise that family environment can play a role in trauma, as both a source and as a help to minimize it. Children exposed to adverse events were less likely than their peers who were not exposed to trauma to eat and sleep well, to live in a protective home, have mothers who were healthy, and have parents who were not aggravated with them. They were also less likely to be resilient and live in safe and supportive neighborhoods.

Even when children had positive health factors and environments, however, they were not immune to adverse childhood experiences, as 33% of children with protective home environments had had adverse childhood events.

Being exposed to trauma at a young age affects a child's schoolwork too. Children with two or more adverse experiences were over two and a half times more likely to repeat a grade in school and had lower odds of being engaged in school than their non-traumatized peers.

Resilience helped, reducing the effects of some of the negative childhood events on academic performance. Those children who were exposed to adverse experiences and showed aspects of resilience were one and a half times more likely to be engaged in school and only about half as likely to have repeated a grade compared to their less resilient, trauma-exposed peers.

Because of the various medical, psychological and social effects of their exposures, children who have experienced traumatic events benefit immensely from personalized and coordinated care and referrals. Family-centered medical facilities — a medical practice with doctors and nurses and staff who know the child and their health history, coordinate the child’s care, and ensure needed referrals for services outside the practice — are best suited to this.

Adverse childhood events don't automatically have to have long-term traumatic impacts for children.

The researchers looked at this aspect of trauma, too, and found that when traumatized children were cared for in a family-centered medical practice, their parents were less likely to report that they were always aggravated with their children. They were also more likely to show resilience, perhaps because of the support they felt they received.

“Adverse childhood events don't automatically have to have long-term traumatic impacts for children,” said Bethell. “Efforts to support children, families and communities, so they can create a culture that supports safe, stable and nurturing relationships, hold great promise.”

The first thing to do, she believes, is to support and teach the adults in children's lives, since they, too, must often learn to heal from trauma and develop resilience themselves.

Since previous research has shown that negative early childhood experiences has an negative effect at the neurological and neurochemical level in the developing child’s brain, they postulate that "neurologic repair methods" such as mindfulness training might be a protective or restorative practice to introduce to children in schools.

The study, published in Health Affairs, offers both a clear picture of just how common traumatic events are in children's lives and calls for a broad-based and multidisciplinary approach to children who are at risk for or victims of adverse childhood experiences.

Developing trauma-informed care systems can help; so can teaching resilience, mindfulness, and other self-management strategies in our school systems. Finally, the study calls for informed public policy to recognize and address the reality that adverse childhood events present a huge and potentially modifiable public health burden.