Today, we’ll tackle the question of Why assessing kids for the potential effects of trauma is so difficult?
On a different blog post, I looked at the Adverse Childhood Experiences (ACE) Study, examining the cumulative effects of trauma, abuse and neglect on measures of long-term mental and physical health. From my perspective as a child and adolescent psychiatrist, I like to know as much as I can about exposure to toxic substances in utero and traumatic experiences after birth because experience tells me that such exposure frequently impacts the effectiveness of the medications and psychosocial treatments I prescribe.
Here’s an example…for six years, my clinical time was evenly divided between work in an inner-city children’s mental health center in Canton, Ohio and what might be described as a “concierge-type” practice in one of the two most affluent counties in our state. I noticed that the average dose of medication I’d prescribe for kids in the inner-city clinic with ADHD was roughly double the dose necessary in my suburban practice, and the kids from the city generally weren’t experiencing the same quality of response as the kids in the suburbs. This observation was far from scientific and there were lots of confounding variables, including the quality of schools and availability of educational supports, but the biggest difference in the inner-city kids seemed to be exposure to toxic substances in utero and toxic environments at the time of referral.
Editor’s Note: That’s a big part of why I’m volunteering for Key Ministry as opposed to working in the inner city clinic. I thought many of the families I saw in the clinic needed a pastor more than they needed a psychiatrist, because the spiritual poverty among the families we served often led parents to make all manner of stupid, maladaptive choices in pursuit of filling the emptiness resulting from the God-shaped void in their lives… those choices all too frequently resulting in major life complications for their children.
In any event, accurately determining the extent to which a child has been exposed to trauma and abuse has been a major impediment to better research on the effects of adverse childhood experiences. Here are some of the reasons why it’s so difficult to get a good handle on the extent to which a child has been impacted by trauma…
- The younger the child is at the time of the trauma, the more difficult it will be for the child to accurately communicate what they experienced. They may not have the expressive language skills to accurately describe their experiences. They may have a difficult time quantifying recurrent traumatic experiences. They may not understand the concept of time to accurately report the sequence of events.
- Developmental regression (including loss of language skills) is not uncommon following traumatic exposure in children. Kids who may have been capable of accurately reporting their experiences prior to a traumatic event may struggle to do so in the aftermath of the event.
- The traumatic experience itself may negatively impact the child’s memory/capacity for recall.
- Avoidance of conversations that stimulate memories of frightening event(s) is a common coping mechanism among kids who’ve experienced trauma. Kids who have experienced trauma generally don’t want to talk about it. They may give brief, superficial answers to questions in screening interviews in order to avoid the need to talk.
- Recurrent, intrusive memories of traumatic events may not manifest as distressing. Kids may act out memories through their play activity with outwardly expressed emotions that don’t necessarily correspond to those expected from the trauma.
- Parents and caregivers are often reluctant to be truthful when children may have been harmed resulting from their actions or inaction. Birth parents of children placed for adoption may be reluctant to disclose the extent to which they smoked, consumed alcohol or abused drugs during their pregnancies. Parents of kids who have been victims of physical or sexual abuse within the home may be reluctant to disclose because they wish to maintain a relationship with the perpetrator of the abuse, or fear that they themselves could be at risk of prosecution. They may hide abuse perpetrated by a sibling or extended family member out of fear of having a child taken away or upsetting the stability of dysfunctional family relationships. They may be ashamed to admit that they weren’t capable of adequately protecting their child from a harmful situation. Staff from orphanages/child care facilities may seek to minimize the extent to which a child experienced pathologic care out of fear that the truth would hinder the chances of a child finding an adoptive home.
Dr. Steve Grcevich is a physician specializing in child and adolescent psychiatry who serves as President and Founder of Key Ministry. He blogs at church4everychild.org and may be reached at steve@keyministry.org.
