Sheila Campbell-Forrester MBBS,DPH; Jennifer Stuart-Dixon DPsych
Sheila Samiel MPH,Dip.Ed, BA.
Introduction: Childhood is often portrayed as a time of innocence and carefree joy. However, for many adolescents, their early years may be marred by experiences of trauma. The aim of this article is to delve into the profound implications of childhood trauma on the health and wellbeing of adolescents and their community .
Childhood Trauma Reverberates through Adolescence and Adulthood
Childhood trauma encompasses a range of adverse experiences, including physical, emotional, or sexual abuse, neglect, family dysfunction, parental divorce, separation or death or witnessing violence. The effects of such trauma can linger long into adolescence and even adulthood, significantly impacting the physical and mental health of individuals. These effects can also spill over into communities and become normative. Such is often the case in child sexual abuse, where reports made by the child to family members or the security force may not be considered credible, especially when the offence is carried out by a family member. This results in little attention being paid to the trauma or its sequelae including the long term and complicated effects on the mental, physical health and wellbeing of the child.
As trauma invades a community, it is not unusual for the community to exhibit acceptance of behaviours such as interpersonal violence, reprisal killings and gender-based violence. Becoming numb to violent acts or engaging in them can become a normal part of community life if there are no interventions at both the individual and community levels to mitigate the impact of trauma. Adolescents themselves may learn to be active participants in violent acts and consider it normal, for example, owning and using a gun. In some communities, fear and anxiety are real concerns for citizens who desire for their children, and themselves to live a “normal” life.
Gun violence has become a major challenge for countries in the Caribbean and the region of the Americas. Homicide rates have increased among young people and according to the Pan American Health Organization, there are 45,000 deaths per year due to homicides in Latin America and the Caribbean. [1] The use of high-powered guns has been responsible for mass shootings and fatalities in schools and public spaces, as well as in the home, by young people in the United States of America (USA). This may be the result of many factors, or a combination of factors related to, access to guns, anger and rage, maladaptive behaviours, and mental ill health. Access and availability of firearms in the Caribbean is a major public policy issue that requires a whole of society and regional approach. Many guns identified in the Caribbean originate in the USA and become accessible to young people contributing to the high rates of homicides especially in Jamaica. While some policies exist, enforcement and our ability to address availability of guns and mental health concerns, are barriers that need to be overcome.
Violence against children and adolescents takes many forms such as bullying, conflicts and wars. For example, children and young people are both victims of and casualties of war such as reported in the Ukrainian and the Israeli-Palestinian wars. This is a worrying trend as we observe the displacement of families, separation as fathers who are drafted into war, the fragility of the environment, the emergence of diseases, the social, emotional, educational, health and economic impact on women, children adolescents and their families, lack of water and sanitation, health care and the increased mental health disorders resulting from the traumatic events.
Bullying, another form of childhood trauma, has been evident in schools. This has increased in our school population with exposure to social media. Cyber bullying is increasing and contributing to adverse childhood experiences as young people especially the vulnerable, “differently abled”, those who belong to other religions or are LGBTQI are targeted. This has been found to contribute to increased suicidal ideation and suicides. Regardless of the type of violence, adverse childhood experiences can have a significant impact on the health and well-being of adolescents.
Impact of Childhood Trauma
Psychological Impact: Childhood trauma can have profound psychological effects on adolescents. Many may struggle with anxiety, depression, post-traumatic stress disorder (PTSD), or other mood disorders. These mental health challenges can manifest as difficulty regulating emotions, low self-esteem, self-harm, suicidal ideation or even attempts. Trauma can disrupt normal cognitive development, impairing attention, memory, and executive functioning skills, which are essential for academic success and social interactions.
Behavioural Patterns: Adolescents who have experienced childhood trauma often exhibit maladaptive behavioural patterns. They may engage in risky behaviours such as substance abuse, reckless driving, or high-risk sexual activity as coping mechanisms or attempts to numb their emotional pain. Some adolescents may display aggression or antisocial behaviour, perpetuating a cycle of violence or dysfunction within their communities. Others may exhibit “introverted” behaviour, becoming more withdrawn. Self-harm and depression are the main responses in this group as they suffer in silence. Their suffering may also go unnoticed.
These behavioural issues can exacerbate social isolation and impair relationships with peers and authority figures.
Physical Health Consequences: The impact of childhood trauma extends beyond psychological and behavioural realms to affect physical health. Research has shown a strong correlation between childhood trauma and various health conditions later in life, including cardiovascular disease, obesity, diabetes, and autoimmune disorders. Adverse childhood experiences (ACEs) can dysregulate stress response systems, leading to chronic inflammation, hormonal imbalances, and impaired immune function. Furthermore, coping mechanisms such as overeating, restrictive eating, substance abuse, or self-harm can contribute to poor health outcomes and increase the risk of premature mortality.
