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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What’s missing in climate change discussion? The certainty of trauma…and building resilience

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This spring, a group of more than 160 mental health professionals, resilience-building specialists and mindfulness teachers officially launched the International Transformational Resilience Coalition. Their goal is a challenging one: to raise awareness of how climate change traumatizes communities around the world. The group’s mission is to not only educate the mental health field about this threat, but to also provide preventive solutions before disaster strikes.

The initiative was first envisioned by Bob Doppelt, executive director of The Resource Innovation Group, an BobDoppelt2Oregon-based nonprofit that works across the U.S. to develop new approaches to social-ecological problems, including climate change. Doppelt said that efforts to mitigate climate change have focused on external aspects like fixing and improving infrastructure and developing new forecasting models.

“And throughout all of that work,” he said, “it dawned on me that we were missing what is likely to be the most important issue facing us, and that is the human response to climate change.”

Doppelt said he’d seen this firsthand after Hurricane Sandy devastated communities in southeast Florida, a region where The Resource Innovation Group played a key role in helping the government address climate change readiness. Trained as a counseling psychologist, Doppelt decided that it was essential to develop programs for teaching people how to become resilient as they faced the acute trauma and chronic stress brought on by climate change.

A year-and-a-half ago, The Resource Innovation Group launched its own program to teach mindfulness skills to individuals, organizations and community leaders across the country. The premise is that everyone will need coping techniques as climate change disrupts communities in both profound and subtle ways.

Yet, resiliency is a word that Doppelt uses carefully. “We came up with the term transformational resilience because in many cases the impacts of climate change mean there is no going back to pre-crisis conditions,” he said.

Doppelt also realized that this approach needed an entire network of dedicated mental health and mindfulness professionals – not just one organization like his championing the cause. That’s when he helped organize nearly two dozen founding members, including Dr. Sandra Bloom, co-creator of the Sanctuary Model, and Elaine Miller-Karas, executive director and co-founder, Trauma Resource Institute.

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Are there non-medication alternatives for ADHD treatment?

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[Photo: robert_rex_jackson, Flickr]

The Question: While more than two-thirds of youth diagnosed with attention-deficit hyperactivity use prescription medication to control their symptoms, it’s not uncommon for both parents and children to want a non-drug alternative. The guidelines recommend evidence-based behavior therapy as the primary treatment for pre-school age children; older students are advised to try ADHD medication alone or in combination with behavior therapy. Despite these clear recommendations, clinicians and parents may not know that alternative treatments exist, or how to access them.

The Alternatives: Three types of non-medication interventions have been demonstrated as effective for ADHD.

  • Parental training is designed to help caretakers improve their own communication and discipline practices. The goal is to better manage a child’s behavior by encouraging positive behavior and deterring what might be seen as classic ADHD conduct. Four parent training programs have been shown to reduce disruptive behavior: Triple P; Incredible Years; Parent-Child Interaction Therapy; and, the New Forest Parenting Program.
  • A mental health professional typically delivers psychosocial therapy, counseling a patient and his or her family on a regular basis about how to manage ADHD symptoms. These therapists, however, may not know the latest evidence-based techniques for working with children who have ADHD.
  • Behavioral therapy focuses on teaching children important skills, such as organizing, socializing, and problem solving. Showing parents and teachers how to help manage behavior and symptoms is an essential aspect of behavioral therapy as well. Some of this training may take place in the classroom, depending on the school’s resources, but it can also occur at sites where therapists have been specifically trained in evidence-based ADHD interventions. Two such examples are the Summer Treatment Program at Florida International University’s Center for Children and Families and the Challenging Horizons Program at the Center for Intervention Research in Schools at Ohio University.

These treatment types can overlap. For instance, some therapists use behavioral modification while behavioral therapy programs often have a parent-training component. For more information about the types of treatment and their costs, see this brochure (PDF) produced by the Agency for Healthcare Research and Quality.

A Note on Trauma: None of the behavioral

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Am I really the worst? A day in the life of parenting special needs children

AfamilyThe other day after a particularly lively visit to PetSmart with my husband and our two special needs children, a woman who had been in the store at the same time drove up and said: “You are the worst parents I have ever seen.” She drove off before I could respond, not that I had a witty comeback. To clarify, no animals were hurt (or even handled), nothing was damaged and we did not leave any messes for store employees to clean up. We were probably the loudest family in the store, but that is normal in our world.

