Complex Trauma in Children:

The Effect of Maltreatment on Developmental Processes

Sydney Mingle

Humanities Research

Dr. Hefferon

26 January 2017

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Complex Trauma in Children: The Effect of Maltreatment on Developmental Processes

Isaac Newton’s third law of motion declares that “for every action there is an

equal and opposite reaction.” Although this principle may have been founded within the

scientific domain, its premise is exemplified in every aspect of human development. Any

and all events that occur during cognitive, emotional, and social development have a

profound influence on a child’s growth. For that reason, childhood trauma is one of the

most serious public health problems facing the global community. Its prevalence is

irrefutable, as 60% of adults have reported experiencing abuse or difficult

circumstances during their childhood (“Statistics”). Because of its ubiquity, researchers

have adopted the term Complex Trauma in order to describe the dual problem of a

child’s exposure to traumatic experiences that begin in early childhood and the impact

of this exposure on immediate and long-term outcomes. These incidents of

maltreatment occur within either the community or the caregiver system – the

immediate social environment meant to be a source of stability and safety (Spinazzola

5). However, the term Complex Trauma only describes specific instances of

maltreatment. While isolated incidents of trauma may produce discrete behavioral and

biological responses, chronic maltreatment has the pervasive impact on development

that is outlined by Complex Trauma (Van Der Kolk 3).

In an effort to research the effect of childhood trauma and maltreatment on later

health and well-being, the Center for Disease Control (CDC) and Kaiser Permanente

conducted a study titled “Adverse Childhood Experiences” (ACEs). The initial study,

conducted in 1995, collected confidential surveys regarding childhood experiences,

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current health status, and behaviors from roughly 17,000 Health Maintenance

Organization members from Southern California (Van Der Kolk 3). The CDC has

continued surveillance for ACEs by evaluating the medical status of current and

previous study participants through morbidity, health, and mortality data. Once

published, the study showed that childhood traumatic experiences are more prevalent

than acknowledged, as they affected nearly two-thirds of the total study participants.

Additionally, the organization discovered that all forms of adverse childhood

experiences have a forceful influence on future adult health. As severity and incidence

of ACEs increases, so does the likelihood of the following negative health outcomes:

alcoholism, depression, heart disease, premature sexual activity, poor academic

performance, the risk of sexual violence, sexually transmitted diseases, and suicide

(“CDC-Kaiser ACE Study”). This direct correlation not only confirms the perceived

relationship between childhood trauma and negative future health outcomes, but

emphasizes the gravity of the problem faced by the afflicted children.

One of the most prevalent forms of exploitation is classified as socio-economic,

meaning that the trauma is created by the interaction between social and economic

factors. Socio-economic trauma is most often seen where children are subjected to a

life below the poverty line. Poverty is arguably the most severe form of trauma, because

it often leads to or is in addition to other maltreatments. One in five children globally can

be considered impoverished, meaning that around 14.6 million children are below the

poverty line (Betson 35). Although they are not at fault for the low-income, they endure

the full-extent of the consequences. Yet, poverty persists throughout history as a

characteristic of low-income families. In 1964, President Lyndon Johnson began the

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War on Poverty in order to launch beneficial initiative plans for those facing financial

hardship (Katel 911). Since then, the global community has attempted to reduce the gap

between the poor and wealthy, to no avail. Politicians continue to argue about methods

and policies to fix the seemingly irreparable damage, but people will suffer until

permanent changes are made. Specifically in developing countries, those living below

the poverty line face seven common deprivations: water access, sanitation, nutrition,

health care, adequate shelter, meaningful education, and access to information

(Delamonica 362). These deprivations, though they do not impact every impoverished

family, are typically used to determine the severity of poverty in these nations. Severity

can similarly be identified based on the duration of poverty — how long they have lived

below the poverty line. If consecutive generations fall below the minimum threshold, it

becomes harder for that family to ever regain a sustainable income (Katel 907). This

cycle of poverty describes the hardships that low-income families deal with on a daily

basis. These families do not earn a living wage, and are not afforded the same

opportunities as those in the middle class. Thus, they are not able to keep jobs that

support even a minimalist way of life.

Along with the inadequate lifestyles of those living below the poverty line, recent

history has brought to light another instance of deprivation in socio-economic trauma;

the refugee crisis. The recently peaked interest in refugees follows that of the rapidly

increasing trend of occurrence. From 1970 to 2000, the documented 2.5 million

refugees expanded to 40 million, and continues to grow (Pumariega 581). Currently

there are over 65 million people worldwide that have been forcibly displaced from their

homes, 28 million of which are children (“UNICEF”). These statistics have finally
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grabbed the world’s attention, bringing awareness to the incredible struggle that these

people must overcome. Not only must they withstand the trauma of displacement, but

they enter new nations without income or any means of supporting a new lifestyle. They

are susceptible to the same forms of impairment as impoverished children, yet in

addition, they must cope with the loss of their cultural identity. After being torn away

from their home communities, children often struggle with integrity, leading to a poor

sense of self and “ethnic self-loathing”. They commonly blame their initial homes for

displacement, subsequently leading children to hate their background. Similarly, the

stigma surrounding refugees gives children more cause to leave their history behind.

Although the refugee crisis stems from a larger global issue, until it is addressed, these

children will continue to suffer the consequences.

Both a life in poverty and of refugee status have pervasive effects on the proper

development of a child. These sources of persistent trauma have the potential to

interfere with access to healthcare, dietary restrictions and food consumption,

accessible resources, transportation, living arrangements, proper clothing, water supply,

and electricity (Vanfleet 37). These essential elements of a child’s well-being may be

stripped away as a consequence of the poor living conditions of the family. Without the

proper resources, the quality of life of these children is significantly reduced. In addition

to the lack of these resources, poverty and displacement have been shown to cause

adverse health effects including a low birth weight, stunting in growth, and a weakened

emotional and behavioral status (Brooks-Gunn 57). Cognitive ability also may be

impaired in addition to the noted health effects. Poor children are 1.3 times more likely

to have a learning disability or developmental delay when compared to their non-poor

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counterparts (Brooks-Gunn 61). Moreover, circumstances involving low-income and

displaced families can severely traumatize children so much as to impair and disrupt

their developmental processes.

Children around the world have faced similar socio-economic trauma, in the form

of child labor, for centuries, until the peak of extreme exploitation during the Industrial

Revolution at the end of the 18th century. Back then, child labor was characterized by

less than satisfactory working conditions and an unacceptably low salary. Frequent

publicity regarding children working in factories sparked outrage and forced humanity to

quickly improve previously accepted standards (Bachman 549). This outcry led to a

movement to reform the laws concerning the rights of child workers, including the

International Labor Organization created by the United Nations. Focused on the

minimum legal age for child workers, the organization initially passed a law that required

children to be at least 14 years old to legally work in labor industries. Later on however,

they changed their initial law to one that required an age of at least 15 years to be

legally employed (Arat 177). Similarly, the Convention on the Rights of the Child was

created to change the way that children are viewed and treated in the labor industries.

