Childhood trauma's impact on the developing brain
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Transcript of Childhood trauma's impact on the developing brain
Early Brain Development + Adverse Childhood Experiences x
Advocacy = Proac;ve prac;ces for children and families most in need of support
Most material developed by the Early Brain and Child Development Leadership Workgroup
A program of the American Academy of Pediatrics
Rosemary L. Wilson, LMSW Early Childhood Comprehensive Systems Coordinator
Department of Health and Environmental Control
CT SC Home Visiting Summit – September 2014
The Adverse Childhood Experiences Study– the Largest Public Health Study You Never Heard Of Jane Ellen Stevens Huffington Post
Excessive Stress Disrupts the Architecture of the Developing Brain Center on the Developing Child Harvard University
Community Members Gather to Fight Adverse Childhood Experiences United Way of East Central Iowa
How Much Could We Improve Children’s Life Chances by Intervening Early and Often? CCF Brief #54 Brookings
“Change the First Five Years and You Change Everything”
h4p://www.youtube.com/watch?v=GbSp88PBe9E
The architecture of the brain depends on the mutual influences of the following
• GeneGcs • Environment • Experience
The Biology of Health
Source: NaGonal ScienGfic Council on the Developing Child, Working Paper 5, The Timing and Quality of Early Experiences Combine to Shape Brain Architecture. Center on the Developing Child at Harvard University.
Shaping the Capacity of the Brain • The interacGve influences of genes and experiences shape the architecture of the developing brain
• Brains are built from the bo4om up
Why Early Experiences MaDer
Newborn Brain Average Weight
333 grams
2 Year Old’s Brain Average Weight
999 grams Brain photo courtesy IsaacMao, Flickr
Trauma leaves tracks in the
developing brain
Source: Bruce Perry, MD, PhD, Child Trauma Academy
Early Stress
What is the Adverse Childhood Experiences (ACE) Study?
The largest study of its kind that looks at the health and social effects of adverse
childhood experiences over a lifespan.
What is the Adverse Childhood Experiences (ACE) Study?
Study participants were middle-class Americans from San Diego, 80% white, 74% attended college,
average age of 57, split evenly between men and women.
NOTE: Not exactly an impoverished or “at-risk population”
Prevalence of Adverse Childhood Experiences
Adverse Childhood Experiences
• Physical, sexual or emoGonal abuse
• Physical or emoGonal neglect • Household mental illness • Living in a household with
substance abuse • Having a parent/caregiver divorce
or separate • Exposure to domesGc violence • Living in a household where a
member was or has been incarcerated
ACE Score (1 point for each category listed)
Prevalence in Study
0 33%
1 26%
2 16%
3 10%
4 6%
5 5%
Data from : www.cdc.gov/nccdphp/ace/
We know that: Early Adverse Experiences (ACEs) contribute directly to the risk for long-term physical and mental health.
U.S. Dept. Health and Human Services, 2010
As the ACE Score increases, the risk of the following health problems increases:
Health Problems • Alcoholism/alcohol abuse • STDs • COPD • Depression • Fetal death • Health related QOL • Liver disease • Smoking • Unintended pregnancy • Suicide attempts • Intimate partner violence • Ischemic heart disease
ACE Score Women Men
0 35% 38%
1 25% 28%
2 16% 16%
3 10% 9%
4 or more 15% 9%
Data from : www.cdc.gov/nccdphp/ace/
Number of Risk Factors
Source: Center on the Developing Child Harvard University. InBrief: the Impact of Early Adversity on Children’s Development. Statistics from research from Barth, et al. (2008)
Chi
ldre
n w
ith
Dev
elop
men
tal
Del
ays
1-2 3 5 4 6 7
20%
40%
60%
80%
100%
Significant Adversity Impairs Development in the First Three Years
Slide modified from V. J. Felic
Why are ACEs important?
Significant adversity in childhood is strongly associated with unhealthy lifestyles and
poor health decades later.
ACEs
Skeletal Fractures
Relationship Problems
Smoking
General Health and Social Functioning
Prevalent Diseases
Sexual Health
Risk Factors for Common Diseases
Hallucinations
Mental Health
ACEs Impact Multiple Outcomes
Difficulty in job performance
Married to an Alcoholic
High perceived stress
Alcoholism
Promiscuity
Illicit Drugs
Obesity
Multiple Somatic Symptoms
IV Drugs
High Perceived Risk of HIV
Poor Perceived Health
Ischemic Heart Disease Sexually
Transmitted Diseases
Cancer Liver Disease
Chronic Lung Disease
Early Age of First
Intercourse Sexual Dissatisfaction
Unintended Pregnancy
Teen Pregnancy
Teen Paternity Fetal Death
Depression
Anxiety
Panic Reactions
Sleep Disturbances
Memory Disturbances
Poor Anger Control
Poor Self-Rated Health
ACEs are common– in fact the number of
people affected by ACEs outnumbers those who
have not been affected by ACEs.
