Hide table of contents

Today I'm flipping through The Body Keeps the Score, a pop sci review of the academic research on trauma to date.

I was quite surprised by this passage, on p. 150 of my copy:

The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears. In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardiovascular health.
But when the ACE study data started to appear on his computer screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse.
[Anda] had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration.

Essentially, the ACE study seems to demonstrate that childhood trauma is upstream of a wide variety of burdensome problems.

Seems plausible that there are tractable interventions that reduce the effects & incidence of childhood trauma. Also the area seems neglected (continuing from p. 150):

When the surgeon general's report on smoking and health was published in 1964, it unleashed a decades-long legal and medical campaign that has changed daily life and long-term health prospects for millions. The number of American smokers fell from 42 percent of adults in 1965 to 19 percent in 2010, and it is estimated that nearly 800,000 deaths from lung cancer were prevented between 1975 and 2000.
The ACE study, however, has had no such effect. Follow-up studies and papers are still appearing around the world, but the day-to-day reality of... the children in outpatient clinics and residential treatment centers around the country remains virtually the same.

Has anyone looked into this?

New Answer
New Comment

4 Answers sorted by

I have been on the board of one charity which focused on child sexual abuse, and another which tackled sexual abuse (not specific to children). I'll share some thoughts based on child sexual abuse (CSA) because that's the area I'm familiar with (even though I appreciate that the question is broader).

The TL;DR is that the area has caused a large scale of suffering; it's hard to tackle, but I'm optimistic that there might be tractable options out there.

  • Prevalence: I've heard people mention CSA prevalence rates that are disturbingly high (e.g. %age rates in the teens or twenties or even higher). I found this surprising. There seems to be some evidence to support this (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518746/ ) however this is not a universally held view (e.g. Radford (L) et al 2011 give a figure of 5%, although even "only" 5% is horrible).
  • How bad is it per person: Through some of my other volunteering I have encountered many people whose lives have been made dramatically worse because of their CSA, with sequelae including dramatically lowered self-esteem, deliberate self-harm, suicidal ideation/intent and major depressive disorder. In short, there can be grave life-long consequences. However that's just the people I've encountered; how often do people survive relatively unscathed? (I know such people exist)
  • Tractability: Some factors will make it difficult to tackle this topic, including the fact that over 90% of sexually abused children were abused by someone they knew (again from Radford (L) et al 2011); this introduces complex family/social dynamics. Furthermore, it's hard to identify those at elevated risk of perpetrating CSA. Past behaviour is hard to use a predictor because it's disturbingly easy to perpetrate CSA and get away with it. Also, anywhere from one-fifth to two-thirds of sexual abuse is committed by other children and young people (source: Hackett, S (2014)). Educating potential victims (i.e. everyone) may be more fruitful, but I haven't looked into this.
  • Neglectedness: The ratio of (annual spend on issue by larger charities) / (number of sufferers of issue) seems to be middling for child abuse (not specific to CSA); i.e. probably higher spend (i.e. less neglected) than international aid but less spend (more neglected) than more popular causes such as homelessness and veterans. Note that this is a very rough-and-ready calc

Happy to support/ be involved if anyone wants to look into this further

Copenhagen Consensus is usually the first place I look for things like this. https://www.copenhagenconsensus.com/post-2015-consensus/conflictandviolence

They cite some interventions (reduction of infanticide in UK, reduction of "severe physical violence as a method of child discipline" in US) but the notes are "unlikely that developing countries have the capacity to rollout early child discipline intervention programmes" and "difficult to generalize to low and middle income countries."

Poverty is correlated with child abuse, I would guess mostly because of parental stress.

I looked at the evidence on preventing child sexual abuse (in developed countries) a while ago: https://thewholesky.wordpress.com/2015/10/08/preventing-child-sexual-abuse/ Children are safer from sexual abuse if they live with both parents, if their parents do not have substance abuse, and if their mother does not have mental illness.

So my not very informed guess is that anti-poverty interventions, maternal health interventions (to reduce maternal mortality), and pro-mental-health interventions are likely a good way to go here.

I don't know much about it, but I did skim through the National Incidence Study on Childhood Abuse and Neglect. The thing that stood out to me the most was the massive difference in abuse rates between different family structures:

  • Married biological parents: < 3 per 1000
  • Single parent with partner: > 55 per 1000

Obviously we can't say this is all causal - in general all good properties are correlated, so it's likely there are shared genetic etc. causes.

I think it's worth noting what the report says about family structures that fall in neither category - both married and unmarried parents where one parent isn't biologically related to the child but still takes on a parental role as well as single parents without a partner fall somewhere in between married biological parents and single parents with partner in terms of child abuse rates.

(I was a bit confused and thought 'single parents with partner' included cases in which the partner takes on parental responsibility so the high rate seemed off to me.)

"Obviously we can't say this is all causal - in general all good properties are correlated, so it's likely there are shared genetic etc. causes."

