tag:theconversation.com,2011:/us/topics/adverse-childhood-events-39153/articlesAdverse childhood events – The Conversation2024-03-19T12:26:43Ztag:theconversation.com,2011:article/2222452024-03-19T12:26:43Z2024-03-19T12:26:43ZHow much stress is too much? A psychiatrist explains the links between toxic stress and poor health − and how to get help<figure><img src="https://images.theconversation.com/files/579438/original/file-20240303-22-dk7t8p.jpg?ixlib=rb-1.1.0&rect=0%2C12%2C8348%2C5957&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Toxic stress increases the risks for obesity, diabetes, depression and other illnesses.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/depressed-man-covering-face-amidst-orange-rays-royalty-free-image/1227304528?phrase=stress+&adppopup=true">Klaus Vedfelt/Digital Vision via Getty Images</a></span></figcaption></figure><p>COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others. </p>
<p>So how much stress is too much, and what can you do about it?</p>
<p>I’m a <a href="https://researchdirectory.uc.edu/p/wulsinlr">psychiatrist specializing in psychosomatic medicine</a>, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues.</p>
<p>I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My <a href="https://www.cambridge.org/core/books/toxic-stress/677FA62B741540DBDB53E2F0A52A74B1">forthcoming book</a> is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.” </p>
<p>A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the <a href="https://doi.org/10.1097/PSY.0000000000001197">effects of smoking and low socioeconomic status</a>, two well-established risk factors for accelerated aging. </p>
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<figcaption><span class="caption">Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.</span></figcaption>
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<h2>The difference between good stress and the toxic kind</h2>
<p>Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit. </p>
<p>Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “<a href="https://www.penguinrandomhouse.com/books/313183/the-body-%20keeps-the-score-by-bessel-van-der-kolk-md/">The Body Keeps the Score</a>.” </p>
<p>The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface. </p>
<p>When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions.</p>
<p>For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors. </p>
<h2>‘Treating’ stress</h2>
<p>Though stress neuroscience in recent years has given researchers like me <a href="https://doi.org/10.1097/PSY.0000000000001051">new ways to measure and understand stress</a>, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan. </p>
<p>Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure. </p>
<p>Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during <a href="https://www.cdc.gov/violenceprevention/aces/ace-brfss.html">vulnerable periods such as childhood</a>. </p>
<p>Over the past 40 years in the U.S., the alarming rise in <a href="https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html">rates of diabetes</a>, <a href="https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf">obesity</a>, depression, PTSD, <a href="https://www.cdc.gov/nchs/products/databriefs/db433.htm">suicide</a> and addictions points to one contributing factor that these different illnesses share: toxic stress. </p>
<p>Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses. </p>
<h2>Suffering from toxic stress</h2>
<p>Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html">four or more adverse events in childhood</a>. This is the threshold for higher risk for illnesses in adulthood.</p>
<p>Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have <a href="https://doi.org/10.7249/TL221">four or more chronic illnesses</a>. If you have even one chronic illness, you can imagine how stressful four must be. </p>
<p>And about 12% of the U.S. population <a href="https://blogs.worldbank.org/opendata/introducing-second-edition-world-banks-global-subnational-atlas-poverty">lives in poverty</a>, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all. </p>
<p>Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress.</p>
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<figcaption><span class="caption">Exercise, meditation and a healthy diet help fight toxic stress.</span></figcaption>
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<h2>Recognizing and managing stress and its associated conditions</h2>
<p>The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a <a href="https://doi.org/10.1097/PSY.0000000000001051">self-reported measure of stress</a>. </p>
<p>The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, <a href="https://lifestylemedicine.org/">called “lifestyle medicine</a>,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate.</p>
<p>Adopting these lifestyle changes is not quick or easy, but it works. </p>
<p>The <a href="https://www.cdc.gov/diabetes/prevention/index.html">National Diabetes Prevention Program</a>, the <a href="https://www.ornish.com/">Ornish “UnDo” heart disease program</a> and the <a href="https://www.ptsd.va.gov/understand_tx/tx_basics.asp">U.S. Department of Veterans Affairs PTSD program</a>, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits.</p>
<p>There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.</p><img src="https://counter.theconversation.com/content/222245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lawson R. Wulsin received funding in 2010 from the Veterans Administration support a secondary analysis of data from the Framingham Heart Study, which was published and contributed in part to the substance of this article. </span></em></p>No one can escape stress, but sometimes it takes a physical and emotional toll that translates to disease and other health effects. The good news is that there are new approaches to treating it.Lawson R. Wulsin, Professor of Psychiatry and Family Medicine, University of Cincinnati Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2171792023-12-19T13:17:23Z2023-12-19T13:17:23ZWhy do some men commit domestic violence? Trauma and social isolation may play a role<figure><img src="https://images.theconversation.com/files/565296/original/file-20231212-23-6xbunh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Domestic violence is experienced unevenly across the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/argument-man-and-woman-having-an-argument-at-home-royalty-free-image/1321546697">kieferpix/iStock via Getty Images Plus</a></span></figcaption></figure><p>Support for survivors of domestic violence is important, but to end domestic violence once and for all, society needs to understand the people who perpetrate it and how to successfully intervene.</p>
<p>Domestic violence is very common in the United States. <a href="https://www.cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">Nearly half of women and men in the U.S.</a> experience sexual or physical violence, stalking or psychological harm or coercion in a romantic relationship during their lifetime. </p>
<p>Domestic violence is also experienced unevenly across the U.S population. Young people are most vulnerable, with <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">nearly three-fourths</a> of female victims reporting that their first experience of domestic violence occurred before age 25. <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">People of color</a> and <a href="https://cdc.gov/violenceprevention/pdf/nisvs/nisvsReportonSexualIdentity.pdf">LGBTQ+</a> <a href="https://doi.org/10.2105/AJPH.2020.305774">people</a> also experience considerably higher rates of domestic violence than the national average. And despite similar rates of domestic violence across men and women, women report <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">more severe effects on their lives</a>, including higher rates of injury and need for medical care, needing help from law enforcement and post-traumatic stress disorder symptoms.</p>
<p>I am a social worker who has spent the <a href="https://scholar.google.com/citations?user=OtG3yWgAAAAJ&hl=en">past 10 years studying</a> how men come to use violence against their intimate partners, since the <a href="https://cdc.gov/violenceprevention/pdf/nisvs/NISVSReportonIPV_2022.pdf">effects of their violence</a> is often the most severe. My research has found that consistent supportive relationships with attentive adults in childhood and adulthood, along with stress management that takes trauma into account, are two promising approaches to prevent domestic violence.</p>
<h2>The roots of domestic violence</h2>
<p>Understanding how someone comes to perpetrate violence is necessary to stop violence from happening in the first place.</p>
<p>Certain childhood experiences can put people at risk of committing domestic violence in the future. Researchers have found that child abuse, neglect and a <a href="https://doi.org/10.1016/j.avb.2015.06.001">negative parent-child relationship</a> are significant risk factors that may lead someone to later perpetrate domestic violence. </p>
<p>Experiencing trauma in early childhood can <a href="https://doi.org/10.1542/peds.2011-2663">alter the brain, how the body responds to stress</a> and whether someone sees the world as a <a href="https://doi.org/10.1177/1524838018791268">threatening, harmful and untrustworthy place</a>. For example, research has shown that people who have been exposed to trauma have increased activity in the amygdala of the brain, resulting in <a href="https://doi.org/10.1016/j.ynstr.2014.10.002">heightened fear and arousal</a> that can lead to aggressive responses in the face of conflict and stress. Trauma exposure is also linked to a <a href="https://doi.org/10.1016/j.jadohealth.2012.04.010">decrease in activity in the prefrontal cortex</a> – that’s the part of the brain responsible for impulse control, concentration and emotional reasoning. These are essential qualities to navigate interpersonal relationships. </p>
<p>Toxic stress – excessive or prolonged activation of the body’s stress response – happens when someone encounters constant threats to their physical or mental safety during sensitive developmental periods. Compared to their peers, youth facing <a href="https://doi.org/10.1542/peds.2021-054493">disproportionate levels of hardship</a> and threats of poverty, racism and other structural inequities are at greater risk for toxic stress. These bodily changes can set kids up for <a href="https://doi.org/10.1037/vio0000156">PTSD, depression</a>, and <a href="https://doi.org/10.1037/vio0000237">alcohol or drug abuse</a> later in life, which are some of the most common risk factors of perpetrating domestic violence. One study found that nearly one-third of men in a domestic violence intervention program <a href="https://doi.org/10.1111/famp.12533">reported clinical levels of PTSD</a>. </p>
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<a href="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Couple arguing in hallway of home" src="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565302/original/file-20231212-25-zhxfvd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There are ways to navigate complex emotional challenges without resorting to violence.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stressed-couple-arguing-blaming-each-other-royalty-free-image/1454529507">bymuratdeniz/E+ via Getty Images</a></span>
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<p>Beliefs about <a href="https://doi.org/10.1007/s10896-022-00451-0">traditional gender roles</a> dictating how men and women should act is another significant contributing factor to domestic violence. Unresolved trauma mixed with rigid gender views can limit the coping skills and tools people have to navigate complex emotional challenges in romantic relationships. For example, homes that promote rigid gender scripts, such as “boys don’t cry,” and limit opportunities to learn from activities that are considered “feminine,” like caring for baby dolls, can <a href="https://doi.org/10.1016/j.neuropsychologia.2011.12.022">stunt the emotional expression</a> of boys and make them less skilled in recognizing emotions in others and themselves. Anger typically becomes the most accessible emotion.</p>
<p>Certainly not all people who have faced childhood adversity and trauma are destined to perpetrate violence. Studies show that a <a href="https://doi.org/10.1177/1524838017692383">secure parent-child attachment</a> and the presence of safe, nurturing relationships and environments during childhood protect against future violence. Positive childhood experiences, such as feeling understood in difficult times and having at least two nonparental adults taking interest in your life, can help. One study of over 6,000 adults in Wisconsin found that those reporting <a href="https://doi.org/10.1001/jamapediatrics.2019.3007">three to five positive childhood experiences</a> were 50% less likely to have depressive symptoms or poor mental health days compared to those who had fewer or no positive childhood experiences.</p>
<p>Without these protective factors, however, many children are at risk of <a href="https://doi.org/10.1007/s00406-005-0624-4">carrying their trauma</a> into their adolescent and adult romantic relationships.</p>
<h2>Prevention and intervention</h2>
<p>Supporting the health and well-being of society calls for research-based efforts to prevent and address domestic violence. Responsive relationships, or relationships where the other person is attentive, attuned and supportive, are a key way to improve the well-being of children and adults, including the <a href="https://doi.org/10.1371/journal.pone.0235177">mental health of survivors</a> of abuse. </p>
<p>Researchers are paying more attention to the dangers of <a href="https://www.cdc.gov/aging/publications/features/lonely-older-adults.html">social isolation among adults</a>. This has been <a href="https://theconversation.com/curing-americas-loneliness-epidemic-would-make-us-healthier-fitter-and-less-likely-to-abuse-drugs-206059">exacerbated by cultural shifts</a> stemming from the COVID-19 pandemic, remote work and social media. Social isolation and unhealthy social networks can be <a href="https://doi.org/10.1016/j.ijintrel.2019.07.005">dangerous for victims of violence</a> and damaging for someone prone to committing violence because they can <a href="https://doi.org/10.3390/ijerph18083890">worsen mental health conditions</a> like PTSD. <a href="https://teamchangingminds.org/">Community-based programs</a> that build supportive social networks have the potential to improve mental health risk factors for perpetrating violence.</p>
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<a href="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person holding their hand on another person's shoulder in a supportive gesture" src="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565305/original/file-20231212-21-mlnsfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Supportive social networks are essential for mental health.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hand-of-young-supportive-man-consoling-his-friend-royalty-free-image/1430601013">shironosov/iStock via Getty Images Plus</a></span>