The convention was ratified by 156 of the 183 members of the International Labor

Organization. Its goal was to change the conditions in the workplace, such that children,

exploited or not, were treated as human beings. This way, children would be given a

distinct set of civil, cultural, economic, political, and social rights rather than be viewed

as passive objects of care and charity (Arat 178).

Once the laws regarding children’s rights had been passed, the focus was

shifted to removing illegal labor practices that were already in place. The Fair Labor
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Standards Act was successful in passing laws that ended unreasonable wages and

hours for children working. These laws laid the groundwork for programs to assist

children after they had been rescued from situations of exploitation. The International

Program on the Elimination of Child Labor continues to explore policies and programs to

reduce child labor in work areas of slavery (Bachman 550). The World Bank on the

other hand, works to eradicate child labor practices at one of its roots, poverty. In this

way, The World Bank has attempted to find a permanent solution rather than provide

relief after the fact (Clark 725). Since then, the involvement of children in the work force

shifted from a source of controversy to an integral part of the agricultural economy, with

an estimated 300,000 to 800,000 children working in agriculture (Kruse 732). At the

time, children working on family farms were an accepted fact of the American economy.

Today however, as more and more children are being phased into the public education

system, less children are available for exploitation. Child labor was said to be eradicated

in the United States early in the century, but evidently, it remains prevalent today as 73

million children are child laborers aged 10-14. (Molina 2). However, the exploitation of

children through labor is not limited to the United States. Globally, 95 percent of working

children are found in developing countries, with 153 million in Asia, 80 million in Africa,

and 17.5 million in Latin America (Arat 180).

Not only does child labor span across continents, but it extends into multiple

domains of development, as the growth of children during adolescence is not limited to

size and stature. Young children develop mentally and emotionally during this pivotal

stage in their childhood. At this time children also advance their observational and
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interactive skills by mimicking the influential world around them1 . Yet, if the growth

process of a child’s psyche were to be altered by a source of significant trauma, the

resulting damage would be detrimental to the future of the child. Unfortunately this

severe exploitation is generally seen in three globally recognized industries: sweatshop

labor, child soldiers, and child trafficking. The leaders in these illegal businesses take

advantage of the children for personal gain and consequentially derail the development

of the child. In addition to the temptations provided by the industries, children seek work

illegally in order to escape instances of poverty, find sources of basic necessities, and

succumb to the wishes or pressures of their family members (Arat 168).

A common misconception when it comes to child labor is that all children are

pried away from their homes and abducted into illegal businesses that thrive on the

exploitation of children. While some children are in fact bound through debt bondage

and forced slavery, the majority of children join the labor force voluntarily (Faulkner

491). The great abundance of volunteers raises the question of why children seem to be

drawn toward these lifestyles. There are two reasons that children enter into labor

practices: the push factors and the pull factors. Push factors are situations in the

environment surrounding the child that are typically home-based stressors. The most

common push factors are the effect of poverty on a child’s decision and the opinions of

the child’s family (Brett 4). Poverty is a socio-economic condition that can cause

significant stress at home and push a child into labor practices. Lower class families

may use the child as chance to supplement their income to support the means of living,

1The Social Learning Theory of Conditioning theorizes that children model their own behavior
after that of the people around them. Thus, it is suggested that children are brought up in an
environment where they receive love and attention, giving the child the chance to foster learned
personality traits of compassion and responsibility.
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even if the contribution of the child is very minimal (Narayan 50). Similarly, if the adults

lack altruism, the needs of the child will be ignored as they are forced to support the

family (Bachman 557). Socially, family and friends are the most influential factor when it

comes to child labor, whether it stems from generational tradition, or a desire to please

the members of the family. In Surat, India for example, children willingly leave schooling

to pursue the diamond-polishing industry, which is believed to offer more long-term job

prospects and benefits than traditional education (Bachman 556).

Pull factors on the other hand, appeal to the needs of the child and offer a

potentially better lifestyle. The pull factor is typically an illusion fabricated by the

businessmen or profiteers that entice the youth populations to join their movement and/

or industry. Pulling causes that appeal to the needs of the child include the false sense

of protection, and the provision of basic necessities. Protection seems to be a recurring

cause for joining labor practices, whether it be self-protection or a need to protect the

child’s family from poverty. If the child feels unsafe in their home environment, they may

mistake the industry as a safe haven and shelter from their troubles. Economically,

children seek work because that may be the only way in which they can get food for

themselves or families. When impoverished children face this choice, they often

sacrifice their quality of life. Especially in children facing long-term hunger and

malnutrition, the forced labor may appear to be a refuge where they can escape their

troubled lives and live in false security. Consequently, street children and refugees

characterize a large portion of children fooled by the illusion of a higher quality life (Brett

41). When coaxed with the promise of a more meaningful and satisfying life, these
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young populations are the first to lunge at the chance. Unfortunately for them, they are

almost completely unaware of the situation they face in the future.

Of most child labor practices, sweatshop labor is the most common throughout

history. The US Department of Labor defines sweatshops as factories that knowingly

violate two or more labor laws, such as those pertaining to wage and benefits, child

labor, or working hours (Clark 738). Sweatshops are infamous for their abusive

exploitation of young workers, submitting them to military discipline, and an absence of

a living wage or benefits. Workers are paid less than their daily expenses, which

prevents them from improving the quality of their lives. In this cycle of exploitation,

children are confined, beaten, denied education, and forced to work in factories

overcrowded with other children. They work long hours in the factory under dangerous

conditions for little to no money. These defining characteristics of sweatshop labor have

stayed the same since their popularization during the Industrial Revolution. The working

conditions within these factories were causing irreparable damage to some of the

children and were violating their rights as human beings.

Despite global attention for poor working conditions, wealthy industries continue

to use children because of the cheaper operational cost that they provide (Clark 729).

