A Critical Review of the Psychological Literature
Alexandra K. Margevich
December 2016
This report provides a critical and comprehensive review of the empirical literature on the sequelae of childhood exposure to potentially traumatic events (PTEs), with special emphasis on low socioeconomic status (SES) populations at disparate risk for exposure to PTEs across the lifespan. First, I will outline the categories and characteristics of childhood PTEs. Second, I will synthesize research on the proximal and distal consequences of childhood PTE exposure. Third, I will identify significant mediators (i.e., how or why PTE-related outcomes occur) and moderators (i.e., when or for whom PTE-related outcomes hold) of children’s responses to trauma. Finally, I will provide recommendations for building resilience in children and their social environments.
Early life adversity is a pervasive problem in the United States— the majority of the population will be exposed to at least one potentially traumatic event before 18 years of age (e.g., Felitti et al., 1998). Early exposure to potentially traumatic events can interrupt typical developmental pathways and elevate risk for problems with health and functioning in the immediate and distant aftermath of trauma exposure (Heim & Nemeroff, 2001; Heim, Shugart, Craighead, & Nemeroff, 2010; Nemeroff, 2004). Although childhood trauma exposure is a nationwide public health issue, children living in low socioeconomic status (SES), high-crime areas are at disparate risk for developing harmful trauma-related outcomes (e.g., physical, psychological, cognitive) due to the increased sources and frequency of potentially traumatic events (Taylor, Way, & Seeman, 2011). Consistent with research on allostatic load (McEwen & Stellar, 1993), the combination of chronic stressors such as economic hardship (e.g., food insecurity), community violence (e.g., gang violence, property crimes), and social discrimination (e.g., racial, class-based) take a cumulative toll on children’s health and functioning (e.g., Body, Yu, & Beach, 2016). Thus, attention should be directed towards addressing this issue in U.S. cities at disparate risk for the sequelae of chronic childhood trauma exposure, like Newark, New Jersey, where approximately 30% of residents currently live in poverty and crime rates are among the highest in the nation (Federal Bureau of Investigation, 2015; U.S. Census Bureau, 2015).
Unfortunately, the observable effects of trauma exposure that present during childhood and adolescence tend either to go unnoticed or to be misattributed to non-trauma-related sources (e.g., juvenile delinquency) by those individuals who are optimally positioned to intervene, including family members, school personnel, and child welfare workers (Aisenberg & Mennen, 2000). For example, adults may overlook external sources of deviant behavior when a child’s traumatic response is stereotype-consistent (e.g., an aggressive boy; Burgoon, 2015). This is a major concern because traumatized children in high-risk communities who “fly under the radar” are unlikely to independently seek help, partly due to health service inaccessibility and mental illness stigma (Aisenberg & Mennen, 2000; Pynoos et al., 2008). Moreover, society is more likely to filter traumatized individuals from cities like Newark, New Jersey into the criminal justice system than the mental health system (Sullivan, 2016; Torrey, Kennard, Eslinger, Lamb, & Pavle, 2010). As a result, these children will continue to experience decrements in health and functioning throughout their life course, making it virtually impossible for them to break the cycle of poverty.
Considering the deleterious effects of childhood trauma exposure, which may disproportionately impact children living in poverty, this review paper seeks to unpack the causes and consequences of this major public health issue through a systematic review of the trauma and victimization literatures. After briefly describing the literature search process, I will first outline the categories and characteristics of potentially traumatic events in childhood. Second, I will synthesize research on the proximal and distal consequences of childhood trauma exposure. Third, I will identify significant mediators (i.e., how or why trauma-related outcomes occur; Baron & Kenny, 1986) and moderators (i.e., when or for whom trauma-related outcomes hold; Baron & Kenny, 1986) of children’s responses to potentially traumatic events. Finally, I will provide recommendations for a community-based approach to trauma prevention, with an emphasis on building resiliency.
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