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ACEs Risk Factor #6: Trauma


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Disasters (9/11, Katrina, COVID-19, School Shooting)

Situations or events that create a serious disruption in the functioning of a community and overwhelm its capacity to deal with the widespread loss and destruction created by the event are called disasters. Disasters can be man-made (9/11,  Sandy Hook), natural (Katrina, Harvey, fires), health (COVID-19/Coronavirus), or technological (Chemical Spills, Power Outages). On average, at least one disaster occurs every day around the world Overstreet (2011).

After a natural disaster, 30-90% of affected children exhibit signs of Posttraumatic Stress Disorder (PTSD) and depression. The psychological response of a young child greatly depends on the reactions of their caregivers; new mental problems could directly correlate with new mental problems of their mother. Children lack the language necessary to express helplessness or fear and instead will show their distress in behavioral changes, such as: loss of developmental skills (toileting, speech), sleep problems, and excessive clinginess. Older children will show signs of distress by decreased academic performance, increased inattention, aggressive behaviors, or physical complaints (head/stomach aches).

After a disaster, adults may be too busy dealing with their own loss of job or home to attend to the children's needs. Children may be more concerned with the experience of losing a loved one, close friend, or family pet as a result of a disaster and may pay no attention to the fact their house was swept away in the aftermath flooding. Family members may experience a prolonged health condition (heart disease, diabetes), resulting in death a few months to a year after the disaster. Loss may continue due to the impact of a disaster on the community and its available resources.

Disasters cause a disruption in the normal routine of children and may result in a social disconnect from needed support networks, such as:

  • Peer Groups
  • Extended Family
  • Schools
  • Child Care Centers

Historical/Parental

25-50% of all children worldwide are affected by child maltreatment, leading to ongoing impacts on physical, social, and emotional health. Parents may experience trauma triggers or fear responses in the first two years (perinatal period) of caring for their distressed child. The long-term effects could lead to intergenerational cycles of trauma, due to the parent's failure to nurture a lasting relationship with the child Chamberlain (2019).

Outcomes of child maltreatment include:

  • Smoking
  • Eating Disorders
  • Unplanned/Teen Pregnancy
  • Depression/Stress/PTSD
  • Substance Use
  • Domestic Violence
  • Poor Parenting Practices
  • Values Corporal Punishment
  • Adverse Birth Outcomes
  • Legal Problems
  • Physical Problems
  • Psychological Problems
  • Poor Social Functioning
  • Poor Relationships
  • Sleep Problems
  • Overeating/working
ACE Risk Factor #6: Trauma

Resilience does not typically develop from a traumatic childhood. The transition to parenthood can also be a time of healing and growth. By restoring a sense of safety through nurturing, supportive relationships.

This transformation positively reinforces elements of healing by replacing the "vicious cycle" with a "virtuous cycle".

Factors that protect against the cycle are:

  • Financial Stability
  • Resource Access
  • Partner Warmth
  • Practicing Self-Care
  • Parent Training
  • Positive Attitude
  • Secure Attachment
  • Resilience
  • Attending Counseling
  • Meditation
  • Volunteering
  • Exercise
  • Parent Satisfaction
  • Less Harsh Parenting

Three phases of healing include:

Understanding the experience of trauma and "meaning making"

  • Thinking/talking through past trauma for prevention

Acting on conscious strategies to address the effects of trauma

  • Leaving violent partner for child's safety

Commitment to not pass on the effects of trauma

  • Determination to parent differently

Death of Family Member/Close Friend/Pet/Marriage

Death of a family member can include parents, siblings, grandparents, etc. Attachment theory suggests that humans have a biosocial urge to seek a feeling of security through connection with others in the face of a challenging outside world environment Marks (2007). In the event of a parental death, the lineage placement (or generational transition/leadership) and its accompanying responsibilities/challenges shift as a result. For example, in the absence of a father, the male (most times the eldest, but not always) will feel obligated to step up and take care of his sisters/siblings. In the absence of a mother, the female (usually the eldest) will take on the responsibility of caregiver to the younger siblings and sometimes the grieving father.

A large portion of literature analyzes child mortality and policy interventions, but few shine a spotlight on the effects of child mortality on other family members. Sibling death can impact the remaining children's development and healthy transition into adulthood. Parents view the death of a child as a profound loss that may result in marital problems, depression, health problems, and neglect of the surviving children Fletcher (2013).

