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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The brain of a serial killer…is a story about child abuse

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There are three interesting aspects of this infographic about the brains of serial killers:

  • The acknowledged link to high levels of childhood trauma.
  • That brain scans of psychopaths are similar to others who exhibit evidence of behaviors besides rage and violence, such as overeating, drinking too much, inappropriate sex and workaholism. Rage, violence and the other behaviors are all  coping skills to deal with childhood adversity.
  • That the experts mentioned in the infographic are coming around to the conclusions from epidemiological research in the CDC’s ACE Study, and from neurobiological research about the effects of toxic stress on children’s brains.

brain2You can find the entire infographic here. There’s one part that’s not accurate  — the concept of a warrior gene. Epigenetics research shows that the social environment turns our genes on and off, so any behavior is likely to be a result of an interplay among many genes and neurodevelopment.

And who put this infographic together? Bestcounselingdegrees.net. Really.

ADHD symptoms? Psychologists, psychiatrists should consider child maltreatment as the cause before prescribing meds

Adhd-facts1While reading a 2007 press release from the National Institute of Mental Health (NIMH), I became unusually hopeful for youths diagnosed with attention deficit hyperactivity disorder (ADHD). A study performed jointly by the NIMH and the National Institute of Health revealed the brains of youths with ADHD develop normally but at different rates. In the prefrontal cortex, development was delayed three years on average in youths diagnosed with ADHD. This region of the brain is associated with higher-order executive functions and is responsible for coordinating actions with thoughts according to a person’s goals and intentions.

But while development of the prefrontal cortex lags in youths with ADHD, the motor cortex, which controls voluntary body movement, matures faster. These combined changes correlate with behaviors seen with ADHD: fidgety, restless bodies that have difficulty inhibiting behavior and focusing attention. These behaviors impact their ability to do well in reward-based systems that require delaying gratification while working towards long-term goals (that is to say, school).

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What happened to “Charlie” started in his mother’s womb

Beginbeforebirth.org was put together by researchers from the Institute of Reproductive and Developmental Biology at Imperial College London. It posted the latest research on how a mother’s stress, caused by everything from domestic violence to natural disaster, affects what happens to the fetus developing in her womb.

The organization produced a series of games and videos, including Charlie’s Story, that look at a mother’s stress, how genes can be turned on and off depending on what’s happening in the mother’s social environment, and what the long-term consequences can be.

The site has a good section on epigenetics. You think the DNA you’re born with is your blueprint for life? Not quite. Your genes can be turned on and off, sometimes temporarily, sometimes permanently by what’s happening in your relationships. Getting a lot of verbal abuse and physical abuse from mom or dad? That’s setting off a flood of toxic stress hormones that are changing your DNA. And if the abuse is severe enough, you can pass the changes on to your children.

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David Brooks tells only part of the story; on Salon (and The Fix), making erroneous assumptions about parents

It’s terrific to see the CDC’s ACE Study, neurobiological research on children’s brains, and trauma-informed practices featured on Salon (Is Your Kid an Addict?) and by David Brooks in his column, The Psych Approach. Just terrific. The more information out there, the better.

Brooks uses Paul Tough’s book, How Children Succeed, to discuss the “psychologizing of domestic policy”. What he means by that is moving from “the material and bureaucratic things that correlate to school failure” (e.g. poverty, school class size) to “the

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ACE Study co-founders tell story on DVD — here’s an intro

It’s interesting how long it takes for solid research to be integrated into daily life, especially research that produces results that shock us, but that we have somehow understood at some deep level all along. The CDC’s ACE Study — which linked childhood trauma with the adult onset of chronic disease, including mental illness, and violence or being a victim of violence — is one of those research studies.

Tuesday’s roundup featured a story about how exposure to child abuse and bullying affected our DNA, showing that stress leads to accelerated biological aging. Stephanie Pappas did a good story about the research in LiveScience, in which she quoted Dr. Elissa Epel, a University of California, San Francisco, health psychologist who studies stress and cell aging.

“Now we have some evidence that indeed children’s immune-system aging can be adversely affected by severe stress early in childhood, a scar that could last possibly decades later,” Epel told LiveScience. “This study underscores the vital importance of reducing violent exposures for children — both serious bullying and abuse in the family.”

The researchers pointed out that the violence doesn’t have to affect the child physically — it’s the cumulative stress that’s affecting the DNA.

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Roundup: 5S’s de-stress infants; toxic stress shortens genes; trauma triggers eating disorders

Here’s a sure-fire way to calm screaming babies, according to this story by NPR’s Patti Neighmond.

John Harrington, a pediatrician at Children’s Hospital of the King’s Daughters in Norfolk, VA, did a study, published in the journal Pediatrics, that proves Los Angeles pediatrician Harvey Karp’s calming system works. Karp calls it the five S’s: swaddle, put on stomach, swing, shush (LOUD shhhh), and offer the baby a pacifier to suck on (although the video shows that’s not always necessary). Essentially, Karp’s mimicking the environment of the womb. The bad news: this method stops working when a baby’s around 4 months old.