Their employment is usually secured through the promise of debt bondage, a person’s

pledge of their labor or services as security for the repayment for a debt or other

obligation. Debt bondage is used in three different ways depending on the

circumstances of the employer, child, and family. Firstly, if the child were to inherit a debt

initially carried by their parents, the child would be handed over to an employer until the

debt was paid off through work by the child. Secondly, if the debt is more extreme or
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unforgivable, the child can be taken as collateral loan until it has been payed off. Held

as a hostage and forced into labor, the child withstands tremendous emotional and

physical trauma. Lastly, a family can sell children to an employer in order to receive

necessary cash advancements, or to request future wages. In these cases, the parents

forfeit the child’s given rights and have no claim to the child after the sale. As the cost of

living begins to outweigh the wages earned by these children, the sum of debt becomes

unobtainable by the wages of the child worker. Eventually, the debt takes over and

forces the workers into the labor force indefinitely (Narayan 69). Left without a

significant change in income, the family of the child is rarely able to support their basic

needs (Clark 727).

From the point of view of the employers, children are desirable workers because

they are willing to work for lower wages, are much more easily managed through threats

and fear, work more flexible hours, and are willing to work in less than satisfactory

conditions. Children constantly subjected to violence are more compliant and can be

paid less than working adults. Children also are believed to have a specific skill set

different from their adult counterparts. In industrial factories, they are considered ideal

for carpet weaving, silk production, gemstone manufacturing, and other intricate factory

occupations because their small hands and size allow them to move in small spaces

and complete intricate designs more easily than a full-size adult (Bachman 559). For

instance, the garment industry in New York prefers young immigrant children in order to

compete with imported goods from low-wage nations.

While children in the sweatshop industry are only useful during their youth, some

forms of child exploitation maintain control of the children well into their adulthood. Child
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soldiers, for example, often grow into adults while under the control of forceful

employment. At a pivotal age where high levels of stress can alter their future, many

impressionable children are dragged into armed conflict characterized by chaos,

destruction, and death. Their direct proximity to constant, violent strife essentially strips

these young soldiers of their childhood. The underlying causes that pressure these

young children into these armed groups are numerous, but are not confined to

abduction. Generally, it is a cumulation of events that eventually push the children to

become soldiers (Faulkner 497). Not only are these children unwillingly witnesses to

unspeakable acts during war, but being exposed to said acts can produce dire

consequences for their lives in the future. With the rise in armed conflict around the

world, the international community is now forced to address the new progression of war,

where children no older than ten years old are facing battle on the front lines (Faulkner

496).

Child soldiers are a unique form of socio-economic trauma because these

children are not compensated for their efforts. Yet, the proportion of volunteers is still

higher than that of all other forms of child exploitation. At least two-thirds of child

soldiers voluntarily join the conflict, making them notably different from other victimized

children (Brett 1). Over the past twenty years, children have been directly exposed to

armed conflict more than ever before. There are more than 50 different groups in

conflict-stricken areas around the world that recruit children, totaling an estimated

250,000 children who face armed conflict. This substantial number of child soldiers is

spread out across at least 14 different countries including, Northern Uganda, Southern

Sudan, the Central African Republic, and the Democratic Republic of the Congo.
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Northern Uganda is home to the most well-known case of Joseph Kony and the Lord’s

Resistance Army. After forcing the enlistment of nearly 75,000 children and young adults

as soldiers, Kony has been charged with various crimes against humanity along with

war crimes (Ertl 1). The severity of this exploitation has not gone unnoticed however, as

136 members of the International Labor Organization pledged to aid in the effort of

eradication with the Convention on the Worst Forms of Child Labor in 1999 (Brett xiii).

The leaders of the armed groups easily exploit children willing to join into military

conflict. To a naive child, armed groups offer a more luxurious life than they are used to.

By purposefully obscuring reality with the glory of war, children unknowingly walk into

the spider’s trap. Life as a child soldier is not all brotherhood and camaraderie as its

leaders make it out to be. It is violence. It is murder. Not only do the children themselves

murder innocent civilians, but they themselves have their innocence murdered by their

inclusion in the war (Faulkner 491). Constant exposure to acts of war and violence

replaces childhood innocence with the gruesome and corrupt existence of murderous,

sociopathic behavior. Once their integrity has been wiped away, the young soldiers

exhibit blind loyalty to their leader and are willing to do anything to appease them. In the

worst cases, children are forced to prove their allegiance to the militant group by

assassinating a member of their own family (Maslow 68). Should they refuse, the

children themselves will be killed for treason. Similarly, young soldiers endure physical

torment as they are beaten and tortured when the thought of escape merely crosses

their mind. Youth soldiers are bred to be frightened by their leaders, for they are more

compliant when they are afraid of the consequences of misbehaving. In this way, the

children are brainwashed to follow every whim of the group and overlook the potential
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consequences of their actions (Iweala 5). Armed groups may break these psychological

barriers by forcibly addicting children to cocaine and alcohol. Not only do these

addictions drive children to take unnecessary risks and heighten a feeling of

indestructibility, but it establishes a reliance of the child on the group as a supplier of the

substance (Iweala 83). Facing violence everyday is also an emotional burden on the

conscience of the soldier. As a result of their sustained contact with violence, the

children become desensitized to the bloodshed and death, leading to potentially severe

emotional disorders in the future (Iweala 53). If things could not get any worse, the risk

of death for these child soldiers rises astronomically because they rarely ever receive

medical treatment for injuries and become malnourished to the point of death (Iweala

115).

Child soldiers have become such an inevitable and inescapable part of our

functioning society, such that the adverse effects on the economic stability are often

forgotten. With countless families unable to provide rehabilitation for both immediate

and long-term health problems, the condition of the economy worsens (Faulkner 499).

In the worst cases, the returned children are orphaned because their parents are not

suited to care for their newfound emotional and psychological needs. This separation

both amplifies the severity of their developmental interruption and forces external

groups to financially support the children. Likewise, society faces the loss of children

from the educational system when they become soldiers of war. Without the members

of the “next generation in centers of education, all economic and societal development

is brought to a screeching halt (Iweala 65). Although there are people who volunteer to

assist in recovery and rehabilitation, they may not comprehend the full extent of the
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situation. Regardless, the international community needs to take action and protect

these children, both before and after they join armed groups. Whether it be through

national task forces, recovery programs, or the effective eradication of groups using

children, the effects of war on child soldiers are immense and need to be specifically

addressed in order to facilitate their effective integration into society.

