How childhood trauma affects health across a lifetime _ Nadine Burke Harris _ TED

Introduction

• Discovery by CDC and Kaiser Permanente in the mid-90s.

• Identified childhood trauma as an exposure increasing the risk of leading causes of death in the US.

• High doses of exposure impact brain development, immune systems, hormonal systems, and DNA transcription.

• High lifetime risk of diseases: triple risk for heart disease and lung cancer; 20-year difference in life expectancy.

Understanding Childhood Trauma

• Types of significant trauma discussed:

  • Abuse or neglect.

  • Growing up with a parent facing mental illness or substance dependence.

• Distinction between everyday challenges and severe trauma that fundamentally alters physiology.

Transitioning Clinical Practice

• Initial view of trauma as social or mental health problems.

• Experience at California Pacific Medical Center changed perspective.

• Focused on health disparities and providing top-quality care in underserved neighborhoods.

Observations on ADHD

• Many children referred for ADHD ended up diagnosed with trauma-related issues instead.

• The need for deeper understanding and screening of underlying conditions rather than immediate ADHD treatment.

Adverse Childhood Experiences (ACEs) Study

• Conducted by Dr. Vince Felitti and Dr. Bob Anda.

• Surveyed 17,500 adults regarding their ACEs.

• Common types of ACEs include:

  • Physical, emotional, or sexual abuse.

  • Physical or emotional neglect.

  • Parental mental illness or substance dependence.

  • Incarceration, separation, divorce, or domestic violence.

• Correlated ACE scores to health outcomes:

  • 67% of the population had at least one ACE.

  • 12.6% had four or more ACEs.

Impact of ACEs on Health Outcomes

• Dose-response relationship between ACEs and health:

  • Higher ACE scores correlate with worse health outcomes.

  • ACE score of 4 or more leads to:

    • 2.5x increased risk for chronic obstructive pulmonary disease.

    • 4.5x increased risk for depression.

    • 12x increased risk for suicidality.

• ACE score of 7 or more linked to triple risk of lung cancer and 3.5 times risk of ischemic heart disease.

Biological Mechanisms of ACEs

• Neurological effects of trauma on:

  • Nucleus accumbens (pleasure and reward center).

  • Prefrontal cortex (impulse control and executive function).

  • Amygdala (fear response center).

• High doses of adversity influence brain structure, immune system, and hormonal systems.

• Hypothalamic-pituitary-adrenal (HPA) axis trauma activation leads to chronic stress responses.

Center for Youth Wellness

• Established to screen and heal impacts of ACEs.

• Routine screening for ACEs during physical exams.

• Tailored multidisciplinary treatment for patients with high ACE scores, including:

  • Home visits, care coordination, mental health care, nutrition, holistic approaches.

  • Education for parents on ACEs impacts.

Movement for Change

• Recognizing ACEs as a significant public health challenge.

• Need for widespread screening and effective treatment protocols in healthcare.

• Comparison to previous public health crises and the necessity for societal commitment and tools to address ACEs.

Addressing the Wider Issue

• Need for understanding that ACEs impact diverse populations, not just underserved communities.

• ACEs and their consequences are prevalent even in well-educated, affluent groups.

• The movement for recognition and treatment of ACEs involves everyone, regardless of background.

Conclusion: A Call to Action

• Understanding the lifetime health impacts of early adversity and aiming for interventions.

• The necessity of courage to acknowledge the reality of ACEs and their wide-reaching effects.

• Ensuring the future generations understand and manage the impacts of ACEs.