Trauma and Adversity in Childhood: History Need Not Be Destiny

Once again, the American Academy of Pediatrics is demonstrating its clinical leadership. Two recent, groundbreaking reports -- "The Lifelong Effects of Early Childhood Adversity and Toxic Stress" and "Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health" -- by the Academy boldly declare what has been known but too hidden from sight: Namely, that brain and emotional development is profoundly disrupted by childhood adversity and trauma.

The pediatric academy quotes Frederick Douglass who said "It is easier to build strong children than to repair broken men."

Toxic stress, or early environmental trauma, has been proven to disrupt normal brain development and trigger genetically predisposed diseases. The tragic results include impairments in the ability to regulate emotions and learn, to adapt socially with others and produce, in adolescence and adulthood, lifelong physical and mental disorders, including heart disease, asthma, arthritis, obesity, diabetes, cancer, depression, substance abuse and PTSD. Trouble staying and succeeding in school are also common, as are brushes with the law.

Adverse Childhood Events, or ACEs, were initially studied by Kaiser Health of Southern California and then by the World Health Organization (WHO) World Mental Health Survey Initiative. ACEs include:

1. Direct psychological abuse

2. Direct sexual abuse

3. Direct physical abuse

4. Substance abuse in household

5. Mental illness in household

6. Mother treated violently

7. Criminal behavior in household

The greater the number of ACEs, the greater the risk of developing a chronic disease,
or multiple chronic diseases. From post traumatic disorder research we know the greater the
severity and frequency of the trauma the more like it will burn itself into the brains neural circuitry.

The mechanisms by which early childhood adversity lays its toxic roots are numerous and complex. The manifestations are as specific as youth engaging in impulsive and dangerous behaviors (well beyond normal adolescent risk taking), including reckless (and drunk) driving and unprotected sexual behaviors, which can result in sexually transmitted diseases and teenage pregnancies. The mechanisms are as fundamental as the unregulated and ongoing release of stress hormones, including cortisol and adrenaline, which weaken body defenses (compromising the immune system's ability to protect from infection and cancer or to turn our immune systems against us in the form of autoimmune diseases), raise blood pressure, promote plaque formation in arteries, and are linked, neurologically, to depressive and post-traumatic stress illnesses.

The specialty of pediatrics was first to develop "medical homes" (popularized today with federal enabling legislation) designed initially for the young with serious and chronic illnesses whose proper care needs to be monitored and clinically managed by one responsible (accountable) doctor and clinic. Pediatricians have long used screening tools to track childhood development and more recently many have introduced depression screening (and treatment paths) as basic tenets of good care. Their declaration, through these recent reports, of the impact of childhood trauma is a rallying call for what heretofore was another example of "don't ask, don't tell."

There are many proven approaches to these problems. Among them are:

- Home visits by nurses to mothers identified as being at high risk for emotional problems (e.g., Dr. David Olds' Nurse Home Visiting Program)

- Primary care screening and early intervention for depression in moms

- Pediatric screening and early intervention for depression and addictive disorders in youth

- Parental skills training programs (e.g., Positive Parenting, The Incredible Years, Bright Futures, About Our Kids)

- Youth support programs (e.g., Big Sister, Big Brother, after school programs)

- Pediatric medical homes that holistically support child development and deliver health, mental health and wellness services

- Trauma-focused mental health programs (for youth already affected)

The health of our youth, today and into their futures, can be protected. We can prevent the diseases and disabilities that result from childhood adversity and trauma. State and national budgets can be protected from decades of preventable health, correctional and social welfare expenditures. By following the wise counsel of the American Academy of Pediatrics, and other professional and policy groups, early experience need not be destiny for countless children, their families and their communities.

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REFERENCES:

Committee on Psychosocial Aspects of Child and Family Health, Committee on
Early Childhood, Adoption, and Dependent Care, and Section on Developmental and
Behavioral Pediatrics, Garner AS, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF,
Garner AS, McGuinn L, Pascoe J, Wood DL: Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health.
Pediatrics. 2012 Jan;129(1):e224-31. Epub 2011 Dec 26. PubMed PMID: 22201148.

