Exploring the Relationship: Aces, Toxic Stress, and Early Childhood · 2017-04-26 · Toxic stress...
Transcript of Exploring the Relationship: Aces, Toxic Stress, and Early Childhood · 2017-04-26 · Toxic stress...
Exploring the Relationship: Aces,
Toxic Stress, and Early
Childhood
Presented by Project CLIMB and CCHAP:
Bridget Burnett, PsyD,
and Ayelet Talmi, PhD
• Overview of Aces
• Definition of Toxic Stress
• Relationship between ACES and Child
Development
Caregiver Substance Use
Family Violence
Goals for Today’s Discussion
Property of Drs. Talmi & Burnett; Do not replicate without permission
ADVERSE CHILDHOOD
EXPERIENCES AND
ENVIRONMENTS
Property of Drs. Talmi & Burnett; Do not replicate without permission
Adverse Childhood Experiences Study
(ACES) http://www.cdc.gov/ace/pyramid.htm
Property of Drs. Talmi & Burnett; Do not replicate without permission
Adverse Childhood Experiences Study
(ACES) http://www.cdc.gov/ace/pyramid.htm
Abuse
• Emotional Abuse
• Physical Abuse
• Sexual Abuse
Neglect
• Emotional Neglect
• Physical Neglect
Household Dysfunction
• Mother Treated
Violently
• Household Substance
Abuse
• Household Mental
Illness
• Parental Separation or
Divorce
• Incarcerated Household
Property of Drs. Talmi & Burnett; Do not replicate without permission
Stress Continuum(Center for the Developing Child, Harvard)
Positive stress response normal and
essential part of healthy development, brief
increases in heart rate and mild elevations in
hormone levels.
Tolerable stress response activates the
body’s alert systems to a greater degree as a
result of more severe, longer-lasting
difficulties. Time-limited activation that is
buffered by relationships with adults who
help with adaptation and recovery.Property of Drs. Talmi & Burnett; Do not replicate without permission
Toxic Stress(Center for the Developing Child, Harvard)
Toxic stress response can occur with the
experience of strong, frequent, and/or
prolonged adversity without adequate
adult support. Prolonged activation of the
stress response systems can disrupt the
development of brain architecture and other
organ systems, and increase the risk for
stress-related disease and cognitive
impairment.
Key concepts
• Chronic stress vs tolerable/positive stress
• Increased health risk factors
• Buffering relationships
• Importance of early detection to prevent
Average child under age 6 had ACE score of
1.94
Additional 1.54 added between age 6 & 12
Additional 1.15 added between ages 12 &
16
Property of Drs. Talmi & Burnett; Do not replicate without permission
Colorado Adult ACES Score
Data• 20% of Adults in Colorado surveyed had
2 or 3 ACES
• 13% had 4+ ACES
• Watamura, S.E., 2016. Report prepared
for the Office of Early Childhood, State of
Colorado.Property of Drs. Talmi & Burnett; Do not replicate without permission
Colorado Children in Early
Head Start • 29.7% had a Parental score of 2 or 3 ACES
• 32.4% had a Parental score of 4+ ACES
• Of the children with 4+ Parental ACES
• *21.9% had diagnosis of ADD/ADHD
• *17.3% had a diagnosis of Anxiety disorders
• *12.8% had Externalizing Behaviors
• Watamura, S.E., 2016. Report prepared for the Office of Early Childhood, State of Colorado.
Property of Drs. Talmi & Burnett; Do not replicate without permission
Caregiver Substance Use Disorders (SUDs)
and Child Mental Health
Mental health problems experienced by children of parents with SUDs can include:
• Anxiety disorders
• Attention-deficit/hyperactivity disorder
• Depression
• Oppositional defiant disorder
• Conduct disorder
• Truancy
• Trauma and stress-related disorders
http://pediatrics.aappublications.org/content/138/2/e20161575
Property of Drs. Talmi & Burnett; Do not replicate without permission
Caregiver substance abuse and
impacts on the child
• A high absenteeism rate
• Impaired attention
• Which compromise their academic productivity
• Behavior problems place children at greater risk of
suspension or expulsion from school.
http://pediatrics.aappublications.org/content/138/2/e20161575
Property of Drs. Talmi & Burnett; Do not replicate without permission
Healthcare and Family
Violence• Clinical studies have proven the
effectiveness of abuse screening by
doctors
• Only 10% of doctors screen for abuse
during new-patient visits
• Only 9% screen for abuse during
periodic checkups.
