Summary
Highlights
A CDC and Kaiser Permanente study in the mid-90s revealed that childhood trauma dramatically increases the risk for seven out of ten leading causes of death. High doses of trauma affect brain development, immune systems, hormonal systems, and DNA, leading to a 20-year difference in life expectancy and triple the risk of heart disease and lung cancer. Despite these severe consequences, doctors are not routinely trained to screen or treat childhood trauma.
Dr. Nadine Burke Harris, initially trained to view trauma as a social or mental health problem, experienced a shift in perspective while working in an underserved community in San Francisco. She noticed many children referred for ADHD actually presented with symptoms stemming from severe trauma, realized her traditional approach was insuficiente, and was prompted to investigate the root causes of these health problems.
Dr. Burke Harris discovered the Adverse Childhood Experiences (ACEs) Study, conducted by Dr. Vince Felitti and Dr. Bob Anda. This study surveyed 17,500 adults about their exposure to various forms of childhood adversity, such as abuse, neglect, and household dysfunction. Participants received an ACE score based on their responses, which was then correlated with health outcomes.
The ACEs study revealed two critical findings: ACEs are incredibly common, with 67% of the population having at least one ACE and 12.6% having four or more. More importantly, there's a clear dose-response relationship: the higher an individual's ACE score, the worse their health outcomes. For example, an ACE score of four or more drastically increased the risk of chronic obstructive pulmonary disease, depression, and suicidality.
The science explains that early adversity affects critical brain areas like the nucleus accumbens (pleasure/reward), prefrontal cortex (impulse control), and amygdala (fear response), leading to higher-risk behaviors. Beyond behavior, even without high-risk activities, the chronic activation of the body's stress response system (hypothalamic–pituitary–adrenal axis) by repeated trauma, termed 'toxic stress,' leads to maladaptive changes that damage health, particularly in developing children.
Armed with this new understanding, Dr. Burke Harris's clinic, the Center for Youth Wellness, began routine ACEs screening for all patients. For those with positive screenings, a multidisciplinary team provides treatment to reduce adversity and address symptoms through interventions like home visits, care coordination, mental health services, nutrition, and holistic approaches.
Dr. Burke Harris advocates for recognizing childhood trauma, or ACEs, as a major unaddressed public health threat. Drawing parallels with successful public health interventions for issues like tobacco and lead poisoning, she asserts that a collective approach is needed. She suggests that society has marginalized the issue perhaps because it touches many, making it uncomfortable to confront directly.
Scientific advancements and economic realities make ignoring the impact of early adversity on health increasingly untenable. Dr. Burke Harris believes that in the future, the failure to recognize and treat ACEs will be seen as a significant oversight, comparable to past medical anomalies. She calls for courage to face this problem head-on, recognizing its universality, and emphasizes that collective action is essential for it to be treatable and beatable.