What Is Traumatic Stress? Childhood exposure to traumatic events is a major public health problem in the United States. Research has shown that exposure to traumatic events early in life can have many negative effects throughout childhood and adolescence, and into adulthood. Children who suffer from child traumatic stress are those who have been exposed to one or more traumas over the course of their lives and develop reactions that persist and affect their daily lives after the traumatic events have ended.1 Traumatic events can include witnessing or experiencing physical or sexual abuse, violence in families and communities, loss of a loved one, refugee and war experiences, living with a family member whose caregiving ability is impaired, and having a life-threatening injury or illness. According to the Centers for Disease Control and Prevention, almost 60 percent of American adults say that they endured abuse or other difficult family circumstances during childhood.2
What Is Historical Trauma? Sometimes referred to as “multi-generational trauma,” historical trauma is the collective emotional and psychological injury both over the life span and across generations, resulting from a cataclysmic history that occurs as a result of genocide and other significant abuses.3 Historical trauma has been experienced by several cultural and ethnic communities. For instance, some Native American and Alaska Native communities talk about the historical trauma they have experienced in the United States based on shared experiences like displacement, forced assimilation, language and culture suppression, and forced attendance at boarding schools. Powerlessness and hopelessness are associated with historical trauma that likely contributes to high rates of alcoholism, substance abuse, suicide, and other health issues. Increasingly, prevention programs are using culture-based strategies to address the effects of historical trauma in individuals, families, and communities.
What Is Resilience? Resilience is the ability to adapt well over time to life-changing situations and stressful conditions. While many things contribute to resilience, studies show that caring and supportive relationships can help enhance resilience. Factors associated with resilience include, but are not limited to:
- The ability to make and implement realistic plans;
- A positive and confident outlook; and
- The ability to communicate and solve problems.4
- More than 25 percent of American youth experience a serious traumatic event by the age of 16, and many children suffer multiple and repeated traumas.5
- For children, traumatic stress can interfere with concentration, learning, and developmental delays. It can lead to other problems related to mental health, substance abuse, education, behavior, and employment. It may also change children’s views of the world, perceptions of the future, behaviors, interests, and relationships.6
- If left untreated, child traumatic stress can interfere with a child’s healthy development and lead to long-term difficulties with school, relationships, jobs, and the ability to participate fully in a healthy life. As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression, alcoholism, drug abuse, suicide attempts, heart and liver disease, pregnancy problems, high stress, uncontrollable anger, and family, financial, and job problems.6
- In 2010 dollars, the estimated average lifetime cost per victim of child maltreatment is $210,012, including:
- $32,648 in childhood health care costs;
- $10,530 in adult medical costs;
- $144,360 in losses in productivity;
- $7,728 in costs related to child welfare;
- $6,747 in costs related to criminal justice; and
- $7,999 in special education costs.7
- The incidence of post traumatic stress disorder (PTSD) among youth in the juvenile justice system is similar to youth in the mental health and substance abuse systems, which is up to eight times higher than comparably aged youth in the general, community population.8
- The prevalence of PTSD is higher among incarcerated female youth (49 percent) than among incarcerated male youth (32 percent), and higher than among youths in the community (less than 10 percent).9
- Most youth who experience psychological trauma recover healthy functioning, but as many as half of the youth in the juvenile justice system experience chronic health and psychological impairments related to trauma.9
- A major research study involving youth in juvenile justice system shows that 92.5 percent had experienced at least one trauma, 84 percent had experienced more than one trauma, and 56.8 percent were exposed to trauma six or more times.10
- Seventy percent of youth in the juvenile justice system have been diagnosed with mental health disorders and 27 percent experience disorders that significantly impair their ability to function on a day to day basis. These rates are approximately 3 times those in the general population.10
- A major study of adults who had been in foster care found higher rates of PTSD (21.5 percent) compared with the general population (4.5 percent). Adults who had been in foster care had higher rates of PTSD than American veterans of war (15 percent in Vietnam veterans, 6 percent in Afghanistan veterans, and 12 percent to 13 percent in Iraq veterans). Adults who had been in foster care also had higher rates of major depressive episodes, social phobia, panic disorder, generalized anxiety, addiction, and bulimia.11
- Children and youth in child welfare systems usually have experienced one or more caregiver-related trauma, such as abuse or neglect.12
- A study involving more than 2,200 children in child welfare systems12, 13 found that:
- More than two-thirds of youth reported exposure to at least two of the following chronic traumatic experiences involving a caregiver: physical, sexual, and emotional abuse, neglect and domestic violence.
