tag:theconversation.com,2011:/us/topics/childhood-abuse-49484/articlesChildhood abuse – The Conversation2023-11-29T13:39:41Ztag:theconversation.com,2011:article/2170582023-11-29T13:39:41Z2023-11-29T13:39:41ZPeople who experienced childhood adversity had poorer COVID-19 outcomes, new study shows<figure><img src="https://images.theconversation.com/files/560637/original/file-20231121-4697-fi65a3.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C6987%2C4668&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The study demonstrated that adverse childhood experiences can have lasting affects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-attending-to-a-patient-royalty-free-image/1447738701?phrase=doctor+wearing+mask+and+shield+examining+middle+aged+woman+during+COVID&searchscope=image%2Cfilm&adppopup=true">andreswd/E+ via Getty Images</a></span></figcaption></figure><p>Adults who faced adversity during childhood were significantly more likely to die from or be hospitalized because of COVID-19. That’s the key finding of <a href="http://dx.doi.org/10.1136/jech-2023-221147">my team’s recent study</a>, published in the Journal of Epidemiology and Community Health. </p>
<p>The study of 150,000 adults in the United Kingdom found those reporting the most childhood trauma had a 25% greater likelihood of death associated with COVID-19, as well as a 22% increase in hospitalization after contracting COVID-19. These figures held up even after accounting for demographics and health conditions. </p>
<p>Childhood trauma includes physical, emotional or sexual abuse, neglect, household dysfunction and <a href="https://developingchild.harvard.edu/science/key-concepts/toxic-stress/">what many call “toxic stress</a>.” </p>
<p>Our study relied on the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, a large biomedical database with more than 500,000 volunteers ages 40 to 69 throughout the United Kingdom. Close to one-third of those volunteers provided information about their childhood. Our team took that data and then searched medical records for participants who died or were hospitalized because of COVID-19. Though more research is needed, these initial results highlight the lasting impacts of childhood stress and the need to provide psychological support early on to mitigate lifelong health risks.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/y3cCAcGeG8E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Childhood trauma is linked not only to COVID-19 but other diseases as well.</span></figcaption>
</figure>
<h2>Why it matters</h2>
<p>COVID-19 had killed nearly <a href="https://covid19.who.int/">7 million people worldwide</a> as of November 2023. This underscores the importance of understanding all of the risk factors leading to pandemic-related hospitalization and death. </p>
<p>Prior research has examined the demographic risk factors for COVID-19, including age, race, ethnicity, income and education. But this is the first study to link childhood experiences to adult COVID-19 outcomes. </p>
<p>The striking findings of the study suggest that early childhood trauma should be added to the list of risk factors for illness – not only for COVID-19 but perhaps for other diseases as well.</p>
<p>The study also suggests that communities disproportionately affected by adversity and trauma may be particularly vulnerable to negative health outcomes. This includes communities where there are high levels of neighborhood violence, stress and poverty.</p>
<h2>What other research is being done</h2>
<p>Our research was prompted by a growing body of work that has found an association between adverse childhood experiences <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">and health problems in adulthood</a>. Adults experiencing significant childhood abuse have an <a href="https://doi.org/10.1007/s00406-005-0624-4">increased risk for chronic conditions</a>, including heart disease, lung disease, cancer and premature death. </p>
<p>Researchers are still trying to understand how childhood adversity contributes to negative health outcomes in adulthood. It could be primarily biological in nature. For instance, adversity has been linked to <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">excess inflammation</a>. Inflammation is normally a protective response from the body, triggered by harmful stimuli such as pathogens, damaged cells or toxins. However, excessive inflammation is related to strokes, heart attacks and other health conditions and can <a href="https://doi.org/10.1038/s41577-020-0311-8">lead to more negative COVID-19 outcomes</a>.</p>
<p>In contrast, the links between early adversity and poorer health could be behavioral in nature. Adversity is associated with having <a href="https://doi.org/10.1177/1077559509355316">less money</a> or <a href="https://doi.org/10.1007/s13524-013-0261-x">education</a> as an adult. These factors could, in turn, be associated with less access to and subpar medical care. Studies have shown that <a href="https://doi.org/10.1038/s41598-022-11706-7">people with lower incomes and lower-paying jobs</a> were exposed to COVID-19 in the workplace more often. Adversity is also associated with <a href="https://doi.org/10.1037/trm0000176">depression and challenges to emotion regulation</a>. This in turn could result in downstream changes in <a href="https://doi.org/10.1016/j.neuron.2020.06.002">biology and behavior</a>.</p>
