Childhood Trauma: How It May Affect Health for a Lifetime

The National Child Traumatic Stress Network (NCTSN) defines childhood trauma as traumatic experiences that occur to children generally in their early childhood years. Events that lead to traumatic stress are largely events that happen unexpectedly, intentionally (with malice as motive) and repeatedly.

Traumatic experiences don’t only mean physical, verbal or sexual abuse, but also include impactful instances that make a child feel severely neglected or endangered. These experiences are shown to have lasting emotional or psychological damage.

During her Ted Talks presentation, Dr. Nadine Burke Harris, noted paediatrician and founder CEO of Center for Youth Wellness (CYW) from San Francisco, defines severe childhood trauma as:

“Threats that are so severe or pervasive that they literally get under our skin and change our physiology: things like abuse or neglect, or growing up with a parent who struggles with mental illness or substance dependence.”

Childhood trauma and its effects

Many of us may feel that children are too young to make sense of events happening around them. But the truth is, their tender brains are more susceptible to devastating and lasting effects caused by trauma.

The “fight-or-flight” response system of our bodies gets activated when we face danger, helping our bodies tackle stress.

When this response system gets repeatedly triggered, it switches from being life-saving to health-damaging. Since children’s bodies are developing, they’re more sensitive to this repeated stress activation and bear the brunt of the response system.

According to Dr. Harris, childhood trauma affects the following:

• Brain development;
• The immune system;
• Hormonal systems;
• The way DNA is read and transcribed;
• Nucleus accumbens, the pleasure and reward center of the brain that is implicated in substance dependence;
• The prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning; and
• The brain’s fear response center, thus giving neurological reasons why people are more likely to engage in high-risk behavior when exposed to high doses of adversity.

It comes as no surprise, therefore, that victims of childhood trauma grapple with upsetting emotions, frightening memories, disease and depression in adulthood.

Correlation between childhood trauma and adult disease

In her Ted Talks presentation, Dr. Burke refers to a study done by Dr. Vince Felitti of Kaiser Permanente and Dr. Bob Anda of the Centers for Disease Control and Prevention (CDC) that shows a strong relation between childhood trauma and adult disease.

Entitled “The Adverse Childhood Experiences Study,” the study surveyed 17,500 adults about their history of exposure to “adverse childhood experiences,” or ACEs. These include:

• Physical, emotional, or sexual abuse (may include serious illness and/or bullying or natural calamity or accident)
• Physical or emotional neglect
• Parental mental illness (includes PTSD)
• Substance dependence
• Incarceration(imprisonment)
• Parental separation
• Divorce
• Domestic violence

Respondents were given an ACE score that was based on the number of times they answered “yes” to exposure to an ACE. By correlating these ACE scores against health outcomes, the researchers discovered two things:

1. ACEs were incredibly common. Sixty-seven percent of the population had at least one ACE, while 12.6 percent, or one in eight, had four or more ACEs; and
2. The higher the ACE score, the worse the health outcome was. Compared to a person with an ACE score of zero:
   • A person with an ACE score of four or more had two and a half times the risk of chronic obstructive pulmonary disease and hepatitis; four and a half times the risk of depression; and 12 times the risk of suicidality; and
   • A person with an ACE score of seven or more had three times the risk of lung cancer and three and a half times the risk of ischemic heart disease, which is the number one killer in the US.

With these findings, healthcare professionals can do better screening and diagnosis of symptoms.

“Because when we understand the mechanism of a disease, when we know not only which pathways are disrupted, but how, then as doctors, it is our job to use this science for prevention and treatment. That’s what we do,” says Dr. Burke.

Is my child traumatised?

Recognising signs of trauma in a child is the first step towards positive damage control. Traumatised children display a wide range of symptoms:

• The child exhibits unusual change in behaviour with a heightened sense of aggression and anger with an inability to be consoled;
• Has disrupted sleep, nightmares and increased clinginess to parents;
• Returns to babyish behaviour like bed wetting, thumb sucking, baby babble, etc.;
• Withdraws from engaging in interesting activities, other children and stops trusting most adults;
• Has phases wherein he/she shows empty emotion;
• Recreates the traumatic event often during play (such as physical abuse or an accident); and
• Complains of physical pain such as stomach aches, headaches, etc., which have no medical backing.

What can I do if my child is a victim of trauma?

First of all, you can be assured that there is a lot you can do to help your child cope with trauma. It is also been observed that with the right support, children have the ability to recover faster.

Here’s a list of what you can do to help your child cope with trauma:

• Recognise: As mentioned earlier, recognising the symptoms of trauma in our kids is the first help we can offer as parents. Observing stark changes in behaviour is the key, especially if your child is too young to use words.
• Accept: If you or a trusted caregiver has observed strong behavioural changes in your child, accept that he/she has been affected. Do not live in denial. This is specifically applicable when you’re aware of the trauma event or have been a part of it yourself.
• Be Available: Assure your child that you are always open to listen to him/her.
• Listen: When your child speaks and hear her/him out fully. Resist the urge to interrupt often as this may clam your child up.
• Encourage: Encourage expression through play acts, drawing, singing, etc. These are wonderful ways in which a child can vent.
• Accept help: Accept professional help to address the problem. Sometimes, the problem can be at home itself. Visiting a psychiatrist does not mean your child is mentally unstable. A professional can help prevent the damage caused by the adversity from getting worse. Do not get discouraged by what people say.
• Normalize: Try to bring back a normal routine in your child’s life, albeit slowly. Be fully convinced that your child is comfortable to leave the house (to school, daycare etc.). This is after you’ve recognised the cause for trauma. Do not send your child to places where you suspect the abuse has occurred.
• Build: Lastly, build your child’s self-worth and sense of security. Let her/him take healthy risks and perform a few tasks. Building your child’s self-worth will make him/her build up confidence and increase her/his trust level with adults.

As parents, we want to fiercely protect our child from any possible harm. Being attuned to our children is one of the wonderful gifts we can give them, to make them feel loved. Nipping the effects of childhood trauma at the earliest can prevent long term effects on our children’s health.

There are multiple avenues in Singapore to seek help from:

• Samaritans of Singapore (SOS)
• PPIS Family Service Centers
• Care Corner (Mandarin) Singapore Ltd
• SINDA (Singapore Indian Development Association) Family Service Centre
• SAMH Counselling Services

Remember, there is a difference between an upset child and a traumatised child. If you are unsure about the change in your child’s behaviour, or suspect adversity or abuse, be alert and talk to your child’s teacher or caregiver in depth to act immediately.

Have you, or someone you know, experienced childhood trauma? Do share your views on this topic in a comment below.