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The Adverse Childhood Experiences Study provides important education to health care providers that can change the course of children’s lives. Unfortunately, this is not regularly educated to patients within primary care. Implementing its teachings would have a significant positive benefit for today’s children.
The Adverse Childhood Experiences (ACE) Study highlighted by the Children’s Trust Fund analyzed for class is not alone it its findings. The connection between early childhood exposures, experiences, and trauma are repeatedly found in other studies yielding similar results. As providers, nurses, and physicians we need to be keenly aware of these all too sad, but true connections. The impact strength any one event up to daily living conditions has on one’s adult health, behavior, and even death related to risk factor outcomes is significant (Felitti, et. al., 1998). As the ACE Study conveys, even small childhood experiences can shape our social behavior and even physical health. Children raised in poor conditions; such as abusive families, repeated bullying, and stress have been proven to have more negative risk factors to their health when they reach adulthood.
The ACE Study outlines the real physiological impacts of what they call “toxic stress.” Children that are exposed to these negative situations and stressors release more cortisol in relation to the fight or flight response. Unfortunately, by having a chemical response so often, as with repeated exposure, physical damage to the brain can occur. Specifically it has been found that learning and memory areas of the brain are more affected by this overexposure. As health care providers recognizing situations that appear to be high in toxic stress can provide a possibility of intervention. Interviewing children during emergency room or physician office visits without parents or guardians present can be the most effective means to this. The earlier we are able to recognize a child at risk for this real physical change to their brain, the better they may be off down the road. We actually may be saving adult lives from being cut short by proper interviewing of pediatric patients, their parents, and recognizing signs of toxic stress.
As we have found so many times in our health care work places and clinicals; education is an extremely important component of prevention. There are many stereotypes about children that can negatively affect positive and protective factors. Some examples witnessed within the medical field include a lack of understanding regarding children’s pain control. Simply because they are unable to verbalize their needs and feelings does not necessarily mean they are not in pain or have another symptom. According to assumptions made possible by the ACE Study, this could potentially lead to future distrust or even misuse of substances due to fear of repeating this earlier-life experience. Another example could include health care providers not intervening, even though in some places required by law, when possible abusive situations or poor living conditions are suspected. This is directly setting the child up for future negative outcomes and putting them at risk for high risk behaviors as a coping mechanism that may have an effect on their health for their entire life.
The outcomes of the ACE Study survey reveal a vicious circle of events. In households where one risk factor was identified, unfortunately there is a likelihood of more than one existing. Looking at the evidence, these negative factors are likely to date back through generations. Many of the maladaptive behaviors are not ones that form out of the blue. While mental illness is not always preventable, some situations such as incarcerated family members would have to have an “igniting” behavior. This is then clearly passed onto the children exposed to these living conditions.
Promoting positive environments and behaviors at a young age is crucial to break the cycle. Some of these measures can be small in scale. Encouraging parents to stop smoking and adopt positive coping mechanisms to stress and passing these on to their children could prevent another generation of smokers. As future providers we have the ability to educate our patients about this valuable study. It is not a difficult concept to understand, but is not an emphasized point within primary care today. It provides the “why” to so many behaviors we discourage in our patient populations.
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