<h2>What’s next</h2>
<p>Our team plans to continue investigating large population studies – that is, at least 30,000 to 50,000 participants – to determine whether adverse childhood experiences relate to other health outcomes, <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">like long COVID</a>. </p>
<p>It’s becoming increasingly clear that learning more about how childhood trauma becomes embedded in the body could inform our understanding of possible interventions and long-term health outcomes, including those potentially connected to COVID-19.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/217058/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hanson receives funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, as well as the National Institute of Mental Health. He also serves on the board of directors of Project Destiny, a Pittsburgh non-profit working on youth development and health disparities. </span></em></p>People with adverse experiences during childhood − whether physical, emotional or sexual abuse − had higher rates of death and hospitalization decades later from COVID-19.Jamie Hanson, Assistant Professor of Psychology, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1631572021-07-21T12:15:49Z2021-07-21T12:15:49ZEffects of childhood adversity linger during college years<figure><img src="https://images.theconversation.com/files/410617/original/file-20210709-13-sex02v.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5017%2C3349&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A study found that 22.8% of college students had experienced at least four adverse childhood experiences. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stressed-student-royalty-free-image/1183395875?adppopup=true">Carol Yepes/Getty Images </a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>College students who experienced a high level of adversity in childhood have lower levels of social support, such as having someone to confide in, ask for advice or go to for emotional support. When students lack these supportive relationships, they are at an increased risk of experiencing depression and anxiety. These are a few of the findings from our <a href="https://doi.org/10.1080/07448481.2020.1791882">peer-reviewed study</a> published in 2020 in the Journal of American College Health.</p>
<p>A <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">substantial body of research</a> reveals that adverse childhood experiences can have lifelong consequences. When children suffer from abuse or neglect, witness domestic violence, or experience parental substance abuse, mental illness or incarceration, they are <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">at increased risk</a> for physical and mental health problems and poor educational outcomes. Our study delves into how childhood adversity relates to specific aspects of the social and psychological well-being of college students. </p>
<p>Our interdisciplinary research team conducted a survey of over 400 students at Texas State University. We found that a little more than one out of every five students – specifically, 22.8% – reported experiencing four or more adverse childhood experiences, an amount of adversity associated with a considerable increase in the risk of poor outcomes. </p>
<p><a href="https://doi.org/10.1002/smi.2761">Consistent with other research</a>, we found that these students had higher rates of depression and anxiety than students with fewer adverse childhood experiences. </p>
<h2>Why it matters</h2>
<p>Mental health disorders among college students have risen significantly in the past 10 years both in terms of <a href="https://doi.org/10.1176/appi.ps.201800332">incidence and severity</a>. </p>
<p>Disorders such as depression and anxiety contribute to poor academic performance and an increased risk of <a href="https://doi.org/10.1016/j.jpsychires.2008.01.016">dropping out</a> of college. The average ratio of students to campus mental health counselors is <a href="https://iacsinc.org/staff-to-student-ratios/">1,600 to 1</a>. The gap between the need for mental health services and available resources has produced what Lauren Lumpkin, of The Washington Post, referred to as a “<a href="https://www.washingtonpost.com/education/2021/03/30/college-students-mental-health-pandemic/">mental health crisis” on college campuses</a>.</p>
<p>When students head back to college in the fall, our research suggests, colleges can help students stay in school if they better understand what students have been through and what they need to succeed. Many of these students were already struggling before the pandemic, and the pandemic has only produced <a href="https://www.washingtonpost.com/education/2021/03/30/college-students-mental-health-pandemic/">more fear, loss and social isolation</a>.</p>
