The bubbly and joyful Dianna was playing volleyball just like any normal teenager. Moments later, she had a burst of anger and threw a chair at her teacher. It’s hard to understand how the two opposite behaviors appeared on the same person. But her life at home would give an explanation.
“I wish I could go back and never be born again,” the 16-year-old said in a 2015 documentary called Paper Tigers. It’s hard to tell how Dianna is different from other teenagers in appearance. She came to Lincoln Alternative School, where the documentary was filmed, being labeled as violent and a troublemaker since she often got into fights.
Dianna grew up being physically abused by her mother. Her brother has sexually harassed her. She was also kicked out of home at a young age.
On the other side of the world, Ming (not his real name), now in his 20s, grew up in a wealthy family but also had negative childhood memories. “If I choose a color to describe my childhood life, I would pick grey,” he said.
The five-year-old Ming once fell from the sofa and his head bled heavily. His mother sitting beside him ignored his pain. “As I cried louder and louder, she finally glanced at me and began blaming me for being careless and stupid. But she still did nothing to help.” Even after more than a decade, Ming still vividly remembers the feeling of helplessness at that time. “But I’m used to it. My parents have always shown little care,” he added.
Stories of Dianna and Ming are typical examples of child maltreatment, which is defined as the abuse and neglect that occur among children under 18 years old. It includes all types of physical and emotional ill-treatment, sexual abuse, negligence, and commercial or other forms of exploitation, which according to the World Health Organization (WHO), will result in actual or potential harm to the child’s health, survival, and development.
Long-term negative effects and severity
Alarmingly, studies find that a majority of the kids grow up in abusive environments. According to WHO, international studies reveal that a quarter of all adults report having been physically abused as children and one in five women and one in thirteen men report having been sexually abused as children. Additionally, in the Adverse Childhood Experience (ACE) Study, the landmark research on the long-term negative impact of child maltreatment, 64% of respondents said they have experienced at least one ACE which include physical and emotional abuse, sexual abuse, exposure to alcohol, substance abuse, mental illness, or criminal behavior, in the household.
Graphic credit: Looking at how ACEs affect our lives & society. CDC infographic
“Child maltreatment is a global problem,” said Bart Klika, the chief research and strategy officer of Prevent Child Abuse America, a nonprofit organization aimed at improving children’s well-being and preventing child abuse in the United States.
While ACEs are common, tests show that they may lead to real damages in kids’ brains and therefore victims may show disruptive behaviors such as self-harm, suicide, substance abuse, and violence. Neuropsychological testing among women who were sexually abused as children through magnetic resonance imaging (MRI) has revealed reductions in their hippocampus, amygdala volumes, as well as deficits in verbal declarative memory.
The parts of the brain ACEs disrupt are all associated with people’s mood regulations, memories, and emotions. The hippocampus processes long-term memory and emotional responses. The amygdala plays a critical role in fear responses and aggressive behaviors. When there is frequent toxic stress, which occurs when a child experiences strong, frequent, and prolonged adversity, the amygdala becomes oversensitive. The brain would memorize the trauma with fragmented sensory of smell or images. Consequently, even though the individual is not in danger at all, he/she may be easily triggered to fight-flight-freeze, the defensive response to threats with attack, escape, or fake-death.
The ACE study also found that persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had a 4- to 12-fold increased health risk of alcoholism, drug abuse, depression, and suicide attempt.
Graphic credit: About the CDC-Kaiser ACE Study
“When kids experience a lot of ACEs, they don't necessarily just have one bad outcome,” Klika said. “They may have a few bad outcomes that sort of pile up or compound on one another. The early experiences of childhood abuse and neglect can have effects that sort of cascade across the life course.”
Graphic credit: Looking at how ACEs affect our lives & society. CDC infographic
Factors behind child maltreatment
The intergenerational transmission of ACEs has been found by many studies. WHO published a report revealing the cycle of violence wherein one in six maltreated boys and girls go on to become violent offenders and one in eight sexually abused boys go on to become sexual offenders. A 2017 study by the United States National Library of Medicine (NLM) also showed that parents who had a childhood history of being abused are at increased risk of hitting their children.
Another reason for child maltreatment is that the parents themselves are experiencing stress, isolation and frustration. “For example, some families are struggling to keep a job that imposes unpaid leaves. Some jobs do not provide flexible work schedule,” Klika said. The financial burden limits the parents’ ability to provide proper care for their children.
Other factors associated with child maltreatment include parents’ beliefs in physical punishment as an effective educational tool, extreme religions, growing up in war zones or crime-ridden neighborhoods, and many more.
The underreporting of child maltreatment
A study by WHO Regional Office for Europe showed that prevalent studies on child abuse and neglect involving victim surveys indicate that the number of people who have been maltreated in childhood is ten times greater than what is reported,.
“There's much more abuse happening in our society that we don't know about. There's a lot of possibility of kids being abused or neglected that has not ever come to the attention of reporting agencies like child protective services,” Klika agreed.
One of the reasons for underreporting is that children are not even aware of the abnormality. “Childhood is the critical period for kids to build their internal network model,” National Certified Counselor (NCC) Pei-Hsuan Liu said. While these young brains would try to understand why their parents who are supposed to love them and care for them make them suffer, Liu said that with limited clues, children would often put the blame on themselves.
“I thought everything I was undergoing was normal. I think most of the children just silently bear the influence of child abuse and realize the negative impact years after they grow up,” Ming shared.
