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Experiencing childhood abuse or neglect is traumatic, and influences the individual’s health, relationships, brain development, and often leads to death. In 2019, 1,840 children in the United States died from abuse and neglect (National Child Abuse Coalition, n.d.). Most states regard maltreatment as physical abuse, neglect, sexual abuse, and emotional abuse (Child Welfare Information Gateway, 2019). Maltreatment tends to take place for extended timeframes, with many individuals experiencing multiple categories of maltreatment.
Adverse childhood experiences (ACEs) are traumatic events or experiences encountered by an individual before turning 18. These incidents can include abuse, neglect, witnessing domestic violence, or having a caregiver that struggles with mental health or substance abuse. Adverse childhood experiences alter brain development, affect stress response, & increase the risk of long-term health problems, including five of the leading ten causes of death in the United States (Centers for Disease Control and Prevention [CDC], 2019). A recent study on adults in the United States found that 61% of participants experienced one adverse childhood experience, and 16% reported experiencing four or more categories (Merrick et al., 2019), exhibiting a considerable increase compared to the original adverse childhood experience study. In Felitti et al.’s (1998) study, approximately 50% of individuals reported experiencing at least one adverse experience, and 6% reported experiencing four or more. Their study also found a dose-response relationship between the number of childhood experiences and the ten top leading causes of death, which signifies that the more categories experienced by the individual, the higher their risk is for future negative health outcomes. The increasing prevalence of individuals reporting adverse childhood experiences implies that the ratio of individuals at an elevated risk for severe long-term health issues is growing. Additionally, experiencing trauma during childhood can affect the individual’s relationships with others throughout their life. Experiencing maltreatment or trauma can negatively impact attachment style, prompting them to avoid intimacy in relationships or reluctance to be close to others. Childhood abuse or observing others experience a traumatic event can prompt many individuals to develop posttraumatic stress symptoms. Children experiencing posttraumatic stress disorder (PTSD) may display changes in mood and cognition, increased physiological arousal, distress, and avoid stimuli or situations that remind them of the trauma lasting at least a month in duration (American Psychiatric Association, [APA], 2013). However, not all individuals who experience trauma will develop posttraumatic stress disorder, as an individual’s interpretation of the event also plays a role in the development. Children under six years old do not demonstrate the same exaggerated pessimistic beliefs concerning themselves, others, and the world or distorted cognitions such as self-blame that older children do (APA, 2013). Age impacts posttraumatic stress symptoms displayed partially due to differences in communication skills. Nightmares are a common posttraumatic stress symptom in children, regardless of age; however, younger children tend to reenact the events during play compared to older children (APA, 2013). Experiencing multiple categories of maltreatment may exaggerate or increase the severity of posttraumatic stress symptoms. Potential risk factors in caregivers that can increase the probability of abusive behavior include experiencing job loss, substance abuse, posttraumatic stress disorder, having negative communication styles, or high rates of conflict (CDC, 2021). Additional social factors such as quarantines, social isolation, school closures, and low socioeconomic status increase the rate of abusive behavior (Cluver et al., 2020; Conrad-Hiebner & Byram, 2020; Peterman et al., 2020). School closures may increase abuse due to increased caregiver stress and more exposure to the abuser, with less contact with educators and other individuals likely to report abuse. Caregivers experiencing job loss during COVID-19 were five times more likely to psychologically abuse their children compared to caregivers that did not experience job loss (Lawson et al., 2020). Economic hardship or financial difficulties are positively correlated with abuse, causing individuals from lower socioeconomic status to be at an increased risk for abuse compared to other groups. This finding emphasizes the significance of implementing interventions that address the stressors associated with this life event. Trauma-focused cognitive-behavioral therapy (TF-CBT) is considered one of the most effective treatments for individuals impacted by trauma in reducing posttraumatic stress symptoms (Runyon et al., 2019). This intervention can be valuable for clients that experienced a single traumatic event or multiple. The intervention often incorporates the non-offending caregiver and child when working with children that have experienced abuse, which can decrease the possibility of revictimization by enhancing parenting skills (Walker et al., 2019). Selecting interventions that supply caregivers with the resources to better cope with stressors, improve parenting skills, and relieve distress, can decrease the probability of abusive behavior occurring again. Research indicates that trauma-focused cognitive-behavioral therapy effectively decreased internalizing and externalizing behavioral problems and improved affect regulation, self-concept, and interpersonal relationships for children that experienced sexual abuse (Hébert & Amédée, 2020). Providing children the tools to improve the harmful consequences trauma can have on self-concept, emotion regulation, posttraumatic stress symptoms, and relationships may decrease long-term consequences. Protective factors that decrease the probability of child abuse include households that focus on providing an environment where children receive the stability, support, and care needed (CDC, 2021). Caregivers with healthy communication styles, steady employment, have positive social support systems, and who can provide food, shelter, and medical care for their children are less likely to engage in abusive behavior. References
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