By: Mary-Russell Roberson
June 1, 2023
A 2023 Preventing Child Trauma Summit Series Article

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When a child experiences physical or emotional trauma, the distress felt in the present moment signifies the beginning of a potential cascade of effects. “Child adversity casts a very long shadow,” said Lisa Amaya-Jackson, MD, professor of psychiatry at Duke and co-founder of the Center for Child and Family Health.

Whether a one-time event, such as a natural disaster or the death of a parent, or ongoing, such as neglect or abuse at home, trauma increases a child’s risk for a host of lifelong physical and mental health problems. Some children are more likely to experience trauma, including those from racial and ethnic minorities and LGBTQ youth.

The COVID-19 pandemic compounded the situation, with impacts ranging from interruptions in socialization and services at school to the loss of a parent or caregiver, not to mention the economic hardships exacerbated by the pandemic―all experiences that are likely to influence child development. “The effect [of the pandemic] on children may not be fully understood for years to come,” she said.

Amaya-Jackson spoke at a statewide summit, “Leveraging North Carolina’s Assets to Prevent Child Trauma,” sponsored by the UNC Frank Porter Graham Child Development Institute (FPG). Speakers shared evidence, experience, and strategies related to the effects of child trauma, how to prevent it, and how to intervene once it has already occurred to improve outcomes.

A Call to Action

“In this event, I wanted to bring everybody together to co-create a statewide movement with constituent groups rallying around the same cause,” said Diana “Denni” Fishbein, PhD, director of translational neuro-prevention research at FPG. “This summit is a call to action to all those entities across North Carolina invested in mitigating harmful consequences of trauma and preventing the exposure at the outset.” Fishbein co-organized the conference with Melissa Clepper-Faith, MD, MPH, translational research program and policy coordinator at FPG.

“All the scientific evidence suggests that while trauma has significant and long-lasting effects on wellbeing, there are numerous opportunities to build resilience and buffers through prevention and intervention,” said Aysenil Belger, PhD, professor of psychiatry at UNC-Chapel Hill. “We can do this.”

The sentiment was echoed by many of the in-person and virtual attendees, who represented academia, government agencies, community and state organizations, lived experience, policymakers, philanthropy, and more.

“There’s so much happening across all these different sectors,” said Kelly Graves, PhD, the director and co-founder of the Kellin Foundation. “Now is the opportunity to strategically align to make a bigger impact. We can make this happen.”

Well Documented Effects

Children who experience trauma show measurable differences in brain development and gene expression. They are at higher risk for mental illness and a range of unwanted outcomes in adulthood, such as substance use and abuse, and involvement in the criminal justice system.

The Great Smoky Mountain Study, which has followed more than 1,400 children in western North Carolina for 30 years, found that 70% of children reported at least one childhood incidence of violent trauma, sexual trauma, injury (car accidents, house fires, natural disasters), witnessing violence, or hearing about a violent event in the community. Children from disadvantaged backgrounds were more likely to report incidents like these than more advantaged children.

The study found that childhood trauma had lasting effects, with severe and/or chronic trauma leading to more mental health problems. “The number of different traumatic experiences that they reported in childhood tells us a lot about their risk for anxiety, depression, and substance abuse in adulthood,” said William Copeland, PhD, a professor of psychiatry at the University of Vermont. The effects persisted into adulthood, affecting health, social connectedness, criminal behavior, and financial stability. “The folks that experience the most [childhood trauma] are the ones we continue to see struggling across all areas of their life,” he said.

Other studies have documented biological effects of childhood trauma. Margaret Sheridan, PhD, assistant professor of psychology and neuroscience at UNC, compared brain MRIs of two groups of Romanian orphans: those who were raised in institutions with little one-on-one attention and those who were raised in high-quality foster care. She found physical and measurable differences in brain development at ages 9 and 16 that explained differences between the two group’s mental health, cognition, and stress response, with those raised in foster care having more typical brain development and behavioral development than those raised in institutions.

“This is proof that experiences early on are embedded in the brain,” she said.

Prevention, Mitigation, Intervention

There’s no one answer when it comes to preventing child trauma, which has myriad causes and can perpetuate itself through generations when people who haven’t healed from child trauma become parents. Furthermore, some of the root causes, such as poverty, health disparities, and structural racism, are ongoing and pervasive. “It’s impossible to heal from something you’re still experiencing,” said Vernisha Crawford, MS, CEO of Trauma Informed Institute and founder of the BYE Foundation.

It's a formidable challenge, but there are many strategies that have been shown to help. “Child maltreatment and trauma are preventable and our policy choices can make a huge difference,” said Sharon Hirsch, president and CEO of Prevent Child Abuse North Carolina.

Many of these policies revolve around providing support to parents, such as increased child tax credits, family-friendly workplace practices, home visits by a nurse or social worker soon after the birth of a child, and high-quality early childhood education. “If we say we’re going to help children, we gotta start by helping parents,” said Kara “Kai” Sanders, who has experienced being unhoused with her young son.

“Prevention is costly,” said Jane Cooley Fruehwirth, PhD, professor of economics at UNC-Chapel Hill, “but the benefits outweigh the costs by far.”

Not all child trauma can be prevented, but its negative effects can be mitigated with positive experiences, such as a supportive relationship with an unrelated adult, a healthy community, and access to mental health treatment. Conference attendees from local and statewide organizations and agencies described ways they are strengthening these protective factors.

Across the variety of successful programs and strategies ran a common thread of ongoing collaboration and the desire for new connections among both organizations and individuals, including those with lived experience of trauma.

“None of us has all the answers,” said Jen Neitzel, PhD, director of Educational Equity Institute. “That’s why we have to have lots of different people at the table. People without fancy degrees have answers too. Listen to people and ask about their trauma and what they need to heal.”