Mild Childhood Trauma Has Serious Disease Consequences
Does harsh physical punishment of children have any lasting physical disease consequences? Children have been surviving childhood, irrespective of childhood trauma, for a long time. If survival were all we were interested in, we could change the subject at this point. However, we hope for more than this, so we must look more deeply at what we do with the little people in our lives.
Kids Are Tough...
We all know children can be very adaptive, resilient, and just plain tough. I once worked with an Indian man whose mother, when he was 10, drove him some 90 miles to the nearest big city, dropped him off at a shopping mall he'd never been to, and drove off, without a word. He was bewildered but kept his head and managed to hitchhike back home.
I heard an even more astounding story, during my years managing a county mental health clinic near to the Colville Indian Reservation in eastern Washington state. In the 1930s, a group of Reservation children of varying ages - grade school to teenaged - wanted to go to the famed Chemawa Indian school in Salem, Oregon. The country was in a grave economic depression - but Indian Reservations are basically always in an economic depression, so I'm not at all sure that it was much noticed at the time. Their parents had, nevertheless, somehow managed to save enough money to buy them bus tickets, and that's how they got there.
Once there, they discovered that there was a mandatory application process, limited openings for new students, and no space at all for any of them. There was nothing to do but to return home. However, they had no money for return tickets and neither did their parents. So they walked home. It was 400 miles - a 6.5 hour drive, if you go by freeway, today. It was winter – raining in Oregon, and snowing in eastern Washington, and it took them weeks. They were just kids, but kids are tough, and Indian kids are tougher than most, so they just got it done.
. . . But Kids Are Not Stress-Proof
End of story? I doubt it, especially in light of recent research on the physical and mental effect of some of the less dramatic traumatic things that can happen to children. That children do get traumatized is no longer news. Yet the reality of PTSD in children, the challenges of accurate assessment and the good news about the effectiveness of treatment, all remain inadequately appreciated, even among health care professionals (Scheeringa & Drury, 2013). Childhood PTSD is too often missed, in part because children respond to stress in ways that can be distinctly different from similarly stressed adults.
Mostly, however, childhood PTSD is often missed simply because healthcare professionals just don't think to screen for it (Scheeringa & Drury, 2013). We all know that childhood is stressful, so if children act stressed, well, that's to be expected, isn't it? Evidence of childhood stress thus gets dismissed as “normal”.
However, not all stress is equal. Serious physical and sexual abuse – the sort that now is illegal (but has been so for only a very few generations) is now expected to have real consequences. But what about less serious problems? And, as has been elsewhere pointed out, we must also recognize that childhood stress is not just caused by abuse – it is also caused by things like being left alone at a hospital, or having your mother become seriously ill when you're only two (an emotionally critical age for all children). In truth, childhood is full of emotional peril and too much of it is largely unrecognized. Some recent research makes this clear.
Effects of Physical Punishment of Children
Parental assault, commonly termed "physical punishment," has serious consequences.
Researchers at the University of Manitoba in Winnipeg (Afifi, Mota, MacMillan, & Sareen, 2013) recently published results of their investigation of the specific question of whether or not physical punishment in childhood had any relationship to a group of several physical health conditions that occur in adulthood. Using a nationally representative sample of U.S. adults, they looked specifically at whether harsh physical punishment in childhood (i.e, pushing, grabbing, shoving, slapping, and hitting) had any physical disease consequences in adulthood, when more severe child maltreatment (i.e, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, and exposure to intimate partner violence) was NOT present in the child's home.
What they found was that it did, though, as expected, not for everyone. After removing from their data the effect of several variables that could also have an effect on adult disease (it is possible to do this mathematically), they found that children abused in the way described had higher rates of cardiovascular disease, arthritis, and obesity. These are all stress-response diseases, interestingly enough, although neither of the reports I've seen on this research mentioned that.
We already have research clearly indicating a relationship between physical punishment of the sort looked at in this study and mental illness, aggression, and delinquency (Gupta, 2013). This study suggests that it has long term serious physical disease consequences as well.
The study has several methodological problems, many of which can be corrected, at least partially, in future studies. It is also important to realize that this sort of study can never be upgraded to a full blown clinical experiment for the obvious reason that it would require the deliberate stressing of randomly selected children.
In making sense of these findings, we just need to consider this: given that children enter this world utterly dependent upon those closest to them, just how surprising is it, really, to learn that when these critical adult caretakers turn out to be assaultive there are long lasting mental and physical consequences? It's too easy to forget that what's mere "punishment" for an adult can be a terrifying assault for a child.
Alternatives to Physical Punishment
Alternatives to physical punishment are available – and they work.
Years ago, I worked as a counselor at a group home for physically and sexually abused children, between the ages of 8 and 12. These kids trusted no one, respected no one, and were experts at driving adults crazy. We were allowed to physically restrain them, when needed, to keep them and others safe. We could, and did, hug them as well. The worst punishment allowed was having them sit (or be held, when necessary) on the couch for an age-appropriate amount of time, or until they showed they had regained control of themselves. We managed to get meals cooked and served and eaten, laundry done, kids to school and doctors, and to have successful outings for recreation. We never hit a kid - it wasn't allowed. We had control of the situation and these kids exhibited distinct behavioral and emotional improvement in this environment.