<h2>What still isn’t known</h2>
<p>Although we found that students who have suffered considerable adversity in childhood lack social support, we still don’t know what types of support they need or want the most. For example, would students participate in a mentoring program, and if so, would they prefer a faculty and staff or a peer support program? Would group counseling sessions be utilized, or would health-promoting group activities, such as nature walks or yoga classes, be more effective at helping students improve their mental health and connect with others on campus?</p>
<h2>What’s next</h2>
<p>Our research team will be working to better understand the needs of students with a history of complex trauma, identify their unique strengths and evaluate how to best help them succeed. We are also examining the potential for post-traumatic growth among these students. Post-traumatic growth is the process through which adversity contributes to the development of positive personal qualities such as empathy, altruism and openness. </p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/163157/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Toni Watt does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Multiple difficult childhood experiences can lead to depression and anxiety during college, research has found. Lack of support often makes things worse.Toni Watt, Professor of Sociology, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538482021-02-04T19:55:36Z2021-02-04T19:55:36ZCriminal justice needs a better understanding of childhood trauma<figure><img src="https://images.theconversation.com/files/382066/original/file-20210202-19-w0gthc.jpg?ixlib=rb-1.1.0&rect=449%2C161%2C3544%2C2131&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Courts have failed to understand the role childhood trauma can play in adult criminal behaviour.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The execution of <a href="https://www.nytimes.com/2021/01/13/us/politics/lisa-montgomery-execution.html">Lisa Montgomery in Indiana</a> in January made headlines around the world. She was the first female inmate executed by the federal government since 1953. Montgomery faced the death penalty for strangling pregnant 23-year old Bobbie Jo Stinnett in 2004. Montgomery cut the unborn baby from Stinnett’s womb, claiming the child as her own. </p>
<p>Montgomery was a woman described as <a href="https://www.ctvnews.ca/world/u-s-carries-out-its-1st-execution-of-female-federal-inmate-since-1953-1.5264590">damaged and delusional</a>, who suffered from depression, schizophrenia, personality disorder, PTSD and <a href="https://www.theguardian.com/world/2021/jan/05/lisa-montgomery-death-row-execution-history">traumatic brain injury</a>. She experienced psychosis and believed God spoke to her through connect-the-dot puzzles. </p>
<p>At the time of the crime, <a href="https://apnews.com/article/lisa-montgomery-executed-d29e4250646d5e177df53efa64da6163">she suffered from pseudocyesis</a>, a rare psychiatric condition where she falsely believed she was pregnant and experienced the same hormonal and body changes. </p>
<h2>Mental illness</h2>
<p>Over the past several decades, researchers have underscored the connection between <a href="https://doi.org/10.1016/j.chiabu.2017.03.016">childhood trauma and mental illness in adulthood</a>. With colleagues, <a href="https://news.athabascau.ca/faculty/faculty-of-health-disciplines/mental-health-and-trauma-influences-on-maternal-infanticide-and-filicide/">I examine how childhood trauma affects criminal behaviour</a>. Our work is concerned with the area of maternal mental health forensics: the process of determining evidence in cases of mothers who are prosecuted for criminal behaviour, such as in cases of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174580/">maternal infanticide</a> where mothers kill their children.</p>
<p>Our culture’s lingering stigma of mental illness means that <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">adverse childhood experiences</a> and their relationship to criminal behaviour remain woefully ignored. As a consequence, compassion and fair legal decisions are not made consistently. While the legal system has come a long way, there is still a long way to go. </p>
<p>It is a most heinous crime imaginable when a mother kills her child — or in this case, the child of another. It violates the archetype of the mother as all-protecting of her young. </p>
<p>Society can be quick to judge these women as sadistic and maniacal, demanding punishment to the fullest extent. With a lack of understanding of the possible mental health basis, these mothers are treated as monsters rather than victims of their mental disturbances lacking the capacity to know or appreciate the nature of their actions.</p>
