Addressing childhood traumas and their lifelong implications

The research is unequivocal: children who experience physical or emotional abuse or neglect; witness domestic violence; live with family members with mental illness, substance abuse, or an absent parent due to separation, divorce or incarceration - in other words, children who have adverse childhood experiences (ACEs) - often struggle in school and grow into adults who are at risk for a range of health issues including heart, lung and liver disease, cancer, and obesity, and as a result are more likely to encounter an early death.

A groundbreaking study by the federal Centers for Disease Control and Prevention, and also Kaiser Permanente, a California based health maintenance organization, discovered the link between ACEs and chronic health issues in adults nearly 20 years ago.

The study also found childhood adversity is more the rule than the exception. Its subjects were predominantly white, middle income; people considered by many to be the healthiest in the U.S. Yet, two-thirds of the 17,000 people in the original ACEs study had at least one adverse childhood experience; one in six reported at least four.

Of the participants, 28 percent reported experiencing physical abuse and 21 percent sexual abuse. Many also reported that their parents had divorced or separated, or a parent had mental illness and/or substance use disorder. Researchers also learned that the greater the exposure to these experiences the greater the likelihood of health problems, and social, and behavioral issues later in life.

ACEs affect health and behavior by keeping the body and mind in a state of hypervigilance - ready and waiting for trouble. The body responds by releasing stress hormones, creating immediate physical, emotional, and behavioral reactions - the fight or flight response.

Since the original study, other experiences and social conditions have been recognized as contributing to childhood adversity. According to the Centers for Disease Control, these cluster into several categories including family disorganization or dissolution, parent military deployment, and being witness to domestic violence, particularly against the mother.

Other sources of childhood distress include disordered community life such as high rates of poverty, housing instability, and unemployment. For every disturbing story or trend reported in the news, there is a child in distress.

Pediatricians have been galvanized. Robert W. Block, MD, FAAP, former president of the American Academy of Pediatrics has been widely quoted: “Children’s exposure to adverse childhood experiences is the greatest unaddressed public health threat of our time.” This month, the Academic Pediatric Association devotes its entire journal to the topic.

It is not just physicians who are dealing with the impact of ACEs; teachers and schools are too.

Children can’t leave trauma at home; their attempts to cope can affect their learning and also put them at odds with schools’ disciplinary practices. Children whose minds are consumed with worry and whose bodies are ready to fight or flee are not ready to learn.

In our own community, Worcester HEARS (Healthy Environments and Resilience in Schools), a pilot project in five Worcester public schools, is bringing together advances in brain science, child development and best practices to address childhood adversity. It’s also helping children develop the social and emotional skills that will enable them to thrive in a complex world.

Funded by multi-year grants from The Health Foundation of Central Massachusetts and the Fred Harris Daniels Foundation, Worcester HEARS includes training for all the adults in the five project schools. They’re learning to understand how ACEs influence children’s behavior and new ways to respond.

Graduate level courses at Lesley University in Cambridge on social emotion learning and restructuring school environments are available for teachers and administrators in the pilot schools; so far 18 administrators and 27 teachers have completed two courses.

The project also supports the up-fitting of a new health center at Worcester East Middle School which will be administered by Family Health Center of Worcester.

Worcester HEARS focuses on creating supportive school environments and on changing adult behavior to better cultivate supportive relationships with children. Changing the focus from “problem students” to changing adult behavior has been a challenge, admitted one school principal. Now, instead of seeing discipline problems, school personnel are learning how to respond to with a new way of interacting with students.

Mindfulness practices have been adopted by all the elementary schools in the pilot project; 170 school staff members were trained in the evidence-based MindUp curriculum. When surveyed, 93 percent of teachers reported that their classes are using MindUp one or more times a week. By taking periodic breaks to quiet their minds, students are improving the way they learn.

Recognizing the pervasiveness of ACEs and their impact on the health and education of our community and, indeed, our nation is groundbreaking. For medical and educational practitioners the recognition of the immediate and long-term effects of ACEs can be transformational. There is much work ahead of us to address this public health and education crisis.

Janice B. Yost, Ed.D., of Worcester, is president of The Health Foundation of Central Massachusetts in Worcester; Margaret LeRoux, of West Boylston, is assistant director of the Worcester Education Collaborative.