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Q&A: The doctor who’s taking on the impact of childhood trauma

Any teacher can tell you anecdotally that what happens outside the classroom has a huge impact on how students do in school and in life. Dr. Nadine Burke Harris has explored the brain science and public health research that’s now driving national conversations about mitigating the effects of childhood trauma and toxic stress.

Burke Harris, founder and CEO of the Center for Youth Wellness in San Francisco, spoke at the Colorado Children’s Campaign annual luncheon today.

Much of Burke Harris’ work is grounded in the landmark “Adverse Childhood Experiences Study,” or ACES, which suggests that traumatic experiences during childhood are risk factors for health problems, difficulties in school, poor quality of life and premature death. This Q&A was conducted shortly before the luncheon.

Was there a point in your career where you had that ah-ha moment about adverse childhood experiences?

Definitely…my passion and background is with health disparities and when I read the Adverse Childhood Experiences Study…in 2008, it was an incredibly powerful experience for me because so much of what I was seeing as a clinician just made sense.

For me, diving into the science of why there’s this connection between adverse childhood experiences and all of these poor behavioral and health outcomes, really in a lot of ways has changed my view of the world. It’s changed my career…it’s certainly influenced my experiences as a mom and I think it’s really exciting to be part of this movement.

There are many health conditions associated with adverse child experiences that show up later in life, like heart disease and cancer, but what about for school-aged children?

First of all, the canary in the coal mine is behavior and learning issues. One of the things we know is that kids who are exposed to high doses of adversity are much more likely to have problems with impulse control, are much more likely to have difficulty with recovery post-provocation, more likely to have difficulty with attention, and sometimes going so far as having learning difficulties.

For the study that was published by myself and a colleague, our kids who had four or more adverse childhood experiences, they were twice as likely to be overweight or obese. We also see recent data out of California…if you have an ACE score of four or more you have twice the lifetime risk of asthma.

What role should schools play or are they already playing in dealing with this issue in a proactive way?

The first really important role that schools have is not making things worse. I know that sounds awful, but really understanding that punitive school discipline policies do not reflect an understanding of the science of how adversity affects the developing brain. I think it’s really important for schools to respond thoughtfully.

The hours that a child spends in school are really an opportunity for establishing safe and healthy relationships, which can also be profoundly positive in terms of coming up with solutions to the issue of adverse childhood experiences and toxic stress.

One of the big things is just thinking about ways to establish a safe and healthy school climate that’s not punitive, and informing some of those policies with the emerging science and research around ACES and toxic stress.

How are schools doing in addressing this issue and creating a safe and healthy environment ?

There are certainly some schools that are models…One of the things we see that makes a world of difference in the school environment is having a school leader who recognizes adverse childhood experiences and toxic stress as a major issue that affects educational attainment and is willing to … take that on. I think that has everything to do with the leadership.

What’s the biggest challenge in spreading the word about adverse childhood experiences?

One of the biggest challenges …is that many of us think of it as an issue only for low-income communities of color. In that, I think we’re missing a big part of the picture. I like to remind people that the original ACE study was done in a population that was 70% caucasion and 70% college educated.

If we only look at it in those communities then what we miss is that this is a public health crisis that affects every socioeconomic status, every geographic location, every racial/ethinic group. It affects all of us.

What other work is happening now that’s piggy-backing on what you started and seeding it even further?

The work that we do really is part of a national movement. There are folks working tremendously hard on this issue, that are really taking leadership in Iowa, in Maine, in Wisconsin, in Washington state, just all over the country.

In California, we just hosted the first California statewide summit on adverse childhood experiences. There are a lot of places where this movement is being seeded. There’s a lot more work to be done.

We need to get to the point to [where] the household recognition of adverse childhood experiences and toxic stress as a threat to the health and development of our children is as well-known as the link between second-hand smoke and adverse health outcomes. It needs to be a thing where people are talking to their neighbors about it. We’re not there yet, but we’re on the way there.

Similarly, I’ve heard people say that adverse childhood experiences needs to be recognized in the same way that lead poisoning is, but one difference seems to be that with lead-poisoning you try to prevent it, but you can’t always prevent adverse childhood experiences.

I think that’s right, but the thing that I would say to that is by treating it when it comes up you’re preventing it for the next generation…That’s the importance of the two-generation approach. When you work with both the caregiver and child, it really does help to decrease the child’s dose of adversity and we need to be thinking about it in that way.

Have you heard of the term herd immunity?…So, everyone gets the flu shot and not only are they less likely to get the flu, they’re less likely to spread the flu. That’s what we need to do here in terms of spreading the word and raising that national awareness, and then also doing interventions for children who are affected.

If we can prevent those kids from going on….or even their parent from having the same issue with their subsequent siblings then we are creating this zone of kids who have much more healthy attachment, who have much more healthy ways of relating…who are able to serve as a healthy emotional buffer for their kids when stressful or traumatic situations come up. So that then really prevents the progression of toxic stress.

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