<p>Exactly 20 years ago, in Houston, Texas, <a href="https://www.buggedspace.com/andrea-yates-mother-who-drowned-her-children/">Andrea Yates took the lives of her five children</a> and faced the death penalty. Yates believed she was saving her children from eternal damnation by drowning them in a bathtub. In 2002, she was convicted of murder and sentenced to life in prison, although an appellate court later ordered a second trial. </p>
<p>At that trial in 2006, <a href="https://narratively.com/he-defended-the-woman-who-drowned-her-five-children-then-dedicated-his-life-to-making-sure-it-never-happens-again/">Yates’s attorney educated the jury about her psychotic mind</a>. Yates was found not guilty by reason of insanity. Public opinion shifted from disdain to compassion for the impact of maternal mental illness, and its role in the crime. However, compassion and understanding from those determining the fate of Lisa Montgomery was lacking. </p>
<h2>A traumatizing childhood</h2>
<p>As a child, Lisa suffered repeated sexual torture and humiliation from her mother. She would strip Lisa naked and push her outside the front door as punishment. She put Lisa in cold showers and whipped her with <a href="https://deathpenaltyworldwide.org/project/savelisa/">belts, cords or hangers</a>. Her step-father built a <a href="https://www.newsweek.com/lisa-montgomery-life-sentence-death-row-abuse-1548750">secret room behind his trailer</a>, where he and others <a href="https://www.huffingtonpost.ca/entry/lisa-montgomery-death-penalty-trump-administration_n_5fa586a3c5b623bfac4f101d?ri18n=true">repeatedly raped her</a>. These types of significant childhood traumas, and even ones not so extreme, have been shown to <a href="https://www.aap.org/en-us/documents/ttb_aces_consequences.pdf">alter brain biology and lead to mental illness in adulthood</a>. </p>
<p>The impact of childhood traumas on adult mental health is like what smoking is to the lung and obesity to the heart. Research shows that extensive trauma at an early age is very common in maternal filicide. Studies confirm that <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">adverse childhood experiences in the first 18 years of life</a> increase risk of psychosis and criminal behaviour. The more adverse childhood experiences one has, the greater the risk of depression, anxiety, suicidality and other mental disorders. While there are factors that can protect people from the severe effects of trauma, like having a safe relationship with an adult, not everyone who experiences adversity or trauma also experiences protective factors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-compassion-can-triumph-over-toxic-childhood-trauma-90756">How compassion can triumph over toxic childhood trauma</a>
</strong>
</em>
</p>
<hr>
<p>When it comes to maternal mental illness, <a href="https://www.attachmenttraumanetwork.org/attachment/">childhood maltreatment at the hands of parents and guardians</a> have the most harmful effects. There is an urgent need to shift the dialogue and acknowledge that childhood traumas impact adult mental health. Studying how laws and judicial decisions can reflect our evolving appreciation of how adverse childhood experiences contribute to mental illness, criminal behaviour and insanity defences, is crucial. </p>
<p>Trauma is not the “<a href="https://www.usatoday.com/story/opinion/policing/2021/01/05/death-sentence-mentally-ill-montgomery-shows-failure-justice-system/4127792001/">abuse-excuse</a>,” as federal prosecutors called Montgomery’s life story. Rather, abuse produces negative outcomes including criminal behaviour. </p>
<p>Had Montgomery been tried in a legal system with a more nuanced understanding of mental illness her life may have been spared, and proper treatment provided. The murder of Bobbi Jo Stinnett was reprehensible and tragic. A second injustice was enacted when Montgomery, herself a victim of her mental illness, was executed.</p><img src="https://counter.theconversation.com/content/153848/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gina Wong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The execution of Lisa Montgomery in the U.S. earlier this year demonstrates how society misunderstands the effects of mental illness and trauma on criminal behaviour.Gina Wong, Professor, Program Director, Psychologist, Athabasca UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1180272019-05-31T11:12:40Z2019-05-31T11:12:40ZHoward Stern talks childhood trauma, and a trauma psychiatrist talks about its lasting effects<p>With the awakening in society of the importance of mental health, combined with advances in neuroscience and psychiatry, much needed attention to trauma and childhood trauma is slowly forming.</p>
<p>In a recent interview with Anderson Cooper and in his latest book published May 14, Howard Stern discussed <a href="https://www.youtube.com/watch?v=aL7c6blpuXM">childhood adversity and trauma</a>. The two men also discussed their exposure to their parents’ stress and how their reactions as children formed their adult behavior. </p>
