Adverse childhood experiences recognized as risk factors
The impact of adverse childhood experiences (ACEs) was first examined in 1995 by the Centers for Disease Control and Prevention (CDC). Over 17,000 Southern California participants – over 46 percent age 60 and older – responded to the two-year study. Among its major findings: Two-thirds of the participants said they had at least one ACE, and one in five reported three or more ACEs. ACEs increase the risk of various health issues such as heart disease, liver disease, alcoholism, and domestic violence.
“I didn’t learn about this in medical school or residency,” said Nadine Burke Harris, a San Francisco-based pediatrician and children’s health advocate, during her appearance at the Westminster Town Hall Forum in downtown Minneapolis on April 10.
A couple of years after Harris, current U.S. Senator Kamala Harris [no relation], and others studied this in a San Francisco neighborhood primarily populated by Blacks, Pacific Islanders and Latinos, she founded in 2012 the Center for Youth Wellness in San Francisco, which researches the impact of ACEs on long-term health behavior.
Harris, renowned as a national expert in childhood adversity and trauma, published her first book earlier this year, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. She told the audience, “Every pediatrician in America needs to be screening for ACE,” adding that only an estimated four percent of U.S. pediatricians currently are doing this.”
Her goal is to see that every doctor by 2028 “is screening for ACEs,” Harris said.
An ACEs self-test is included in Harris’ book, and the CDC website also has links to testing and determining a personal ACEs score. The higher the score, the higher a person’s risk for various health problems later in life.
“I am not a mental health specialist. I’m a pediatrician,” Harris stressed. While examining her child patients, she recalled, “I started noticing a disturbing trend. Lots of kids were being referred to me for ADHD. But when I did what I was trained to do, when I did a thorough [medical] history and physical exam, for most of my patients, I couldn’t make a diagnosis of ADHD.”
What she found, instead, was that many children were exposed “to the highest rates of adversity,” she continued. “Kids were being exposed to abuse, living in homes with caregivers that were co-dependent [on drugs and/or alcohol].
“When I saw the stress on my patients…and their history of adversity, their behavior and health problems, I threw myself into the research and science. What I found completely changed my medical practice and ultimately changed my career.”
It is important that physicians and other health practitioners are “able to recognize that what happens in a child’s earliest days put us on a trajectory for a life and health outcomes… We need to make sure early that that trajectory is a strong and healthy one,” Harris said. “Children are especially sensitive… Their brain and body are just developing.”
Regular exercise, good hygiene and proper nutrition, along with a safe, secure home environment “helps to reduce stress hormones…and helps our brains,” Harris said.
During the audience Q&A, Harris was asked if ACEs are generational. “I have never come across a patient who has significant adverse childhood experiences that didn’t also have” a family member with the same experiences, she responded.
“We can break this intergenerational cycle, but in order to do that, we need to take a two-generational approach. We need to support not only the children, but also their caregivers. Their understanding of their ACEs can affect their parenting.
“What is traumatic to children is also traumatic to their parents. It affects the entire family,” Harris stressed. “Whether you’re young or old, these are difficult conversations.”
Asked if racism can be included among the factors of ACEs, Harris told the MSR, “What we understand is that…the threat the individual faces because of race also activates the same biological response [as traditional risk factors] and puts an individual’s health at risk. We now understand that race is a risk factor.”
Harris’ advice to doctors, parents, teachers and others when children are having problems either at home or school is, “Instead of looking at these kids and saying, ‘What’s wrong with you?’ begin to look at them and ask, ‘What happened to you?’”
For more information, visit the CDC website at www.cdc.gov.
Charles Hallman is a contributing reporter and award-winning sports columnist at the Minnesota Spokesman-Recorder.