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Childhood trauma linked to higher rates of mental health problems and obesity, says Stanford/Packard psychiatrist


PALO ALTO, Calif.
-- New research has shown that children’s risk for learning and behavior problems and obesity rises in correlation to their level of trauma exposure, says the psychiatrist at the Stanford University School of Medicine and Lucile Packard Children’s Hospital who oversaw the study. The findings could encourage physicians to consider diagnosing post-traumatic stress disorder rather than attention deficit/hyperactivity disorder, which has similar symptoms to PTSD but very different treatment.

 The study examined children living in a violent, low-income neighborhood and documented an unexpectedly strong link between abuse, trauma and neglect and the children’s mental and physical health: It reported, for instance, that children experiencing four types of trauma were 30 times more likely to have behavior and learning problems than those not exposed to trauma.
 
“In communities where there is violence, where children are exposed to events such as shootings in their neighborhoods, kids experience a constant environmental threat,” said senior author Victor Carrion, MD, associate professor of psychiatry and behavioral sciences at Stanford. “Contrary to some people’s belief, these children don’t get used to trauma. These events remain stressful and impact children’s physiology.”
 
The new study is being published online today in Child Abuse & Neglect: The International Journal. Carrion collaborated on the research with scientists at the University of New Orleans and the Bayview Child Health Center, part of San Francisco’s California Pacific Medical Center.
 
The findings provide compelling evidence that pediatricians should routinely screen children for trauma exposures, said Carrion, who is also a child psychiatrist at Packard Children’s.
 
“As simple as it may seem, physicians do not ask about trauma,” he said. “And kids get the wrong diagnoses.”
 
The study builds on earlier work that linked worsening health in adults with their dose of exposure to nine types of adverse childhood events, including being subject to various kinds of abuse or neglect; having a household member who abused alcohol or drugs, was incarcerated or was mentally ill; having a mother who was treated violently; and not living in a two-parent household. Middle-class men exposed to more of these events had more chronic diseases in adulthood, the prior research found. The results of the current study highlight the need for early identification of such adversity-associated health problems, and early intervention. Obesity, for example, may act as a mediator to other health problems such as diabetes, cardiac risk and inflammatory illness.
 
To perform the study, the researchers evaluated medical records from 701 children treated at a primary-care clinic in Bayview-Hunter’s Point, a San Francisco neighborhood with high rates of poverty and violence. About half the children were African-American; the rest came from other ethnic backgrounds. Each child’s exposure to adverse events was scored on a scale from 0 to 9, with one point given for each type of adversity. The researchers also evaluated the medical records for evidence of obesity and learning or behavior problems.
 
Two-thirds of the children in the study had experienced at least one category of adversity, and 12 percent experienced four or more categories. An adversity score of 4 or higher left kids 30 times as likely to show learning and behavior problems and twice as likely to be obese as those with a score of 0. Children with an adversity score of 1 were 10 times as likely to have learning and behavior problems as those not exposed to trauma.
 
Prior research has shown that about 30 percent of children in violent communities have symptoms of post-traumatic stress disorder, which can include the learning and behavior problems detected in the current study, Carrion noted. However, a physician unaware of the fact that a child experienced trauma, and noting the child’s physiological hyperarousability and cognitive difficulties, may diagnose ADHD instead of PTSD. That’s a problem because the two disorders have opposite treatments, he said. Kids with PTSD need psychotherapy, not the stimulant medications given for ADHD.
 
“Children can recover from PTSD with the appropriate treatment, which is one of approach and not avoidance,” Carrion said. “By not asking about trauma, we’re utilizing avoidance. We’re perpetuating PTSD.”
 
As part of their efforts to address the long-term health problems that stem from childhood trauma, Carrion, his collaborators and several San Francisco community partners are working to launch the Center for Youth Wellness, a one-stop health and wellness center for urban children and families in San Francisco. The Center for Youth Wellness will combine pediatrics with mental health services, educational support, family support, research and best practices in child-abuse response under one roof. With both public and private support, the center will coordinate the services of multiple agencies to give children a safe and accessible place to increase their resilience to adverse life experiences and improve their well-being.
 
The center, which aims to begin operation by mid-2012, is a partnership between California Pacific Medical Center’s Bayview Child Health Center, San Francisco Child Abuse Prevention Center, San Francisco District Attorney’s Office, Stanford’s Early Life Stress Research Program at Lucile Packard Children’s Hospital and Tipping Point Community. Nadine Burke, MD, director of the Bayview center, is also a co-author of the study.
 
“We need to create trauma-informed systems,” Carrion concluded, adding that the Center for Youth Wellness hopes to function as a model for such systems across the nation. People working for the welfare of children need to be on the lookout for trauma and know how to intervene, and how to work with the family and with schools, he said. “If trauma goes untreated, it’s very costly for the individuals involved and for society in general.”
 
The research was funded by the Lennar Urban Corp. and awards to Carrion from the National Institute of Mental Health and the Evans Foundation.

Authors

About Stanford Children’s Health and Lucile Packard Children’s Hospital Stanford
Stanford Children’s Health, with Lucile Packard Children’s Hospital Stanford at its core, is an internationally recognized leader in world-class, nurturing care and extraordinary outcomes in every pediatric and obstetric specialty from the routine to rare, for every child and pregnant woman. Together with our Stanford Medicine physicians, nurses, and staff, we deliver this innovative care and research through partnerships, collaborations, outreach, specialty clinics and primary care practices at more than 100 locations in the U.S. western region. As a non-profit, we are committed to supporting our community – from caring for uninsured or underinsured kids, homeless teens and pregnant moms, to helping re-establish school nurse positions in local schools. Learn more about our full range of preeminent programs and network of care at stanfordchildrens.org, and on our Healthier, Happy Lives blog. Join us on Facebook, Twitter, LinkedIn, and YouTube.

Lucile Packard Children’s Hospital Stanford is the heart of Stanford Children’s Health, and is one of the nation’s top hospitals for the care of children and expectant mothers. For a decade, we have received the highest specialty rankings of any Northern California children’s hospital, according to U.S. News & World Report’s 2014-15 Best Children’s Hospitals survey, and are the only hospital in Northern California to receive the national 2013 Leapfrog Group Top Children’s Hospital award for quality and patient care safety. Discover more at stanfordchildrens.org.

About Stanford University School of Medicine
The Stanford University School of Medicine consistently ranks among the nation’s top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.