Child Trauma

This research Web page seeks to provide a general overview of childhood trauma, along with some resources for further research, training, and understanding.

About Childhood Trauma

According to the National Child Traumatic Stress Network—funded by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration—about one in four children will experience some traumatic event by age 16. This may include global, national, community, or personal events, such as:

  • Natural disasters
  • Terrorism
  • War
  • Medical trauma
  • Abuse
  • Violence
  • Loss

Trauma can occur anytime a child “experiences an intense event that threatens or causes harm to his or her emotional and physical well-being” (National Child Traumatic Stress Network [NCTSN]). Trauma affects children both physically and psychologically.

Exposure to multiple traumas for a prolonged period of time can lead to complex trauma. This type of exposure can have persistent neurological and emotional effects. According to Cooke et al., complex trauma can affect children across a variety of domains. These domains may include: attachment, behavioral control, cognition, self-concept, biology, affect regulation, and dissociation (NCTSN).

This can lead to behaviors that affect the child’s experience of the world and the world’s view of the child. These behaviors include:

  • Aggression
  • Sleep disturbances
  • Substance abuse
  • Learning disabilities
  • Attention difficulties
  • Low self-esteem
  • Unhealthy attachments
  • Increased medical problems
Effects of Childhood Trauma

Some children who experience complex trauma will develop and be diagnosed with post-traumatic stress disorder (PTSD). Not all children, however,  will fit this label. Therefore, a new diagnosis is currently under consideration for the DSM-V.

The diagnosis of complex post-traumatic stress disorder (C-PTSD) encompasses many children who experience complex trauma, and who have the psychological, physical, and emotional symptoms described above.

Following you will find research on child trauma as well as information about some web resources, including some helpful organizations.

References

National Child Traumatic Stress Network. (2003). What is child traumatic stress? Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/what_is_child_traumatic_stress.pdf on April 11, 2008.

National Child Traumatic Stress Network. (2003). Complex trauma task force complex trauma in children [White paper]. Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/edu_materials/ComplexTrauma_All.pdf on April 11, 2008.

Web Resources

American Professional Society on the Abuse of Children
http://www.apsac.org/mc/page.do
The American Professional Society on the Abuse of Children is a national organization whose mission is to enhance the ability of professionals to respond to children and families affected by abuse and violence. APSAC tries to fulfill this mission in a number of ways, most notably through providing education and other sources of information to professionals who work in child maltreatment and related fields.

Battered Women and Their Children
http://hosting.uaa.alaska.edu/afrhm1/wacan/
This Web site is devoted to a professional and scholarly examination of the connections between domestic violence (woman abuse) and child maltreatment (child abuse and neglect). It provides research findings, training materials, professional resources, and links to additional information.

Center for the Study of Traumatic Stress
http://www.centerforthestudyoftraumaticstress.org/home.shtml
The Center for the Study of Traumatic Stress conducts research, education, consultation, and training on preparing for, and responding to, the psychological effects and health consequences of traumatic events. These events include natural (hurricanes, floods, and tsunami) and human made disasters (motor vehicle and plane crashes, war, terrorism, and bioterrorism). The Center’s work spans studies of genetic vulnerability to stress, individual and community responses to terrorism, and policy recommendations to help our nation and its military and civilian populations.

ChildTrauma Academy
http://www.childtrauma.org
The Academy’s mission  is to help improve traumatized and maltreated children’s lives. They endeavor to improve the systems that educate, nurture, protect, and enrich these children through education, service delivery, and program consultation. The Academy works to improve individual lives through clinical assessment and treatment. It also provides online educational materials, an e-newsletter, and links to other resources.

Child Welfare Information Gateway
http://www.childwelfare.gov/
The Child Welfare Information Gateway is a service of the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services. It provides access to print and electronic publications, Web sites, and online databases, covering a wide range of topics. These topics range from prevention to permanency, including: child welfare, child abuse and neglect, adoption, search and reunion, and more.

Federal Emergency Management Agency
http://www.fema.gov/kids
This Web site provides information for parents and teachers. FEMA also offers a large amount of information created just for kids, such as games, books, and quizzes. This Web site also includes resources for prevention activities and tips on how to communicate with children who have experienced trauma.