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<p>Most <a href="https://doi.org/10.1177/1524838018791268">domestic violence intervention programs for men</a> have not incorporated the understanding that trauma registers in the body as much as it does in someone’s way of thinking. These programs mostly focus on unlearning abusive tendencies and relearning healthy ways of engagement. This kind of approach includes using workbooks and thought exercises to identify abusive behaviors and thoughts about subjugating women, understand why they’re harmful, and learn healthy ways to resolve conflict. </p>
<p>However, focusing on cognitive thought processes as the primary mechanism for change by itself is insufficient for lasting change. In order to meaningfully alter the effects of trauma, interventions must also <a href="https://doi.org/10.1016/j.neubiorev.2023.105033">engage autonomic brain processes</a>. </p>
<p>Interventions that focus on <a href="https://doi.org/10.1177/1524838018791268">regulating stress and emotions</a>, such as deep breathing and mindfulness, can help address physiological symptoms of trauma and reset the body’s stress response. Resetting the body’s stress response can then help people engage in the higher-level learning necessary to adopt nonviolent thinking and behaviors and discard abusive tendencies.</p>
<p>Alleviating symptoms of PTSD and trauma in people who have perpetrated domestic violence may help them identify key triggers and develop the coping skills to respond to stress in healthier ways instead of violence.</p><img src="https://counter.theconversation.com/content/217179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Voith receives funding from the National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Human Development; the U.S. Department for Health and Human Services, Administration for Children and Families; and Victims of Crime Acts (VOCA), Office for Victims of Crime. </span></em></p>Childhood adversity can put people at risk of perpetrating domestic violence in the future. Having a supportive social network and learning ways to regulate the stress response, however, can help.Laura Voith, Associate Professor of Applied Social Sciences, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076622023-06-21T20:28:01Z2023-06-21T20:28:01ZFor some NBA draftees who overcame adversity, making the transition to fame and fortune is no slam dunk<figure><img src="https://images.theconversation.com/files/533266/original/file-20230621-29-ey9u2.jpg?ixlib=rb-1.1.0&rect=0%2C28%2C6325%2C4554&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">NBA rookies must navigate their way over a series of pitfalls.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-moves-with-basket-ball-royalty-free-image/872843990?phrase=basketball+professional&adppopup=true">Credit: Jon Enoch Photography Ltd via Getty Images</a></span></figcaption></figure><p>When a young athlete is drafted into the NBA – as <a href="https://www.nba.com/news/2023-nba-draft-order">58 players</a> were on <a href="https://www.espn.com/nba/story/_/id/37869579/2023-nba-draft-guide-date-how-watch-top-prospects">June 22, 2023</a> – it is often seen as a <a href="https://www.thestreet.com/sports/how-much-money-nba-draft-picks-make">life-changing event</a>. The money makes it so.</p>
<p>Salaries for first-round draft picks this year are projected to range from <a href="https://www.spotrac.com/nba/draft/">about $2.4 million at the low end to $12 million at the very top</a>. That’s a lot of bread for a young person to handle. The <a href="https://www.si.com/nba/draft/newsfeed/2023-nba-draft-breaking-down-the-youngest-draft-eligible-players#gid=ci02bc3aeb50002453&pid=usatsi_20262972">three youngest prospects</a> this year will still be 18 at the time of the draft.</p>
<p>Perhaps for some spectators, the big salaries might seem as if they should cushion the young players from whatever economic hardships or social challenges they may have faced growing up. But through research that I conducted with NBA coaches, NBA union representatives and former NBA players, I discovered that <a href="https://doi.org/10.1080/10413200.2021.1958953">it’s not always so easy</a>.</p>
<p>“Poverty is a trauma, and there is a <a href="https://doi.org/10.18043/ncm.79.2.124">lot of data</a> to support that,” one NBA union representative told me. “Men are essentially incentivized to say nothing, be tough, man up, and this mask is what I call invisible tattoos. We’re talking sexual trauma, incarceration, spousal battery, alcohol, or gang violence.”</p>
<p>As I point out in my study, these issues are not necessarily unique to professional basketball players and affect athletes in other sports as well.</p>
<h2>Overnight fortunes</h2>
<p>Through the draft, newly minted NBA players may skyrocket into an astronomically higher tax bracket overnight. But just because they’ve become instant millionaires doesn’t mean they’re going to easily transition into lives of prosperity.</p>
<p>This may be particularly true, I have found, for players who have faced the <a href="https://doi.org/10.18043/ncm.79.2.124">adversity of poverty in childhood</a>, or who <a href="https://doi.org/10.1080/10413200.2021.1958953">grew up in low-income communities</a>.</p>
<p>Indeed, one former NBA player, who retired in the late 2010s, told me that rookies may find it difficult to break ties with friends who could derail their careers.</p>
<p>“I will always feel a tight bond to the community in which I was raised, and I know that people from the outside might not understand that,” the player told me. “So, even though my new coaches or agent might tell me to stop hanging with my old friends, it isn’t that simple.”</p>
<p>The player told me that when he was a rookie, what he needed back then was “someone from this new world who actually went through this transition to help because I certainly made a lot of mistakes.” Specifically, he said he found it difficult to sever ties with old acquaintances who were still involved in lives of crime.</p>
<h2>Lessons for new professionals</h2>
<p>It’s not that the NBA is completely oblivious to the need to orient new players on how to comport themselves and handle their newfound fame and fortune. And it’s not like the story of basketball players seeking to overcome adversity is an unfamiliar one, if somewhat of a <a href="https://doi.org/10.1177/1012690210384660">misleading cultural trope</a>. Researchers have found, for instance, that despite the popular image of NBA players rising from impoverished backgrounds, “<a href="https://doi.org/10.1177/1012690210384660">Most NBA players come from relatively advantaged social origins</a>.” But that’s often not the story that gets told.</p>
<p>As early as 1979, movies like “<a href="https://www.imdb.com/title/tt0079136/">Fast Break</a>” and TV shows like “<a href="https://www.imdb.com/title/tt0077101/">The White Shadow</a>” portrayed the challenges that young players faced off the court. A more recent example is “<a href="https://www.netflix.com/title/81046613">Last Chance U: Basketball</a>,” a Netflix docuseries that chronicles the lives of community college basketball players who are <a href="https://theconversation.com/netflix-series-last-chance-u-speaks-to-the-reality-of-athletes-i-study-156095">seeking to go pro despite their difficult pasts</a>, which is one of my focal points of study.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/b-YCKtBb0L4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The official Netflix trailer for ‘Last Chance U: Basketball.’</span></figcaption>
</figure>
<p>The NBA – clearly cognizant of the challenges that young players face – offers a four-day <a href="https://bleacherreport.com/articles/2160033-nik-stauskas-biggest-takeaways-from-the-nbas-rookie-transition-program">rookie transition program</a> to get the young athletes acclimated to their new lives as professional basketball players. Among other things, speakers advise the young players to avoid the pitfalls associated with guns, drugs and sexual relationships with groupies.</p>
<p>Some – myself included – question whether the four-day symposium is enough, or whether there needs to be a more sustained effort. Among the skeptics is one former coach of an NBA player who got sent to prison after being convicted of a felony.</p>
<p>“It’s like, we gave you the information and now it’s on you because you are a grown man,” the former coach said. “But even though he was grown, he was still young, and he had lots of chances to make some bad decisions, which he obviously did,” he said of the player who went to prison.</p>
<h2>Between worlds</h2>
<p>One former NBA player told me of a time when he drew attention after he lashed out at someone for stepping on his shoe.</p>
<p>“I was out one night with some teammates and someone stepped on my shoe and I just lost it and I remember everyone looking at me like I was crazy,” the player told me. “The thing is that where I was from, you simply couldn’t let these things pass or else it would make me look weak and then you became a target. In that moment I realized that the same behaviors I learned which allowed me to survive and thrive in my old environment could cause me to get locked up in my new one.”</p>
<p>Through the rookie transition program, players are advised to seek out veteran players for advice. </p>
<p>Ultimately, one former NBA official told me, that may be the best advice.</p>
<p>“If a rookie gets to the NBA and the only place he feels like he belongs is athletically, he is going to revert back to past behaviors because of the trauma he has endured,” the former executive told me. “In these cases, NBA teams need to understand this transition has a lot of underlying issues that very often aren’t addressed.”</p><img src="https://counter.theconversation.com/content/207662/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Book does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With newfound fame and fortune, NBA rookies who come from poverty face a bevy of challenges that threaten to derail their success.Rob Book, Associate Professor of Cultural Sport Psychology, University of Southern DenmarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051842023-05-15T15:01:07Z2023-05-15T15:01:07ZThriving in the face of adversity: Resilient gorillas reveal clues about overcoming childhood misfortune<figure><img src="https://images.theconversation.com/files/525949/original/file-20230512-23918-udbd4r.jpeg?ixlib=rb-1.1.0&rect=837%2C1234%2C5222%2C3305&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A lot of bad things can happen to young mountain gorillas in the wild.</span> <span class="attribution"><span class="source">Dian Fossey Gorilla Fund</span></span></figcaption></figure><p>In 1974, an infant mountain gorilla was born in Volcanoes National Park in Rwanda. Researchers named him Titus. As is typical for young gorillas in the wild, Titus spent the first years of his life surrounded by his mother, father and siblings, as well as more distant relatives and unrelated gorillas that made up his social group.</p>
<p>In 1978, however, tragedy struck. Poachers killed Titus’ father and brother. In the chaos that followed, his younger sister was killed by another gorilla, and his mother and older sister fled the group. Juvenile Titus, who was at a developmental stage similar to that of an 8- or 9-year-old human, <a href="https://www.imdb.com/title/tt1922764/">experienced more tragedy</a> in his first four years of life than many animals do in a lifetime.</p>
<p>In people, <a href="https://doi.org/10.1016/j.neuron.2017.09.027">a rough start in life</a> is often associated with significant problems later on. <a href="https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean">Early life adversity</a> can take a wide variety of forms, including malnutrition, war and abuse. People who experience these kinds of traumas, assuming they survive the initial event, are <a href="https://doi.org/10.1542/peds.2011-2663">more likely to suffer health problems</a> and social dysfunction in adulthood and to have shorter life spans. Often, <a href="https://doi.org/10.1111/nyas.13928">these outcomes trace back at least in part</a> to what public health researchers call health risk behaviors – things like smoking, poor eating habits and a sedentary lifestyle.</p>
<p>But researchers have documented the same kinds of <a href="https://doi.org/10.1073/pnas.1205340109">problems in adulthood in nonhuman animals</a> <a href="https://doi.org/10.1016/j.cobeha.2020.06.006">that experienced early life adversity</a>. For example, female baboons who have the hardest childhoods have <a href="https://doi.org/10.1038/ncomms11181">life spans that are on average only half as long</a> as their peers that have the easiest. Activities like smoking and unhealthy food choices can’t be the whole story, then, since animals don’t engage in typical human health risk behaviors.</p>
<p>Given the connection between adverse events while young and poor health later in life, one might expect that Titus’ unlucky early years would predict a short, unhealthy adulthood for him. However, there are interesting hints that things <a href="https://doi.org/10.1016/j.cub.2023.04.051">might work differently in mountain gorillas</a>, which are one of humans’ closest living relatives.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="juvenile gorilla seated" src="https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525945/original/file-20230512-23-8omdyq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researchers analyzed decades of observational data to determine how life turned out for young gorillas that had faced adversity.</span>
<span class="attribution"><span class="source">Dian Fossey Gorilla Fund</span></span>
</figcaption>
</figure>
<h2>Decades of gorilla observations</h2>
<p><a href="https://scholar.google.com/citations?user=GxpHf-AAAAAJ&hl=en&oi=ao">As scientists who have spent</a> <a href="https://scholar.google.com/citations?user=1I9_QM0AAAAJ&hl=en&oi=ao">many years studying wild gorillas</a>, we have observed a wide variety of early life experiences and an equally wide variety of adult health outcomes in these great apes. Unlike other primates, mountain gorillas don’t appear to suffer any long-term negative effects of <a href="https://doi.org/10.7554/eLife.62939">losing their mothers at an early age</a>, provided that they reach the age at which they are old enough to have finished nursing.</p>
<p>Losing your mother is only one of many bad things that can happen to a young gorilla, though. We wanted to investigate whether a pattern of resilience was more generalized. If so, could we gather any insight into the fundamental question of how early life experiences can have long-lasting effects?</p>
<p>To do this, we needed exceptionally detailed long-term data on wild gorillas across their lifetimes. This is no mean feat, given <a href="https://doi.org/10.1038/sdata.2016.6">gorillas’ long life spans</a>. Primatologists know that males can survive into their late 30s and females into their mid-40s.</p>
