The quest to find biomarkers for toxic stress, resilience in children — A Q-and-A with Jack Shonkoff

The JPB Research Network on Toxic Stress, led by Dr. Jack Shonkoff, is working on developing biological and behavioral markers for adverse childhood experiences (ACEs) and resilience that they believe will be able to measure to what extent a child is experiencing toxic stress, and what effect that stress may be having on the child’s brain and development.

The JPB Research Network on Toxic Stress is comprised of scientists, pediatricians and community leaders, and is a project of the Center on the Developing Child at Harvard University.

Jack P. Shonkoff, M.D. is the Julius B. Richmond FAMRI Professor of Child Health and Development at the Harvard T.H. Chan School of Public Health and Harvard Graduate School of Education; Professor of Pediatrics at Harvard Medical School and Boston Children’s Hospital; and Director of the Center on the Developing Child at Harvard University. He currently chairs the National Scientific Council on the Developing Child, whose mission is to bring credible science to bear on public policy affecting children and families, and The JPB Research Network on Toxic Stress. In 2011, he launched Frontiers of Innovation, a multi-sector R&D platform committed to achieving breakthrough outcomes at scale for young children facing adversity.

Dr. Shonkoff was interviewed by filmmaker Roger Weisberg about the innovations in research around developing ways of measuring toxic stress in Weisberg’s documentary Broken Placeswhich will be previewed at the National ACEs Conference. That interview was the impetus for the following conversation.

Laurie Udesky: In your interview with the filmmaker Roger Weisberg for the documentary Broken Places you said:

“We will have a measure to be able to differentiate between children who seem to be more sensitive to adversity and therefore need more attention. And at the same time this will be a measure of resilience because there are a lot of children living in very tough environments who are doing well and whose parents are doing a magnificent job. That’s the big breakthrough. It’s being able to measure this at an individual level.”

Laurie Udesky: Where is the science now in our ability to measure and differentiate children with ACEs who are more sensitive to adversity from those who are less so? 

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Dr. Jack Shonkoff

Dr. Jack Shonkoff: It’s very close; the measurement battery we’re working on is no more than a couple of years away from being ready to start being used widely in pediatric settings.

Basically what we’re talking about is the JPB Research Network on Toxic Stress, and I direct that group standing on the shoulders of a dream team of scientists, and a dream team of practicing pediatricians, and a dream team of community leaders, primarily community leaders of color, who have collectively been working together three and a half years now as coequal partners on this. And the reason that’s important is because there’s obviously a scientific dimension to this, which

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Oakland, CA, trying out model used in Baltimore to reduce trauma, increase resilience

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Baltimore BSC faculty and planning team

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When a group of community organizations in Baltimore came together in 2015, they already knew trauma figured large in many lives. There was violence in the community, in schools, and in community members’ homes. Police brutality occurred. Many suffered the loss of loved ones to incarceration or death. There were house fires and homelessness. Much of the dysfunction was systemic and rooted in racism, according to a report on a collaborative effort to restructure city organizations and agencies. The goal was to build community resilience.

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Study shows most pregnant women and their docs like ACEs screening

Would pregnant women participate in surveys from their doctors asking them about whether they had experienced trauma in their childhood? In surveying moms-to-be at two Northern California Kaiser sites, clinicians discovered that the women were receptive to filling out an adverse childhood experiences (ACE) survey, according to a study that was published earlier this year in the Journal of Women’s Health.

In fact, researchers found out that the vast majority of pregnant women — 91 percent of the 375 women— were “very or somewhat comfortable,” filling out the ACE survey. Even more, 93 percent, said that they were comfortable talking about the results with their doctors. The women were surveyed from March through June 2016 at Kaiser Permanente clinics in Antioch and Richmond, CA.

ACE refers to the groundbreaking CDC/Kaiser Permanente Adverse Childhood Experiences Study that tied 10 types of childhood trauma, including living with an alcoholic family member or experiencing verbal abuse from a parent, to a host of health consequences. (Got Your ACE Score?)

