Family therapist Robin Karr-Morse, author of Scared Sick: The Role of Childhood Trauma in Adult Disease, opened the discussion by talking about the effects of both emotional and physical trauma on children’s brains. Both trigger the fight-or-flight response, she explained, meaning that fear enters the brain, affecting a variety of functions including the pituitary and adrenal systems that regulate important hormones. Constant stress affects the brain and nervous system at fundamental architectural levels.

KQED healthcare reporter and moderator Sarah Varney asked what type of home situation causes this sort of stress. Dr. Nadine Burke Harris, the founding physician and former medical director of San Francisco’s Bayview Child Health Center, answered that any threat to a child’s integrity can trigger a fear response. Children who have lived in homes with domestic violence, who have experienced physical, emotional, or sexual abuse, or who have been separated suddenly from their parents all experience trauma. “It’s different for different kids,” she said. “People talk a lot about resilience, and I’m very cautious of that word. It has to do with your own DNA,” and how susceptible you are to trauma. Two siblings in the same household can have a very different response to the same trauma.

Katie Albright, the executive director of the San Francisco Child Abuse Prevention Center, added that children develop resiliencies in different ways and protect themselves naturally. But she also works to provide mechanisms to help both children and parents react when bad things happen. “We teach kids to use their voices” to tell a safe adult what’s going on–and we “teach parents to listen to them,” she said.

Karr-Morse explained that trauma is different for a baby. During gestation or in the first two years of life, more subtle issues like maternal depression can affect a baby chemically. “I was amazed to find that in many studies, maternal depression has as great an impact as childhood abuse and neglect,” she said, because it damages the attachment relationship between mother and child–which is normally “the best health insurance policy we have.”

How and when can medical practice and public policy intervene?

Working as a pediatrician for a high-risk population, Burke Harris noticed that when she took histories, in addition to having a variety of health issues and problems with behavior and learning, most of her patients were on the spectrum for trauma. When Burke read about the Adverse Childhood Experience (ACE) study–which showed that adverse childhood experiences correlate directly with a number of diseases–she realized that she needed to do something about it: “I give the tetanus shot all day long, but I haven’t treated a case of tetanus for a while.” The ACE study asked adults to answer questions about their personal histories–if they’d experienced events like parental divorce or emotional neglect, and if they’d lived with a parent who was an alcoholic or drug abuser. A child who has experienced four or more adverse experiences–as 12 percent of Burke Harris’s patients had-“is twice as likely to have heart disease, 2.5 more times likely to have hepatitis, and 46 times more likely to be an IV drug user.” At Bayview, Burke Harris interviewed parents to find out if their children had been exposed to trauma, then worked with colleagues–a social worker, a psychologist, an insurance counselor–to plug the family into the right resources.

Albright explained that prevention is key at the policy level as well as the personal level. This means everything from talking about good parenting to identifying at-risk children and families and providing multidisciplinary intervention. Child abuse is a public health problem, said Albright, and it should be viewed through a healthcare lens.

Karr-Morse stressed that childhood trauma crosses class and ethnic lines. Burke Harris concurred, explaining that the ACEs study was of adults who came from middle-class backgrounds. “In terms of how we’re looking at this challenge, its really important for us to recognize that it’s an issue for everyone,” she said. It’s epidemic.

“When you’re thinking about public policy change, it really is across all zip codes,” said Albright. The public policy approach needs not to fall on a particular group of people, she concluded.

In the question-and-answer session, the audience asked the panelists to expand on their ideas about solutions. Burke Harris was asked what can be done to treat victims of trauma. As a scientist and physician, she recommended a combination of therapy, regular exercise–which increases endorphins to the brain and speeds up the metabolism–and “mindfulness-based awareness-type work” like meditation.

Albright put the issue into historical perspective, noting that it wasn’t until the 1960s that children’s rights became an issue. An abused child was taken to the Society for the Prevention of Cruelty to Animals because there was nowhere for children to go at that time. The role of children in the family and society began to change in the 1960s and 1970s, and Albright sees hope in the current climate. “It’s actually amazing that our potential presidents are actually talking about family issues,” she said. “It’s a great step forward for children in America that we’re beginning to talk about these issues at the presidential level.”

Watch full video here.
See more photos here.
Read expert opinions on preventing childhood trauma here.

*Photos by Aaron Salcido.

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She kept in touch with us, sent us letters, cards, and care packages. We spoke on the phone. She came to visit once. We accepted her absence without really understanding it. Then, one day, when we were 12, our father sat us down on our bunk bed and told us that our mother was dead. She had taken her life.

Had we suffered a trauma? Most people would say yes. We’d been uprooted from our home, moved without explanation across the country, and lost our mother. Before I answer that question, though, let me discuss what psychologists today know about the effects of childhood trauma.