<p>The best data in the world to conduct such a study comes from the <a href="https://gorillafund.org/">Dian Fossey Gorilla Fund</a>, which has been following individual mountain gorillas in Rwanda almost daily for 55 years. We conducted doctoral and postdoctoral research with the Fossey Fund and have collaborated with other scientists there for more than 20 years.</p>
<p>From their database, which stretches back to 1967, we extracted information on more than 250 gorillas tracked from the day they were born to the day they died or left the study area.</p>
<p>We used this data to identify six adverse events that gorillas younger than age 6 can endure: maternal loss, paternal loss, extreme violence, social isolation, social instability and sibling competition. These experiences are the gorilla equivalent of some kinds of adversity that are linked with long-term negative effects in humans and other animals.</p>
<p>Many young gorillas didn’t survive these challenges. This is a strong indication that these experiences were indeed adverse from the perspective of a gorilla.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Adult female gorilla seated tightly together with two young gorillas" src="https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525946/original/file-20230512-15-ldzmn2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ubufatanye experienced the loss of her mother and father and the disintegration of her family group before the age of 5. Now 20, she has become a successful mother, raising three offspring.</span>
<span class="attribution"><span class="source">Dian Fossey Gorilla Fund</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.cub.2023.04.051">We were surprised to discover</a>, however, that most of the repercussions of these hardships were confined to early life: animals that survived past the age of 6 did not have the shorter life spans commonly associated with early life adversity in other species.</p>
<p>In fact, gorillas that experienced three or more forms of adversity actually had better survival outcomes, with a 70% reduction in the risk of death across their adult years. Part of this hardiness, especially for males, may be due to a phenomenon called <a href="https://www.biologyonline.com/dictionary/viability#:%7E:text=Viability%20selection%20can%20be%20defined,on%20the%20road%20for%20it.">viability selection</a>: Only the strongest animals survive early adversity, and thus they are also the animals with the longest life spans.</p>
<p>While viability selection may be part of the story, the patterns in our data strongly suggest that as a species, mountain gorillas are also remarkably resilient to early adversity.</p>
<h2>Where do gorillas get their resilience?</h2>
<p>Although our findings corroborate previous research on maternal loss in gorillas, they contrast with other studies on <a href="https://doi.org/10.1037/pag0000394">early adversity in humans</a> and <a href="https://doi.org/10.1111/1365-2656.13785">other long-lived mammals</a>. Our study indicates that the negative later-life consequences of early adversity are not universal.</p>
<p>The absence of this connection in one of our closest relatives suggests there might be protective mechanisms that help build resiliency to early-life knocks. Gorillas may provide valuable clues to understand how early life experiences have such far-reaching effects and how people can potentially overcome them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two adult and one young gorilla seated together" src="https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525944/original/file-20230512-20526-7wom64.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Young gorillas live with their parents as part of larger social groups.</span>
<span class="attribution"><span class="source">Dian Fossey Gorilla Fund</span></span>
</figcaption>
</figure>
<p>While there is still much left to explore, we suspect that gorillas’ food-rich habitat and cohesive social groups could underpin their resiliency. When young gorillas lose their mothers, <a href="https://doi.org/10.7554/eLife.62939">other social group members fill in</a> the companionship hole she leaves behind. Something similar may happen for other types of early adversity as well. A supportive social network combined with plentiful food may help a young gorilla push through challenges.</p>
<p>This possibility underscores the importance of ensuring that human children who experience early adversity are <a href="https://doi.org/10.1001/jamapediatrics.2016.1559">supported in multiple ways</a>: socially, but also economically, especially since early adversity is particularly prevalent among children living in poverty – itself a form of adversity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&rect=436%2C0%2C3845%2C2702&q=45&auto=format&w=1000&fit=clip"><img alt="large adult male gorilla against leafy background" src="https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&rect=436%2C0%2C3845%2C2702&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525223/original/file-20230509-25-vqm6q4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Titus, pictured here as an adult, survived more adversity before age 4 than many animals confront in a lifetime.</span>
<span class="attribution"><span class="source">Dian Fossey Gorilla Fund</span></span>
</figcaption>
</figure>
<p><a href="https://www.imdb.com/title/tt1922764/">And what became of Titus</a>? Despite his difficult start in life, Titus went on to lead his group for two decades, siring at least 13 offspring and surviving to his 35th birthday, making him one of the most successful gorillas the Dian Fossey Gorilla Fund has ever studied.</p>
<p>Though Titus’ story is only a single anecdote, it turns out that his resilience is not so unusual for a member of his species.</p><img src="https://counter.theconversation.com/content/205184/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stacy Rosenbaum receives funding from the National Institutes of Health (NIH) and the University of Michigan. </span></em></p><p class="fine-print"><em><span>Robin Morrison receives funding from the Dian Fossey Gorilla Fund and the Swiss National Science Foundation. </span></em></p>In many animals, including humans, adverse events in youth have lasting negative health effects over the life span. But new research suggests something different is going on in mountain gorillas.Stacy Rosenbaum, Assistant Professor of Anthropology, University of MichiganRobin Morrison, Postdoctoral Fellow in Animal Behavior, University of ExeterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1884152022-08-22T19:07:40Z2022-08-22T19:07:40ZThere is an urgent need to prevent the lifelong damage caused by adverse childhood experiences<figure><img src="https://images.theconversation.com/files/479766/original/file-20220817-11701-ay1khs.jpg?ixlib=rb-1.1.0&rect=201%2C40%2C6166%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recent advances in research on human development, and brain science in particular, have revealed that traumatic childhood literally changes the human body, affecting brain development.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/there-is-an-urgent-need-to-prevent-the-lifelong-damage-caused-by-adverse-childhood-experiences" width="100%" height="400"></iframe>
<p><a href="https://doi.org/10.1192/bjp.bp.110.080499">More than one-third of the population experiences adversity in childhood</a> — including abuse, neglect or family violence — leaving hundreds of thousands in need of treatment. </p>
<p>Predictably, as clinical psychologists, we both recommend psychotherapy to minimize the consequences of adverse childhoods. However, an even greater concern is how, in addition to reducing the suffering it causes, chronic childhood adversity can be prevented from flooding our health-care system.</p>
<h2>The impact of childhood trauma</h2>
<p>Recent advances in research on human development, and brain science in particular, have revealed that <a href="https://doi.org/10.1146%2Fannurev-devpsych-121318-084950">traumatic childhood literally changes the human body</a>. It affects brain development, the programming of our stress response system and is <a href="https://doi.org/10.1016/j.biopsych.2017.07.009">even passed on to the next generation</a>. </p>
<p>Knowing this helps us better understand why somebody might develop mental illness or addiction. For example, people who score four items or more on a scale of 13 traumatic childhood events (like neglect or exposure to violence) are <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">37 times as likely to attempt suicide</a> as people without childhood trauma. They are also 10 times as likely to develop problematic drug use as people with less trauma exposure.</p>
<p>On top of that, people with high adversity scores are four times as likely to develop depression and twice as likely to be afflicted by cancer and heart disease. In other words, all facets of health are affected. </p>
<h2>A narrow window for prevention</h2>
<p>Research on the link between trauma and illness is rich, but also complex, with few simple answers. However, that complexity should not prevent us from moving forward. In a <a href="https://doi.org/10.1111/jcpp.13541">recent editorial for the <em>Journal of Child Psychology and Psychiatry</em></a>, we argued that prevention programs have a lot of promise but require extremely early action, namely during pregnancy and the first two years of life. </p>
<p>That narrow timing is critical because those earliest years provide a window in which environmental experiences become biologically embedded, and then very difficult to change. </p>
<p>The human brain has billions of nerves and connections between them, called <a href="https://www.britannica.com/science/synapse">synapses</a>. Together, they form networks like spider webs that begin development during pregnancy and absolutely explode in speed and complexity during the first two years of life. </p>
<figure class="align-center ">
<img alt="Interconnecting white lines against a blue background" src="https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479966/original/file-20220818-186-xf85eo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The human brain has billions of nerves and connections between them, called synapses.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>The next phase of <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">brain development</a> is very different: the brain seeks efficiency and will lock in, or solidify, the brain connections that are used the most often. Furthermore, it will shrink or get rid of the pathways that are rarely used, in a process called synaptic pruning. </p>
<p>The bottom line is that before the age of two, a child might have already learned that the world is unsafe and adults cannot be trusted — perhaps not even to provide a stable food supply. <a href="http://dx.doi.org/10.35248/2161-0487.19.9.365">The nervous system solidifies that experience and retains especially those connections that reflect fear and distrust of adults</a>. Constant reactivation of these ingrained pathways likely leads to exaggerated stress responses and interferes with needed adaptations for years to come. </p>
<p>Understanding this typical brain development leads to one overwhelmingly clear message: that we need to invest in parallel physical and mental health approaches to support healthy pregnancies and stable, caring early childhoods. However, a lot of political will and cultural sensitivity is needed for these programs to succeed.</p>
<h2>Prevention programs</h2>
<p>The <a href="https://doi.org/10.1177%2F1049731505284391">research base supporting the efficacy of prevention programs</a> is strong, and supports the creation of high quality pregnancy supports and services that facilitate attachment for the child, as well as emotion regulation skills. </p>
<p>There is no one program that “fixes” everything. Prevention programs need to be tailored to specific needs and people. One type of program might be a nurse-led education and support group for first time mothers. Another might be a web-based self-help group for <a href="https://doi.org/10.3390/ijerph18199952">pregnant women with substance use concerns</a>. </p>
<p>A key problem with implementation is the up-front cost, and the long period of waiting before benefits are seen. This waiting-period implies that politicians and policy-makers often need to invest in programs that cannot reveal benefits before they are up for re-election. This <a href="https://doi.org/10.1177%2F070674370204700903">makes prevention programs very vulnerable to changes in the political landscape</a>. </p>
<p>Scientists and health professionals cannot do this alone; society as a whole needs to engage. Voters can play a critical role by encouraging and supporting politicians who are willing to invest in long-term programming. The science is there; now is the time to act on it.</p><img src="https://counter.theconversation.com/content/188415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joelle LeMoult receives funding from CIHR, SSHRC, NSERC, and the Michael Smith Foundation for Health Research. </span></em></p><p class="fine-print"><em><span>Wolfgang Linden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The impact of early childhood trauma on lifelong physical and mental health makes it urgent to invest in programs to support healthy pregnancies and stable, caring very early childhoods.Wolfgang Linden, Professor Emeritus in Clinical and Health Psychology, University of British ColumbiaJoelle LeMoult, Associate Professor, Department of Psychology, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1761322022-02-10T20:24:26Z2022-02-10T20:24:26ZChildhood adversity is a ‘cause of causes’ of adult illnesses and mental health problems<figure><img src="https://images.theconversation.com/files/443792/original/file-20220201-22-127qj18.png?ixlib=rb-1.1.0&rect=16%2C663%2C4497%2C2948&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One child in three is physically or sexually abused or witnesses violence between adults in their home. Other adversities including emotional neglect, living in an unsafe neighbourhood or experiencing prejudice and bullying are even more common.</span> <span class="attribution"><span class="source">(iStock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/childhood-adversity-is-a--cause-of-causes--of-adult-illnesses-and-mental-health-problems" width="100%" height="400"></iframe>
<p>Every day we are exposed to things like pollution and ultraviolet light which increase our risk of illness. Many people take on additional risks — due to tobacco smoke, fast food or alcohol, for example. </p>
<p>But there is a less-recogized exposure that is even more common than smoking and increases the risk of <a href="https://doi.org/10.1161/cir.0000000000000536">heart disease, diabetes</a>, <a href="https://doi.org/10.1002/cncr.24372">cancer</a>, <a href="https://doi.org/10.1016/s0749-3797(98)00017-8">chronic lung diseases</a>, <a href="https://dx.doi.org/10.2105%2FAJPH.2007.131599">sexually transmitted infections</a>, <a href="https://doi.org/10.1001/jama.2009.1091">chronic pain</a>, <a href="https://doi.org/10.1503/cmaj.131792">mental illness</a> and <a href="https://doi.org/10.1016/j.amepre.2009.06.021">reduces one’s life by as much as 20 years</a>. </p>