Federation of Families for Children’s Mental Health
http://www.ffcmh.org/
The Federation of Families for Children’s Mental Health is a family-run organization dedicated exclusively to helping children with mental health needs—and their families—achieve a better quality of life. The Federation offers publications and fact sheets aimed at helping families cope with children’s mental illnesses; provides training opportunities; and hosts an annual conference.

International Society for Traumatic Stress Study (ISTSS)
http://www.istss.org
ISTSS is an international multidisciplinary, professional membership organization that promotes advancement and exchange of knowledge about severe stress and trauma. This knowledge includes: understanding the scope and consequences of traumatic exposure; preventing traumatic events and ameliorating their consequences; and advocating for the field of traumatic stress. The Web site provides research and resources, information about upcoming meetings, resources for professional and public education, information about treatment guidelines, and an opportunity for worldwide networking and support.

National Center for PTSD
http://www.ncptsd.va.gov/ncmain/index.jsp
The National Center for PTSD is the center for research & education on the prevention, understanding, and treatment of PTSD. The Center’s mission is to advance the clinical care and social welfare of America’s veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. Over its history, the Center has come to be recognized as a world leader in research into the causes, assessment, treatment—and, increasingly, the prevention—of traumatic stress disorders.

National Center for Victims of Crime
http://www.ncvc.org/ncvc/Main.aspx
The National Center for Victims of Crime is the nation’s leading resource and advocacy organization for crime victims and those who serve them. Since its inception in 1985, the National Center has worked with grassroots organizations and criminal justice agencies throughout the United States serving millions of crime victims. The Center provides information through its resource library. Additionally, its special “Teen Victim Project” provides information and training to assist teen victims of crime.

National Child Traumatic Stress Network http://www.nctsnet.org/nccts/nav.do?pid=abt_hist
Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) is a unique collaboration of academic and community-based service centers. Its mission is: to raise the standard of care and increase access to services for traumatized children and their families across the United States. Combining knowledge of child development, expertise in the full range of child traumatic experiences, and attention to cultural perspectives, NCTSN serves as a national resource for developing and disseminating evidence-based interventions, trauma-informed services, and public and professional education. The Network’s Web site provides a variety of resources targeted toward educators, the general public, juvenile justice professionals, law enforcement, first responders, media, mental health/medical professionals, parents and caregivers, and policy makers.

National Crime Victims Research and Treatment Center
http://colleges.musc.edu/ncvc
The National Crime Victims Research and Treatment Center is a division of the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston, South Carolina. Since 1974 the Center’s faculty and staff have been devoted to achieving a better understanding of the impact of criminal victimization on adults, children, and their families. The Web site provides information on training opportunities and research findings.

The National Institute for Trauma and Loss in Children’s (TLC) http://www.tlcinstitute.org/
TLC provides information for parents and professional about trauma. They publish an online journal and provide online courses and training opportunities. The resources available on the Web site provide a comprehensive overview of trauma and a lot of helpful information about how to help a child suffering from trauma.

Research

The following are research examples found in Social Work Abstracts, an NASW publication, which culls behavioral and social science literature. A search for “child* and trauma” yielded 93 articles published between 2002 and 2008. The following references were selected to show a range of social work research.

Baer, J. & Maschi, T. (2003, April). Random acts of delinquency: Trauma and self-destructiveness in juvenile offenders. Child and Adolescent Social Work Journal, 20(2), 85–98.
This article provides an explanatory model of the way in which trauma leads to serious delinquency. Using perspectives from information processing, social learning, and self-regulation theories, we present evidence to suggest that adolescents whose lives were shaped by trauma perceive and encode social cues differently than non-traumatized individuals. A number of assessment tools and therapeutic interventions are recommended, followed by suggestions for advocating on the behalf of adolescents incarcerated in the juvenile justice system.