- More than four in five youth were diagnosed with a mental health disorder, such as depression or generalized anxiety disorder
- The average number of types of traumatic exposures for those sampled in the report was at least five
- Youth who were white, non-Hispanic, and residing in foster care were more likely to have complex trauma histories than those in other racial/ethnic groups.
- Abuse and neglect can disrupt attachment and stem the development of important relational capacities. Nearly 35 percent of children and youth who are reported for maltreatment demonstrate significant deficits in social skills.14
- A major study conducted by the Centers for Disease Control and Prevention looked at the long-term effects of exposure to seven categories of emotional, physical, or sexual abuse, and household dysfunction during one’s childhood. The study found that the when compared to people with no exposure to these categories, those who had experienced at least four categories during childhood, had a:
- 4- to 12-fold increase risk for alcoholism, drug abuse, depression, and suicide attempt;
- 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse partners, and sexually transmitted disease; and
- 1.4- to 1.6-fold increase in physical inactivity and severe obesity.15
- Nearly 1 in 10 American children saw a family member assault another family member, and more than 25 percent had been exposed to family violence during their life.16, 17
- School climates can promote or discourage positive and negative behavior among students. Furthermore, social norms that exist within schools may worsen behavior problems such as bullying and victimization.18
- Youth who were maltreated early in life had lower grades, lower standardized test scores in language arts, had twice as many school absences and school suspension than those who were not maltreated. For youth in the 11th grade, their mothers reported that those who were maltreated early in life had “levels of aggression, anxiety/depression, dissociation, delinquent behaviors, PTSD, social problems, thought problems, and social withdrawal that were, on average, twice as high as those of their nonmaltreated counterparts.”19
- Children and youth may react to the death of a parent or someone close to them more intensely. In some of these instances, children and youth may develop childhood traumatic grief, which includes symptoms associated with PTSD. Children and youth in military families may experience trauma if they experience the death of a loved one that was sudden, traumatic, and terrifying. Children and youth may experience post-traumatic stress reactions after a deployed parent or caregiver was killed in combat, but symptoms may occur weeks or months later.20
- When a military parent or caregiver dies, their children may experience additional stress that intensifies their loss. For instance, they may move from their home on a military installation to a new community where no one is aware of their connection to the military or the circumstances regarding their family member's death. These children and youth may also lose their “military” identity in addition to losing the friends, activities, schools, or care providers that they have known through their relationship with the military. As members of a new community, these children and youth must also make tough decision about what they wish to share about their experiences related to the military.20
- National Child Traumatic Stress Network. Retrieved from http://www.nctsn.org/resources/audiences/parents-caregivers/what-is-cts
- Centers for Disease Control and Prevention, (2010). Mortality and Morbidity Weekly Report, 59, 1609–1613.
- Native American Center for Excellence. Retrieved from http://nace.samhsa.gov/HistoricalTrauma.aspx, and Yellow Horse Brave Heart, M. Retrieved from http://www.class.uidaho.edu/engl484jj/Historical_Trauma.htm and http://historicaltrauma.com/
- American Psychological Association. Adapted from “The Road to Resilience.” Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx
- Costello, E. J., Erkanli, A., Fairbank, J. A. and Angold, A. (2002), The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress, 15: 99–112. doi: 10.1023/A:1014851823163
- National Child Traumatic Stress Network. (ND). National Center for Child Traumatic Stress Online Press Kit. http://www.nctsnet.org/resources/audiences/for-the-media/online-press-kit#q5 . Last accessed April 11, 2012.
