𝐄𝐱𝐩𝐞𝐫𝐭𝐬 𝐖𝐚𝐫𝐧 𝐎𝐟 𝐋𝐚𝐬𝐭𝐢𝐧𝐠 𝐈𝐦𝐩𝐚𝐜𝐭 𝐎𝐟 𝐂𝐡𝐢𝐥𝐝𝐡𝐨𝐨𝐝 𝐍𝐞𝐠𝐥𝐞𝐜𝐭

…𝒍𝒂𝒄𝒌 𝒐𝒇 𝒄𝒐𝒏𝒔𝒊𝒔𝒕𝒆𝒏𝒕 𝒄𝒂𝒓𝒆-𝒈𝒊𝒗𝒊𝒏𝒈 𝒄𝒂𝒏 𝒍𝒆𝒂𝒅 𝒕𝒐 𝒔𝒖𝒃𝒔𝒕𝒂𝒏𝒄𝒆 𝒖𝒔𝒆 𝒂𝒈𝒈𝒓𝒆𝒔𝒔𝒊𝒐𝒏 𝒂𝒏𝒅 𝒎𝒆𝒏𝒕𝒂𝒍 𝒉𝒆𝒂𝒍𝒕𝒉 𝒊𝒔𝒔𝒖𝒆𝒔

By Yeshi Dolma

In the nation, children who grow up without consistent care-giving face long-term challenges that can affect their development, behavior, and mental health. Experts warn that early neglect and trauma can shape life trajectories, leading to delayed speech, substance use, aggression, and cycles of mental health issues.

Dr. Ugyen Dem, a child and adolescent psychiatrist at JDWNRH, has seen firsthand how absent or inadequate caregiving can affect a child’s life. She shared the case of a three-and-a-half-year-old boy referred for delayed speech. The child’s parents live abroad, leaving him in the care of his grandmother since he was nine months old. She moved from Trashigang to Thimphu to care for him while also supporting her adolescent daughter, who struggles with mental health challenges. With no formal education, the grandmother struggles to manage the boy’s excessive screen time, and he has not yet joined early childhood care and development programs.

Dr. Dem said, “This child needs social-emotional learning. He is totally deprived of that. At this age, he needs stimulation. Our focus is not just on him. We have to help the grandmother, and reach out to the aunt as well.” He emphasized that early intervention is critical. “It’s as if one case represents one child at different developmental stages. If we do not address the needs of the three-and-a-half-year-old now, he could become like the 14-year-old boy. If the 14-year-old’s issues are not tackled, he could grow up to be the 21-year-old with psychosis. Cannabis-induced psychosis is treatable, but repeated episodes can lead to irreversible conditions, even schizophrenia.”

Dr. Dem also described a 14-year-old boy referred by police after being caught using cannabis. His parents divorced when he was five due to domestic violence and alcohol use. Raised by a single mother without formal education, the boy started smoking at age 10 and using cannabis at 12. He missed school for a month without his mother’s knowledge. “We can admit him for detoxification and refer him to a rehab center,” Dr. Dem said. “But what next? Will they follow through with treatment plans? We can not go after them. Our hands are tied. Caregiving involves everyone- not just clinicians.”

The psychiatrist recounted a third case: a 21-year-old man brought in for aggression and violence at home and in the community, including property damage. With parents working abroad, he was raised by extended family. He began using multiple drugs, dropped out of school, and had repeated hospital visits and police detentions. Dr. Dem said, “Every individual has a role in caregiving. Parenting is all about sacrifice. Just because you have a guitar does not make you a guitarist if you do not know how to play a guitar. I am a parent myself. I know how difficult it is. But we really have to put in effort to raise these children who we brought into this world.”

These examples highlight the nation’s broader challenge: the absence of supportive caregivers can set children on trajectories of neglect, substance use, and mental health crises. While clinical intervention is vital, experts stress that families, schools, and communities must actively support children’s development, especially through early intervention.
The child justice system offers another perspective on how care-giving gaps manifest in legal outcomes. Dasho Pelden Wangmo, Judge at the Family and Child Bench, shared the story of a 16-year-old in conflict with the law who initially refused to speak in court. Psychiatric assessment revealed he had a learning and intellectual disability. He came from a family of many siblings, and his parents were alcoholic. “As a small child, he could not cope like the others. He was even sent to the monk body, but he did not do well there either,” she said.

Dasho Pelden emphasized that reintegration is central to the nation’s child justice system. Alternative sentencing, community service, and diversion programs aim to keep children with families and integrate them into society. “We want to keep children away from detention whenever possible. But when parents do not want to take responsibility, or when children fail to complete diversion agreements, detention sometimes becomes the only option. That is a failure of the system.”

Her analysis of national trends reveals recurring patterns: boys are more likely than girls to come into conflict with the law, many come from low-income or broken families, and a significant number were former monks. “Sometimes parents, when they feel there is no way out, dump their children somewhere, thinking they are taken care of. But often, they are not,” she said. She also noted that while child protection budgets have increased, funds often fail to reach institutions where children need them most.

Trauma-informed care is another essential part of addressing adverse childhood experiences. Kesang Dukpa, Chief consellor, The PEMA Secretariat explained, “Every person carries an invisible backpack. Some are light, some are very heavy. Trauma-informed care is about remembering that we don’t always know what somebody is actually carrying, but it shapes the way they walk through life.”

Dukpa recounted the story of a young girl sexually abused by her father for five years. “She never knew what trauma was. When referred to a service, the questions asked were not necessarily healthy and re-traumatized her. Questions like, ‘Why did you allow it the second time?’ or ‘Why didn’t you shout?’ cut deep inside.” He stressed that trauma-informed care prioritizes safety, trust, and empowerment. Children express trauma differently: some fight, some flee, some freeze, some try to please. “These behaviors are responses to experiences, not deliberate defiance,” he said.
Trauma affects not only the mind but also brain development. Exposure can shrink critical areas like the cortex, hippocampus, and amygdala. Long-term trauma compromises information processing, leaving individuals hyper-vigilant, reactive, and distrustful. “Even a good message can be seen as a threat. Even love and care can be interpreted as danger,” Dukpa said.

Experts argue that early intervention through schools, caregivers, and institutions is crucial. Early childhood educators, teachers, and community workers can detect distress, provide supportive environments, and ensure children access services. Dr. Dem stressed that timely intervention can change life trajectories: “The three-and-a-half-year-old boy may benefit from speech therapy or social-emotional learning. Without intervention, he risks following the same path as the older boys.”

If left unaddressed, adverse childhood experiences perpetuate cycles of trauma, mental illness, substance use, and social instability. Experts advocate for coordinated national efforts combining clinical services, parenting support, trauma-informed practices, and strong child protection systems.

“Caregiving is a shared responsibility,” Dr. Dem concluded. “Clinicians, parents, schools, and communities all have a role. If we want a stronger nation, we must first raise children who feel safe, seen, and cared for.”