Adverse childhood experiences and mental health disorders in adulthood have “a very strong link” to each other, according to Dr. Frank Maffei, president of pediatrics at Geisinger.
This is why the rise in child abuse cases across the nation is so “worrying”. Having adverse childhood experiences (ACEs) can lead to behavioral health problems in children and adolescents, which puts them at risk for suicide, Maffei said.
“If you have someone who has a high ACE score, the risk of mental illness is substantially higher,” said Maffei. “The CDC (Centers for Disease Control and Prevention) is now looking at the adverse experiences of childhood as a predictor not only of mental illness but also of physical illness. Our bodies respond emotionally and physically to these adverse childhood experiences. They have serious consequences “.
An ACE score is a count of different types of abuse, neglect, and other adverse childhood experiences. A higher score indicates a higher risk of health problems later in life.
The State Department of Human Services reported in its latest annual report on child abuse that there were 73 deaths and 115 near deaths related to child abuse in Pennsylvania in 2020. The previous report showed that there were 51 deaths and 93 near deaths in Pennsylvania in 2019. Nationwide an estimated 1,840 children died from abuse or neglect in 2019, a slight increase from the number of 1,780 in 2018. However, that’s a 10.8% increase from to the number of 1,660 of 2015.
The number of child abuse deaths far exceeded the combined number of deaths from COVID-19 and influenza in children. Cases have gotten worse, but the common belief is that even cases of child abuse are not reported, Maffei said.
“It is simply not truly understood and appreciated to the point that we have a sense of urgency to address the child abuse epidemic in the same way that we have dealt with COVID,” said Maffei. “It’s just getting worse.”
Near-deaths are “horrific” and often leave children with “devastating long-term consequences,” including brain injury, neurodevelopmental injury, and emotional devastation. Surviving children do not survive unscathed, they survive with “disastrous disabilities for life,” Maffei said.
All connected
Everything in childhood mentally, emotionally and physically affects adulthood, she said.
“We want to keep our children fed and safe,” said Maffei. “Not just to enjoy their childhood, but also to have a healthy and productive adulthood. You can’t have one without the other. If you want healthy adults, you need to start caring for babies in the womb, making sure moms have nutrition. During childhood, you must also take care of the children. “
William Brecker, Northumberland County Children’s Mental Health Program Specialist, County Behavioral Health and Intellectual Disability Services, said he sees more mental health needs services than ever, but there are waiting lists for the agencies that provide these services.
“The children are being cared for, we work with them on a daily basis, and the workers have children grappling with their cases for three years, and it won’t change if nothing changes in the child’s home,” said Brecker. “We continue to treat these (mentally ill) children, but unfortunately these children are in the same environment where the trauma occurred. It is difficult to improve someone’s mental health when the factors that cause their mental health are not addressed. “
Symptoms are being treated but none are improving the root cause of children’s mental health problems, Brecker said.
“They are having problems because of their environment: abuse, neglect, missing parents, trauma,” Brecker said. “They could be cutting edge, they could say they were depressed or suicidal. We can treat it, but until they are no longer traumatized, we will continue to provide them with services. “
Most teens won’t get better if they stay in the same home environment, she said.
“I don’t think there is enough public light on the problems of child abuse and neglect, and that children are in a home they shouldn’t be in,” Brecker said. “I look at the heroin epidemic. It’s not bad, don’t get me wrong, but I think we should focus as much on child abuse, neglect and lack of parenting as we do, they will bring a lot of things to light. That’s all where it starts. “
These children who are abused or neglected are more likely to develop mental illness, commit crimes, or abuse drugs and substances when they are adults, she said.
“You have to stop the cycle somewhere. That’s where you should start, ”Brecker said. “In my opinion it’s a big problem and not enough attention is paid to it.”
Suicide
For young people between the ages of 10 and 24, suicide is the second leading cause of death, resulting in the loss of nearly 6,500 lives each year, according to the Centers for Disease Control and Prevention. The CDC’s Adolescent Behavior and Experiences Survey (ABES) shows that more than one in three high school students experienced poor mental health during the pandemic, and nearly half of the students felt constantly sad or hopeless.
