Childhood adversity
The impact of adverse childhood experience
The landmark study on Adverse Childhood Experiences (ACE) was conducted by Vincent Felitti, MD, and the team from Kaiser Permanente in San Diego, along with Robert Anda, MD, epidemiologist at the Centre for Disease Control in Atlanta. With more than 17,000 participants involved in the study, they found that the impact of adverse childhood experiences first showed up in school as behaviour and learning problems. Participants did not 'outgrow' the effects of their early childhood experiences. Instead the impact of trauma pervaded their adult lives.
The ACE Study
The ACE questionnaire had ten different categories of childhood adverse experiences, such as sexual abuse, physical and emotional abuse, parental divorce and alcoholism, and frequent verbal abuse. With one point for each category, one in eight had an ACE score of four or more. Higher ACE scores tended to correlate with higher work place absenteeism, financial problems, lower life-time income, and depression.
Markedly, only one third of the mostly white, middle-class, middle aged, and well educated respondents in the study reported no adverse childhood experiences. However, one in ten individuals answered 'yes' to questions about being hit, sworn at, insulted, or put down by their parent or another adult in the household often or very often. More than a quarter responded 'yes' to being being repeatedly physically abused as a child such as pushed, grabbed, slapped, or having something thrown at them leaving marks or injury, often or very often. Those who were sexually assaulted by a person at least five years older were 28 percent women and 16 percent men. And one in eight people responded positively to the question: 'As a child, did you witness your mother sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her?'
Felitti had observed that when he successfully treated adult patients for long term health risks such as obesity, another more harmful behaviour such as self-harm or suicide would emerge. This lead him and others to develop the ACE study. The results of the study revealed that health risk conditions treated in adulthood such as obesity, or alcohol and drug abuse, often began in childhood. These conditions were in fact coping mechanisms — a solution to a different problem. Anda's reported that the correlations between adverse childhood experiences and negative adult outcomes were so powerful that they 'stunned us.'
When Robert Anda formally presented the ACE study results he could not hold back the tears. He calculated that the overall public cost of child abuse exceeded that of cancer or heart disease. Further, that eradicating child abuse would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. Not to mention benefits for workplace performance and lower incarcerations. A result so startling, because the cause was child abuse.
Children, the most vulnerable in society, rely on their caregivers for safety and protection, warmth and attunement. Van Der Kolk (2015) writes that it is quite hard to be a neglectful, and emotionally and physically abusive parent. Most parents do a good job, and good enough is good enough. Parents have the occasional meltdown and rupture in their relationship with their child. And repairing this rupture in a timely manner is key to fostering security, stability and closeness with children. However, the ACE study has significantly highlighted that rising scores on the adverse childhood experiences scale can impact mental and physical health in adulthood.
Catch them early — prevention is better than cure
Michael Meaney's famous study on newborn rat pups and their mothers found that those pups who were licked and groomed more by their mother's in the first twelve hours after their birth produced less stress hormones. This attentiveness and warmth from their mothers altered their brain architecture through the process of epigenetics. These pups were not only braver, they recovered more quickly from distress, developed thicker neural networks for learning and memory, and performed better in finding their way through mazes — a skill akin to rodents, not us thank goodness.
The work of Stephen Suomi on the transmission of personality in rhesus monkeys, which share 95 percent of human genes, found that early experience has at least as much impact on biology as heredity. Monkeys, like humans, have the same two variants of the serotonin gene known as long and short serotonin transporter alleles. In humans the short alleles have been associated with impulsivity, aggression, sensation seeking, suicide attempts, and severe depression. In Suomi's study, monkeys with the short allele that were raised by an adequate mother behaved normally without any deficit in their serotonin metabolism. While those raised with their peers, not surprisingly, became aggressive risk takers.
New Zealand researcher, Alec Roy, found that humans with short alleles had higher rates of depression only if there was also a childhood history of abuse or neglect. The conclusion drawn from this research was that children who were fortunate enough to have an attuned and attentive parent or care-giver were not going to develop this genetically related problem. Safe and protective early relationships are critical to protect children from long-term problems.
Attachment research, developed by Mary Aisnworth with the Strange Situation, identifies the different patterns with which infants bond and relate to their primary care-giver. Securely attached children are like the nurtured pups from Meaney's study. The infant can predict and know they will be safe and cared for and their brain architecture will in turn enable them to recover more quickly from distress, and develop thicker neural networks for learning and memory.
Other children may experience less competent parenting and develop anxious or avoidant styles of coping. For children raised in homes where adverse experience scores are high, it would be expected the attachment relationship to their parent would be disturbed, resulting in a disorganised attachment pattern and an increased vulnerability to subsequent difficulties.
Children who don't feel safe as infants have difficulty regulating their moods and emotional responses as they grow older. At a young age they become aggressive or spaced out and disengaged. They show more physiological stress, as expressed in heart rate, stress hormone responses, and lowered immune factors. This biological dysregulation does not reset to normal as the child matures or if they are moved to a safer environment.
The body keeps score
Following on from the findings of the ACE study, scientists over the past decade have reached a consensus that the key channel through which early adversity causes damage to developing bodies and brains is stress. However, it is not stress itself, but rather the body's reaction to the stress.
Neuroendocrinologist Bruce McEwen at the Rockerfeller University, developed the concept of allostatic load. If the body's stress management systems are over worked, they eventually break down under the strain, a process he called allostasis, a measure of; blood pressure, heart rate, cholesterol, C - reactive protein (a leading marker for cardiovascular disease), cortisol readings, stress hormones in urine, and glucose, insulin and lipids in the bloodstream.
Gary Evans, a Cornell scientist, analysed three different kinds of data for each child in his study. They were; a cumulative-risk score that took in ambient noise in a home to family friction; an allostatic load measure; and a rating of maternal responsiveness which combined a child's answers and researcher's observations on a game of Jenga with their mother. Evans found the higher the environmental risk score, the higher the allostatic load. However, this was markedly remediated by a parent's responsiveness to their child. Evan's research showed that regular good parenting — such as being helpful and attentive during a game of Jenga — can make a profound difference to a child's future prospects.
The ACE study significantly highlighted that rising scores on the adverse childhood experiences scale can impact mental and physical health in adulthood. Research shows that responsive parenting attenuates stress in children. Warmth and security builds strong neural networks for learning and memory. And good enough parenting is good enough for newborns to grow into adults who can live in good physical and mental health, develop warm responsive relationships, and thrive in their chosen career.
Source:
Tough, P. (2013). How Children Succeed. New York. Mariner Books.
Van Der Kolk, B. (2014). The Body Keeps The Score: New York. Penguin Books.