Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment

Abstract

Children who have suffered early abuse or neglect may later present with significant health and behavior problems that may persist long after the abusive or neglectful environment has been remediated. Neurobiological research suggests that early maltreatment may result in an altered psychological and physiologic response to stressful stimuli, a response that deleteriously affects the child’s subsequent development. Pediatricians can assist caregivers by helping them recognize the abused or neglected child’s emotional and behavioral responses associated with child maltreatment and guide them in the use of positive parenting strategies, referring the children and families to evidence-based therapeutic treatment and mobilizing available community resources.

Trauma-Informed Care: Essential Elements for Pediatric Health Care

“…The diagnostic criteria for PTSD in children are as follows: a tendency to persistently re-experience the traumatic event through intrusive thoughts, feelings, dreams, and flashbacks; avoidance of stimuli that remind the child of the traumatic event; negative alterations in mood and cognitions (negative beliefs about self and the world); persistent feelings of fear, horror, anger, guilt, shame, or detachment; and alterations in arousal and reactivity (hypervigilance, irritability, anger outbursts, reckless behavior, decreased attention, poor concentration, and sleep disturbance; American Psychiatric Association, 2013). Other mental health disorders that often coexist with PTSD include depression, anxiety, disruptive behavioral disorders (oppositional defiant disorder and conduct disorders), substance abuse, and suicidal behaviors (Sege et al, 2017). The concept of trauma-informed pediatric care involves incorporating an understanding of posttraumatic stress symptoms (trauma symptoms) and a realization that what appears to be a behavioral or mental health disorder in a child could be the result of trauma exposure (Kassam-Adams et al, 2014).…”

“…Many of the serious long-term behavioral impairments associated with trauma exposure may become apparent in adolescence as risk behaviors: suicide attempts, sexually transmitted diseases, drug use, and risky sexual behavior (Sege et al, 2017). Adolescents may experience cognitive and emotional dysregulation with feelings of rage and shame.…”

The Impact of Trauma on Learning

“…Much of these internalizing and externalizing problematic behaviors arise from negative thoughts about themselves and the world (e.g., "no one likes me" or "I'm bad") as they try to make meaning of the trauma on their own (Holmes et al, 2015). They become the students in the classroom who have overall difficulties in socializing with their peers (Berthelot et al, 2015;Holt, Finkelhor, & Kantor, 2007) and are at greater risk later on, in adolescence, of turning to binge drinking (Shin, Edwards, & Heeren, 2009), drug use, and risky sexual behavior (Sege & Amaya-Jackson, 2017).…”

“…This is a child who needs support and services, but this type of child is often overlooked if internalizing and is often sent out of the classroom if externalizing. Aggressiveness and hyperactivity tend to draw the most attention in a classroom (Lamers-Winkelman et al, 2012), and diagnoses of ADHD and conduct disorder are the most common (Sege & Amaya-Jackson, 2017), which may also overlook the presence of trauma.…”

Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians

“…It is well recognised that developmental trauma has lasting impacts on child and adult physical and mental health and can lead to neurobiological changes . A history of developmental trauma is the single most significant predictor for the requirement of mental health services as an adult .…”