Childhood Trauma: Effects and Diagnosis

• Childhood trauma increases the risk for 7 out of 10 of the leading causes of death in the US, discovered in the mid-90s by the CDC and Kaiser Permanente.
• High doses of childhood trauma affect brain development, the immune system, hormonal systems, and DNA transcription.
• Exposure to high doses of childhood trauma triples the lifetime risk of heart disease and lung cancer and results in a 20-year difference in life expectancy.
• Abuse, neglect, having a parent with mental illness or who is incarcerated, and parental substance abuse qualify as childhood trauma.

California Pacific Medical Center

• This is a private hospital.
• Bayview Hunters Point is a poor, underserved neighborhood of San Francisco.
• There is only one pediatrician in Bayview to serve over 10,000 children.
• Many children are referred for ADHD, but in-depth physicals reveal that the diagnosis is often incorrect and the children are experiencing severe trauma instead.
• If 100 kids drink from the same well and 98 of them develop diarrhea, do you prescribe antibiotics or check the well?

Adverse Childhood Experiences (ACES) Study

• How does adversity affect the developing brains and bodies of children?
• The ACES - Adverse Childhood Experiences Study was conducted by Dr. Vince Felitti at Kaiser and Dr. Bob Anda at the CDC.
• The study asked 17,500 adults about their history of exposure to physical, emotional, or sexual abuse; physical or emotional neglect; parental mental illness; substance dependence; incarceration; parental separation or divorce; or domestic violence, collectively called ACES.
• For every "yes" to an ACE question, a point was added to the individual's ACE score.
• ACE scores were correlated against health outcomes.
• ACES are incredibly common; 67% of the population had at least one ACE, and 12.6% had four or more ACES.
• There is a dose-response relationship between ACES and health outcomes; the higher the ACE score, the worse the health outcome.
• People with an ACE score of four or more had 2.5 times the risk of obstructive pulmonary disease and hepatitis, 4.5 times the risk of depression, and 12 times the risk of suicide compared to those with an ACE score of zero.
• People with an ACE score of seven or more had triple the lifetime risk of lung cancer and 3.5 times the risk of heart disease, the number one killer in the U.S.
• Exposure to early adversity affects the nucleus accumbens, the pleasure and reward center of the brain, and inhibits the prefrontal cortex.
• MRI scans reveal measurable differences in the amygdala, the brain's fear and response center.
• Even if people do not engage in any high-risk behavior, they are still more likely to develop heart disease or cancer if they have a high ACE score.

Hypothalamic-Pituitary-Adrenal Axis

• The hypothalamic-pituitary-adrenal axis (HPA axis) that governs the fight-or-flight response.
• If you encounter a bear in the forest, your hypothalamus signals your pituitary gland, which signals your adrenal gland to release stress hormones like adrenaline and cortisol, causing your heart to pound, pupils to dilate, and airways to open up, preparing you to fight or run.
• Repeated activation of this system transitions from adaptive and life-saving to maladaptive and damaging.
• Children are especially sensitive to repeated stress activation as their bodies and brains are developing.
• The original ACES study was conducted in a population that was 70% Caucasian and 70% college-educated.