Childhood labor trauma is not confined to children in war-torn communities and

those working in industrial factories. Another illicit industry exists globally in all social

classes. Child sex trafficking and exploitation is a thriving business that can be

characterized as a high-profit, low-risk trade of people. Despite the belief that it only

thrives in impoverished, over-seas countries, the trade prevails among even the most

progressive nations. Yet, people turn away from the women and children forced to

parade the streets at night, reluctant to accept the presence of trafficking in front of their

very eyes. Their ignorance allows the industry to generate $32 billion per year while

remaining relatively unscathed by local and global police forces (Kiener 477). Sex

trafficking can be described as a sequence of events that lead to the exploitation of

people for a profit. Typically, the phases occur in the following order; recruitment,

exploitation, withdrawal, and recovery with possible reintegration (Dottridge 21). The

process begins with a child that is forced into exploitation through kidnaping, sale, or

debt bondage. While not all children may fall victim, low-risk children with low socio-

economic standing, a substandard education, and fewer health standards are the most

vulnerable to sex trafficking (Duger 118-19). Children become trapped in an infinite

cycle of trauma because until they are rescued by an extradition organization, reach out

for help, or escape on their own, they are resigned to a life of exploitation.
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Even though the economic transaction of children is reprehensible and illegal, the

root of the problem is not the transaction itself, but rather the violation against the right

of the child to consent with full knowledge of the repercussions (Mikhail 43). These

chronic abuses persist due to the coercive nature of their abusers. The groups that are

notorious for exploiting children for a profit include sexual trading rings, armed groups,

and sweatshops (Kiener 476). In order to maintain control over the children being held

against their will, the groups will resort to tactics similar to those used on child soldiers,

such as physical and psychological abuse, isolation, alcohol and drug dependence, and

limited nutrients (Rafferty 13). If the victims manage to escape, they face years of

rehabilitation and recovery to overcome the trauma they faced on a daily basis. In the

worst cases, the children can never repair the damage done by the chronic abuse. Yet,

the global community still at times fails to recognize the presence of coercion and

imprisonment, prosecuting the children instead of the adults responsible. International

laws attack the children rather than the abusers, labeling the victims as juvenile sexual

offenders and prosecuting them accordingly (Duger 116). Despite the fact that the child

was forced into business, they must endure the consequences of prosecution. In light of

this injustice, some countries have begun to recognize the unacceptable nature of this

illicit trade. However, several have done nothing to aid in the dismantling of the child sex

trafficking trade. These blacklisted countries include Libya, Sudan, Algeria, and North

Korea (Kiener 480). Before the issue can even begin to be addressed, countries with

high rates of trafficking, such as those listed above, must be willing to acknowledge their

faults and change their laws drastically.

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As if the debilitating psychological effects of child sex trafficking weren’t enough

to permanently alter developmental processes, working in the sex trafficking industry

significantly increases the chance of an HIV/AIDS infection. If a child is infected with

HIV/AIDS, they face an entirely new level of discrimination and impairment along with

the health effects associated with the virus. Human Immunodeficiency Virus (HIV)

attacks the body’s immune system, damaging its ability to fight off infections. The virus

is transmitted when an exposed membrane or bloodstream comes in contact with body

fluid that has been infected by the virus. Transmission generally occurs through sex,

blood transfusion, contaminated hypodermic needles, and mother-to-child exchanges

during pregnancy and breastfeeding (Bristol 898). The transmission of the virus is

inherently non-discriminatory, yet the virus disproportionately affects the economically

deprived in sub-Saharan Africa. Nearly two-thirds of the documented HIV/AIDS cases

are based in this region (Bristol 891). The virus thrives amongst the disenfranchised,

especially in communities facing poverty, poor infrastructure, and those who have

limited access to basic services (Geoff 278). Although there is currently no cure for the

virus, when treated properly with anti-retro viral medication, it can be managed. Yet,

76% of children living with HIV are unable to access treatment in middle and low income

countries (“Children and HIV/AIDS” 4). Anti-retroviral medication and treatment is

essential to preventing the onset of Acquired Immunodeficiency Syndrome (AIDS). As

the final stage of an HIV infection, AIDS makes the body unable to fight off current
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infections and vulnerable to opportunistic infections. When untreated, people diagnosed

with the disease survive for only about 3 years. 2

While child labor practices, life in poverty, and life as a refugee constitute severe

forms of socio-economic trauma, there are instances of human deviant behavior that

are known as caregiver trauma, meaning that they occur within the caregiver system. As

the name suggests, this type of victimization refers to when a parent, guardian, or

immediate relative is responsible for the trauma faced by the child. Disruptions of this

invasive nature are especially detrimental to the growth of a child in terms of cognitive,

emotional, and social skills. Without immediate intervention or rehabilitation, the afflicted

child faces impairments that may persist throughout their adult lives. Specifically,

caregiver trauma falls into two distinct categories that each denote different forms of

maltreatment: aggression and absence. When a parent is aggressive during one’s

childhood, there is the potential for multiple forms of child abuse. When a parent is

notably absent from a child’s life, there is the potential for child neglect. In all cases of

aggression and absence, the parent is exploiting their status as the dominant figure in

the relationship, leaving the child vulnerable to future damage as they continue to

develop.

Child abuse is a common and well-known form of complex trauma. In 2011,

650,000 were reportedly victimized by their caregivers or immediate relatives (“Long

Term Consequences…” 1). In these many cases of abuse, the children likely face at

2 An HIV/AIDS diagnosis may also disrupt relationships with the surrounding community. The
quality of life for a child diminishes regardless of who in the family is infected. Whether a
household income goes towards treatment or a child becomes orphaned, they do not need to be
infected in order to suffer the repercussions. Infected families are often stigmatized by the
community. Depending on differences in cultural norms, prejudices and assumptions may be
levied against HIV/AIDS families and used as a way to ostracize them from their cultural identity.
This stigma prevents patients from building a necessary support system as they are treated.
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least one of the four main effects of an abusive caregiver relationship: traumatic

sexualization, betrayal, powerlessness, and stigmatization. Traumatic sexualization

refers to the event of abuse itself, where children may develop post traumatic stress

disorder symptoms. Betrayal refers to the broken relationship between the parent and

the child on account of the abuse. This often results in a variety of social disorders that

limit the child’s trusting abilities and peer interactions. Powerlessness refers to how an

abusive relationship often destroys a child’s self-confidence and affects their personality.

Abused children express submissive traits that reinforces that trauma that they face.

Stigmatization refers to the reaction of the child’s surroundings after the traumatic event

of events. If the child has a strong support system, they are more likely to recover

quickly as opposed to a community that shames the child for the abuse they have

suffered (Coutois 12). Typically, if a child is subjected to any of these effects, they are

more likely to exhibit long-term deficits throughout their adult life. When children model

the aggressive behavior of their caregivers and act aggressively when prompted, they

lose the ability to regulate their emotions and are quick to react to small stimuli. More

often than not, this cumulates to produce different anxiety and depressive disorders

(Margolin 153).

While abusive relationships have detrimental effects on the development of a

child, the specific types of abusive are associated with different behaviors. One

common misconception about physical abuse is that victims only exhibit aggressive

behaviors. However, children that suffer physical abuse also become withdrawn from

their peers and fail to interact appropriately based on their age (Salzinger 171).

