|| Can We Stop A Traumatized Child From Becoming A Traumatized Adult?
Robert Pearl, M.D.
Every day a child somewhere will suffer from abuse and neglect, the result of growing up in a home with domestic violence, mental illness or addiction, or from the loss of a parent due to separation or imprisonment. Such trauma can inflict psychological and physical damage that appears when that child grows into an adult and lasts the rest of his life.
That troubling cause-and-effect link between early and later events is well documented.
But for far too long we have done little to break that inextricable connection or even openly acknowledge it.
After all, we freely talk about the bodily harm that chemicals, pollution, and secondhand smoke does to children. And when it comes to physical problems such as cancer and heart disease, increasing public attention, early intervention and aggressive treatment have lowered incidence rates and the likelihood of death in both conditions.
Now it's time we do that with childhood trauma time to minimize its consequences for the bodies and brains of children both early and later in life. Though this problem is widely recognized and some resources are available, we can do much more to stop its domino effect than we're doing now.
New, groundbreaking research might finally point us toward solutions. The Center for Disease Control's (CDC) Adverse Childhood Experiences (ACE) study, the largest of its kind ever conducted, looked at the long-term effects of these toxic childhood exposures. And the devastating impact on the 17,337 American adults studied is clear.
Researchers, collaborating with Kaiser Permanente's San Diego Health Appraisal Center, found that participants who experienced ACEs encountered a much higher risk of illness and premature death as adults. They reported more frequent problems with job performance and earned significantly less income than the control group. In total they also had a poorer overall quality of life than those that did not.
For this reason, the CDC has identified ACEs as leading determinants of the health, and social and economic well-being, of our nation.
Some Surprising Study Findings
Much as we might like to believe that these childhood traumas happen only to other people those with lower incomes, less education, from different neighborhoods that's simply untrue.
Among the most important conclusions from the CDC study:
- ACEs are common. Nearly two-thirds of participants experienced at least one ACE growing up.
- The more ACEs a child experienced, the more likely are later health risks, disease, medical costs and premature death. They also faced higher risk for depression, suicide attempts, addiction and multiple other mental health conditions.
- The more ACEs experienced, the more likely are job-related problems such as absentee-ism and poor workplace performance.
- ACEs rarely occur unaccompanied by other ACEs. Nearly 13% of respondents reported four or more ACEs as children.
Evidence That Connects The Dots Is Mounting
Many scientists have investigated how negative childhood experiences can affect future health and well-being. Indeed, more than 70 published papers have researched this issue, demonstrating a broad set of medical problems that can arise.
Most recently, a 10-state study published in the American Journal of Preventive Medicine showed much higher rates of chronic conditions, including asthma and obesity, and poorer school performance (such as repeating a grade).
Other studies found that individuals who suffered childhood trauma are more likely to smoke, overeat and abuse alcohol and/or drugs to better cope with stress, compounding the negative impact on the body's and the brain's development.
Hard science supports these new understandings. Over the past 20 years, rapid advances in neurobiology have revealed how childhood trauma directly affects the developing brain, and these changes can be seen on functional MRI studies.
These devastating experiences modify the neurological, endocrine and immune systems. They activate stress hormones, initiate inflammatory processes, and change immune function, each of which is associated with the development of chronic diseases in adults
What Can We Do To Help?
As public health experts have pointed out and I agree our nation should focus more on ensuring the healthy development of infants, children and families. In the interest of improving our country's social and economic well-being and global competitiveness, it would be one of the best investments we can make.
We need to remember that even individuals with only a single ACE are at risk and can benefit from support. And we need to remind ourselves that adverse childhood experiences are common, regardless of race, ethnicity or socio-economic status.
The biggest requirement will be a serious and sustained commitment on our part to take action. Otherwise childhood trauma will keep running its course.
The first step to take is clearcut: The earlier we identify these destructive experiences and intervene with counseling and other support, the greater the likelihood the victim will achieve long-term health and well-being. The brains of children have a greater neuroplasticity than the brains of adults and the damage can be reversed more easily when we intervene early in children's lives.
Next, establishing positive relationships for those children with caring adults and offering, often through schools, personalized assistance and support can serve to buffer the trauma endured.
Providing tools that reduce stress, including mindfulness training, and robust community- based peer and adult support systems as the child gets older can reduce the long-term negative impact.
Furnishing healing resources to adults who have experienced ACEs can prevent trauma from harming the next generation, too. We need to help parents and young families recognize how ACEs may be affecting their own lives and provide group counseling services to assist them. By offering support and resources, we can help them develop safe, stable, nurturing relationships with their children.
Every community should have health care professionals available to deliver these types of services to both children and adults. All physicians should be urged to look for signs of an ACE and ask about them. All teachers need to be trained to detect changes in behavior that might be a sign of an ACE.
Child-focused programs like Head Start, school-based counseling, and adult-led youth groups have proven to decrease the negative consequences from these adverse childhood experiences.
The bottom line here is clear and important. If we are quick to recognize a problem and intervene effectively, we can dramatically lower the inevitable disease burden from ACE and prevent much long-term harm. But if we fail to do so, we as a society, along with the victims, will pay a huge price in terms of health care costs, workplace productivity and our children.
About Robert Pearl: Dr. Robert Pearl is the CEO of The Permanente Medical Group, a certified plastic and reconstructive surgeon, and Stanford University professor. Follow him on Twitter: @RobertPearlMD.