Lecture on Adverse Childhood Experiences (ACEs) and Toxic Stress

Key Discoveries

1990s CDC and Kaiser Permanente Study
- Discovered an exposure dramatically increasing risk for 7/10 leading causes of death in the U.S.
- Affects brain development, immune system, hormonal systems, and DNA transcription.
- High-dose exposure:
  - Triple lifetime risk of heart disease and lung cancer
  - 20-year reduction in life expectancy
- Lacking routine screening and treatment in medical practice
- Exposure: Childhood trauma, not pesticides or chemicals

Severe or pervasive threats affecting physiology:
- Abuse and neglect
- Parental mental illness or substance dependence
- Other severe adversities

Dr. Burke's Experience:
- Worked in Bayview-Hunters Point, San Francisco
- Observed high rates of ADHD referrals, but with underlying traumatic experiences
- Realized traditional views on trauma were inadequate

Conducted by Dr. Vince Felitti and Dr. Bob Anda
17,500 adults surveyed about exposure to ACEs:
- Physical, emotional, sexual abuse
- Neglect
- Parental mental illness, substance dependence, incarceration
- Parental separation, divorce, domestic violence
Findings:
- 67% population had at least one ACE
- 12.6% had four or more ACEs
- Dose-response relationship: Higher ACE scores -> Worse health outcomes
  - COPD, hepatitis, depression, suicidality, heart disease, lung cancer risks increase

Neurological & Physiological Effects:
- Impact on nucleus accumbens (pleasure/reward), prefrontal cortex (impulse control/executive function), and amygdala (fear response)
- Affects stress response system (hypothalamic–pituitary–adrenal axis)
- Repeat activation of stress response -> Health damaging
- Changes in immune and hormonal systems, DNA transcription

Center for Youth Wellness:
- Focus on prevention, screening, healing impacts of ACEs and toxic stress
- Routine screening and multidisciplinary treatment for patients with high ACE scores
- Educate parents on ACEs impacts similar to lead poisoning protection
- Tailored care for chronic conditions recognizing ACEs impacts

Public Health Crisis:
- Recognition of ACEs and toxic stress as a major public health issue
- Learn from public health successes (tobacco, lead poisoning, HIV/AIDS)
- Importance of addressing ACEs for all demographics, not just marginalized communities
- Need for courage to address the problem directly

Immediate action needed to address ACEs and toxic stress
Collective effort required to treat and beat the impacts of early childhood adversity
Vision for the future where ACEs are recognized and managed effectively

Thank you (Applause)