ACEs are not desGny, and early trauma does not have to dictate a
life story
Slide modified from V. J. Felec
What happens early can change lives . . .
The social and physical environment can serve as a buffer to these “bad things.”
ACEs and the Brain Early nurturing, responsive interacGons build healthy brain architecture that serves as the
foundaGon for health and well-‐being.
How You Can Build the Founda;on for Healthier Lives
If Toxic Stress is the missing link between ACE exposure and poor adult outcomes, we need to know: • Are there ways to:
– treat, – mi;gate, and/or – immunize against the effects of toxic stress?
Resilience is the capacity to thrive in both good ;mes
and difficult ones. And it can be built and nourished at any age, in every human being.
Resilience isn’t just a gift of nature or an exercise of will;
resilience grows through positive experiences,
supportive environments and the caring intervention of others.
http://communityresiliencecookbook.org/
Safe, Stable, Nurturing Relationships and Environments became The CDC strategic direction for child maltreatment prevention and their vision for what we want for all children
Essentials for Childhood is the broad “umbrella” for all of CDC child maltreatment work Essentials for Childhood – Steps to Create Safe, Stable, and Nurturing Relationships document
SAFE, STABLE, NURTURING RELATIONSHIPS (SSNRs)
http://www.cdc.gov/violenceprevention/childmaltreatment/essentials
• Safety: The extent to which a child is free from fear and secure from physical or psychological harm within their social and physical environment • Stability: The degree of predictability and consistency in a child’s social, emotional, and physical environment • Nurturing: The extent to which a parent or caregiver is available and able to sensitively respond to and meet the needs of their child
Essentials for Childhood (EfC)
• A document that proposes strategies that communities can consider to promote Safe, Stable, Nurturing Relationships (SSNRs) and Environments
• Steps for promoting SSNRs are suggested in four goal areas: – Raise Awareness and Commitment to Support SSNRs and Prefent Child
Maltreatment – Use Data to Inform Solutions – Create the context for Healthy Children and Families through Norms Change
and Programs – Create the Context for Healthy Children and Families through Policies – Currently available Public Health Leadership Toolkit http://veto violence.cdc.gov./childmaltreatment/phl/ Media sources, ACEs infographic: Videos
Increasing Effectiveness Through Moving from Isolated Impact to Collective Impact: Fundamentally different, more disciplined, and highly structured and higher performing approach to large scale social impact than other types of collaboration
Promote the Five R’s of Early Childhood Educa;on
• Reading together as a daily family acGvity • Rhyming, playing, talking, singing and cuddling together ohen
• Rou;nes and regular Gmes for meals, play and sleeping, which help children know what they can expect and what is expected of them
• Rewards for everyday successes, realizing that praise from those closest to a child is a very potent reward
• Rela;onships that are reciprocal, nurturing and enduring are the foundaGon of healthy child development
EffecGve Treatments for Childhood Adversity
Treatments that have been designed specifically to address toxic stress and trauma are the most effective. Including parents in treatment is important in helping the child “practice” new therapeutic strategies at home and creating a more stable, supportive environment. Evidence-based treatments include: Child-Parent Psychotherapy (CPP) – seeks to heal the effects of stress on young children through helping the parent and child develop a more positive relationship, regulate affect and behavior, and alter unhealthy behavior patterns and beliefs Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb
EffecGve Treatments for Childhood Adversity Trauma-Focused Cognitive Behavioral Therapy –
includes stress management and relaxation skills; techniques to help children deal with emotional dysregulation; cognitive coping skills to help them recognize the relationship between current thoughts, feelings and behaviors, and traumatic experiences; and guidance in developing a trauma narrative to process what happened during traumatic experiences Attachment, Self-Regulation, and Competency (ARC) uses a variety of treatments and services to address three key areas that are affected by trauma -- attachment, self-regulation and competency –and are important for resiliency In addition, medications are sometimes used to relieve symptoms such as depression, sleeping difficulties and anxiety. Source: Toxic Stress and Trauma-Informed Pediatric Care By Elaine Gottlieb
Public Investment in Children by Age
The Heckman Equa;on
Source: heckmanequation.org
“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths.” —Elisabeth Kübler-Ross, Psychiatrist & Author
Videos for HV PresentaGon
h4ps://www.youtube.com/watch?v=zQZnO0Mr_vY&feature=youtu.be
h4p://billmoyers.com/episode/full-‐show-‐maya-‐angelou-‐on-‐facing-‐evil/
Thanks for listening!
Rosemary L. Wilson, LMSW DHEC – Early Childhood Comprehensive Systems
“How wonderful it is that nobody need wait a single moment before starting to improve the world.” —Anne Frank