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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Failing schools or failing paradigm?

Roberto is an eight-year-old, former student in my second-grade class.  (All names are pseudonyms.)  In his short life, he’s experienced at least five major life traumas. One: his mother abandoned him when he was a baby. Two: he was placed in foster care with strangers. Three: he joined his father, but shortly after, Daddy was sent to prison. Four: Roberto moved again to live with Grandpop. Grandpop was ill and on house arrest, unable to leave his home, so Roberto was essentially under “house arrest” too, except for school. Roberto came to school, walked the perimeter of the classroom staring out windows, distracting other children. Sometimes, he just walked out of the classroom. His father was eventually released from prison and came to live with Grandpop, but Grandpop soon evicted Daddy after a fight with him. Five: Grandpop died.

Ashley, a bright and engaging nine-year-old, witnessed her stepfather break her stepbrother’s leg with a baseball bat last night. The police were called, invaded her home about 1 a.m., and took her stepfather away. This morning, she came to school as usual, but in a trance, unable to focus.

Jasmine responds much more aggressively. When she is off her medications, and her traumas are re-triggered, her tiny, wiry 45-pound frame can muscle a chair over her head. She screams and curses in guttural tones while heaving the chair at a classmate. She’s being raised by a hesitant uncle in place of her deceased parents.  Jasmine goes home to a darkened row-house, with ”illegal smoke” wafting out the front door that hangs wide open to the street.

Jamar’s been absent from school. After several suicide attempts, he’s at the Crisis Center. Jamar suffered brutal beatings from Mom’s boyfriend, who stuffed a sock in his mouth to muffle his screams. He will come back directly to my classroom from the Crisis Center, without the dedicated adult support he is due.

Ashley, Roberto, Jasmine and Jamar had at least eight other classmates with similar stories in our one classroom at the same time. These four real vignettes are hard to read. They’re tragic. Yet these kids are only a small portion of my class.  For the last 13 years, one-half to two-thirds of the students in my urban, public school classrooms have experienced similar lives.  These children are only four of the thousands across only one city: Philadelphia.

Theirs is not a deficit issue. They’re not “sick” or “bad” children; they’re injured.

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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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Patrick Kennedy delivers raw, revealing speech to mental health advocates

Just before former Rhode Island Congressman Patrick Kennedy delivered the closing speech to attendees of the National Council for Behavioral Health conference, my daughter and I had a warm, light-hearted conversation with him outside the hall about my daughter’s work in peer services in Texas, about her anticipated motherhood, his young children, and about a Texas ranch he visited once that is bigger than the entire state Rhode Island. We stuck around to hear him talk, even though we thought we could probably miss it since it was part of the send-off for attendees going on visits to Capitol Hill and we weren’t going. We were grateful we stayed; here’s why.Image

Kennedy gave a raw and revealing talk about his mental illness, addiction, and the “God-sized” hole in his soul before his recovery. He said his illness is “bio/psycho/social”, but added that it is also “spiritual.” After achieving successes in his political career—election to the Rhode Island state legislature at 21, Member of Congress at 27, master fundraiser for Democrats—you “would have thought that would have filled the hole in my soul but it didn’t.”

After being arrested “on the high seas, in airports, and by traffic cops,” and being in rehab over and over again, he felt that as long as he was re-elected, he was managing. He was, after all,  meeting the family’s definition of success by winning elective office and serving the public.

“Would I have freely chosen to bring such disregard, such disdain, and antipathy for me and bring shame on my family, like I woke up one day and said this is how I want to be perceived — as an alcoholic, drug addict who can’t get his life together? That’s not what I want for my life. And yet it was the inevitable result of me living in my illness and not knowing there was a solution. And of course I was given solutions and pointed to rehab over and over again. You would have thought I would have gotten it through my thick head that I had a problem. But my real problem was denial, thinking that if I could just continue to function and manage—continue to get re-elected­—then I must be okay.”

Then three years ago, after crashing into a barrier at the U.S. Capitol, he waited for the “final jackpot.” He woke up, not remembering what had happened the night before. Did he have a Chappaquiddick of his own (a referral to an accident that involved his father, Sen. Edward Kennedy)? Fortunately, the event took place at 3:00 a.m., when the streets and sidewalks, were empty and no one was hurt.

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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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Echo Parenting & Education rides the trauma wave

Changing the Paradigm keynote speakers Dr. Janina Fisher and Ruth Beaglehole, Founder of Echo Parenting & Education

Sometimes we don’t notice when history is being made. We ride a wave of logical progression and don’t even notice when it peaks – that snapshot moment when we are lifted, arms outstretched, into the waiting air and remain suspended for one glorious second before the wave breaks and pushes powerfully to shore.

What the heck am I talking about? Our Changing the Paradigm conference. Last month, 120 participants, 22 speakers and a slew of volunteers gathered at The California Endowment for our two-day conference on developmental trauma. Everything went off perfectly. The evaluations were glowing (apart from the person who wanted avocado on the lunchtime sandwiches – I guess you can’t please everyone). But don’t take my word for it. Here’s what some of the speakers had to say:

“It was a deep honor and a pleasure to be part of such a wonderful and inspiring exchange of hearts, minds

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Trying to make LA schools less toxic is hit-and-miss; relatively few students receive care they need

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The Peacemakers of Harmony Elementary School in Los Angeles, CA.

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For millions of troubled children across the country, schools have been toxic places. That’s not just because many schools don’t control bullying by students or teachers, but because they enforce arbitrary and discriminatory zero tolerance school discipline policies, such as suspensions for “willful defiance”. Many also ignore the kids who sit in the back of the room and don’t engage – the ones called “lazy” or “unmotivated” – and who are likely to drop out of school.

In the Los Angeles Unified School District (LAUSD), which banned suspensions for willful defiance last May, the CBITS program (pronounced SEE-bits), aims to find and help troubled students before their reactions to their own trauma trigger a punitive response from their school environment, including a teacher or principal.

Gabriella Garcia’s son attended Harmony Elementary School during the 2012-2013 school year. The school has 730 children in kindergarten through fifth grade. She says without CBITS, she would have lost custody of him and her other two children. “But for some reason,” she says, “I let him (her son) take that test.”

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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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