ever had a argument with a loved one that lead to… hurtful words? broken things? and later...

Ever had a argument Ever had a argument with a loved one with a loved one

that lead to…that lead to…

*Hurtful Words?*Hurtful Words?*Broken Things?*Broken Things?

And later reflected onAnd later reflected on“What just happened?”“What just happened?”

The 2 BrainsThe 2 Brains

Human BrainHuman Brain&&

Primitive BrainPrimitive Brain

The Cerebral Cortex:The Cerebral Cortex:Thinking/Personality BrainThinking/Personality Brain

Evaluates emotions in a more sophisticated manner

Impulse control, planning, organization, personality

Making meaning & choices



Large in HumansLarge in HumansOur IndividualityOur Individuality

How We Take ActionHow We Take Action

““we rule the world because of our large brains”we rule the world because of our large brains”

The Brain Stem:The Brain Stem:Primitive/Survival BrainPrimitive/Survival Brain

Controls the rhythms of life: heartbeat, waking, sleeping,

breathing, cyclical release of hormones

Arousal systems Reaction to threat: fight, flight or freeze



As Animals we…As Animals we…

Eat, Breathe, MoveEat, Breathe, Move

Make waste prodctsMake waste prodcts

Make babiesMake babies

The Limbic System The Limbic System The Emotional Brain The Emotional Brain

Human Brain Human Brain – in our control– in our controlWe think and control urgesWe think and control urges

Primitive Brain Primitive Brain – out of our control– out of our controlFast response and urgesFast response and urges

The Stress Response SystemThe Stress Response SystemVideo 1 Video 2

The alarm reaction

A quick, complex, total body response to a serious threat

The body is mobilized for “fight, flight or freeze”

https://www.youtube.com/watch?v=BIfK0L8xDP0

https://www.youtube.com/watch?v=RyP8L3qTW9Q

Physiological Changes Involved in the Physiological Changes Involved in the Alarm Response (Fight or Flight)Alarm Response (Fight or Flight)

Increased heart rate, blood pressure & breathing

Release of glucose + increased muscle tone

Nervous system changes increased focus on the threat and tuning out of everything else

Stress hormones (adrenaline, cortisol) are the messengers that initiate all of the above

The Story of a SoldierThe Story of a Soldier

The Basic Instinct to SurviveThe Basic Instinct to SurviveFight Flight FreezeFight Flight Freeze

When the threat is so overwhelming When the threat is so overwhelming there is no hope in fighting or fleeingthere is no hope in fighting or fleeing

Freeze – Submission - Collapse

The body prepares to be injured

Heart rate slows, blood moves from extremities to inner organs

The mind detaches from current situation

Natural endorphins are released which decreases perception of anxiety and pain

The Story of a StudentThe Story of a Student

Overwhelmed, can’t think and Overwhelmed, can’t think and becomes detached from realitybecomes detached from reality

Physiological Problems Constant High Physiological Problems Constant High Levels of Stress HormonesLevels of Stress Hormones

High Blood Pressure

High Glucose Levels (weight gain, diabetes)

Cortisol inhibits anti-inflammatory chemicals to inflammation lead to pain (fibromyalgia)

With high levels of stress hormones (adrenaline, cortisol) the body downgrades the receptors.

Memories are hard to make (hard to learn)

Early Brain Development

• Nurturing, responsive, and individualized interactions from birth build healthy brain structure.

• Healthy brain architecture is the necessary foundation required for optimal future learning, behavior and health.

Regional Child Abuse Prevention Councils 2011

The brain develops in the context of human relationships

Review of Brain Development Review of Brain Development Most of Brain Development Most of Brain Development Occurs in the Early YearsOccurs in the Early Years

Stress and the Brain

• Excessive and repeated stress:– Neglect, violence– Chaos, unpredictability– Hostility, rejection

• Causes disruption of brain architecture:– Impairs cell growth– Interferes with healthy neural circuits


FlashbacksFlashbacks

Trauma memories that have not been verbally integrated and come back in the form of sensory memories that make it feel as if the trauma were occurring again in the here and now.

Trauma TriggersTrauma TriggersFlashbacks are most often triggered by Flashbacks are most often triggered by

a non-verbal memorya non-verbal memory Sights Sounds Smells Bodily sensations Emotional reactions Motor memories

Scientific Gaps

25

Death

Conception

Who

le L

ife P

ersp

ectiv

e

Early Death

Disease, Disabilityand Social Problems

Adoption of Health risk Behaviours

Social, Emotional and Cognitive Impairment

Adverse Childhood Experiences

The ACE pyramid

26

Some findings so far...