<p><a href="https://www.starclab.org/members/arash-javanbakht">As a trauma psychiatrist</a>, I am glad that men with such celebrity are willing to talk about their experiences, because it can help bring awareness to the public and reduce stigma.</p>
<h2>Childhood: Learning about the world and the self</h2>
<p>A child’s brain is a sponge for learning about how the world works and who they themselves are. We humans have an <a href="http://theconversation.com/to-feel-happier-we-have-to-resolve-to-the-life-we-evolved-to-live-108965">evolutionary advantage</a> in having the ability to trust the older and learn from them about the world. That leads to cumulative knowledge and protection against adversity, about which only the experienced know. A child absorbs the patterns of perceiving the world, relating to others and to the self by learning from adults.</p>
<p>But when the initial environment is unusually tough and unfriendly, then a child’s perception of the world may form around violence, fear, lack of safety and sadness. Brains of adults who experience childhood adversity, or even poverty, are <a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2015.00154/full">more prone to detecting danger</a>, at the cost of ignoring the positive or neutral experiences. </p>
<p>Some who experience childhood adversity have to mature faster and become caretakers or provide emotional support for siblings or parents at an age they themselves need to be taken care of. They may end up carrying those patterns of relating to others throughout their adult life. </p>
<p>The child of trauma may also perceive himself or herself as unworthy of love, guilty or bad. The brain of an unknowing child may think: If they do this to me, there should be something wrong with me, I deserve it. </p>
<p>The little world people experience as children forms the way we perceive the real big world, its people and the people we are as adults. This will then form the way the world reacts to us based on our actions.</p>
<h2>A world filled with trauma</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An unidentified young person participating in therapy at a center for refugees in Detroit.</span>
<span class="attribution"><span class="source">David Dalton/Wayne State University</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Childhood trauma is more common than one would think: Up to two-thirds of children experience <a href="https://www.ncbi.nlm.nih.gov/pubmed/18349090/">at least one traumatic event</a>. <a href="https://www.samhsa.gov/sites/default/files/programs_campaigns/nctsi/nctsi-infographic-full.pdf">These include</a> serious medical illness or injury, firsthand experience of violence or sexual abuse or witnessing them, neglect, bullying and the newest addition to the list: <a href="http://theconversation.com/what-mass-shootings-do-to-those-not-shot-social-consequences-of-mass-gun-violence-106677">mass shootings</a>. </p>
<p>Unfortunately, when it comes to domestic violence and sexual abuse, it is often <a href="https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma">chronic, repetitive exposure</a>, which can be even more detrimental to the child’s mental and physical health and behavior. </p>
<p>Ongoing civil wars and refugee crises also expose millions of children to <a href="https://theconversation.com/syrian-refugees-in-america-the-forgotten-psychological-wounds-of-the-stress-of-migration-96155">extremely high levels of trauma</a>, which is often ignored.</p>
<h2>How do children react to trauma?</h2>
<p>To understand the child’s reaction to trauma, one has to keep in mind their developmental level of emotional and cognitive maturity. Most of the time, confusion is the reaction: The child does not know what is happening or why it is happening. </p>
<p>I hear frequently from my adult patients that when they were molested by a relative as a five-year-old, they did not know what was happening or why a supposedly trusting caregiver was doing it to them. Fear and terror, coupled with a sense of lack of control, are often companions of this confusion. </p>
<p>There is also guilt, as the child may believe they did something wrong to deserve the abuse, and often the perpetrating adults claim they did something wrong to deserve the abuse. Sadly when it comes to sexual abuse, sometimes when the parents are told about it, they choose to deny or ignore the incident. This makes the feelings of guilt and helplessness worse. When the trauma is happening to parents, such as frequent battering of a mother by an alcoholic father, children are stuck between two people they are supposed to love. They may be angry with the father for violence, or angry at the mother for not being able to protect herself and themselves. </p>
<p>They may try to rise to protect mom from father or from her sadness. They may feel guilty for not being able to save her, or have to raise their siblings when parents fail to do so. They learn the world is a brutal and unsafe place, a place where one is abused and one is violent.</p>
