Trauma and Abuse in Children

Trauma and abuse in children encompass maltreatment, including physical, sexual, and emotional abuse and neglect, and exposure to other frightening or overwhelming events. Such experiences are associated with disturbances of emotion, behaviour, and development, and with raised risk of mental and physical health problems across the lifespan.

Definition

Trauma and abuse in children refers to maltreatment, comprising physical, sexual, and emotional abuse and neglect, and to exposure to other traumatic events, together with the resulting psychological and developmental disturbances, including post-traumatic stress symptoms.

Scope

The entry covers the recognised forms of child maltreatment, the concept of adverse childhood experiences and toxic stress, how exposure and its effects are measured, and the evidence base for trauma-focused psychological treatment. It is a reference overview and does not provide protocols for identifying, reporting, or treating abuse in an individual case.

Core questions

• What forms does child maltreatment take, and how is each recognised?
• How does early adversity affect emotional and developmental outcomes?
• How are exposure to trauma and its psychological effects measured?
• What psychological treatments have evidence for trauma-related symptoms in children?

Key concepts

• Physical, sexual, and emotional abuse
• Neglect
• Adverse childhood experiences (ACEs)
• Toxic stress
• Post-traumatic stress symptoms in children
• Trauma-focused cognitive behavioural therapy

Key theories

Toxic stress

A framework in which strong, frequent, or prolonged activation of the stress response in childhood, in the absence of buffering caregiving, can disrupt developing systems and raise lifelong risk of disease and impairment.

Mechanisms

Maltreatment is understood to affect children both directly, through fear and harm, and indirectly, by disrupting the caregiving relationships and developmental processes on which emotional and cognitive growth depend (Cicchetti & Toth, 2005). The toxic-stress framework proposes that severe or chronic adversity, unbuffered by supportive caregiving, can perturb developing stress-response and other systems, contributing to later mental and physical health problems (Shonkoff et al., 2012). Exposure and its effects are assessed with validated instruments such as the Childhood Trauma Questionnaire (Bernstein et al., 2003), though retrospective adult reports of childhood adversity have known measurement limitations (Hardt & Rutter, 2004).

Clinical relevance

Recognising the forms and consequences of maltreatment underpins how clinicians assess trauma exposure and its psychological effects, and trauma-focused cognitive behavioural therapy is an evidence-supported treatment for abuse-related post-traumatic stress symptoms (Cohen et al., 2004). This entry is reference material describing the field and is not guidance for identifying, reporting, or treating abuse in an individual child.

Epidemiology

Child maltreatment is common and substantially underdetected; in high-income countries a large share of children experience some form of abuse or neglect, and maltreatment contributes to a considerable burden of mental and physical ill health (Gilbert et al., 2009).

Evidence & guidelines

Trauma-focused cognitive behavioural therapy has randomised-trial support for reducing post-traumatic stress symptoms in children with abuse-related trauma and is widely regarded as a first-line psychological treatment (Cohen et al., 2004).

History

Systematic medical and psychological attention to child abuse expanded after mid-twentieth-century recognition of physical abuse as a clinical entity, broadened over later decades to include sexual abuse, emotional abuse, and neglect, and was reframed in the early twenty-first century around adverse childhood experiences and the developmental concept of toxic stress.

Debates

Validity of retrospective reports of childhood adversity

Much knowledge about childhood trauma rests on adults recalling earlier experiences; such retrospective reports are subject to forgetting and bias, so their validity and the inferences drawn from them are debated.

Key figures

• Dante Cicchetti
• Jack Shonkoff
• Judith Cohen
• Cathy Spatz Widom

Seminal works

• gilbert-2009
• cicchetti-2005
• shonkoff-2012

Frequently asked questions

What is meant by toxic stress in childhood?

Toxic stress describes strong, frequent, or prolonged activation of the body's stress response in childhood without supportive caregiving to buffer it, which can disrupt development and raise lifelong health risk.

Is there an effective psychological treatment for childhood trauma?

Trauma-focused cognitive behavioural therapy has randomised-trial support for reducing post-traumatic stress symptoms in children affected by abuse and is widely regarded as a first-line treatment.