Bogat, G. A., DeJonghe, E., Levendosky, A. A., Davidson, W. S., & von Eye, A. (2006, February). Trauma symptoms among infants exposed to intimate partner violence. Child Abuse and Neglect, 30(2), 109–125.
To determine whether infants have a traumatic response to intimate partner violence (male violence toward their female partner; IPV) experienced by their mothers, two questions were explored: (1) Is the number of infant trauma symptoms related to the infant’s temperament and the mother’s mental health? (2) Does severity of violence moderate those relationships? Forty-eight mothers reported whether their one-year-old infants experienced trauma symptoms as a result of witnessing episodes of IPV during their first year of life. Mothers also reported on their own trauma symptoms that resulted from experiences of IPV. For those infants experiencing severe IPV and whose mothers exhibit trauma symptoms, we were able to predict whether infants exhibited trauma symptoms (b = .53, p < .01). This was not true for children who witnessed less severe IPV (b = −.14, ns). Maternal depressive symptoms and difficult infant temperament did not predict infant trauma symptoms for either group of infants. Mothers report that infants as young as one-year-old can experience trauma symptoms as a result of hearing or witnessing IPV. The significant relationships between infant and maternal trauma symptoms, especially among those infants experiencing severe IPV, are consistent with the theory of relational PTSD. Findings suggest that interventions for mothers and families need to consider the influence of the severity of IPV on very young children.

Briscoe-Smith, A. M., & Hinshaw, S. P. (2006, November). Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: Behavioral and social correlates. Child Abuse and Neglect, 30(11), 1239–1255.
The objectives of this study were to examine whether girls with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of having histories of abuse and to assess whether the presence of an abuse history may constitute a distinct subgroup of youth with ADHD. The authors examined rates and correlates of child abuse in an ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; n = 140) and a matched comparison sample of girls without ADHD (n = 88), all aged 6–12 years. A thorough chart review reliably established documented rates of physical and sexual abuse in both samples. There were significantly higher rates of abuse for girls with ADHD (14.3 percent) than for the comparison sample (4.5 percent), with most of the abuse found in girls with the Combined as opposed to the Inattentive type. Higher rates of externalizing behaviors (including objective observations in a research summer camp) and peer rejection (indexed through peer sociometric nominations) characterized the subgroup of girls with ADHD with abuse histories compared to the subgroup without such histories, with moderate to large effect sizes. Subgroup differences regarding internalizing problems and cognitive deficits did not emerge. Findings regarding peer rejection were explained, in part, by higher rates of observed aggressive behavior in the abused subgroup. The findings raise important questions about the possible etiologic and/or exacerbating role of abusive trauma in a subgroup of children with ADHD.

Craig, C. D. & Sprang, G. (April 2007). Trauma exposure and child abuse potential: Investigating the cycle of violence. American Journal of Orthopsychiatry, 77(2), pp. 296–305.
This study was designed to ascertain the relationship between trauma exposure and child abuse potential, considering a number of demographic and trauma-specific factors. The sample consisted of 1,680 caregivers with open, substantiated cases of abuse or neglect who were evaluated at a university-based outpatient assessment and treatment center. As part of a larger battery of instruments, the participants completed the Child Abuse Potential Inventory (CAPI) and a trauma history screen. In partial support of the proposed hypotheses, univariate and multivariate analyses revealed important differences in CAPI scores between the no-trauma-exposure group and the child-only, adult-only, and child-adult exposure groups. In addition, the type of trauma, age, and gender proved to be powerful predictors of elevated CAPI scores. These findings advance understanding of the developmental and cumulative effects of trauma exposure and suggest a profile of individuals who may be at risk for developing characteristics similar to known physical abusers.

Cryder, C. H., Kilmer, R. P., Tedeschi, R. G., & Calhoun, L. G. (2006, January). An exploratory study of posttraumatic growth in children following a natural disaster. American Journal of Orthopsychiatry, 76(1), 65–69.
This study extends L.G. Calhoun and R.G. Tedeschi’s (1998) model of post-traumatic growth (PTG), positive change resulting from the struggle with trauma, to children by exploring the construct among youngsters who experienced Hurricane Floyd and the subsequent flooding. Despite burgeoning interest in PTG, few studies have examined the phenomenon among non-adults. This first systematic study of PTG in children explores hypothesized linkages among PTG and social support, competency beliefs, and ruminative thinking. Results suggest that competency beliefs relate to PTG, and that a supportive social environment and ruminative thinking are associated with positive competency beliefs. Contrary to expectations, social support did not relate to rumination. Findings testify to the merit of studying the PTG process in children. Clinical implications and future directions are considered.

