Trauma Experiences of Children with Special Healthcare Needs: A Scoping Review

Background and Purpose: The experiences of trauma significantly impact children with special healthcare needs (CSHCN); they are nearly four times more likely to endure three or more adverse childhood experiences (ACEs) than their peers without SHCN. However, existing research has not used standardized terminology when describing the experiences of trauma among CSHCN; thus, their trauma prevalence may likely be underreported. SAMHSA defines trauma as individual-level events. This definition neglects community-level trauma, identified as adverse community experiences in the socio-cultural, physical/built, and economic environments. Therefore, we conducted a scoping review of trauma among CSHCNs that captured both individual- and community-level trauma. The study was guided by the following research question: What is the prevalence of individual and community trauma in CSHCNs?

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews (PRISMA-ScR) guidelines and checklist were used. The first author interviewed librarians, scholars, and local community service advocates to inform this review. The systematic search included articles from January 2010 to December 2021 in the following electronic databases: ERIC, Education Source, and PubMed. The inclusion criteria were: participants aged 3 to 21, measured trauma, peer-reviewed, U.S.-based, and written in English. Additionally, a grey literature search was conducted with Google. The keywords included special healthcare needs, autism, developmental disabilities, intellectual disability, neurodivergent, trauma, adverse childhood experiences, and poverty. We used Covidence to screen and extract data. Measures used for coding included individual-level trauma (e.g., bullying, poverty, and ACEs) and community-level trauma (e.g., adverse community environments).

Results: The systematic keyword search found 3002 articles; 81 met the inclusion criteria for data extraction. Findings indicated no evidence of a standard definition of trauma. The top three most described trauma experiences were bullying (58.0% of articles), poverty (23.5%), and all ACEs (17.3%). Although bullying was not a search term, it was most frequent, while ACEs were less frequent than expected. Nearly all articles had researched trauma in isolation rather than as interconnected experiences. Of the 81 articles, community-level trauma (8.6%) was rare, 10.81 to 21.4% of CSHCN experienced neighborhood violence. Interestingly, systemic racism (2.5%) was discovered only in the grey literature. In articles reporting systemic racism, 6.6% of CSHCN experienced racism.

Conclusions and Implications: This review contributes to the study of trauma in CSHCN because it identified gaps where prevention and intervention could support CSHCN. Individual-level trauma is a significant public health issue that disproportionately impacts CSHCN, which may be further affected by their environments. Additionally, bullying significantly affects the well-being of CSHCN and implies a need to foster improved peer relationships. CSHCN who belong to marginalized racial and ethnic groups may experience more trauma but are overlooked using individual-level trauma. Future research should examine how racism and adverse community experiences multiply marginalize and traumatize. Service systems guided by an individual-level trauma context inadvertently miss the traumas of these children, which further marginalizes them. Ultimately, we need to amplify the voices of CSHCN to advance the grand challenge of building healthy relationships to end violence for holistic well-being and equity.