What is the approach to assessing the health of someone with childhood trauma?

Comprehensive Health Assessment for Individuals with Childhood Trauma

A thorough health assessment for individuals with childhood trauma must include physical, mental, and developmental evaluations, as childhood trauma can have profound effects on multiple body systems and lead to significant morbidity and mortality across the lifespan. 1

Physical Health Assessment

Vital Signs and Growth Parameters

• Measure blood pressure at all visits - elevated BP may be the first sign of childhood traumatic stress, especially as youth age 1
• Assess growth parameters (height, weight, BMI) - abnormalities may indicate neglect or adverse childhood experiences 1
• Check for overweight/obesity which has been associated with ACEs 1

Physical Examination

• Complete skin examination for bruising or other injuries - pay special attention to unusual locations such as ears, neck, or trunk 1
• Assess for signs of neglect or abuse 1
• Evaluate for inflammatory or infectious consequences which may result from trauma's immunologic effects 1
• Check hearing and vision - abnormalities can be clues to adversities 1

Laboratory Evaluation (When Indicated)

• Consider screening for:
  • Inflammatory markers (trauma can cause chronic inflammation)
  • Metabolic parameters (trauma is associated with metabolic syndrome)
  • Immune function tests when clinically indicated 1

Mental Health and Behavioral Assessment

Screening Tools

• Use validated screening tools appropriate for age and cultural background:
  • Ages and Stages Questionnaire for developmental assessment 1
  • Pediatric Symptom Checklist or Strengths and Difficulties Questionnaire for behavioral/emotional symptoms 1
  • Patient Health Questionnaire-9 for depression 1
  • PTSD Reaction Index Brief Form for those with known trauma exposure 1

Behavioral Observations

• Watch for common trauma-related behaviors:
  • Rapid, reflexive responses to triggers
  • Inattention, poor focus, hyperactivity
  • Difficulty tolerating negative mood
  • Emotional lability
  • Negative self-narrative or flat affect 1

Trauma History

• Ask directly: "Has anything scary or concerning happened to you?" 1
• For adolescents, incorporate trauma questions into the HEADSSS psychosocial interview 1
• Assess for specific types of trauma (physical, emotional, sexual abuse, neglect, household dysfunction) 2

Functional Assessment

Immune Function Symptoms

• Assess for recurrent infections, inflammatory conditions (asthma), and "sick syndrome" (headaches, stomachaches, lethargy) 1

Cognitive and Developmental Impact

• Evaluate for developmental delays or regression
• Assess for learning difficulties
• Evaluate executive functioning (attention, impulse control, planning) 1

Relationship and Social Functioning

• Observe caregiver-child interactions
• Assess peer relationships and social skills
• Evaluate for attachment difficulties 1

Critical Considerations

Cultural Sensitivity

• Consider cultural context when interpreting screening results - instruments not normed for the population or properly translated can yield misleading results 1
• Recognize cultural variations in trauma expression and reporting

Differential Diagnosis

• Consider trauma as a possible etiology for developmental, mental health, behavioral, and physical symptoms in all encounters because:
  1. Adversity experiences are common
  2. Trauma symptoms overlap with other pediatric conditions
  3. Missing trauma can lead to incorrect diagnosis and treatment 1

Common Pitfalls to Avoid

• Failing to screen for trauma in the presence of physical symptoms - childhood trauma predicts development of adult physical disorders 3
• Overlooking somatic manifestations of trauma - childhood trauma is associated with adult somatic symptoms 4
• Attributing anger solely to mood disorders - childhood trauma shows dose-response association with anger constructs in adulthood 5
• Relying on single-informant assessment - comprehensive assessment requires multiple informants and techniques 6

Follow-up and Monitoring

• Schedule regular follow-up visits to monitor physical and mental health
• Reassess trauma symptoms periodically
• Track developmental progress and academic functioning
• Monitor for emergence of new physical or mental health conditions

By implementing this comprehensive assessment approach, clinicians can better identify the effects of childhood trauma and develop appropriate interventions to improve health outcomes and quality of life for affected individuals.