How the NFL can stop abuse AND keep its players on the field

A young fan wears an Adrian Peterson jersey.  [Photo: Ann Heisenfelt/AP]

A young fan wears an Adrian Peterson jersey. [Photo: Ann Heisenfelt/AP]

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Many people are happy that the Vikings kicked Adrian Peterson off the team and that Ray Rice can no longer play for the Ravens. Their off-field violence has cascaded into harm and loss for everyone involved – spouses, children, team, league and fans — all because of the consequences of their childhood trauma. And the only way the NFL can stop further abuse, harm and loss is…well…to deal with its players’ childhood trauma.

The severe and toxic stresses in Peterson’s past – or what we in the trauma-informed community count on a scale from one to 10 as adverse childhood experiences or ACEs – aren’t minor. As a child, he lost his father to prison, suffered through his parents’ divorce, saw his brother killed by a drunk driver, and was beaten by his stepfather. Repeating the pattern, he whipped his own four-year-old son with a switch so harshly that he raised welts on the child’s body. And if Peterson is convicted and goes to prison, his son can add another ACE to his trauma-filled life.

Peterson and Rice are two of millions of child and spouse abusers who love their families and can learn from their mistakes, if provided with help early enough. The average child abuser or spouse abuser isn’t dirty, disheveled, reeking of alcohol or stoned on meth. Child and spouse abusers are corporate CEOs, ministers, priests, actors, business owners, teachers, truck drivers, physicians, nurses, basketball heroes, journalists, computer programmers, and your next-door neighbors.

They’re dads and moms who have a hard time controlling their emotions when they’re under stress because they themselves were abused. Nobody helped them when they were kids and nobody’s helping them as adults.

Plain and simple, childhood trauma is the nation’s No. 1 public health problem. The CDC’s Adverse Childhood Experiences Study (ACE Study) – the largest public health study you never heard of — shows that childhood trauma is very, very common. (ACE surveys in 22 states echo the results.) And this childhood adversity causes violence, including family violence, as well as the adult onset of chronic disease and mental illness.

By learning about the science of childhood adversity, and following the lead of many other organizations that are becoming trauma-informed, the NFL could have players whose families are happier and healthier, it could have better players (more focused, less stressed), and it might never have to deal with a Ray Rice or Adrian Peterson situation again.

The NFL has 1,696 players. Of those 1,696 players, probably two-thirds – 1,119 young men – have experienced one type of serious childhood trauma. And it’s likely that 22 percent – about 370 players –

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The Philadelphia story: Education and activism converge in “ACEs epicenter”

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The women and men gathered for a training on trauma and resilience were recovery counselors and social workers, charter-school teachers and prison administrators. But to Stephen Paesani, the child and adolescent training specialist who was leading the session, every person in the room was a potential protective factor in a child’s life.

“When a child experiences adversity or trauma, he goes into the fight-or-flight stance,” Paesani explained. “That’s going to impact brain development. “But no matter what happens, all of you can be the agents for resilience.”

Paesani works for Philadelphia’s Behavioral Health Training and Education Network (BHTEN), which provides training to practitioners and community members, part of the city’s effort to infuse mental health and substance abuse services with principles of recovery, resilience and self-determination.

But BHTEN’s trainings are just one piece of the Philadelphia ACEs story. In this city of 1.5 million—a city rife with disparities of class, education and health, with pockets of multi-generational poverty and trickle-down trauma—the last decade has seen a steady effort to bring understanding of adversity, trauma and resilience to thousands of front-line workers, supervisors and administrators across the map of human services.

This work is not the result of a top-down initiative or a single funder’s vision for change. It is, instead, the gradual flowering of multiple seeds, planted by activist leaders in pediatrics, public health, behavioral health, child welfare, justice and education.

Today, Philadelphia is home to the ACE Task Force, a group of 50 practitioners intent on putting the knowledge of brain development, adversity and resilience to work in pediatric and primary care clinics, child abuse prevention networks and early childhood programs. The social network site ACEsConnection.com recently launched a Philadelphia group whose members share questions, successes and challenges.

And thanks to the Institute for Safe Families, with support from the Robert Wood Johnson Foundation, Philadelphia was the site of the first National Summit on ACEs in May 2013, attended by 160 physicians, academics, social workers and human service administrators. There, speakers called the ACEs movement “a revolution” in thinking about health and illness, human suffering and strength.

In Philadelphia, that revolution began even before the groundbreaking Centers for Disease Control Adverse Childhood Experiences Study (ACE Study) demonstrated the lifelong impact of early adversity.

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Trauma-informed judges take gentler approach, administer problem-solving justice to stop cycle of ACEs

Judge Lynn Tepper hugs Taylor, 11, at his final adoption hearing. Before finding his permanent home, he'd been returned by three families since being removed from his biological mother when he was three years old.

Judge Lynn Tepper hugs Taylor, 11, at his final adoption hearing. Before finding his permanent home, he’d been returned by three families. [Photo: Edmund D. Fountain, Tampa Bay Times]

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Three years ago, Judge Lynn Tepper of Florida’s Sixth Judicial Circuit Court in Dade City, FL, learned about the CDC-Kaiser Adverse Childhood Experiences (ACE) Study The ground-breaking research links childhood abuse and neglect with adult onset of chronic disease, mental illness, violence and being a victim of violence.

It was like flipping a switch.

“I suddenly had this trauma-informed lens, as we call it. I see it everywhere,” she says, giving an example of someone in front of her on child abuse charges for whom she might recommend counseling and/or anger management. “I have discovered the reality is that when I start asking a few questions, that parent or partner has experienced ACEs,” she says.

The 10 types of childhood trauma measured in the ACE Study are: physical, verbal and sexual abuse, and physical and emotional neglect; a family member who abused alcohol or other drugs, who was depressed or mentally ill, or was in prison; witnessing a mother being abused, and loss of a parent through separation or divorce.

Tepper, a veteran of 37 years on the bench, realized that childhood trauma experienced by the people who ended up in her courtroom was much worse than their paperwork showed. “When you dig down deeper, you wonder how these people get up in the morning,” she says. “I remember thinking at one point, ‘Oh boy, did we blow it all these years on these delinquents.’ ”

Most judges in the United States are unfamiliar with the ACE Study and the research on the neurobiology of toxic stress that has emerged over the last 15 years. But that’s beginning to change in courtrooms across the U.S., due to a number of educational programs aimed at producing trauma-informed judges—and courts. As a result, trauma-informed judges have made three big changes:

  • They’ve modified their courts to be safer and less threatening to defendants with histories of childhood trauma and who are often already traumatized.
  • They recognize that trauma is passed from one generation to another, and take a two- or three-generational approach in child abuse and neglect cases.
  • Because, they say, the traditional approach in criminal justice continues the traumatization of children, youth and families, they’re taking a solution-oriented approach.

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

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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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