You can sense it when you walk into any children’s hospital. Behind the intake desk, there was a quiet urgency. A mother with a clipboard in her hand. An adolescent gazing at the ground. Something much more costly and older than the symptoms lurks somewhere behind the paperwork.
Finally, a number has been assigned to it by recent research. A 2023 study supported by the CDC estimates that if widespread childhood trauma had been avoided, the U.S. economy might have grown by $14 trillion. The concept is not new. It is the scale that is new. We’re talking about more than just hurt feelings; we’re talking about permanent harm, lost wages, long-term illness, and broken potential.
| Category | Key Insight |
|---|---|
| National Economic Impact | Preventing Adverse Childhood Experiences (ACEs) could increase the U.S. economy by $14 trillion. |
| Health Consequences | Childhood trauma significantly raises risk for cancer, heart disease, and other chronic conditions. |
| Family Financial Burden | Families paid $2.9 billion out-of-pocket for children’s behavioral health in 2022 alone. |
| Employment Impacts | Adults with childhood psychological trauma earn less, work fewer hours, and face higher unemployment. |
| Regional Case Study | South Carolina alone loses $74 billion annually to child abuse-related costs in health and productivity. |
Abuse, neglect, domestic violence, and unstable families are examples of adverse childhood experiences that have a lasting impact. They are connected to 70% of the nation’s top adult killers, according to Harvard researchers. Rare exceptions like these don’t exist. These are early-onset patterns that build up subtly. They have already influenced decades by the time they appear in unemployment or cancer statistics.
The degree to which this has become predictable is especially startling. South Carolina and other states are measuring their own expenses. According to a recent study, child abuse and neglect cost the country $74 billion annually. That goes beyond healthcare; it also includes lost income, unfilled positions, and ruined futures. Economists such as Dr. Joseph Von Nessen characterize it as a long-term productivity leak rather than a social problem.
Families bear the brunt of these expenses. According to a December 2025 study published in JAMA Pediatrics, $41.8 billion of 2022 U.S. health spending was on pediatric behavioral care. $2.9 billion of that was paid for out of pocket by families, accounting for more than 25% of their overall expenditures on children’s medical care. There is no taper to that burden. Every year, it increases, especially among the least able to afford it.
Today, 40% of all pediatric health spending goes toward behavioral health care, which is almost twice as much as it did in 2011. The cost of behavioral health services to families is rising at a rate of 6.4% per year, while other medical expenses have increased somewhat. The outcome? “Extreme financial burden” refers to the fact that one in twenty-one American families must pay more than 10% of their income for this care.
According to pediatric emergency physician Dr. Ashley Foster of UCSF Benioff Children’s Hospitals, the trend is picking up speed. According to her, “families with even one child who struggles with behavioral health are 60% more likely to face financial strain.” “And that’s before you take into account missed work or higher caregiving expenses.”
In Indiana, I recall sitting across from a father who admitted that he had to miss two months of heat because of his son’s therapy costs. He spoke in a matter-of-fact, resigned tone, akin to someone reciting a grocery list. Something was sharpened for me in that moment. These are not uncommon occurrences. They are becoming more and more commonplace.
Naturally, the pandemic made everything worse. Between 2020 and 2022, telehealth visits for pediatric behavioral care increased by 99% per year. Access was facilitated by that change, but it also presented administrative and legal difficulties, particularly for low-income families attempting to travel across state lines for specialized care. In the meantime, home health services increased by 25% and in-person counseling continued to increase by 11% annually.
Even with this increase in demand, prevention initiatives are still small and poorly funded. When you consider programs that genuinely function, that is especially annoying. Although they frequently depend on erratic public funding, programs like the Strengthening Families Program and Triple P (Positive Parenting Program) have demonstrated remarkably effective results.
Researchers predict that over the next ten years, even modest preventative efforts could save South Carolina $21 billion. This includes lowering welfare dependency, absenteeism, and medical expenses. It’s not a theory. Math is involved. However, prevention continues to be neglected—an afterthought in budgets that prioritize crisis care.
Stronger parity laws are being pushed by proponents of behavioral health in an effort to equalize insurance coverage for mental and physical health. Chicago pediatric emergency physician Dr. Jennifer Hoffmann observes that families are frequently compelled to go out of network. According to her, “the outcome is worsening outcomes, fewer visits, and higher out-of-pocket costs.” “The fight is uneven.”
For people who have experienced four or more ACEs—a threshold that significantly raises the risk of serious consequences—the disparity is particularly large. According to studies, these people are more likely to experience depression, early mortality, addiction, incarceration, and chronic illness. We cannot afford to ignore this crisis, as almost one in six adults report having experienced four or more ACEs.
Simultaneously, scientists are discovering how trauma damages resilience. Psychiatrist Dr. Neha Jain of the University of Connecticut has personally witnessed it in elderly patients. According to her, “ACEs reduce our ability to recover.” “They undermine the internal support system we depend on when things go wrong, in addition to influencing mental health.”
Our economy is impacted by that scaffolding—or lack thereof—far beyond the clinic. Adults who were traumatized as children are much less likely to keep a steady job. They work fewer hours, make less money, and are more likely to depend on public benefits, according to a study from the Center for Longitudinal Studies. It’s a structural struggle, not just a personal one.
Despite the numbers, this is still a very human problem. It concerns parents who must decide between therapy and groceries. about children who miss school due to excruciating anxiety. And about how, long after the headlines fade, communities continue to quietly absorb the impact.
The good news is that we do not have no power. We can significantly lessen this burden by making investments in early care, increasing insurance coverage, and addressing childhood trauma as a public health priority rather than a personal embarrassment.
Though it may not garner much attention, prevention creates futures. Perhaps fewer kids will grow up to count expenses their parents didn’t choose in that future.
