Adverse Childhood Experiences
Adverse Childhood Experiences are the number one public health crisis in our country today -- and teachers are on the front lines. I just watched a super-important TED talk by Dr. Nadine Burke Harris on the effects of childhood trauma -- or Adverse Childhood Experiences, or ACEs -- on physical and mental health. I am moved to write about this TED talk because ACEs are affecting classrooms every day, all the time. And I believe teachers need help dealing with them.
Dr. Harris characterizes ACEs (pronounced like the playing card as in "aces high") as involving
- physical, emotional, or sexual abuse
- physical or emotional neglect
- parental mental illness, substance dependence, or incarceration
- parental separation or divorce
- domestic violence
She alludes to a study that was begun in the mid-nineties by Kaiser Permanente and the Center for Disease Control and Prevention that looked at the long-term effects of ACEs on physical and mental health. First of all, the researchers found that, among the study's subjects (who were, by the way, 70% Caucasian and 70% college-educated), 67% had at least one ACE. And 1 in 8 of the subjects had at least four ACEs. The results showed that the higher a person's ACE score was, the higher the likelihood of negative health outcomes.
What can we expect from people with high ACE scores? In addition to devastating medical problems (COPD, lung cancer, heart disease), people with four or more ACEs are 4.5 times more likely to experience depression in their lives and twelve times more likely to attempt suicide.
As Dr. Harris points out, a natural response to these data would be "Well, yeah. You're traumatized as a kid so you engage in more risky behaviors -- like drinking, smoking, doing drugs -- that screw up your health in the long run." But that is not what the study found.
The study found that trauma affects our brains. Adverse Childhood Experiences, Dr. Harris tells us, affects
- the pleasure-reward center of the brain, which, Dr. Harris says, is “implicated in substance dependence”
- the pre-frontal cortex, which is involved in impulse control and executive function, “a critical area for learning”
- the amygdala, or the "fear-response center"
- the stress-response system, or "fight-or-flight"
Dr. Harris went into detail about this last system. As she put it, the fight-or-flight response is ideally suited to occasional dire life-or-death moments we might encounter (and probably won't), such as coming face-to-face with a bear in the woods. At these moments, our bodies are appropriately flooded with hormones and other substances that help us deal with the emergency.
But, she asks, “what happens when the bear comes home every night?”
Here's what happens: Our fight-or-flight system “goes from being adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive to this repeated stress activation because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function. They affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.”
Did you hear that? Dr. Harris said, "...even the way our DNA is read and transcribed." Does this mean that the effects of trauma -- whether the trauma is related to domestic abuse, the Holocaust, or slavery -- can be passed down from generation to generation through our genes? I certainly believe trauma-related behaviors can be passed down, but even our genes are affected?
As a result of her concerns and discoveries, Dr. Harris started the Center for Youth Wellness in San Francisco. Here, clinicians engage in what Dr. Harris calls "best practices" for treatment, approaches that "reduce the dose of adversity," that "prevent, screen, and heal the impacts of ACEs and toxic stress": home visits, coordination of care, mental health care, nutrition, holistic interventions, medication when necessary, and, importantly, parent education, since parents need to know about the dangers of ACEs "the same way [they need to know about] covering electrical outlets or lead poisoning."
I think teachers need to know about the dangers of ACEs, too.
Why? Because teachers are faced every day with children who have suffered -- or, importantly, ARE CURRENTLY SUFFERING -- from ACEs. These students' behaviors absolutely affect their ability to learn as well as the quality of the relationships they have with their teachers, who are actually in a position to help "reduce the dose of adversity" these students have been exposed to.
But here's the thing: Many teachers have themselves suffered from ACEs. As Dr. Harris says in her TED talk, ACEs do not strike just "those kids in those neighborhoods." They happen to people across the board. As she puts it, "The single most important thing that we need today is the courage to look this problem in the face and say, ‘This is real, and this is all of us.’”
Another way of putting it, as did Dr. Robert Block, a former president of the American Academy of Pediatrics, whom Dr. Harris quotes, is "Adverse Childhood Experiences are the single greatest unaddressed public health threat facing our nation today."
Holy sh*t squared.
I go into detail about this amazing TED talk and the ACEs study because, whether we like it or not, ACEs do have consequences for teachers, classrooms, and schools. And, it appears, the sluggish response in the medical field to the facts about ACEs is mirrored in the field of education.
Dr. Harris describes how perplexed she was when pediatricians around the world did not pick up on the approach taken by the Center for Youth Wellness. “Why haven’t we taken this more seriously?” she asks in her TED talk. Surely, it's not because ACEs don't apply to "us," for research shows that a huge number of "us" have been exposed to ACEs.
No, says Dr. Harris. “I'm beginning to believe that we marginalize the issue because it does apply to us. Maybe it’s easier to see in other zip codes because we don’t want to look at it. We’d rather be sick.”
Holy sh*t cubed.
And so, says Dr. Harris, "what I had thought of as simply best clinical practice I now understand to be a movement.” Her leadership is based on her certainty that "this is treatable. This is beatable."
Dr. Harris has started the movement in the medical field. Let's also work on it within the field of education. Let's not "rather be sick." Let's foster healthy development for everyone inside school walls by supporting teachers in their own healing and by helping them respond healthily to children whose maddening behaviors might indicate they are caught in the "public health crisis" of toxic stress.
This really is a life-or-death issue.