WITH research linking childhood trauma to five of the 10 leading causes of death globally, head of community health and psychiatry at The University of the West Indies Professor Wendel Abel says Jamaica should be exploring that connection more.

Describing his experience in the early years of training — during which children who were “cutting, stealing, lying, irritable, always fighting, hyperactive, restless in class” were more often than not diagnosed with conduct disorder, attention deficit disorder or oppositional defiant disorder — Abel said his quest to unravel “what’s wrong with that child” was answered by a 1998 study on adverse childhood experiences (ACEs) in the United States.

He said the study, which questioned more than 17,000 adults about early trauma in 10 categories, led to the “astounding” finding that ACEs are “common”, with “two out of every three” individuals having at least one ACE. The study also showed that one in six respondents had reported four or more ACEs. It also revealed that these adverse childhood experiences — which ranged from physical, emotional and sexual abuse to neglect, domestic violence and loss of a parent — were linked to five of the 10 leading causes of death globally.

“What is also interesting in terms of the findings from this study is that, the more ACEs you have, the more likely you are to die earlier. With six or more ACEs, persons actually had premature mortality, meaning that they would die 20 years earlier. So if our trauma is not dealt with, we die early,” Abel said in his guest lecture at GraceKennedy Foundation’s Annual Lecture last Wednesday.

According to that study, having four or more ACEs were associated with higher rates of stroke, heart disease, diabetes, lung diseases, and many other conditions.

Abel, in pointing out that in 2021 the leading causes of death were COVID-19, stroke, diabetes, ischemic heart disease, violence, and hypertensive heart disease, said, “the reason I am actually highlighting this is so you realise that the leading causes of death here in Jamaica are similar to what we’re seeing globally and we realise the connection with these conditions and adverse childhood experiences”.

“Obviously, we need to be studying more, we need to be looking more at the situation as it is in Jamaica and recognise that trauma contributes or is linked to many health conditions, and what is also interesting in this study is that as the number of ACEs increase, so does the risk for health outcomes. If you have four or more ACEs, it increases the risk of suicide by 12; the risk for alcohol seven times; depression five times; and ACEs are also linked with post-traumatic stress disorder and conditions such as anxiety,” he added.

“Childhood trauma is about prolonged repeated stress, day in day out, night after night. Children are exposed to prolonged repeated stress and what it does is causes over-activation of their stress response, so the cortisol that is produced becomes poisonous, toxic to the brain and the body,” Abel said in explaining what might be behind the actions of children who exhibit troubled behaviours.

“Our brains are wired for connection; trauma rewires the brain for protection and that’s why healthy relationships are difficult for wounded people. So toxic stress — how does it affect early development — can cause growth delay problems with attention, learning, memory, lower academic performance. Because of the problem with the prefrontal cortex you have problems controlling your impulses,” he said further.

“Children who are irritable, they’re irritable because they’re… not regulated, the alarm system is constantly off. Yes, the child who won’t sit still in class may be hypervigilant, always expecting danger. The child who is not sleeping, always fighting, has poor impulse on control because the prefrontal cortex is actually not working well. The child who is daydreaming, not listening, may actually be dissociating, thinking about trauma and has just left his body in the classroom,” said Abel, whose lecture titled ‘Breaking the Cycle on Childhood Trauma’, explored the effects of childhood trauma and strategies for healing.

In appealing for understanding for such children, he said, “these children, they were not ‘bad’. I hate to use the word; nor were they ‘mad’, they’re actually sad children… responding to chronic toxic stress and so, going forth, let us not ask ‘what is wrong with this child,’ but, ‘what has happened to that child?’”

The consultant psychiatrist and therapist urged adults to change the discourse because behaviour is the language of trauma.

“Children will show you before they tell you they are in distress; that’s what we were seeing in the clinic, that’s what we’re seeing in the classroom, that’s what we’re seeing in the children in State care. They’re seeing their behaviour as a result of trauma,” he said.

In pointing out that there is hope for these children, Abel said, while effective interventions are neither quick nor cheap, the most effective interventions are those that involve screening.

“Screening is relatively cheap. We should be screening our population, screening in schools, screening in our health-care setting for persons with a history of trauma,” he said.

“Home visitation has also been shown to be very effective; positive parenting programmes, high-quality childcare, early education and, of course, multi-component programmes,” Abel told the audience.

He said those interventions are best carried out within the three windows of development in a child’s life: 0-2 years, 9-4 years and 19-21 years.

“We need to prioritise childhood trauma. Childhood trauma abuse is a public health problem, and I don’t think we fully recognise this. I know the resources are challenged and what we do is focus on chronic diseases, but we should also realise that a lot of the chronic diseases are linked to trauma and so we, our public health system, needs to better orientate itself to recognise that we need a more coordinated and integrated approach to trauma at a societal level,” Abel said.

ABEL… going forth, let us not ask ‘what is wrong with this child,’ but, ‘what has happened to that child?