<h2>Adulthood scars of childhood trauma</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who are abused can be helped when adults take seriously their reports of abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-little-girl-pink-dress-sits-232819528?src=byIM36lPnwzpyYMTyj91UQ-1-4">BestPhotoStudio/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>There is a growing body of research suggesting longstanding impact of childhood trauma: not only that such childhood experiences can form the way the person perceives and reacts to the world, but also that there are lifelong academic, occupational, mental and physical health consequences. These children may have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232057/">lower intellectual and school performance</a>, <a href="https://theconversation.com/syrian-refugees-in-america-the-forgotten-psychological-wounds-of-the-stress-of-migration-96155">higher anxiety</a>, depression, substance use and a variety of <a href="https://www.ncbi.nlm.nih.gov/pubmed/16006380">physical health problems</a> including autoimmune disease.</p>
<p>Adults who endured childhood trauma have a higher chance of developing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108182/">post-traumatic stress disorder</a> when exposed to new trauma and show higher rates of <a href="https://www.ncbi.nlm.nih.gov/pubmed/12142846">anxiety</a>, depression, substance use and <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Childhood+trauma+and+suicide+attempt%3A+A+meta-analysis+of+longitudinal+studies+from+the+last+decade">suicide</a>. Physical health consequences of childhood trauma in adults include but are not limited to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26247216">obesity</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23421962">chronic fatigue</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22787111">cardiovascular disease</a>, autoimmune disease, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24524907">metabolic syndrome</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/24360527">pain</a>.</p>
<p>Not all who are exposed to childhood adversity are permanently scarred, and a front line in research of childhood adversity is the predictors of risk and resilience. For instance, there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/25162199">genetic variations</a> which may make the person more or less vulnerable to impact of trauma. I often see those who were lucky enough to transform their trauma to a meaningful cause, and with the help of a good mentor, therapist, grandparent or positive experiences rise and develop more strength. </p>
<p>This, however, does not mean those who sustain long-term impacts were weaker or tried less. There are a multitude of genetic, neurobiological, family, support, socioeconomic and environmental factors, besides the severity and how chronic the trauma is, that can lead to breaking of the strongest of people when exposed to trauma.</p>
<h2>How to deal with childhood trauma</h2>
<p>We as a society can do a lot: reduce poverty; educate and provide less privileged parents with support needed for raising their children (although childhood trauma happens also in privileged homes); take seriously children’s report of abuse; remove the source of trauma or remove the child from the traumatic environment; psychotherapy. When necessary, medications can also help. </p>
<p>Fortunately for all of us, recent advances in neuroscience, <a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00328/full">psychotherapy</a> and psychiatry have provided us with strong tools to prevent the negative impact in the child and reduce a lot of the negative impact in the adults, if we choose to use them.</p><img src="https://counter.theconversation.com/content/118027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Childhood trauma is far more pervasive and injurious than many people know. Its effects last long into adulthood, if left untreated. A trauma psychiatrist unpacks its effects on the developing brain.Arash Javanbakht, Assistant Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890692018-02-07T11:27:49Z2018-02-07T11:27:49ZHow childhood experiences contribute to the education-health link<figure><img src="https://images.theconversation.com/files/205172/original/file-20180206-88784-hy8yxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A teen looking out of a window. Research shows that traumatic events in childhood can affect children as they mature and limit their education, which in turn can harm their health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-lonely-orphan-boy-orphanage-looking-369853097?src=34utG_EdzVzQ1RhrSo9-PQ-1-6">Jan Andersen/Shutterstock.com</a></span></figcaption></figure><p>The interconnection between education and health is well established. </p>
