Trauma & Stigma

Adverse Childhood Experiences (ACEs)?

A large study has shown that children who have had difficult social and emotional experiences in childhood (ages 0–17 years) are at risk of developing lifelong physical and mental health problems as adolescents and adults.^[1] These experiences, known as Adverse Childhood Experiences (ACEs), include exposure to verbal abuse, physical abuse, neglect, sexual abuse, having a mother who has been exposed to violence, household substance abuse, household mental illness, a relative sent to prison, and parental separation or divorce. The research shows that exposure to several ACEs may lead to lifelong physical and mental health problems that emerge in adolescence and remain into adulthood,^[2] including depression, alcohol and drug abuse which also increases the risk of smoking, obesity, employment difficulties, physical health issues such as diabetes, cancer, heart disease, and stroke, being at higher risk of contracting a sexually transmitted disease and attempting suicide.^[3] 

Unfortunately, exposure to ACEs are common – about 60% of adults have had at least one ACE, and over 16% have experienced four or more ACEs. Studies show that having four adverse childhood experiences was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema. An ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide. More recent studies show that certain social factors, such as exposure to violence, racism, and poverty can also be adverse experiences for particular groups of children, leading to higher risk of disease among adults from specific populations.^[4] 

What Can We Do about ACES? 

It's important to know about ACEs and the ACEs study so we can do something to help children and youth who are exposed to these harmful events before they develop behavior problems that lead to long-term physical disease, substance use disorders, and mental health issues. Treatments that focus on supporting children and youth to process and understand what has happened to them and that build resilience are key, especially treatments at a young age. Treatment should include the family or caregivers and should include an assessment of the child’s history. Early signs of problems reacting to ACEs include problems relating to adults and other children, behavior problems, problems in school, development problems, eating problems, unusual anxiety and fear, or extreme withdrawal from typical activities. 

Additional Info and Resources

• Visit this Centers for Disease Control website for more information about ACEs Or watch this CDC video about how to prevent ACEs: 
• Harvard Center for the Developing Child FAQ page about ACEs

What Is Trauma and How Can It Impact Children and Youth?

A traumatic event is one that is frightening, dangerous, or violent and that poses a threat to a person’s feelings of safety or well-being. Witnessing a traumatic event that threatens the life of or is physically harmful to a loved one can also be traumatic. This is particularly true for young children, as their sense of safety and security depends on the people they love and who take care of them.

Traumatic events can include:

• Psychological, physical, or sexual abuse or witnessing such abuse of another person
• School or community violence
• The sudden or violent loss of a loved one
• Being a refugee or experiencing war
• Neglect
• Being in a serious accident or having a life-threatening illness

Children exposed to traumatic events may have reactions such as an inability to sleep, terror, helplessness, or fear, as well as physical reactions such as heart pounding, vomiting, or loss of bowel or bladder control. This is normal and can be treated with short-term therapy.

Traumatic Stress: The Result of Multiple Exposures to Trauma

When a child is exposed to repeated traumatic events, they may develop traumatic stress and longer-term problems after the events have ended. Every child differs, but the child who has traumatic stress may show intense and ongoing emotional upset; be depressed, withdrawn, or overly anxious; have concerning behavioral changes; problems controlling their emotions or relating to others or forming attachments; regression or loss of skills they had before; attention and academic difficulties; nightmares or difficulty sleeping and eating; and physical symptoms, such as aches and pains. Adolescents may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity. Consult with a trained clinician if you see any of these problems.

Learn more about traumatic stress in children

What You Can Do if You Think a Child or Youth is Experiencing Traumatic Stress

We can’t always protect children from bad things such as traumatic events, but it is important to know that even very young children may be impacted by these events. Not all children experience child traumatic stress after a traumatic event, but those who do can recover. With proper support, many children overcome such experiences and go on to lead happy and healthy lives.

For more information about what you can do if you think a child or youth is experiencing traumatic stress, visit Recognizing and Treating Child Traumatic Stress from the National Child Traumatic Stress Initiative by SAMHSA.

The first step you can take is to reassure the child that they are safe and that you are going to try to help them. You also want to get a screening or mental health assessment for the child or youth to find out what is happening and to find the best treatments or supports. These assessments almost always include an interview with the parent or primary caregiver. For more information on assessments and screenings, the National Child Traumatic Stress Network created this helpful resource about trauma screening tools and processes.

Places you can go for a mental health or trauma assessment include:

• Your community mental health center
• A Federally Qualified Health Center
• A family resource center
• Your child’s school counselor or school psychologist
• Your child’s primary care doctor

Eligibility for these providers varies, so check with your healthcare insurer for guidance.

