ISSN: 1679-9941 (Print), 2177-5281 (Online)
Official website of the journal Adolescencia e Saude (Adolescence and Health Journal)

Vol. 3 No. 2 - Apr/Jun - 2006

Traumas and their repercussions in childhood and adolescence

Children and adolescents experience an intense period of growth, emotional and cognitive development, and brain and body maturation, in a dynamic and complex process of changes that are interdependent and associated. They always need favorable nutritional, environmental and contextual conditions to make this transition in a healthy way to adulthood and to fully integrate into society.

All these transformations in childhood and adolescence can be influenced positively, leading to the full achievement of vital potential, or negatively, with distortions caused by risk situations and traumas, which can interrupt this trajectory and have repercussions for the rest of their lives.

The combination of multiple risk situations and constant traumas that threaten physical and emotional integrity can contribute to the fragmentation of the sequence of development stages and the acquisition of skills necessary for learning and performing social roles. Every day, and progressively, the causes and effects of trauma, when not interrupted or resolved, contribute to marginalization at school and social exclusion, to more discrimination and inequities, and mainly to other episodes of violence and abuse with post-traumatic symptoms and mental problems. Or, even more seriously, they can lead to tragic outcomes, such as disasters or armed conflicts between rival factions and the police, with stray bullets and premature death.

The mortality rate from external causes in the 10 to 19 age group for the whole of Brazil in 2002 was 47.6 per 100,000 inhabitants, with a marked difference between males (79.8/100,000) and females (14.9/100,000 inhabitants). For the state of Rio de Janeiro, this mortality rate increases to 80.4, while for the Southeast region, which also includes the states of São Paulo, Minas Gerais and Espírito Santo, it is 59.9/100,000 inhabitants (IBGE, 2002).

The protection of children and adolescents against any form of abuse, abandonment, exploitation and violence is guaranteed by the United Nations Convention on the Rights of the Child and confirmed by Brazil, a signatory country to this document. It is also one of the five goals of the commitment made in 2002 (A World Fit for Children) that has been attempted to be implemented in this country ever since, despite the government’s political fluctuations and the constant lack of public resources available for the areas of health and education. Since 1990, there has also been the Statute of Children and Adolescents, Law 8,069, which ensures citizenship and health rights as priorities for all children and adolescents up to the age of 18. At least on paper, the laws exist and must be complied with in a state of law and in a country with a democratic regime!

However, social inequality, unemployment, the interplay of poverty and violence, drug trafficking and the lack of social support in schools are some of the factors that contribute most to the constant episodes of abuse, neglect and traumatic situations in the pockets of urban poverty and in the alleys of more than 200 favelas in Rio de Janeiro.

Traumatic experiences are striking and have devastating consequences for the growth and emotional development of children and adolescents, in addition to the enormous social cost and impact on public health in Brazil. Many of the social indicators and health problems are not even disclosed, for local or governmental political reasons, or even because they are not documented or collected. The print media, which is more populist, is responsible for reporting many of the cases that occur daily in the large urban centers of Brazil, as is the case in Rio de Janeiro, in most of the favelas, in constant armed conflicts with the local police.

Traumatic problems, which range from primary chronic malnutrition to infections and frequent hospitalizations due to diseases common in these age groups, as well as bodily injuries, sexual abuse and cases of neglect and family abandonment, have a cumulative, chronic and progressive effect and cause delays in brain and cognitive development, learning and literacy disorders, grade repetition and school exclusion, in addition to an increase in mental problems such as depression, dissociative episodes, seizures, drug and alcohol abuse and conduct disorders. Currently, post-traumatic stress disorder , classified as diagnostic criterion F43.1 by the tenth edition of the International Classification of Diseases (ICD-10) of the World Health Organization (WHO), and depressive disorder , diagnostic criterion F32, represent significant percentages among mental disorders in childhood and adolescence in our country.

Stress can be defined as a serious conflict or threat to freedom or physical, mental, sexual or social integrity, and is experienced when a person loses one or more important sources of human emotional values, such as a mother, father or family member, or possessions such as a home, residence or place of residence, or other connections of affection and love that are valuable and important. Stress factors, to which it is difficult to adapt, are always undesirable, uncontrollable and sudden, resulting in severe, intense and negative reactions to habitual behavior, which is influenced by the hypothalamic-pituitary-adrenal axis of the central nervous system (CNS), with the release of several hormones and neurotransmitters that will activate the body’s adaptation mechanisms for survival. Hence the major risk factors that cause damage to health, with immediate and long-term repercussions on the behavior and quality of life of people who experienced these traumas during childhood and adolescence.