<p>Take, for example, smoking. Smoking continues to be the leading cause of preventable disease and death in the U.S. The highest percent of smoking is seen among persons with <a href="https://www.cdc.gov/nchs/data/hus/hus15.pdf">less than a high school or General Educational Development (GED) high school equivalency diploma</a>, and the lowest is among persons with a bachelor’s degree or higher. </p>
<p>Trends in efforts to quit smoking also <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm">vary by educational level</a>. Adults with a GED certificate, adults with no high school diploma, and adults with a high school diploma historically have had the lowest rates of quitting smoking compared to adults overall.</p>
<p>But these data document the relationship when it is too late: Adults don’t drop out of school, children do. </p>
<p>The field of public health recognizes education is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22102542">social determinant of health</a> and an indicator of well-being. National efforts are currently focused on <a href="https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health/objectives">promoting language and literacy, increasing high school completion and increasing college enrollment</a>. It is critical to ensure that children have positive learning experiences while they are still young so that they can achieve educational success. This is one of the best ways to ensure that they can live healthier lives as adults.</p>
<p>Other researchers and I have contributed to <a href="https://ac.els-cdn.com/S0091743503001233/1-s2.0-S0091743503001233-main.pdf?_tid=774ed5d6-0b43-11e8-85d0-00000aacb35d&acdnat=1517924691_2aca51d73f4e8764142e303afbec76fa">widening body of research</a> that shows how these experiences harm over the lifespan and across generations. Abuse, neglect and related stressors contribute to <a href="https://jamanetwork.com/journals/jama/fullarticle/194504">mental illness, substance use</a>, and a host of other negative <a href="https://www.cdc.gov/violenceprevention/acestudy/index.html">social and behavioral</a> outcomes decades later in life. </p>
<h2>Early childhood development</h2>
<p>A human baby’s brain is not fully developed at birth. Rapid brain development occurs in the <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">first few years of life</a> and then steadies into childhood and adolescence. The biodevelopmental impact of exposure to severe forms of stress and trauma is not immediately visible. But <a href="http://pediatrics.aappublications.org/content/129/1/e224">abuse, neglect, poverty and related stressful exposures</a> can put children at risk for problems with healthy cognitive, social and emotional development, which can interfere with learning. Thus, research has shown that these adverse childhood experiences not only contribute to health outcomes, but there appears to be a link with adult <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm">educational attainment</a>.</p>
<p><iframe id="Stbs9" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Stbs9/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Knowing that education begins in childhood and acts as a social determinant of health, I decided it was time that we take a close look at how childhood adversities impact learning and education. I recently had the honor to serve as guest editor for a special journal issue in Child Abuse & Neglect focused on this very topic. </p>
<p>To effectively address education as a social determinant of health, I have found that learning environments must include staff who have knowledge about trauma and symptoms of trauma. Most importantly, the school ecosystems, which are comprised of the schools’ staff, must be prepared and able to provide children, and each other, safe, supportive and trusting environments. Thus, creating effective solutions will require a multigenerational approach – those that not only focus on the children affected, but also on adults. </p>
<h2>Education for all</h2>
<p>Child labor increased when the U.S. Industrial Revolution started in the late 1700s and early 1800s. During this time, children worked in unfit conditions sometimes for up to 70 hours per week. After many attempts to change child labor laws between the late 1800s and early 1900s, Congress passed the <a href="https://www.dol.gov/whd/childlabor.htm#Overview">Fair Labor Standards Act of 1938</a>. The purpose was to ensure the health and safety of children and to promote well-being through educational pursuits.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While every child in the U.S. is entitled to an education, inequalities exist across school systems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-smiling-little-school-kids-corridor-259319342?src=AuwJ5aI0WCNdUGOwK3QptA-1-12">ESB Professional/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Despite the fact that every child is entitled to a public education in the U.S., <a href="https://news.stanford.edu/2016/04/29/local-education-inequities-across-u-s-revealed-new-stanford-data-set/">educational inequalities exist across school systems</a>. In addition, some children enter school ready to learn, while others, who experience abuse, neglect and other forms of related toxic stress, may have difficulties learning. </p>