Similarly, emotional abuse is correlated with antisocial behaviors that are seen in the
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interactions with their surroundings and their peers (Jung 1004). Verbal abuse adds to

the lack of trust and the development of a false sense of identity3, while sexual abuse

leads to an impaired sense of self and can cause avoidant behaviors including

dissociation and suicidality (Briere 59).

While child abuse is the more overt form of caregiver trauma, the insidious nature

of child neglect emphasizes its significance. As a parent, people are meant to keep the

interests of that child above their own and protect them at all costs. When a parent no

longer acts in the best interest of that child, the parents are neglecting to take

responsibility for the life they created. Neglect specifically describes the omission of a

child’s basic needs, heath care, education, supervision, and protection (Dubowitz 1891).

These deprivations, though used to identify cases of child neglect, are not the definitive

markers of an absent parent. Even the smallest disregard for the needs and the best

interest of the child can hint at a neglectful relationship. Thus, it is much more common

for a disobedient relationship, which may start off as just punishment, to develop into a

severe case of child neglect. However, this form of maltreatment lacks substantial

research. Although it is a common form of complex trauma, its private nature and small

discrepancies prevent it from being analyzed and thoughtfully explored. This

phenomena is often referred to as the neglect of neglect (Kendall-Tacket 161). Despite

the lack of research, there is one common theme throughout any case of child neglect.

Absent parents are unable to provide a stimulating environment in which their child is

able to thrive. Without the constant interaction, children develop cognitive performance

3 Similar to a child’s sense of self-worth, their sense of identity is reliant on the parent-child
relationship formed during infancy. A child’s identity is formed once they separate themselves
from an undifferentiated unity with their mother. An abusive relationship can alter this identity,
making the child believe themselves to be unrelated or indifferent in the relationship.
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deficits and behavior problems that extend through childhood and into adolescence and

adulthood (Kendall-Tackett 162).

Poor cognitive performance is not the only impairment suffered by children who

are neglected by their parents. Children often lack social development, which is an

essential skill that determines peer communication and social understanding.

Depending on the severity of the trauma faced by the child, these deficits permanently

alter the way in which they interact with the world around them. Moreover, children who

are unable to adapt socially and lack social skills among peers are usually unable to

differentiate emotions displayed by their peers (Hildyard 683). Not only does this

represent a lack in understanding social cues, but it details the struggle that previously

neglected children face throughout their adulthood. Similarly, a neglected child does not

have the skills necessary to thrive independently after leaving the source of trauma.

With the existence of a neglectful relationship since infancy, they would have never

developed a strong self-reliance or aptitude for self-sufficiency, so after childhood they

face an increased vulnerability for re-traumatization. Without the direct guidance of a

responsible figure, the rate of self-destructive behavior rises dramatically. Neglected

children are more likely to abuse alcohol, self-harm, and become young mothers

because there is no caregiver supervising their behavior (Kirkengen 104). In this way, a

neglected child’s social development is impaired, but they also face deficits in emotional

development.4 Neglected children often undervalue themselves as worthless and resign

themselves to a life they deem to deserve. This false interpretation is due to a child’s

4 Children learn self-worth from their parents, often as an extension of their relationship.
Therefore, a neglectful parent promotes a low sense of self-worth that follows the child through
their development and into their adulthood.
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disorganized attachment strategy, the broken relationship with nurturing figures, that

they develop as a result of their neglect (Hildyard 683).

Although Complex Trauma has begun to emerge as an eminent hindrance to the

developmental processes of children, it continues to be misdiagnosed as post-traumatic

stress disorder (PTSD). The diagnosis of PTSD fails to accurately capture the profound

developmental effects of complex trauma. Depending on the form of traumatization, a

child may fit diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD),

oppositional defiant disorder (ODD), conduct disorders, anxiety disorders, eating

disorders, and other behavioral regulation disorders (Cook 392). This broad spectrum of

deficits on cognitive, emotional, and social platforms are displayed differently for each

child, making a singular diagnosis difficult. Consequently, clinicians opt for a series of

“comorbid” diagnoses, where all impairments are treated as if they occurred

independently from the PTSD symptoms (Van Der Kolk 8). When using comorbidities in

this case, the diagnosis fails to evaluate the traumatic experience as the source of the

deficits and instead regards the trauma-related symptoms as unrelated conditions. In

this way, clinicians treat the after-effects without a consideration for why they occur.

With as many as 80% of PTSD patients fitting the criteria for another disorder, their

treatment is often restricted to PTSD and may not adequately address all of their

symptoms (Schmid 6). Concerned for the need of a more appropriate diagnosis for

children, the Complex Trauma Taskforce of the National Child Traumatic Stress Network

has begun to consider a new diagnosis coined Developmental Trauma Disorder (Van

Der Kolk 10). The proposed diagnosis would focus on maltreatment and traumatization

as the “psychopathological trigger” for the demonstrated impairments. By evaluating

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both the origin of the trauma as well as treating the exhibited symptoms, Developmental

Trauma Disorder would decrease the likelihood of long-term impairment after the child

recovers. (Schmid 6).5

In order to further understand the potential impairments faced by maltreated

children, it is essential to comprehend the process by which the brain develops, and

how chronic exposure to trauma can alter that development. The brain is comprised of

specialized nerve cells, called neurons, that are created during fetal growth. Although

the neuron is similar to other cells in the body, they function as a part of the nervous

system, processing and transmitting information throughout the body. Once they are

created, neurons relocate and combine to form the different sections of the brain. While

this migration occurs, neurons specialize in order to perform various functions in

response to stimuli and chemical signals. The development of specialized neurons

happens gradually, starting during fetal growth and continuing through adolescence.

The process is sequential, beginning at the base of the brain and ending at the top.

During its early stages, neurons develop to form the brainstem and forebrain, which are

responsible for necessary life functions such as breathing and heart rate. Executive

functioning, meaning more complex skills such as emotions, language, and abstract

thought, are localized in the higher cerebral cortex, and thus, they do not develop until

later in the sequential process (“Understanding…” 2). Thus, while necessary life

functions are not impaired by the existence of trauma, executive functioning is more

vulnerable to impairment due to its delayed development.

5Evaluating the origin of the trauma allows clinicians to end the symptoms at their source,
potentially identifying triggers for flashbacks and dissociative states.
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Even though neurons are the building blocks for brain maturation, the process of

learning is specific to the connections between each neuron, known as the synapse.

