At San Francisco General Hospital, Chandra Ghosh Ippen, associate research director of the Child Trauma Research Program at the University of California, San Francisco, works with children ages zero to 6 who have experienced severe trauma. Her specialty is working with children whose parents have been murdered and with children who have been the victims of sexual abuse. At the workshop, she told the story of one young boy named Armando. At 5 years of age, Armando has serious speech and language delays. His mother says he was always an odd kid, and his teacher echoes that. She says she is worried about whether she can keep him in the classroom. He seems very tangential. More important, he does disturbing things with scissors, trying to cut himself or other people.

When Armando was less than a year old, he was left in the care of some relatives and was burned severely on his fingertips while they were drinking. When Child Protective Services became involved, the caseworkers found that his mother had a history of drinking, and he was removed from the home and placed in foster care. As more was learned about his history, it became clear that he had witnessed domestic violence between his parents. Ultimately, his mother returned and went into treatment, wanting to reunite with her son. She is an immigrant from Nicaragua and lived through the conflict there. She saw her own mother killed with a machete and then cared for her brother when he was young. “You can imagine these clinical processes affecting what we are seeing today,” said Ghosh Ippen. “The mother who perhaps does not care so well for the child. The child who triggers her because he reminds her of her brother whom she was caring for. This little boy who is carrying around this story. . . . This is the clinical reality that underlies the research picture that we have all been trying to study.”

Childhood trauma is an epidemic in the United States, especially in the age range from zero to 6. According to recent studies, 15.5 million children in the United States—1 in 5—live in families with partner violence (McDonald et al., 2006). Certain populations, including some ethnic minorities and people living in poverty, are more highly affected.

Younger children are more likely to be exposed to domestic violence than older children (Fantuzzo and Fusco, 2007). In the Minnesota Parent-Child Project, a 25-year longitudinal study of mothers and children in poverty, 12 percent of mothers reported mild partner violence and 25 percent reported severe partner violence when children were ages 18 to 64 months (Yates et al., 2003). In 2008, 3.7 million children were investigated for exposure to maltreatment, and 772,000 were considered to be victims of maltreatment (U.S. Department of Health and Human Services, 2010). More than half of these maltreated children are less than 7 years old.

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