How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED

TED
17 Feb 201516:03
EducationalLearning
32 Likes 10 Comments

TLDRThe video script discusses the profound impact of childhood trauma, or Adverse Childhood Experiences (ACEs), on health outcomes later in life. It reveals that ACEs, which can include abuse, neglect, or growing up with a parent struggling with mental illness or substance dependence, are alarmingly common and significantly increase the risk of chronic diseases and mental health issues. The speaker, Dr. Nadine Harris, highlights the findings of the ACE Study by Dr. Vince Felitti and Dr. Bob Anda, which showed a direct correlation between ACE scores and poor health outcomes. Dr. Harris emphasizes the need for routine screening and treatment of ACEs, as understanding the neurobiological effects of early adversity can lead to better preventive and therapeutic approaches. She shares her experience in establishing the Center for Youth Wellness to address the issue and calls for a collective effort to recognize and tackle this public health crisis.

Takeaways
  • 🔍 Childhood trauma significantly increases the risk for major health issues like heart disease, lung cancer, and reduced life expectancy.
  • 🧬 Exposure to high levels of adversity affects critical areas of brain development, hormonal systems, and even DNA transcription.
  • 📉 There is a dose-response relationship between Adverse Childhood Experiences (ACEs) and negative health outcomes; higher ACE scores correlate with worse health.
  • 📚 The groundbreaking Adverse Childhood Experiences Study by the CDC and Kaiser Permanente highlighted the widespread prevalence and profound health impact of childhood trauma.
  • 🏥 Traditional medical training often overlooks the necessity to screen for and treat childhood trauma as a root cause of various adult health problems.
  • 🧠 Neurological science shows that early adversity disrupts key brain areas involved in stress response, impulse control, and overall mental health.
  • 👶 Children are especially vulnerable to repeated stress activation, which can lead to chronic health issues and behavioral problems.
  • 🛠 Dr. Burke advocates for a holistic approach to treating children with high ACE scores, involving multidisciplinary teams and tailored interventions.
  • 🌍 Recognizing and addressing childhood adversity is framed as a public health crisis, similar to tackling issues like tobacco use and lead poisoning.
  • 💪 The call to action is for broader awareness and proactive engagement in addressing childhood trauma to prevent its long-lasting effects.
Q & A

  • What is the exposure that the CDC and Kaiser Permanente discovered in the mid-90s that significantly increased health risks?

    -The exposure discovered is childhood trauma, which includes severe or pervasive threats such as abuse, neglect, or growing up with a parent who struggles with mental illness or substance dependence.

  • How does high-dose exposure to this risk factor impact a person's health?

    -High-dose exposure to childhood trauma can affect brain development, the immune system, hormonal systems, and the way DNA is read and transcribed. It can triple the lifetime risk of heart disease and lung cancer and lead to a 20-year difference in life expectancy.

  • What is the Adverse Childhood Experiences (ACE) Study, and what does it reveal about the prevalence of childhood trauma?

    -The ACE Study is a research study conducted by Dr. Vince Felitti and Dr. Bob Anda, which surveyed 17,500 adults about their history of exposure to adverse childhood experiences. It revealed that 67% of the population had at least one ACE, and 12.6% had four or more ACEs.

  • What is the relationship between ACE scores and health outcomes?

    -There is a dose-response relationship between ACE scores and health outcomes, meaning the higher the ACE score, the worse the health outcomes. For instance, a person with an ACE score of four or more has a significantly higher risk of chronic obstructive pulmonary disease, hepatitis, depression, and suicidality.

  • How does the hypothalamic–pituitary–adrenal axis contribute to the increased risk of disease in individuals with high ACE scores?

    -The hypothalamic–pituitary–adrenal axis is the body's stress response system. Repeated activation due to high doses of adversity can shift the system from adaptive to maladaptive, leading to health-damaging effects, especially in children whose brains and bodies are still developing.

  • What is the role of the Center for Youth Wellness in addressing the impacts of ACEs and toxic stress?

    -The Center for Youth Wellness was created to prevent, screen, and heal the impacts of ACEs and toxic stress. It conducts routine screenings for children, uses a multidisciplinary treatment team to reduce adversity and treat symptoms, and educates parents about the impacts of ACEs and toxic stress.

  • Why is it important to recognize ACEs as a public health crisis?

    -Recognizing ACEs as a public health crisis allows for the use of the correct toolkit to develop solutions. It shifts the focus from individual behavior to a broader understanding of the systemic issues contributing to poor health outcomes, enabling a more comprehensive approach to prevention and treatment.