The synapse describes the small gap between the axon terminal, the part of the neuron

designed to send electrical impulses, and the dendrite, the part of the neuron designed

to accept electrical impulses. These pathways connect the different parts of the brain

that control all aspects of life, including breathing and thinking. As these pathways from

neuron to neuron are strengthened through repetition and experience, the pathway

eventually becomes a memory. Once the pathway is efficient, the brain is able to

process this “memorized” information with little to no effort (“Understanding… 4). This

system of strengthening synaptic pathways describes the majority of brain development

after birth, as the only synapses created during fetal development are those responsible

for autonomic functions. Similarly, the efficiency of synapses depend on the myelin6 that

surrounds part of the neuron. Like the creation of synapses, myelin begins to develop in

the brain stem and gradually continues up to the cerebral cortex. However, synaptic

connections are not simply created over time. Experience is partially responsible for the

growth of synaptic pathways between neurons. Research illustrates the role of

experience in synaptogenesis, the process of creating synapses, with two proposed

mechanisms; experience-expectant synaptogenesis and experience-dependent

synaptogenesis. Experience-expectant synaptogenesis describes situations typically

experienced by the entire species. For example, the visual cortex “expects” to be

exposed to light, and therefore creates synapses in preparation. Experience-dependent

synaptogenesis refers to new experiences that foster brain development differently in

6Myelinis a fatty tissue that protects brain cells, ensuring a smooth transition of electrical
impulses.
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each individual (Nelson 980). Hence, early childhood experiences are essential to

determining the overall demeanor and personality of a child. Yet, the vulnerability of a

child’s behavior at this pivotal stage in life cannot be understated. Children are more

deeply impacted by trauma, in part due to the plasticity7 of their brain behavior and

biology. Behavioral discrepancies and neural pathways become more concrete with

age, leaving children more able to adapt to outside experiences. It is because of the

early plasticity of the brain that traumatic experiences are more influential for children

than their adult counterparts (Thompson 50).

These stressful situations leave children vulnerable to an array of developmental

impairments, but it is important to note that not all instances of stress negatively affect a

child’s growth. The National Scientific Council on the Developing Child dictates three

categories of stress: positive stress, tolerable stress, and toxic stress. Positive stress is

described as a brief, normal part of life that is important for a healthy development.

These cases do not result in significant trauma and teach children how to adjust to

unfavorable circumstances. An example of positive stress would be a child facing

separation from a parent for a short period of time. Tolerable stress is present during

more intense circumstances that rarely result in impairment, and although unlikely, have

the potential to alter brain development. For example, a death of a loved one would

qualify as tolerable stress on a child. Healthy responses to these stressors include the

release of hormones and neurotransmitters within systems such as the hypothalamic-

pituitary-adrenocortical (HPA) system8, which releases cortisol (Thompson 44).

7Plasticity
refers to the ability of the brain to change based on stimuli and the overall
impressionability of different systems.
8The HPA system activates when the body detects stress, producing cortisol that mobilizes
energy, suppressing immune functioning and enhancing cardiovascular tone.
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However, exposure to toxic stress can alter the development of these systems. Toxic

stress is a term adopted by the American Academy of Pediatrics (AAP) to describe a

frequent or prolonged activation of the body’s stress response system (Thompson 48).

The characteristics of an altered HPA system include heightened vigilance, poor coping,

cognitive and attention problems, poor emotional regulation and a difficulty in social

functioning. In addition to the noted behavioral problems associated with chronic

activation of the stress response, toxic stress can lead to elevated heart rate and the

suppression of immune functioning (Thompson 45). Yet, there is another way in which

stress can alter the development of a child. Instead of inciting hyper-reactivity in

response to stressful events, the body can become hypo-responsive, meaning it under

reacts to potentially toxic stress. This pattern of response would indicate signs that the

child’s stress system is shutting down. Regardless, both a hyper-reactive and hypo-

responsive stress response are disrupted patterns that risk the healthy development of

the child (Thompson 49).

Aside from the evident disruption of healthy endocrine function, child

maltreatment affects each specialized section of the brain and its acuity as a whole.

Within the limbic system, adults who have been maltreated had noticeably reduced

volume in the hippocampus, a structure strongly associated with memory. This also

reduces the hippocampus's ability to lower cortisol levels following a traumatic event.

The amygdala is another vital part of the limbic system that involves the regulation of

emotions. Although amygdala volume is not altered, trauma can cause overactivity,

which would change how one perceives a threatening stimulus and their emotional

response. The corpus callosum is a band of nerve fibers that allow for communication
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between the left and right hemispheres of the brain. Studies with maltreated children

tend to show a decreased volume, suggesting impairments in arousal and higher

cognitive abilities. The cerebellum rests at back of the head below the occipital lobe,

responsible for voluntary motion and balance. Maltreated children show a decreased

volume in that region, diminishing their coordination, motor behavior, and executive

functioning capabilities. In the prefrontal cortex at the front of the brain, maltreated

children seem to lack the normal size seen in their non-maltreated counterparts. The

prefrontal cortex is essential to behavior, impulse control, cognition, and emotional

regulation (“Understanding…” 6). Thus, children exposed to trauma exhibit diminished

functioning in these areas. The modified brain structures listed above suggest that

synaptic connection have not been fortified due to inactivity. Without the proper

stimulation needed to reach their full capacity, these structures may be permanently

impaired.

The consequences of adverse childhood experiences and otherwise stressful

scenarios extend beyond brain structure and activity, altering behavioral, social, and

emotional functioning. Traumatic experiences can result in a biological response to fear

unlike non-maltreated children. Within the hypothalamus, which is responsible for fight

or flight response and eating, the chronic activation of neuronal pathways inducing fear

can produce permanent states of paranoia. This ability of the brain to regulate fear

response is useful in a threatening situation, but in everyday life, a child may lose the

ability to distinguish nonthreatening situations from traumatic ones. Responding to the

environment in this way is a marker for potential anxiety disorders including social

anxiety and PTSD. This chronic reaction to stimuli without conscious thought is known
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as hyperarousal. Sensitive children are less likely to accurately interpret social cues and

respond appropriately. After these pathways have been forged, it is hard for a child to

revert back to their normal selves without constant intervention and treatment. Structural

malformations and chemical imbalances also may lead to an increase in internalizing

symptoms, meaning that maltreated children find difficulty in expressing their

emotions.This lack of connectivity between the hippocampus and amygdala also

changes the emotional well-being of the child. Maltreated children also face a

diminished level of executive functioning as a result of their trauma. Executive

functioning details three components of complex development including working

memory, inhibitory control, and cognitive flexibility. Without these key skills, maltreated

children may have difficulty in career success, social interactions, academic

achievement, IQ, and attention (“Understanding…” 8-9).

