Lecture on Adverse Childhood Experiences (ACEs)

Introduction

• In the mid-90s, the CDC and Kaiser Permanente discovered a significant exposure increasing the risk for major causes of death in the US.
• Exposure affects brain development, immune system, hormonal systems, and DNA transcription.
• High exposure leads to a tripled risk of heart disease and lung cancer, with a 20-year reduced life expectancy.
• Doctors are not routinely trained in screening or treatment for this exposure.
• The exposure is childhood trauma, not chemicals or pesticides.

Types of Trauma

• Not minor incidents like failing a test or losing a game.
• Severe experiences such as abuse, neglect, or living with a parent with mental illness or substance dependence.

Dr. Burke's Experience

• Initially viewed trauma as a social or mental health issue.
• Worked in an underserved area of San Francisco, opened a clinic in Bayview-Hunters Point.
• Noticed a trend of misdiagnosed ADHD in children, often finding severe trauma instead.
• Learned from public health training to investigate underlying causes ("what's in the well?").

Adverse Childhood Experiences (ACE) Study

• Conducted by Dr. Vince Felitti and Dr. Bob Anda.
• Surveyed 17,500 adults about exposure to ACEs: abuse, neglect, parental mental illness, substance dependence, incarceration, separation/divorce, domestic violence.
• Correlated ACE scores with health outcomes.

Key Findings of the ACE Study

• Prevalence: 67% had at least one ACE; 12.6% had four or more.
• Dose-Response Relationship: Higher ACE scores correlated with worse health outcomes.
  • COPD risk 2.5 times higher for 4+ ACEs.
  • Depression risk 4.5 times higher.
  • Suicidality risk 12 times higher.
  • Heart disease and lung cancer risks significantly higher.

Scientific Insights

• Early adversity affects the nucleus accumbens (pleasure/reward center), prefrontal cortex (impulse control), and amygdala (fear response).
• Stress response system (HPA axis) becomes maladaptive with repeated activation.
• Changes in brain structure/function, immune and hormonal systems, and DNA transcription.

Clinical Implications and Interventions

• Created the Center for Youth Wellness in San Francisco to address ACEs.
• Routine screening for ACEs in pediatric care.
• Multidisciplinary treatment teams to address adversity and symptoms.
• Educating parents about ACEs is as crucial as physical safety measures.

Broader Public Health Context

• Recognized as a significant public health threat by Dr. Robert Block.
• Challenge: Extending awareness and intervention beyond individual clinics.
• Hope: Historical success in public health initiatives provides a framework for tackling ACEs.
• Urgency: Scientific evidence supports early intervention to prevent long-term health issues.

Conclusion

• Recognizing and addressing ACEs involves societal and clinical commitment.
• Understanding ACEs is a movement needing collective effort.
• Personal reflection on ACEs is vital as it impacts many individuals.
• Courage and acknowledgment of the issue are crucial for progress.