Journal of Child & Adolescent Trauma

, Volume 10, Issue 3, pp 289–297 | Cite as

Understanding the Long-Term Effects of Childhood Adversities: beyond Diagnosis and Abuse



Studies of the effects of childhood adversities often use psychiatric diagnoses and focus on physical or sexual abuse. This study explored relationships between a broader range of adversities and both diagnoses and specific symptoms. The files of 217 child and adolescent mental health service users were audited. Information regarding 14 adverse childhood experiences, 20 diagnoses and 38 symptoms was analysed. Only two diagnoses (Psychosis and Oppositional Defiant Disorder) were predicted by mean number of adversities. However, the symptom clusters indicative of six diagnoses were related to one or more childhood adversities. Strong specific relationships were found between sexual abuse and hyperarousal, between parental substance abuse and rule violation, and between loss and avoidance/numbing. Mean number of adversities predicted six specific symptoms as well as global functioning, risk to self, and risk to others. Parental mental health, a proxy for genetic influence, was unrelated to all diagnoses, all symptom clusters and all but one of the 38 symptoms. It is concluded that understanding the complex nature of the effects of childhood adversities are constrained by focusing on diagnoses and a restricted range of adversities. The need to take a full psychosocial history in child and adolescent mental health services, and the implications for primary prevention, are discussed.


Child maltreatment Child abuse Child neglect Bullying Loss Domestic violence Psychiatric diagnoses Psychiatric symptoms 


Compliance with Ethical Standards

Procedures were in accordance with the 1964 Helsinki declaration and its later amendments. Permission for the study was given by the Ethics Committees of the University of Auckland and the local District Health Board. The study was an audit and did not, therefore, require signed consent from the individual participants or their parents. The participants’ data was depersonalised in the data collection process. The names of the clients were not recorded on the data collection sheets.


