To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma

TabithaLawson

Tabitha Lawson and her two happy children

When parents bring their four-month-olds to a well-baby checkup at the Children’s Clinic in Portland, OR, Drs. Teri Petersen, R.J. Gillespie and their 15 other partners ask the parents about their adverse childhood experiences (ACEs).

When parents bring a child who’s bouncing off the walls and having nightmares to the Bayview Child Health Center in San Francisco, Dr. Nadine Burke Harris doesn’t ask: “What’s wrong with this child?” Instead, she asks, “What happened to this child?” and calculates the child’s ACE score.

In rural northern Michigan, a teacher tells a parent that her “problem” child has ADHD and needs drugs. The parent brings the child to see Dr. Tina Marie Hahn, who experienced more childhood trauma than most people. Instead of writing a prescription, Hahn has a heart-to-heart conversation with the parent and the child about what’s happening in their lives that might be leading to the behavior, and figures out the child’s ACE score.

What’s an ACE score? Think of it as a cholesterol score for childhood trauma.

Why is it important? Because childhood trauma can cause the adult onset of chronic disease (including cancer, heart disease and diabetes), mental illness, violence, becoming a victim of violence, divorce, broken bones, obesity, teen and unwanted pregnancies, and work absences.

The CDC’s Adverse Childhood Experiences Study (ACE Study) measured 10 types of childhood adversity: sexual, physical and verbal abuse, and

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Research reveals new ways of understanding ADHD

AbrainsMore than 6.4 million U.S. children have received a diagnosis of attention-deficit/hyperactivity disorder, according to the Centers for Disease Control and Prevention. Despite the prevalence of ADHD, researchers continue to search for answers about what causes the disorder, why it affects children differently, and how to best treat each individual case.

Related Story: How childhood trauma could be mistaken for ADHD

Three very different studies show the potential for scientific research to offer fresh insight into these unanswered questions.

  • The first study, published in a recent issue of the Journal of Child Psychology and Psychiatry, found that the condition might be influenced by a child’s socioeconomic environment.
  • Meanwhile, in 2012, scientists looked at how parenting style affected behavior in children who possessed genotypes associated with ADHD. Their findings, published in the Journal of Abnormal Child Psychology, revealed that negative parenting predicted inattention symptoms in certain children.
  • Finally, in the third study, which is currently unpublished, U.C. Berkeley researchers tracked and analyzed long-term outcomes for girls who were both diagnosed with ADHD and experienced severe abuse or neglect. The results indicate that experiencing ADHD and trauma may put some youth at an increased risk for eating disorders, depression and suicide later in life.

Study #1: Dr. Ginny Russell and her colleagues at the University of Exeter set out to better understand how a child’s socioeconomic standing might play a role in the development of ADHD. Russell firmly believes that ADHD is indeed a brain disorder with genetic underpinnings, but she also worries that it has been characterized as a “context-free condition.” Time and again, studies have shown that poor or disadvantaged children are more likely to have ADHD, and this fact struck Russell.

Some researchers have argued that this increased likelihood could be the result of reverse causality, or in other words, that the difficulty of parenting a child with behavioral problems might lead to economic hardship and divorce. In Russell’s study, which used data from a longitudinal study of more than 19,000 children in the United Kingdom, low-income families were more likely to have a child with ADHD – but that couldn’t be traced back to reverse causality. In fact, household income for families with an ADHD-diagnosed child didn’t decline over a period of several years compared to families without a diagnosis. Both sets of families had matching earnings at the start.

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How childhood trauma could be mistaken for ADHD

 

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[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”

Considered a heritable brain disorder, one in nine U.S. children—or 6.4 million youth—currently have a diagnosis of ADHD. In recent years, parents and experts have questioned whether the growing prevalence of ADHD has to do with hasty medical evaluations, a flood of advertising for ADHD drugs, and increased pressure on teachers to cultivate high-performing students. Now Brown and other researchers are drawing attention to a compelling possibility: Inattentive, hyperactive, and impulsive behavior may in fact mirror the effects of adversity, and many pediatricians, psychiatrists, and psychologists don’t know how—or don’t have the time—to tell the difference.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children.

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Q-and-A: Pediatrician screens parents, kids for trauma because her ACE score is 9

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Dr. Tina Marie Hahn

Dr. Tina Marie Hahn is a pediatrician in Alpena, Michigan. She agreed to answer these more personal questions as part of an interview about how she and other pediatricians are screening children — and parents — for adverse childhood experiences.

Q. What personal or professional moment or event in your life inspired you to work on adverse childhood experiences (ACEs)?