On the one hand, childhood adversity appears to pose health risks: children with traumatic histories become adults with a disproportionate number of physical ailments. On the other hand, most children are remarkably resilient, and they overcome everything but the most extreme deprivation. How do we reconcile these conflicting findings?

One explanation could be that the effects of early trauma show up late. They may subtly alter our capacity to regulate the stress response, only gradually and cumulatively manifesting themselves, usually well into adulthood.

But that’s just one explanation. Another is that, while childhood adversity can produce long-term health effects, it ordinarily doesn’t. For children, resilience to adversity, even extreme adversity, is the norm rather than the exception. Ann Masten, who researches resilience at the University of Minnesota, has called this “ordinary magic.” Most children weather the storms of early adversity, she has found, and their trajectories differ little from those who are not so exposed. A psychoanalytic theorist of an earlier age, Donald Winnicott, anticipated some of these findings with his famous phrase: the “good enough mother.”

In other words, we don’t need perfect parenting or a stable environment to grow into stable and productive adults. There is even evidence that our resources against stress and adversity are mobilized in utero. In a fascinating study entitled “Prescient Human Fetuses Thrive,” published last week in Psychological Science, authors Curt A. Sandman, Elysia Poggi Davis, and Laura M. Glynn looked at the pre-natal environment of infants to see how they might be affected by a mother’s depression. What they found was that the healthiest developmental trajectories from 3 to 12 months were observed among infants whose pre-natal and post-natal environments were similar, regardless of whether those environments were adverse or not. In short, having a depressed mother isn’t necessarily a liability, because the infant can anticipate it in utero.

In our trauma-focused age, we sometimes lose sight of our innate capacity to endure. We seem to assume that “traumatic events” must result in “trauma.” And yet the research tells us the opposite. Most people cope with the worst things with only modest and transient disruptions in functioning.

Part of the problem is language. In psychiatry, the word “trauma” refers to a type of response to an incident, not to the incident itself. An event is “traumatic” only inasmuch as it leads to trauma. That’s why a number of scholars, particularly Columbia University researcher George Bonanno, argue that a more accurate choice of words for a terrible experience would be a “potentially traumatic event.” This would underscore that events are not inherently traumatic, even though they may be inherently painful and stressful.

This principle applies to children, too. A terrible, stressful environment is not inherently a traumatizing one. In fact, early adversity may confer some long-term benefits for functioning. Yes, people who report having experienced very high levels of adversity during childhood show poor functioning, but so do those who experienced very low levels of adversity. It turns out that those who experience moderate adversity do the best. This is an important qualification. For all the recent studies showing long-term negative health effects from early adversity, the full story may be more ambiguous. Persons with some early adversity may actually experience health benefits.

And as for me? My mother’s death was a painful, defining experience. But, again, was it a trauma?

It didn’t feel like one. It still doesn’t. The shallowness of that word, the ease with which we toss it around, grates on me. All lives include pain, loss, disappointment, and betrayal. No one is exempt. We learn to make peace with our past. That is the only way forward. My twelve-year-old self resolved to use the pain of my experience to understand the pain of others. I became a psychologist and a researcher largely in order to stay true to that pledge. I would be a different and, I believe, a lesser person without the adversity I experienced.

This isn’t to say the long-term impact of childhood adversity isn’t a critical social issue that deserves our full attention. We must understand how to ameliorate the impact of early adversity and prevent health problems before they occur. But we must also keep in mind the resilience that we all possess. Unfortunately, for those who still suffer the after-effects of trauma, we don’t have any proven methods specifically designed to remediate them. But we do know a lot about how to manage stress and boost health in general. Exercise and meditation might seem simple, or even trivial when viewed in the context of great suffering, but their benefits are both well-documented and underappreciated. The positive effects of just 30 minutes a day of moderate exercise are nothing short of breathtaking. As little as 15 minutes of meditation a day can reduce feelings of depression and anxiety, increase positive emotions, and improve your immune response. We would all benefit from these two simple interventions.

Early traumatic experiences undoubtedly leave marks that last a lifetime. But most children manage to carry on and live normal lives. As a research psychologist, I seek to understand and help people who suffer the scars of painful, sometimes traumatic, experiences. But I never forget that we all possess resources of which we are often unaware. We would do well to remember our innate resilience, which is what allows us, as it did with my brother and me, to help ourselves.

Anthony Mancini is an assistant professor of psychology at Pace University.

*Photo courtesy of Mykl Roventine.

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Epidemiologists have found that childhood trauma leaves more than just bad memories. Children who suffer trauma often become adults with physical ailments like heart disease. And trauma can perpetuate trauma. Our states and cities have some programs in place that are intended to intervene in the lives of children to prevent trauma, but what more should we do? This was the question we posed in advance of “Can Childhood Trauma Make Your Sick?“, a Zócalo event.