Increased risk of: lung cancer

auto immune disease

prescription drug use

chronic obstructive airways disease

poor health related quality of life.

27

Neurobiology

Structures tend to be fixed by birth, but the connections and functions carry on being sorted until early adulthood.

Frontal lobe

Motor speecharea of Broca

Parietal lobe

Reading comprehension area

Occipital lobe

Sensory speech area of Wernicke

Cerebellum

Pons

Neglect and the brain

28

Front

Back

Front

Back

Temporal lobes Temporal lobes

Most activity Least activity

Illustration based on actual PET scan images - Center for Disease Control and Prevention

Healthy brain An abused brain

http://images.google.com/imgres?imgurl=http://img.dailymail.co.uk/i/pix/2007/09_02/childabuseG1109_468x329.jpg&imgrefurl=http://www.dailymail.co.uk/news/article-481243/How-NSPCC-faked-child-abuse-stories-generate-cash.html&usg=__IrwAgLPXJD61nh6vpHEPfNe3urk=&h=329&w=468&sz=114&hl=en&start=2&tbnid=GtyzlOv60YmSOM:&tbnh=90&tbnw=128&prev=/images?q=child+abuse&gbv=2&hl=en

Positive Stress

Tolerable Stress

Toxic Stress

Normal and essential part of healthy development

Brief increases in heart rate and blood pressure

Mild elevations in hormonal levels

Example: Tough test at school. Playoff game.

Body’s alert systems activated to a greater degree

Activation is time-limited and buffered by caring adult relationships.

Brain and organs recover

Example: Death of a loved one, divorce, natural disaster

Occurs with strong, frequent or prolonged adversity

Disrupts brain architecture and other organ systems

Increased risk of stress-related disease and cognitive impairment

Example: abuse, neglect, caregiver substance dependence or mental illness

Intense, prolonged, repeated, unaddressedIntense, prolonged, repeated, unaddressed

Social-Emotional buffering, Parental Resilience, Early Detection, Effective Intervention

Social-Emotional buffering, Parental Resilience, Early Detection, Effective Intervention

What are ACEs?Adverse Childhood Experiences

• ACEs are experiences in childhood that are unhappy, unpleasant, hurtful

• Sometimes referred to as toxic stress or childhood trauma

1. Child physical abuse

2. Child sexual abuse

3. Child emotional abuse

4. Physical Neglect

5. Emotional Neglect

6. Mentally ill, depressed or suicidal person in the home

What are theAdverse Childhood Experiences?

7. Drug addicted or alcoholic family member

8. Witnessing domestic violence against the mother

9. Loss of a parent to death or abandonment, including abandonment by divorce

10. Incarceration of any family member

What are theAdverse Childhood Experiences?

ACEs often last a lifetime . . . but they don’t have to

• Healing can occur

• Cycle can be broken

• Safe, stable, nurturing relationships heal parent and child

Family Centered Practice, June 8, 2007

Adverse Childhood Experiences vs. Adult Alcoholism

0

2

4

6

8

10

12

14

16

18

% A

lco

ho

lic

ACE Score

0 1 2 3 >=4

Childhood experiences underlie chronic depression

0

10

20

30

40

50

60

70

80

% W

ith

a L

ife

tim

e H

isto

ry o

f D

ep

res

sio

n

0 1 2 3 >=4

ACE Score

Women

Men

ACE score vs. serious job problems

0

2

4

6

8

10

12

14

16

18

% w

ith

Jo

b P

rob

lem

s

0 1 2 3 4 or more

ACE Score

Abuse and Neglect1. Child physical abuse 2. Child sexual abuse3. Child emotional abuse4. Neglect

Indicators of Family Dysfunction5. Mentally ill, depressed or suicidal person in the home6. Drug addicted or alcoholic family member7. Witnessing domestic violence against the mother8. Parental discord – indicated by divorce, separation, abandonment9. Incarceration of any family member

ACE Score: the number of categories of adverse childhood experience to which a person was exposed.

ADVERSE CHILDHOOD EXPERIENCES The Most Powerful Determinate of the Public’s Health

NEUTRAL START

OUTCOMEIndividual & species survive the worst conditions.