Additional Resources on Trauma

• New Hampshire Family Voices lists several books and resources that you and your child can use to learn more about trauma
• Ask for a developmental screening if you are worried and the child is very young (under age 5). You may also want to ask about Watch Me Grow (WMG), NH’s developmental screening, monitoring, information, and referral system. Composed of a statewide partnership of organizations and agencies, WMG is designed to help identify and support children who may need services that will help promote their growth and development. New Hampshire Family Voices provides more information about Watch Me Grow (WMG)
• One screening tool that is known to be accurate is the Ages and Stages Questionnaires®, Third Edition (ASQ®-3) for children under age 5 ½.
• The National Child Traumatic Stress Network (NCTSN) is a national resource developed specifically to support providers and families in addressing the needs of children, youth, and families impacted by traumatic events.

Think about Hope and Resilience

Resilience is the ability of a child or youth to recover and do well after a potentially traumatic event.

Resilience comes from each child’s strengths, but it also comes from having a supportive family and other safe and supportive relationships; a positive social environment at school or childcare; adequate material resources (i.e., money, food, a stable place to live); and community resources, such as access to healthcare or a safe neighborhood.

It is not the child’s fault if they have been exposed to traumatic events, and many children and youth go on to accomplish great things even after some bad things have happened to them. You can help a child or youth recover by helping them to feel heard and understood and look to the future.

Providers: learn more about resilience and traumatic stress

Treatments

There are several proven treatments for children and youth who experience the effects of traumatic stress, including:

Stigma: What to Know

Studies show that 1 in 5 children are diagnosed with a serious mental health condition during their adolescence and, yet, fewer than half receive treatment (Whitney & Peterson, 2019). In addition, half of teenage students who drop out of high school have a mental health condition and half of young people who get into trouble with the law have untreated mental health or substance use concerns. Most suicides are caused by untreated mental health conditions.

Unfortunately, children, youth, and their families feel shame and guilt when there is a mental health concern and can suffer because they do not get treatment.

Teenagers can be at higher risk because of the way other young people, or their community, reacts to them. This is especially true for adolescents who are abusing substances; are pregnant at a young age; are black or brown; or who identify as lesbian, gay, bi-sexual, non-binary, transgender, or questioning their gender identity. The isolation they feel may trigger a mental health episode and make their feelings of isolation even worse.

Myths about Mental Health Concerns

Stigma surrounding mental health can cause people who really need help to not get it. This is called “self-stigma.” Examples of thoughts guided by self-stigma include:

• "I need to see a therapist, but if my friends/peers find out that I leave class to see a therapist, they will make fun of me. I'll get through this on my own."
• "I've always felt anxious and depressed, and I'll always feel like this."
• "I must be going crazy. No one else is going through this."

Youth may find it difficult to seek treatment for mental health concerns when they encounter these perceptions about mental health disorders and people who are diagnosed with a disorder.

Think About Addressing Stigma

The purpose of reducing stigma is to get individuals and families the help they need, and it begins with early intervention. Children with varying severities of mental health conditions are not receiving the treatment they need due to the stigma associated with mental health. Mental health treatment includes therapy, counseling, psychiatric care/psychotherapy, psychiatric medication, and sometimes hospitalization. One or more of these treatments can help a child or youth with a mental health condition manage their symptoms and condition(s). Treatment allows individuals to live a fulfilled and productive life.

Learn more at about the impact of stigma on mental health for children

What You Can Do to Combat Stigma

1. Educate yourself and your children about mental health.
2. Give examples of others who have mental health concerns to add context.
3. Understand that there is a range of mental health concerns, and that many youth are struggling as a natural reaction to their situation.
4. Show sympathy and empathy towards people who have mental health concerns.
5. Promote messages and examples of recovery and resilience.

This article from Behavioral Health News aims to help readers understand the impact that stigma has on mental health treatment for children, parental concerns, and treatment options: 5 ways to end mental health stigma

^[1]About the CDC-Kaiser ACE Study

^[2]"Adverse childhood experiences: what support do young people need?". NIHR Evidence. 2022-06-08.
doi:10.3310/nihrevidence_51024. S2CID 251774877. 

^[3] Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, et al. (April 2006). "The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology". European Archives of Psychiatry and Clinical Neuroscience. 256 (3): 174–186. doi:10.1007/s00406-005-0624-4. PMC 3232061. PMID 16311898. 

^[4]CDC Community Violence Prevention