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September 16, 2019

Shortfall of Intervention Research Over Correlational Research in Childhood Maltreatment: An Impasse to be Overcome

Author Affiliations
  • 1Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
  • 2Centre de Neuromédecine Personnalisée et du Neurodéveloppement de l’Enfant, Centre de Recherche Cervo, Quebec City, Quebec, Canada
  • 3Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
JAMA Pediatr. Published online September 16, 2019. doi:10.1001/jamapediatrics.2019.1684

For more than 40 years, child maltreatment (also known as childhood abuse and neglect [CAN]) has been recognized by the Council for International Organizations of Medical Sciences and the World Health Organization as a major public health problem, particularly for the pediatric practice. Child maltreatment has been confirmed in 1 in every 8 children in the United States before they reach age 18 years1 and is an important risk factor for cognitive development2 and physical health issues3 in the short term and long term. Furthermore, CAN accounts for 45% of the attributable risk for childhood psychiatric disorders.4 The transmission of maltreatment and the associated impairments that trap parents and children in a malfunctioning cycle from one generation to the next have been documented for a long time,5 just as they have been for the generational transmission of major psychiatric disorders.6 Therefore, CAN is considered to be “the most important preventable cause of psychopathology.”3(p241) The strength of evidence on the negative outcomes of childhood maltreatment at the individual and familial levels is such that every effort should be made by pediatricians and decision makers to fully relieve the neurobiological and psychological effects of trauma early in childhood. Such efforts should also be designed to prevent the intergenerational transmission of CAN. While clinicians and policy makers typically bear the bulk of the burden of change in practice, academics also share a crucial responsibility. Indeed, the promotion of clinical research that aims at providing empirical information to support preventive and therapeutic interventions was stated as a priority 25 years ago by the National Research Council, a statement that was reaffirmed recently by the World Health Organization,7 the Institute of Medicine, and the National Research Council.8 Likewise, in a 2016 special communication article in JAMA Pediatrics, Shonkoff argued that “the time has come to leverage 21st-century science to catalyze the design, testing, and scaling of more powerful approaches for reducing lifelong disease by mitigating the effects of early adversity.”9(p1003)

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