Didie, E. R., Tortolani, C. C., Pope, C. G., Menard, W., Fay, C., & Phillips, K. A. (2006, October). Childhood abuse and neglect in body dysmorphic disorder. Child Abuse and Neglect, 30(10), 1105–1115.
No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder. Seventy-five subjects (69.3 percent female, mean age = 35.4 ± 12.0) with DSM-IV BDD completed the Childhood Trauma Questionnaire and were interviewed with other reliable and valid measures. Of these subjects, 78.7 percent reported a history of childhood maltreatment: emotional neglect (68.0 percent), emotional abuse (56.0 percent), physical abuse (34.7 percent), physical neglect (33.3 percent), and sexual abuse (28.0 percent). Forty percent of subjects reported severe maltreatment. Among females (n = 52), severity of reported abuse and neglect were .32–.57 standard deviation units higher than norms for a health maintenance organization (HMO) sample of women. Severity of sexual abuse was the only type of maltreatment significantly associated with current BDD severity (r = .23, p = .047). However, severity of sexual abuse did not predict current BDD severity in a simultaneous multiple regression analysis with age and current treatment status. There were other significant associations with childhood maltreatment: history of attempted suicide was related to emotional (p = .004), physical (p = .014), and sexual abuse (p = .038). Childhood emotional abuse was associated with a lifetime substance use disorder (r = .26, p = .02), and physical abuse was negatively associated with a lifetime mood disorder (r = −.37, p = .001). A high proportion of individuals with BDD reported childhood abuse and neglect. Certain types of abuse and neglect appear modestly associated with BDD symptom severity and with gender, suicidality, and certain disorders.

Gerke, C. K., Mazzeo, S. E., & Kliewer, W. (2006, October). The role of depression and dissociation in the relationship between childhood trauma and bulimic symptoms among ethnically diverse female undergraduates. Child Abuse and Neglect, 30(10), 1161–1172.
The goals of this study were to examine the role of dissociation and depression as possible mediators of the relationship between several forms of childhood trauma and bulimic symptomatology and to explore potential ethnic differences in these relationships. Four hundred seventeen female undergraduates participated in this cross-sectional study. They completed measures of dissociative, depressive, and bulimic symptoms, and childhood trauma. Experiences of multiple forms of childhood trauma were measured, including physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. However, only emotional abuse was correlated with bulimic symptoms at p < .01. Therefore, other forms of trauma were excluded from the analyses to control for Type I error. Dissociation was not associated with emotional abuse after controlling for depression; therefore, tests of dissociation as a mediator were discontinued. Depression was significantly associated with emotional abuse after controlling for dissociation. Emotional abuse was significantly associated with bulimia. Finally, emotional abuse and depression together were significantly associated with bulimia after controlling for dissociation. However, emotional abuse became non-significant when entered with depression, indicating that depression mediated the relationship between emotional abuse and bulimic symptoms. There were no ethnic differences in this relationship. It appears that among women who have experienced childhood emotional abuse, depression is more strongly associated with unhealthy eating behaviors than is dissociation. Results also suggest that emotional abuse is a form of childhood trauma particularly relevant to bulimia.

Gwadz, M. V., Nish, D., Leonard, N. R., & Strauss, S. M. (2007, February). Gender differences in traumatic events and rates of post-traumatic stress disorder among homeless youth. Journal of Adolescence, 30(1), 117–129.
The present report describes patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49 percent female) recruited from a drop-in center in New York City in 2000. Youth completed a structured interview lasting 1.5 h. Rates of childhood maltreatment were substantial. Further, almost all youth experienced at least one traumatic event, with most experiencing multiple types of trauma. Gender differences were found in the types, but not prevalence or magnitude, of childhood maltreatment and traumatic events experienced. Partial symptomatology of PTSD was common for females but not males. Symptoms of depression and anxiety were found to co-occur with PTSD for females, which may complicate treatment efforts. Further investigation of the impact of trauma on homeless males is needed.

