Childhood Trauma: A Public Health Problem that Requires a Robust Response
Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.
Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.
Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.
There is also a concern that an emphasis on trauma further stigmatizes children and the cultural groups to which they belong, reinforcing existing negative stereotypes. You can understand their caution that children’s trauma histories could be used against them, that children might automatically be diagnosed with a mental health disorder, or that they would be seen as a danger to society and in need of the highest, most restrictive level of care. That care often takes children away from their families to secure facilities outside of their communities and even outside of their states.
We cannot, however, ignore how widespread trauma is for vulnerable children. It is estimated that among healthy, typically developing children, 26 percent will witness or experience a trauma event before 4 years of age (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010). Among vulnerable children, those who are at risk for poor health outcomes because they live in socioeconomically disadvantaged communities and have fewer health resources, the prevalence of trauma events has been reported to be 49 percent (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010) to 75 percent (Roberts, Campbell, Ferguson, & Crusto, 2013).
Trauma can negatively impact several developmental processes such as attention and learning, memory, emotion regulation, personality development, and relationships—the foundation of all subsequent development and self-regulation.
Furthermore, traumatic stressors activate the stress-response system, which forces the brain to use its resources continuously to ward off perceived or real danger. Children are then at greater risk for mental health problems, though it does not mean that they will automatically have them.
To prevent that from happening, we have to intervene. Rather than pathologize children or families, let’s look at how we can support communities and the educational, medical, juvenile justice, and child welfare systems that serve them. This means support for trauma exposure screening for all children, in-depth assessment, training for caregivers to understand the central role that trauma can play in health and development, provision of interventions to help those who work with children exposed to trauma, and work with parents and caregivers if they, too, have trauma histories. There is a federal program designed to support children experiencing trauma and the systems that serve them: the Child Abuse Prevention and Treatment Act.
There may be fear at the potential cost of the resources needed. However, if we want to truly make a difference in the lives of children and their families, we have to understand that the annual financial burden to society of untreated childhood abuse—the trauma-encompassing medical costs, mental health utilization, law enforcement, child welfare, and judicial system costs—is approximately $103 billion.
According to Julian Ford, PhD, a child trauma expert, trauma threatens children’s safety and security and thus is a survival challenge. Trauma events evoke stress reactions in children, which are much like those described in the report. If we do not proactively address these experiences, we are jeopardizing children’s health and development, and all of our futures.