A. When I was four-and-a-half years old, I saw my father murder my grandmother.

My father was quite a demanding man — he felt as if everyone owed him. But he was also lazy. He didn’t work my entire childhood. He supported himself from state welfare checks intended to provide for his three children. My father wanted Grandma Hahn to give him money for cigarettes, but she refused. She told him he needed to go work at the hardware store and do something productive before she would give him more money. He became VERY angry and he pushed her down her basement steps.

After pushing her, he screamed angrily: “I don’t care if she dies. When she dies, I’m going to piss on her grave.” It terrified me. It seemed as if Satan possessed him. Even though I was frightened, I stayed at grandma’s side for a day and a half, trying to give her water from a bathroom Dixie cup because she kept saying that she was thirsty. My screaming father and my mother, ignoring the whole thing, left Grandma trapped at the bottom of those steps for almost two days until her cries ceased.

Diane, my mother, did nothing, not because she was afraid of my father, but because she followed him around

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In the middle of the night, finding resilience in a storm of ACEs

Astress2I had been asleep for a few hours when I answered the call.  At first, I did not realize it was my work cell phone.  The caller on the other end was sobbing uncontrollably and in the background I could hear someone yelling, “You’re a f#c%ing hoe.  Why do you think you are so much better than us? What makes you think you can live here for free, you f#c%ing b!t@#.”

“Take a deep breath,” I said to the caller. “Tell me where you are.”

“I’m at home. My mom and sister won’t leave me alone. They want me to f#c% men for money, like my sister does. They are mad that I am a going to school and not giving them any money. I just want to graduate.  I just want a chance to get out of here. They don’t understand and they won’t leave me alone.”

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“Dear Survivor”: A letter about the hard truths of healing from child abuse

Dear Survivor,

Credit: Oldangelmidnight from Northampton, MA

Credit: Oldangelmidnight from Northampton, MA

“Because then I knew it was over.”

That’s what most strive to feel about the lingering effects of childhood abuse, although not about the actual events. Those are long gone, and often dissociated from awareness.

Rather, most want to end sleepless nights and startled awakenings; feeling as if they live in a parallel universe, outside the world inhabited by ‘normal’ people who lack histories of abuse; intrusive images, feelings, sounds, and smells; the desire to drink, smoke, toke, shoot up, sex to oblivion; the avoidance of intimacy because of a seemingly endless reserve of anxiety simmering below a brittle surface of civility; or fighting because the rage never seems to dissipate and you just want to push back, because the planet is not big enough to hold all your hurt, let alone the emotional needs of another person.

At the first inkling of the wish to heal, some try to barter with themselves as a way out of this paradoxical life of repetitive chaos. This often starts with a naïvely made promise with oneself to be good. This promise usually starts with the belief that by being good and trying really hard, one day life will finally, if not miraculously, turn out differently. This is not an easy promise to let go of; even when it’s obvious you are failing miserably at keeping it.

Even so, there will still be a part of you that keeps the promise. Why? Often because of the secretly held wish that if you finally get it ‘right’ the love that wasn’t there will materialize, or your savior will come and magically change everything (releasing you from both effort and responsibility), or the opportunity for revenge will become available, and there you have it: the transformative moment you have waited for has arrived.

This I can tell you is a colossal waste of time and the imagination. Even if the perfect love, the ideal savior, or the opportunity for the most humiliating payback becomes available, you will never become who you might have been had the abuse never happened, or get the time back that you have wasted waiting for your personal Godot.

You might think I am giving you that old song and dance about picking your ass up off the curb, brushing off the dust of trauma, stomping its dirt from your shoes, and manning up to life’s inevitable trials and tribulations. Not at all. Rather, I think childhood

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Georgia juvenile court judge galvanizes statewide child trauma initiatives

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Douglas County (GA) Juvenile Court Judge Peggy Walker and “Dalton”

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Douglas County Juvenile Court Judge Peggy Walker is an activist judge for the children of Georgia – the children she loves who do not get what they need for healthy, successful lives.  She’s seen how the children are failed when they come back to court again and again. Now she’s doing something about it.  When she takes over later this year as the president of the National Council of Juvenile and Family Court Judges, she’ll have a national platform to promote changes in polices and practices to prevent and treat childhood trauma.  For now, she is spreading the word around the state of Georgia through conferences in four different regions, with the first one held January 10 at the Carter Center in Atlanta.