The higher the number of ACEs that people have, researchers learned, markedly increases their risk for poor health outcomes, as well as social and economic consequences. Having four ACEs, for example, nearly doubles a person’s risk for heart disease and cancer, raises the risk of attempted suicides by 1200 percent and alcoholism by 700 percent.

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Early childhood educators learn new ways to spot trauma triggers, build resiliency in preschoolers

Julie Kurtz, co-director, trauma-informed practices in early childhood education, WestEd Center for Child & Family Studies/photo by Laurie Udesky

A hug may be comforting to many children, but for a child who has experienced trauma, it may not feel safe.

That’s an example used by Julie Kurtz, co-director of trauma-informed practices in early childhood education at the WestEd Center for Child & Family Studies (CCFS), as she begins a trauma training session. Her audience, preschool teachers and staff of the San Francisco, CA-based Wu Yee Children’s Services at San Francisco’s Women’s Building, listen attentively.

Kurtz leads them into a description of how a child’s young brain functions, how young children – regardless of whether they have experienced trauma or not — live in their reptile brain.

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Tonier Cain Deserves an Evidence-Based Apology

Tonier Cain. Photo: Yi-Chin Lee/USA TODAY NETWORK-Wisconsin

Editor’s note: Over 15 years, Tonier Cain was arrested 83 times, and convicted 66 times. She was addicted to crack. She was a prostitute. She had four children and lost them to child protective services. Remarkably, she didn’t give up hope, and one day, she found someone in the system who knew about trauma and who didn’t give up on her. Cain now advocates for trauma-informed care in prisons and mental health facilities. She gives speeches around the country and the world. Cissy White was fortunate to attend a conference in North Carolina where Cain gave a presentation. This is Cissy’s reaction.
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When Tonier Cain gave a keynote presentation at the Benchmarks’ Partnering for Excellence conference in North Carolina, it took me months to recover from her speech.
Seriously. It was hard to stand after she spoke. When I did, I went right to a yoga mat in the self-care calm room for a while. I took off my high heels and curled up in a ball for a bit.
I’m still digesting her words. It’s not that the content was intense and heavy, though it was. It wasn’t that she talked about a ton of traumatic experiences she had survived – though she did.

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ACEs science can prevent school shootings, but first people have to learn about ACEs science

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David Hogg, a senior at Marjory Stoneman Douglas High School, speaks at a rally calling for more gun control. Photo by Jonathan Drake / Reuters

After 17 people, mostly teens, were shot and killed by another teen last week in Parkland, FL, what seems to be a real movement is growing, propelled by kids devastated by their friends’ deaths and wanting to prevent such a massacre from ever happening again.

Their rallies and marches and lie-downs probably won’t have much effect in the short-term, as some of the Parkland teens learned as they witnessed — and some of them wept during — today’s lightning vote by state lawmakers along party lines to end debate on an assault weapons ban, which killed any further consideration of the bill in the Florida legislature’s current session.

But their persistence can make a difference in the long run, especially if they — and we — widen this to include the dozens of kids shot on the streets of Chicago or Camden or in other communities every week. We can even broaden the approach to include the 200 people, including many children, who died in Syrian air strikes in the last two days, because the roots and solutions are the same.

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Dozens of Kaiser Permanente pediatricians in Northern California screening three-year-olds for ACEs

kidsSince August 2016, more than 300 three-year-olds who visit Kaiser Permanente’s pediatric clinics in Hayward and San Leandro have been screened for adverse childhood experiences (ACEs), such as living with a family member who is an alcoholic or losing a parent to separation or divorce. But when the idea to screen toddlers and their families for ACEs was first broached at the Kaiser Permanente Hayward Medical Center, the staff were, in a word, “angsty,” says Dr. Paul Espinas, who led the effort.

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