María Dolores Braquehais, M.D., Ph.D.

There is an increasing evidence of the effects of childhood trauma in the developing brain of children and adolescents (1). Child maltreatment (or child abuse and neglect) substantially contributes to child mortality and morbidity and has long-lasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood (2). It has also been related to school failure, although complex psychosocial factors contribute to this phenomenon (2).

Child maltreatment elevates the risk of psychiatric and medical diseases (3;4) although not all exposed individuals demonstrate the same altered responses, suggesting that genetic variations influence the consequences of trauma exposure. In addition, the effects of maltreatment may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioral changes in affected individuals. Exposure to multiple forms of abuse has been said to be associated with very large effect sizes (2;5). Most maltreated children are exposed to multiple types of abuse, and the number of different types is a critically important factor (6).

With regard to the brain, child maltreatment leads to an acquired inability of the brain to inhibit some negative actions (1). Child abuse may result in a chronic inability to modulate emotions, thus augmenting the risk of getting involved in indiscriminate relationships with others in which old traumas may be repeated (1;7-12) and/or of being exposed to new traumas.

Despite great efforts made in the last decades to improve the quality of programs devoted to preventing child maltreatment, there is still a lack of proper assessment of the interventions that are currently being put in place. Most of the interventions lack adequate evaluation (13) and interventions are often implemented before undergoing adequate assessment (14). However, enough evidence available supports a superior effectiveness of the primary prevention policies (and, specifically, some home-visiting programs such as the Nurse-Family Partnership) have demonstrated its efficacy over the second and tertiary strategies (15;16).

New efforts should be developed in the future in order to improve all preventive strategies for child abuse but, especially, primary prevention interventions.

References

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3. Neigh GN, Gillespie CF, Nemeroff CB. The neurobiological toll of child abuse and neglect. Trauma Violence Abuse 2009 Oct;10(4):389-410.
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