Childhood exposure to maltreatment carries with it a tremendous cost to society,

both economically and socially. The cumulative annual cost of trauma has steadily

increased from 94 billion dollars in 2001 (Spinazzola 6), to 104 billion dollars in 2007

(“Impact…” 4). These totals are comprised of both the direct and indirect costs of

trauma. Direct costs cover the urgent needs of victimized children including

hospitalization, mental health care, welfare systems, law enforcement, and any judicial

system fees. Indirect costs deal with the long-term effects of child maltreatment such as

special education, juvenile delinquency, mental health and health care, the adult

criminal justice system, and lost productivity to society. Moreover, the economic price of

complex trauma is determined by the severity of traumatization. The fatal cases of child

maltreatment cost approximately 1.3 million dollars per case, for medical expenses and
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productivity loss, while the non-fatal cases show lifetime costs of 210,000 dollars per

victim (“Impact…” 4,5). These fees are subsidized by the federal government, meaning

that the taxpayers are the majority contributor to the rehabilitation of victimized children.

Although fatal cases entail higher costs than non-fatal cases, surviving victims are

forced to endure a life pain, sorrow, and a reduced quality of life; which arguably makes

the non-fatal cases more severe. These trying circumstances for survivors make

treatment and recovery more complex and unpredictable. In this way, the cost of

childhood trauma can be incalculable, given the intangible losses and psychological toll

faced by the victims and their families.

Human development depends on a safe and secure environment in order for a

child to establish a positive sense of self and adequate cognitive, emotional, and social

competence. The consequences of a child's exposure to victimization and other

traumatic experiences can extend through adolescence and into adulthood. The

maltreatment faced by these children, including life in poverty and refugee status,

subjection to war and labor, abuse, and neglect, constitutes complex trauma, which has

the potential to alter the development of the afflicted child. Disruptions of this invasive

nature inhibits the psychological formation of a healthy individual. While children may

have a resilience to such impairments, they more likely will endure overwhelming

deficits on cognitive, emotional, developmental, and social platforms.

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Works Cited

"A Study on Children Affected by AIDS in ZImbabwe." Orphans and Other Vulnerable

Children and Adolescents in Zimbabwe. UNICEF, 2001. Web. 14 Nov. 2015.

Arat, Zehra F. "Analyzing Child Labor as a Human Rights Issue: Its Causes, Aggravating

Policies, and Alternative Proposals." Human Rights Quarterly 24.1 (2002):

177-204. JSTOR. Web. 26 Oct. 2015.

Bachman, Sarah L. "A New Economics of Child Labor: Searching for Answers Behind

the Headlines." Journal of International Affairs 53.2, Shadow Economies:

Promoting Prosperity or Undermining Stability? (2000): 545-72. JSTOR. Web. 26

Oct. 2015.

Beegle, Kathleen, Rajeev Dehejia, and Roberta Gatti. "Why Should We Care about

Child Labor? The Education, Labor Market, and Health Consequences of Child

Labor." The Journal of Human Resources 44.4 (2009): 871-89. JSTOR. Web. 26

Oct. 2015.

Betson, David M. "Why So Many Children Are Poor." The Future of Children 7.2,

Children and Poverty (1997): 25-39. JSTOR. Web. 28 Jan. 2016.

Brett, Rachel, and Irma Specht. Young Soldiers: Why They Choose to Fight. Comp.

Lynne Rienner. CO: Boulder, 2004. Pdf.

Briere, John N., and Diana M. Elliott. "Immediate and Long-Term Impacts of Child

Sexual Abuse." The Future of Children 4.2, Sexual Abuse of Children (1994):

54-69. JSTOR. Web. 01 Mar. 2016

Bristol, Nellie. "Battling HIV/AIDS." Congressional Quarterly Inc. 17.38 (2007): 889-912.

CQResearcher. CQPress, 26 Oct. 2007. Web. 10 Nov. 2015.“CDC-Kaiser ACE

 Mingle 3
! 0

Study." Cdc.gov. Centers for Disease Control and Prevention, 08 Mar. 2016.

Web. 4 June 2016.

Brooks-Gunn, Jeanne, and Greg J. Duncan. "The Effects of Poverty on Children." The

Future of Children 7.2 (1997): 55-71. JSTOR. Web. 28 Jan. 2016.

"CDC-Kaiser ACE Study." Cdc.gov. Centers for Disease Control and Prevention, 08

Mar. 2016. Web. 4 June 2016.

"Children and HIV/AIDS | AVERT." Children and HIV/AIDS | AVERT. N.p., 2015. Web. 16

Nov. 2015.

Clark, Charles S. "Child Labor and Sweatshops." Congressional Quarterly Inc. 6.31

(1996): 721-44. CQ Researcher Online [CQ Press]. Web. 25 Oct. 2015.

Cook, Alexandra, Dr., et. al. ”Complex Trauma in Children and Adolescents.”

PsycEXTRA Dataset 35.5 (2005): 390-98. Psychiatric Annals, May 2005. Web. 5

Feb. 2016.

Coutois, Christine A., Ph.D. "The Sexual After-Effects of Incest/Child Sexual Abuse."

Siecus Report (2000): 11-16. Proquest. Web. 1 Mar. 2016.

Delamonica, Enrique Ernesto. "INCIDENCE, DEPTH AND SEVERITY OF CHILDREN

IN POVERTY." Social Indicators Research 82.2 (2007): 361-74. JSTOR. Web. 26

Jan. 2016.

Dottridge, Mike. "Understanding the Causes of Child Trafficking as a Precondition for

Prevention." (n.d.): 21-48. Unicef.org. UNICEF. Web. 4 Dec. 2015.

Dubowitz, Howard, and Susan Bennett. "Physical Abuse and Neglect of Children." The

Lancet 369 (2007): 1891-899. Proquest. Web. 1 Apr. 2016.

 Mingle 3
! 1

Duger, Angela. "Focusing on Prevention: The Social and Economic Rights of Children

Vulnerable to Sex Trafficking." Health and Human Rights 17.1 (2015): 114-23.

JSTOR [JSTOR]. Web. 4 Dec. 2015.

Eisenbruch, Maurice. "The Mental Health of Refugee Children and Their Cultural

Development." The International Migration Review 22.2 (1988): 282-300. JSTOR.

Web. 05 May 2016.

Ertl, Verena, Anett Pfeiffer, Elisabeth Schauer-Kaiser, Thomas Elbert, and Frank

Neuner. "The Challenge of Living On: Psychopathology and Its Mediating

Influence on the Readjustment of Former Child Soldiers." PLoS ONE 9.7 (2014):

1-11. Web. 20 Oct. 2015.