  1. Agar, K., & Read, J. (2002). What happens when people disclose sexual or physical abuse to staff at a community mental health Centre? International Journal of Mental Health Nursing, 11, 70–79. doi: 10.1046/j.1440-0979.2002.00230.x.CrossRefPubMedGoogle Scholar
  2. Agar, K., Read, J., & Bush, J. (2002). Identification of abuse histories in a community mental health Centre: The need for policies and training. Journal of Mental Health, 11, 533–543. doi: 10.1080/09638230020023886.CrossRefGoogle Scholar
  3. Albee, G. (1985). The argument for primary prevention. Journal of Primary Prevention, 5, 213–219. Retrieved from
  4. Allen, G. (2011). Early intervention: The next steps. London: H.M. Government.Google Scholar
  5. Bateman, J., Henderson, C., & Kezelman, C. (2013). Trauma-informed care and practice: Towards a cultural shift in policy reform across mental health and human services in Australia. Rozelle: Mental Health Coordinating Council Retrieved from Scholar
  6. Bentall, R., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., & Read, J. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49, 1011–1022. doi: 10.1007/s00127-014-0914-0.CrossRefPubMedGoogle Scholar
  7. Briscoe-Smith, A., & Hinshaw, S. (2006). Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: behavioral and social correlates. Child Abuse & Neglect, 30, 1239–1255. doi: 10.1016/j.chiabu.2006.04.008.
  8. Cunningham, T., Shannon, C., Crothers, I., Hoy, K., Fitzsimmons, C., McCann, R., et al. (2016). Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires. Psychosis, 8(4), 301–310. doi: 10.1080/17522439.2015.1115542.
  9. Endo, T., Sugiyama, T., & Someya, T. (2006). Attention-deficit/hyperactivity disorder and dissociative disorder among abused children. Psychiatry and Clinical Neurosciences, 60, 434–438. doi: 10.1111/j.1440-1819.2006.01528.x.CrossRefPubMedGoogle Scholar
  10. Fergusson, D., & Horwood, L. (1999). Prospective childhood predictors of deviant peer affiliations in adolescence. Journal of Child Psychology and Psychiatry, 40, 581–592. doi: 10.1111/1469-7610.00475.CrossRefPubMedGoogle Scholar
  11. Ford, J., Connor, D., & Hawke, J. (2009). Complex trauma among psychiatrically impaired children: A cross-sectional, chart-review study. Journal of Clinical Psychiatry, 70, 1155–1163. doi: 10.4088/JCP.08m04783.CrossRefPubMedGoogle Scholar
  12. Ford, J., Wasser, T., & Connor, D. (2011). Identifying and determining the symptomseverity associated with polyvictimization among psychiatrically impaired children in the outpatient setting. Child Maltreatment, 16, 16–226. doi: 10.1177/1077559511406109.CrossRefGoogle Scholar
  13. Hechtman, L. (2005). ADHD. In B. Sadock & V. Sadock (Eds.), Comprehensive textbook of psychiatry (8th edn) (pp. 3183–3198). Philadelphia: Lippincott, Williams & Wilkins.Google Scholar
  14. Hepworth, I., & McGowan, L. (2013). Do mental health professionals enquire about childhood sexual abuse during routine mental health assessment in acute mental health settings? A substantive literature review. Journal of Psychiatric and Mental Health Nursing, 20, 473–483. doi: 10.1111/j.1365-2850.2012.01939.x.CrossRefPubMedGoogle Scholar
  15. Kisiel, C., Fehrenback, T., Small, L., & Lyons, J. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child and Adolescent Trauma, 2, 143–160. doi: 10.1080/19361520903120467.CrossRefGoogle Scholar
  16. Longden, E., Sampson, M., & Read, J. (2016). Childhood adversity and psychosis: Generalised or specific effects? Epidemiology and Psychiatric Sciences, 25, 349-359. doi: 10.1017/S204579601500044X.
  17. Maguire, S., Williams, B., Naughton, A., Cowley, L., Tempest, V., Mann, M., et al. (2015). A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child: Care, Health and Development, 41, 641–653. doi: 10.1111/cch.12227.Google Scholar
  18. Maniglio, R. (2015). Significance, nature, and direction of the association between child sexual abuse and conduct disorder: A systematic review. Trauma, Violence & Abuse, 16, 241–257. doi: 10.1177/1524838014526068.CrossRefGoogle Scholar
  19. McLaren, J., & Brown, R. (1989). Childhood problems associated with abuse and neglect. Canada's Mental Health, 37(3), 1–6 Retrieved from Scholar
  20. McLeer, S., Deblinger, E., Henry, D., & Orvaschel, H. (1992). Sexually abused-children at high-risk for posttraumatic-stress-disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 3, 875–879. doi: 10.1097/00004583-199209000-00015.CrossRefGoogle Scholar
  21. Meller, S., Kuperman, K., McCullough, C., & Shaffer, A. (2016). Adverse effects of childhood emotional maltreatment on child behavioral outcomes. Journal of Aggression, Maltreatment & Trauma, 2, 127–144. doi: 10.1080/10926771.2016.1101034.CrossRefGoogle Scholar
  22. Merry, S., & Andrews, L. (1994). Psychiatric status of sexually abused children 12 months after disclosure of abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 939–944. doi: 10.1097/00004583-199409000-00002.CrossRefPubMedGoogle Scholar
