Ten Common Causes of Child Trauma Due to Violence

I started this post several weeks ago to answer the question "What are the most common causes of child trauma?" It was much harder than I expected. The task of reviewing statistics wasn't just comparing apples to oranges. It was, instead, like comparing the ingredients of a fruit salad. The statistics varied greatly, in part, due to differences in research design:
  • Some studies reported how many children experienced traumatic events in one year while others reported lifetime experience (incidence vs prevalence).
  • Some included only children or adolescents while others asked adults to report on their entire childhood.
  • Most focused on one type of trauma (for example child sexual abuse) rather than a wider range of traumatic experiences.
  • Most weren't large enough or representative enough of the entire nation to draw firm conclusions. (Unfortunately, few researchers are able to obtain the funding needed to conduct large, representative studies.)
  • Those that relied on victim reports to child welfare or law enforcement weren't able to estimate the number of victims who had not reported.
There are several ways to estimate how many children have experienced trauma. One way is to ask about a short period of time (incidence) rather than a person's entire childhood (prevalence). Some advantages of this approach is that it relies less on memory, and it is easier to compare different ages. Otherwise, when asked if an event has ever occurred, more teenagers are likely to report an experience than younger children simply because they've had more years for it to have happened.

A disadvantage is that the results do not reflect the full magnitude of a problem which is often better represented by an estimate of prevalence. For example, a familiar childhood statistic such as "one out of four girls experience sexual victimization before age 18" will be higher than the number of girls victimized in one year. Still, the advantages can outweigh the disadvantages when comparing rates across various traumatic experiences within different age groups, and a one-year snapshot of new cases can be more useful for current policy and service delivery.

My list is limited to child trauma caused by violence because there has been more research done for it than for other traumas (such as disaster or accidental injury). I selected a single study that included a wide range of violence-related victimizations by David Finkelhor and colleagues designed to address many of the issues listed above.
Finkelhor, D., Ormrod, R., Turner, H., & Hamby S. L. (2005). The Victimization of Children and Youth: A Comprehensive, National Survey Child Maltreatment, 10 (1), 5-25 DOI: 10.1177/1077559504271287

Their study included:
  • a large, nationally representative sample of children ages 2 to 17
  • younger children (through interviews with their parents)
  • a comprehensive list of child abuse and other victimization experiences
  • examined the number of victims for each trauma during one year
  • relied on direct reports rather indirect statistics collected by reporting agencies
  • reported how many children experienced multiple traumas
Of the 34 different direct and indirect victimizations included in the study, I've selected the top ten I believe best fit the criteria needed to diagnose PTSD. I converted population rates (number per 1000) to percentages more familiar to most readers. I've also included the definition of each trauma used in the study.

untitled #171. Bullying - 22% - A peer picked on child (for example, by chasing, grabbing hair or clothes, or making child do something he or she did not want to do).

2. Assault with injury - 10%
- Someone hit or attacked child, and child was physically hurt when this happened. (Hurt means child felt pain the next day, or had a bruise, a cut that bled, or a broken bone.) No weapon was used.

3. Assault with a weapon - 8% -
Someone hit or attacked child on purpose with something that would hurt (like a stick, rock, gun, knife or other thing).

4. Exposure to shooting, bombs, riots - 6%

Child was in a place (in real life) where child could see or hear random shootings, terror bombings, or riots.

5. Non-sexual genital assault - 5%
- A peer tried to hurt child's private parts on purpose by hitting or kicking.

6. Robbery by nonsibling- 4%
- A nonsibling (peer or adult) used force to take something away from child that child was carrying or wearing.

7. Physical abuse by caregiver - 4%

An adult in child's life hit, beat, kicked, or physically abused child in any way.

8. Witness domestic violence - 4% -
Child saw one parent get hit (for example, slapped, hit, punched, or beat up) by another parent, or parent's boyfriend or girlfriend.

9. Sexual assault - 3% -
Someone touched child's private parts when unwanted, make child touch their private parts, or forced child to have sex. Or attempted any of these acts.