Due to the perception of a close friend/pet (or non-kinship) being of lower status than blood relatives, the experience of grieving the death of a friend/pet receives less social support. Physical and emotional support is needed for up to four years after the death. Responses are influenced by:

  • Age
  • Gender
  • Race
  • Religion
  • Personality (Altruistic)
  • Mental Health

The death of a marriage (or divorce) can be devastating for the entire family, parents, children, (sometimes grandparents/other relatives), the economy, and society. Many adults feel that open cohabitation relationships are more conducive to personal development. If a relationship does not provide personal happiness, then parents believe that divorce or separation is best and will not be detrimental to the function of the family. Before no-fault divorce laws, only the most dysfunctional marriages ended in divorce because legal procedures were difficult and expensive Anderson (2014).

As a result of a divorce, children may:

  • Lose time with each parent - Grief, Anger, Shared Visits
  • Lose economic security - 25-50% income loss
  • Lose emotional security - Weakened family relationships
  • Social/Psychological maturity - Anxiety, depression
  • Change outlook on sexual behavior - Less trust/earlier sex
  • Lose religious faith/practice - More likely to abandon
  • Lose cognitive/academic stimulation - Failing a grade
  • Be less physically healthy
  • Higher Emotional Distress Risk - Violence, neglect

Incarceration - Jail/Prison

Family members of incarcerated individuals are often referred to as "hidden victims" — victims of the criminal justice system who are neither acknowledged, heard, nor given personal support Martin (2017). Nearly 5% of all children in foster care entered because of parental incarceration Wildeman (2018). Children who entered foster care because of parental incarceration were found to remain in foster care for significantly longer than children who entered for other reasons.

Incarceration has negative effects on prenatal health, such as fewer prenatal care visits and is associated with other stressors that could indirectly stress fetal health or result in infant/child mortality.

Parental incarceration was found to be associated with:

  • Poor overall health
  • Learning disabilities
  • Developmental delays
  • Migraines
  • Negative educational outcomes
  • Risk of criminality
  • Family structure disruption
  • Asthma
  • Obesity
  • Speech/language problems
  • PTSD
  • Risk of drug use/abuse
  • Risk of incarceration
  • Economic instability/Stigma

Mental health problems include:

  • ADD/ADHD
  • Depression
  • Psychological strain
  • Anxiety
  • Behavioral problems
  • Antisocial

Little attention is given to the effects of separations and stressful situations that children face when parents are involved in the criminal justice process, such as: arrest, pre-trial detention, conviction, jail, probation, imprisonment, and parole.


Foster Care

1 in 200 U.S. children are in foster care on any given day. 75-80% of foster children are taken from their home due to inadequate care by the parent, such as: physical/mental illness, imprisonment, drug addiction, unaware of parental responsibility, child abuse, neglect, or abandonment. 15-20% enter the system because they have problems the parent cannot cope with, such as: mental retardation or physical handicaps. Less than 5% are caused by environmental factors, such as: financial need, inadequate housing, unemployment, or poverty McDonald (1992).

Foster family care was recommended as the best substitute for a natural home at a White House Conference of Children in 1909, as opposed to orphanages, institutions, or almshouses (which housed children and insane, senile, or diseased adults).

The hierarchy of goals in planning permanent placement included:

  1. To keep the child in the home, unless it was imperative to remove him/her
  2. Timely reunification of the child with his/her family
  3. Adoption
  4. Guardianship
  5. Long-term foster care

Foster care impacts the child in a variety of ways, such as:

  • Education - below average performance in school
  • Poor Physical/Mental Health - anxiety, depression, low self-esteem
  • Relationships - trouble forming stability in parenting, socially
  • Financial - foster/biological family provide economic support
  • Homelessness - among the homeless are many former foster children

Some situations involve dangerous environments for the children and the parent makes the decision to give up the children so that they may have a chance at a better life, essentially to save the child, such as: history of incest, mental illness, or maltreatment.

Other situations may include a rebellious teenager, the parent also makes the decision to put the child in foster care, essentially giving up on parenting.

A segment of the foster care system that rarely receives any attention are any biological children in the home while the foster children are residing with the foster family. The majority of attention is given to the foster child's adjustment, their appointments, meetings, and amount of payment received according to the child's "level". Many future foster parents fail to think about the effects of housing foster children who have been abused, neglected, or traumatized with their biological children who are less likely to have experienced any of the mentioned traumas.

Age and type of abuse can determine how the foster child's former experiences will manifest while in the home, such as: a foster child sexually abusing a younger biological child for years while the abuse goes on unaddressed, essentially risking the childhood of your own children to help piece together and salvage the childhood of someone else's children.


Failed Adoption

Approximately 50,000 children are adopted in the U.S. each year from foster care, compared to private and international adoptions. Most children enter foster care as because of abuse, neglect, or prenatal substance exposure (alcohol, cocaine) Doubledee (2015). These children are at a greater risk of negative outcomes due to pre-adoption experiences, such as: higher rates of mental illness and behavioral problems. Negative outcomes are reduced when the child enters a warm, loving, familial environment.

