JURIDOGENIC HARM AND ADVERSE CHILDHOOD EXPERIENCES.

• Author: Ascano, Autumn R.

1. INTRODUCTION

   The consequences of trauma can be devastating and long-term. Children, trauma, victimization, and the legal system are complex topics and can become overwhelming when combined. Yet, due to the immense risk, juridogenic harm must be recognized and addressed. Juridogenic harm is "harm that law may generate as a consequence of its operations." (1) Without a clear understanding of developmental psychology and its intersection with the law, there is potential for the legal system to cause significant adverse childhood experiences above and beyond victimization events.

2. TRAUMA

   1. WHAT IS TRAUMA?

      At its core, trauma is an event that causes physical, emotional, and psychological harm that is associated with a "constellation of negative outcomes in adulthood" and needs to be appropriately classified to allow for evidenced-based treatment. (2) There is a great deal of research on the psychological distress that results from trauma, including effects due to directly experienced trauma, re-traumatization, and re-victimization. When addressing trauma, most first think of post-traumatic stress disorder ("PTSD"), but reactions to trauma are highly individualized. People can experience the same type of traumatic event; however, some will develop PTSD and others will not. Despite this, there are still lasting negative outcomes with trauma experience even if it does not lead to PTSD. (3)

      PTSD as a diagnosis captures trauma, but not complex trauma. (4) Complex trauma (i.e. chronic maltreatment or repeated trauma exposures) has "pervasive effects on the development of mind and brain [neurobiological development]." (5) Other trauma-related difficulties include substance abuse, anxiety, shame, and impairment of daily functioning. (6) It can be difficult treating children as they are often treated for anxiety disorders, rather than the underlying trauma, even if they are victims with a clear history of confirmed adverse childhood experience. (7) If the underlying distress is not treated symptoms such as anxiety may continue to manifest. (8)

   2. CONSEQUENCES OF TRAUMA

      Trauma during childhood leads to a significant increase in the need for correctional and mental health services. Indeed, many individuals in the juvenile criminal justice population have a history of childhood trauma, abuse, and neglect. (9) The Centers for Disease Control and Kaiser Permanente conducted the Adverse Childhood Experiences study with 17,337 participants. (10) In 63.9% of participants, a minimum of one type of adverse childhood experience was reported; however, four or more adverse childhood experiences were reported in 12.5% of participants. (11) Adverse childhood experiences included emotional abuse, physical abuse, sexual abuse, witnessing parental alcohol abuse, mothers being battered, family drug abuse, and exposure to family mental illness that impacted them negatively. (12)

      The consequences of childhood trauma can be devastating and long-term. In children, brain development is altered after experiencing trauma resulting in neurocognitive delays. (13) Trauma "interrupts and strains children's cognitive abilities and development," and puts them a significant risk for the development of severe psychiatric problems. (14) The higher the number of adverse childhood experiences, the higher the risk of depression, suicide attempts, alcoholism, domestic violence, and physical illnesses related to stress including cancer, heart disease, diabetes, and stroke. (15) Attempted suicide risk increases two to five times if there is adverse childhood experience in any category. (16) If a mental disorder appears in childhood, it will often persist into adulthood. (17) Given the long lasting impact of trauma in early child development, it is no surprise that this has become a pressing public health issue. According to some research, the effects of childhood trauma may even be one of the key factors associated with early death. (18)

3. JURIDOGENIC HARM

   Society operates under the assumption that medicine cures and promotes health without consideration for the harm that can occur as a result of medical error. (19) Yet, medical error accounts for nearly a quarter of patient deaths. (20) Similarly, society also operates under the premise that law is about "extending rights rather than creating wrongs," but it is clear that the system is fallible and does cause harm. (21) Litigation itself can contribute to and maintain psychological trauma. (22)

   Harm is a broad, multidimensional term that encompasses trauma. (23) In medicine and psychology, there is an emerging concept called "iatrogenic harm" that specifically addresses harm caused to the client by professionals. For example, the goal of therapy is to increase freedom, (24) but if therapy induces shame and guilt, then harm occurs. (25) At the present time, however, there is limited research on the concept of iatrogenic harm as it applies to the legal system and child trauma victims.

   Juridogenic harm is the "legal equivalent of iatrogenic harm." (26) Juridogenic harm is "harm that law may generate as a consequence of its operations." (27) At its core, juridogenic harm results when "legalistic approaches to decision-making" violate what is in the best interest of the patient. (28) There are competing interests, such as the immediate preservation of evidence (i.e., social services photographing marks on a child victim without parental consent or court order in a nonmedical location) and avoiding the creation of an adverse childhood experience. Which should take precedence?

   At a minimum, consideration of this issue should take place, rather than marching onwards with the faulty assumption that the resilience of children can get them through another traumatic experience. Resilience is not found in an unlimited amount, particularly when an increase of psychosocial stress factors is present (e.g., emotional stress or abuse within the family, inconsistency in caregivers, or a peer group with negative influence). (29) Without appropriate support and a facilitative environment, vulnerability will overtake resilience. (30) There is a correlation between child-reported traumatic experiences and child-reported onset of psychiatric symptoms. (31)

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