  • What are some of the neurologic reasons that individuals exposed to high doses of adversity are more likely to engage in high-risk behavior?

    -Exposure to early adversity affects areas of the brain such as the nucleus accumbens, which is involved in substance dependence, inhibits the prefrontal cortex necessary for impulse control, and alters the amygdala, the brain's fear response center. These changes can lead to higher-risk behaviors.

  • How does the speaker's experience in Bayview-Hunters Point change their perspective on addressing health disparities?

    -The speaker's experience in Bayview-Hunters Point, a disadvantaged neighborhood, led to the realization that traditional health interventions were not enough. The high prevalence of severe trauma among children indicated a need to address the underlying causes, such as ACEs, rather than just the symptoms.

  • Why does the speaker believe that the issue of ACEs has not been taken as seriously as it should be?

    -The speaker suggests that the issue may be marginalized because it is perceived as not applying to everyone, or because it is easier to ignore the problem than to confront it. The speaker also points out that the data from the original ACEs study includes a diverse population, contradicting the notion that it is an issue exclusive to certain neighborhoods.

  • What does the speaker suggest is the most important factor needed to address the issue of ACEs and toxic stress?

    -The speaker emphasizes the need for courage to acknowledge the reality of the problem and to recognize that it affects everyone. They believe that collective action and a movement mindset are crucial for making progress in addressing the issue of ACEs and toxic stress.

Outlines
00:00
😨 Childhood Trauma's Impact on Health

This paragraph introduces the significant impact of childhood trauma on health outcomes. It reveals that exposure to trauma can increase the risk for leading causes of death in the United States. High doses of trauma affect brain development, immune and hormonal systems, and DNA transcription. The lifetime risk of heart disease and lung cancer is tripled in those exposed to high doses, with a 20-year difference in life expectancy. The speaker discusses the lack of routine training for doctors in screening or treating such trauma, which is not a chemical exposure but severe threats like abuse, neglect, or growing up with a mentally ill or substance-dependent parent. The paragraph also highlights the speaker's change in perspective after working in a disadvantaged neighborhood and encountering the Adverse Childhood Experiences (ACE) Study.

05:03
📊 The Correlation Between ACEs and Health Outcomes

The second paragraph delves into the findings of the ACE Study conducted by Dr. Vince Felitti and Dr. Bob Anda, which surveyed 17,500 adults about their history of adverse childhood experiences (ACEs). These experiences include abuse, neglect, mental illness in the family, substance abuse, and more. Each affirmative response to these experiences adds a point to an individual's ACE score. The study found a strong correlation between higher ACE scores and poorer health outcomes, with increased risks of various diseases and conditions. The narrative also addresses misconceptions about ACEs being a result of bad behavior rather than a scientific reality, explaining how early adversity affects brain areas associated with pleasure, reward, impulse control, and fear response, leading to high-risk behaviors and increased likelihood of disease even in the absence of such behaviors.

10:04
🏥 The Creation of the Center for Youth Wellness

In this paragraph, the speaker describes the establishment of the Center for Youth Wellness in San Francisco, which aims to prevent, screen, and heal the impacts of ACEs and toxic stress. The center begins with routine screening of children during physical check-ups to identify those at higher risk due to their ACE scores. For those who screen positive, a multidisciplinary team employs various strategies to reduce adversity and treat symptoms, including home visits, mental health care, nutrition, and medication when necessary. The center also educates parents about ACEs and tailors care for conditions like asthma and diabetes to account for the potential exacerbating effects of ACEs on hormonal and immune systems. The speaker expresses frustration that despite the clear scientific evidence, there has not been a widespread adoption of routine screening and multidisciplinary treatment for ACEs.

15:05
🌟 The Importance of Recognizing and Addressing ACEs

The final paragraph emphasizes the treatability and beatability of the issues stemming from ACEs. The speaker calls for the courage to acknowledge the reality and collective responsibility towards the problem of childhood trauma. They express optimism that the audience represents the movement to bring about change, highlighting that early adversity affects health across a lifetime but that there is a growing understanding of how to interrupt this progression. The speaker envisions a future where children with high ACE scores who do not receive proper recognition and treatment will be as rare as the six-month mortality from HIV/AIDS is today, indicating a belief in the power of awareness, science, and collective action to address the public health crisis of ACEs.

