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Psychologist James Garbarino, PhD, once interviewed a murderer so violent, six correctional officers were needed to control him when he appeared in court. The offender had killed two inmates while in prison. But when Garbarino asked the man to reveal something about himself that would surprise others, he confessed that he cried himself to sleep every night.

"I always try to impress upon a jury that they're not looking at a big, scary man, but really the untreated, traumatized child who inhabits that big, scary man," said Garbarino, a psychology professor at Loyola University Chicago.

Garbarino's story was one of many that challenged conventional thinking about violence at a conference cosponsored by APA and the American Bar Association in May. The event, with the theme "Confronting Family and Community Violence: The Intersection of Law and Psychology," brought psychologists, attorneys, judges and others together to discuss new ways to prevent child abuse, respond to troubled children and prevent family violence in the first place.

Understanding child maltreatment

Family violence is rampant in our society, said George W. Holden, PhD, a psychology professor at Southern Methodist University in Dallas.

An estimated 676,000 children each year suffer from child maltreatment, which typically takes the form of physical, psychological or sexual abuse or neglect. But those confirmed cases are "a woeful underestimate of the problem," said Holden.

For one, many cases are still not reported. And that number doesn't include the 10 percent of children who research suggests are exposed to intimate partner violence at home. For a quarter to half of them, such an environment can cause signs of post-traumatic stress disorder. Other reactions include attachment problems and disruptions in eating and sleeping routines in toddlers and anxiety, depression and aggression among older children, Holden said.

What's more, many children face multiple challenges simultaneously. "One of the major new insights in the last 15 years is the concept of polyvictimization — that is, children being multiply victimized," Holden said, adding that the Adverse Childhood Experiences (ACE) study of 17,000 adults was the first major research to reveal the extent of polyvictimization. Almost two-thirds of participants reported at least one adverse experience, while more than one in five had three or more such experiences. The more adverse experiences a child has, the more problems those experiences are likely to cause, Holden said.

The problems may also continue on into adulthood. The ACE study and other research have found that adverse child experiences are linked to diabetes, cardiovascular disease and even cancer in adulthood, Holden said. Part of the reason may be that maltreatment in the first three years of life — and the resulting release of stress hormones — can affect brain development and compromise the immune system, research has found. Meanwhile, children's social and emotional health can suffer from an insecure attachment style and negative ideas about themselves and others that can affect later relationships.

The good news: Many children are resilient. In fact, studies find that about one-third of children exposed to violence experience no negative consequences. "The key finding is that resiliency is not a personality trait but rather is better characterized as a mindset," Holden said, explaining that resilient children view their vulnerabilities as areas for development instead of personality flaws. What's needed, he said, are interventions to help all children develop this kind of mindset.

Promoting positive parenting

Finding ways to promote resiliency among parents is also key, said Mary E. Haskett, PhD, a psychology professor at North Carolina State University.

Most child maltreatment prevention efforts focus on families who are already struggling with parenting challenges. And child abuse prevention messages have typically emphasized that abusive parents are toxic to kids and defective in some way. "The message has been that there are these people out there, essentially with horns, called abusive parents," Haskett said. "They are different from the rest of us."

But that isn't accurate or helpful to families, said Haskett. Instead, the field should widen prevention efforts to target all families, she said.

"If everyone in a community is being supported around challenges related to parenting because we basically all experience those challenges, there's less stigma around asking for help," she said. "We're not saying, ‘I'm a bad parent,' we're saying, ‘I need some help with a current challenge I'm experiencing.'"

Triple P, the Positive Parenting Program, is one such program. The evidence-based program offers five levels of intervention, starting with universal prevention messages delivered via the media that emphasize that parenting can be challenging for everyone. One message, for example, emphasizes that potty training is something any parent might struggle with. Subsequent levels of intervention offer support to parents having minor to moderate struggles, with the most intensive intervention reserved for high-risk parents. "Parents get what they need and only what they need," said Haskett.

Results from the ACE study — which found positive effects for children with nurturing parents as well as negative outcomes for those with a history of maltreatment — support this shift to a public health approach to preventing child maltreatment, said Haskett.

The shift is already happening, thanks to the health implications revealed by the ACE study. The Public Health Leadership Initiative at the U.S. Centers for Disease Control and Prevention (CDC), for instance, encourages public health and other agencies to take responsibility for preventing child maltreatment instead of expecting child welfare agencies to take on the sole responsibility.

"The CDC said, ‘We're not going to focus on child abuse prevention per se,'" said Haskett. "Instead, they said, ‘We're going to talk about supporting safe, stable, nurturing relationships.'" While the shift is subtle, she says, it communicates a more positive message of universal prevention.

Protecting versus controlling children

It's especially important to change the way parents and society at large discipline children, said Robert D. Macy, PhD, founder and president of the International Trauma Center in Boston and a founding member of the National Child Traumatic Stress Network. Children, Macy argued, are being punished for normal development and their experience of trauma.

"This requires a revolution — from society controlling the child to society protecting the child," he said.

For hundreds of years, society called for strong discipline of children and even termination of parental rights for parents not using corporal punishment to control their children's behavior. The same philosophy of trying to control children looms today. These days, such efforts tend to target racial and ethnic minority youth, said Macy, pointing to the disproportionate minority racial and ethnic representation in the juvenile justice system.

"Kids are being punished for their development," said Macy.

Because of the way the brain develops, he said, adolescents have trouble controlling their impulsivity, making good decisions and anticipating consequences. APA recognized these and other developmental factors in an amicus brief in the 2012 Supreme Court case prohibiting life without parole for juvenile homicide offenders. The brief explained that juveniles have diminished culpability because of their developmental differences from adults.

Even more important is addressing the trauma that underlies many young people's violent acts, said Macy. The research is clear that trauma has a negative influence on brain development, said Macy. And new epigenetic evidence suggests that traumatic environments can actually change genes across generations.

While the traditional American approach has blamed problems on individuals' lack of motivation or discipline, Macy said that approach hasn't worked. Instead, he called for trauma-informed care. Rather than trying to suppress violence in young people who have been maltreated, the field should treat their trauma, he said.

"Traumatic childhood events are documented in the histories in as much as 98.6 percent of juvenile delinquents," Macy said. "We have to stop asking, ‘What's wrong with you?' and ask this question: ‘What happened to you?'"

Rejecting labels

It's also important to have a trauma-informed view of adult offenders, many of whom have suffered maltreatment as children, said Garbarino.

"What's the most effective way to produce a sociopath?" he asked. "It's some combination of traumatizing them in childhood, then putting them in a socially toxic environment."

The clinical and law enforcement worlds often fail to recognize trauma's role in violence, Garbarino said. Instead, the tendency is to label the consequences of childhood maltreatment — acting out, being aggressive and violating the rights of others — as conduct disorder, antisocial personality disorder or sociopathy. "The more you accept these diagnostic labels, particularly for children, the more you're on the road to depersonalization and dehumanization of the other," he said. But the very traits caused by abuse, including hypersensitivity to threats and the sense of aggression as a legitimate response to threats, make it easier to see these individuals as perpetrators rather than victims.

"Dissociative symptoms make it hard for a person to be seen as a trauma victim, especially if they've committed a violent act, because they're remorseless and emotionally numb," said Garbarino. "The more you can make people see the traumatized child within, the more you can open the floodgates of compassion."

Rebecca A. Clay is a journalist in Washington, D.C.