Lecture Notes on Adverse Childhood Experiences (ACEs)
Introduction
In the mid-90s, CDC and Kaiser Permanente identified that childhood trauma significantly increases the risk of leading causes of death in the USA.
High doses of trauma affect brain development, the immune system, hormonal systems, and DNA transcription.
Those exposed to severe trauma have triple the lifetime risk of heart disease and lung cancer, and a 20-year reduction in life expectancy.
Doctors lack training in routine screening and treatment for childhood trauma.
Definition of Trauma
Focus on severe and pervasive threats that change physiology.
Types of trauma:
Abuse (physical, emotional, sexual)
Neglect
Growing up with a parent with mental illness or substance dependence
Other severe stressors (incarceration, domestic violence, parental separation/divorce)
Professional Background
Initially, viewed trauma as either a social problem (refer to social services) or a mental health problem (refer to mental health services).
Worked at California Pacific Medical Center, opening a clinic in Bayview-Hunters Point, a severely underserved area.
Focused on health disparities (access to care, immunization rates, asthma hospitalization rates).
Shift in Understanding
Many children referred for ADHD had histories of severe trauma rather than ADHD.
Realized the need to understand how adversity affects development.
Came across the Adverse Childhood Experiences Study (ACEs) by Dr. Vince Felitti and Dr. Bob Anda.
Adverse Childhood Experiences Study
Surveyed 17,500 adults about their exposure to ACEs.
ACEs include:
Physical, emotional, or sexual abuse
Physical or emotional neglect
Parental mental illness or substance dependence
Incarceration or domestic violence
Parental separation or divorce
Each affirmative response increased an individual's ACE score.
Key Findings
ACEs are common: 67% of the population has at least one ACE; 12.6% have four or more.
Correlation between ACE score and poor health outcomes:
Higher ACE scores correlate with increased risk of various diseases.
For example, ACE score of 4+ correlates with 2.5 times higher risk of chronic obstructive pulmonary disease (COPD) and hepatitis, 4.5 times higher risk of depression, and 12 times higher risk of suicidality.
ACE score of 7+ triples the risk of lung cancer and increases the risk of ischemic heart disease by 3.5 times.
Neurological Impact
ACEs affect brain structure and function:
Areas affected include the nucleus accumbens (pleasure/reward), prefrontal cortex (impulse control/executive function), and amygdala (fear response).
Even without high-risk behaviors, individuals with high ACE scores are still at a greater risk for chronic diseases due to changes in the stress response system (HPA axis).
Response and Treatment
Created the Center for Youth Wellness in San Francisco to address ACEs and toxic stress.
Routine screening for all children during physical exams.
Multidisciplinary treatment for children with positive ACE scores, focusing on reducing adversity and treating symptoms.
Education for parents on the impact of ACEs.
Tailored care for chronic conditions considering ACEs impact on hormonal and immune systems.
Public Health Perspective
Recognizing ACEs as a public health crisis is essential for effective solutions.
Historical public health successes (tobacco, lead poisoning, HIV-AIDS) can guide responses to ACEs.
Need for determination and commitment to address this issue nationwide.
Conclusion
ACEs affect many people, not just those in specific neighborhoods.
The need to face the issue of ACEs, as it is a collective challenge.
Emphasis on the importance of courage to acknowledge the reality of ACEs and the impact on health.