Shonkoff JP, Garner AS, Siegel BS, Dobbins MI, Earls MF, Garner AS, McGuinn L, Pascoe J, Wood DL. The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics. 2012 Jan;129(1):e232-e246. Epub 2011 Dec 26. PubMed PMID: 22201156.

Association of Childhood Adversities and Early-Onset Mental Disorders With Adult-Onset
Chronic Physical Conditions: Scott,KM, Korff, M, ScD; Angermeyer,MC Benjet,C, Bruffaerts,R, de Girolamo,G, Haro, JM, Le´pine,J-P, Ormel, J, Posada-Villa, J, Tachimori, H, Kessler, RC, Archives of General Psychiatry Volume 68, August 2011

Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report, Volume 59, December 17, 2010.

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Comments

[been2there]

12:19 AM on 03/02/2012

Five on the list apply to me--and while I struggle with depression, I have avoided promiscuity, gang ties, substance abuse and bad relationships. The mess can be overcome, but only after the victim admits that the mess is not normal, but a mess!

[Ossit]

07:00 PM on 02/29/2012

ANY hitting to me is abuse.

It didn't help when I was hit. I got a bloody nose out of one back hand.What did I say to mom? "You don't do anything!" Dad would do all the cooking by grilling. *I* made the salads. *I* cleared the table. *I* set the table. *I* wiped the table. *I* loaded and unloaded the dishwasher and put the dishes away. *I* cleaned up the kitchen. I was never asked I was commanded until I demanded not to be commanded. I was not an indentured servant! Maids cleaned the house and did the laundry. Mom did the marketing and acted like it was a chore. Mom would go to work but it was dad's paycheck that got the house and paid the bills. Mom'd come home and drink. Next time she decided to go after me for nothing at all I threw a broiler pan at her in defense. She never laid a hand on me again.

ANY hitting is physical abuse no matter how much one tries to justify it. Parents feel the need to hit, get a pillow!

[Ossit]

06:53 PM on 02/29/2012

The next big topic of dismissal is what direct physical abuse is. ANY hitting to me is abuse. A beating, broken bones, bruising. Direct physical abuse can also be spanking. Yeah, yeah, I know people are going to say what? Spanking doesn't give bruises. There are people who start out with a spanking and go overboard and it turns to a beating, it turns to spanking with a belt that leaves bruises and welts. Spanking isn't just with the hand. But noooo. People say spanking is good. Only a cowardly parent too lazy to talk results to spanking. It's easier. It's a temporary fix. They threaten spanking. Yup. Nothing like a tyrant bully parent that has to threaten to hit. You don't gain respect by instilling fear. Oh well I was spanked as a child you say and I turned out fine. Fine? Passing it on is fine? Thinking that hitting a child is normal fine?

Sadly we think it's only physical abuse when you've got bruises and broken bones by a beating. Kids are NOT punching bags no matter how you try to justify it.

[onwisconsin]

05:11 PM on 02/29/2012

I have 5 of these markers. I still survived and I was not a risk taker or a criminal. I finished high school, college and graduate school. I have a great life now with a loving marriage.

The reason? A stepfather who adopted me and believed in me. He told me I was smart and helped me set goals. He loved me simply for who I am. Yeah, I'm probably resilient as well but there is power in one adult caring for a kid who's gone through an abusive childhood.

[Ossit]

03:30 PM on 02/28/2012

As odd as it seems, I credit a little the trauma I got at home for how I am now. That's why I have no sympathy for parents who think hitting kids is the answer. It never worked for me. That's why I say if you don't respect kids they won't respect you. My parents got no respect from me until they respected me. I grew up with verbal abuse and I didn't tolerate it. That's why I always say on boards, be civil. Verbal abuse is unacceptable. Funny how that lesson isn't learned well on these boards with all the "removed comments" because people think verbal abuse is acceptable.

[Ossit]

03:24 PM on 02/28/2012

"Direct physical abuse" Sounds like spanking that most parents think a kid has to be through. That trauma is brought over to the next generation who thinks it normal.

"Primary care screening and early intervention for depression in moms" What a stereotype! So if mom doesn't behave the way she's expected or 'supposed' to, she's considered depressed? The Post Partum Depression? I believe it's real for one reason. Moms are expected to automatically bond. They're made to feel like crap if they're human and don't. What, dads don't get depressed? Of course not They don't do much. They dump it all on mom.