<p>This public health hazard that hides in plain sight is childhood adversity: experiences like physical abuse, sexual abuse and neglect.</p>
<h2>Childhood adversity is common</h2>
<p>In Canada, <a href="https://doi.org/10.1503/cmaj.131792">one child in three is physically or sexually abused or witnesses violence between adults in their home</a>. Other adversities such as <a href="https://doi.org/10.1016/j.amepre.2015.02.001">emotional neglect, living in an unsafe neighbourhood or experiencing prejudice and bullying</a> are even more common. Studies in the United States show about <a href="https://doi.org/10.1016/j.amepre.2014.09.006">60 per cent of children and teenagers have these adverse childhood experiences</a>, or ACEs. The more severe the exposure, the greater the health risk. </p>
<p>The reason that ACEs contribute to so many diseases is that they are associated with many things that trigger other causes of disease. Think of ACEs as a “cause of causes.”</p>
<h2>Health risk behaviours and physiological changes</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of two people standing at a starting line. One lane is clear while the other has a pitfall." src="https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445491/original/file-20220209-1970-18lmi5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adverse childhood events may contribute to cascading health risks over a lifetime.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As kids who have had adverse experiences grow up, they are more likely to <a href="https://dx.doi.org/10.1016%2Fj.jadohealth.2007.08.029">smoke</a>, to <a href="https://doi.org/10.1111/acer.12053">drink excessively</a> and to <a href="https://dx.doi.org/10.1016%2Fj.jaac.2016.05.010">use nonprescription drugs</a>. They are more likely to <a href="https://doi.org/10.1016/j.chiabu.2016.11.023">engage in risky sexual activities</a> and to <a href="https://doi.org/10.1038/s41598-021-93242-4">become obese</a>. Not all kids with ACEs take on risky activities, of course, but enough to contribute to ACEs’ health consequences.</p>
<p>Growing up in conditions that are consistently frightening or stressful affects the biology of developing bodies, <a href="https://pubmed.ncbi.nlm.nih.gov/24426793/">especially the development of the systems that regulate our reactions to threats</a>, from predators to viruses. ACEs are even associated with <a href="https://doi.org/10.1038/mp.2012.32">changes in our chromosomes</a> that are linked to early mortality. </p>
<h2>Interpersonal and psychological effects</h2>
<p>As psychiatrists for adults who experience physical and mental illness in combination, our patients often tell us about the personal impact of ACEs. One man said he did not “have even the slightest shadow of a doubt that a loss of human connection is the most substantial negative impact” of these experiences. The health costs of human disconnection are profound. Indeed, <a href="https://doi.org/10.1371/journal.pmed.1000316">lacking interpersonal support may hasten mortality as much or more than smoking, excessive drinking, inactivity, obesity or untreated high blood pressure</a>. </p>
<p>The psychological effects of ACEs may be more obvious and can include fearful expectations, a conviction that one is unworthy of love or protection, unregulated anger or shame and discombobulating memories of bad events. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of five red hot-air balloons rising into the air, with one held back by a large rock tied to it." src="https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445498/original/file-20220209-25-rl380b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">ACEs greatly increase the risk of depression, anxiety disorders, post-traumatic stress disorder and addictions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It greatly increases the risk of depression, anxiety disorders, post-traumatic stress disorder and addictions. The one in three adults who experienced childhood sexual or physical abuse or witnessed interpersonal violence at home <a href="https://doi.org/10.1503/cmaj.131792">have at least twice the incidence of these disorders</a> compared to others.</p>
<p>And then the dominoes fall: mental illness greatly increases the likelihood, burden and consequences of physical illness. To give just one example, <a href="https://doi.org/10.1016/s0006-3223(03)00111-2">in the months after experiencing a heart attack, those who are depressed are several times more likely to die</a>.
So, we see that ACEs don’t only lead to one kind of trouble, but to many. </p>
<h2>Social determinants of health</h2>
<p>Finally, the burden of illness is not distributed fairly. Maintaining health is more challenging for those who are disadvantaged by poverty, lack of education, language barriers, discrimination and living with the continuing systemic harms of colonization and multi-generational trauma.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of a child climbing up one side of a pyramid in steady steps, helped by an adult. On the other side, another child climbs over a substance-using parent and struggles to find a route up the pyramid." src="https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=521&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=521&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=521&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=655&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=655&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445493/original/file-20220209-19735-1q36hq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=655&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Childhood trauma has a complex relationship with social determinants of health.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Childhood trauma has a complex relationship with these social determinants of health. On one hand, ACEs are not unique to marginalized groups and can occur across all strata of society. On the other hand, the risk of experiencing ACEs may be greater in some groups and the consequences of ACEs may multiply as social forces interact. </p>
<p>For example, <a href="https://doi.org/10.1016/s0749-3797(99)00084-7">childhood trauma is strongly associated with behaviours that increase the risk of sexually transmitted infections</a>. About <a href="https://doi.org/10.1016/j.psym.2014.10.006">half of the people living with HIV have experienced childhood abuse</a>. HIV is also more common in groups that face discrimination, including <a href="https://www.catie.ca/the-epidemiology-of-hiv-in-canada">men who have sex with men, people who use injectable drugs, Indigenous people</a> and <a href="https://www.ohtn.on.ca/research-portals/priority-populations/african-caribbean-and-black-communities/">immigrants from countries in which HIV is endemic</a>. </p>
<p>Intersecting components of personal experience and identity attract stigma and discrimination, which in turn influences mental health, self-care and one’s ability to navigate a healthcare system that has multiple barriers and gaps. <a href="https://doi.org/10.1016/j.psym.2014.10.006">It is a complex web and ACEs contribute to this complexity</a>.</p>
<h2>A cause of causes</h2>
<p>Events that occur in childhood may contribute to cascading health risks over one’s lifetime. There are so many paths to illness interacting with one another over decades and compromising health in so many ways, that it should be no surprise that <a href="https://doi.org/10.1016/s2468-2667(21)00237-1">childhood adversity is a profound public health problem</a>. </p>
<p>It is time that we, as a society, recognized ACEs as the malignant force that they are. Those affected need to be treated with compassion and also with awareness of the long-lasting effects of early adversity on health. Research that helps us understand the lifelong impact of ACEs could help guide prevention of chronic illnesses and mental health issues in the many people who experience adversity during childhood.</p><img src="https://counter.theconversation.com/content/176132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Maunder receives funding from Sinai Health and the University of Toronto as Chair of Health and Behaviour at Sinai Health and receives royalties from the University of Toronto Press for Damaged: Childhood Adversity, Adult Illness, and the Need for a Health Care Revolution.</span></em></p><p class="fine-print"><em><span>Jon Hunter receives funding from Sinai Health and is The Pencer Family Chair in Applied General Psychiatry at Sinai Health. He receives royalties from the University of Toronto Press for Damaged: Childhood Adversity, Adult Illness, and the Need for a Health Care Revolution. </span></em></p>One in three children experiences abuse or neglect. These adverse events increase lifelong risks for chronic diseases and mental health issues, creating a public health hazard hiding in plain sight.Robert Maunder, Professor of Psychiatry, University of TorontoJon Hunter, Professor of Psychiatry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1623112021-07-06T15:54:12Z2021-07-06T15:54:12ZGood storytellers get better health care — but childhood trauma confuses the narrative<figure><img src="https://images.theconversation.com/files/409669/original/file-20210705-26172-1opejpp.png?ixlib=rb-1.1.0&rect=802%2C0%2C1173%2C755&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Survivors of childhood trauma often struggle to clearly describe current health issues to health-care providers, and may not get the help they need. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>When describing their symptoms, medical history and health changes at a clinic or hospital, every patient is the storyteller of their own health. Good storytellers tend to get better health care, but a history of childhood trauma plays havoc with telling your own story. </p>
<p>Consider Florence, as a (fictional) example:</p>
<p>It is a hot July night and Florence is having dizzy spells again. She feels dreadful and is worried. What if it happens when she is driving? What if it doesn’t get better? How can she work like this? What if it is a stroke or a tumour? She goes to the emergency department in spite of her past experience that it isn’t very helpful. </p>
<p>The triage nurse asks what she is there for. “Well, I had this bad thing… they did tests and it was almost normal…” </p>
<p>The nurse looks puzzled. “When was that?” </p>
<p>“October. I was…” The triage nurse doesn’t need to hear what happened nine months ago. She cuts Florence off and points her toward the waiting area. </p>
<p>A while later Florence meets with a doctor. She has been practising what to say while she waits. He interrupts after a few seconds to ask what Florence means by “dizzy.” </p>
<p>Florence replies, “You know, it’s like that dizzy feeling, oh I hate that, you know …”</p>
<p>Although it doesn’t occur to either Florence or the doctor, a lifetime of difficulty — starting with violence that she witnessed and experienced as a child — is compromising Florence’s health.</p>
<h2>ACEs and health</h2>
<p>Research on the links between <a href="https://www.cdc.gov/violenceprevention/aces/index.html">adverse childhood experiences</a> (ACEs) and poor mental and physical health has made this formerly hidden risk factor for many of our most common and burdensome chronic diseases a topic of public discussion. </p>
<p>The numbers are mind-boggling. <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html">About 60 per cent of adults experienced at least one type of ACE</a> as they are usually defined. <a href="https://dx.doi.org/10.1503%2Fcmaj.131792">About one in three children experience serious physical or sexual abuse or are exposed to interpersonal violence</a>. It is a major public health problem.</p>
<figure class="align-center ">
<img alt="A doctor consulting with a patient." src="https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409736/original/file-20210705-126544-jdl040.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is a strong relationship between unresolved developmental trauma and impaired storytelling. This ‘narrative incoherence’ makes it more difficult to get good health care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>ACEs are linked to unhealthy behaviour and experiences later in life. They increase the risk that a child <a href="https://doi.org/10.1016/S2468-2667(17)30118-4">will smoke cigarettes, adopt unhealthy drug and alcohol use, become obese,</a> or <a href="https://doi.org/10.3402/gha.v9.31516">experience further trauma as an adult</a>. Because of this, and because of other effects of stress on health, ACEs <a href="https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2016003/article/14339-eng.pdf?st=BgdCGxS8">increase the risk of diseases of the heart, lungs and liver, pain syndromes, and some cancers</a>. </p>
<p>What Florence is experiencing in the emergency room is a further consequence of childhood adversity — one that makes it much harder to get good health care. There is a strong relationship between unresolved developmental trauma and impaired storytelling. <a href="https://doi.org/10.1521/pdps.2012.40.4.549">This is technically called “narrative incoherence</a>.”</p>
<h2>Storytelling and health</h2>
<p>The qualities of a good narrative were <a href="https://doi.org/10.1163/9789004368811_003">described by the philosopher Paul Grice in four maxims</a>: </p>
<ul>
<li>have evidence for what you say (quality),</li>
<li>be succinct, yet complete (quantity),</li>
<li>be relevant to the topic at hand (relation) and </li>
<li>be clear and orderly (manner).</li>
</ul>
<p>Psychologist Mary Main and her collaborators <a href="https://doi.org/10.1177%2F00030651000480041801">used Grice’s maxims to describe how unresolved childhood trauma and loss can affect a person’s state of mind</a> regarding important relationships in their life. They found people with unresolved trauma could be identified by failures in the quality, quantity, relation and manner of the stories they told during an emotionally taxing interview about those relationships. </p>
<p>It is a short leap from that research to high-stakes conversations in an emergency department or doctor’s office where someone like Florence struggles to make her condition clear and receive the help they need. </p>
<h2>Styles of narrative incoherence</h2>
<p>There are two common <a href="https://dx.doi.org/10.1097%2FPSY.0000000000000107">patterns of incoherence</a> in these interactions. Florence’s pattern is called <em>preoccupied</em>. Her anxiety is obvious. She is too overwhelmed by fear to organize her thoughts. She presents events out of sequence; her thoughts are unfinished; there are too many details; it is hard to tell the signal from the noise. </p>
<p>As a result, it can seem like the story of Florence’s health is a jigsaw puzzle and all the pieces have been dumped on the table at once. A listener feels baffled and frustrated. The doctor may start his note with the comment “poor historian.” </p>
<p>The second pattern of narrative incoherence is quite different from Florence’s preoccupied pattern of providing too much disorganzied information. A person with a <em>dismissing</em> pattern tends to provide conclusions without evidence, and generalizations without examples. </p>