Possible causal mechanism:

Through infanticide, males can eliminate the offspring of their competition and get the female back to full baby-making capacity faster

oof, this speaks against tractability due to politics.


There are non-political ways to address this, such as better contraceptives like Vasalgel.

EA already has semi-official positions on intractable political issues like immigration. If stable two-parent families are indeed an effective way to prevent child abuse, I don't see why we shouldn't have a semi-official position on promoting those as well. It could help address conservative underrepresentation in the EA movement. I think if some positions are taken publicly on both sides, that increases our credibility as an independent source of truth. Otherwise we might be seen as "EA-washing" the political positions that we already held as coastal liberal types.

But really I think stable two-parent families are a bipartisan issue. For example, abortion probably helps reduce the incidence of single motherhood (though of course the ethics of abortion itself is another can of worms). I don't think your average liberal person is actually against fatherhood or stable households, they just prioritize other outcome measures (perhaps incorrectly if the data here is right).

Nathan Young
In this sense I think the govt should create appropriate incentives for long term committed relationships where children are concerned - perhaps like a no claims bonus (an increasing yearly benefit of not crashing a car in the UK) for each year parents with children who stay together until their last child is 18?
Maybe. I think some interventions here are more apolitical than others. e.g. MDMA therapy for PTSD has bipartisan support & veteran support, and plausibly resolving someone's PTSD reduces the likelihood of them being abusive to their own children.
Reminds me that MDMA was originally used for marriage counseling.

I think this is done by 1) reducing parental stress and improving mental health so that abuse doesn't happen 2) reducing dependence of child on parents so they can leave if abuse happens 3) reducing material dependence of parents on each other (women's dependence on spouses is widespread) so either can leave if abuse happens and take their child with them. All three of which are accomplished via poverty reduction, imo. It could inform the ways we go about poverty reduction, such as who is considered "head of household" when distributing money, etc. Access to and education about contraception may also be a plausible way to improve the proportion of abused children. I think another potentially promising and more direct avenue is reducing child marriage. (unresearched opinion)

I see some people suggesting "keep nuclear families together" because of correlations. Since 25% of American divorces cite violent domestic abuse, and that common sense suggests the relative proportion of abuse is higher where reluctance to divorce is higher due to relatively fewer divorces over smaller matters, attempts to keep families together by discouraging divorce will probably increase the severity of abuse (not to mention potentially reducing the happiness and autonomy of the adults) https://www.wf-lawyers.com/divorce-statistics-and-facts/

Sorted by Click to highlight new comments since:

As a policy-maker in child protection/ child welfare and also a foster parent to a previously abused child (but only a lurker on EA and rationality communities), I'm glad to see this topic brought up here. I'd be enthusiastic to try to contribute to this conversation, but I won't jump deep into it here right now, as I don't know what is the previous level of knowledge on this topic of you and other readers of this forum, and which parts of my knowledge would be obvious to you and which not; and also, what would be, from the perspective of a cause, the benefit of being a "cause X" in the EA community :)

I would be extremely interested if you were to hypothetically write an "intro to child protection/welfare for EAs" post on this forum! (And it would probably be a great candidate for a prize as well!) I think the number of upvotes on this comment show that other people agree :)

Personally, I have ~zero knowledge of this topic (and probably at least as many misconceptions as accurate beliefs!) and would be happy to start learning about it from scratch.

"Cause X" usually refers to an issue that is (one of) the most important one(s) to work on, but has been either missed or deprioritized for bad reasons by the effective altruism community (it may come from this talk). So I'd expect a cause which the EA community decided was "cause X" to receive an influx of interest in donations and direct work from the EA community, like how GiveWell directed hundreds of millions of dollars to their top charities, or how a good number of EAs went to work at nonprofits working on animal welfare. (For a potentially negative take on being Cause X, see this biorisk person's take.)


I'd also be very interested in a book review post of The Body Keeps the Score. (I may do this myself at some point, but not sure when I'll have the capacity.)

Update: Slate Star Codex reviewed The Body Keeps the Score

I don't know what is the previous level of knowledge on this topic of you and other readers of this forum, and which parts of my knowledge would be obvious to you and which not;

I think it's generally best to assume the level of common knowledge you'd expect from a graduate student in an unrelated field.

what would be, from the perspective of a cause, the benefit of being a "cause X" in the EA community

Right now I think the main effect would be more intellectual talent directed towards researching the various strategies that might further the cause. In particular: figuring out the bottlenecks to improving that area, attempting to measure how much those improvements cost (especially if the key bottleneck is "lack of funding", but even otherwise), and attempting to measure the scope of how much we expect they improve quality of life.

If the outcomes of those analyses suggest that it's promising, then some potential results would include: funding directed towards those strategies, advising of more people to acquire skills and take careers that directly contribute to those strategies, and more intellectual talent devoted to improving those strategies on a meta level.

(PS: if you're interested in posting but unsure about content, I'd be excited to help answer any q's or read a draft! My email is in my profile.)

