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Building resiliency against adverse childhood experiences

Studies show stress, trauma hinder learning and health - but one trusted adult can help

    A behavior contract intended to help Jeremiah curb negative behavior hangs on a cupboard at the home of Amanda and Matt Zhorne in Cedar Rapids on Thursday, March 16, 2017. The family uses a variety of positive reinforcement techniques to help the boys learn to manage their emotions and regulate their own behaviors. (Rebecca F. Miller/The Gazette)
    Feb 13, 2018 at 3:26 pm

    In his seventh-grade English class, Jeremiah Zhorne showed his teacher an essay he’d written for homework. Maybe, he told her, he should start over. Maybe he should have picked a different topic.

    He’d written four paragraphs about the difference between prescription and over-the-counter drugs and “bad and illegal” drugs.

    “Drugs may be bad for you, but they make you feel so good!” the 13-year-old had written in pencil. “You shouldn’t ever do drugs because they are very addicting. I know how it feels to get high. It’s awesome but not good.”

    His teacher, Robin Crow, agreed a different topic would be best. Jeremiah buried his head in a book for the rest of class, taking notes for a new essay about fighter jets.

    “Every once in awhile,” Crow said, after Jeremiah left for his next class, “I’ll get a hint of a past life from him.”

     

    Jeremiah spent most of his childhood bouncing from house to house, and for years many of the adults he knew weren’t safe for a child to be around. A couple in Cedar Rapids, Amanda and Matt Zhorne, adopted him about a year-and-a-half ago.

    Jeremiah is bright, Amanda Zhorne said. His teachers say he has a good heart. Before his English class, when he accidentally smacked his head into his locker door in the hallway, he laughed at himself with a handful of friends.

    But sometimes he acts out for attention. When he’s frustrated in class, sometimes he’ll stand up and leave the classroom. When he does his work, he often misplaces it before he’s had a chance to turn it in.

    Data from the 2014 Iowa Youth Survey, which polled more than 77,000 Iowa children and was sponsored by the Iowa Department of Public Health, suggest some 25 percent of Iowa children, like Jeremiah, have lived in environments that cause a toxic stress level. That level of stress affects a child’s development, and it can lead to academic problems as well as negative health outcomes in adulthood.

     

    The Zhornes adopted another son, 15-year-old Gage, when he was 8. Before his adoption, Gage, too, was “made aware of the evils of the world,” Zhorne said.

    “It’s hard to get them to care about grades because these kids come from environments where it was all about survival,” she said. “ I do believe that comes from, at least in part, their past experiences. It’s changed how they think, changed how their brains were wired.”

     

    The science of adverse childhood experiences

     

    Both Jeremiah and Gage lived through several adverse childhood experiences, or ACEs, before their adoptions. The more a child is exposed to a toxic level of stress, many studies have found, the more the development of his or her impulse control system, responses to stress and other primal brain functions can be affected.

    Researchers at the Centers for Disease Prevention and Control, Kaiser Permanente, Harvard University and many state agencies have studied the brain science of childhood trauma. They’ve found children with higher numbers of traumatic experiences often have physically different brains — and high levels of trauma have been correlated with a greater risks of several negative occurrences later in life, including poor physical, mental and emotional health.

    Starting in 2012, researchers in Iowa measured trauma through the existence of eight adverse childhood experiences:

    -- Physical abuse

    -- Emotional abuse

    -- Sexual abuse

    -- Substance abuse in the home

    -- Having a family member with mental illness

    -- Having an incarcerated family member

    -- Losing a parent to separation or divorce

    -- Having domestic violence in the home.

    In 2014, they started using a list of 10, which also includes emotional and physical neglect.

    About 15 percent of adults in Iowa had four or more adverse childhood experiences, according to a 2016 study by the Central Iowa ACEs Coalition. The study analyzed data collected through the state’s Behavioral Risk Factor Surveillance System from 2012 to 2014, which includes results from about 23,450 phone surveys over three years.

     

    John McGlothlen / The Gazette

     

    Having more than four adverse childhood experiences, known as an “ACE score,” connotes significant trauma. Compared to someone without any adverse childhood experiences, an adult with four or more ACEs is six times as likely to have depression, four times as likely to have a chronic lung disease and three times as likely to have a stroke. (Want to know your ACE score? Find a quiz at the bottom of this article.)

