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The Link Between Childhood Trauma and Adult Disability

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Trauma is one of this country’s most urgent public health issues.  In a Center for Disease Control Report of 2019, Americans who had experienced adverse childhood experiences (“ACEs”) were at a higher risk of dying from five of the top ten leading causes of death.  The reported noted that one in six children across the United States had experienced four of more kinds of adverse childhood experiences.  An “adverse childhood experience” is defined in a landmark 1998 study by Kaiser Permanente as physical, sexual and emotional abuse; living with household members who abuse substances, had mental illness or were suicidal, violent treatment of mother/stepmother; and criminal behavior in the household or imprisonment of a household member.

The National Institute of Health reports that trauma affects a person’s mental and physical health, employment, education, and social functioning. Childhood trauma, particularly those that are interpersonal, intentional and chronic are associated with greater rates of PTSD, depression, anxiety and antisocial behaviors, including alcohol and substance abuse disorders  Secondarily, exposure to a traumatic event or a series of traumatic events (e.g. child maltreatment) activates the body’s biological stress response system.  Stress activation has biological, behavioral and emotional effects.

The majority of abused or neglected children have difficulty developing strong, healthy attachments.  Children who do not have strong healthy attachments have trouble controlling and expressing emotions and may react violently or inappropriately to situations.  A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures such as teachers or police officers.

Childhood trauma also affects the body’s biological development.  When a child grows up afraid or under constant or extreme stress, the immune system and body’s stress response system may not develop normally.  Later when the adult is exposed to even ordinary stress, these systems may automatically respond as if the individual is under extreme stress.  Children with complex trauma history may develop chronic or recurrent physical complaints such as headaches or stomach aches.  Adults with trauma histories have been shown to have more chronic physical conditions and problems.  They may also engage in risky behaviors that compound these conditions.

Children who have complex trauma often have difficulty expressing and managing emotions and may have limited language for their feelings.  They often internalize or externalize stress reactions and as a result may experience significant depression, anxiety or anger.  Dissociation is often seen in children with complex trauma histories.  When children encounter an overwhelming and terrifying experience they may dissociate or mentally separate themselves from the experience.  They may even lose all memories or sense of the experience having happened to them, resulting in gaps in time or even gaps in personal history.  This may have an adverse effect on learning, classroom behavior and social interactions.

Traumatic childhood experiences – such as emotional and physical abuse and neglect, early loss of caregivers and insecure attachment – are reported in 85% of patients with various psychiatric disorders.  Problems with social cognitive function are a hallmark feature of major psychiatric disorders resulting in poor social and occupational functioning, specifically with regard to emotion recognition and regulation.  Traumatic early social environment often leads to social cognitive problems and greater illness severity for people.  Currently nine million individuals receive SSDI Disability and 8 million individuals receive SSI Disability.  Of those 35.2% qualify based on a mental health condition.

Supportive, nurturing relationships and environments for both children and families are at the heart of prevention, according to the 2019 CDC report, which describes six approaches to prevention. Those approaches include strengthening economic support for families, helping parents and youth better handle stress, as well as improved access to primary care screening for childhood trauma when it occurs.