April is Child Abuse Prevention Month

Child Abuse impacts ALL of us either personally or by being close to someone with this trauma. It is our hope that with the sharing of knowledge, we can help support children and adults who have experienced child abuse and trauma by understanding and knowing the truth and how to help.

To increase awareness, let’s start at the top: What is child abuse?

While Federal legislation sets minimum standards for individual states, the states themselves are ultimately responsible for defining child maltreatment in their State law. Washington state defines abuse and neglect in RCW 26.44.020 as “injury, sexual abuse, sexual exploitation, negligent treatment or maltreatment of a child by any person under circumstances which indicate that the child's health, welfare, and safety is harmed”. Other states of similar laws.

You may wonder, what exactly does that mean? For example, the law may define the difference between reasonable and unreasonable uses of force used during physical discipline as outlined in RCW 9A.16.100, yet is a child’s experience of such discipline as cut and dry? Perhaps you suspect abuse or neglect is happening to someone you know and are unsure if it rises to a reportable standard. Children are a vulnerable population and do not have the agency to advocate for the themselves. If you suspect child abuse or neglect, please call WA state’s 24/7 hotline: 1-866-ENDHARM (363-4276) or call your local Child Protective Services. For more information on how to recognize signs and symptoms, who are mandated reporters, and what are potential outcomes from reporting, please refer to the Washington state attorney general’s office for a comprehensive overview.

Reporting suspected neglect or abuse may result in the short-term goal of decreasing or stopping child maltreatment. In the interest of better understanding long-term effects of adverse childhood experiences such as abuse and neglect, studies were conducted, risks were uncovered, and preventative and protective measures uncovered, and treatments developed. The largest of these studies investigated “the connections between chronic stress caused by early adversity and long-term health” (Center for Youth Wellness, 2017) and was conducted by the U.S. Centers for Disease Control and Prevention and Kaiser Permanente in the mid 1990s, known as the Adverse Childhood Experiences (ACE) Study. The ACE study measured abuse, neglect, and household dysfunction in these ten subcategories: Abuse- Physical, Emotional, and Sexual; Neglect- Physical and Emotional; Household Dysfunction- Mental Illness, Divorce, Substance Abuse, Mother Mistreatment, and Incarcerated Relative. It was determined that only one of these experiences resulted in developmental impact of the child and family system long term.

The ACEs questionnaire (Burke Harris, 2014, Harvard University, 2019,Center for Youth Wellness, 2017) was administered to over 17,000 adults and was comprised of ten yes/no questions evaluating the ten categories above; each yes equated to one point on their ACE score. The scores were then correlated against health outcomes. The key findings of this and subsequent studies using the original ACEs data were, first, that the ACEs are very common, even across social classes; 67% of participants, or two thirds of the population, reported at least one ACE and 13%, or one in eight people, reported four ACEs or more (Burke Harris, 2014; Harvard University, 2019; Center for Youth Wellness, 2017). Second, they found that the higher the ACE score, the higher the risk for negative health outcomes. Although these correlates are alarming and suggest “the more ACEs experienced and the greater the chance of poor outcomes later in life, including dramatically increased risk of heart disease, diabetes, obesity, depression, substance abuse, smoking, poor academic achievement, time out of work, and early death”(Harvard University, 2019), no one with an ACE score is irreparably damaged. In fact, early treatment for ACE's trauma improves the overall health of the family.

The physiological impacts of exposure to intense, frequent, or chronic stress, as described by the ACEs, without the buffer of supportive adults, can alter children’s brains and bodies. Disruption to the developing brain as found in the prefrontal cortex, hippocampus, and amygdala can develop into mood disorders, anxiety disorders, cognitive impairments such as learning disabilities or attentional deficits, and difficulties with self-regulation, memory, and hyperactivity (Center for Youth Wellness, 2017). These presentations can often be mistaken for ADHD when ACEs may be at the root of the symptomology (Burke Harris, 2014). As toxic stress on the body is analogous to prolonged revving of a car motor across days and weeks, it wears down considerably faster than a body that has time to cool down and reestablish homeostasis between stress responses.

