Book Review: The Biology of Early Life Stress Understanding Child Maltreatment and Trauma
Early life stress and exposure to maltreatment adversely affect the child’s life. It not only interrupts the child’s psychological development but also may cause chronic psychiatric conditions such as chronic Post-Traumatic Stress Disorder. Such conditions alter the child’s short- and long-term life by affecting essential aspects such as education and relationships.
This paper presents a book review for a book with a childhood/adolescent trauma theme and its reflection and application in personal and professional life and development. The selected book is The Biology of Early Life Stress, Understanding Child Maltreatment, and Trauma (Noll & Shalev, 2018).
The biology of early life stress, understanding child maltreatment and trauma (Noll & Shalev, 2018), is a combination of research work by some of the best and most trusted researchers based on exposure to maltreatment in the early developmental life stages of a child and its contribution to trauma. It discusses in detail abuse, the neglect of vulnerable children, and how the children exposed are affected by related trauma and early life stress.
The book begins by laying out an understanding of the biological embedding of child maltreatment through inflammation. The relationship between early life stress and the immune system is discussed using relevant clinical studies and their implications. Chronic psychological stress caused by maltreatment triggers an inflammatory response. Chronic exposure to inflammatory responses leads to dementia, cardiovascular diseases, and diabetes. Also, individuals with a history of childhood maltreatment are associated with poor health outcomes in psychological treatment.
Furthermore, the psychobiological consequences of child maltreatment are discussed. Stressors in childhood or early life stressors include neglect, abuse, violence, loss of parents, or maltreatment. These stressors expose the child to adverse lifelong developmental outcomes, placing them at a higher risk of developing various health conditions. Maltreatment affects the immune system, brain structure/function, and stress response system, eventually leading to depression, suicide risk, chronic pain, substance abuse, and cardiovascular, metabolic, and anxiety disorders.
Additionally, the book discusses whether exposure to childhood stress only has adverse effects or has some positive influence on the development of the child and adult life. Animal and human research was evaluated to validate this perspective of early life stress, thus incorporating it in the interventions meant to correct the effects of exposure to stressful environments during growth. The author argues that understanding the cognitive adaptation to harsh environments can be used to develop interventions that fit the child’s needs.
Additionally, developmental traumatology is discussed using a comparison of the brain development in maltreated children with PTSD and without PTSD. Although most children who are maltreated or exposed to early life stressors get PTSD, child maltreatment is not a definite cause of PTSD. Some children who undergo maltreatment and inevitable early life stressors, such as losing a parent, do not necessarily have PTSD.
However, exposure to maltreatment and early life stressors considerably impact neurobiological development in children and adolescents. Additionally, children with PTSD, whether it results from maltreatment or not, have poor functioning and poorly developed neurobiological development.
The association between childhood maltreatment, pediatric PTSD, and abnormalities in threat neural circuitry is also discussed. Childhood maltreatment and other adversity forms in children and adolescents are known to cause neural abnormalities, especially when processing emotions. However, it is not clear which abnormalities lead to adaptive or maladaptive emotional responses following maltreatment.
The book also explores pediatric post-traumatic stress disorder in general, aiming to explain to the general audience the current practices available to assist children and equip them with the necessary skills required to adapt and overcome Post-traumatic deficits.
A child is considered to have PTSD when their sense of distress, performance in school, and relationships are affected following exposure to a life-threatening event/s. Therefore, children should be empowered to control their responses to stress. The authors also mention that early life stress is associated with variations in epigenetic modifications, including DNA methylation.
The book provides an integrative framework to guide future research on psychological experience. Towards the end of the book, the authors hold a panel discussion whereby the panelists are asked about the next steps in progressing the issue of child/adolescent maltreatment and trauma. They all hold that the book’s contents are a stepping stone for future research.
As I read the book, I connected to some of my early childhood memories. I got a personal connection with the book, and it sounded as if it was speaking to me directly as memories of my childhood memories began to roll. The book has explored the issue of trauma in children and adolescents from different perspectives, ranging from how maltreatment affects depression and post-traumatic stress disorder to the health risks that children and adolescents exposed to maltreatment and Post-Traumatic Stress Disorder are prone to. I had a personal connection with the booking flow as the authors explored how exposure to harsh environments when growing up and early life stressors contribute significantly to pediatric Post-Traumatic Stress Disorder.
