Children and Families

Violence is a significant causal factor in childhood and adolescent mental health problems, brain damage, substance abuse, developmental disabilities, school failure, and delinquency. Violence against children is a significant and inadequately addressed public health problem.

Facts and Discussion Points:

* People who are abused as children may be more prone to developing schizophrenia. A high rate of physical and sexual abuse is reported among children who were later diagnosed as schizophrenic. A particularly strong link exists between childhood abuse and the hearing of voices. Changes in the brain seen in abused children are similar to those found in adults with schizophrenia.1

* Adolescents with alcohol dependence are 6 to 12 times more likely to have a childhood history of physical abuse and 18 to 21 times more likely to have a history of sexual abuse than those without substance abuse problems.2

* The U.S. Department of Health and Human Services reported that almost 1 million children were identified as victims of abuse and neglect in 1996, and more than 1,000 children died as a result. A survey by the National Committee to Prevent Child Abuse indicated that more than 3 million children were suspected of being victims of abuse and/or neglect in 1998. In the United States, a child is reported abused or neglected every ten seconds. Every two hours, a child is a homicide victim. And every four hours, a child commits suicide.3

* Among juvenile girls identified by the courts as delinquent, more than 75% have been sexually abused.4

* About 3.9 million adolescents have been victims of a serious physical assault, and almost 9 million have witnessed an act of serious violence.5

* About 1.8 million adolescents have met diagnostic criteria for PTSD during their lives.6

* The level of exposure to catastrophic violence and loss together with the resulting posttraumatic stress have been found to be as severe in America’s inner cities as in post-earthquake Armenia, war-torn Bosnia, post-invasion Kuwait and other trauma zones. Yet, the United States has no formal public health policy to address the problem.7

* When failing adolescent students with severe PTSD symptoms were recognized and treated for trauma, their symptoms were markedly reduced, they required no further discipline, and their grade point averages went up significantly.8

* Three to six percent of all children have some degree of permanent disability as a result of abuse.9

* Between 20 and 50% of abused children suffer mild to severe brain damage.10

* Violence is a significant causal factor in 10 to 25% of all developmental disabilities.9,11

* Eighty-two percent of all adolescents and children in continuing care inpatient and intensive residential treatment programs in Massachusetts have histories of trauma as reflected by a point-in-time review of medical records.12

* The number of children whose lives have been disrupted by war, oppression, terror, and other forms of conflict has grown significantly—from 1.5 million refugees and displaced persons following WWII, to 14 million refugees and displaced persons by 2001. Many of these young people experience long-term physical and emotional health problems, including PTSD.13

Recommendations:

1--- SAMHSA should take the lead in developing a formal public health policy to address the problem of PTSD in children. This policy should caution service providers against overlooking or misdiagnosing abuse and PTSD symptoms as symptoms of Attention Deficit Hyperactivity Disorder (ADD), Oppositional Defiance Disorder (ODD), etc.

2--- Mandatory trauma assessment should be available for all children referred for behavior, learning, or emotional disturbances, followed by referral to appropriate trauma treatment.14-17

3--- Trauma training should be made available for juvenile justice settings.18

4--- SAMHSA should take the lead in developing and promoting a strength- and resiliency-based care program for children and adolescents who have immediate or past trauma histories. This program should be based on formal curriculum that includes pragmatic instruction, techniques and activities for children designed to promote emotional strength and to decrease vulnerability to stress, adversity and challenges.19

Children and Families References

1. Read, J. (Winter 2001). The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model. Psychiatry; Vol. 64 (4), pp. 319-45.

2. Clark, H. W., McClanahan, T. M., & Sees, K. L. (Spring 1997). Cultural aspects of adolescent addiction and treatment. Valparaiso University Law Review. Vol. 31(2).

3. Mazelis, R. (Summer/Fall, 1999). SIV: The context is trauma. The Cutting Edge: A Newsletter for Women Living With Self-Inflicted Violence. Vol. 10, Issues 2/3 (38/39).

4. Calhoun, O., Jurgens, E., Chen, F. (1993). The neophyte female delinquent: A review of the literature. Adolescence, 28, 461-471.

5. Kilpatrick, D. G., Saunders, B. E., Smith, D. W. (2001). Research in brief: Child and adolescent victimization in America: Prevalence and implications, pp.163-186. Washington DC: American Psychiatric Press, Inc.

6. Kilpatrick, et al., cited in Layne, C. M., Pynoos, R. S., Cardenas, J. (2001). Wounded adolescence. School-based group psychotherapy for adolescents who sustained or witnessed violent injury. In M. Shafii, & S. L. Shafii (Eds.), School Violence: Assessment, Management, Prevention (pp. 163-186). Washington, DC: American Psychiatric Press, Inc.

7. Pynoos, R. S. (1999). The legacy of violence and the restoration of our school communities. Plenary Address, National Education Association.

8. Saltzman, W. R., Pynoos, R. S., Layne, C. M., et al. (2001). Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5(4):291–303.

9. Sobsey, D. (1995). Violence and abuse in the lives of people with disabilities: The end of silent acceptance? In D. Valenti-Hein, & L. Schwartz. The sexual abuse interview for those with developmental disabilities. Santa Barbara, CA: James Stanfield Company.

10. Rose, E., & Hardman, M. L. (April 1981). The abused mentally retarded child. Education and Training of the Mentally Retarded, Vol. 16(2): 114-118.

11. Valenti-Hein, D., & Schwartz, L. (1995). The sexual abuse interview for those with developmental disabilities. Santa Barbara, CA: James Stanfield Company.

12. Heuberger. (March 2001). Massachusetts Department of Mental Health.

13. Berman, H. (July/August 2001). Children and war: Current understandings and future directions. Public Health Nursing, Vol.18, Issue 4.

14. Holaday, M. (August 2000). Rorschach protocols from children and adolescents diagnosed with Posttraumatic Stress Disorder. Journal of Personality Assessment (ISSN: 0022-3891), Vol. 75, No. 1, pp.143-157.

15. Ford, J. D., Racusin, R., Ellis, C. A., Davis, William, B., Reiser, J., Fleischer, A., & Thomas, J. (August 2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and Attention Deficit Hyperactivity Disorders. Child Maltreatment (ISSN: 1077-5595), Vol. 5, No. 3, pp. 205-217.

16. Ford, J. D., Racusin, R., Davis, William, B., Ellis, C. A, Thomas, J., Rogers, K., Reiser, J., Schiffman, J., & Sengupta, A. (October, 1999). Trauma exposure among children with oppositional defiant disorder and Attention Deficit-Hyperactivity Disorder. Journal of Consulting and Clinical Psychology (ISSN: 0022-006X), Vol. 67, No. 5, pp. 786-789.

17. Brown, R. W. (1999). An examination of the relationship between Posttraumatic Stress Disorder symptoms and conduct disordered behaviors (Dissertation, ISBN: 0-599-39945-7). Temple University.

18. King, S. A. (2000). PTSD: An overlooked diagnosis among adjudicated juvenile delinquents (Dissertation, ISBN: 0-599-68845-9). University of Hartford.

19. N. Stromburg (personal communication, April 2002).