It's good however to see this kind of article despite my criticisms. At least we're starting to realize that kids' problems they're not born with, they're exposed to. Too many blame kids for their behavior, and don't put responsibility on what's happening at home TO them. Like I always say, kids aren't born 'bad' they're created. Screw the kid up at home, they're not going to keep it at home.

[gneep]

03:27 PM on 02/29/2012

funny how these so called "studies" always support more Government intervention. and for the name callers...verbal abuse IS abuse.

[Ossit]

05:03 PM on 02/29/2012

Right on, gneep!

[KDMac]

05:20 PM on 02/29/2012

Direct physical abuse likely refers to actual physical abuse. Our son was abused as a baby and came to us at 11 months with a broken arm and other injuries. At the age of 8, he has a lot of emotional and anger issues, and has case workers and a therapist. We would do absolutely anything to help him, but there are days when it seems hopeless.

[Ossit]

06:04 PM on 02/29/2012

How dare you say it's hopeless about your son. Babies remember a heck of a lot more than people give them credit for. I could never figure out, until I asked why I don't like people touching me. I had that when I was a baby! My skin is so sensitive that it hurts when it's touched by others. Of course your son has issues because his unconscious remembers. Kids and babies aren't light bulbs that can be turned off and on, KDMac. They don't remember or forget things on an adult's schedule and don't you ever say that there are days that it's hopeless with your son despite workers and a therapist. YOU have to take some responsibility in trying to win his trust and get him out of his emotional and anger issues. YOU! It only seems hopeless because you want to give up. It'll take a LONG time for your son to get over things. Maybe he never will, but you never give up because it's not easy on you, and that's exactly what you want. You want things to be easy on YOU! Think about him for a change!

[willowtree3]

09:22 AM on 02/28/2012

This is what the "have a baby no matter what" zealots DO NOT UNDERSTAND.
Not every woman (or man for that matter) wants a kid, doesn't know how to love it
or nurture it.
I know of what I speak-being stuck in a closet for the first 7 years of my life because
"she" couldn't be bothered.
For years after, the only way I could "socialize" was when I was drinking. After years
of drinking too much, I finally quit in 2002. I'm still working on understanding why
"she" was that cold hearted.

[DogDancer]

01:01 AM on 02/29/2012

Sorry, willowtress3. Your mother was a broken person who could not provide what any child needed. Perhaps abuse in her early years or perhaps she just came out that way, wired wrong, thermostat set on frost -- likely some sort of personality disorder or mood disorder in reality. Regardless, so sorry she could be the person you needed and deserved. Keep working on your health and I strength. I know I am - a work in progress.

[willowtree3]

05:56 AM on 02/29/2012

Thank you for the kind words DogDancer. I appreciate it.

[KDMac]

05:22 PM on 02/29/2012

Sending Mom hugs to you (( ))

[willowtree3]

07:47 AM on 03/01/2012

That's very sweet of you. Thank you.

[Jan Baer]

07:22 AM on 02/28/2012

This is a positive wake up call, hopefully! The comments so far are sobering and show how deep-seated the damage can be. There need to be ways for "observers" of abuse can alert people who can intervene.But there need to be people and organizations there who can help (I understand, for example, there are long waiting lists for alcohol/drug recovery programs). I know doctors can't discuss their patients, but they can listen to a phone call. Offer to help a parent juggling with shopping and their child being difficult? There are parents who accept help and are grateful and then there are those who get more nasty and take their frustration out on their child even more. And, to make things even more difficult, abuse goes up with unemployment and economic hardship. Help has to come from many sources! www.grandparentoptions.com

[Kimberly Rex]

09:43 PM on 02/27/2012

Great appreciation for this article... As a therapist and consultant/teacher working with children and families, it's important to bring awareness to the roots of issues rippling out into generational patterns.
The information in the body-mind system is available anytime you are willing to update your system to restore more optimal balance and harmony. For more on ways to begin the process: http://windowstotheheart.wordpress.com/2009/08/09/is-it-bliss-or-blast-from-the-past-how-to-empower-your-memory-for-greater-happiness/

[Rosalba Sanchez Gonzalez]

07:52 PM on 02/27/2012

I had 3 of the 7...not everyone goes through the paths described. I wonder how many go into the uber perfectionist/overachieverness path...

