It’s time to shift our thinking about adverse childhood experiences

We have discovered in the last two decades that childhood trauma is much more common than we thought and it has a strong association with the most deadly illnesses of our time.

Most common adverse childhood experiences (ACEs) include child abuse (emotional, physical, or sexual), child neglect (emotional or physical), household dysfunction (domestic violence, substance abuse, mental illness or criminal activity, or parental absence), and societal adversity (extreme poverty, bullying, and community violence).

Chronic negative environmental factors can lead to sustained high level of stress hormones in the brain. Thus, traumatic toxic stress leads to changes in the young brain with subsequent behavioral, social, medical and mental coping skills that help them survive but may not be to their benefit in the long run: These coping 'skills” or 'trauma organized” lifestyle include substance abuse, smoking, high-risk sexuality, and overeating. Having experienced four or more ACEs increases the risk for these behaviors by 2 to 11 times. These adaptations lead to genetic changes through epigenetic modifications that allow intergenerational cycling of maladaptive behaviors.

These adaptive behaviors used for survival lead to diseases such as heart disease, stroke, liver disease, lung cancer, chronic obstructive lung disease, diabetes, anxiety depression, suicide, and PTSD. Four or more ACEs are associated with learning problems that lead to academic failure and increased risk of depression (4.5 times) and suicide attempts (12.2 to 15.3 times).

Childhood adversity is very common. In 2012, a statewide survey revealed that 55 percent of Iowa adult population reported at least one ACE, 15 percent four or more ACEs. The most common ACE was emotional abuse (28 percent), followed with parental substance abuse (26 percent), parental absence (22 percent), parental mental illness (17 percent), exposure to domestic violence (16 percent), physical abuse (15 percent), sexual abuse (10 percent), and household criminal activity (7). Similar results have been reproduced across the USA for the last two decades.

As well known, diseases listed above are the most common public health issues our society faces today with significant morbidity, mortality, and financial burden to our systems of care (health care, social services, educational and justice systems). We have to start transforming our paradigm for the public service agencies' work style to a trauma informed one. Currently these systems are also trauma organized offering 'crisis response” to most client needs, since our communities are not yet, fully organized to provide trauma informed care. Our approaches to clients involve mostly a silent 'what's wrong with you?” rather than 'tell me what happened to you?”, the latter of which allow clients and providers collaborate more effectively to solve problems.

It is time for our communities to organize our services through trauma informed care and make adequate trauma specific services available. For the public, it is our right to demand trauma informed care from our providers, since none of us is alone in our adverse childhood experiences: We have the right to ask for solutions from our schools, hospitals, jails, social services agencies, campuses, and employers.

' Dr. Resmiye Oral is a Clinical Professor of Pediatrics and Director of the University of Iowa, Carver College of Medicine's Child Protection Program. Comments: (319)384-6308; resmiye-oral@uiowa.edu