What if one area of research could prevent some of society's biggest problems?
Researchers say an ever-expanding pool of data on the effects of childhood trauma-and how to counteract those effects-might be the key to alleviating countless societal problems. These include criminality, substance abuse, mental health problems and some of the leading causes of death.
Those who work with children, in health care and with incarcerated populations in Crow Wing County are seeking to bring local awareness to studies on adverse childhood experiences, commonly known as ACEs. A presentation earlier this month at the Brainerd Public Library explored the connection between ACEs and incarceration. It also focused on building resiliency among those with ACEs, a factor identified through research as essential in avoiding negative consequences of childhood trauma.
"The bigger movement is about how do we break the cycle?" said Lowell Johnson of Crow Wing Inside Out Connections, one of the groups that sponsored the presentation. "How do we intervene in a way so that those people that are adults with high ACEs don't pass that on to the next generation? So that's our challenge."
A body of research
Twenty-plus years of data collection show ACEs are directly linked to measurable negative impacts on brain development. These impacts dramatically increase the risk of children experiencing problems later in life.
The original study of childhood trauma and later-life health and well-being took place in 1995-97, when Kaiser Permanente collected data from confidential surveys completed by 17,000 of its HMO members. The surveys asked people to identify whether they'd experienced any of 10 adverse experiences in childhood: emotional abuse, physical abuse, sexual abuse, mother treated violently, household substance abuse, mental illness in the household, parental separation or divorce, a criminal household member, emotional neglect or physical neglect.
The study was the first time the relationship between health risk behavior and disease in adulthood and childhood trauma was explored. The results were startling: a strong relationship was found between ACEs and the leading causes of death.
In years since, the Centers for Disease Control and Prevention continued monitoring and expanding upon these links. In 2008, questions about ACEs were added to the Behavioral Risk Factor Surveillance System, a survey used by states. Three years later, Minnesota became the 18th state to add these questions to its survey and the Minnesota Department of Health published a study on ACEs among Minnesotans in 2013.
Data from the MDH was consistent with many other ACEs studies. More than half of Minnesotans surveyed reported experiencing at least one ACE in childhood. Of those, 60 percent reported experiencing two or more ACEs, and 15 percent had five or more ACEs.
The risk factors of later-life health and well-being problems increase in lock-step with the number of identified ACEs. Charts and graphs shared in the local presentation showed again and again the correlation between higher ACE scores and a higher incidence of problems. Among Minnesota's eighth, ninth and 11th graders, for example, 70.3 percent of those with four or more ACEs reported experiencing depression and hopelessness. This is compared to 36.3 percent of those with one ACE.
Within that same survey group, the number of those reporting alcohol use within the past 30 days increased with ACE scores. One-fifth of those with one ACE reported alcohol use, while nearly half-47 percent-of those with four or more ACEs drank in that timeframe.
A chart that drew a big response from those who attended the local presentation was one showing the attributable risk of societal problems for those with high ACE scores. After controlling for gender, age, income, education, race and ethnicity, the data showed those with high ACE scores are at markedly higher risk for a number of negative life experiences: serious persistent mental illness, alcoholism, incarceration, intimate partner violence, promiscuity, chronic depression and more.
Ultimately, these factors combine to greatly increase the risk of early death.
A brain awash in stress
While some might find it intuitive that those with troubled upbringings are at greater risk of having troubled adulthoods, ACEs researchers are collecting data that puts scientific veracity behind those assumptions. Brain science emerging from the research-science that shows causation between childhood trauma and negative consequences on brain development-is adding complexity to the age-old debate of nature vs. nurture.
While stress is a normal human response to various situations, it can become toxic to the developing brain when prolonged or acute, a study from Harvard University found. When people experience stress, the brain releases hormones such as cortisol. In the brains of children living with ACEs, cortisol is released much more frequently and for longer periods of time.
According to MDH's summary of the study: "Persistent and intense stress stemming from ACEs actually influences how the brain develops, strengthening connections in the parts of the brain that are associated with fear, arousal and emotional regulation at the cost of other parts of the brain associated with learning and memory. Continuous activation of the stress response system can also produce disruptions of the immune and metabolic systems, resulting in a lifetime of greater susceptibility to physical illness as well as mental health problems."
