The Adverse Childhood Experiences (ACE’s) Study and the implications of outcomes Josephine McKay, MSW

Found in the middle of the Brain Limbic system Found in the middle of the Brain Known as “emotional bran” Responsible for emotion, behavior, motivation, learning, & memory Consists of: Hypothalamus, Thalamus, Amygdala, and Hippocampus

Limbic system Sexual Behavior Hunger/Thirst Sleep Body Temperature Hypothalamus Amygdala Hippocampus thalamus Sexual Behavior Hunger/Thirst Sleep Body Temperature Hormone Secretion Identify emotion from facial expression Creating & storing new memories Storage of long-term memory (emotions, location, people, objects) Receives auditory, somatosensory, & visual signals Controls sleep/wake states of consciousness

Cerebral cortex Outer portion of forebrain Divided into 2 spheres: left and right Divided into 4 lobes: frontal, temporal, occipital, parietal

Regions of the brain Parietal: Processes somatic information, hearing Frontal: muscle movement, thinking, emotional control, personality Occipital: Receives visual information Temporal: Receives auditory information

Frontal lobe Left Positive Emotions: Happiness Joy Confidence Love Right Negative Emotions: Sadness Anxiety Depression Anger

right left Hemisphere Hemisphere Left side of body Faces Emotional Expression Non Language Sounds Nonverbal Memory Emotion of Speech Sense Distance Right side of body Words & Letters Sounds of Language Verbal Memory Speech, reading, writing, math Function Vision Hearing Memory Language Spatial Ability

Childhood Responses to Trauma Cortex: Cognitive Memory Limbic: Emotional Memory Cerebellum: Motor Memory Cognitive- names, faces, facts Limbic- fear, pleasure, sadness Cerebellum- action like riding a bike, playing Brainstem- anxiety or arousal states- fight or flight responses Re-exposure to trauma (sights, sounds, smells) can elicit response from stored memories As the events recur in the child’s mind, not only will the thoughts of the event be recalled but the emotions and feelings (fear, pain, anxiety) will be re-experienced too Brainstem: State Memory Bruce Perry, Child Trauma Center

Childhood Responses to Trauma Continuum Rest Vigilance Crying Tantrums Aggression Continuum Avoidance Detached Fetal Fainting Internal State Calm Arousal Alarm Fear Terror Hyperarousal continuum- Fight or Flight Response Dissociative Continuum- Freeze or Surrender Response Fear changes thinking, feeling, and behaving Internal state changes by increase in heart rate, blood pressure, respiration, glucose levels Bruce Perry, Child Trauma Academy

Trauma- How do we get from here?

Trauma- to here?

Adverse childhood experiences (ace’s): Vincent Felitti, MD- Specialist in prevention medicine Kaiser/UC San Diego Question: “What if having a bad childhood could affect health in other ways?” Robert Anda, MD- Epidemiologist with CDC&P 17,000 patients- White, middle-aged, upper-middle class -First longitudinal study into childhood trauma and impact to brain development in relationship to emotional and physical health, 1995-1997 - Began when Dr. Felitti tried a new liquid diet for obese patients. One patient shared history of SA, asked another then found that half of the 300 patients had hx.

ACE’s Outcomes: Identified Adverse Experiences 10 Identified types of adverse childhood experiences: -Sexual Abuse -Loss of parent due to divorce -Physical Abuse -Loss of parent due to incarceration -Emotional Abuse -Mental Illness in parent -Neglect -Drug Abuse by parent -Loss of parent due to death -Alcohol Abuse by parent

ACE’s Outcomes What do the Numbers Mean? Higher score on the tool = greater chance the child will have medical, mental, and societal challenges as an adult Score of >4 = 4 to 12 times more likely to experience alcoholism, drug abuse, and suicide attempt compared to those with 0 score Score of <4 = twice as likely to have heart disease Women with score of >5 = 4 times likely to suffer depression Score of 2-4 greater rates of smoking, poor self-rated health, and severe obesity Significant impact of the study on prevention funding in mental health, substance abuse treatment for women pre-natally, early childhood education, afterschool programs-> all with aim at reducing family isolation and creating community interdependence.

How Does This Impact Me? “Safety and security don’t just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear.” ~Nelson Mandela

Thoughts? What took so long for the ACE’s findings to become public knowledge? What can society do with this information? What can you do as an individual with this information? Is there hope for change?

Brain can rejuvenate One solid caregiver can show affection and the brain can heal Exercise can help restore metabolism to “normal” and reduce implications of diabetes, hypertension, cardiovascular disease Sleep can reduce chronic stress; at least 7 hours per day, which reduces early mortality Mindfulness practices can re-regulate the sympathetic nervous system, i.e. reset the “abused” flight or fight response