Woven into Judge Walker’s Georgia Summit on Complex Trauma keynote address to more than 400 participants —  including judges, their staffs, child and family services professionals, and advocates — was a description of a painful case from her work as a judge.  She began her presentation on what science tells us to do for children who have experienced complex trauma with a photo of herself (shown above) holding “Dalton.” He was the first drug-free child in the court’s family drug treatment program; his mother “Tonya” was a participant (both names are pseudonyms).

During the 10 years that “Tonya” had been in and out of her court, Judge Walker did not know her story. When she found out, she learned that  “Tonya’s” mother was alcoholic, emotionally abusive, and manipulative.  At age seven, “Tonya” was raped by a 50-year-old neighbor who was later incarcerated but freed after three years.  She tried drug treatment in

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Tom Ska “sex talk” doesn’t shy away from addressing assault and abuse

One of the reasons British director and comedian Tom Ska did this 7-minute video about sex is that the first time he had sex, he was forced into it. As you’ll see below, that may have inspired him to address sexual assault in his version of the “the sex talk”:

I made this video because I never had ‘the talk’ and instead “learned” everything about sex through the Internet and society as a whole. In short: I had a pretty unhealthy and ill-informed understanding of sex, sexualities and sexism. I also look at my audience and see a lot of young adults and teenagers who, much like I was, are in need of a little education. When a third of women are sexually assaulted in their lifetimes it means at least 1 in every 9 of my subscribers will face sexual abuse at some point. I simply don’t feel comfortable just ignoring a statistic like that when I potentially have the ability to inform people at potentially stop even ONE instance of sexual assault, rape, bullying, unwanted pregnancy, shame and overall ignorance.

Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Our Earth and and moon.

Our Earth and moon

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Different explanations have been given for the increased number of people suffering from mental illness. Some have claimed the increase is the result of ever-expanding diagnostic criteria and syndromes that risk medicalizing normal emotional reactions. Others argue the increase is the result of the pharmaceutical industry financially courting the medical establishment as well as using advertisements to attract potential users of their medications. While both these arguments seem correct, they nevertheless fail to address that an increasing number of people regularly experience despair and anguish and are struggling to make a meaningful life, if not keep themselves psychologically, socially, and financially afloat.

I would like to suggest an additional explanation for the increase in mental illness: The upsurge is the result of the collective failure to alleviate conditions that contribute to trauma-related stress. I also believe the mental health field has stood in the way of people overcoming mental illness and returning to growth-centered lives. In particular, models of mental illness as chronic, genetic-based disorders gives us the sense that we are reaching the origins of our suffering — that is to say, the genes we inherited — when in actuality, we risk denying the traumatizing conditions in which many of us grew up or continue to live. Although a diagnosis and medications may provide temporary relief, they may also cause Americans to evade making the challenging changes that are necessary for moving into an emotionally sustainable future.

Childhood abuse and other emotional damaging experiences are so prevalent today that trauma-focused psychiatrist Bessel van der Kolk claimed the single most important health problem facing Americans is our exposure to what are increasingly referred to as “adverse childhood experiences,” which have been rigorously

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Trauma-informed psychotherapy puts the body – and love – back in mental healthcare

AloveFor the past 50 years, psychotherapy has taken a back seat to biomedical psychiatry, largely due to reliance on medications for the treatment of mental disorders. Yet clinical evidence increasingly points to chronic, unresolved traumatic stress as the source of many — if not most — mental disorders. Furthermore, longitudinal analyses show continued use of psychotropic medications is bad for the body, even causing chronic diseases. Granted, medications can stabilize a body wracked by recurrent distress, but such an approach is hardly a long-term cure. According to psychiatrist and trauma specialist Bessel Van der Kolk, “dramatic advances in pharmacotherapy have helped enormously to control some of the neurochemical abnormalities caused by trauma, but they obviously are not capable of correcting the imbalance.” To correct the “imbalance” often requires learning to inhabit one’s body and relationships in new ways.

Fortunately, the psychotherapeutic treatment of psychological trauma has advanced significantly the past several decades. In part, this is due to scientific discoveries of how the body and relationships naturally defend against traumatic stress. In particular, trauma-informed psychotherapies that draw from neuroscience and attachment studies are more holistic and scientifically based than ever before, although they often support the intuitions held by originators of psychotherapy such as Pierre Janet, Sigmund Freud, and C. G. Jung.

The neurobiology of trauma

Pierre Janet was the first to recognize how the body responds to present events as if past traumas were recurring — what today we call flashbacks. He observed patients

“continuing the action, or rather the attempt at action, which began when the [traumatic event] happened, and they exhaust themselves in these everlasting recommencements.”

Today we know the neurobiological reasons for flashbacks. Unlike narrative memories that seamlessly integrate

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