10. Murder of someone close - 3% -
Someone close to child (for example, family member, friend, or neighbor) was murdered.

There are some surprises here. Bullying was the most common. Significant numbers of children in the United States have been exposed to shootings, bombs, or riots. Many children have had someone close to them murdered though perhaps this shouldn't be surprising given the U.S.'s high murder rate.

In this article, I've focused on the number of children in the United States who experience trauma related to violence. In future articles, I will address other forms of child trauma such as disaster or serious accidents. I will also, from time to time, provide an in-depth look at items in the list including what is known about rates of PTSD and other negative consequences.
This post was featured in Doc Gurley » Grand Rounds, Vol. 5, No. 44: Mystery!


  1. Concerning #5, non-sexual genital assault, where did the 5 percent number come from? When I read Dr. Finkelhor's study from 1995 he found 1 in 9 boys had been subjected to this at least once, and often more than once, in only a 12 month period. In 2007 he did some further research, I don't recall if any of the focus on non-genital assault was new or not. And recently in the news in Indiana they are reporting on an epidemic of this violence in their schools, which the students have labeled "ball tapping" and which is happening, according to the victims, to every boy. For many of the boys it is happening every single day, often many times per day.

    This Indiana news story broke when a 13-year-old who was having a breakdown as a result of being abused in such a humiliating sexual manner while teachers did nothing, could not take it anymore. Finding no help at all from teachers, parents, principal, etc, he ran to a news reporter begging for help. The reporter researched the boy's claims, found them to be true, and found another boy, 18, who had endured the same abuse daily, several times per day, for 6 years until he finally graduated. That boy ended up in emergency surgery due to accumulated scar tissue in his genitals which shut everything down and caused horrific, unbearable pain. His testicles were never ruptured. They were simply injured little by little each time he was assaulted until the accumulated damage was horrendous. He can be seen breaking down in tears twice in his interview on the news webpage. He states "it's assault" and seems upset that absolutely nothing is being done to stop it or punish the assailants. Most people consider it to be sexual assault and I am part of a push to require the law to recognize it as such, especially in light of Dr. Finkelhor's accidental finding relating to the deep psychological damage suffered by the victims. I am very serious about this and am interested in your views on why it is not categorized as sexual assault. I know of no studies on the psychology of the assailants, but I know what I have seen in the eyes and faces of genital assailants as well as witnesses who cheer and appear to become highly sexually excited.

    The news articles I'm referencing are here:

  2. Steve--
    The 5% number is for both boys and girls. For boys only, it is 8% and for girls only, it is 3%. I appreciate your bringing up the issue of "ball-tapping." It is not something I have run into very often, and it has not been in the local media here. The stories you referenced are heart-breaking.

    As to why it has not been categorized as sexual assault, there are several reasons I can think of. First, Finkelhor classified non-sexual genital assault as a sub-category of physical assault and as far as I can tell, his studies are the only ones even documenting the problem. Second, the criminal justice system uses different criteria to categorize crimes than what would make sense to the average person and often doesn't reflect the victim's experience. A particularly egregious example in my state, Maryland, is that males cannot be rape victims, because the criminal code defines only vaginal penetration as rape. Clearly, this unjustly minimizes the trauma that male rape victims experience. Probably the other issue is that sex crimes are defined as sexual acts forced upon another person. It would be difficult to prove that "ball-tapping" was for the purpose of sexual gratification of the assailant since it is not a common sexual activity.

    I'm not as familiar with the laws about physical assault & battery, but I believe that assault with the intent of serious injury (aggravated assault) is a felony, and the penalties may be as severe as for sexual assault. You and other advocates are more likely to be successful pushing to have non-sexual genital assault classified as aggravated assault. It certainly would be easier for prosecutors to prove intent to cause serious injury to a jury than to prove intent to gain sexual gratification, especially, given some of the attitudes ("boys will be boys") mentioned in the articles you linked to.


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