IMPACT OF ADVERSE CHILDHOOD EXPERIENCES [ACE]

Starting in the 1980s, there was a focus on identifying risk factors for developing disease and yet it was clear that risk factors such as smoking, alcohol abuse and sexual behaviors were not evenly [randomly] distributed across the population.  It was also found that risk factors for chronic diseases clustered with many people having more than one risk factor. This led to a study addressing the connection between adverse childhood experiences [ACEs] and later risk factors for health and social problems.  Starting in 1995 over 17,000 people had physical exams and were asked to fill out questionnaires about childhood maltreatment [forms of abuse] and family dysfunction. They found that almost two thirds of them had at least one ACE and more than one fifth had three or more ACEs. Women experienced more emotional and sexual abuse compared to men.  About one fourth experienced both physical and sexual abuse.  The prevalence of ACEs is a major social and health concern and when their impact on later health and social factors are recognized it is even concerning.  

They found that as the number of ACEs increased, the risk for health and social problems increased as well.  These include: alcoholism and alcohol abuse; chronic obstructive pulmonary disease [COPD]; depression; fetal death; health-related quality of life problems; illicit drug use; ischemic heart disease [IHD]; liver disease; risk for intimate partner violence [domestic violence]; multiple sexual partners; sexually transmitted diseases [STDs]; smoking; suicide attempts; unintended pregnancies; early initiation of smoking; early initiation of sexual activity; and adolescent pregnancy.  A prospective study in ongoing that is continuing to evaluate the impact of ACEs and family dysfunction on later health, social problems and early death. 

It is tragic to see the terrible impact of ACEs that lead to chronic stress, on future health and social problems.  So what can be done.  Already, there are more efforts to identify victims of ACEs and see that research based treatment are available for them.  This is quite a daunting task considering the large number of children and adolescents who are victimized by ACEs.  So what about preventing ACEs?  Well, there is a growing movement to provide good preschool programs for all preschool aged children.  Where these programs have been in place there is evidence that long term outcomes [high school graduation rates; employment and no legal problems] improve and that this in part seems related to parents spending more time reading to their young children.  This is addtionally encouraging as other studies have shown that the more young children are spoken to by their parents, the more likely it is that they will become successful adults.  

I believe that if good preschool programs are available to all families that the incidence of ACEs will go down. I am hoping that we can all band together and support the funding of preschool programs as well as funding to be able to identify victims of ACE and make available effective treatments that can prevent the occurance of later health and social problems.

BEING PRESENT DOESN'T HAVE TO BE AN ART

David Brooks had an opinion piece in the New York Times on January 21, 2014 that he entitled "The Art of Presence." He describes how a victim of trauma have times when they feel overwelming despair and paralyzed by fear.  These victims have experienced what is helpful from other people who interact with them.  One of these victims, Catherine who was riding her bike and hit by a car, wrote a blog post for Sourjourners and lists ways people have been helpful to her: do be there; don't compare,ever; do bring soup; do not say "you'll get over it"; do be a builder; and don't say it is all for the best or try to make sense of what has happened.

Do be there.  Being present with the trauma victims and their families is very important. Catherine comments that she was surprised how many of their not as close friends showed up over and over and that some of their close friends were not present [did not come by].  This may be because a lot people think that people who have been traumatized or have experienced a loss, "need space."  Catherine is clear about this, stating that people who are traumatized or experience loss need people to visit.  Don't compare ever: it is not helpful to act like you knowwhat they are going through because of your own experience.  It is never comforting and frequently feels like you don't understand and are saying to get over it.  Do bring soup: it is still true that bringing food brings comfort.  Catherine tells of a friend bringing a bathmat when she noticed that they did not have one!  Don't say "you'll get over it": Catherine says "there is no such thing as getting over it," when someone is traumatized or experience losses, they never get over it but experience a new normal.  It is important to emphasize that each of us who is traumatized or experience loss has an opportunity to establish a new normal and a new sense of themselves and be better off for this.  Do be a builder: this is someone who keeps coming back and being present for the long haul.  There are people who are good at putting out fires [coming immediately and helping] but the builders are very important.  Don't say it's all for the best or try to make sense out of what has happened: this is distracting for the victims and again feels like these comments are insensitive and it has to be something that the victims understand for themselves and cannot be told what it means.  Actually, none of us can be told what things mean as we all have to discover this for ourselves. 

So, being with people who have been traumatized or have suffered a loss, is very important.  Literally being with them and spending time with them and providing food are all helpful. It is important to realize that being with people is supportive and to resist talking ourselves out of realizing how helpful being with people can be.

GOOD GRIEF!