Interpersonal Relationships: Healthy interpersonal relationships are crucial for adolescent development, yet childhood trauma can disrupt the ability to form secure attachments and trust others. Adolescents who have experienced trauma may struggle with intimacy, communication, and boundaries in relationships. They may have difficulty expressing emotions or recognizing signs of abuse or manipulation, making them vulnerable to further victimization. As a result, they may withdraw from social interactions or engage in tumultuous relationships characterized by conflict and instability.
Pandemic Isolation – Special Case
The COVID-19 Pandemic: The COVID-19 pandemic was a traumatic event for adolescents as they had to endure “lock downs”, social isolation, having to adapt fulltime to homelife (some of which was dysfunctional), being away from school and their peers and having to engage in virtual schooling. This type of schooling would have been new and challenging to some adolescents. It was further compounded by a lack of skills and technological equipment to enable their schooling as experienced by some young people. Inequities existed between those who were rich and those who were poor; if you lived in a rural or an urban community and if you had reliable access to the internet. These inequities still exist in some settings today.
At the end of the pandemic, adolescents had lost two years of school. For many adolescents school is a safe and nurturing space where they learn in a caring environment, for the most part, supported by caring teachers, and their peers. For some, this is where meals for the week are guaranteed. Young people and their parents had to cope with the emotional, psychological, financial, and social impact of COVID-19 and for some it was challenging. During the period of isolation, exposure to social media increased, and with time on their hands and insufficient parental guidance, some adolescents were exposed to risky behaviours which they applied on their return to school. At the end of the pandemic, it was very challenging for adolescents to become reintegrated into normal school life. For those who were ill-prepared for the transition, coping became a challenge. The result was an increase in conflicts at school with increased risk-taking resulting in injuries and increased fatalities among students.
Resilience and Healing is Possible
While the impact of childhood trauma on adolescent health is significant, it is essential to recognize that not all individuals experience negative outcomes. Resilience factors, such as supportive relationships, access to mental health services, and adaptive coping strategies, play a crucial role in mitigating the effects of trauma. Early intervention and trauma-informed care can help adolescents process their experiences, develop healthy coping mechanisms, and rebuild a sense of safety and empowerment. Cultivating resilience not only promotes healing but also equips adolescents with the skills to navigate future challenges and thrive despite adversity.
Why and what should be our response?
Felitti suggested societal changes that improve the quality of family and household environments during childhood to be a key strategy for reducing ACE’s. A “whole of country” approach along the following steps are other strategies that can form part of our response:
Defining “Love” as the core value and how it can be measured.
Defining the "Nation family" (how our leaders should behave and their role in setting behavioural standards), recognizing that they themselves may have suffered childhood trauma.
Advocacy for governments to strengthen the policy environment to reduce, and prevent inequities and trauma in children, and adolescents.
Investing in the training of competent and compassionate social workers, community people including community health workers, pastors, guidance counsellors, Justices of the Peace, and psychologists working with community structures such community based organizations, non-governmental organizations, faith-based organizations, and youth serving organizations.
Defining the profile of the Caribbean citizen (customized for each country) and implementing interventions that protect the rights of children and youth in general while ensuring that parental and community responsibility are understood and taken seriously. Interventions should align to a country’s cultural values that support the protection of children and young people; and discourage the ones that do not.
Organizing communities and empowering them to be protectors of children and young people as well as ensuring measurable outcomes.
Investing in mitigation strategies including advocacy to reduce the burden of violence and abuse on families, health services and the country. This could be “cost beneficial” to a country.
Building partnerships across countries, communities, and agencies. Engaging families, schools and parents to advocate for healthy public policies.
Conclusion: Childhood trauma casts a long shadow over the health and well-being of adolescents, affecting their psychological, behavioural, and physical health outcomes. Identifying and understanding the complex interplay between trauma and health is essential for healthcare professionals, educators, policymakers, and communities to provide appropriate support and interventions. By fostering resilience and creating trauma-informed environments, we can empower adolescents to overcome adversity and lead fulfilling lives beyond their traumatic past.
References:
Felitti, V. J., et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Anda, R. F., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174-186.
Teicher, M. H., et al. (2016). Childhood trauma and the enduring consequences of forcibly separating children from parents at the United States border. BMC Medicine, 14(1), 1-15.
Shonkoff, J. P., et al. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246.
Masten, A. S., et al. (1999). Resilience in individual development: Successful adaptation despite risk and adversity. In M. D. Glantz & J. L. Johnson (Eds.), Resilience and development: Positive life adaptations (pp. 1-25). Springer.
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