Extreme traumatic factors can be defined as those that cause harm, injury or bodily harm and mental breakdown, or that threaten one’s own life or the lives of others, leading to unexpected death. They are also associated with feelings of loss, lack of security, increased vulnerability and night terrors. The most frequent causes faced by children and adolescents living in the favelas are the death or witnessing of murders or assaults of loved ones, family separation, punishments, torture, abuse, mental illness or family alcoholism and violence between armed groups of local drug traffickers.

Constant and prolonged traumatic events affect the entire family and community dynamics, causing a greater impact on adaptation and survival mechanisms. Women, children and adolescents are always a group at greater risk, as they are more vulnerable and dependent, in addition to sometimes suffering in silence , being forced into social isolation with absurd cultural and structural impositions in relation to gender and age group. Adolescents often stop going to school due to shootings and local disputes. They are either threatened and marked with death or have their fingers amputated due to punishments imposed by those in power , who thus strengthen their authority .

Post-traumatic reactions manifest themselves in different forms and reactions that vary according to the age group and the stage of physical, emotional, cognitive and mental development in which the child or adolescent finds themselves. The most frequently encountered reactions can be divided into four groups:

1. Physical reactions – short stature, delayed growth and pubertal development, loss of appetite, insomnia and difficulty sleeping due to nightmares, headaches, convulsions and tremors, hyperactivity, gastrointestinal problems, immunological problems and allergic reactions, speech and hearing problems; 2. Emotional reactions

– shock with amnesia, intense fear, emotional and reality dissociation, anger and irritability, guilt, anxiety reactions, regressions, despair, apathy, frequent crying, depressive reactions and night terrors with enuresis;

3. Cognitive reactions – difficulty concentrating, memory loss and mental confusion, distortions of reality and imagination ( flashbacks ), intrusive and suicidal thoughts, loss of self-esteem, dyslexia and writing problems;

4. Psychosocial reactions – alienation, passivity, aggressiveness, isolation and loneliness, difficulties in emotional relationships, drug abuse, loss of vocational skills and common interest in school activities.

Constant trauma destroys the sense of personal security and trust in relationships with other adults or family members, in addition to contributing to a lack of emotional connections and expectations for the future. There are disruptions and interruptions in the progression of growth and development phases, causing a profound impact on adaptation and survival mechanisms. Children and adolescents who have suffered abuse or abandonment and have been traumatized may react with defensive behaviors and become more aggressive, with behavioral problems, due to difficulty in controlling their impulses and emotions, which leads to other antisocial or criminal situations, drug abuse and self-harm with bodily mutilation.

The main prevention and intervention strategies involve not only interrupting the mistreatment that causes traumatic reactions, but also developing a positive, healthy relationship of trust that conveys protection and security, restoring self-esteem and developing skills (cognitive, sports, cultural and leisure) and essential potential for the future.

It is also important to have a place that serves as a shelter, community support and reference in critical situations, providing guidance on primary care and educational support. The expansion of prevention programs with appropriate educational and informational materials should be part of family and community support instruments and be multiplied in programs and other services, forming a more lasting and respected local protection network. Social, health and educational recovery data and indicators should be evaluated every six months, aiming at improving programs that serve children and adolescents in terms of health and assistance in Brazil.

Bibliographic References
1. Assumpção Jr FB. Affective disorders of childhood and adolescence. São Paulo: Lemos Ed. and Graphics. 1996.

2. Chrousos G et al (eds.). Stress, basic mechanisms and clinical implications. New York: Annals of the NY Academy of Sciences, 1995. v.771.

3. Cooper JE. Classification of Mental and Behavioral Disorders ICD-10, Quick Reference. Porto Alegre: Artes Médicas. 1997.

4. Eisenstein E, Lidchi V. Child and adolescent abuse and protection. Rio de Janeiro: CEIIAS-ISPCAN. 2004.

5. Green BL et al (eds.). Trauma interventions in war and peace: prevention, practice and policy. New York: Kluwer Academic/Plenum Publishers. 2003.

6. Child Friendly Network. A Brazil for children: Brazilian society and the millennium development goals for childhood and adolescence. Brasília: Child-Friendly Monitoring Network. 2004.

7. Yehuda R, McFarlane AC (eds.). Psychobiology of posttraumatic stress disorder. New York: Annals of the NY Academy of Sciences 1997. v.821.

1. Assistant Professor at the Center for Adolescent Health Studies at the School of Medical Sciences of the State University of Rio de Janeiro (NESA/FCM/UERJ).