<p>Q: “How does that feel?” A: “Same as always.” </p>
<p>Q: “How long has this been going on?” A: “A while.” </p>
<p>The conversation is short and at its end a health-care provider is unilluminated. While someone like Florence wears her anxiety on her sleeve, a person with the dismissing style keeps their cards close to their chest. A listener feels uninvited to ask more.</p>
<h2>Practical steps</h2>
<p>If Florence and her health-care providers are able to recognize that trouble telling her own story is a clue to what is going on — not just a marker that she is a “poor historian” — they can take steps to meet the challenge. Some steps Florence can take include:</p>
<ul>
<li>Bringing a friend with her who helps her stay calm and organized.</li>
<li>Explaining that she is anxious and needs a little time to describe the trouble.</li>
<li>Making notes in advance about her most important points and questions.</li>
</ul>
<p>Even more importantly, health-care workers need to recognize the face of fear. The doctor can help Florence to organize her thoughts instead of interrupting to interrogate her. They can help each other to find the story that allows her dizziness to be understood.</p>
<p>Every patient is forced to be a storyteller; a health-care professional’s job is to make them an excellent one.</p><img src="https://counter.theconversation.com/content/162311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adults who experienced trauma in childhood may get poor medical care because they have trouble telling a clear story about their health.Robert Maunder, Professor of Psychiatry, University of TorontoJon Hunter, Professor of Psychiatry, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1514192021-01-29T13:27:20Z2021-01-29T13:27:20Z10 parenting strategies to reduce your kids’ pandemic stress<figure><img src="https://images.theconversation.com/files/380588/original/file-20210125-23-1824kto.jpg?ixlib=rb-1.1.0&rect=299%2C132%2C5414%2C3174&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Making time to connect one on one is crucial.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/BrbogxYe7FE">S&B Vonlanthen/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Parents are dealing with huge demands on their time and energy. Children may not be attending school or involved in regular activities. As the pandemic continues to wreak havoc on families, routines have collapsed, patience is wearing thin and self-care is a distant memory.</p>
<p><a href="https://doi.org/10.1037/0000177-000">Decades of research</a> have <a href="https://scholar.google.com/citations?user=7ML3dNEAAAAJ&hl=en&oi=ao">taught</a> <a href="https://scholar.google.com/citations?user=BHBN1dUAAAAJ&hl=en&oi=sra">us</a> that <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">adversity during childhood</a> has <a href="https://doi.org/10.1007/s00406-005-0624-4">damaging effects on health and development</a>. Many studies have shown that kids who have faced abuse, neglect and family conflict struggle forming friendships, have academic difficulties and face physical and mental health problems in adolescence and adulthood.</p>
<p>Fortunately, developmental scientists have identified ways to help children <a href="https://www.wiley.com/en-us/Handbook+of+Child+Psychology+and+Developmental+Science%2C+Volume+3%2C+Socioemotional+Processes%2C+7th+Edition-p-9781118953891">survive and thrive</a> <a href="https://www.guilford.com/books/Ordinary-Magic/Ann-Masten/9781462523719">during times of adversity</a>. The beneficial effects of protective and nurturing experiences are <a href="https://doi.org/10.1007/978-3-030-03110-7_1">powerful antidotes to stress and adversity</a> and prepare children to cope with hard times for years to come.</p>
<p>Families worried about possible long-term effects of pandemic-related disruption can learn from these proven strategies. Here are 10 ways parents can foster children’s resilience during challenging times.</p>
<h2>1. Connect with one another</h2>
<p>Make time to talk, listen and play without distractions. Be sure children know they are loved unconditionally. This can include taking breaks to check in during the day when learning and working at home, having a special bedtime routine that includes talking about the day, taking walks together, or playing favorite games. <a href="https://doi.org/10.1037/13948-000">Making the effort to connect</a> helps children know they’re valued and creates a sense of security.</p>
<h2>2. Support children’s friendships</h2>
<p>Think about ways for children to play together outdoors, talk via technology or play a video game virtually with friends. Some families are creating safe zones or bubbles, where they allow children to pick a close friend or two whose family is practicing recommended coronavirus precautions that they can interact with more closely. <a href="https://doi.org/10.1037/a0025401">Maintaining friendships</a> gives children opportunities to learn from peers and reduces stress, providing support and acceptance.</p>
<h2>3. Find ways children can help others</h2>
<p>Talk about how others are also struggling. Encourage them to donate toys they’ve outgrown, save money for a special cause or help a neighbor with errands like shopping, bringing in mail, doing yardwork or dog-walking. When you do things for others in the community, include your children and talk about why you do it. This helps children <a href="https://doi.org/10.1111/j.1467-9507.1996.tb00073.x">learn about the needs of others and cultivates empathy</a>.</p>
<h2>4. Help children stay involved in clubs or groups</h2>
<p>Some groups that work well during a pandemic include outdoor Scouting, Zoom clubs and other special-interest clubs such as outdoor sports, fishing, hiking or biking. <a href="https://doi.org/10.1037/0012-1649.42.4.698">Being part of a group</a> helps children feel a sense of belonging and promotes identity development. It can also help build morals and values and even promote academic success.</p>
<h2>5. Stay in touch with important adults</h2>
<p>Children benefit from <a href="https://doi.org/10.1002/jcop.20106">relationships with other grown-ups</a>, like grandparents and teachers. They can be another source of support and someone to talk to about problems or successes. They’re particularly important when parents are unavailable due to work or other obligations. Help kids stay connected through Zoom, email, phone calls, FaceTime and special activities like outdoor events. Some social media groups have targeted programs to link children with others to play games or chat. </p>
<h2>6. Keep up with hobbies</h2>
<p>Boredom is a parent’s worst enemy. Having an enjoyable hobby is rewarding for kids; it provides engaging leisure time and opportunities to master something. Such activities provide connections with others, can teach discipline and how to manage one’s emotions and behavior, and promote self-esteem. <a href="https://doi.org/10.1177/1757913917712283">Explore art, music</a>, science projects, writing, chess and other hobbies that develop physical, artistic and intellectual skills while providing hours of enjoyment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="parents and kids working out at home together" src="https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381191/original/file-20210128-15-6fq4jt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercising together has physical and mental benefits.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-exercising-at-home-royalty-free-image/1225102298">gilaxia/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>7. Be physically active</h2>
<p>Make exercise a part of family routines. Take walks or ride bikes, play active video games like Wii, go to the park, stretch or do yoga together. <a href="https://doi.org/10.1080/10409289.2013.780505">Exercise has many of the same benefits</a> as hobbies. It also helps children handle the physical effects of stress on the body and improves mood and mental health.</p>
<h2>8. Create routines</h2>
<p><a href="https://theconversation.com/4-good-practices-for-anyone-caring-for-quarantined-kids-135626">Routines are a powerful nonverbal signal</a> to children’s brains that they are safe and that life is predictable. <a href="https://doi.org/10.1097/01.IYC.0000290352.32170.5a">Keeping a routine</a> can reduce the number of conflicts, and children know what to do and expect during different points of the day.</p>
<p>Create and display (together, ideally) daily or weekly calendars with words or pictures that remind children when learning, playing, resting, sleeping and eating activities occur. Invent little rituals that comfort as well as accomplish goals, especially at bedtime: read, tell stories, sing a special song, say a prayer or list loved ones. <a href="https://doi.org/10.1016/j.sleh.2014.12.002">Such activities ensure better sleep</a> than allowing children to drift off watching a video. Children may push back if they’ve gotten used to less structure during the day, but most will welcome knowing what to expect.</p>
<h2>9. Keep realistic expectations for learning</h2>
<p>Children’s involvement in schooling varies widely during the pandemic, with some hardly affected and others learning entirely at home. Virtual schooling requires parents to be more involved than before – monitoring assignments, checking in during the day and seeking help when children are struggling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Daughter and dad baking together" src="https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381193/original/file-20210128-19-xzqtbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Learning doesn’t have to happen in a scholastic setting – for instance, baking relies on math.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-family-at-home-together-royalty-free-image/554916875">Michael Heffernan/Stone via Getty Images</a></span>
</figcaption>
</figure>
<p>While schoolwork is indeed important, not all learning takes place in class. Involve children in opportunities to learn during everyday tasks such as cooking (measuring, timing), gardening, shopping (figuring sales prices, adding), and games (cards, dominoes, board games) that build memory and thinking skills. <a href="https://doi.org/10.1016/j.amepre.2018.11.018">Read with your child every day</a>. Depending on the level of the book, you can read to your child or take turns reading pages.</p>
<h2>10. Maintain a healthy and safe home</h2>
<p>In addition to maintaining COVID-19 precautions, make nutritious meals, declutter and organize toys, games, hobby supplies and learning materials. Find ways to involve children in preparing meals, organizing their work and play spaces, cleaning up after activities, and sharing in conversations about family rules. Chaos and clutter are the enemies of calm. <a href="https://doi.org/10.1037/dev0000087">Creating safe and orderly spaces</a> helps children manage stress. Eating healthy foods together benefits physical and mental health. </p>
<h2>Parenting in the time of coronavirus</h2>
<p>Many parents naturally do the things listed above. However, with increased stress and demands on time, these activities are difficult to maintain. Now is a good time to pick a few of these strategies and get back on track.</p>
<p>Every family is different, and what’s appropriate <a href="http://www.acesandpaces.com/uploads/6/4/3/1/64312853/morris___hays-grudo_parent_tips_during_covid-19.pdf">differs by children’s ages</a>, whether infants and toddlers, school-age children or teens and young adults. But adjusted for age and circumstances, these tried-and-true techniques can help youngsters make it through tough times and come out the other side OK.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/151419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Hays-Grudo receives funding from the National Institute of General Medical Sciences of the National Institutes of Health
under Award Number P20GM109097.</span></em></p><p class="fine-print"><em><span>Amanda Sheffield Morris does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Parents can take a page from psychological research on trauma and recovery to help kids struggling with pandemic life.Amanda Sheffield Morris, Professor of Human Development and Family Science, Oklahoma State UniversityJennifer Hays-Grudo, Professor of Psychiatry and Behavioral Sciences, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1264862019-11-18T14:04:16Z2019-11-18T14:04:16ZWhy the nation should screen all students for trauma like California does<figure><img src="https://images.theconversation.com/files/301652/original/file-20191113-77326-97rx6q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The effects of childhood trauma can be long-lasting.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/child-psychology-psychiatric-therapy-children-concept-611762108?src=8561abd2-efb1-41ec-85e1-0322bb931bf0-2-0">shutterstock.com/lightspring</a></span></figcaption></figure><p>As the first person to hold the new role of Surgeon General of California, Dr. Nadine Burke Harris is pushing an unprecedented plan to <a href="https://www.nbcnews.com/news/nbcblk/california-s-first-surgeon-general-screen-every-student-childhood-trauma-n1064286">implement universal screenings for childhood trauma</a> for children in the state’s Medicaid program.</p>
<p>Childhood trauma is <a href="https://www.isbe.net/Pages/Trauma.aspx">defined</a> by the National Institute of Mental Health as an “emotionally painful or distressful” event that “often results in lasting mental and physical effects.”</p>
<p>Burke Harris’ plan is already more than a dream: In June, Gov. Gavin Newsom approved a budget that provides <a href="https://cpehn.org/blog/201901/governor-newsom%E2%80%99s-budget-makes-important-investments-health-equity-and-prevention">roughly $45 million</a> for trauma screenings and another $50 million to cover training for those who will administer the screenings. Burke Harris’ vision of universal screening for trauma in children may be a massive undertaking, but it’s also already under way.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301653/original/file-20191113-77363-acbz5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The first ever Surgeon General of California, Dr. Nadine Burke Harris, being sworn in.</span>
<span class="attribution"><a class="source" href="https://www.gov.ca.gov/">California Governor's Office</a></span>
</figcaption>
</figure>
<p>Well-intentioned critics might question the cost of Burke Harris’ project. As a <a href="https://socialwork.vcu.edu/about/our-team/sunny-h-shin-phd.html">social work professor</a> whose <a href="https://rampages.us/innovativewellness/">research</a> has long focused on childhood traumatic experiences and addiction, I believe such a program is needed nationwide.</p>
<p>If all the country’s children could undergo developmentally appropriate screenings for what we in the medical and social work communities call adverse childhood experiences, I suggest, based on my research, millions of tax dollars could be saved every year, <a href="https://rampages.us/innovativewellness/adverse-childhood-experiences-child-maltreatment/">premature deaths and diseases could be prevented</a> and schools would be healthier, happier places for students and teachers. A quiet but urgent public health crisis could finally be seriously addressed. Here’s why:</p>
