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Zachary Meehan on Childhood Trauma

Updated: 15 hours ago



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).



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


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 age, gender, and the nature of the traumatic event. For instance, adolescent girls more often experience sexual victimization (13%-17%) than adolescent boys (3%-5%; Saunders & Adams, 2014). On the other hand, boys more often experience assault with injury (13%) than girls (8%; Finkelhor et al., 2013). Irrespective of age, gender, and type of traumatic event, the overall one-year prevalence of childhood trauma is around 14% (SAMHSA, 2022). It is worth noting, however, that this value is likely an underestimation due to factors such as underreporting.



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.


HPA Axis

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 ability and decrease depressive symptoms by upregulation of the PFC and other areas associated with positive emotion (Linden et al., 2012). Further, mindfulness-based treatments, which promote emotion tolerance and introspection, demonstrate long-term efficacy for symptoms of depression, PTSD, and anxiety (Earley et al., 2014). Despite the serious consequences of childhood trauma, recovery is possible.



Glossary


amygdala: neural system partly responsible for processing fearful and threatening stimuli, also involved detection of threat and activation of fear-based responses.


bias to threat: selective attention that biases toward detection and identification of cues associated with the threat.


childhood trauma: experiencing harm or threat of harm to oneself or others.

chronicity: number of developmental periods in which the traumatic event(s) occur.

cognitive flexibility: adapting patterns of thinking to new perspectives or contexts.

developmental cascades: the domino-like effect whereby skill attainment early in development affects functioning later in development.

developmental timing: the age at which the traumatic event occurs.

emotional processes: executive functioning, emotion regulation, and interoceptive awareness that comprise an emotional experience.

emotion tolerance: the capacity to withstand difficult emotional experiences without methods to escape.

hippocampus: neural system partly responsible for memory formation.

hypothalamic-pituitary-adrenal axis: the neuroendocrine mechanism that modulates numerous physiological systems (e.g., immune, metabolism).

inhibitory control: selectively limiting attention, behavior, thoughts, and emotions.

mindfulness treatment: a form of talk therapy that focuses on self-awareness and acceptance of thoughts, emotions, and situations.

social-informational processing: perceiving, identifying, and interpreting social information.

trauma type: characteristics of the traumatic event (e.g., experiencing, witnessing, familial, community).

working memory: the small amount of information that can be held in the mind while executing cognitive tasks.



References


Alisic, E., Zalta, A. K., Van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry, 204, 335-340. https://doi.org/10.1192/bjp.bp.113.131227


Cicchetti, D., & Toth, S. L. (2016). Child maltreatment and developmental psychopathology: A multilevel perspective. In D. Cicchetti (Ed.), Developmental psychopathology: Maladaptation and psychopathology (pp. 457–512). John Wiley & Sons, Inc. https://doi.org/10.1002/9781119125556.devpsy311


Cowell, R. A., Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2015). Childhood maltreatment and its effect on neurocognitive functioning: Timing and chronicity matter. Development and Psychopathology, 27, 521-533. https://doi.org/10.1017/S0954579415000139


Cross, D., Fani, N., Powers, A., & Bradley, B. (2017). Neurobiological development in the context of childhood trauma. Clinical Psychology: Science and Practice, 24, 111. https://doi.org/10.1111/cpsp.12198


Dias, B. G., Maddox, S. A., Klengel, T., & Ressler, K. J. (2015). Epigenetic mechanisms underlying learning and the inheritance of learned behaviors. Trends in Neurosciences, 38, 96-107. https://doi.org/10.1016/j.tins.2014.12.003


Earley, M. D., Chesney, M. A., Frye, J., Greene, P. A., Berman, B., & Kimbrough, E. (2014). Mindfulness intervention for child abuse survivors: A 2.5‐year follow‐up. Journal of Clinical Psychology, 70, 933-941. https://doi.org/10.1002/jclp.22102


Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth: An update. JAMA pediatrics, 167, 614-621. https://doi.org/10.1001/jamapediatrics.2013.42


Gunnar, M. R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology, 27, 199-220. https://doi.org/10.1016/S0306-4530(01)00045-2


Hagan, M. J., Sulik, M. J., & Lieberman, A. F. (2016). Traumatic life events and psychopathology in a high risk, ethnically diverse sample of young children: A person-centered approach. Journal of Abnormal Child Psychology, 44, 833-844. https://doi.org/10.1007/s10802-015-0078-8


Li, M., D'Arcy, C., & Meng, X. (2016). Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: Systematic review, meta-analysis, and proportional attributable fractions. Psychological Medicine, 46, 717-730. https://doi.org/10.1017/S0033291715002743


Linden, D. E., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., Sorger, B., Healy, D., & Goebel, R. (2012). Real-time self-regulation of emotion networks in patients with depression. PloS One, 7, e38115. https://doi.org/10.1371/journal.pone.0038115


Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491-495. https://doi.org/10.1017/S0954579410000222


McLaughlin, K. A., Colich, N. L., Rodman, A. M., & Weissman, D. G. (2020). Mechanisms linking childhood trauma exposure and psychopathology: A transdiagnostic model of risk and resilience. BMC Medicine, 18, 1-11. https://doi.org/10.1186/s12916-020-01561-6


Russotti, J., Warmingham, J. M., Duprey, E. B., Handley, E. D., Manly, J. T., Rogosch, F. A., & Cicchetti, D. (2021). Child maltreatment and the development of psychopathology: The role of developmental timing and chronicity. Child Abuse & Neglect, 120, 105215. https://doi.org/10.1016/j.chiabu.2021.105215


Substance Abuse and Mental Health Services Administration. (2022, September 27). Understanding child trauma. SAMHSA. Retrieved January 23, 2023, from https://www.samhsa.gov/child-trauma/understanding-child-trauma


Saunders, B. E., & Adams, Z. W. (2014). Epidemiology of traumatic experiences in childhood. Child and Adolescent Psychiatric Clinics, 23, 167-184. https://doi.org/10.1016/j.chc.2013.12.003



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