[Wendyness]

08:15 PM on 02/27/2012

Lots.

[Rosalba Sanchez Gonzalez]

09:17 PM on 02/27/2012

I meant how many studies are out there about the other set...the ones who don't go down the path of "recklessness" so to speak, cause uber perfectionism/overachieverness is not exactly the picture of health...granted not having to pay for rehab is kind of nice...

[dpkjj]

02:30 AM on 02/28/2012

That's me.

[Jeanne Ball]

07:47 PM on 02/27/2012

Great article! I'd like to add another proven approach to your list: The Transcendental Meditation technique. It has been found to reduce stress, cortisol and improve brain functioning. Students in inner city schools who practice this easy meditation are found to have improved ability to focus, better grades, more harmonious behavior. Check out http://www.youtube.com/watch?v=PgjoMRXXoro

[Lacee Inger Nori]

06:46 PM on 02/27/2012

My childhood I had the wonderful experience to have 10/10 checked off that list. My therapist said i'm lucky i'm not dead by some of my actions resulting from said traumas. Am in college, 20 yrs old, see a therapist every week, and most days I can cope. I wish people woulc take these studies more seriously because adults who have experienced one or more of these, or all of them truly cannot function "normally" in the world. It's a constant battle, for me at least to basically relearn everything I learned as a child (under18). I hope some new parents read this article and will take an active role in raising their children and PROTECTING THEM from these things as opposed to adding insult to injury and committing them or by refusing to get help.

[Wendyness]

09:43 PM on 02/27/2012

Hang in there, there are millions of us that are survivors! I have had many tell me that it's a miracle I'm not dead. I'm still here and so are you! Frankly, even those that have not been abused or traumatized as children do not function "normally" in the world. We are walking miracles.

[Jan Baer]

07:00 AM on 02/28/2012

Thank you for sharing this! and for getting support! Through this struggle, you'll have strengths that will help you through life. Remember, "living well is the best revenge." One day at a time.

[A1Tours]

06:43 PM on 02/27/2012

"By following the wise counsel of the American Academy of Pediatrics, and other professional and policy groups, early experience need not be destiny for countless children, their families and their communities." Unfortunately, nearly all the things mentioned are not fully realized, or discovered until AFTER the fact, often not until much later in life. This would make your statement above not only inaccurate and incorrect but also unrealistic = trying to 'teach' people to be better people / parents after generations of dysfunction in nearly all American families (of one sort or another) is not possible - unless, perhaps one has some psychic or otherwise predictive abilities! This sounds good on paper and "looking back" to find the CAUSE of some behaviors, but I don't see how it could be possible to prevent future outcomes that have yet to materialize??? Take a look at the comment sections beneath any news story for a peek into the many and varied mental states of people and you need not look much further to realize the futility of what you propose!

[HowardFalco]

09:07 PM on 02/27/2012

We have to start somewhere. The first step is always awareness. When enough people understand a problem it begins to change. Doing nothing is the worst option. This is start, albeit very late in coming. This may help validate and relieve millions who carry some personal sense of worthlessness for the way they were treated as children and what has happened to their lives since. It also may help them from repeating the same with their own children. This is a start...

[Dave Ryan MD]

05:38 PM on 02/27/2012

It's an important fact that the calls to action here are only possible under a continued progressive political administration. Likely only with a well growing economy, too. We need to make this list a reality and to re-evaluate states that have questionable foster-care/child-protective services as well.

[JunnLudy Gamo]

03:47 PM on 02/27/2012

I think the teachers should talk with the parents if they suspect a problem with a child, before it's too late. Children at kindergarten are mostly vulnerable.

[Wendyness]

05:10 PM on 02/27/2012

What should have been a red flag in kindergarten was the fact that I could not sit still. I would stand on my chair to do my work. I completed my work, accurately, before the rest of the children. I was considered "bright" and "active." Thank God for a caring teacher, she would keep me busy by having me do such things as clean the chalk erasers, which I was happy to do! In this day and age I would be considered ADD/ADHD, but that was not the case. All the dysfunction in the home manifested itself in NERVOUSNESS. In many ways I am blessed that the many diagnostic tools were not available at the time, they would have no doubt medicated me.