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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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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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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Survey shows 1 in 5 Iowans have 3 or more adverse childhood experiences

iowaacesIowa’s 2012 ACE survey found that 55 percent of Iowans have at least one adverse childhood experience, while one in five of the state’s residents have an ACE score of 3 or higher.

In the Iowa study, there was more emotional abuse than physical and sexual abuse, while adult substance abuse was higher than other household dysfunctions.iowaprevalence

This survey echoed the original CDC ACE Study in that as the number of types of adverse childhood experiences increase, the risk of chronic health problems — such as diabetes, depression, heart disease and cancer — increases. So does violence, becoming a victim of violence, and missing work days.

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Terrifying children into a life of asthma

Credit: Cellular Image/Flickr

Credit: Cellular Image/Flickr

Sometimes the clearest indicator of a family’s dysfunction is, unfortunately, illness in its children. Like the proverbial canaries in the coal mine, it’s the children who are most susceptible to the toxicity of family addiction and dysfunction. Hurt people hurt people, and literally scare the life out of little kids.

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The growing interest in ACEs and trauma-informed practices

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So much is happening in events, reports, research and news about adverse childhood experiences and trauma informed practices that it’s hard to keep up. But here are a few notable results:

  • According to Dr. Robert Anda, one of the co-founders of the CDC’s ACE Study, 21 states have done or are completing their own ACE surveys.
  • At last month’s National ACEs Summit in Philadelphia, PA, two unifying themes emerged: to be successful in preventing childhood trauma and to stop further traumatizing children and adults who are already traumatized, people have to work across professional silos and systems, and the changes have to occur at the community level. In other words — this ain’t a top-down endeavor. Martha Davis, executive director of the Institute for Safe Families, which hosted the summit, wrote up six interesting short overviews of the presentations. She and Kristin Schubert of the Robert Wood Johnson Foundation, which sponsored the summit, wrote an op-ed that appeared in the Philadelphia Inquirer this week.
  • At that same meeting, ISFS released an ACE survey of Philadelphia — the first of a major U.S. city. The results were grim:  37.3% of adults experienced 4 or more ACEs — three times higher than the 12.5% in the CDC’s ACE Study. That works out to 432,100 people. This substantially increases their risk of long-term health effects. But, as to the city’s resilience factors, the results were also hopeful: 85% felt the “neighborhoods in which they grew up in were safe”, 77.5% thought their “neighbors looked out, supported, and trusted each other”, and 92.3% said that “someone made them feel special while growing up”.
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The CDC’s ACE Study summarized in 14-minute video from Academy on Violence & Abuse

The Academy on Violence and Abuse, which educates health care professionals about the often unrecognizable health effects of violence and abuse, produced a four-hour DVD of interviews with the co-founders of the CDC’s Adverse Childhood Experiences Study, released a 14-minute executive summary.

The organization released a three-minute teaser last year. For those unfamiliar with the ACE STudy, this 14-minute puts a little more meat on the bones.

And if you want to know what your ACE score is — as well as how you’re doing on building resilience into your life — go to the survey: Got Your ACE Score? The ACE survey has 10 questions, and the resilience survey has 14.

A 15-second look at how U.S. population became obese over 25 years

The Atlantic.com posted an animated graphic that takes us from 1985….

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…..to 2010. In just 15 short seconds, you can watch the obesity epidemic balloon across the U.S. The CDC defines obesity as having a body mass index that’s 30 or higher.

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Reporter James Hamblin also posted the 10 metropolitan areas with the lowest obesity rates, and the 11 with the highest. The pegs at either end are Boulder, CO, at 12.5 percent, and McAllen-Edinburg-Mission, TX at 38.5%.

Obesity is linked to childhood adversity. One of the CDC’s ACE Study publications found a link physical, sexual and verbal child abuse and obesity in at least 8 percent of the adult obese population. If there are 70 million obese and morbidly obese Americans, as the CDC says, that means that several million obese and morbidly obese people are likely to have suffered physical, sexual and/or verbal abuse during their childhoods. (It should be noted that this particular publication looked at only three of the 10 types of adverse childhood experiences.)

A number of other researchers are looking into the link between obesity and childhood adversity. Here

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The secret to fixing school discipline problems? Change the behavior of adults

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Godwin Higa, principal, Cherokee Point Elementary School

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Two kindergarteners at Cherokee Point Elementary School in San Diego’s City Heights neighborhood get into a fight on the playground. Their teacher sends them to the principal’s office. 

Instead of suspending or expelling the six-year-olds, as happens in many schools, Principal Godwin Higa ushers them to his side of the desk. He sits down so that he can talk with them eye-to-eye and quietly asks: “What happened?” He points to one of the boys. “You go first.” 

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Rape is not inevitable; 25 years of Prozac; how racism is bad for health

rapeThree posts caught my eye last night. The first was by Jessica Valenti, who writes about feminism, sexuality and social justice for the Nation. She looked at the vitriolic response to political commentator and writer Zerlina Maxwell’s appearance on Fox News’ Hannity. Maxwell made the point that having a gun doesn’t prevent rape. Valenti quoted her as saying: “I don’t think that we should be telling women anything. I think we should be telling men not to rape women and start the conversation there.”

A headline on TheBlaze.com, a right-wing site, shouted Democratic Strategist’s Shocking Claim: Women Don’t Need Guns for Self-Defense, Just Tell Men “Not to Rape Women” and called her approach “bizarre”. Online comments were, well, what you might expect. Valenti pointed out:

The truth is that focusing on ways women can prevent rape will always backfire. Not only because it’s ineffective—what a woman wears or

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