It is not easy to discuss, but this subject, which is important to the health and well-being of our children – and indeed our society, deserves to be brought from the shadows into the spotlight.
According to the Centers for Disease Control and Prevention, in 2012, more than 680,000 children were reported victims of maltreatment, a number that is vastly exceeded by the estimated actual rate of 1 in 4 children in the United States.
Nearly 50 percent of child victims were younger than 5 years old, with the highest rate of victimization among infants less than 1 year old. Equally troubling is that 80 percent of perpetrators were parents.
There is emerging evidence that child maltreatment affects not only the immediate well-being of the child but is likely to have long-lasting impacts that affect the health and even survival of the child well into adulthood.
The Centers for Disease Control, in partnership with Kaiser Permanente in San Diego, is tracking the long-term health impacts of adverse childhood experiences (ACE) on a group of people enrolled in the ACE study in the 1990s.
The original ACE study assessed the prevalence of 10 specific types of childhood trauma. These involve five personal experiences, including physical abuse, verbal abuse, sexual abuse, physical neglect and emotional neglect. They also examine five family experiences, including an alcoholic parent, a mother who is a victim of domestic violence, a jailed family member, a family member with a mental illness and the disappearance of a parent through divorce, death or abandonment.
With one point assigned to each element, the resulting total is the ACE score. What is remarkable is that more than 50 scientific publications have shown a link between the ACE score and chronic diseases or adverse health behaviors. These have included alcoholism, depression, ischemic heart disease, teen pregnancy, liver disease, chronic obstructive pulmonary disease and smoking – to name just a few.
Experts from the ACE study have suggested that there may be a link between such experiences and adverse health conditions, leading to premature death. In theory, the social, emotional and cognitive impairment that results from adverse childhood events may lead to the adoption of risky behaviors leading to disease, social problems and even early death.
This theory is based on the observation of a clustering of adverse health conditions and their risk factors related to adverse childhood events. To be clear, the study is ongoing among the original 17,000 children enrolled two decades ago. Yet, evidence to date supports the link.
The implication of this research is clear. By examining the link between adverse childhood experiences and health throughout the human lifespan, the opportunity may exist to intervene to bend the trajectory of this process toward improved health outcomes and well-being.
Regardless, it should be clear to all of us that the high prevalence of child neglect and maltreatment is unacceptable, with immediate implications for child victims, which may continue to adversely affect health for a lifetime.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.