This document discusses the negative impacts of childhood trauma, including abuse and household dysfunction. It summarizes research finding that childhood trauma can cause neurological and biological harm, as well as increased risks for mental health issues, physical health problems, and perpetuating intergenerational cycles of abuse and trauma. The document advocates for greater recognition of childhood trauma across social services, and implementing evidence-based prevention and treatment programs.

1. Opportunities to change the outcomes of traumatized children
Child Welfare Reform
Urban Caucus and Rural Working Group
June 19, 2008
Frank W. Putnam, MD
Cincinnati Children’s Hospital Medical Center

2. Adverse Childhood Experiences
•Abuse and Neglect (e.g., psychological, physical, sexual)
•Household Dysfunction (e.g., domestic violence, substance abuse, mental illness)
Impact on Child Development
•Neurobiologic Effects (e.g., brain abnormalities, stress hormone dysregulation)
•Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy)
•Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity)
Long-Term Consequences
Data: www.AceStudy.org, www.nasmhpd.org
Disease and Disability
•Major Depression, Suicide, PTSD
•Drug and Alcohol Abuse
•Heart Disease
•Cancer
•Chronic Lung Disease
•Sexually Transmitted Diseases
•Intergenerational transmission of abuse
Social Problems
•Homelessness
•Prostitution
•Criminal Behavior
•Unemployment
•Parenting problems
•Family violence
•High utilization of health and social services
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3. Lifetime Consequences of Childhood Trauma
•Impaired brain development
–Smaller brain size for body size
–Decreased IQ (4-12 IQ points)
–Doubled rate of learning disabilities
–Impaired control of emotions and impulses
•Impaired stress responses
–Dysregulation of cortisol stress response
–Increased arousal in the sympathetic nervous system
–Immune and inflammatory system abnormalities
•Alterations in physical growth –
–Doubled risk for obesity
•Gene by Environment interactions for depression and aggression
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4. Developmental Cascade of
Transgenerational Child Maltreatment Risk
Child
Adolescent
Adult
Child
Abuse
Child
Abuse
Aggression
Conduct
Problems
Depression
PTSD
Anxiety
School
Problems
Revictim-ization
School
Dropout
Substance
Abuse
Depression
PTSD
Anxiety
Parenting
Problems
Domestic
Violence
Maternal
Depression
PTSD
Poverty
Substance
Abuse
OhioCanDo4Kids.Org 3

5. Incidence and Types of Child Maltreatment
Victimization Rates by Age Group, 2000
15.7
13.3
11.8
10.4
5.8
0 5 10 15 20
age 0-3
age 4-7
age 8-11
age 12-15
age 16-17
Rate per 1,000 children of same age group
NCANDS, 2005
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
0
0.5
1
1.5
2
2.5
3
3.5
Million
National Estimated Child Maltreatment Reports
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6. Child Maltreatment is Common
•The Centers for Disease Control estimates that 1 of 7 children between ages 2 and 17 is a victim of maltreatment CDC, 2008
•In 2006 1 of 43 infants less than 1 year of age suffered abuse or neglect
•Population surveys find much higher rates of child abuse and neglect than are officially reported
CDC, 2008
OhioCanDo4Kids.Org
(Theodore et al., (2005) Pediatrics 115:e331-337)
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7. Childhood Trauma is Cumulative
www.Acestudy.org
Copeland et al., Archives of Gen Psychiatry 2007, 64:577-584
N=1420
Great Smokey Mountains Study of
Child Mental Health
Adverse Childhood Experiences (ACE) Study
N>17,000
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8. Childhood Trauma is Cumulative
0
1
2
3
4
5
6
7
8
Mean Number of DSM Dx
0 1 2 3 4+
NCS- R All Respondents N=5692
Putnam, Perry, Putnam, Harris
unpublished data, 2008
National Comorbidity Study – Replication Sample
Mood
Anxiety
Substance Abuse
Any Disorder
Type of Disorder
0
2
4
6
8
10
Odds Ratio
No. of Adverse
Childhood Events
1
2
3
Adjusted Odds Ratios for Psychiatric Disorders about Women
in the US General Population: National Comorbidity
Survey Replication, 2001-2003
Afifi, et al (2008). Population attributable fractions of psychiatric disorders and
suicide ideation and attempts associated with adverse childhood experiences.
Research and Practice, 98(5), 946-952. 7

9. Cumulative Trauma Lowers Intelligence
Koenen et al. Development and Psychology, 2003, 15:297-311
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10. www.acestudy.org
www.Acestudy.org
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11. Family Violence and Public Health
•Single most preventable cause of mental illness
•Single most preventable cause of drug and alcohol abuse in women
•Single most preventable cause of HIV high-risk behavior (IV drugs, promiscuity)
•Significant contributor to leading causes of death (heart disease, cancer, stroke, diabetes, suicide)
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12. Trauma is to Mental Health as Smoking is to Cancer!
Steven Sharfstein, MD
Past President of the American Psychiatric Association
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13. Cost Estimates of Child Maltreatment
•Alabama1 – in 2005 dollars
–Direct costs - $392 Million
–Indirect costs - $129 Million
–Total annual costs - $521 Million
•Ohio2 – in 2007 dollars
–Direct costs - $290 Million
–Indirect costs - $2.1 Billion
–Total annual costs – $3 Billion
•US3 – in 2007 dollars
–Direct costs - $33 Billion
–Indirect costs - $71 Billion
–Total annual costs - $104 Billion
1 – Center for Business & Economic Research, Univ of Alabama, 2007
2 – Preventing Family Violence, Anthem Foundation of Ohio, 2007
3 – Wang & Holton – Economic Impact Study, Prevent Child Abuse America, 2007
OhioCanDo4Kids.Org
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14. What can we do now?
•Examples of effective, evidence-based prevention and treatment models
•Multiple systems and networks within which to embed screening, prevention and treatment
•Replication strategies to scale existing interventions
•Scientific and technological tools to maintain and improve quality in the field
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15. There are several congressional committees with jurisdiction over programs and policies affecting traumatized children and their families. Reexamining programs and policies through a trauma-informed lens could be beneficial to the constituents whom they serve.
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16. Prevention, identification, and treatment can be embedded in systems that serve children
•Child care
•Education
•Medical
•Well-child
•Home visitation
•Military families
•Child welfare
•Mental health
•Drug and alcohol
•Criminal justice
•Immigration
•Faith based
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17. Every system and piece of legislation that serves children and families should consider a “Trauma Impact Statement”
OhioCanDo4Kids.Org
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