<p>Truancy is too often viewed and treated as a form of misconduct without identifying the <a href="https://eric.ed.gov/?id=EJ835979">underlying reason for the behavior</a>. The field of education needs to realize that a large percent of children are exposed to adversities, and that learning and behavioral problems are often times a symptom. </p>
<h2>What is the research telling us?</h2>
<p>Research on adverse childhood experiences is being applied in multiple contexts, including school systems. In short, the fields of public health and education are learning a great deal more about how childhood adversities can negatively impact educational success, a social determinant of health. </p>
<p>Given all we know about the impact of <a href="http://pediatrics.aappublications.org/content/129/1/e224">toxic stress on the developing brain of children</a>, more attention is needed on <a href="https://www.sciencedirect.com/journal/child-abuse-and-neglect/vol/75/suppl/C">children’s education and learning in the context of adverse life experiences</a>. To address <a href="https://www.ncbi.nlm.nih.gov/pubmed/22102542">education as a social determinant of health</a>, ensuring children’s successful and positive educational experience while they are still young requires increased awareness of the widespread but hidden problem of childhood adversities and their impact on learning. </p>
<p>Childhood traumatic stress from <a href="http://www.sciencedirect.com/science/article/pii/S0145213417302491">violence</a>, <a href="http://www.sciencedirect.com/science/article/pii/S0145213417303186">abuse</a>, <a href="http://www.sciencedirect.com/science/article/pii/S014521341730234X">corporal punishment</a> and neglect contribute to educational outcomes such as excessive absenteeism, school dropout and school performance. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0145213417301710?via%3Dihub">Problems with emotional regulation</a> that result from maltreatment can also interfere with positive learning, class attendance, and problems with <a href="https://ac.els-cdn.com/S0145213417302302/1-s2.0-S0145213417302302-main.pdf?_tid=235d3b6a-ea65-11e7-920e-00000aab0f26&acdnat=1514310756_5435650a0dad19e94e20a111ba7d6c22">language development</a> and communication. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0145213417301916">Educational neglect</a> requires more attention from the field. It is a form of maltreatment that lacks sufficient studies to fully understand why it occurs and how it can impact children’s ability to learn and educationally succeed. </p>
<p>Older students are also at risk. <a href="http://www.sciencedirect.com/science/article/pii/S0145213417301710?via%3Dihub">College-aged students</a> who have a history of childhood trauma may encounter difficulties with post-secondary education. </p>
<p>Children who have been through the foster care system are particularly at high risk. <a href="https://ac.els-cdn.com/S0145213417302788/1-s2.0-S0145213417302788-main.pdf?_tid=bb68c316-ea65-11e7-8216-00000aab0f26&acdnat=1514311012_0fc91061cf00e0a495bd90545ef1b2d6">Family-school partnerships</a> and school connections are especially important factors that can promote their learning in the face of adversities. </p>
<p>Most importantly, I believe that both education and public health must work together to effectively <a href="https://ac.els-cdn.com/S0145213417303654/1-s2.0-S0145213417303654-main.pdf?_tid=99f336ba-0925-11e8-97fa-00000aab0f02&acdnat=1517691962_54c0be9313d31b93b0c0a5a40e24cdd3">promote and foster positive learning environments for all children</a>. Utilizing principles and strategies of <a href="https://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816">trauma-informed care</a> is a movement that is rapidly sweeping across schools. A recognition that education is a key indicator of well-being can help bring in focus the true nexus of education and health.</p>
<p>In my view, childhood stress and trauma is a public health crisis. As a society, we must recognize that shame and secrecy keep it a hidden problem. Unlike infectious diseases, trauma cannot be sanitized, vaccinated against or treated with antibiotics. Therefore, to promote well-being across the lifespan, we must collectively invest in meeting the needs of future generations.</p><img src="https://counter.theconversation.com/content/89069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shanta R. Dube is founder and owner of Vision of Wellness, LLC and mWELL, LLC. She serves as one of the Associate Editors for the international journal, Child Abuse & Neglect and is working with the GA Department of Education. </span></em></p>Adverse childhood events can not only cause lasting psychological effects but also learning problems. That, in turn, worsens health outcomes, as literacy is an integral part of health care.Shanta R. Dube, Associate Professor, School of Public Health, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.