Massachusetts' 1851 Adoption of Children Act first recognized children's best interests in adoption law as a social and legal institution based on the welfare of the child and not benefit of the adult, as free laborers to businesses/individuals. Government involvement is highest in foster care adoptions because the state assumes guardianship "in loco parentis" or in place of the parents. Although, children may adapt to long-term foster care, once they reach adulthood, they often experience obstacles due to lack of support systems, such as: homelessness, incarceration, joblessness, and low education levels. It is assumed that adoption reduces the obstacles that emancipated foster children would face because it offers permanent parental support.

The children of adoption suffer the trauma of separation from the biological mother; placement in foster homes or orphanages; separation again if finally adopted – all disruptions that certainly could and most likely do, contribute to the high number of troubled teen and adult adoptees with a myriad of mental & physical illnesses in higher numbers than their age-peers.

What happens when their "forever home" turns into a failed adoption also known as post-permanency discontinuity? 1%-15% of adoptions result in children returning to foster care. This could occur due to the death of the adoptive parent or for a variety of other reasons. Age was found to be a consistent association with post-adoption challenges, the older the child at the time of adoption the more difficulty they encountered with adjusting to their adoptive families Rolock (2018).

Failed adoption can include:

  • You were adopted but returned to foster care
  • " " but unwanted by the family; one way in public-different behind closed doors
  • " " but parents were alcoholics, abusive-sexually, physically, emotionally

References

Anderson J. (2014). The impact of family structure on the health of children: Effects of divorce. The Linacre quarterly, 81(4), 378–387. https://doi.org/10.1179/0024363914Z.00000000087

Chamberlain, C., Gee, G., Harfield, S., Campbell, S., Brennan, S., Clark, Y., Mensah, F., Arabena, K., Herrman, H., Brown, S., & ‘Healing the Past by Nurturing the Future’ group. (2019). Parenting after a history of childhood maltreatment: A scoping review and map of evidence in the perinatal period. PloS one, 14(3), e0213460. https://doi.org/10.1371/journal.pone.0213460

Doubledee, R. (2015). The Effects of Adoption on Foster Children's Well-Being: A Systematic Review. https://www.researchgate.net/publication/309563739_ The_Effects_of_Adoption_on_Foster_Children%27s_Well-Being_A_Systematic_Review

Fletcher, J., Mailick, M., Song, J., & Wolfe, B. (2013). A sibling death in the family: common and consequential. Demography, 50(3), 803–826. https://doi.org/10.1007/s13524-012-0162-4

Liu, W-M., Forbat, L., Anderson, K. (2019). Death of a close friend:Shortand long-term impacts on physical, psychological and social well-being. PLoSONE 14 (4):e0214838.https://doi.org/10.1371/journal.pone.0218026

Marks, N. F., Jun, H., & Song, J. (2007). Death of Parents and Adult Psychological and Physical Well-Being: A Prospective U.S. National Study. Journal of family issues, 28(12), 1611–1638. https://doi.org/10.1177/0192513X07302728

Martin, E. (2017). Hidden Consequences: The Impact of Incarceration on Dependent Children. National Institute of Justice Journal (278). https://nij.ojp.gov/topics/articles/hidden-consequences-impact-incarceration-dependent-children

McDonald, T., Allen, R., Westerfelt, A., & Piliavin, I. (1992). What We Know about the Effects of Foster Care. Institute for Research on Poverty at the University of Wisconsin - Madison, 22-34. DOI: https://www.irp.wisc.edu/publications/focus/pdfs/foc142g.pdf

Overstreet. S., Salloum, A., Burch, B., & West, J. (2011). Challenges Associated with Childhood Exposure to Severe Natural Disasters: Research Review and Clinical Implications, Journal of Child & Adolescent Trauma, 4(1), 52-68. DOI:https://www.tandfonline.com/doi/full/10.1080/19361521.2011.545103

Rolock, N., Blakey, J. M., Wahl, M., & Devine, A. (2018). The evolution of challenges for adoptive families: the impact of age as a framework for differentiation. Journal of Adolescent and Family Health, Vol. 9 : Iss. 1 , Article 3. Available at: https://scholar.utc.edu/jafh/vol9/iss1/3

Wildeman, C., Goldman, A., Turney, K. (2018). Parental Incarceration and Child Health in the United States, Epidemiologic Reviews, 40(1), 146–156, https://doi.org/10.1093/epirev/mxx013


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Resources

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Adverse Childhood Experiences - Healing Journey Workbook - A Self-Reflection Based Action Plan to Healing Body, Mind, and Spirit - Digital Download
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