The practice of ACEs science in the time of Trump

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As with any remarkable change, the 2016 presidential election, a swirl of intense acrimony that foreshadowed current events, actually produced a couple of major opportunities. It stripped away the ragged bandage covering a deep, festering wound of classism, racism, and economic inequality. This wound burst painfully, but it’s now open to the air and sunlight, the first step toward real healing. The second opportunity is how the election and its aftermath are engaging more Americans from many different walks of life. The election brought out people who hadn’t voted in years; its aftermath has engaged people who’d counted on someone else to do their citizenship work for them. All these people — all of us — now have an opportunity to work together to solve our most intractable problems. That knowledge is embodied in the science of adverse childhood experiences (ACEs).

In a nutshell, this ACEs science clearly shows that childhood trauma results in the adult onset of chronic physical and mental illness, violence, and being a victim of violence. It shows that most of us have experienced childhood trauma. And it shows that the systems we’ve created to change human behavior — whether criminal, unhealthy or unwanted — will actually work if we change them from blaming, shaming and punishing people to understanding, nurturing and and healing them.

The divide we start from is stark: an Electoral College that chose Donald Trump to be president by a vote of 306 to 232, and the voters who chose Hillary Clinton by a nearly three-million vote margin (65,844,610 to 62,979,636).

So, here we are with an administration, whether you agree with its policies or not, that often uses bullying to try to get its way instead of respectful negotiation, responds to decisions it doesn’t like with threats instead of respectful disagreement, describes events it doesn’t like by saying they didn’t happen, and is enacting some policies that harm children and families.

Those actions are not just a matter of being merely “politically incorrect”. ACEs science is clear: bullying, losing a parent (to divorce, separation or deportation), emotional abuse, racist or religious discrimination, physical abuse and witnessing others being hurt — along with several other types of adversity — harm children and adults.

In the case of children, these experiences damage the structure and function of their brains, which can lead to them becoming unhealthy adults who may harm themselves or other people. If their adverse experiences are unrelenting, children live much of their lives in survival mode, responding to their world by fighting, by being frozen into inaction by fear, or by fleeing. They can’t learn as well as those who haven’t been traumatized and they don’t form healthy relationships because they have trouble trusting.

Besides the damage to their brains, children’s health suffers in two other ways: The over-production of the stress hormone cortisol damages their immune response system, leading to illness and chronic diseases that can affect them immediately and/or emerge when they’re adults. These diseases include asthma, obesity, cancer, heart disease, autoimmune diseases, etc. And to cope with the anxiety, depression, frustration, anger, etc. caused by toxic stress from ACEs, children grow into adults who drink too much alcohol or become addicted to other drugs or activities such as shopping, or who overeat, rage, engage in thrill sports, and even overachieve (workaholism), all of which can also contribute to poor health.

These same behaviors — bullying, emotional abuse, racist or religious discrimination, physical abuse and/or witnessing others being hurt — can harm adults, too. Depending on the number of the ACEs they experienced, the duration and when they occurred, the nurturing they received when they were growing up, or the healing that they experienced, adults can be triggered into reliving those same experiences virtually, with the same fight, flight or freeze responses, and, in absence of healthy behaviors, the same harmful coping behaviors. Adults carry these behaviors with them to shape how they interact with their co-workers, their children, and people in their community.

And so the cycle continues.

As we progress through these next few years, this knowledge about ACEs science helps us in two ways:

First, it helps us understand that our responses of fight, flight, or fear to current bullying, threats, and/or humiliation are normal and expected if we’ve had those experiences in our childhood. And one part of ACEs science — the CDC-Kaiser Permanente Adverse Childhood Experiences Study — as well as the dozens of subsequent ACE surveys completed by 32 U.S. states and several countries — show that most of us have had those experiences. It helps us recognize that anger, though useful to motivate, will harm us if we don’t move through it to constructive – not destructive — action. Anger comes from survival brain, and we need to be in thinking brain (our prefrontal cortex), if we’re to make good decisions.

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Be worried about boys, especially baby boys

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We often hear that boys need to be toughened up so as not to be sissies. Parent toughness toward babies is celebrated as “not spoiling the baby.” Wrong! These ideas are based on a misunderstanding of how babies develop. Instead, babies rely on tender, responsive care to grow well—with self-control, social skills and concern for others.