So, I KNOW that physical punishment is abusive, period, simply because it's not necessary. Child abuse is physical or mental pain that is avoidable, but is perpetrated anyway. We now have good reason to think that the main effect of such abuse is to increase the risk of lifelong mental and physical diseases. I hope you think hard about this, and then tell everyone you know your conclusions. Personally, I'm convinced that no child benefits from being spanked, hit, or physically or emotionally abused. They are only likely to be hurt. There are better - non-assaultive - ways to manage childrens' behavior. We should learn these ways, use them, and allow nothing else in our homes. It's just the right thing to do if we want healthy children.
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Afifi, T. O., Mota, N., MacMillan, H. L., & Sareen, J. (2013). Harsh Physical Punishment in Childhood and Adult Physical Health. PEDIATRICS. doi:10.1542/peds.2012-4021
Gupta, S., MD. July 15, 2013. Hitting in Childhood Tied to Adult Obesity and Heart Disease. Retrieved July 15, 2013, from http://www.medpagetoday.com/TheGuptaGuide/Pediatrics/40451.
Scheeringa, M. & Drury, S. (2013, July 16). Assessment and Treatment of Very Young Children Victims of Trauma:Resources for Clinicians. Retrieved from http://tulane.edu/news/newwave/upload/Trauma-Resources-for-Clinicians-on-Young-Children.pdf
*graph image (C) Tom Cloyd - permission given for reuse, without modification (other than size) with creator credit.
Connect with Tom Cloyd also at Google+, LinkedIn, Facebook, Twitter, his Sleight of Mind blog, his Trauma Psych blog, and the Tom Cloyd website.
Cloyd, T. (2013, July 16). Mild Childhood Trauma Has Serious Disease Consequences, HealthyPlace. Retrieved on 2023, June 4 from https://www.healthyplace.com/blogs/traumaptsdblog/2013/07/mild-childhood-trauma-has-serious-disease-consequences
Author: Tom Cloyd, MS, MA
I wish all the parents/legal caregivers read the article or similar ones and were aware of the destruction out-coming from verbal and physical abuse on the young, and innocent souls. My question is, I guess, how to educate those parents on the danger of any kind abuse so they would acknowledge it and implement it actually in their homes? As we realize many of them do not read articles and blogs. As a matter of fact many of them do not have time to educate themselves due to life stress and problems or they are not interested in educating. How to help them first so they can raise healthy children? My concern is can an abusive behavior of the parent be changed? And my question is HOW?
Monika, you ask a central and very challenging question. It's really a culture-change question, as it has to do with an entire group of people. The first problem here is the sheer number of people involved. Then there's the problem of credibility. Many folks are a bit wary of psychology, and especially of child psychologists and therapists. Traditional culture has no need of these folks. Finally, there's the delayed and hidden effects problem. While a train person can see the effects of neglect and abuse fairly quickly, for many people it's just not obvious, so you're trying to get them to change behavior relative to a problem they just don't see.
One approach I know that HAS gotten good results is to ask who is most responsible for child abuse and neglect. The answer is young, single mothers who are over-stressed. It is possible to identify at-risk young mothers in advance. For a time, it was being done in Honolulu. At risk mothers were offered a package of free (to them) support services. Their stress levels went down, and the reported abuse and neglect rates did too. But the politicians didn't want to keep paying for this (it was roughly $1000 per mother as I recall), so the program was dropped. It's been tried other places, and always with good result. It's a modest start, but it's been difficult to achieve even this much, and as a general approach it hasn't been adopted.
Change IS happening, though. It's just not rapid, so it's easy to miss it. You and I want it faster, but that's not the way of things, it seems. I do wish we could do better, though. We just have to keep talk, and writing, and voting, and making phone calls.
Thank you for responding to my thoughts and explanation of the problem. It is good to know that people at least do attempt to make small changes within societies and some of them care to live a better life! :)
These programs your referring, where could I find more info on what they focused on and what tools they found effective for young single mothers.
We should be really careful in case any injury have occurred to the child in the early phases and should observe the necessary precautions without neglecting in taking treatments immediately after the trauma. One thing we have to consider is that the majority of the people who have experienced this effect were set to okay in a very short span of time, the cases are rare facing serious difficulties.
Thanks for your thoughts. It's unclear to me whether you're referring to physical or psychological injury. One problem with trauma of either kind in childhood is that adequate screening for psychological aftereffects is not common. Children can appear healthy when they are not. Crying, sleep problems, whining, oppositional behavior - these can too easily be dismissed as just normal childhood developmental side-effects, and usually this is true. But the rest of the time it is not. I agree with your general comment about most children recovering without serious side-effects. I just wish we caught earlier more of those who do not.
It's so true. Thanks for replying.
Also, as equally imperative as physical harshness is verbal abuse. Yelling and screaming at a child can cause stress and lower a child's self esteem. I believe in natural parenting or attachment parenting as providing an effective method in parenting and even discipline.
Thanks for your thoughtful and well-informed response!
There are SO MANY people who I wish understood what you just said. In truth, what matters, always, is the emotional response in the child. THAT is what traumatizes. Children have poor ego defenses, and are more emotional than thoughtful. That's a perfect setup for high levels of vulnerability to verbal abuse.
To do a bit of a rewrite on your first sentence - to make your point even more strongly: it's not the physical abuse, or even the verbal abuse, that traumatizes. It's the emotional response provoked in the child. The same is true for anyone, regardless of age. Children are just more vulnerable, ESPECIALLY when the abuser is an adult upon whom they rely for their physical and emotional support.