Paivio, S. C. & McCulloch, C. R. (2004, March). Alexithymia as a mediator between childhood trauma and self-injurious behaviors. Child Abuse and Neglect, 28(3), 339–354.
The aim of this study was to test whether alexithymia mediates the relationship between childhood maltreatment and self-injurious behaviors (SIB) in college women. The sample was comprised of 100 female undergraduate students. Measures were: the Childhood Trauma Questionnaire [D. Bernstein, L. Fink, Manual for the Childhood Trauma Questionnaire, The Psychological Corporation, New York, 1998]; the Toronto Alexithymia Scale-20 [Journal of Psychosomatic Research, 38 (1994) 23; Journal of Psychosomatic Research 38 (1994) 33], and the Self-Injurious Behaviors Questionnaire, which assessed the lifetime frequency of six methods of superficial self-injury (hair pulling, head banging, punching, scratching, cutting, and burning). Regression analyses were used to test the proposed mediational model. Forty-one percent of respondents reported having engaged in SIB; most engaged in multiple methods, and self-cutting was the most frequently endorsed method. Results of regression analyses supported the proposed mediational model for all types of maltreatment except sexual abuse. Sexual abuse, considered alone, was not significantly associated with alexithymia which precluded testing for mediational effects. Results support a link between a history of childhood maltreatment and SIB among college women and the hypothesis that alexithymia mediates this relationship.

Rivard, J. C., McCorkle, D., Duncan, M. E., Pasquale, L. E., Bloom, S. L., & Abramovitz, R. (2004, October). Implementing a trauma recovery framework for youths in residential treatment. Child and Adolescent Social Work Journal, 21(5), 529–550.
This paper describes an intervention designed to address the special needs of youths with histories of maltreatment and exposure to family and community violence. The primary components of the model include an enhanced therapeutic community environment and a psychoeducation program that is aimed at changing non-adaptive cognitive and behavioral patterns which developed as means of coping with traumatic experiences. The implementation of the model and proximal effects on the therapeutic communities and youths are being examined in comparison to standard residential services. Initial perceptions of staff illustrate the challenges in applying an intervention that calls for changing the organizational culture.

Rodgers, C. S., Lang, A. J., Laffaye, C., Satz, L. E., Dresselhaus, T. R., & Stein, M. B. (2004, May).  The impact of individual forms of childhood maltreatment on health behavior. Child Abuse and Neglect, 28(5), 575–586.
This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.

Weitzman, J. (2005, August). Maltreatment and trauma: Toward a comprehensive model of abused children from developmental psychology. Child and Adolescent Social Work Journal, 22(3-4), 321–341.
Knowledge of how maltreatment and trauma affects personality functioning in abused children has been greatly enhanced by clinical theory and research in developmental psychology. Developmental research and theory has allowed the child abuse field to move beyond symptom-lists toward broader models of how trauma impacts major domains of personality functioning. However, these models continue to be based largely on discrete theories of development that parallel, if not confound, one another. This paper attempts to expand the understanding of the traumatized child by using the synthetic model of personality development expounded by Fred Pine that promotes a more holistic and comprehensive view of the abused child and, thus, enhances clinical theory and intervention.

Whisman, M. A. (2006, December). Childhood trauma and marital outcomes in adulthood. Personal Relationships, 13(4), 375–386.
Although existing research suggests that certain childhood traumas such as childhood sexual abuse are associated with interpersonal (e.g., marital) difficulties in adulthood, there has been limited research on interpersonal sequelae of other types of traumas. In addition, the association between childhood traumas and interpersonal outcomes has often been limited to a particular outcome such as divorce, and existing studies have rarely controlled for the co-occurrence of other traumas when evaluating interpersonal outcomes. The current study sought to evaluate the associations between 7 childhood traumas and 2 marital outcomes—marital disruption (i.e., divorce and separation) and marital satisfaction—in a large, national probability sample. Results from univariate and multivariate analyses indicated that (a) probability of marital disruption was higher among people who during childhood had experienced physical abuse, rape, or serious physical attack or assault; and (b) current marital satisfaction was lower among people who during childhood had experienced rape or sexual molestation. Results support the importance of childhood traumas in predicting 2 important marital outcomes.

Whitfield, C. L., Dube, S. R., Felitti, V. J., & Anda, R. F. (2005, July). Adverse childhood experiences and hallucinations. Child Abuse and Neglect, 29(7), 797–810.
Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. The authors used data from the ACE study to assess this relationship. They conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations. They used logistic regression to assess the relationship of the ACE score to self-reported hallucinations. They found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with zero ACEs, those with seven or more ACEs had a five-fold increase in the risk of reporting hallucinations. These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations.

March 24th, 2010 at 11:10 am

Posted in Research