Translation: the biology of children's brains is directly influenced by the environment in which a child grows up-with the potential for lasting consequences. Neural connections are made-or fade-depending upon the types of experiences reinforced in a child's life.
"If the environment is not safe, and the child has limited positive interactions with an adult, the child may develop a more vigilant approach to the world to avoid known and unknown dangers, and those maladaptive pathways in the brain grow stronger," the MDH stated.
A ray of hope
The cumulative effect of ACEs research can feel overwhelming, Johnson said at the library presentation. So many of those who grew up in troubled homes were surrounded by adults who themselves had high ACE scores, oftentimes going back for generations, he added.
But Johnson's passion for sharing the research with others is driven by the rays of hope he sees in how a community can make a difference in children's lives.
"You can say, 'it stops here,'" Johnson said. "It's the awareness that these patterns tend to be repeated in families. If you see that there's a pattern in your family and see the problems it causes, you can decide to stop it. Easy to say that, but there's a lot of hope. ... It can be stopped, there are many success stories of people who have broken the ACEs cycle."
Also emerging from ACEs research is recognizing that not every child with a high ACEs score ends up committing crimes, developing addictions or engaging in any other of a host of societal problems.
What's been identified as a common factor in repelling the negative impacts of adversity is the development of resiliency-something that can come from a combination of individual characteristics and outside influence. Johnson said as little as one positive adult in a child's life can have a tremendously positive impact on that child's ability to become resilient.
Counties seek grant to become 'trauma-informed' - Click here to read
Learn about how Crow Wing County Community Services and other Region Five counties are seeking a grant to become trauma-informed organizations, which involves tailoring services to those who've experienced trauma.
"Resilience is the result of a dynamic set of interactions between a person's adverse experiences and his or her protective factors. This interaction is what determines the developmental path towards health and well-being or towards illness and dysfunction," the MDH states on its website. "No child is magically resilient or invulnerable to ACEs, just as no individual child is automatically doomed in the face of ACEs."
The "protective factors" refer to a number of things on the individual, family and community levels in a child's life: close relationships with competent caregivers; identifying and cultivating a sense of purpose through faith, culture or identity; social connections and more.
Johnson shared information on the results of one city's intentional focus on developing resilience in young people. At a high school in Walla Walla, Wash., school leaders took a different approach to discipline in light of ACEs research. Instead of instant suspensions or written warnings in response to a negative student behavior, teachers at the school began asking more questions-such as "What is making you angry?"-and giving students an opportunity to calm down for sometimes more than a day before discussing an issue.
"Teens who live with complex trauma are walking post-traumatic stress time bombs," an article on the website ACEs Too High states. "They teeter through their days. The smallest incident can push them into a full-blown meltdown. Some kids run away. Some explode in rage. Some just mentally check out. ... Until a school helps kids learn how to control their emotions, they'll just keep losing it. For some kids, erupting is a stress reflex response."
During the time the school took the new approach focused on positive problem solving and increased resilience, it saw a dramatic decrease in disciplinary problems. Out-of-school suspensions dropped from 798 to 135. Expulsions dropped by half, and police reports went from 48 to 17.
"These are measureable outcomes from a community that got behind resiliency training," Johnson said.
'Not a destiny'
The goal of Johnson and others-including the local public health initiative Crow Wing Energized-is to educate as many people as possible on the topic. At the presentation, Johnson asked those in attendance to brainstorm ideas for how resiliency could be improved in the Brainerd lakes area. Many were volunteers at the Crow Wing County Jail and noted they'd like to see some of the programs they run in the jail available on the outside-whether that be book clubs, parenting classes and support circles-specifically tailored to "returning citizens" recently released.
Also mentioned were transition teams for people exiting jail, ensuring they are connected with services and resources to reduce recidivism and improve outcomes for those people's children.
"ACEs are not a destiny," Johnson said. "Sometimes, they just need people to lean on, to provide the hope and the help."