Echoes of Trauma

Childhood traumas are prevalent and can cause harm that lasts well into adulthood. There is a strong correlation between childhood trauma and serious adult health problems including tobacco use, substance abuse, obesity, cancer, heart disease, depression and a higher risk for unintended pregnancy.

Those are key findings from the Adverse Childhood Experiences (ACE) study, according to principal investigators Robert Block, MD, FAAP, Vincent Felitti, MD and Robert Anda, MD. They briefed Congressional aides about their study and its implications for public policy at an April 18 event sponsored by the American Academy of Pediatrics and the Family Violence Prevention Fund (FVPF). The study makes a strong case for a greater focus on prevention and early intervention to protect children from harm caused by violence.

The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente’s Department of Preventive Medicine conducted the ACE study, which included interviews with more than 18,000 adults about their childhood health status. Participants were asked whether they had experienced various childhood traumas, including: being a victim of child abuse or neglect; and living in a home with domestic violence, mental illness or substance abuse. Investigators found that adverse childhood experiences rarely occur in isolation and often come in groups.

They found high incidence to exposure to violence during childhood among the middle- and upper-middle class San Diego population that they surveyed in the late 1990s. Twenty-one percent of respondents (25 percent of women and 16 percent of men) were exposed to sexual abuse as children, and 13 percent said their mothers were sometimes, often or very often pushed, grabbed, slapped or had something thrown at them and/or sometimes, often or very often kicked, bitten, hit with a fist, or hit with something hard, and/or ever repeatedly hit over at least a few minutes and/or ever threatened or hurt by a knife or a gun.

The chronic stress associated with these traumas can have major implications for brain development, the investigators said. During periods of childhood trauma, the brain releases specific hormones in response to stresses, and over time a child’s developing brain can suffer. Block asked, “For a child, can there be a more stressful experience than living in an abusive household? Last year almost one million children were victims of child abuse and neglect.”

Anda added, “Adverse childhood experiences are a leading, if not the leading, determinant of health and social well-being from adolescence to late adulthood.”

The ACE study supports the possibility that a biopsychosocial and trauma-oriented approach to medical care is feasible, affordable and acceptable. Rescuing primary care from its current symptom-reactive mode of practice and changing it to a concept of preventative medicine will start to deal with the basic causes of long term health illnesses and reduce medical care costs, the investigators said.

“The ACE data recommits advocates to sharpen their focus on prevention and helps them understand the long lasting effects of abuse,” said FVPF Public Policy Director Kiersten Stewart at the briefing. “We must continue to reach out to health care providers because this research continues to affirm that women will confide in their doctor long before they will call law enforcement or seek outside shelter.” Stewart stressed the importance of fully funding the Violence Against Women Act, to ensure that much-needed prevention programs can be started or continued.

In order to continue the work of the ACE study and learn more about the effects of childhood trauma, 30 organizations including the American Dental Association, Child Welfare League of America and Emergency Nurses Association wrote to Senator Arlen Specter (R-PA), Chairman of a key Appropriations Subcommittee, to urge him to support a $10 million increase in the budget for the CDC’s National Center for Injury Prevention and Control. The increase would establish a network to discuss and share innovations about medical aspects of child abuse and neglect.

Representative Diana DeGette (D-CO) also wrote to Representative Ralph Regula (R-OH), Chairman of the House Labor, Health, and Human Services, Education and Related Agencies Appropriations Subcommittee, and other colleagues to support the call for a funding increase for this infrastructure.

“Time does not heal,” Felitti warned in urging speedy action to protect children exposed to violence. “Time helps conceal incidences of childhood trauma.”

More information on the ACE study is available at www.acestudy.org or www.cdc.gov/NCCDPHP/ACE

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