- Xiangming Fang, Derek S. Brown, Curtis S. Florence, James A. Mercy. (February 2012). The economic burden of child maltreatment in the United States and implications for prevention, Child Abuse & Neglect, 36(2), 156-165 Retrieved from: http://www.sciencedirect.com/science/article/pii/S0145213411003140
- Abram, K.M., Teplin, L.A., Charles, D.R., Longworth, S., McClelland, G., & Dulcan, M. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61, 403-410.
- Arroyo, W. (2001). PTSD in children and adolescents in the juvenile justice system. In J.M. Oldham & M.B. Riba (Series Eds) & S. Eth (Vol. Ed.), Review of Psychiatry Series: Vol. 20, Number 1. PTSD in Children and Adolescents. Washington DC: American Psychiatric Publishing.
- Tepin, L., Abram, K., Washburn, J., Welty, L., Hershfield, J., and Dulcan, M. (In Press) PTSD, Trauma and Co-Morbid Psychiatric Disorders in Detained Youth and the Northwestern Juvenile Project Overview.
- Pecora, P. J., Kessler, R. C., Williams, J., O'Brien, K., Downs, A. C., English, D., White, J., Hiripi, E., White, C. R., Wiggins, T., & Holmes, K. E. (2005). Improving family foster care: Findings from the Northwest Foster Care Alumni Study. Seattle, WA: Casey Family Programs. Retrieved from http://www.casey.org/Resources/Publications/pdf/ImprovingFamilyFosterCare_FR.pdf (PDF - 1.6 mb). Last accessed April 11, 2012.
- National Child Traumatic Stress Network. (2011) FACTS FOR POLICYMAKERS: Complex Trauma and Mental Health of Children Placed in Foster Care, Highlights from the National Center for Child Traumatic Stress (NCCTS) Core Data Set. Retrieved from http://www.nctsnet.org/sites/default/files/assets/pdfs/policybrief4_complextrauma.pdf (PDF - 155 kb). Last accessed April 3, 2012.
- Greeson, J. K. P., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., Ko, S. J., Gerrity, E. T., Steinberg, A. M., Howard, M. L., Pynoos, R. S., & Fairbank, J. A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91-108
- Casanueva, C., Ringeisen, H., Wilson, E., Smith, K., & Dolan, M. (2011). NSCAW II Baseline Report: Child Well-Being. OPRE Report #2011-27b, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Retrieved from http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/nscaw2_child/nscaw2_child.pdf (PDF - 864 kb). Last accessed April 11, 2012.
- Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks. (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14(4), 245. Retrieved from http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract . Last accessed April 11, 2012.
- Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’s Exposure to Violence: A Comprehensive National Survey. Bulletin. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention. Retrieved from http://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf (PDF - 902 kb) or http://www.unh.edu/ccrc/projects/natscev.html
- Finkelhor, D., Turner, H., Hamby, S., and Ormrod, R., 2011. Polyvictimization: Children’s Exposure to Multiple Types of Violence, Crime and Abuse. Bulletin. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention. Retrieved from http://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf (PDF - 902 kb) or http://www.unh.edu/ccrc/projects/natscev.html
- Wilson D. (2004). The interface of school climate and school connectedness and relationships with aggression and victimization. Journal of School Health, 74, 293-299.
- Jennifer E. Lansford; Kenneth A. Dodge; Gregory S. Pettit; John E. Bates; Joseph Crozier; Julie Kaplow. (2002). A 12-Year Prospective Study of the Long-term Effects of Early Child Physical Maltreatment on Psychological, Behavioral, and Academic Problems in Adolescence. Archives of Pediatric Adolescent Medicine, 156(8), 824-830. http://archpedi.ama-assn.org/cgi/content/full/156/8/824 . Last accessed April 2, 2012.
- National Child Traumatic Stress Network. (2008). Traumatic Grief in Military Children: Information for Educators. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress. Retrieved from http://www.nctsnet.org/sites/default/files/assets/pdfs/military_grief_educators.pdf (PDF - 1.9 mb) Last accessed April 2, 2012.