Being Dealt A Losing Hand That Lingers

There are times in life when four aces is a tough hand to hold.

Common themes on this public policy forum include poverty and its causes and cures, school failure and related discipline matters, health problems and the difficulty understanding why these conditions remain so widespread in this great nation and commonwealth.  I invite you to temporarily suspend your preconceived notions and examine some hard data that upset some of mine.

My quick summary is not doing this work justice but this is a blog, not the New Yorker.

More than twenty years ago two researchers on opposite sides of the country were feeling their way toward explaining strong correlations they observed between childhood experiences and later physical diseases.  One noted that people who dropped out of obesity treatment were often sex abuse victims.  A collaborative study was funded by the Centers for Disease Control and Kaiser Permanente.  About 17,000 people were asked to fill out a simple 10-question survey on various adverse childhood experiences (ACEs) and then the results were correlated with their health records.

Here, take the test yourself.

The results were astounding.  Adults who had high ACE scores also were substantially more likely to have – decades later — a number of health problems up to and including early death. People with a score of six or more were potentially looking at lifespans of 20 fewer years.  From the summary I linked:  “Compared to an ACE score of zero, having four adverse childhood experiences was associated with a seven-fold (700%) increase in alcoholism, a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema; an ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide.”

It was widely known that children who were physically or sexually abused were more likely to become offenders themselves, and the concept of psychosomatic illness is ancient.  We’ve long talked about the cycle of poverty.  But here was hard proof in a simple and easy to replicate study.  It then led to brain studies that discovered that trauma and the resulting floods of cortisol and adrenaline actually change physical brain structures.  The how is becoming clearer.

This initial group was not a low-income population.  Heart disease, depression, family violence, drugs and learning problems are not limited to poor neighborhoods.  But the work has sparked a slowly spreading revolution in education and social services.

Consider the implications of simply changing the question “What is wrong with this child?” to “What has happened to this child?”  When you make that mental shift, does it change the way you think about the argument over long suspensions for primary school students with control issues?  Do you really think sitting out of school for a long period (unsupervised) is going to change anything?  Do you worry a little bit more about the impact on a child of a being evicted a series of times?  Are you a bit more interested in providing Medicaid to the whole family instead of just the children?

Source: CDC

Monday morning I had a chance to see a one-hour film on this research and the changes it has inspired.  “Resilience” is still not in general release but I think you can see it here.  As the title implies a high ACE scores can be overcome but the key is usually the right kind of help in a supportive environment, the kind of support which is far less common in those low income populations.

Divorce, domestic violence, alcohol abuse and even sexual abuse can happen in any family.  But add in a neighborhood where gunfire is regularly heard, violent death can sweep away a sibling or friend, many parents are in jail, and the police are viewed as enemies and the concept of toxic stress gets clearer.   Schools, the police and courts, the health care system – all need to understand the role of toxic stress and become “trauma informed” in their responses.  This does not mean do not respond at all.

As a physician in the film explains, if a child with learning problems due to trauma is treated as if she has an attention deficit problem, the standard stimulant drug regime can worsen the problem.  An ACE score of four or more increases the incidence of learning problems by 32 times.  Add in the financial incentives to dose a whole generation with Ritalin and don’t be surprised by what you see.

The challenge of course is what do we do about this?  I think the “revolution” is on a slow roll because the solutions are hardly simple or inexpensive.   Suspending a child for acting out is so much simpler than family therapy.  The War on Poverty is a stalemate at best. So far nobody has found a way to reverse the trend of single parenthood and too few understand it as tragic. Don’t run out and give the ACE test to a thousand kids unless you are ready to face the hundreds of real abuse allegations you find.  (The ACE test I linked above is the research tool, not a screening tool.)

This does double underline the importance of prevention.  Home visitation programs like those conducted by Families Forward (I’m on its board) are directly aimed at helping low-income parents reduce the stress in their households, so the children can be better prepared for success in school. Mentoring programs like Big Brothers Big Sisters and the Boys and Girls Clubs are doing their work.  Local child abuse prevention programs are now focused on this research.  This was all going on before the ACEs study with plenty of success.

But the ACEs study and two decades of follow-up have demonstrated a firm link to physical disease, not just social problems, presenting decades later.   All of us, parents and caregivers and policymakers, need to fully absorb the fact that children are not naturally resilient and expecting them to “suck it up” and “get over it” and simply avoid “bad choices” by themselves is now proven folly.