<h2>1. Untreated childhood trauma can cause permanent biological damage</h2>
<p>Recent <a href="https://acestoohigh.com/2016/09/08/7-ways-childhood-adversity-changes-a-childs-brain/">biological evidence</a> confirms what many child development experts have long suspected: When kids experience certain types of childhood trauma, the impacts are not necessarily temporary. It can fundamentally change their brain development and other aspects of physical development.</p>
<p>One example of this: It appears that for some children who face adverse childhood experiences, the brain and body <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968319/">changes the way it responds to future stress</a>. Many of the changes affect the prefrontal cortex, which plays a key role in the regulation of emotions. A possible consequence: Some children with unresolved traumas are <a href="https://www.sciencedirect.com/science/article/pii/S0145213415000551?via%3Dihub">not sufficiently able to understand their own or their peers’ emotions</a>. Perhaps unsurprisingly, this disconnect can lead to various <a href="https://rampages.us/innovativewellness/addictive-behaviors/">behavioral problems in schools</a>.</p>
<h2>2. Early detection can largely resolve the impacts of trauma</h2>
<p>A traumatic experience itself cannot be undone. However, adults often underestimate just how <a href="http://www.child-encyclopedia.com/resilience/according-experts/resilience-after-trauma-early-development">resilient</a> children can be in the face of even the most serious adverse childhood experiences. And when adverse experiences are detected <a href="https://www.ncbi.nlm.nih.gov/pubmed/14686458">early</a>, trained professionals can help sufferers resolve lingering effects of trauma through therapy before they turn into much bigger behavioral problems.</p>
<p>Efforts, then, should focus on ensuring early detection of traumatic experiences. They should also focus on fostering habits that strengthen children’s resilience. That includes getting enough sleep and exercise, opportunities for mindfulness practice, and the support of a nurturing community.</p>
<h2>3. Screenings can help educators better understand their students</h2>
<p>When teachers better understand what might lie behind violent, stubborn or erratic behavior, it can help them be <a href="https://www.sciencedirect.com/science/article/pii/S0190740914000267">less punitive</a> and respond in ways that get closer to the root cause. In other words, teachers can spend more time proactively addressing the bigger potential issues rather than simply reacting to what has already happened. For example, if a teacher knows a child has been exposed to domestic violence, the teacher may have the school nurse check regularly whether the child is having any biological reactions. And school social workers and psychologists can talk to the child about whenever the student reacts negatively to something that took place in class.</p>
<h2>What’s next after universal trauma screenings?</h2>
<p>Once we’re screening for trauma across the board, educators and school systems will have no choice but to develop a language and practice around trauma-sensitive and trauma-informed education. This can only be a good thing for our schools, our children, and our society.</p>
<p>I think of trauma screenings as being similar in some ways to an X-ray: Even the most advanced machines cannot heal the bone. In order to heal the fracture, what you need is treatment that often involves resetting the bones and immobilizing it with a cast or splint. We will have to stress: What will we do with these results? How can we help our systems get to the point where they’re more than ready to handle the next step?</p>
<p>Implementing universal trauma screenings is an understandably daunting proposition. It would be highly costly and require intense logistical planning. School systems will also need to anticipate what they’ll do with the results if universal trauma screenings become a reality. The benefits of such screenings, however, far outweigh the logistical and financial costs. In my view, not implementing screenings for childhood trauma should be more worrisome than the challenges associated with the implementation. Too many modern societal problems, such as chronic disease and addictive behaviors, originate from ignorance around childhood trauma. But with a trauma screening plan like the one in California, schools could better work toward massively beneficial solutions.</p>
<p><em>This article has been corrected to show that the childhood trauma screenings in California are not set to take place in the state’s schools.</em></p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend.</a> ]</p><img src="https://counter.theconversation.com/content/126486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sunny Shin receives funding from the National Institutes of Health, Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation, ABMRF/The Foundation for Alcohol Research, Virginia Department of Social Services, and Virginia Foundation for Healthy Youth. </span></em></p>California’s surgeon general has implemented schoolwide screenings for trauma. A social work professor explains why the rest of the nation should do the same.Sunny Shin, Associate Professor, Virginia Commonwealth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1180272019-05-31T11:12:40Z2019-05-31T11:12:40ZHoward Stern talks childhood trauma, and a trauma psychiatrist talks about its lasting effects<p>With the awakening in society of the importance of mental health, combined with advances in neuroscience and psychiatry, much needed attention to trauma and childhood trauma is slowly forming.</p>
<p>In a recent interview with Anderson Cooper and in his latest book published May 14, Howard Stern discussed <a href="https://www.youtube.com/watch?v=aL7c6blpuXM">childhood adversity and trauma</a>. The two men also discussed their exposure to their parents’ stress and how their reactions as children formed their adult behavior. </p>
<p><a href="https://www.starclab.org/members/arash-javanbakht">As a trauma psychiatrist</a>, I am glad that men with such celebrity are willing to talk about their experiences, because it can help bring awareness to the public and reduce stigma.</p>
<h2>Childhood: Learning about the world and the self</h2>
<p>A child’s brain is a sponge for learning about how the world works and who they themselves are. We humans have an <a href="http://theconversation.com/to-feel-happier-we-have-to-resolve-to-the-life-we-evolved-to-live-108965">evolutionary advantage</a> in having the ability to trust the older and learn from them about the world. That leads to cumulative knowledge and protection against adversity, about which only the experienced know. A child absorbs the patterns of perceiving the world, relating to others and to the self by learning from adults.</p>
<p>But when the initial environment is unusually tough and unfriendly, then a child’s perception of the world may form around violence, fear, lack of safety and sadness. Brains of adults who experience childhood adversity, or even poverty, are <a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2015.00154/full">more prone to detecting danger</a>, at the cost of ignoring the positive or neutral experiences. </p>
<p>Some who experience childhood adversity have to mature faster and become caretakers or provide emotional support for siblings or parents at an age they themselves need to be taken care of. They may end up carrying those patterns of relating to others throughout their adult life. </p>
<p>The child of trauma may also perceive himself or herself as unworthy of love, guilty or bad. The brain of an unknowing child may think: If they do this to me, there should be something wrong with me, I deserve it. </p>
<p>The little world people experience as children forms the way we perceive the real big world, its people and the people we are as adults. This will then form the way the world reacts to us based on our actions.</p>
<h2>A world filled with trauma</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277241/original/file-20190530-69071-14cosbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An unidentified young person participating in therapy at a center for refugees in Detroit.</span>
<span class="attribution"><span class="source">David Dalton/Wayne State University</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Childhood trauma is more common than one would think: Up to two-thirds of children experience <a href="https://www.ncbi.nlm.nih.gov/pubmed/18349090/">at least one traumatic event</a>. <a href="https://www.samhsa.gov/sites/default/files/programs_campaigns/nctsi/nctsi-infographic-full.pdf">These include</a> serious medical illness or injury, firsthand experience of violence or sexual abuse or witnessing them, neglect, bullying and the newest addition to the list: <a href="http://theconversation.com/what-mass-shootings-do-to-those-not-shot-social-consequences-of-mass-gun-violence-106677">mass shootings</a>. </p>
<p>Unfortunately, when it comes to domestic violence and sexual abuse, it is often <a href="https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma">chronic, repetitive exposure</a>, which can be even more detrimental to the child’s mental and physical health and behavior. </p>
<p>Ongoing civil wars and refugee crises also expose millions of children to <a href="https://theconversation.com/syrian-refugees-in-america-the-forgotten-psychological-wounds-of-the-stress-of-migration-96155">extremely high levels of trauma</a>, which is often ignored.</p>
<h2>How do children react to trauma?</h2>
<p>To understand the child’s reaction to trauma, one has to keep in mind their developmental level of emotional and cognitive maturity. Most of the time, confusion is the reaction: The child does not know what is happening or why it is happening. </p>
<p>I hear frequently from my adult patients that when they were molested by a relative as a five-year-old, they did not know what was happening or why a supposedly trusting caregiver was doing it to them. Fear and terror, coupled with a sense of lack of control, are often companions of this confusion. </p>
<p>There is also guilt, as the child may believe they did something wrong to deserve the abuse, and often the perpetrating adults claim they did something wrong to deserve the abuse. Sadly when it comes to sexual abuse, sometimes when the parents are told about it, they choose to deny or ignore the incident. This makes the feelings of guilt and helplessness worse. When the trauma is happening to parents, such as frequent battering of a mother by an alcoholic father, children are stuck between two people they are supposed to love. They may be angry with the father for violence, or angry at the mother for not being able to protect herself and themselves. </p>
<p>They may try to rise to protect mom from father or from her sadness. They may feel guilty for not being able to save her, or have to raise their siblings when parents fail to do so. They learn the world is a brutal and unsafe place, a place where one is abused and one is violent.</p>
<h2>Adulthood scars of childhood trauma</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277242/original/file-20190530-69087-1x201hf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who are abused can be helped when adults take seriously their reports of abuse.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-little-girl-pink-dress-sits-232819528?src=byIM36lPnwzpyYMTyj91UQ-1-4">BestPhotoStudio/Shutterstock.com</a></span>
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</figure>
<p>There is a growing body of research suggesting longstanding impact of childhood trauma: not only that such childhood experiences can form the way the person perceives and reacts to the world, but also that there are lifelong academic, occupational, mental and physical health consequences. These children may have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232057/">lower intellectual and school performance</a>, <a href="https://theconversation.com/syrian-refugees-in-america-the-forgotten-psychological-wounds-of-the-stress-of-migration-96155">higher anxiety</a>, depression, substance use and a variety of <a href="https://www.ncbi.nlm.nih.gov/pubmed/16006380">physical health problems</a> including autoimmune disease.</p>
<p>Adults who endured childhood trauma have a higher chance of developing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108182/">post-traumatic stress disorder</a> when exposed to new trauma and show higher rates of <a href="https://www.ncbi.nlm.nih.gov/pubmed/12142846">anxiety</a>, depression, substance use and <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Childhood+trauma+and+suicide+attempt%3A+A+meta-analysis+of+longitudinal+studies+from+the+last+decade">suicide</a>. Physical health consequences of childhood trauma in adults include but are not limited to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26247216">obesity</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/23421962">chronic fatigue</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22787111">cardiovascular disease</a>, autoimmune disease, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24524907">metabolic syndrome</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/24360527">pain</a>.</p>
<p>Not all who are exposed to childhood adversity are permanently scarred, and a front line in research of childhood adversity is the predictors of risk and resilience. For instance, there are <a href="https://www.ncbi.nlm.nih.gov/pubmed/25162199">genetic variations</a> which may make the person more or less vulnerable to impact of trauma. I often see those who were lucky enough to transform their trauma to a meaningful cause, and with the help of a good mentor, therapist, grandparent or positive experiences rise and develop more strength. </p>
<p>This, however, does not mean those who sustain long-term impacts were weaker or tried less. There are a multitude of genetic, neurobiological, family, support, socioeconomic and environmental factors, besides the severity and how chronic the trauma is, that can lead to breaking of the strongest of people when exposed to trauma.</p>
<h2>How to deal with childhood trauma</h2>
<p>We as a society can do a lot: reduce poverty; educate and provide less privileged parents with support needed for raising their children (although childhood trauma happens also in privileged homes); take seriously children’s report of abuse; remove the source of trauma or remove the child from the traumatic environment; psychotherapy. When necessary, medications can also help. </p>
