Zachary Meehan on Childhood Trauma

Events are traumatic when they involve harm or threat of harm to oneself or others (McLaughlin et al., 2014). Childhood trauma is a prevalent concern with serious short- and long-term consequences, as those who experience trauma in childhood are three times more likely to develop psychopathology in adulthood (Li et al., 2016). Current research details several factors that increase individuals’ risk for consequences, which can be measured at the neurological, cognitive, physiological, and neuroendocrine levels (Cross et al., 2017). Despite the possibility of adverse outcomes, protective social and biological factors can mitigate or prevent children from these detrimental effects (Dias et al., 2015).

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Prevalence

Among children, the most common traumatic events are either the experience or witnessing of interpersonal violence (e.g., physical abuse), whether at home or in the community. The number of children exposed to trauma varies widely by gender and the nature of the traumatic event. For instance, girls more often experience sexual victimization (13%-17%) than boys (3%-5%; Saunders & Adams, 2014). On the other hand, boys are more often victims of assault (45%) than girls (37%; Finkelhor et al., 2013). The overall one-year prevalence of childhood trauma is around 14% (SAMHSA, 2022); however, this number is likely an underestimation.

Consequences

Most children who experience trauma do not later develop psychopathology. For instance, one study found that approximately 84% of children who experienced trauma did not develop post-traumatic stress disorder (Alisic et al., 2014). That said, trauma is a potent risk factor substantially increasing one’s likelihood of later concerns. Specifically, children who experience trauma are three times more likely to develop psychopathology in adulthood than children who were not exposed to trauma (Li et al., 2016). Several factors help explain why some children may be at greater risk for both short- and long-term consequences of trauma

Influential Factors

Whether, how, and to what extent these problems develop may be explained by (1) trauma type, (2) developmental timing, and (3) chronicity. First, trauma type refers to the characteristics of the traumatic event. Some children witness violence in the community, whereas others experience it firsthand at home. Children who witness and experience family violence tend to develop more severe concerns than those who experience just one form (Hagan et al., 2015). Higher rates of psychopathology are likely due to the erosion of social support that leads to maladaptive cognitions (e.g., self-blame; Alisic et al., 2014). Note that the many types of traumas can interact uniquely to yield diverse consequences (Hagan et al., 2015).

Second, developmental timing refers to the age at which the traumatic event occurs. The consequences of victimization differ depending on the age of the youth. Whereas those in early childhood (<8 years old) are more likely to develop later internalizing concerns (e.g., depression, anxiety), those in late childhood (8-12 years old) or adolescence (13-18 years old) are more likely to develop externalizing concerns such as substance use and conduct problems (SAMHSA, 2018).

Third, chronicity refers to the number of developmental periods in which the traumatic event(s) occur. More chronic traumatic events tend to yield more severe outcomes (Russotti et al., 2021), as those occurring across more than one developmental period (e.g., early childhood to adolescence) can delay or prevent children from fully achieving developmental milestones (e.g., self-regulation; Cicchetti & Toth, 2016). Not fully achieving developmental milestones can result in developmental cascades, the domino-like effect whereby skill attainment early in development affects later functioning (Masten & Cicchetti, 2010). For example, a child who struggles with self-regulation in elementary school may become upset quicker and to a greater extent than their peers, thereby impacting their ability to make and maintain social relationships, resulting in social exclusion/isolation and low social support that increases the risk for internalizing disorders.

Multisystemic Response to Trauma

Children experience a response to trauma that can be measured at the neurological, cognitive, physiological, and neuroendocrine levels (see Cross and colleagues, 2017, for a thorough review). In terms of brain function, disruptions to the stress-sensitive areas of the hippocampus, prefrontal cortex (PFC), and amygdala negatively impact working memory, cognitive flexibility, inhibitory control, and the ability to understand abstract concepts (Cowell et al., 2015). Trauma can also affect the hypothalamic-pituitary-adrenal (HPA) axis’ regulation of cortisol, which may have neurotoxic effects on genetic expressions such as neuroplasticity (Dias et al., 2015). Graphic © Designua/Shutterstock.com.

Together, these difficulties can reduce children’s awareness, understanding, and acceptance of emotional experiences (Cross et al., 2017).

Perhaps more clinically relevant are the disruptions to cognitive and emotional processes relevant to perceiving, identifying, and interpreting social information, otherwise known as social information processing (SIP). Disrupted SIP biases attention toward potentially threatening stimuli (McLaughlin et al., 2020). As a result, traumatized children tend to orient their attention more quickly to angry faces and interpret ambiguous situations as dangerous more often than non-traumatized children (McLaughlin et al., 2020).

In combination are disruptions to emotional processes (e.g., emotion regulation), magnifying emotional responses to this perceived threat (Cross et al., 2017). Although these biases are adaptive in the short term, as they help kids more quickly identify and respond to signals of danger in historically dangerous contexts, they are maladaptive in the long term. Sustained bias to threat and magnified emotional responses confer risk for different forms of psychology, including anxiety, depression, PTSD, psychosis, and the general psychopathology factor p (McLaughlin et al., 2020).

Bolstering Protective and Mitigating Risk Factors

Protective social and biological factors can mitigate or prevent children from these detrimental effects (Dias et al., 2015). Recall that around 86% of children who experience trauma do not later develop PTSD (Alisic et al., 2014). Parents, other caregivers, and peers can buffer the neurobiological effects of trauma if supportive and responsive to the child (Gunnar & Donzella, 2002). Those who still experience the effects may benefit from psychotherapeutic or pharmacological intervention. One systematic review showed that pharmacotherapy can promote structural changes to the HPA axis, amygdala, PFC, and hippocampus when paired with psychotherapy (Thomaes et al., 2014). Regarding individual treatments, neurofeedback may improve emotion regulation abil