and adolescence, including compromised socioemotional and cognitive development, psychopathology (see later section) and participation in criminal behavior (Cicchetti et al., 2000; Felitti et al., 1998; Glaser, 2000).

A common theme is the failure of traumatized children to self-regulate their mood and behavior (De Bellis, 2001). Another major theme is the importance of a developmental perspective—that the consequences of trauma vary according to intensity and form at distinct developmental stages. Also key are moderating variables such as the quality of family and social relations and child characteristics, such as cognitive style and temperament (see Chapter 3, Margolin and Gordis, 2000; NRC, 1993). Yet it is worth underscoring that a significant proportion of maltreated children—by some estimates between 20–49 percent after child sexual abuse—do not display noticeable symptoms11 (Kendall-Tackett et al., 1993; NRC, 1993; Stevenson, 1999). Protective factors include high intelligence and scholastic achievement, paternal care or support, connection to other competent adults, internal locus of control and social skills (Lynskey and Fergusson, 1997; NRC, 1993; Tiet et al., 1998). Further discussion of individual-level protective factors can be found in Chapter 3, and societal-level protective factors in Chapter 6. The following sections are meant to be illustrative rather than comprehensive about the adverse effects of childhood trauma.

Cognitive and Psychological Effects

Lower self-esteem is a major cognitive effect of several types of childhood trauma. It has been found after sexual abuse, physical abuse, neglect, and exposure to parental psychopathology (for reviews, see Kendall-Tackett et al., 1993; Margolin and Gordis, 2000; Yang and Clum, 1996). Lower self-esteem can persist into adulthood. A large study of women with past physical or sexual abuse found them to be three times more likely to have lower self-esteem than women without a history (McCauley et al., 1997). In separate studies, including longitudinal studies, low self-esteem has been found to be a long-term predictor of suicidal behavior (Yang and Clum, 1996).

Poorer school performance has also been found after many types of trauma, but the effect is strongest for childhood neglect (Margolin and Gordis, 2000). For child sexual abuse, a meta-analysis found a relatively weak effect size of .19 for poor academic achievement (Paolucci et al.,


The reasons for lack of symptoms may relate to insufficient follow-up time and insufficient sensitivity of measurement (Kendall-Tackett et al., 1993).

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