<p>Fortunately for all of us, recent advances in neuroscience, <a href="https://www.frontiersin.org/articles/10.3389/fnbeh.2018.00328/full">psychotherapy</a> and psychiatry have provided us with strong tools to prevent the negative impact in the child and reduce a lot of the negative impact in the adults, if we choose to use them.</p><img src="https://counter.theconversation.com/content/118027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Childhood trauma is far more pervasive and injurious than many people know. Its effects last long into adulthood, if left untreated. A trauma psychiatrist unpacks its effects on the developing brain.Arash Javanbakht, Assistant Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/968842018-06-20T10:26:13Z2018-06-20T10:26:13ZExtreme stress during childhood can hurt social learning for years to come<figure><img src="https://images.theconversation.com/files/223661/original/file-20180618-85858-ymwf8b.jpg?ixlib=rb-1.1.0&rect=1350%2C522%2C4656%2C3368&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Which cognitive processes explain long-term effects of childhood adversity?</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/SHe_xNDFOLU">Ricky Kharawala on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Each year, more than 6 million children in the United States are <a href="https://doi.org/10.1016/j.chiabu.2011.10.006">referred to Child Protective Services for abuse or neglect</a>. <a href="https://doi.org/10.1001/jamapsychiatry.2015.1792">Previous research</a> on the consequences of early life stress and child maltreatment shows that these children will be more likely to develop a multitude of <a href="https://dx.doi.org/10.1017%2FS0954579415000826">social and mental health problems</a>. Teens and adults who experienced early adversity such as abuse, neglect or extreme deprivation are more likely to be socially isolated, spend time in jail, and develop psychological disorders including anxiety and <a href="https://doi.org/10.1146/annurev-clinpsy-050212-185606">depression</a>.</p>
<p>Researchers have long puzzled over why early life stress is linked to such a wide variety of problems years later. Why do many of these problems <a href="https://doi.org/10.1111/j.1540-5834.2011.00631.x">emerge only in adolescence or even adulthood</a>? These “sleeper effects” suggest early life stress might disrupt aspects of brain development that support key emotional and cognitive processes which normally promote positive social relationships and mental health.</p>
<p>Psychologists know that early life stress affects people’s <a href="https://doi.org/10.1007/s00213-010-2009-2">ability to control or regulate their emotions</a> and the <a href="https://doi.org/10.1111/j.1469-7610.2012.02597.x">brain regions that support these skills</a>. For example, children who have experienced a lot of stress seem to have more difficulty containing negative emotions like anger or anxiety.</p>
<p>But emotion regulation might not be the whole story. Because early life stress is associated with such a wide array of later problems, it seems likely that these adverse experiences also affect some other very basic cognitive processes. My colleagues <a href="https://scholar.google.com/citations?user=FfGM-GMAAAAJ&hl=en&oi=ao">and I</a> carried out <a href="https://doi.org/10.1111/desc.12596">a study to investigate</a>. Our findings suggest that, beyond emotion, two general learning mechanisms are also affected by early life stress – and these have the potential to explain long-term effects of childhood adversity.</p>
<h2>Two types of social learning</h2>
<p>My colleagues and I decided to focus on two cognitive skills that are fundamental to how people function socially in the world.</p>
<p>The first is the ability to learn and update associations between one’s own actions and the outcomes that result from them — what psychologists call “instrumental learning.” A very simple example would be learning that when I ring the doorbell, someone comes to the door.</p>
<p>But ringing a doorbell doesn’t always result in someone coming to the door – maybe no one is home. So links between actions and outcomes depend on the context. In this study, we were also interested in how stress affects the ability to update one’s knowledge when circumstances change — what psychologists call “cognitive flexibility.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223915/original/file-20180619-126540-11grn3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Part of having a successful social interaction is updating what you’re doing based on the feedback you’re receiving.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bored-girl-listening-her-friend-having-561922549">Antonio Guillem/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Say I’m telling my friend about the last ultramarathon I ran, giving her a mile-by-mile recap. My friend might be really engaged at first, so I’d form a positive association between my chosen conversation topic and her enthusiasm. But eventually she might start to get bored – I can be pretty long-winded when I talk about running.</p>
<p>Hopefully I’ll notice this shift – my association between me talking and her reaction will change – and I’ll wrap up my recap. But if I repeatedly fail to pick up on signals that my conversation partner is losing interest in what I’m talking about, she might start taking more rain checks on our coffee dates.</p>
<p>The circumstances around you, including other people’s reactions to your behavior, are continually changing, and it’s good for you to be able to recognize these changes and adjust your behavior accordingly. If not, you’ll have trouble developing healthy social relationships. It’s these skills our study focused on.</p>
<h2>Looking for effects of stress in the lab</h2>
<p>My colleagues and I brought teenage participants – half of whom had been physically abused by their caregivers in early childhood – into our lab to investigate how they did on particular cognitive tasks.</p>
<p>We first tested whether adolescents who had been abused in early childhood were as good as their peers at linking their actions in context to rewards and punishments.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=219&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=219&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=219&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=275&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=275&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223658/original/file-20180618-85849-uxskza.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=275&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Participants first learned whether responding to a neutral picture was rewarded or punished.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1111/desc.12596">Harms et al. Developmental Science. 2017;e12596.</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>The teens viewed pictures of everyday objects, like a shoe or a broom. These are neutral objects that aren’t inherently good or bad, so in this task participants had to learn through experience whether each picture was linked to a reward or a punishment. Each time they saw a picture, they had the option to either press a button or do nothing. If they pressed the button, they would either win points or lose points. Some pictures led to a reward and others to a loss. If they didn’t press the button, nothing happened.</p>
<p>Halfway through the task, we switched things up. Because other studies found that children who experienced early life stress <a href="https://doi.org/10.1016/j.neuropsychologia.2010.06.013">can have an especially hard time changing their responses</a>, we were interested in our participants’ cognitive flexibility. Some of the pictures that had initially led to a reward now led to a loss and vice versa. This situation was akin to my friend getting bored with all my running stories. Participants needed to change their responses if they wanted to continue earning points.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=706&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=706&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=706&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=888&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=888&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223679/original/file-20180618-85822-1a1zgf2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=888&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children exposed to early life stress had difficulty learning what to do when images switched their associations.</span>
<span class="attribution"><span class="source">Harms et al. Developmental Science. 2017;e12596.</span></span>
</figcaption>
</figure>
<p>It turns out that teens who had been physically abused had more trouble with both parts of the task than their peers who had not been abused. Their difficulties were especially obvious when they had to change their responses. Once they had learned the links between context, action and outcome, they had a hard time updating and adjusting their behavior when the situation changed – like when an event that had been linked to reward became linked to punishment, or vice versa.</p>
<p>While teens worked on this task, my colleagues and I used functional magnetic resonance imaging to measure which areas of their brains were active. When abused teens saw pictures that led to reward, the putamen and anterior cingulate cortex – two regions of the brain that help people learn associations between their actions and outcomes – were less active. Interestingly, researchers have found similar patterns of reduced brain activity when reward is at stake in people who have psychological disorders <a href="https://doi.org/10.1111/j.1469-7610.2011.02477.x">such as depression</a>.</p>
<h2>Lingering effects – and how to counteract them</h2>
<p>Put together, these research findings suggest that early adversity could affect how people learn to obtain rewards in their lives. It’s possible that stress disrupts the development of key brain regions that help people associate specific events or actions with positive or negative outcomes. Children exposed to early stress might therefore have trouble learning how to achieve positive outcomes in their lives, like doing well in school or making friends — and these problems likely cause additional stress.</p>
<p>As a result, these individuals might encounter fewer positive and more negative experiences even after the initial adversity has ended, and end up with <a href="https://doi.org/10.1111/j.1469-7610.2011.02477.x">higher risks for mental health problems like depression</a>. Because these learning difficulties don’t go away once the stress ends, this pathway also helps explain the sleeper effects of early life stress that only show up a bit later in life. </p>
<p>If early life stress disrupts something as fundamental as basic learning, is there any hope for these kids? Yes. In fact, these studies suggest new ways researchers could think about creating interventions to help kids who’ve experienced early adversity. For example, carefully designed computer games could teach children to pay attention to rewards in their environment and to gather information about how to obtain these rewards.</p>
<p>Other interventions could target children’s abilities to deal with changing circumstances. In fact, programs like Big Brothers and Big Sisters, <a href="http://ppv.issuelab.org/resource/making-a-difference-an-impact-study-of-big-brothers-big-sisters-re-issue-of-1995-study.html">which seem to improve outcomes in at-risk kids</a> might already work this way by exposing children to new environments and new people. Boosting children’s learning abilities in these ways might be an effective way to improve social and mental health outcomes.</p>
<p>Although society should strive to prevent children from being exposed to high levels of stress in the first place, new research on how exposure to stress affects learning can lead to more ways to help kids who have already experienced early adversity.</p><img src="https://counter.theconversation.com/content/96884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Madeline Harms has received funding from the National Institute of Mental Health (award number by T32-MH018931).</span></em></p>Childhood adversity is linked to social and mental health problems later in life. New research suggests brains that aren’t as good at recognizing rewards and responding to change may be to blame.Madeline Harms, Postdoctoral Researcher in Psychology, University of Wisconsin-MadisonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/890692018-02-07T11:27:49Z2018-02-07T11:27:49ZHow childhood experiences contribute to the education-health link<figure><img src="https://images.theconversation.com/files/205172/original/file-20180206-88784-hy8yxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A teen looking out of a window. Research shows that traumatic events in childhood can affect children as they mature and limit their education, which in turn can harm their health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-lonely-orphan-boy-orphanage-looking-369853097?src=34utG_EdzVzQ1RhrSo9-PQ-1-6">Jan Andersen/Shutterstock.com</a></span></figcaption></figure><p>The interconnection between education and health is well established. </p>
<p>Take, for example, smoking. Smoking continues to be the leading cause of preventable disease and death in the U.S. The highest percent of smoking is seen among persons with <a href="https://www.cdc.gov/nchs/data/hus/hus15.pdf">less than a high school or General Educational Development (GED) high school equivalency diploma</a>, and the lowest is among persons with a bachelor’s degree or higher. </p>
<p>Trends in efforts to quit smoking also <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm">vary by educational level</a>. Adults with a GED certificate, adults with no high school diploma, and adults with a high school diploma historically have had the lowest rates of quitting smoking compared to adults overall.</p>
<p>But these data document the relationship when it is too late: Adults don’t drop out of school, children do. </p>
<p>The field of public health recognizes education is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/22102542">social determinant of health</a> and an indicator of well-being. National efforts are currently focused on <a href="https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health/objectives">promoting language and literacy, increasing high school completion and increasing college enrollment</a>. It is critical to ensure that children have positive learning experiences while they are still young so that they can achieve educational success. This is one of the best ways to ensure that they can live healthier lives as adults.</p>
<p>Other researchers and I have contributed to <a href="https://ac.els-cdn.com/S0091743503001233/1-s2.0-S0091743503001233-main.pdf?_tid=774ed5d6-0b43-11e8-85d0-00000aacb35d&acdnat=1517924691_2aca51d73f4e8764142e303afbec76fa">widening body of research</a> that shows how these experiences harm over the lifespan and across generations. Abuse, neglect and related stressors contribute to <a href="https://jamanetwork.com/journals/jama/fullarticle/194504">mental illness, substance use</a>, and a host of other negative <a href="https://www.cdc.gov/violenceprevention/acestudy/index.html">social and behavioral</a> outcomes decades later in life. </p>
<h2>Early childhood development</h2>
