Childhood Trauma Connected to Increased Mental Health Problems

Recent research has shown that the risk of a child developing learning and behavioral problems, as well as the risk for obesity, rises in direct correlation to their level of trauma exposure, according to the study performed at by Stanford University School of Medicine and Lucile Packard Children's Hospital.

The study investigated the mental and physical status as well as the living conditions of children inhabiting a violent, low-income neighborhood. The researchers documented a surprisingly strong connection linking abuse, trauma, and neglect with the children's mental and physical health.

"In communities where there is violence, where children are exposed to events such as shootings in their neighborhoods, kids experience a constant environmental threat,” said senior author Victor Carrion, MD, associate professor of psychiatry and behavioral sciences at Stanford.

The researchers assessed the medical records from 701 children treated at a primary-care clinic in Bayview-Hunter's Point—a San Francisco neighborhood known for high rates of poverty and violence. Roughly 50% of the children were African-American, while the rest came from other various ethnic backgrounds.

The exposure of each child to traumatic events was scored on a scale from zero to nine, with one point given for each type of adversity. The researchers also evaluated the medical records for evidence of obesity and learning or behavior problems.

Researchers determined that two-thirds of the children in the study had gone through at least one category of adversity; 12% experienced four or more categories. An adversity score of four or higher left children thirty times as likely to develop learning and behavior problems, and twice as likely to suffer from obesity as those with a score of zero. Children with an adversity score of one were ten times as likely to have learning and behavior problems as those not exposed to trauma.

“Contrary to some people's belief, these children don't get used to trauma. These events remain stressful and impact children's physiology,” Carrion stated.

The researchers said the findings will hopefully encourage physicians to consider diagnosing post-traumatic stress disorder (PTSD) instead of attention deficit/hyperactivity disorder (ADD/ADHD), which has similar symptoms to PTSD but requires a very different treatment.

As of now, the researchers reported, children from high risk environments are not screened routinely enough by pediatricians for trauma exposures.

"As simple as it may seem, physicians do not ask about trauma," said Carrion. "And kids get the wrong diagnoses."

Previous studies have proven that roughly 30% of children inhabiting violent communities show symptoms of PTSD, which can include the learning and behavior problems detected in the current study, Carrion noted.

However, a physician may be unaware of the fact that a child experienced trauma, and instead may only be noting the child's physiological hyperarousability and cognitive difficulties; this might lead to a diagnosis of ADHD instead of PTSD. The two disorders have opposite treatments: Children suffering from PTSD require psychotherapy, not the stimulant medications given for ADHD.

"Children can recover from PTSD with the appropriate treatment, which is one of approach and not avoidance," Carrion said. "By not asking about trauma, we're utilizing avoidance. We're perpetuating PTSD."

Fortunately, Carrion and his collaborators, as well as several San Francisco community leaders, are working together to create the Center for Youth Wellness, a wellness and health center specifically for urban children and families in San Francisco. The Center for Youth Wellness will combine pediatrics with mental health services, educational support, family support, research, and best practices in child-abuse response under one roof.

The center will hopefully be operationally by the middle of 2012.

"We need to create trauma-informed systems," Carrion continued, adding that the Center for Youth Wellness will ideally serve as a model for such systems across the nation. Individuals working for the welfare of children need to be aware of potential effects of trauma and know how to intervene, as well as how to work with the child’s family and with the education system, he said. "If trauma goes untreated, it's very costly for the individuals involved and for society in general."

The study is being published online today in the International Journal Child Abuse & Neglect.