ACEs experienced in the family and the effects of toxic stress and trauma experienced in the community such as racial or gender discrimination, poverty, or community violence have a costly impact across the lifespan. These risks can be mitigated by reducing stress loads on families’, providing children and adults with positive relationships, and strengthening life skills. As Dr. Jack Shonkoff and his team at the Center on the Developing Child at Harvard University conclude, “The single most common factor for children who develop resilience”, or the ability to bounce back, “is at least one stable and committed relationship with a supportive parent, caregiver, or other adult” (2019). This means that improving parental and caregiver awareness of the signs and symptoms of ACEs can give them leverage to respond proactively. Children may re-enact the trauma through play, have reoccurring thoughts of a stressful event, or suffer with sleep disruption and nightmares. Connecting these behaviors to the problem may increase the likelihood of effective interventions. Seeking a mental health professional to work with the child and parent/caregiver can provide awareness, support, and skill building to integrate the experiences and protect against future stressors. Developing adaptive parenting skills can deepen the strength of the attachment to the child suffering from ACEs and increase their resilience and ability to thrive. Do not underestimate the power of ‘being with’ the child’s emotions as opposed to a ‘fix it’ mentality. Research supports the use of serve and return interactions between child and parent/caregiver. This type of interaction activates mirror neurons in the brain and supports a child’s sense of being seen, heard, and safely connected, building resilience. Play Therapy by a Registered Play Therapist, can provide specialized treatment that is neurobiologically informed and developmentally appropriate for their healing.

The CDC’s proposed prevention strategies against child abuse and neglect (2019):

It is imperative that parents, teachers, therapists, and adults at large strive to build resiliency in our children daily. The list above gives us some key understandings of how to be preventive and healing for those who have experienced ACE's and seek healing. Parent psycho-education such as Playful Wisdom and group therapy such as Child Parent Relationship Training can change the family dynamic and improve outcomes for families with and without ACE's. Trauma and abuse is often trans-generational, meaning it is passed on from generation to generation. To prevent this effect having a child or adult enter therapy and have healing is key, we are then helping our communities to strengthen and grow in a healthy manner. When a child experiences an ACE it can have an effect on them for the rest of their life. Let's stop the cycle. Treatment is available and can help reverse any damage that has been done. If you have questions, please comment below or send us an email. If you are in Washington and would like to seek treatment for you own child, please call our office at 360-357-2370. If you are in another state please seek out help by a licensed professional in your state.

Resources:

Burke Harris, N. & TEDMED (September 2014) How childhood trauma affects health across a lifetime. Retrieved from: https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

Centers for Disease Control and Prevention (CDC) (April 1, 2016) Violence Prevention: Adverse Childhood Experiences (ACEs). Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Findex.html

Centers for Disease Control and Prevention (CDC) (April 1, 2016) Violence Prevention: About the CDC – Kaiser ACE study. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html

Center for Youth and Wellness (2017). How ACEs affect health: Childhood adversity increases risk for long-term health and behavioral issues. Retrieved from: https://centerforyouthwellness.org/health-impacts/

Center for Youth and Wellness (2017). The science: Decades of scientific investigation guides our work to solve this public health crisis. Retrieved from: https://centerforyouthwellness.org/the-science/

Center on the Developing Child, Harvard University (2019). ACEs and toxic stress: frequently asked questions. Retrieved from: https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/#

Center on the Developing Child, Harvard University (2019). Resilience. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/resilience/

Center on the Developing Child, Harvard University (2019). Serve and return interaction shapes brain circuitry. Retrieved from: https://developingchild.harvard.edu/resources/serve-return-interaction-shapes-brain-circuitry/

Center on the Developing Child, Harvard University (2019). Toxic stress derails healthy development. Retrieved from: https://developingchild.harvard.edu/resources/toxic-stress-derails-healthy-development/

Ferguson, B & WA State Office of the Attorney General (No date). Protecting youth: Child abuse & neglect. Retrieved from: https://www.atg.wa.gov/child-abuse-neglect

Starecheski, L (March 2, 2015). Health News from NPR: Take the ACE quiz – And learn what it does and doesn’t mean. Retrieved from: https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean

Washington State Legislature. (N.D.) RCW 26.44.020 Definitions. Retrieved from: https://apps.leg.wa.gov/rcw/default.aspx?cite=26.44.020

Washington State Legislature. (N.D.) RCW 9A.16.100 Use of force on children-Policy-Actions presumed unreasonable. Retrieved from: https://apps.leg.wa.gov/rcw/default.aspx?cite=9A.16.100

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