Trauma/ACEs 101. Tom Bradach IL Chapter, American Academy of Pediatrics
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1 Trauma/ACEs 101 Tom Bradach IL Chapter, American Academy of Pediatrics
2 Providing pediatrician and interprofessional education, resources, and technical assistance Working on policy, advocacy, and systems improvement issues Connecting providers and families to community resources for education, treatment, and other services
3 THE INFLUENCE OF ADVERSE CHILDHOOD EXPERIENCES (ACEs) ON DEVELOPMENTAL OUTCOMES
4 ACE Study The largest study of its kind that looks at the health and social effects of adverse childhood experiences over a lifespan
5 ACEs Impact Multiple Outcomes Smoking Alcoholism Promiscuity High Perceived Risk of HIV Obesity Risk Factors for Common Diseases Poor Perceived Health IV Drugs Multiple Somatic Symptoms Cancer Skeletal Fractures Sexually Transmitted Diseases Illicit Drugs Relationship Problems High perceived stress Prevalent Diseases Difficulty in job performance General Health and Social Functioning Liver Disease Chronic Lung Disease Ischemic Heart Disease ACEs Married to an Alcoholic Sexual Health Teen Paternity Teen Pregnancy Depression Mental Health Anxiety Unintended Pregnancy Sexual Dissatisfaction Fetal Death Poor Self- Rated Health Hallucinations Sleep Disturbances Memory Disturbances Panic Reactions Poor Anger Control Early Age of First Intercourse
6 ACEs Include Abuse Emotional Physical Sexual Neglect Emotional Physical Home environment Mother treated violently Household substance abuse Household mental illness Parental separation or divorce Incarcerated household member
7 Odds Ratio Risk Factors for Adult Depression are Embedded in ACE ACE Score Source: Chapman et al, 2004
8 % Attempting Suicide ACE vs. Suicide Attempts ACE Score
9 % with Problem ACE vs. Smoking and COPD ACE Score or more 0 Regular Smoking by Age 14 COPD
10 % Alcoholic ACE vs. Adult Alcoholism ACE Score
11 Odds Ratio Risk Factors of Adult Heart Disease are Embedded in ACE ,6 7,8 Adverse Experiences 11 Source: Dong, et al. (2004) via Center on the Developing Child at Harvard University
12 Children with Developmental Delays Risk Factors of Developmental Delay are Embedded in ACE 100% 80% 60% 40% 20% Number of Risk Factors Data Source: Barth, et al. (2008) Graphic adapted from 2011, Center on the Developing Child at Harvard University 12
13 Understanding the Impact of ACE Death Early Death Disease & Disability Adoption of Health-Risk Behaviors Social, Emotional, and Cognitive Impairment Conception Adverse Childhood Experiences 13
14 ACEs Impact Multiple Outcomes Smoking Alcoholism Promiscuity High Perceived Risk of HIV Obesity Risk Factors for Common Diseases Poor Perceived Health IV Drugs Multiple Somatic Symptoms Cancer Skeletal Fractures Sexually Transmitted Diseases Illicit Drugs Relationship Problems High perceived stress Prevalent Diseases Difficulty in job performance General Health and Social Functioning Liver Disease Chronic Lung Disease Ischemic Heart Disease ACEs Married to an Alcoholic Sexual Health Teen Paternity Teen Pregnancy Depression Mental Health Anxiety Unintended Pregnancy Sexual Dissatisfaction Fetal Death Poor Self- Rated Health Hallucinations Sleep Disturbances Memory Disturbances Panic Reactions Poor Anger Control Early Age of First Intercourse
15 ACE and the Brain WHAT IS THE ROLE OF STRESS?
16 Three Levels of Stress Response POSITIVE Important to development in the context of stable and supportive relationships
17 Three Levels of Stress Response: TOLERABLE Serious and temporary, but impact buffered by supportive relationships and safe environments
18 Three Levels of Stress Response: Positive, Tolerable, Toxic TOXIC Prolonged activation of stress response systems in the absence of protective relationships
19
20 Toxic Stress and Brain Development effects on body systems can damage brain architecture can lead to lifelong problems
21 In the Classroom
22 Academic Performance Behavioral issues/concerns Ability to learn High absenteeism
23 Trauma can look like other things Developmental delay ADHD Behavior issues
24 What teachers might observe Separation anxiety Lack of developmental progress Re-creating traumatic event Physical complaints
25 From Child to Parent How does stress affect parenting?
26 EFFECT OF TRAUMA ON PARENTING ABILITY Reduced parenting capacity/responses Unhealthy response to stress High ACE score and risky adult behaviors Intergenerational effect
27 How Brains are Built: A Review
28 The Good News
29 Although Early Adversity CAN Impair Development Significant Adversity Healthy Developmental Trajectory Impaired Health and Development
30 it doesn t have to Significant Adversity New Protective Interventions Healthy Developmental Trajectory Supportive Relationships Stimulating Experiences Health-Promoting Environments
31 WHAT COMES TO MIND WHEN YOU HEAR THE WORD RESILIENCE?
32
33 RESILIENCE AND OTHER REASONS FOR OPTIMISM Several factors for resiliency, including: Cognitive capacity Healthy attachment relationships Confidence in personal strengths and abilities The ability to regulate emotions and behavior Supportive environmental systems
34 What can YOU do to build resiliency in children and families?
35 What can you do to support a child with complex trauma? Respond through compassion, not discipline Be trauma-informed when assessing children s behaviors or your expectations of the family Provide consistency and stability in your interactions with children, families, colleagues
36 You do not have to be a therapist to be therapeutic
37 What s wrong with this person?
38 What has happened to this person?
39 Just as important
40 Take Care of Yourself! Increased irritability or impatience with students, families, or colleagues Decreased concentration Denying that traumatic events impact those we serve or feeling numb or detached Intense feelings and intrusive thoughts, that don t lessen over time, about someone else s trauma
41 Self Care Assessment
42 STRESS!
43
44 Things we recommend to manage Don t go it alone. stress Recognize compassion fatigue as an occupational hazard. Guard against your work becoming the only activity that defines who you are. Address your physical, psychic, and spiritual needs.
45
46 Your charge today Think about all the children you serve Think about their families Think about the community in which you work Think about your colleagues Think about the ways you can build resilience with and for all of them
47 Thank You Tom Bradach Coordinator, Child Development Initiatives Illinois Chapter, American Academy of Pediatrics (ICAAP)
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