I was exposed to some of the strongest and inevitable life stressors from a tender age. To begin with, I lost my father when I was six. It was a period of my life whereby I had begun taking momentum. My father served in the military and would just come home once in a while and sometimes have up to 6 months leave. Shortly before his passing, he took a 6-months leave. I remember that summer when we spent a lot of time together.
Furthermore, I had just begun forming a strong bond with him at this age. Little did I know it would be short-lived. The devastating news of his death came suddenly as soon as he returned to his unit after the leave. Unfortunately, I did not know much about death. I remember asking my mother whether my father would return during his burial. Are we going to receive him with flowers like we always do? I asked, among other hundreds of questions, just as any 6-year-old would. Being the first early life stressor that I encountered, my life changed. My school performance began to decline, and I would not even find time to play since I was mostly at home, helping my mother take care of the baby.
My father’s death took a toll on my mother, who had lost a life partner and the breadwinner of our family. Life began to take a turnaround since my mother had previously quit her job to care for our young sister, who was just four months old. She found it challenging to meet our needs, take care of the baby, and our ailing grandfather, who was then living with us. I remember my mother would always be stressed, lock herself up in her room, and vent her anger on us most of the time.
I was not only subjected to maltreatment through constant physical and verbal abuse, but I later learned that I had also been exposed to trauma at an early age. I was diagnosed with pediatric PTSD at the age of 11. I remember being socially isolated and having anger outbursts. I also had anger outbursts and tirades occasionally. Based on the understanding from this book, I now understand how maltreatment contributed to the condition and how PTSD had affected my brain development. I had to undergo therapies, including trauma-focused cognitive behavioral therapy.
As discussed in the book, exposure to early life stressors, child maltreatment, and depression have adverse consequences, including a higher risk of substance abuse, anxiety disorders, and depression. I got into substance use (tobacco) early in high school, which affected my school performance. However, I got over it after a number of counseling sessions and psychosocial support from a teen’s antidrug and support group. The book has therefore helped me understand the different life experiences I had with early life stressors, maltreatment, and trauma and their effect on my life and development.
Reading and interacting with the contents of this book has been a great learning experience, raising different questions and challenging my understanding of trauma, maltreatment, and post-traumatic stress disorder. The most important thing/concept that has excited me while reading this book is the robust exploration and analysis of the different perspectives surrounding trauma, depression, and maltreatment in children and adolescents. Most concepts have been well discussed and supported by existing literature, clinical trials, and studies.
The authors have also challenged various reasoning and information on the body of knowledge surrounding child maltreatment, depression, and trauma, giving further directions for future research to provide more information on places with deficits. More so, this book’s content aligns with my passion for mental health for children/adolescents. This book is also timely for me as I had just been exploring childhood and adolescent trauma. It has therefore deepened my perspective on the concept and given me more insight.
Some issues in the book warrant further exploration and information. Research shows that child maltreatment and post-traumatic stress disorder interrupt neural circuitry, thus affecting how the brain processes threats (Herringa, 2018). Thus, the child may develop adaptive and maladaptive emotional responses, especially when exposed to reminders of life-threatening events.
According to Noll and Shalev (2018), current literature supports that childhood maltreatment and pediatric PTSD threaten the neural circuitry. However, it is unclear which specific abnormalities lead to adaptive and maladaptive or adaptive emotional responses from children exposed to maltreatment. Thus, the studies included in this discussion have been generalized.
However, there is a need to specialize in the specific abnormalities and to which extent they affect the neural circuitry, thus informing the development of specific psychotherapy interventions based on the specific abnormalities, thus propagating better health outcomes for the affected patients.
I agree with most of the contents of the book. The concept that caught my attention, however, is the discussion of pediatric post-traumatic stress disorder to create awareness among the public and the attempt to inform the general audience on the current practices and interventions that can assist children in overcoming the effects of Post-Traumatic Stress Disorder, following maltreatment, depression, and exposure to early life stressors.
Pediatric PTSD is a significant health concern that the public should be sensitized to. According to the centers for disease Control and Prevention (CDC), most children experience traumatic events in their childhood or have a close person who experiences such events (CDC.gov, n.d.). However, children heal and recover without having to be diagnosed with PTSD.
In some cases, children do not recover fast, especially when exposed to chronic trauma. When the PTSD symptoms present in a child o for one month, the child is diagnosed with PTSD. As discussed above, pediatric PTSD has many adverse effects on the child’s development and growth, and the effect may even extend to a lifetime.