    For school-aged children who have experienced trauma, students with higher ACE scores are more likely to fail a grade, score lower on standardized tests and to be suspended or expelled, according to studies conducted in Washington state. That state began studying the issue years before Iowa, Prevent Child Abuse Iowa Executive Director Liz Cox said.

    Cox said Washington state’s data also shows children with seven or more adverse childhood experiences are nearly guaranteed to have a developmental delay.

    “Behaviors are so obvious with these kids, so we often look at behaviors,” Zhorne said. “But academics are really affected.”

     

    The Zhornes’ older son, Gage, missed chunks of kindergarten and first grade, and Zhorne said those gaps are still apparent. He can do grade-level high school math, for example, but needs to count using his fingers.

    “He has big holes in his learning,” Zhorne said. “One of the things that I think is evident with Gage is that not being at school or being in a state when you can process school when you’re young, how much that affects you moving on.”

    Gage also has trouble staying organized. In an English class one Friday, he spread binders, books and loose sheets of paper across a large table. Eventually, he had to ask his teacher if he could go to his locker, where he dug his homework out of yet another pile of crumpled papers.

    He’s been diagnosed with auditory dyslexia, executive function disorder and attention deficit hyperactivity disorder. Jeremiah — whose locker is similarly haphazard — also has been diagnosed with executive function disorder.

    Both boys attend Cedar Valley Christian School, a small private school of about 250 students. Before transferring, they attended public schools in the Cedar Rapids Community School District.

    Zhorne said she chose to move both boys because Gage was overwhelmed by a middle school of more than 500 students, while keeping Jeremiah in the public district would mean an eventual reunion with children he has a history of fighting.

    “They’re definitely not our normal kids in the school,” Cedar Valley Christian Principal Jeff Pospisil said. “We know they have special needs and they’re different, but they’re not so different they can’t be here.”

    Knowing both Gage and Jeremiah’s backgrounds, Pospisil said, has helped teachers and other staff understand why they sometimes struggle or misbehave.

    “Not as an excuse for anything, but as an understanding,” he said. “ I don’t know that it would be a good environment for all kids with special needs, but we are for them.”

     

    Trauma-sensitive approach in schools

     

    Taking a compassionate and sensitive approach to students is the foundation of trauma-informed care, a framework that is making its way into some schools across the country. Pospisil said Cedar Valley Christian doesn’t formally subscribe to the method.

    Trauma-informed schools exist in scattered pockets and are typically alternative high schools. The approach is only just making its way to younger students, and some of the first elementary schools to become trauma-informed are in the College Community School District in Cedar Rapids. Jan Powers, a doctoral student at the University of Iowa, is piloting a research-based model there.

    “It took a long time to get to schools,” said Powers, who previously worked in the College Community district. “It’s picking up momentum — and the research behind it is so compelling.”

    Powers, who was a school counselor for a decade, stressed her work won’t result in “another program for teachers to implement” but instead should provide teachers a new lens to view students through.

    Upcoming ACEs training

    - Are you an educator, counselor or community support leader who wants to learn more about the effects of ACEs on students? Liz Cox and Jan Powers are facilitating three trainings in May. Register at my.aea267.k12.ia.us using Course #15587. Training sessions are 9 a.m. to 3 p.m. and cost $95.

    -- Clear Lake, May 3

    -- Marshalltown, May 4

    -- Cedar Falls, May 11

     

    Trauma-informed care, which de-emphasizes punishment in favor of restorative practices, works for all students — even those who haven’t experienced trauma, she said.

    “It’s about changing staff’s minds and capabilities for dealing with behavior,” Powers said.

    Teachers at Prairie Crest Elementary, where staff have practiced trauma-informed care since the fall of 2015, rarely punish students for misbehavior. Instead, they use non-punitive supports and try to understand why a child is acting out.

    “If there’s a student who gets in that mode, we want to make sure we give them support,” said Stephanie Cooper, who has worked at Prairie Crest for seven years. “If a child starts showing anxiety (for example), we never know if it’s them going back to their trauma.”

