This month’s articles in Pediatrics include two research studies and an invited commentary that support what we know all too well: child abuse has significant societal impact. Not only does child abuse cause harm to the victims when they are children, but it has lasting effects well into adulthood. These consequences cause an excessive public health burden in addition to the individual trauma to each person affected by the abuse.
We have known about the consequences of child abuse for years. In the late 1990’s we learned about Adverse Childhood Experiences (ACEs) from Felitti and Anda. These researchers found that the more ACEs an adult reports, the more risk they have for long-term, chronic medical conditions including substance abuse, depression, cancer and even diabetes. Almost all of the defined ACEs are related to child abuse and neglect. In the years since the first ACEs publication, there have been dozens more studies which support these findings. In 2012, Shonkoff and Garner published both a policy statement and a technical report highlighting how early childhood adversity (toxic stress) affects the growth and development of children and thus places them at increased risk for lifelong consequences.
This month, Lansford et al (10.1542/peds.2020-0873) found that children who are victims of physical abuse are more likely to need special education, to repeat a grade, and have decreased 4-year college completion rates. In addition, these same researchers noted significantly lower reported health and an increase in mental health disorders in the same cohort. Finally, Segal et al found that in Australia, just having a child protective service report placed in a child’s health record actually doubled the risk of death in early adulthood (10.1542/peds.2020-023416). This early death was most likely related to substance use/poisoning and suicide.
Why do we continue to do research on the harmful effects of child abuse, but there has been little done to prevent or properly treat that abuse? Berger (10.1542/peds.2020-031963) in the accompanying commentary rightfully calls this a “shameful society failure” when we do not support the victims and when we fail to prevent abuse in the first place. We clearly need to do more.