INDIVIDUAL•Edgy•Hot temper•Impulsive•Hyper vigilant•“Brawn over

brains”TRAUMATIC

STRESS

OUTCOMEIndividual & species live peacefully in good times; vulnerable in poor conditions

INDIVIDUAL•Laid back•Relationship-

oriented•Thinks things

through•“Process over

power”

BRAINHormones, chemicals & cellular systems prepare for a tough life in an evil world

BRAINHormones, chemicals & cellular systems prepare for life in a benevolent world

ACEs INFLUENCE VIA BIOLOGIC IMPACT ON NEURODEVELOPMENT

CHRONIC DISEASE

ALCOHOL, TOBACCO,

DRUGS

PSYCHIATRIC DISORDERS

RISKY SEX

IMPAIRED COGNITION

WORK/SCHOOL Attendance, Behavior,

Performance

GENETICSIncluding gender –

Remember that experience triggers gene expression

(Epigenetics)

ACEs HAVE MANY IMPACTS THROUGHOUT THE LIFESPAN

CRITICAL & SENSITIVE

DEVELOPMENTAL PERIODS

Early childhood, ages 7-9, Pre-puberty,

Aging into adulthood

ADVERSE CHILDHOOD EXPERIENCE

MORE CATEGORIES – GREATER IMPACT

Physical Abuse, Sexual AbuseEmotional Abuse, Neglect

Witnessing Domestic ViolenceDepression/Mental Illness in Home

Incarcerated Family MemberSubstance Abuse in Home

Loss of a Parent

ADAPTATIONHard-Wired Into

Biology

BRAIN DEVELOPMENT

Electrical, Chemical, Cellular Mass

CRIME

OBESITY

POVERTYINTERGENERATIONAL

TRANSMISSION, DISPARITY

BEHAVIORAL HEALTH CHRONIC DISEASE

MENTAL HEALTH DISABILITY

NEUTRAL START

OUTCOMEIndividual & species survive the worst conditions.

INDIVIDUAL•Edgy•Hot temper•Impulsive•Hyper vigilant•“Brawn over

brains”TRAUMATIC

STRESS

OUTCOMEIndividual & species live peacefully in good times; vulnerable in poor conditions

INDIVIDUAL•Laid back•Relationship-

oriented•Thinks things

through•“Process over

power”

BRAINHormones, chemicals & cellular systems prepare for a tough life in an evil world

BRAINHormones, chemicals & cellular systems prepare for life in a benevolent world

ACEs INFLUENCE VIA BIOLOGIC IMPACT ON NEURODEVELOPMENT

Normal Biologic Response to Toxic Stress Can Make Parenting Harder

Impact of ACEs on Brain Development

A PET scan of a normal brain (left) shows a high level of brain activity in the temporal lobes of the brain. The temporal lobes are responsible for regulating emotions and receive input from the senses. The temporal lobes on the right are from a severely traumatize child in which the lobes are inactive. Children with damage to this part of the brain suffer sever emotional and cognitive problems as well as have difficulty in making and/or sustaining positive relationships.

Top 10 risk factors for death in the USA

smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, history of STD


ACE Scoreand Teen Sexual Behaviors – National

Data

0

5

10

15

20

25

30

35

40

45

Perc

en

t W

ith

Healt

h P

rob

lem

(%

)

0 1 2 3 4 or more

ACE Score

Intercourse by Age 15

Teen Pregnancy Teen Paternity

0

10

20

30

40

50

60

Relationship Between Number of Adverse Childhood Experiences and Adolescent Pregnancy

Pe

rce

nt

wh

o h

ad

a

t

een

pre

gn

an

cy

ACE Score

0 1 2 3 4 5 6 7-8

ACE Score and HIV Risks

0

2

4

6

8

10

12

14

16

18

20P

erc

en

t W

ith

Healt

h P

rob

lem

(%

)

0 1 2 3 4 or moreACE Score

Ever Injected Drugs

Had 50 or MoreIntercourse Partners

Ever Had an STD

The ACE Score and the Prevalence of Attempted Suicide

0

5

10

15

20

0 1 2 3 >=4

ACE Score

Perc

en

t att

em

pte

d (

%)

High Residential Mobility (>8 moves) During Childhood by ACE Score

0

5

10

15

20

25

30

0 1 2 3 4 or 5 >=6

ACE Score

Perc

en

t w

ho m

oved

8 o

r m

ore

tim

es (

%)

“…early experiences help to determine brain structure, thus shaping the way people learn, think, and behave for the rest of their lives.”

I Am Your Child Reiner

Foundation

Taking care of yourselfSelf-care checklist

• Physical fitness• Nutrition and hydration• Sleep and rest• Assertiveness skills• Centering and solitude• Creative activities• Fun and enjoyment• Support provided & recieved• Set and monitored goals

“The solution of all adult problems tomorrow depends in large measure upon the way our children grow up today.”

- Margaret Mead, Anthropologist


What Are ACEs?Adverse Childhood Experiences

• ACEs are experiences in childhood that are unhappy, unpleasant, hurtful.


• Sometimes referred to as toxic stress or childhood trauma.