Suicide rates remained stable between 2000 and 2007, but rates started to rise between 2007 and 2018, the pre-pandemic period. Dr Angelica Kloos, interim medical director for pediatric psychiatry at Geisinger, said the trend in mental health and suicide risk has been on the rise over the past 20 years.
“We had it during the pandemic,” Kloos said. “As children and families entered the pandemic, they faced multiple stressors. When we emphasize the family system and the child, we can only anticipate that the risks to mental health are exacerbated ”.
‘Dynamic social change’
A shift in “social dynamic in adolescents” may be partly responsible, Maffei said.
“The thing that often comes to the fore is whether the explosion of social media and electronic communications has somehow led to further isolation,” said Maffei. “I don’t think this is the only reason, but it certainly is the one that most experts have recognized as part of this multidimensional reason for the increase in adolescent suicide in childhood.”
While it can lead to social isolation and feelings of insecurity, Maffei said social media can’t be the only factor. There has also been an increase in substance abuse, she said.
“The pandemic has amplified the importance of social connections and the dynamics that adolescents have,” said Maffei. “We have seen an increase in suicide attempts among teenagers, especially girls and young women. There has been a 50 percent increase in emergency room visits among young women due to suicide attempts in the nation. The rise in boys wasn’t all that much at 5 percent.
The teen’s brain is still developing. One portion of the brain – the prefrontal cortex – didn’t fully develop until the mid-1920s, Maffei said.
“It’s a very intricate force in the brain that really sharpens decision making,” he said. “It’s at the heart of impulse control. If you don’t have this fully mature prefrontal cortex, you may be making a decision based on feeling rather than logic or facts. That’s why all of us as teenagers took risks, we were impulsive, sometimes prone to emotional fluctuations. This is because we were developing “.
‘Vulnerable population’
Plus, Maffei said, teens are trying to find their way in so many different ways. They face a unique set of circumstances. High school has bullying. Some groups are marginalized, which leads to greater isolation, she said.
“They just went through a physical transformation called puberty,” she said. “Now they have to deal with a body that has undergone a significant change in adulthood. With this comes a great deal of stress. They are solving a lot of problems. They have to do with sexual identity. They have to do with researching their group. They are trying to find where they fit. It can be very difficult ”.
Teenagers are a “very vulnerable population,” Kloos said.
“They gave this new and robust social environment,” he said. “Their environment has become much larger and their interest in socialization in terms of development is much stronger. These social interactions help develop their sense of self. At the same time, especially these younger teenagers, they lack the ability to regulate these emotions and understand some of these situations. They are exposed to many things, but perhaps they don’t have the skills and strategies to deal with them. “
Kloos also noted that gun violence weighs heavily on the mental health of teenagers and children.
“Whenever there is a tragedy like the one that has recently been in the news, it is upsetting for children and families as our sense of safety and normality is disrupted,” said Kloos. “As parents, we can make sure we provide support and comfort to our children. We also need to limit our exposure to the media and listen carefully to the questions or concerns they raise and provide development-appropriate responses to help them feel safe. “
Younger children will respond more to stressors in their homes and classrooms. Older children and teenagers respond more to their social groups, she said.
“Older teenagers are trying to gain autonomy,” Kloos said. “They are learning to drive, they are thinking about colleges, they have the next curfew. Navigating in those circumstances is a good stressor most of the time, but it can also be a challenge for them. “
Younger children often respond with behavioral problems when they are stressed. As they age and reach adolescence and young adulthood, they are more likely to show classic depression, Kloos said.
“If a younger child is depressed, you may not see those classic signs of depression,” she said. “It could turn out to be more like irritability, it could turn out to be anger, it could turn out to be boredom.”
How much COVID has played a role is still in the air. Children and teens are eager to go to school as well as not having a continuous structure with the transition from in-person and distance learning, Kloos said.
“It was a real struggle for them to get back on track,” said Kloos. “The more we can provide them with stability and predictability, we will see improvements in those areas as we hope to overcome the pandemic.”
The teen’s brain needs to be nurtured and controlled. Do mental hygiene with children and teenagers: ask how they are, what happens at school, make sure they get enough sleep, make sure they are not dismissing certain suicidal behaviors, said Maffei.