Only Connect

Day after day I counsel people who have experienced trauma in their early childhood. They struggle with high anxiety, depression, lack of focus, mood issues, sleeplessness, dissociation from their bodies, and many other symptoms that impair their ability to function in school, jobs, or relationships.

Their suffering is often solitary. Children who have experienced trauma tend to lose trust in others. They launch into “survival mode” to shield themselves from future pain and regain the control they lost when their trauma made them feel powerless.

Survival mode can be a fantastic mechanism for helping us to endure trauma, but getting out of it can be hard. A heightened state of alert is fueled by a stress hormone called cortisol, and it takes a toll on the body. Medication has its place in tempering some of the stress, but doesn’t come close to the healing power of human connection.

In order to feel trust again and disengage from survival mode, traumatized people must feel safe. Those close to them must be calm, confident, and even-tempered, projecting strength upon which victims can draw to pull through their pain. When my clients trust me enough to disclose their trauma–and their experience is met with compassion and understanding–an overwhelming sense of relief washes over them. I see their anxiety diminish and a sense of calm envelop their bodies.

To be able to understand what a child is trying to communicate is the most satisfying feeling one can have. There is no kid or situation that is hopeless; it is simply a matter of us taking a step back to assess what language is being spoken. Kids and adults from traumatic and dysfunctional childhoods often speak the language of hurt, pain, loss and mistrust. We need to put our preconceptions aside to be receptive to their communication; only then can we truly understand their needs.

Mark Coen is a founder of the Attachment and Trauma Specialists, an agency specializing in the treatment of youth and adults with attachment and trauma-related issues.

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Create Circles of Support

Safe, healthy relationships typically beget strong, healthy children and adults. Impaired and insecure relationships beget children and adults with a greater vulnerability to stress and life challenges. Many factors can lead to stress in relationships, including mental illness, poverty, and historical adversity. Trauma may happen in close family relationships (as occurs with child maltreatment and domestic violence), and trauma may also happen in non-familial relationships–or effect non-familial relationships (as occurs with the abused child who acts out and then gets treated punitively by school personnel or the legal system).

The experience of childhood trauma is complex, and no single solution exists. However, a solid start involves an emphasis on building circles of support.

A child must be supported by a strong caregiving system that is in turn supported by a strong community. Childhood trauma is far too large and widespread to be “the problem” of any one group, any one community, or any one service system, and treatment targeted purely toward those already identified as having experienced trauma–while important–will limit the impact we can have on a challenge that cuts across demographic lines.

In the absence of circles of support, those who experience adversity often get further harmed by relationships and institutions that perpetuate that adversity. (Juvenile justice facilities–in which up to 90 percent of the residents have experienced traumatic stress-often do not have the training to reduce the effects of trauma, for instance.) Trauma isolates and divides, and a negative systemic response can exacerbate these effects. But we can counteract that if we increase our capacity, family-wide and community-wide, to create circles of support for the next generation and for those responsible for their care.

Margaret Blaustein, Ph.D. is the Director of Training at the Trauma Center at Justice Resource Institute in Boston, MA, and co-author of the text, “Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency.”

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Bring in Outside Help

Those of us who have raised children know what a challenging job it is in the best of circumstances. In the worst of circumstances, many parents fail–or, worse, abuse or neglect their children.

In our mobile society, a young family can be cut off from support and information from older and more experienced family members or neighbors. Therefore, making sure that all young families have support and information from other adults concerning child-rearing is important. One of the best programs for preventing childhood trauma is home visitation, in which nurses or well-trained paraprofessionals take information and support to the homes of families with small children. They also look for potential problems such as mental illness, family violence, or substance abuse.

The bottom line is that society needs more adults who are experienced to help younger and less experienced adults and teens. A parent mentor or assistant might be a good idea.

Dr. Kathy Seifert is a psychologist, entrepreneur, and author of How Children Become Violent, Youth Violence, and the CARE-2 Manual. She operates three public mental health clinics.

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Break the Silence on the Violence Suffered By Women

The facts are clear: far too many children in our country experience trauma. But equally clear is a silent epidemic of violence against girls and young women. Studies have found that 78 percent to 89 percent of child sexual-abuse victims are female. One third of all young women will experience sexual abuse before they reach the age of 18. Furthermore, 61 percent of all female rape victims are under the age of 18.

We all agree that we must prevent childhood trauma, but too few programs are in place–and even fewer are designed–to meet the specific developmental needs of girls and young women. The key to prevention is breaking the cycle of childhood trauma for girls in their families and communities. This requires more effective programs, services, and supports, but it also means that we must acknowledge the epidemic of abuse and demand support for the survivors. So let’s start simply by breaking the silence.

Jeannette Pai-Espinosa is president of The National Crittenton Foundation.

*Photo courtesy of gemsling.

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