adverse childhood experiences – predictor’s of future health · 2018-10-09 · adverse...
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Adverse Childhood Experiences –
Predictor’s of Future Health
“In my end is my beginning”
T.S. Eliot
Four quartets
Steve Wolfe, M.D.
Professor Emeritus
University of Iowa
Department of Family Medicine
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Learning Objectives:
Understand and articulate the relationship between
adverse childhood experiences and adult health
risks/behaviors
Understand the relationship between adverse
childhood experiences and social outcomes
Understand the ecobiodevelopmental model of
health and the impact of ACEs and toxic stress on
childhood brain development
Use the ACEs screening tool in your practice to
access future health risks/behaviors
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SPONSORED:
IOWA MEDICAID ENTERPRISE AND
CENTER FOR DISEASE AND DISABILITY
UNIVERSITY OF IOWA
Disclosure:
Consultant, Iowa Medicaid Enterprise &
Iowa Department of Public Health 1st Five
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The ACEs Study
Relationship of Childhood Abuse and
Household Dysfunction to Many of the
Leading Causes of Death in Adults: The
Adverse Childhood Experiences (ACE) Study.
Vincent J. Felitti, FACP, Robert F. Anda, MD,
MS, et al. Am J Prev Med 1998;14(4)245-258.
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ACE Pyramid Concept for ACE Study
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ACEs Study Design
1995-1997
ACEs questionnaire completed by 17,421 of
26,000 HMO members of Kaiser Permanente,
San Diego Department of Preventive Medicine
www.acestudy.org
www.cdc.gov/ace/
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Iowa BRFSSAnnual survey conducted by CDC and Iowa
2012 BRFSS include questions to assess for ACES
Surveyed 6,361 Iowans –
Iowa ACES data consistent with original ACES study data
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Adverse Childhood Experiences
ACE = Events/Incidents which harm social, cognitive,
and emotional functioning causing a dramatic upset in
the safe, nurturing environments children require to
thrive.
ACEs are common stressful traumatic experiences
which affect children’s neurodevelopment. The
Ecobiodevelopmental Model of Health.
ACE score is a measure of the cumulative exposure to
household dysfunction, abuse, and neglect.
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What Did We Learn
ACEs Are Common
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ACEs Are Interrelated
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ACEs Are Cumulative:Co-occurrence and Cumulative Effect of ACES
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ACEs -- Strong Association With
Alcohol Abuse
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Relationship of ACE Score to
Alcohol Use And Abuse
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ACEs Are Common in Iowa
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ACEs in Iowa Co-Occurrence
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Iowans With ACEs Score 4 or Greater Experiencing
Each ACE Category
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ACEs Predict Future Health Risk
Behaviors And Overall Quality of Life
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Health Risk Behavior
And Illness Burden
Worse Case:
childhood
trauma as
measured by
ACE score can
reduce life
expectancy by
20 years
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Depression and Suicide
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Iowa ACEs/Depression
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ACE Score and
Teen Sexual Behaviors
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ACEs and Population
Attributable Risks
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Iowa ACEs Study
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ACEs Adversely Affects
Many Health Outcomes
RISK FACTOR % INCREASE
Smoking 242%
Obesity 22%
Depression 357%
Illicit drug use 443%
Injected drug use 1133%
STD 298%
Attempted suicide 1525%
Alcoholism 555%
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ACE National Issue
Impact: Adolescent health, teen pregnancy and
sexual behavior, risk of revictimization, stability
of relationship, life performance at work and
school.
Impact: heart disease, liver disease, injuries,
obesity, diabetes, arthritis
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ACE Scores Among Parents in Iowa
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Impact on Education And
Future Work Place Problems
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Spokane Washington
Students with 3 or more ACEs:
2 ½ times more likely to fail a grade
Score lower on standardized tests
Have language difficulties
Suspended or expelled more
Designated to special education more frequently
Poorer health
Courtesy of Chris Blodgett, PHD ~ Washington State University
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Effect of ACEs on
Educational Outcomes
N.J. Burke et al/Child Abuse And Neglect, 2011; 35(6):408-413.
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New ACEs Pyramid Concept
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“IT IS EASIER TO BUILD
STRONG CHILDREN
THAN TO REPAIR
BROKEN MEN.”
FREDERICK DOUGLAS
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Nature Plus Nurture—The Neurobiology of Development
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Critical First 1000 Days
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Synapse Development
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Brain Architecture
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Healthy Brain
This PET scan of the
brain of a normal child
shows regions of high
(red) and low (blue and
black) activity. At birth,
only primitive structures
such as the brain stem
(center) are fully
functional: in regions
like the temporal lobes
(top), early childhood
experiences wire the
circuits.
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Serve and Return
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Brain Architecture
Persistent Stress Changes Brain Architecture
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Toxic Stress
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Still Face Experiment
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An Abused Brain
This PET scan of the brain of a Romanian orphan, who was institutionalized shortly after birth, shows the effect of extreme deprivation in infancy. The temporal lobes (top), which regulate emotions and receive input from the senses, are nearly quiescent. Such children suffer emotional and cognitive problems.
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Epigenetics
Process determines which genes are turned
on/off – synthesizer
Environment/experience impacts how
genotype is translated into phenotype
“Genes load the gun, the environment pulls
the trigger”
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How Early Experiences Alter Gene
Expression and Shape Development
National Scientific Council on the Developing ChildWorking Paper 10: Early Experiences Can Alter the Gene Expression and Affect Long-Term Development
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Eco-Bio-Development Model
Experience(Ecology)
Brain Development Epigenetic Changes(Biology)
Behavior(Development)
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Public Health Approach to ACEs
1) Identify protective factors:
Encourage nurturing and positive relationships
Provide knowledge of parenting and child
development
Assist in developing parental resilience
Social connections
Concrete support in times of need
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Public Health Approach to ACEs
2) Build Strong Communities:
Inform and Educate
Enhance Skills
Provide Support
Enhance Access And Reduce Barriers
Community Activities
Modify/Change Policy
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“THE QUALITY OF LIFE
FOR A CHILD BEGINS
WITH THE BIRTH OF HIS
OR HER PARENTS.”
---UNKNOWN
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References The Adverse Childhood Experiences Study: www.acestudy.org
ACEs 360 Iowa: www.iowaaces360.org
Health in Iowa, Annual Report from the Behavioral Risk Factor Surveillance System, Iowa 2012:www.idph.state.ia.us/brfss/common/pdf/2012BRFSSannual.pdf
Center of the Developing Child at Harvard University:http://developingchild.harvard.edu
National Scientific Council on the Developing Child (2005). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3 from: http://developingchild.harvard.edu/index.php/resources/reports_and_working_papers/working_papers/wp3/
Nadine J. Burke et al. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse and Neglect 35(2011)408-413
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QUESTIONS AND
COMMENTS
Thank You