ACEs Often Last a Lifetime . . . But They Don’t Have To

• Healing can occur

• The cycle can be broken

• Safe, stable, nurturing relationships heal parent and child.


Complete ACE Questionnaire

• What does it make you think about?

• Keep in mind your thoughts as we present the ACE Study


What are Adverse Childhood Experiences (ACEs)?

• Growing up (prior to age 18) in a household with:

• Recurrent physical abuse.

• Recurrent emotional abuse.

• Sexual abuse.

• Emotional or physical neglect.


Growing up (prior to age 18) in a household with (cont):

• An alcohol or drug abuser

• An incarcerated household member.

• Someone who is chronically depressed, suicidal, institutionalized or mentally ill.

• Mother being treated violently.

• One or no parents.


Why is This Important?Because ACEs are:

• Surprisingly common

• Occur in clusters

• The basis for many common public health

problems

• Strong predictors of later social functioning,

well-being, health risks, disease, and death


ACE Scores

•1/3 of adults have an ACE score of 0

•The majority of adults with an ACE score of 0 have few, if any, risk factors for diseases that are common causes of death in the US.


ACE’s are Highly Interrelated

Alcohol Abuse in the Home and the Risk of Other Household Exposures During Childhood


•An ACE Score of 4 or more results in having multiple risk factors for these diseases or the disease themselves. •An ACE score of 6 or more results in a 20 year decrease in life expectancy.


Evidence Suggests:

• Many chronic diseases in adults are determined decades earlier, by experiences in childhood

• Risk factors/behaviors for these diseases are initiated during childhood or adolescence and continue into adult life.


Seeking to Cope

• The risk factors/behaviors underlying these adult diseases are actually effective coping devices.

• What is viewed as a problem is actually a solution to bad experiences.

• Dismissing these coping devices as “bad habits” or “self destructive behavior” misses their functionality.


Family Centered Practice, June 8, 2007Regional Child Abuse Prevention Councils 2011

Behavior is Predictable

All behavior has meaning - both good behavior and bad behavior

We need to look closely

at what preceded the

behavior - What happened

first that is causing this

behavior?


Life in a Tough WorldIf trauma/toxic stress occurs early in life, the brain becomes wired to survive it.


By adolescence, children seek relief through:

• Drinking alcohol

• Smoking tobacco

• Sexual promiscuity

• Using drugs

• Overeating/eating disorders

• Delinquent behavior


High Risk Teen Behaviors

• May not be the core problem

• They may be the coping devices

• A way to feel safe or just feel better


Adverse Childhood Experiences vs. Smoking as an Adult

0

2

4

6

8

10

12

14

16

18

20

0 1 2 3 4-5 6 or moreACE Score


Adverse Childhood Experiences

vs. Adult Alcoholism

0

2

4

6

8

10

12

14

16

18

% A

lco

ho

lic

ACE Score

0 1 2 3 >=4


ACE Score vs. Intravenous Drug Use

0

0.5

1

1.5

2

2.5

3

3.5

% H

ave

Inje

cted

Dru

gs

0 1 2 3 4 or more

ACE Score


Adverse Childhood Experiences Adverse Childhood Experiences vs. Likelihood of > 50 Sexual vs. Likelihood of > 50 Sexual

PartnersPartners

0

1

2

3

4

Ad

jus

ted

Od

ds

Ra

tio

0 1 2 3 4 or more

ACE Score


ACE Score vs. Unintended ACE Score vs. Unintended Pregnancy or Elective AbortionPregnancy or Elective Abortion

0

10

20

30

40

50

60

70

80

%

ha

ve

Un

inte

nd

ed

PG

, or

AB

0 1 2 3 4 or more

ACE Score

Unintended Pregnancy

Elective Abortion


Childhood Experiences Underlie Chronic Depression

0

10

20

30

40

50

60

70

80

% W

ith

a L

ife

tim

e H

isto

ry o

f D

ep

res

sio

n

0 1 2 3 >=4

ACE Score

Women

Men


Childhood Experiences Underlie Later Suicide

0

5

10

15

20

25

% A

ttem

pti

ng

Su

icid

e

ACE Score

0 1 2 3 >=4


ACE Score vs. Serious Job Problems

0

2

4

6

8

10

12

14

16

18

% w

ith

Jo

b P

rob

lem

s

0 1 2 3 4 or more

ACE Score


ever had a argument with a loved one that lead to… hurtful words? broken things? and later...

Documents

primitivesurvival brain

emotional brain slide

pain slide

reality slide

brain stem

brain excessive

fight flight freeze

healthy brain architecture

ever had a argument with a loved one that lead to… *hurtful words? *broken things? and later...

ever had a argument with a loved one that lead to… hurtful words? broken things? and later...