CDC proposes that the parent/guardian support the child by giving emotional and social support and seeking psychotherapy interventions when the symptoms persist. Thus, it is imperative to create public awareness of the issue and inform the public on the steps to take when their children face PTSD and its effects. The research done through the studies in this book has been put to general use to inform the public, thus contributing to translational research and enhancing better health outcomes for children.
One of the areas whereby I could not agree with the authors is that maltreatment is not a definitive cause of pediatric PTSD. The others conclusion is based on the fact that not all children who are maltreated or exposed to early life stressors develop depression and PDST. However, I believe that even if other factors cause PTSD, maltreatment can considerably result in PTSD.
The information in this book will significantly influence how I continue to advance my professional and personal growth. To begin with, I will enhance my professional growth by getting involved in research and studies in my passion areas. I will seek various gaps in information and the body of knowledge and carry out studies and research to bridge the gaps. For example, this book has laid a foundation for further research, whereby other researchers can build upon and contribute to further expanding the body of knowledge. Childhood and adolescent trauma is my area of passion; therefore, I can use it to grow my profession.
In addition, I will enhance my personal growth by participating in workplace surveys, workshops, trainings, and studies I come across while delivering my services. According to Pylvas, Li, and Noklainen (2022), learning opportunities in the workplace play a huge role in enhancing personal growth. Every chapter in this book had goals at the beginning and discussed whether the goal had been met in the conclusion. Also, as learned from this book, it is vital to set goals and work towards achieving them. Similarly, I will enhance my personal and professional development by setting professional and personal goals and working towards achieving them.
Following the understanding from this book, there are several actions and changes that I will make based on the learning. The first action I will intentionally take is to avoid exposing my children or other children under my care to any maltreatment. Looking back to my personal experience, I realized that some forms of maltreatment are unintentional. For instance, my mother was also undergoing changes in her life, forcing her to adapt emotionally. Thus, she would react in anger, and sometimes her outburst would translate to verbal abuse, a form of maltreatment. Therefore, I will avoid exposing children and adolescents to maltreatment.
Additionally, I will change my way of assessment and therapy intervention delivery when dealing with children and adolescents with PTSDA who have a history of maltreatment. According to Noll and Shalev (2018), symptoms presentations for PTSD in children and adolescents are different when the child has been exposed to maltreatment and when the child’s condition is a result of other factors such as an accident incident. Children constantly exposed to maltreatment are more likely to have chronic trauma and thus require more attention.
Furthermore, I will ensure that therapies used for children exposed to maltreatment include psychosocial support from their close relatives, especially parents and guardians. Since they are the ones that spend more time with the children and adolescents, they can be very instrumental in enhancing the success of the therapy interventions.
They can also be assessed to find out the source and causes of maltreatment, thus addressing the problem’s root cause. Parents and guardians who are found to have mental health issues leading to maltreatment should be referred to psychiatrists or enrolled in therapy interventions when needed.
Furthermore, since I have understood that some of the early life stressors are unintentional and inevitable, for instance, the loss of a parent, as a counselor and therapist, it is my responsibility to address these issues when possible. It means that some of the health promotions I should carry out include creating awareness on how to care for children’s and adolescents’ mental health. For instance, I will emphasize the importance of grief and loss therapy for children who lose their parents at an early age, thus assisting them to cope effectively and avoid stress and depression resulting from the same.
Trauma and post-traumatic stress disorder in children and adolescents is a significant public health concern that needs attention. Trauma and depression in children are associated with exposure to early life stress and child maltreatment. The book reviewed has explored different aspects and concepts revolving around it. The reflection, personal experience, and application in professional growth have been discussed above.
Centers for Disease Control and Prevention. (n.d.). Post-Traumatic Stress Disorder in children, Coping with PTSD. https://www.cdc.gov/masstrauma/factsheets/public/coping.pdf
Herringa, R. (2018). Childhood Maltreatment and Pediatric PTSD: Abnormalities in Threat Neural Circuitry. In The Biology of Early Life Stress (pp. 57-70). Springer, Cham. https://doi.org/10.1007/978-3-319-72589-5_5
Noll, J. G., & Shalev, I. (Eds.). (2018). The Biology of Early Life Stress. Child Maltreatment Solutions Network. https://doi.org/10.1007/978-3-319-72589-5
Pylväs, L., Li, J., & Nokelainen, P. (2022). Professional growth and workplace learning. In Research Approaches on Workplace Learning (pp. 137-155). Springer, Cham. https://doi.org/10.1007/978-3-030-89582-2_6