exploring the relationship: aces, toxic stress, and early childhood · 2017-04-26 · toxic stress...

Exploring the Relationship: Aces,

Toxic Stress, and Early

Childhood

Presented by Project CLIMB and CCHAP:

Bridget Burnett, PsyD,

and Ayelet Talmi, PhD

• Overview of Aces

• Definition of Toxic Stress

• Relationship between ACES and Child

Development

Caregiver Substance Use

Family Violence

Goals for Today’s Discussion

Property of Drs. Talmi & Burnett; Do not replicate without permission

ADVERSE CHILDHOOD

EXPERIENCES AND

ENVIRONMENTS


Adverse Childhood Experiences Study

(ACES) http://www.cdc.gov/ace/pyramid.htm


Adverse Childhood Experiences Study

(ACES) http://www.cdc.gov/ace/pyramid.htm

Abuse

• Emotional Abuse

• Physical Abuse

• Sexual Abuse

Neglect

• Emotional Neglect

• Physical Neglect

Household Dysfunction

• Mother Treated

Violently

• Household Substance

Abuse

• Household Mental

Illness

• Parental Separation or

Divorce

• Incarcerated Household


Stress Continuum(Center for the Developing Child, Harvard)

Positive stress response normal and

essential part of healthy development, brief

increases in heart rate and mild elevations in

hormone levels.

Tolerable stress response activates the

body’s alert systems to a greater degree as a

result of more severe, longer-lasting

difficulties. Time-limited activation that is

buffered by relationships with adults who

help with adaptation and recovery.Property of Drs. Talmi & Burnett; Do not replicate without permission

Toxic Stress(Center for the Developing Child, Harvard)

Toxic stress response can occur with the

experience of strong, frequent, and/or

prolonged adversity without adequate

adult support. Prolonged activation of the

stress response systems can disrupt the

development of brain architecture and other

organ systems, and increase the risk for

stress-related disease and cognitive

impairment.

Key concepts

• Chronic stress vs tolerable/positive stress

• Increased health risk factors

• Buffering relationships

• Importance of early detection to prevent

Average child under age 6 had ACE score of

1.94

Additional 1.54 added between age 6 & 12

Additional 1.15 added between ages 12 &

16


Colorado Adult ACES Score

Data• 20% of Adults in Colorado surveyed had

2 or 3 ACES

• 13% had 4+ ACES

• Watamura, S.E., 2016. Report prepared

for the Office of Early Childhood, State of

Colorado.Property of Drs. Talmi & Burnett; Do not replicate without permission

Colorado Children in Early

Head Start • 29.7% had a Parental score of 2 or 3 ACES

• 32.4% had a Parental score of 4+ ACES

• Of the children with 4+ Parental ACES

• *21.9% had diagnosis of ADD/ADHD

• *17.3% had a diagnosis of Anxiety disorders

• *12.8% had Externalizing Behaviors

• Watamura, S.E., 2016. Report prepared for the Office of Early Childhood, State of Colorado.


Caregiver Substance Use Disorders (SUDs)

and Child Mental Health

Mental health problems experienced by children of parents with SUDs can include:

• Anxiety disorders

• Attention-deficit/hyperactivity disorder

• Depression

• Oppositional defiant disorder

• Conduct disorder

• Truancy

• Trauma and stress-related disorders

http://pediatrics.aappublications.org/content/138/2/e20161575



Caregiver substance abuse and

impacts on the child

• A high absenteeism rate

• Impaired attention

• Which compromise their academic productivity

• Behavior problems place children at greater risk of

suspension or expulsion from school.




Healthcare and Family

Violence• Clinical studies have proven the

effectiveness of abuse screening by

doctors

• Only 10% of doctors screen for abuse

during new-patient visits

• Only 9% screen for abuse during

periodic checkups.


Short-term reactions/effects of

exposure to family violence• Generalized anxiety

• Sleeplessness

• Nightmares

• Difficulty concentrating

• High activity levels

• Increased aggression

• Increased anxiety about being separated from a parent

• Intense worry about their safety or the safety of a parent

• http://www.nctsn.org/content/children-and-domestic-violence


http://www.nctsn.org/content/children-and-domestic-violence

Long-term effects of exposure

to family violence

• Physical health problems

• Behavior problems in adolescence (e.g.,

juvenile delinquency, alcohol, substance

abuse)

• Emotional difficulties in adulthood (e.g.,

depression, anxiety disorders, PTSD)

• http://www.nctsn.org/content/children-

and-domestic-violence



Case Example

A 2 month old presents for well child check up with both parents.

During the course of regular screening for second hand smoke

family discloses that they smoke marijuana in the bathroom a few

times a day. With further questioning they say they ‘take turns’ so

that baby is not alone and not exposed. Both parents seemed to:

Answer questions a little slowly

Appeared to be high

• What would you say next?

• What would you do next?


What to do? The right dosage

of an intervention• Psychosocial Screening, response and referrals in Early

Childhood

• Good nutrition

• Exercise / Physical activity

• Sleep

• Mental Health treatment

• *Supportive Relationships*


Resources: Nadine Burke

Harris Ted Talk And CDC• https://www.ted.com/talks/nadine_burke_

harris_how_childhood_trauma_affects_h

ealth_across_a_lifetime?language=en

• https://www.cdc.gov/violenceprevention/a

cestudy/

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

Resources

DV and Family Violence:

• Prevention tools: PREP

• Direct Intervention

• http://www.nctsn.org/content/children-and-domestic-violence

• Groves, Augustyn, Lee, Sawires. 2004. Identifying and Responding to

Domestic Violence Consensus Recommendations for Child and

Adolescent Health, Provided by Family Violence Prevention

• Maternal Domestic Violence Screening in an Office-Based Pediatric Practice

http://www.pediatrics.org/cgi/content/full/108/3/e43


http://www.pediatrics.org/cgi/content/full/108/3/e43

Resources Continued:

Substance Abuse:

• http://pediatrics.aappublications.org/content/138/2/e20161575

• Prenatal Exposure and Effect on Children SAMHS Resource Guide

https://ncsacw.samhsa.gov/resources/annotatedbiblio/Perinatal_Prenatal.aspx

• Substance Exposed Infants State Responses to the Problem

https://www.ncsacw.samhsa.gov/files/Substance-Exposed-Infants.pdf

• Substance Abuse Treatment

• Center For Recovery-Lois Leder-IOP substance abuse for 14.5-18.5 303—694-7492

• Arapahoe House-substance abuse-303-657-3700

• ARTS substance abuse and research program 303-388-5894

• Cornerstone substance abuse treatment 720-540-0961


Acknowledgements

• Child Health Clinic, Children’s Hospital Colorado

• Project CLIMB Team

• BHIPP:0-5 Technical Assistance Team

• University of Colorado School of Medicine

Departments of Psychiatry and Pediatrics

• Children’s Hospital Colorado Pediatric Mental

Health Institute

• Irving Harris Program in Child Development and

Infant Mental Health

• Colorado Children’s Healthcare Access Program

exploring the relationship: aces, toxic stress, and early childhood · 2017-04-26 · toxic stress...

Documents