Property of Drs. Talmi & Burnett; Do not replicate without permission
Short-term reactions/effects of
exposure to family violence• Generalized anxiety
• Sleeplessness
• Nightmares
• Difficulty concentrating
• High activity levels
• Increased aggression
• Increased anxiety about being separated from a parent
• Intense worry about their safety or the safety of a parent
• http://www.nctsn.org/content/children-and-domestic-violence
Property of Drs. Talmi & Burnett; Do not replicate without permission
Long-term effects of exposure
to family violence
• Physical health problems
• Behavior problems in adolescence (e.g.,
juvenile delinquency, alcohol, substance
abuse)
• Emotional difficulties in adulthood (e.g.,
depression, anxiety disorders, PTSD)
• http://www.nctsn.org/content/children-
and-domestic-violence
Property of Drs. Talmi & Burnett; Do not replicate without permission
Case Example
A 2 month old presents for well child check up with both parents.
During the course of regular screening for second hand smoke
family discloses that they smoke marijuana in the bathroom a few
times a day. With further questioning they say they ‘take turns’ so
that baby is not alone and not exposed. Both parents seemed to:
Answer questions a little slowly
Appeared to be high
• What would you say next?
• What would you do next?
Property of Drs. Talmi & Burnett; Do not replicate without permission
What to do? The right dosage
of an intervention• Psychosocial Screening, response and referrals in Early
Childhood
• Good nutrition
• Exercise / Physical activity
• Sleep
• Mental Health treatment
• *Supportive Relationships*
Property of Drs. Talmi & Burnett; Do not replicate without permission
Resources: Nadine Burke
Harris Ted Talk And CDC• https://www.ted.com/talks/nadine_burke_
harris_how_childhood_trauma_affects_h
ealth_across_a_lifetime?language=en
• https://www.cdc.gov/violenceprevention/a
cestudy/
Resources
DV and Family Violence:
• Prevention tools: PREP
• Direct Intervention
• http://www.nctsn.org/content/children-and-domestic-violence
• Groves, Augustyn, Lee, Sawires. 2004. Identifying and Responding to
Domestic Violence Consensus Recommendations for Child and
Adolescent Health, Provided by Family Violence Prevention
• Maternal Domestic Violence Screening in an Office-Based Pediatric Practice
http://www.pediatrics.org/cgi/content/full/108/3/e43
Resources Continued:
Substance Abuse:
• http://pediatrics.aappublications.org/content/138/2/e20161575
• Prenatal Exposure and Effect on Children SAMHS Resource Guide
https://ncsacw.samhsa.gov/resources/annotatedbiblio/Perinatal_Prenatal.aspx
• Substance Exposed Infants State Responses to the Problem
https://www.ncsacw.samhsa.gov/files/Substance-Exposed-Infants.pdf
• Substance Abuse Treatment
• Center For Recovery-Lois Leder-IOP substance abuse for 14.5-18.5 303—694-7492
• Arapahoe House-substance abuse-303-657-3700
• ARTS substance abuse and research program 303-388-5894
• Cornerstone substance abuse treatment 720-540-0961
Acknowledgements
• Child Health Clinic, Children’s Hospital Colorado
• Project CLIMB Team
• BHIPP:0-5 Technical Assistance Team
• University of Colorado School of Medicine
Departments of Psychiatry and Pediatrics
• Children’s Hospital Colorado Pediatric Mental
Health Institute
• Irving Harris Program in Child Development and
Infant Mental Health
• Colorado Children’s Healthcare Access Program