So, what is good about grief? Grieving is considered something that we need to do if we want to be able to cope with losses.  Bereavement is another word used for grieving.  WebMD defines grief as an emotional reaction to a loss.  Grief type feelings can occur after a number of different types of loss, including a loved one, pet, place you are living, job, object, etc.  Years ago, Elizabeth Kubler Ross identified the stages of grief.  These include: denial, anger, bargaining, depression and acceptance.  Kubler Ross felt that being able to talk about the feelings associated with grief with others is helpful to learning to cope with the loss. Other researchers, notably George Bonanno's research into grieving found that many people do not go through the stages of grief and seem to cope because they have a "natural resilience."  This seems to be also associated with being in a positive environment [surrounded by people who are supportive and encouraging].  Risilience is considered a process where a number of protective factors can support an individual's ability to cope with loss without experiencing intense feelings of loss

Again, what is good about having feelings of grief?  It is more obvious what might be considered good about having resilience.  Of course, there are plenty of sudies that document the importance of having supportive and encouraging people around you, especially when you are under what could be a stressful situation.  So, maybe the grief feelings serve a similar function.  If so, how can they help us cope with losses so that they are less stressful for us? The movement towards acceptance [Kubler Ross' last stage of grief] would seem to be desirable as acceptance relieves us of having to put brain activity into resisting the acceptance as this resistance would keep us focused on the past and require a lot of brain activity to keep it going.  This focus on the past creates stress for us.

There is evidence that chronic stress is not good for our brains or our bodies.  It occupies a lot of brain activity and seems to keep the brain in a hyperalert or crisis type mode. This can lead to a compromised immune system and increased risk of illnesses.  Our brains are in this mode because of instructions from us as we resist accepting the facts of losses as if accepting them is dangerous. If people around us hesitate to talk about the loss or their feelings, that can be interpreted by us as a sign that the feelings are dangerous.  

One of the good things that can come from our accepting a loss is the recognition that strong feelings are safe.  They can be and often are intense but are not overwelming unless we believe that they are. Experiencing the feelings and sticking with them can teach us that they are safe.  This will then reduce our stress level and help us to then cope with feelings in the future and not have to experience stress. This is good for us and our brains.

THIS WE KNOW: THE EARTH DOES NOT BELONG TO US. WE BELONG TO THE EARTH.

The above quote is attributed to Chief Seattle, although it is not certain.  Another quote attributed to Chief Seattle is "This we know: We do not inherit the earth from our ancestors, we borrow it from our children." Another quote is: "This we know: all things are bound together! all thing connect."  Chief Seattle was chief of the Duwamish tribe that was in the north west and the city of Seattle was named after him.  The above quotes were from the mid 1800s when the US was buying their land and relocating the tribe to a reservation. The quotes indicate the Native Americans view that the earth and everything in it are sacred.  They also did not think anyone could own land as it be longed to the Great Spirit.  

I wonder if we could all benefit from living like we believed that the earth and everything in it are sacred. That would mean that we would consider all living things to be sacred.  I believe that this would lead us to change how we treated each other and how we treated our earth.  Also, we were to do this, it could become part of our effort to make amends for the way we have treated Native Americans.  I think that it is important that we acknowledge our responsibility for the mistreatment of Native Americans to help heal this scar in our history as a nation.  It seems fitting that part of this healing would involve treating each other and the earth as sacred, since this would be a way of honoring Native Americans (and honoring ourselves).

RAISING CONFIDENT CHILDREN

In an earlier blog, "Risk of Suicide and of Suicide Attempts," I described a study by Hart and Risley that followed 42 families for 3 1/2 years counting the number and nature of words directed to young children aged 7months to 2 1/2 years with the families divided into three groups identified as professional, working class and welfare.  Hart and Risley found that the more words spoken to these very young children the better their vocabulary, the higher their IQ and better their success in school.  Their success continued into adulthood.

The difference in words spoken was dramatic as over the first 4 years of a child's life.  In the professional category of family, the child would hear 48 million words, while those from working classs families would hear 23 million words and those from the welfare category of family would hear 13 million words.  The difference in number of words the children heard was correlated for chldren from welfare families starting school 12-14 months behind the children from professional families. Follow-up studies found that this difference was not made up even with efforts by the schools to increase their vocabularies.  The study also found that children are more confident [and successful] if they hear more positive words directed to them when they are young [and older too].  

So, it may be obvious why I consider this important.  All of us can talk more to our children [not just asking questions!].  We can also encourage and support our children as this will improve their self-conficence and reduce risk that they will be suicidal or attempt suicide.  This indicates how important it is to be positive with our children.  It is also a good way to be with each other as parents and really with anyone.  

If more of us were encouraging and supportive with people that we interact with, the stress level around us would be a lot less.  Let's give it a try.