<p>A human baby’s brain is not fully developed at birth. Rapid brain development occurs in the <a href="https://developingchild.harvard.edu/science/key-concepts/brain-architecture/">first few years of life</a> and then steadies into childhood and adolescence. The biodevelopmental impact of exposure to severe forms of stress and trauma is not immediately visible. But <a href="http://pediatrics.aappublications.org/content/129/1/e224">abuse, neglect, poverty and related stressful exposures</a> can put children at risk for problems with healthy cognitive, social and emotional development, which can interfere with learning. Thus, research has shown that these adverse childhood experiences not only contribute to health outcomes, but there appears to be a link with adult <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm">educational attainment</a>.</p>
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<p>Knowing that education begins in childhood and acts as a social determinant of health, I decided it was time that we take a close look at how childhood adversities impact learning and education. I recently had the honor to serve as guest editor for a special journal issue in Child Abuse & Neglect focused on this very topic. </p>
<p>To effectively address education as a social determinant of health, I have found that learning environments must include staff who have knowledge about trauma and symptoms of trauma. Most importantly, the school ecosystems, which are comprised of the schools’ staff, must be prepared and able to provide children, and each other, safe, supportive and trusting environments. Thus, creating effective solutions will require a multigenerational approach – those that not only focus on the children affected, but also on adults. </p>
<h2>Education for all</h2>
<p>Child labor increased when the U.S. Industrial Revolution started in the late 1700s and early 1800s. During this time, children worked in unfit conditions sometimes for up to 70 hours per week. After many attempts to change child labor laws between the late 1800s and early 1900s, Congress passed the <a href="https://www.dol.gov/whd/childlabor.htm#Overview">Fair Labor Standards Act of 1938</a>. The purpose was to ensure the health and safety of children and to promote well-being through educational pursuits.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/205173/original/file-20180206-88775-1a87yt0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">While every child in the U.S. is entitled to an education, inequalities exist across school systems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-smiling-little-school-kids-corridor-259319342?src=AuwJ5aI0WCNdUGOwK3QptA-1-12">ESB Professional/Shutterstock.com</a></span>
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<p>Despite the fact that every child is entitled to a public education in the U.S., <a href="https://news.stanford.edu/2016/04/29/local-education-inequities-across-u-s-revealed-new-stanford-data-set/">educational inequalities exist across school systems</a>. In addition, some children enter school ready to learn, while others, who experience abuse, neglect and other forms of related toxic stress, may have difficulties learning. </p>
<p>Truancy is too often viewed and treated as a form of misconduct without identifying the <a href="https://eric.ed.gov/?id=EJ835979">underlying reason for the behavior</a>. The field of education needs to realize that a large percent of children are exposed to adversities, and that learning and behavioral problems are often times a symptom. </p>
<h2>What is the research telling us?</h2>
<p>Research on adverse childhood experiences is being applied in multiple contexts, including school systems. In short, the fields of public health and education are learning a great deal more about how childhood adversities can negatively impact educational success, a social determinant of health. </p>
<p>Given all we know about the impact of <a href="http://pediatrics.aappublications.org/content/129/1/e224">toxic stress on the developing brain of children</a>, more attention is needed on <a href="https://www.sciencedirect.com/journal/child-abuse-and-neglect/vol/75/suppl/C">children’s education and learning in the context of adverse life experiences</a>. To address <a href="https://www.ncbi.nlm.nih.gov/pubmed/22102542">education as a social determinant of health</a>, ensuring children’s successful and positive educational experience while they are still young requires increased awareness of the widespread but hidden problem of childhood adversities and their impact on learning. </p>
<p>Childhood traumatic stress from <a href="http://www.sciencedirect.com/science/article/pii/S0145213417302491">violence</a>, <a href="http://www.sciencedirect.com/science/article/pii/S0145213417303186">abuse</a>, <a href="http://www.sciencedirect.com/science/article/pii/S014521341730234X">corporal punishment</a> and neglect contribute to educational outcomes such as excessive absenteeism, school dropout and school performance. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0145213417301710?via%3Dihub">Problems with emotional regulation</a> that result from maltreatment can also interfere with positive learning, class attendance, and problems with <a href="https://ac.els-cdn.com/S0145213417302302/1-s2.0-S0145213417302302-main.pdf?_tid=235d3b6a-ea65-11e7-920e-00000aab0f26&acdnat=1514310756_5435650a0dad19e94e20a111ba7d6c22">language development</a> and communication. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0145213417301916">Educational neglect</a> requires more attention from the field. It is a form of maltreatment that lacks sufficient studies to fully understand why it occurs and how it can impact children’s ability to learn and educationally succeed. </p>
<p>Older students are also at risk. <a href="http://www.sciencedirect.com/science/article/pii/S0145213417301710?via%3Dihub">College-aged students</a> who have a history of childhood trauma may encounter difficulties with post-secondary education. </p>
<p>Children who have been through the foster care system are particularly at high risk. <a href="https://ac.els-cdn.com/S0145213417302788/1-s2.0-S0145213417302788-main.pdf?_tid=bb68c316-ea65-11e7-8216-00000aab0f26&acdnat=1514311012_0fc91061cf00e0a495bd90545ef1b2d6">Family-school partnerships</a> and school connections are especially important factors that can promote their learning in the face of adversities. </p>
<p>Most importantly, I believe that both education and public health must work together to effectively <a href="https://ac.els-cdn.com/S0145213417303654/1-s2.0-S0145213417303654-main.pdf?_tid=99f336ba-0925-11e8-97fa-00000aab0f02&acdnat=1517691962_54c0be9313d31b93b0c0a5a40e24cdd3">promote and foster positive learning environments for all children</a>. Utilizing principles and strategies of <a href="https://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816">trauma-informed care</a> is a movement that is rapidly sweeping across schools. A recognition that education is a key indicator of well-being can help bring in focus the true nexus of education and health.</p>
<p>In my view, childhood stress and trauma is a public health crisis. As a society, we must recognize that shame and secrecy keep it a hidden problem. Unlike infectious diseases, trauma cannot be sanitized, vaccinated against or treated with antibiotics. Therefore, to promote well-being across the lifespan, we must collectively invest in meeting the needs of future generations.</p><img src="https://counter.theconversation.com/content/89069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shanta R. Dube is founder and owner of Vision of Wellness, LLC and mWELL, LLC. She serves as one of the Associate Editors for the international journal, Child Abuse & Neglect and is working with the GA Department of Education. </span></em></p>Adverse childhood events can not only cause lasting psychological effects but also learning problems. That, in turn, worsens health outcomes, as literacy is an integral part of health care.Shanta R. Dube, Associate Professor, School of Public Health, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781612017-06-01T01:57:15Z2017-06-01T01:57:15ZHow yoga is helping girls heal from trauma<figure><img src="https://images.theconversation.com/files/171511/original/file-20170530-23672-m2il5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Photo copyright TheArtOfYogaProject.</span> </figcaption></figure><p>Rocsana Enriquez started thinking about yoga again when she was pregnant. She was 19 and in an abusive relationship. </p>
<p>When she was younger, Rocsana, whom I interviewed as part of my research, had taken part in a yoga program in a San Francisco Bay Area juvenile hall run by <a href="http://theartofyogaproject.org">The Art of Yoga Project</a>. She began using the skills she learned on the mat to slow herself down when she got angry and to pause before reacting. She remembered the breathing techniques and poses that made her feel better about herself. </p>
<p>Now, seeking the same quietness she had been able to achieve in class back in juvenile hall, she reached out to the program, never expecting to hear back. </p>
<p>Childhood trauma has a devastating impact on both the mind and the body of children who experience it. But that mind-body connection also offers a path toward healing. A growing body of research demonstrates the effectiveness of addressing the mental and physical impact of trauma through yoga and other somatic, or body-based, programs.</p>
<p><a href="https://www.law.georgetown.edu/academics/centers-institutes/poverty-inequality/">The Georgetown Law Center on Poverty and Inequality</a>, of which I am executive director, released a <a href="http://www.law.georgetown.edu/academics/centers-institutes/poverty-inequality/upload/gender-and-trauma.pdf">first-of-its-kind report</a> in April that synthesizes existing research, interviews with experts across the country and two original pilot studies focused on at-risk girls. </p>
<p>Our conclusion: yoga and mindfulness programs can equip girls like Rocsana – especially those in the juvenile justice system – with tools that help them thrive.</p>
<h2>Widespread abuse leads to widespread anxiety</h2>
<p>Research shows that Rocsana is not alone in experiencing abuse as a young person. Children in the United States experience trauma at breathtakingly high rates. In the seminal <a href="https://www.cdc.gov/violenceprevention/acestudy/about.html">Adverse Childhood Experiences survey</a> of more than 17,000 participants, 21 percent reported experiencing sexual abuse as children; 26 percent reported physical abuse; and 14.8 percent reported emotional neglect. <a href="https://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf">Youth in the juvenile justice system are the most vulnerable</a>, reporting higher rates of trauma than their peers. These experiences take a <a href="http://www.nctsn.org/trauma-types/complex-trauma/effects-of-complex-trauma">long-term toll not only on their mental health, but their physical health as well</a>. These children are more likely than others to experience depression and substance abuse as adults – and they exhibit higher rates of heart disease, cancer and liver disease. </p>
<p><a href="http://www.traumacenter.org/products/pdf_files/Peaceful_Embodiment_Through_Yoga_R0002.pdf">Studies reveal</a> that yoga programs designed specifically for victims of trauma – programs that include regulated breathing, controlled movement and mindfulness practices – can have far-ranging benefits for any participant. <a href="https://www.ncbi.nlm.nih.gov/pubmed/25004196">Improvements have been shown in mental health</a> (self-regulation, self-esteem) and <a href="http://dro.deakin.edu.au/view/DU:30086944">physical health</a> (better sleep, a reduction in gastric symptoms and many other positive outcomes).</p>
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<img alt="" src="https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171519/original/file-20170530-23699-fg95i9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Yoga and relaxation can help trauma victims.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-practicing-yoga-studio-shavasana-311459891?src=BgBJgX63OUqGMKIXAdiQGw-1-52">Luna Vandoome/Shutterstock</a></span>
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<p>As our report makes clear, these programs’ potential to help at-risk adolescent girls is only beginning to be realized. The next step is to design curricula that specifically address girls’ unique experiences and perspectives.</p>
<p>For example, yoga and mindfulness programs should emphasize relationship-building, to reflect the value that girls often place on interpersonal connections. Somatic therapy should also account for the fact that girls experience much higher rates of sexual abuse than boys. According to a <a href="http://nationalcrittenton.org/wp-content/uploads/2016/09/ACE_REPORT_finalsm.pdf">recent study by The National Crittenton Foundation</a>, the differential between girls’ and boys’ reported rates of sexual abuse is 32 percent – a discrepancy seen in <a href="http://www.nctsn.org/sites/default/files/assets/pdfs/trauma_among_girls_in_the_jj_system_2014.pdf">other studies</a> as well. </p>
<p>In addition, <a href="https://www.ojjdp.gov/ojstatbb/dmcdb/asp/display.asp?display_in=3">a disproportionate number of girls in the justice system are girls of color</a>; and many girls are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118668/">LGBT and have been targeted for violence because of their identity</a>. These layers of identity profoundly shape their experiences of trauma and the world’s response to them. To be truly effective, yoga and mindfulness programs must respond, thoughtfully, to these unique factors.</p>
<p>If they do, the physical and mental benefits of yoga can reach – and help – a much wider range of girls who are greatly in need. And that need is profound: <a href="https://www.law.georgetown.edu/academics/centers-institutes/poverty-inequality/upload/2015_COP_sexual-abuse_layout_web-2.pdf">In the justice system, girls are often underserved, with inadequate access to mental health services</a>.</p>
<h2>From student to teacher</h2>
<p><a href="http://theartofygaproject.org/">The Art of Yoga Project</a> did call Rocsana back. Not only that: She has now made the transition from student to teacher, employed by the program that she credits with changing her life and helping her become the kind of parent and role model she wants to be. </p>
<p>Rocsana told me that if people can learn the skills of regulated breathing, physical engagement and mindfulness, it can help break the cycle of trauma. <a href="https://www.law.georgetown.edu/news/press-releases/yoga-helps-at-risk-girls.cfm">Our research supports her belief.</a></p><img src="https://counter.theconversation.com/content/78161/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Epstein serves on a voluntary basis as an advisor to The Art of Yoga Project. </span></em></p>Yoga programs specifically designed to heal girls’ trauma are showing results in facilities across the country. Here’s how.Rebecca Epstein, Executive Director, Georgetown Law Center on Poverty and Inequality, Georgetown UniversityLicensed as Creative Commons – attribution, no derivatives.