Meta note: I feel a vague sense of doom about a lot of questions on the EA forum (contrasted with LessWrong), which is that questions end up focused on "how should EA overall coordinate", "what should be the top causes" and "what should be part of the EA narrative?"

I worry about this because I think it's harder to think clearly about narratives and coordination mechanisms that it is about object level facts. I also have a sense that the questions are often framed in a way that is trying to tell me the answer rather than help me figure things out.

And often I think the questions could be reframed as empirical questions without the "should" and "we" frames, which a) I think would be easier to reason about, b) would remain approximately as useful for helping people to coordinate.

"Is X a top cause area?" is a sort of weird question. The whole point of EA is that you need to prioritize, and there are only ever going to be a smallish number of "top causes". So the answer to any given "Is this Cause X" is going to be "probably not."

But, it's still useful to curiously explore cause areas that are underexplored. "What are the tractable interventions of [this particular cause]?" is a question that you can explore without making it about whether it's one of the top causes overall.

I also think this suggests something is going wrong. I'm guessing a lot of it is that people feel a need to justify posts as on-topic. If they post a thing because it seems interesting, confusing, exciting, etc., they're likely to get challenged about why the post belongs on the EA Forum.

This means that EAs can't talk about ideas and areas unless either (a) they've already been sufficiently well-explored by EAs elsewhere (e.g., in an 80K blog post or an Open Phil report) that there's a pre-existing consensus this is an especially good thing to talk about; or (b) they're willing to make the discussion very meta-oriented and general. ("Why don't EAs care more about reducing rates of medical error?", as opposed to "Hey, here's an interesting study on things that mediate medical error rates!")

This seems OK iff the EA Forum is only intended to intervene on a particular part of the idea pipeline — maybe the idea is for individuals and groups to explore new frontiers elsewhere, and bring them to the EA Forum once they're already well-established enough that everyone can agree they make sense as an EA priority. In that case, it might be helpful to have canonical locations people can go to have those earlier discussions.

EA is more concerned with capital allocation than LessWrong, so this doesn't seem surprising.

Being a "top cause area" is basically synonymous with "put EA capital towards this thing."

"What are the tractable interventions of [this particular cause]?" is a question that you can explore without making it about whether it's one of the top causes overall.

At root, we'll only want to explore tractable interventions in cause areas that are plausible candidates for EA capital allocation, so I don't think this framing sidesteps the issue.

I have more thoughts but it's sufficiently off topic for this post that I'll probably start a new thread about it.


Please do expand this onto a top level post if you are able to!

I didn't write a top level post but I sketched out some of the relevant background ideas here. (I'm not sure if they answer your particular concerns, but you can ask more specific questions there if you have them)

Interesting question! I have upvoted. A (very) minor issue (and it perhaps is just me), but you may want to consider adding in what 'ACE' stands for, took me a minute to realise that Animal Charity Evaluators hadn't gone completely off the wall.

Only tangentially related, but you might be interested in the report on child marriage that Jacob Williamson did a few years ago from an EA point of view. In addition to discussing the harms caused by child marriage, it discusses various possible interventions for tackling it.


Thanks for linking!

From the GWWC report summary:

As a cause, it is worth taking child marriage very seriously.

Do you know what came of this? Did any exploratory grantmaking happening as a result of this report?

As far as I'm aware, no grantmaking happened, for the reason in the paragraph before that line - that no charities doing effective work on it were found.

This was posted on the EA Forum about a year and a half ago: https://web.archive.org/web/20171105140307/http://effective-altruism.com/ea/19m/reduction_and_abolition_of_physical_punishment_of/ (not sure why non-archived link brings up "Sorry, we couldn't find what you were looking for." now).

Thank you for sharing! I think it is a good post and the topic raised there (tied to this current post) is worth a deeper discussion than it got in the comments (which were imho rather tangential, the monetary estimate actually not being central to the post). Does anyone know whether the person who wrote that has permanently left the EA forum? (Btw if there is a cause area 'animal welfare', maybe there indeed should also be one called 'child welfare', but if this is too broad, then maybe 'positive parenting', which is the flip side of corporal punishment and other abuse of children, and skills in which actually help to prevent most abuse).

It's by Jiwoon Hwang, and it's also posted on his blog: http://jiwoonhwang.org/physical-punishment-of-children-the-neglected-3-6-trillion-year-problem/ . He hasn't posted anything later on the EA Forum. There are three usernames on the current EA Forum containing the word "Jiwoon", but they seem to be deleted.

I like to make the following taxonomy of cause areas:

  • near-term humans: global poverty, mental health, child abuse?
  • near-term animals: factory farming, wild animals
  • long-term future: AI alignment, biosecurity, nuclear weapon security, alternative foods, s-risks

Sadly, Jiwoon passed away last year.

Do you know if there's an obituary or memorial page somewhere?

As a member of what the commenters on that post call "the Left," I will say that many leftists I know do care about mental health, recognize that child abuse often leads to long-lasting health problems for victims, and believe that society should treat children with dignity and respect.

Curated and popular this week
Relevant opportunities