TO THE LIST OF TOXIC STRESSORS that shorten our genes to age us prematurely  — smoking, radiation, and taking care of a chronically ill person — add violence, says Liz Szabo in today’s USA Today. Research published in Molecular Psychiatry found more evidence that our social environment alters genes. The genes of children who were exposed to two or more types of violence — witnessing domestic violence between the mother and her partner, experiencing physical abuse or bullying — shorten faster. This can lead to early onset of aging diseases, such as heart disease or memory loss.

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Get gobsmacked about child trauma, genes and your life with this online course

Did you know that child trauma (abuse and other serious childhood adversity):

…is a leading cause of early death in adulthood?

…is a main cause of our high health-care costs, special education needs, high rates of kids failing

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Pediatrics academy tells baby docs: your new job is to reduce toxic stress

According to research over the last 15 years, there’s no doubt now that child trauma causes toxic stress on the brains of babies and children, which causes short-term harm and long-term health consequences. So, it’s not a big surprise that the American Academy of Pediatrics issued a policy statement about the issue. What’s significant is the advice to pediatricians: Radically change how you do your job and take new approaches to protect those fragile developing brains.

The report advised pediatricians to:

  • Integrate a psychosocial approach into doing medicine. “Psychosocial problems and the new morbidities should no longer be viewed as categorically different from the causes and consequences of other biologically based health impairments.”
  • Incorporate into medical school and continuing education classes the knowledge of how childhood toxic stress affects “disruptions of the developing nervous, cardiovascular, immune, and metabolic systems, and the evidence that these disruptions can lead to lifelong impairments in learning, behavior, and both physical and mental health.” A technical report, in press, will provide more details about this.
  • Take an active leadership role in educating everyone — public, policy makers, educators, etc. — about the long-term consequences of childhood toxic stress.
  • Advocate for “new, evidence-based interventions (regardless of the provider or venue) that reduce sources of toxic stress and/or mitigate their adverse effects on young children.”

Child abuse affects genes

Picture 12While adding info to this blog’s resources and research sections today, I found “Abuse affects genes”, an article by Brona McVittie on the Epigenetics? site. The site is put together by The Epigenome Network of Excellence, a European research network that focuses on epigenetics. Epigenetics looks at how our experiences and our environment turn our genes on and off. Yes — it’s an amazing thought, isn’t it. The genes we’re born with don’t set our personalities and behavior in stone. It’s all those experiences — our family life, our school life, our country’s life (war or peace?), our economic life (extreme poverty or jet-setter), our environment.

Epigenome means “above” or “in addition to”  the genome. We all have genes, which have all the code and instructions for how our bodies function. But not all of those genes are functioning all of the time. Our epigenome tells our genes what to do and when to do it. (For more info, go to this blog’s resources section.)

The article describes what researchers at McGill University and the Douglas Institute in Canada found when they compared the brains of 12 suicide victims who’d suffered child abuse, 12 suicide victims who weren’t abused, and 12 normal individuals. They looked at the genes that affect a person’s ability to cope with stress. They found differences between the same genes in the abuse victims and those not abused — the genes weren’t different, but the epigenetic marks on the genes were different. [How this works is shown in a fabulous animation -- specifically the second part of the five parts -- put together by the folks at NOVA, who have produced an episode about epigenetics:  Ghost in Your Genes. A shorter version is on NOVA's Science Now.]

What’s important about this? Previous research shows that if these genes don’t function correctly, they can’t keep  stress hormones under control. So, the study suggests this scenario: Children suffer abuse, their nervous systems responds appropriately by producing stress hormones (fight, flight or freeze). But continued abuse without relief produces way too much stress hormone, which sets off something that significantly slows or stifles the genes that sop up those stress hormone. Too much stress keeps a person in a state of anxiety, fear, nervousness, agitation, or rage mixed with depression. One reason people commit suicide is because they feel they can no longer cope with these unrelenting overwhelming feelings over which they feel they have no control.

“The function of our DNA is not as fixed as previously thought,” adds Michael Meaney (Douglas Institute, Quebec). “The interaction between genes and the environment plays a crucial role in determining our resistance to stress and the risk for suicide. Epigenetic marks are the product of this interaction.”

In another article, one of the researchers, Moshe Szyf, a professor of pharmacolog at McGill University, said:

this study is the first that he knew of in which there is a clear link between human social environments and their epigenetic code. “It is dynamic, and it acts through life,” he says. “And it’s not just chemicals that affect these mechanisms, it’s the social, and even political, environment.”

The study was published in the Feb. 22, 2009 issue of Nature Neuroscience.