I am confident I cannot possibly be the worst parent out there.

My children, who both struggle with multiple disabilities, had a fun outing to the pet store with two parents who love them dearly. Despite their challenges, they are on the honor roll at school, play sports and engage in other extracurricular activities and have received awards for their accomplishments. Of course, it is easy to listen and accept negative comments of someone who sees my life for less than 15 minutes and makes a faulty assessment. I am like every other parent: I worry. I have doubts and fears. I doubt myself. I question if I am doing enough.

Most parents worry about their children, but parents of special needs children need to know the world is a better place because they are in it. We are parents who have been to more medical appointments with our young children than most adults have been to in their whole lives.  Our children often have had multiple diagnoses yet don’t really “fit” any of them. We sometimes feel isolated because our children don’t seem to fit into any group, even the “special needs” ones. We’ve scoured books, magazines and web sites in the hopes of finding something new that might be effective for our children’s needs. We feel exhausted, overwhelmed and incompetent on a daily basis but still get up every morning and try to provide the best for our children. We fight schools, doctors, friends and even family members every day just to get them to understand the basic needs of our children. And after all of that, we have to put a positive spin on some very ugly comments our children hear on a regular basis.

To paraphrase the late Erma Bombeck, God is looking down from heaven and pairing children with appropriate parents. When He chooses parents for a handicapped child, He decides they must be happy so the child can know laughter; they cannot have too much patience or they will drown in a sea of self-pity and despair; they must have a sense of self and independence so they will be able help the child who is in her or his own world function. They must to be a little bit selfish to separate themselves from the child occasionally to survive. They will see clearly ignorance, cruelty and prejudice and be able to rise above it.

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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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DOJ official advocates for juvenile justice reforms

I expected the luncheon keynoter at the American Bar Association–American Psychological Association “Confronting Family and Community Violence” meeting in Washington, D.C., last week to be informative, even impressive, but not necessarily inspiring and motivating. Robert L. Listenbee Jr. was all of these. Demonstrating how important cross-disciplinary conversations are, his words were as relevant to the psychologists in the room as they were for the lawyers.

Listenbee, administrator of the U.S. Justice Department’s Office of Juvenile Justice and Delinquency Prevention, served as co-chair, with former Yankees manager Joe Torre, of the National Task Force on Children Exposed to Violence. He mentioned the importance remembering what the ACE Study tells us when he talked about how Joe Torre’s childhood trauma impacted his adult life. Here are a few other highlights of his talk on May 2:Image

—The $1.5 million Academy of Sciences report “Reforming Juvenile Justice: A Developmental Approach” has been criticized for not providing new knowledge, but the NAS-certification (an institution he noted

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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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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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In mental illness, let’s go beyond nature v. nurture to look at what interferes with the brain’s function

AmindbodyBased on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present.

Identifying the origins of mental illness likely depends on both interpretations. There is an undeniable organic component to mental illness, just as psychological and social conditions are inexorably linked to mental well-being. But like the Democrats and Republicans, these two approaches are often pitted against one another, often leading to that old, tiresome nature versus nurture debate.

Unfortunately, in a world of limited resources, including limited time, the implicit guiding question — Where should we place our focus? — naturally divides our attention. Is it helpful to explore genes and neurobiology in our efforts to reach best outcomes? Or is it better to explore the social conditions that contribute to mental disorders? Unfortunately, much like U.S. politics, the treatment of mental illness often is derailed when such questions become fodder for polarizing arguments that serves allegiances and professional agendas more than persons in the throes of mental suffering.

Instead of worrying if nature is more influential than nurture, perhaps it would be more helpful to identify what counts as optimal functioning for the brain. Perhaps we could then focus on the value of combining information, thus leading to better outcomes rather than increased competition (and often, market share). I think the significance of function often gets overlooked because we aren’t adept at looking at any issues from multiple levels. Although the term biopsychosocial was coined to address the issue of scale and focus in the treatment of mental illness, it often feels piecemeal in approach.

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Arresting our way out of drug crisis is yesterday’s theory, says VT Gov. Shumlin; urges public health approach

AshumlinState of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education.  Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis.  The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.

“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.”  Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.

Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.

CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S.  Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths.  The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase.  An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.

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