    In stressful situations, students can switch into primal “fight, flight or freeze” responses. Instead of reprimanding students who have the impulse to run away from a stressful situation, for example, Prairie Crest staff have given students somewhere to go when they feel they need to flee. Every classroom has a “relax and return” space, where students can draw or play with Play-Doh until they calm down.

    Training on trauma-informed care for most of Prairie Crest Elementary’s staff also has created a common language for all staff and students around adverse childhood experiences, said Cooper, who coaches staff members as a building facilitator.

    “We never know (which students have experienced trauma), and that’s not information we ever have,” she said. “But the more we build an understanding around how trauma impacts the brain, I think it’s helped strengthen our culture, and it’s working for all students, not just students who demonstrate some behaviors in the classroom.”

    Adverse childhood experiences impact people as adults as well, and trauma-informed training can help teachers regulate their own reactions to student behavior as well as deal with their own histories, Powers said. Most adult Iowans, 56 percent, have experienced at least one childhood trauma, according to an analysis by the Central Iowa ACEs Coalition.

    For many adults, “this is something you just don’t talk about,” Powers said.

    “It’s hard to get them to care about grades because these kids come from environments where it was all about survival."

    - Amanda Zhorne

    Mother to Gage and Jeremiah

     

    For years, she said, she avoided discussing her own adverse childhood experiences. The first time she was confronted with ACEs research, she avoided calculating her own score. When she finally did — scoring an eight out of 10 — she hid it from her colleagues at Prairie Crest.

    “It started hitting me,” she said. “But the science takes away the shame and blame. This research helped me put together all the pieces. … Becoming trauma-informed helped me realize I can say it out loud.”

    Using methods Powers developed at the UI, Prairie Crest Elementary is now in its second school year as a trauma-informed school. Staff this year have “been able to make the biggest connection between our learning to our student support plans,” Cooper said.

    “Our plan is for all students, especially ones who’ve experienced trauma, is to help them learn resiliency,” Cooper said. “When we hold high expectations for all students, I think that’s going to be the key that’s going to help them build resiliency.”

     

    Counteracting adverse childhood experiences

     

    Building that resiliency often starts with a safe relationship. A high ACE score doesn’t ensure a poor adulthood — a positive, trusting relationship with an adult can offset trauma’s effects on a child’s future physical, mental and emotional health.

    “There are people who’ve been through some pretty darn traumatic events, but have this resiliency and some pretty good outcomes,” Prevent Child Abuse Iowa’s Cox said. “ These relationships don’t have to be really intense (or) really close. They can be very simple. But it seems the primary factor is: There was at least one adult in a child’s life that they trusted and that they knew cared about them.”

     

    With Jeremiah, Zhorne said she tries to build on their trust every day. Seven years after his adoption, Gage is well-adjusted to the family.

    “It’s an ongoing process” for Jeremiah, she said. “Just constantly showing up is what we’re doing now.”

    A parent can be that trusted adult who helps counteract the effects of adverse childhood effects, Cox said, but it also can be a friend’s parent, a scout leader or a community member.

    “When you look outside of that (family) circle, you see that kids spend a lot of time at school,” Cox said. “A lot of time those caring relationships are teachers or parents or coaches.”

    While trauma-informed care is making its way into some Iowa schools, Cox said implementing the practice should be an urgent priority.

    According to the 2014 Iowa Youth Survey — which polls children in grades six, eight and 11 — 25 percent of children in Iowa show signs of living in environments that give them toxic stress. Adults polled about adverse childhood experiences, who reflect on their pasts, showed similar rates.

    “What’s concerning is if we look at the 25 percent of kids right now, we can say that their ACE scores might go up because they could experience more trauma — they’re still kids,” Cox said. “I’m predicting that unless we turn things around, the future is going to actually be more severe in terms of ACEs in Iowa.”

    Turning things around, she said, begins with creating a common understanding among Iowans about the negative, long-term outcomes of adverse childhood experiences. Then, it’s about creating support systems around that trauma.

    “The more connections a community has, the lower their child abuse rate,” she said. “We would like Iowa to be not only the healthiest state, but the best place for kids and families.”

    This story appears in the second edition of the Iowa Ideas magazine. Order a free copy here.

    Comments: (319) 398-8330; molly.duffy@thegazette.com

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