“Breaking the Silence on Child Abuse: Protection, Prevention, Intervention and Deterrence.” Testimony of Robert W. Block MD, FAAP

“Breaking the Silence on Child Abuse: Protection, Prevention, Intervention and Deterrence.” Testimony of Robert W. Block MD, FAAP

“Based on the [Adverse Childhood Experiences] study, childhood trauma, including abuse and neglect, may be the leading cause of poor health among adults in the United States.”  —  Robert Block MD


December 13, 2011 testimony of Robert W. Block, MD, Fellow of the American Academy of Pediatrics, before the Senate Health, Education, Labor and Pensions Committee hearing on behalf of the American Academy of Pediatrics

(Full text: “Breaking the Silence on Child Abuse: Protection, Prevention, Intervention and Deterrence.”)

[edited for length]

“Throughout my many years in this field [child abuse pediatrics], the question I am most frequently asked is, ‘How can you do this work? My answer is, how can you not?’

“In 2008, US state and local child protective services (CPS) received 3.3 million reports of children being abused or neglected. 71% of the children were classified as victims of child neglect; 16% as victims of physical abuse; 9% as victims of sexual abuse; and 7% as victims of emotional abuse.

“Sadly, these numbers are almost certainly only the tip of the iceberg. The majority of cases of abuse and neglect go unreported. In one major study sponsored by the Center for Disease Control, 25% of adults reported having been victims of physical and/or emotional abuse as a child, 28% said they had been physically abused, 21% said that they had been sexually abused and 11% had been psychologically abused’.

“Children who have suffered abuse or neglect may develop a variety of short or long-term behavioral and functional problems including conduct disorders, poor academic performance, decreased cognitive functioning, emotional instability, depression, a tendency to be aggressive or violent with others, posttraumatic stress disorder (PTSD), sleep disturbances, anxiety, oppositional behavior and others. These conditions can linger long after the abuse or neglect has ceased, even with consistent and attentive parenting by foster or adoptive parents or birthparents who have successfully changed their own behaviors.

“Until recently, the medical field did not have a complete understanding that child abuse and neglect not only damage an individual’s short-term health, but also alter a child’s neural physiology. Pediatricians now understand that the dysfunctional behaviors that manifest themselves in children who experience abuse or neglect are the result of the brain’s physiological adaptations to the abnormal world in which the developing child exists.

“When a child suffers an adverse experience, the part of the brain that acts in emotional regulation (amygdala) initially becomes more sensitive to stress. However when a child suffers repeated stressful experiences, the amygdala will shrink as a result of chronic exposure to high concentrations of stress hormones, thereby becoming less sensitive to stressful experiences over time. The more chronic stress the child experiences, the more physiological changes in the brain are likely to take place… These adaptations in the brain, although initially useful for managing and surviving in the child’s stressful environment, do not prepare the child for success in school or for lifelong health and productivity.

“Child abuse not only alters the child’s brain chemistry and neurophysiology, but an increasing body of evidence also documents the robust relationship between adverse experiences in early childhood and a host of other medical complications that manifest throughout an individual’s life. It was not until the 1980s and 1990s that researchers recognized that risk factors for diseases such as smoking, alcohol abuse and risky sexual behaviors, were not randomly distributed in the population [emphasis mine]. In fact, risk factors for many chronic diseases tended to cluster; if an individual had one risk factor, or she was likely to have one or more other risk factors as well. The landmark Adverse Childhood Experiences (ACE) study, sponsored by the CDC and Kaiser Permanente and conducted by co-principal investigators Vincent J. Fellitti, MD and Robert F. Anda MD MS, was one of the first long-term studies to examine the direct connection between risk factors for disease and poor health status in adulthood and their antecedents in adverse experiences during childhood. “The ACE study surveyed almost 18,000 middle-class adults insured through Kaiser Permanente’s Health Maintenance Organization (HMO), regarding their childhood experiences involving abuse, neglect or family dysfunction. Specifically, individuals were asked about their experiences of psychological, physical or sexual abuse; violence against their mother; living in a household with individuals who were substance abusers, mentally ill, suicidal or ever imprisoned; and the death of a biological parent, regardless of the cause of death.

“Of the thousands of responders, more than half reported at least one adverse childhood experience and more than 10% experienced five or more adverse experiences. Among those adults who experienced the highest levels of childhood trauma, those individuals were:

  • five times more likely to have been alcoholic;
  • nine times more likely to have abused illegal drugs;
  • three times more likely to be clinically depressed;
  • four times more likely to smoke;
  • 17 times more likely to have attempted suicide;
  • three times more likely to have an unintended pregnancy;
  • three times more likely to report more than 50 sexual partners;
  • two times more likely to develop heart disease; and
  • two times more likely to be obese.

“The ACE study demonstrated a graded relationship of adverse childhood experiences to the presence of adult diseases, including heart disease, cancer, chronic lung disease and liver disease, as well as unintended pregnancy, sexually transmitted diseases and alcoholism. Individuals who experienced multiple categories of adverse experiences during childhood were likely to have multiple health risk factors as adults. Child abuse, neglect and other circumstances that disrupt the parent-child relationship are significantly associated with many leading causes of adult death and poor quality of life. Based on this study, childhood trauma, including abuse and neglect, may be the leading cause of poor health among adults in the United States [emphasis mine]…”