A 2008 report by MedPage Today, an accredited medical news service, said that professionals who work closely with children, such as teachers and pediatricians, had also contributed to the underreporting. In a study of 434 U.S. physicians, about 10% of 15,000 child injury cases were suspected to be the result of abuse, but only 6% were reported as such.
The report said that a lack of awareness of the signs of child abuse and understanding of the report system, a belief that reporting the suspicion might do more harm than good, and a fear of damaging a relationship with a student all affect the reporting.
Prevention
Klika said that the key to lessen the numbers of child abuse is to give families support, ideally before a child is born.
Prevent Child Abuse America developed a home visiting program called Healthy Families America, an evidence-based home visiting model built on the idea that if families build strong relationships with their children, it will likely prevent abuse and neglect.
Currently, the organization has nearly 600 sites across the United States that are implementing the program. Home visitors enter the homes of new and expecting families, get to know them, and help them identify any challenges they might be experiencing. “It's really helping parents enjoy, observe and appreciate their children,” Klika shared. “So a lot of our work is helping parents read their children’s cues to be able to better understand their developmental stage.”
Change is possible
The damage of childhood trauma is centered on the profound sense of self-doubt on worthiness and consequential life experience. As victims grow up, processing the trauma means returning to the abusive war zone and fight again. It takes enormous courage to step out and seek help voluntarily. “Child maltreatment is a public health issue. It requires the collaboration from multiple parties, such as school, government, prison, and the community,” Liu said.
According to Klika, in order to help people break that silence, the general public needs to understand places and ways they could get help. “At the same time, we need to make sure that in our community that we have what we would consider evidence-based treatments for these kids who have been abused and neglected,” he added.
In a 2016 speech, Vincent J. Felitti, the co-principal investigator of the ACE study and currently a clinical professor of medicine at the University of California, mentioned his unexpected success in the experiment of adding trauma-oriented questions to the questionnaire patients routinely fill in at home. It resulted in a 35% reduction of doctor visits and an 11% reduction of emergency room visits in the subsequent year.
Photo credit: Dr. Felitti’s speech at Sealaska Heritage Institute
The questionnaire opened up opportunities community to be aware of the trauma and to make a difference by showing warmth and acceptance.
Trauma-informed Care is also a proven method of building effective support systems in school. Schools like Lincoln High School in the United States and Cheng-Yang Junior High School in Taiwan have already started to implement Trauma-informed Care. The implementation has seen a reduction of fights and student suspensions.
NGOs can also help grown-up victims improve their life with trauma-informed care. I-Life Association in Taiwan has helped more than 100 young people rebuild self-confidence and start a purposeful life with the Long-term Partner Program. The program includes unconventional counseling sessions, art courses, career exploration and material-free adventures. As a result, the service complement the coverage of the government’s support system.
Hope is out there
Even though numerous studies show that childhood trauma can have negative effects on people through a lifespan, Liu said that there’s still hope for people to get healed. “Studies have showed that our brain has plasticity. Your brain was trying to adapt to the toxic environment in your past. Now if you can take professional treatment, exercise, meditate and practice mindfulness, your brain will try to adapt to a healthier life and therefore form a new neurocircuit replacing the old one.”
Above all the support system and resources, the victim’s willingness to process the trauma and handle the stress is mandatory to start the treatment.
Kids like Dianna could have gone on criminal path easily. Luckily, she found an unlikely foster family with a teacher at Lincoln. Thanks to the implementation of trauma-informed care at school, she gained support and confidence to build a purposeful life.
In the end of Paper Tiger, Dianna did not fall into the cycle of getting pregnant early. “One thing I realized is that my mom, my aunts, and my grandma all had kids when they were 15 or 14 and I’m the first one that’s 17 and have no kids. How proud I am of myself!” she shared.
After graduation, though she’s still struggling with managing her temper, she plans to take up cosmetology and to continue supporting her younger brothers.
For Ming, he said he would totally change the method of approaching and educating his own children. “If I have kids in the future, I will give them love, tons of love.”
________
While child maltreatment is a common and complicated issue, there’s a light of hope in reducing the negative effects on victims. After the publication of the ACE Study, numerous practices have been conducted . The United States has successfully implemented the trauma-informed care in many schools. Local governments in Taiwan have also started the training for schools staffs. There are free therapy services on campus provided by NGOs in both countries.
Everyone can start understanding each other with less labeling and fewer stereotypes as a community. With medical knowledge and professional resources, the cycle of violence and its negative impacts can be put to an end. This generation will march on to a bright future.
________
Sources:
https://www.who.int/news-room/fact-sheets/detail/child-maltreatment (Child maltreatment definition and facts)
https://www.healthychildren.org/English/safety-prevention/at-home/Pages/What-to-Know-about-Child-Abuse.aspx (child maltreatment reason)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426107/ （child maltreatment reason）
https://aquila.usm.edu/cgi/viewcontent.cgi?article=1041&context=ojhe (change the underreported child maltreatment situation)
https://www.medpagetoday.org/emergencymedicine/domesticviolence/12015?vpass=1 (underreported)
https://vimeo.com/155143547 (Dr. Fellitti’s speech in 2016)
https://www.avahealth.org/resources/aces_best_practices/impacts-on-health.html (general intro of ACE Study)
http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html (infographic of ACE Study)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232061/ (the scientific fact of the negative effect of ACE on human brains and resultant behavior)
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