Faulkner, Frank. "Kindergarten Killers: Morality, Murder and the Child Soldier Problem."

Third World Quarterly 22.4 (2001): 491-504. JSTOR. Web. 22 Oct. 2015.

Geoff Foster, and John Williamson. "A Review of Current Literature of the Impact of HIV/

AIDS on Children in Sub-Saharan Africa." AIDS2000 14 (2000): 275-93.

Lippincott Williams & Wilkins. Web. 10 Nov. 2015.

Hildyard, Kathryn L., and David A. Wolfe. "Child Neglect: Developmental Issues and

Outcomes☆." Child Abuse & Neglect 26.6-7 (2002): 679-95. Web. 1 Apr. 2016.

“Impact of Complex Trauma." (n.d.): 1-5. Nctsn.org. The National Child Traumatic

Stress Network. Web. 5 Feb. 2016.

Iweala, Uzodinma. Beasts of No Nation: A Novel. New York: HarperCollins, 2005. Print.

Jung, Hyunzee, Todd I. Herrenkohl, Jungeun Olivia Lee, J. Bart Klika, and Martie L.

Skinner. "Effects of Physical and Emotional Child Abuse and Its Chronicity on
 Mingle 3
! 2

Crime Into Adulthood." Violence and Victims Violence 30.6 (2015): 1004-018.

Web. 1 Mar. 2016.

Katel, Peter. "Child Poverty." CQReseacrcher. CQPress, 28 Oct. 2011. Web. 21 Jan.

2016

Kendall-Tackett, Kathleen A., and John Eckenrode. "The Effects of Neglect on Academic

Achievement and Disciplinary Problems: A Developmental Perspective." Child

Abuse & Neglect 20.3 (1996): 161-69. Web. 1 Apr. 2016.

Kiener, Robert. "Human Trafficking and Slavery." CQ Global Reasearcher 6.20 (2012):

473-96. CQ Researcher Online [CQ Press]. Web. 4 Dec. 2015.

Kirkengen, Anna Luise. "Inscriptions of Violence: Societal and Medical Neglect of Child

Abuse – Impact on Life and Health." Medicine, Health Care and Philosophy Med

Health Care and Philos 11.1 (2007): 99-110. JSTOR. Web. 1 Apr. 2016.

Kruse, Douglas L. "Illegal Child Labor in the United States: Prevalence and

Characteristics." Industrial and Labor Relations Review 54.1 (2000): 17-40.

JSTOR. Web. 26 Oct. 2015.

"Long-Term Consequences of Child Abuse and Neglect." PsycEXTRA Dataset (2013):

1-10. Child Welfare Information Gateway, July 2013. Web. 1 Mar. 2016.

Margolin, Gayla. "Children's Exposure to Violence in the Family and Community."

Current Directions in Psychological Science 13.4 (2004): 152-55. JSTOR. Web.

01 Mar. 2016.

Maslow, Jacqueline N., and Allison Baer L. "Lives Beyond Suffering: The Child Soldiers

of African Wars." English Journal 100.6 (2011): 68-77. Web. 22 Oct. 2015.
 Mingle 3
! 3

Mikhail, Susanne Louis B. "Child Marriage and Child Prostitution: Two Forms of Sexual

Exploitation." Gender & Development 10.1 (2002): 43-49. JSTOR [JSTOR]. Web.

4 Dec. 2015.

Molina, Flor, Vannak Prum, Shamere McKenzie, Ishmael Beah, Dina Chan, James

Annan, Ravi Kumar Shanker, and Beatrice Fernando. "Child Labor."

Endslaverynow.org. National Underground Railroad Freedom Center, 2015:1-15

Web. 16 Dec. 2015.

Narayan, Navin. "Stolen Childhoods: Tackling the Health Burdens of Child Labor."

Harvard International Review 19.4 (1997): 50+. JSTOR. Web. 01 Nov. 2015.

Nelson, Charles A. "Child Development and Neuroscience." Child Development 68.5

(1997): 970-87. JSTOR. Web. 10 Nov. 2016.

Pumariega, Andrés J., MD, Eugenio Rothe, MD, and JoAnne B. Pumariega, MA.

"Mental Health of Immigrants and Refugees." Community Mental Health 41.5

(2005): 581-97. Springer Science-Business Media. Web. 28 Apr. 2016.

Rafferty, Yvonne. "The Impact of Trafficking on Children: Psychological and Social

Policy Perspectives." Child Dev Perspectives Child Development Perspectives

2.1 (2008): 13-18. JSTOR [JSTOR]. Web. 4 Dec. 2015.

Salzinger, Suzanne, and Richard S. Feldman. "The Effects of Physical Abuse on

Children's Social Relationships." Child Development 64.1 (1993): 169-87.

JSTOR. Web. 01 Mar. 2016.

Schmid, Marc, Franz Petermann, and Joerg Fergert. "Developmental Trauma Disorder:

Pros and Cons of including Formal Criteria in the Psychiatric Diagnostic

 Mingle 3
! 4

Systems." BioMed Central 13.3 (2013): 1-12. BMC Psychiatry, 2013. Web. 12

Mar. 2016.

Spinazzola, Joseph, Dr., Alexandra Cook, Dr., Margaret Blaustein. Ph.D., Bessel Van

Der Kolk, Dr. "Complex Trauma in Children and Adolescents." PsycEXTRA

Dataset (n.d.): 1-41. Nctsnet.org. National Child Traumatic Stress Network. Web.

12 Mar. 2016.

“Statistics" Childhood Trauma. Mental Health Connection, n.d. Web. 1 Mar. 2016.

Thompson, Ross A. "Stress and Child Development." The Future of Children 24.1,

Helping Parents, Helping Children: Two-Generation Mechanisms (2014): 41-59.

JSTOR. Web. 10 Nov. 2016.

Van Der Kolk, Bessel, Dr. "Developmental Trauma Disorder." Psychiatric Annals (2005):

1-18. Byronclinic.com.au. May 2005. Web. 5 Feb. 2016.

Understanding the Effects of Maltreatment on Brain Development. Washington, DC:

Child Welfare Information Gateway, Children's Bureau / ACYF, 2009. 1-19. Child

Welfare Information Gateway, Apr. 2015. Web. 10 Nov. 2016.

UNICEF. Nearly 50 Million Children “uprooted” Worldwide. Unicef.org. N.p., 7 Sept.

2016. Web. 22 Jan. 2017.

VanFleet, Jennifer. "The Struggles and Predicaments of Low-Income Families and

Children in Poverty." Human Architecture Journal of The Sociology of Self-

Knowledge 1.2 (2002): 37-46. Proquest. Web. 21 Jan. 2016.