DEEP LINKS

The emerging, devastating evidence that childhood trauma could affect the next generation

It is a well-documented and deeply sad fact that if you suffer from trauma as a child, you are more likely to suffer as an adult. People with a childhood history of trauma have a greater risk of being obese, getting cancer, suffering from heart disease and mental illness, and dying sooner. They’re also more likely to engage in risky behaviors—smoking, illicit drugs, and high-risk sex—which is also predictive of bad outcomes.

Now researchers are going a step further, examining whether a parent’s trauma might materialize in their children’s health.

A new study, published in Pediatrics, found that for every type of “adverse childhood event” (ACE) a parent went through, their children had 19% higher odds of poorer health and 17% higher odds of having asthma. ACEs are serious traumas or stressors that happen in a child’s early years, including physical abuse, sexual abuse, emotional abuse, physical neglect, and domestic violence, among others. An expanded definition also includes witnessing violence, facing racial or ethnic discrimination, and living in an unsafe neighborhood.

Félice Lê-Scherban, the study’s lead researcher and an assistant professor in Drexel’s Dornsife School of Public Health, said that we are probably underestimating the effects of trauma by looking at only how it impacts the person who experiences it directly. “Looking intergenerationally gives us a more comprehensive picture of the long-term processes that might affect children’s health,” she said.

The study used surveys taken by 350 Philadelphia parents who answered questions about their own “ACEs” as well as questions about their children’s health, health behaviors—like eating fruits and vegetables and getting exercise—and health-care access. The respondents were overwhelmingly female (80%), and 45% were African-American. The results held when the authors controlled for income and education. (The survey was part of two larger surveys: the Southeastern Pennsylvania Household Health Survey, and the Philadelphia ACE survey.)

The data revealed a shocking history of abuse and neglect: Overall, 85% of parents in the survey had experienced at least one ACE (with the expanded definition), and 18% had experienced more than six. The parent-child pairs were all from Philadelphia, where one-quarter of residents live in poverty.

Specifically, of the parents surveyed:

  • Nearly 42% said they’d witnessed violence, such as seeing someone shot, stabbed or beaten, as a child
  • 38% said they lived with a problem drinker or someone who used drugs during their youth
  • About 37% said that they had been physically abused as children

Lê-Scherban says the study—which does not show causation, only association—shows how strong the link between trauma and long-term negative health outcomes might be. The more ACEs a parent had suffered as a child, the more likely their own children were to have poorer health status. Particularly worrying, she said in an interview, was the fact that having asthma and poor health as a child are a strong predictors of having them into adulthood, which in turn predict higher mortality rates.

Toward trauma-informed care

The authors do not know the mechanism by which trauma is passed on—that is, if it is primarily environmental, genetic, or epigenetic (involving genetic changes that are caused by environmental factors, such as smoking, diet, or stress). For example, many parents who suffered ACEs have mental illness as adults, which has been shown to impair parenting. ACEs also alter neural functioning and increase inflammation, which could affect how genes express themselves. (One study found that the trauma experienced by Holocaust survivors caused genetic changes, which could be passed down to their children.)

The study did not measure factors which could buffer ACEs: strong families and tight-knit communities, both of which can build resilience against trauma. The sample was small and skewed female. But the association warrants further research: The better we understand the effects of trauma, the better chance we have of intervening in order to help mitigate the damage.

Lê-Scherban suggests this shift is already underway. “There is this movement in health care and in social services toward trauma-informed care, which is really important,” she said.

Research shows that when kids are exposed to moderate or high levels of stress, the biology of their brains changes. They are less able to perform complex intellectual tasks and regulate their emotions, and their working memory is impaired. Paul Tough, author of Helping Children Succeed: What Works and Why, explains, “Research has shown that when parents behave harshly or unpredictably — especially at moments when their children are upset — the children are less likely over time to develop the ability to manage strong emotions and more likely to respond ineffectively to stressful situations.”

And so programs that coach parents who have suffered from ACEs, and encourage the parents to form sensitive connections with their children, are crucial. Smita Malhotra, a doctor who has herself suffered from debilitating anxiety, writes in the Washington Post: “Just as chronic toxic stress can rewire a child’s brain, the exposure to interventions that promote resilience (including trauma-focused therapy, proper nutrition, yoga and mindfulness) can help the brain to form new connections, a phenomenon called neuroplasticity. With the right tools, children can thrive despite having experienced trauma.”

The study authors also note that while most pediatricians understand the link between childhood adversity and future poor health, few tend to ask parents about their own histories of trauma. “This may represent a missed opportunity,” the researchers suggest. By taking an intergenerational approach to trauma, doctors may be in a position to improve the health of both parents and their kids.

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