Lecture Notes: The Impact of Childhood Trauma on Health

Introduction

• Discovery in the mid-90s by CDC and Kaiser Permanente: Exposure increases risk for 7 out of 10 leading causes of death in the US.
• High doses affect brain development, immune system, hormonal systems, and DNA transcription.
• Significantly reduces life expectancy by 20 years for those with high exposure.
• Little training or routine screening for this exposure in medical practice.
• Exposure identified: Childhood trauma.

Types of Childhood Trauma

• Severe threats that alter physiology: abuse, neglect, parental mental illness, substance dependence.
• Not typical setbacks like failing a test or losing a game.

Initial Misconception

• Traditional view: Social problem or mental health issue, refer to social or mental health services.
• Personal experience led to a shift in approach.

Clinical Practice and Community Impact

• Worked in Bayview-Hunters Point, SF; a severely underserved area.
• Previously only one pediatrician for over 10,000 children.
• Clinic addressed health disparities: care access, immunization, asthma hospitalization.

Observations and Concerns

• High referrals for ADHD but found severe trauma instead.
• Public health training: examine common exposure points for solutions ("What is in the well?").

Adverse Childhood Experiences (ACE) Study

• Conducted by Dr. Vince Felitti and Dr. Bob Anda.
• ACEs: Abuse, neglect, parental mental illness, substance dependence, incarceration, separation/divorce, domestic violence.
• ACE Score: correlates with health outcomes based on exposure.

Key Findings of the ACE Study

• ACEs are common: 67% with at least one ACE, 12.6% with four or more.
• Dose-response relationship: Higher ACE score correlates with worse health outcomes.
  • Examples:
    • COPD risk 2.5x, depression risk 4.5x, suicidality risk 12x.
    • Lung cancer risk triples with an ACE score of 7+.

Psychological and Physiological Impact

• Trauma affects brain regions like the nucleus accumbens, prefrontal cortex, and amygdala.
• Even without high-risk behavior, increased risk for diseases due to stress response (hypothalamic–pituitary–adrenal axis).

Approach to Treatment and Prevention

• Center for Youth Wellness: Prevent, screen, heal impacts of ACEs and toxic stress.
• Routine screening in physicals.
• Multidisciplinary team for those with positive screenings.
• Education for parents about ACEs and toxic stress.

Broader Implications and Movement

• Understanding the science aids in prevention and treatment.
• Need for a public health framework to address ACEs as a crisis.
• Historical success in US with public health issues.

Challenges and Call to Action

• Public awareness and mainstream adoption lagging.
• Marginalization due to personal relevance across demographics.
• Importance of recognizing the universality of the issue.
• Urgent need for courage and action to address the problem.

Conclusion

• Early adversity affects lifetime health.
• Scientific progress offers pathways for treatment.
• The movement requires collective acknowledgment and action.
• Key message: "This is real and this is all of us."