A review of empirical research just came out by Allan N. Schore, called “All our sons: The developmental neurobiology and neuroendocrinology of boys at risk.”

This thorough review shows why we should be worried about how we treat boys early in their lives. Here are a few highlights:

Why does early life experience influence boys significantly more than girls?

  • Boys mature slower physically, socially and linguistically.
  • Stress-regulating brain circuitries mature slower in boys prenatally, perinatally and postnatally.
  • Boys are affected more negatively by early environmental stress, inside and outside the womb, than are girls. Girls have more built-in mechanisms that foster resiliency against stress.

How are boys affected more than girls?

  • Boys are more vulnerable to maternal stress and depression in the womb, birth trauma (e.g., separation from mother), and unresponsive caregiving (caregiving that leaves them in distress). These comprise attachment trauma and significantly impact right brain hemisphere development—which develops more rapidly in early life than the left brain hemisphere. The right hemisphere normally establishes self-regulatory brain circuitry related to self control and sociality.
  • Normal term newborn boys react differently to neonatal behavior assessment, showing higher cortisol levels (a mobilizing hormone indicating stress) afterward than girls.
  • At six months, boys show more frustration than girls do. At 12 months boys show a greater reaction to negative stimuli.
  • Schore cites the research of Tronick, who concluded that “Boys . . . are more demanding social partners, have more difficult times regulating their affective states, and may need more of their mothers support to help them regulate affect. This increased demandingness would affect the infant boys’ interactive partner” (p. 4).

What can we conclude from the data?

Boys are more vulnerable to neuropsychiatric disorders that appear developmentally (girls more vulnerable to disorders that appear later). These include autism, early onset schizophrenia, ADHD, and conduct disorders. These have been increasing in recent decades (interestingly, as more babies have been put into daycare settings, nearly all of which provide inadequate care for babies).

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From hell to healing: A survivor’s journey

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Malcolm Aquinas

It was a sweltering day in the summer of 1987 in Limestone County, Alabama. The air, thick with humidity, sapped what little strength remained from already heat-wearied bodies; the chittering of bush crickets rose as the sun sank.

Following 11 hours of clearing hillside with a sling blade at the Elk River State Park, I let my thoughts wander while resting my right arm on the window frame of my father’s pickup truck, grateful for the air rushing against me. He and my stepmother, Louise, were continuing a disagreement they’d begun some time earlier about the whereabouts of a frying skillet.

The combination of fatigue and stifling heat dulled my usual hypervigilance around my father, so my response to Louise’s seemingly innocent question, “Don’t you remember your Daddy using the skillet last?” was unusually honest and unfiltered.

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Putting resilience and resilience surveys under the microscope

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“Resilience is a message of hope,” says Debbie Alleyne, a child welfare specialist at the Center for Resilient Children at Devereux Advanced Behavioral Health, located in Villanova, PA.“It is important for everyone to know that no matter their experience, there is always hope for a positive outcome. Risk does not define destiny.”

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The most important thing I didn’t learn about in medical school: Adverse childhood experiences

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Dr. Nancy Hardt

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The most important thing I didn’t learn in medical school is about adverse childhood experiences, also known as ACEs.

To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes.

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Years after juvenile detention, adults struggle, study finds

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By Jeremy Loudenback

Children who have been admitted to a juvenile detention center often struggle with a range of issues years after being detained, according to results from a study published in JAMA Pediatrics.

The longitudinal study affords a rare look at how youth who experienced juvenile detention fared in terms of eight positive outcomes five and 12 years after detention.

The eight domains included the following: educational attainment, residential independence, gainful activity, desistance from criminal activity, mental health, abstaining from substance abuse, interpersonal functioning, and parenting responsibility.

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Just one year of child abuse costs San Francisco, CA, $300 million….but it doesn’t have to

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In 2015, 5,545 children in San Francisco, CA, were reported to have experienced abuse. Of those, the reports of 753 children were substantiated. The expense to San Francisco for not preventing that abuse will cost $400,533 per child over his or her lifetime. That adds up to $301.6 million for just that one year, according to “The Economics of Child Abuse: A Study of San Francisco.”

And, because child abuse is profoundly underreported, the costs are likely to be as much as $5.6 billion for one year of children experiencing trauma, the report found.

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