  23. Muskett, C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23, 51–59. doi: 10.1111/inm.12012.CrossRefPubMedGoogle Scholar
  24. Nigg, J., & Craver, L. (2014). Commentary: ADHD and social disadvantage: An inconvenient truth? Journal of Child Psychology and Psychiatry, 55, 446–447. doi: 10.1111/jcpp.12237.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Ouyang, L., Fang, X., Mercy, J., Perou, R., & Grosse, S. (2008). Attention-deficit/hyperactivity disorder symptoms and child maltreatment: A population-based study. Journal of Pediatrics, 153, 851–856. doi: 10.1016/j.jpeds.2008.06.002.CrossRefPubMedGoogle Scholar
  26. Perry, B. (2013). Brief: Reflections on childhood, trauma and society. Houston: Child Trauma Academy Press.Google Scholar
  27. Posner, J., Eilenberg, J., Friedman, J., & Fullilove, M. (2008). Quality and use of trauma histories obtained from psychiatric outpatients: A ten-year follow-up. Psychiatric Services, 59, 318–321. doi: 10.1176/ Scholar
  28. Read, J. (2013). Childhood adversity and psychosis: From heresy to certainty. In J. Read & J. Dillon (Eds.), Models of madness: Psychological, social and biological approaches to psychosis, (2 nd edn) (pp. 249–275). London: Routledge.Google Scholar
  29. Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions, and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice, 76, 1–22. doi: 10.1348/14760830260569210.CrossRefGoogle Scholar
  30. Read, J., Hammersley, P., & Rudegeair, T. (2007). Why, when and how to ask about abuse. Advances in Psychiatric Treatment, 13, 101–110. doi: 10.1192/apt.bp.106.002840.CrossRefGoogle Scholar
  31. Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4, 65–79. doi: 10.2217/npy.13.89.CrossRefGoogle Scholar
  32. Read, J., Sampson, M., & Critchley, C. (2016). Are mental health services getting better at responding to abuse, assault and neglect? Acta Psychiatrica Scandinavica, 134, 287-294. doi: 10.1111/acps.12552.
  33. Rose, S., Freeman, C., & Proudlock, S. (2012). Despite the evidence - why are we still not creating more trauma informed mental health services? Journal of Public Mental Health, 11, 5–9. doi: 10.1108/17465721211207266.CrossRefGoogle Scholar
  34. Rossiter, A., Byrne, F., Wota, A., Nisar, Z., Ofuafor, T., Murray, I., et al. (2015). Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma. Child Abuse & Neglect, 44, 36–45. doi: 10.1016/j.chiabu.2015.01.001.CrossRefGoogle Scholar
  35. Russell, G., Ford, T., Rosenberg, R., & Kelly, S. (2014). The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: Alternative explanations and evidence. Journal of Child Psychology and Psychiatry, 55, 436–445. doi: 10.1111/jcpp.12170.CrossRefPubMedGoogle Scholar
  36. Sadock, B., & Sadock, V. (Eds.). (2005). Comprehensive textbook of psychiatry (8th ed.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  37. Sadock, B., & Sadock, V. (Eds.). (2014). Concise textbook of child and adolescent psychiatry. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  38. Sampson, M., & Read, J. (2016). Are mental health staff getting better at asking about abuse and neglect? International Journal of Mental Health Nursing, 26, 95–104. doi: 10.1111/inm.12237.
  39. Stern, A., Lynch, D., Oates, R., O’Toole, B., & Cooney, G. (1995). Self-esteem, depression, behavior and family functioning in sexually abused-children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 36, 1077–1089. doi: 10.1111/j.1469-7610.1995.tb01352.x.CrossRefPubMedGoogle Scholar
  40. Teicher, M., & Samson, J. (2016). Annual research review: enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57, 241–266. doi: 10.1111/jcpp.12507.
  41. Walters, S., Hogg, L., & Gillmore, C. (2016). Evaluation of a tailored training programme to improve the assessment and treatment of trauma in an early intervention in psychosis service. Psychosis: Psychological, Social and Integrative Approaches, 8, 226–237. doi: 10.1080/17522439.2015.1131324.
  42. Webster, R. (2001). Symptoms and long-term outcomes for children who have been sexually assaulted. Psychology in the Schools, 38, 533–547. doi: 10.1002/pits.1041.CrossRefGoogle Scholar
  43. Weinstein, D., Staffelbach, D., & Biaggio, M. (2000). Attention-deficit hyperactivity disorder and posttraumatic stress disorder: Differential diagnosis in childhood sexual abuse. Clinical Psychology Review, 20, 359–378. doi: 10.1016/S0272-7358(98)00107-X.CrossRefPubMedGoogle Scholar
  44. Young, M., Read, J., Barker-Collo, S., & Harrison, R. (2001). Evaluating and overcoming barriers to taking abuse histories. Professional Psychology: Research and Practice, 32, 407–414. doi: 10.1037/0735-7028.32.4.407.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.School of PsychologyUniversity of East London, Stratford CampusLondonUK
  2. 2.Great Ormond Street Hospital for ChildrenLondonUK

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