Mindmap
Keywords
💡Childhood Trauma
Childhood trauma refers to deeply distressing or life-altering experiences that occur during childhood, such as abuse, neglect, or growing up with a parent who has mental illness or substance dependence. In the video, it is portrayed as a significant factor that can dramatically increase the risk for leading causes of death in adults, affecting brain development, immune and hormonal systems, and even DNA transcription.
💡Adverse Childhood Experiences (ACEs)
ACEs are a range of potentially harmful experiences in childhood, including physical, emotional, or sexual abuse, neglect, and growing up with domestic violence or a family member with mental illness or substance abuse. The video emphasizes that ACEs are common and have a dose-response relationship with health outcomes, meaning the more ACEs a person experiences, the worse their health outcomes tend to be.
💡Dose-Response Relationship
This term describes the relationship between the exposure to a certain risk factor and the probability of an outcome. In the context of the video, it is used to describe how the number of ACEs a person experiences correlates with their risk for various health issues, with higher ACE scores indicating worse health outcomes.
💡Nucleus Accumbens
The nucleus accumbens is a region of the brain associated with pleasure, reward, and addiction. The video discusses how childhood trauma can affect this area, potentially leading to substance dependence and other high-risk behaviors.
💡Prefrontal Cortex
The prefrontal cortex is a part of the brain critical for impulse control and executive function, which is essential for learning. The video explains that exposure to early adversity can inhibit the development of the prefrontal cortex, leading to difficulties in these areas.
💡Amygdala
The amygdala is the brain's fear response center. The video mentions that MRI scans can show measurable differences in the amygdala of individuals who have experienced high levels of adversity, which can contribute to a heightened fear response and increased risk behaviors.
💡Hypothalamic–Pituitary–Adrenal (HPA) Axis
The HPA axis is the body's primary stress response system, which activates the fight-or-flight response. The video explains how repeated activation of the HPA axis due to ongoing adversity can shift from being adaptive to maladaptive, leading to long-term health issues.
💡Center for Youth Wellness
The Center for Youth Wellness is an initiative mentioned in the video that aims to prevent, screen, and heal the impacts of ACEs and toxic stress. It represents a proactive approach to addressing the public health crisis of childhood trauma by providing routine screening and multidisciplinary treatment.
💡Toxic Stress
Toxic stress refers to the harmful effects of prolonged exposure to stress without adequate support or buffering. In the video, it is discussed as a consequence of experiencing ACEs, which can lead to changes in brain structure and function, and increased risk for health problems later in life.
💡Health Disparities
Health disparities refer to differences in the incidence, prevalence, or burden of health conditions across different populations. The video discusses how the clinic in Bayview-Hunters Point targeted typical health disparities such as access to care and immunization rates, but also recognized the need to address the underlying issue of ACEs.
💡Public Health Threat
A public health threat is a condition or issue that has significant negative effects on the health of a population. The video identifies ACEs as the single greatest unaddressed public health threat facing the nation, highlighting the need for a collective and concerted effort to address this issue.
Highlights

Childhood trauma is linked to a dramatic increase in the risk for leading causes of death in the U.S.

High doses of childhood trauma affect brain development, immune system, hormonal systems, and DNA transcription.

Exposure to high doses of trauma triples the lifetime risk of heart disease and lung cancer.

There is a 20-year difference in life expectancy for those exposed to high levels of childhood trauma.

Doctors are not routinely trained in screening or treating the effects of childhood trauma.

Childhood trauma includes severe threats like abuse, neglect, and growing up with a parent struggling with mental illness or substance dependence.

The Adverse Childhood Experiences (ACE) Study revealed a strong correlation between childhood trauma and poor health outcomes.

ACEs are common, with 67% of the population having at least one ACE and 12.6% having four or more.

Higher ACE scores correlate with worse health outcomes, including increased risks for various diseases.

Early adversity affects the developing brain and body, including the nucleus accumbens, prefrontal cortex, and amygdala.

The hypothalamic–pituitary–adrenal axis, the body's stress response system, is affected by repeated stress from childhood trauma.

Children are particularly sensitive to repeated stress activation due to their developing brains and bodies.

The Center for Youth Wellness was created to address the impacts of ACEs and toxic stress through prevention, screening, and healing.

Routine screening for ACEs is conducted at physical check-ups to identify those at higher risk for health issues.

A multidisciplinary treatment team is used to reduce adversity and treat symptoms for those who screen positive for ACEs.

Parents are educated on the impacts of ACEs and toxic stress, similar to preventative measures for other health issues.

The science behind ACEs is clear and provides a framework for understanding and addressing the public health crisis.

Early adversity can lead to disease and early death, but the progression can be interrupted with proper recognition and treatment.

The courage to acknowledge and address childhood trauma is essential for societal and public health progress.

Transcripts

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Childhood TraumaHealth RisksACE StudyStress ResponseMental HealthPublic HealthPreventionTreatmentNeuroscienceSocial Services