ACEs: Understanding Trauma in Childhood

0:00CEUs available at AllCEUs.com/Trauma-CEU

0:11i'd like to welcome everybody today's presentation on adverse childhood experiences and trauma and

0:17how it impacts the person throughout their lifespan i am your host dr dawn elise snipes

0:27in this presentation we're going to explore the relationship between adverse childhood experiences

0:32henceforth and forevermore referred to as aces and trauma we'll identify identify the impact of

0:39aces and traumatic injury on mental physical and interpersonal health in adults so we're

0:45looking at the lifespan perspective and explore risk factors for aces and subsequent prevention

0:52and intervention measures and i am going to challenge you to think when we get down

0:58to prevention and intervention and even the risk factors think about ways that you can modify your

1:08current work environment or you can work with agencies within your community in order to

1:16make services more available to help create more preventative factors and buffer against those risk

1:22factors so adverse childhood experiences or aces are stressful or traumatic events that children

1:31experience before age 18 years now why before age 18 years well that is the age of majority

1:38in reality the brain does not finish developing until about age 24 and the last part of the

1:45brain to develop is the frontal cortex which is involved in all of our executive processing our

1:52impulse control our organization our decision making you know so there's a lot of stuff that

1:59isn't formally matured until even after the age of 18. but we know that when the brain is developing

2:08it's kind of like pottery that has not been yet been put into the kiln it is much more

2:15susceptible or much more fragile when it uh when it encounters insults so this is why aces can

2:25be so detrimental before the age of 18. we're not saying that people do not experience trauma

2:32in their 30s 40s and 50s of course they do but when people are young when their brain is still

2:39developing the impact is often more extensive studies have linked exposure to aces and negative

2:48and negative health and developmental and behavioral outcomes so these

2:55early childhood experiences these aces actually do cause problems physiologically

3:02psychologically behaviorally and as a consequence interpersonally

3:08now traumatic events are those things that are can be defined as direct or indirect exposure

3:17to an event that involved the possibility of death or serious injury if you've diagnosed

3:23ptsd before you're familiar with this now it's direct either the person themselves

3:31was at risk of death or serious injury or they saw it you know and that is the case in

3:37intimate partner violence for example when we see a child um viewing their their parents in physical

3:46altercations or even verbal verbally abusive altercations so it is important to recognize

3:54that it doesn't have to be something that the person experienced themselves traumatic

4:01injury can happen after a traumatic event but it doesn't always happen now in children a lot of

4:10times it does but it is important to recognize that there are people who've experienced aces

4:18even multiple aces who have had a sufficient support system and sufficient resources and

4:27mitigating factors that it didn't end up causing traumatic injury now at this point they are in

4:33the minority the majority of people who experience multiple aces end up having

4:41some level of physiological and psychological injury as a result

4:4761 of adults surveyed across 25 states reported that they had experienced at least one type

4:54of ace and nearly one in six reported that they had experienced four or more types of aces and

5:03we're going to talk about what those aces are but just kind of let that sink in for a minute

5:0861 percent of adults um had experienced at least one but nearly one in six had experienced four

5:16or more you know that's a huge leap from one to four in my opinion over 50 percent

5:23of adolescents have been exposed to aces which can have detrimental effects on learning and

5:28behavior and is associated with increased suicidal ideation we want to be aware of this so when we're

5:36screening adolescence when we're interacting with adolescents it's important to be aware of um

5:43and to kind of try to figure out if they've been exposed to aces 68.1 percent of people who

5:51reported homelessness in childhood also reported experiencing four or more aces now it's important

5:59to remember that homelessness is not just someone who is living in their car or living under a

6:05bridge homelessness is actually defined as someone who doesn't have a permanent shelter so it can be

6:13a family who has lost their home and now they're living with family or friends but that is not a

6:22permanent uh setting that is not their home their their residing with friends and family

6:29until they can get back on their feet that still meets the definition of homelessness

6:35only 16.3 percent of people who were never homeless in childhood reported experiencing four

6:41or more aces so we know that homelessness even homelessness that where the person still has some

6:50degree of shelter uh significantly increases the likelihood of aces which totally makes sense

6:57aces have a different impact on the brain based upon the age of exposure

7:02individual factors and microsystem protective factors what that means well the strongest

7:10impacts are found for younger children ages two to five okay well that totally makes sense

7:16a two to five year old hasn't experienced much in life they're still very egocentric

7:23they still have very primitive thought patterns they still are extremely like totally

7:30dependent on their parents you know they are in a position where they are extremely vulnerable so

7:38when they experience these aces what would be threatening or distressing to a 16 year old

7:46is just way overwhelming it's a tsunami of emotion for a two to five year old for a toddler

7:54under the age of two a lot of times children understand something's wrong but they don't

8:01cognitively get it quite as much so we do know that children who have experienced aces

8:06during their toddler years have the strongest impacts from the aces and

8:12those living in households with incomes below 200 percent of the federal poverty level also

8:20have the strongest impacts so we want to look at both the age of the child and understand that

8:28you know what what might be a minor impact for an older child could be

8:33an extreme impact for a younger child the same thing is true if the person is in a household

8:40that is struggling socioeconomically why well because as you will see

8:48poverty contributes to just about every single adverse childhood experience out there

8:56aces contribute to disturbances in cognitive and affective processing including heightened

9:02attention toward threatening stimuli so we have a child who becomes hyper vigilant when they are

9:11you know awake when they're hyper vigilant they are scanning they are aware they have heightened

9:17attention toward threatening stimuli which leaves precious little time attention and energy

9:23to notice non-threatening stimuli so what do you think their perception of the world is

9:29you know that is a terrifying kind of place to be they have an increased experience of loneliness

9:36well a lot of times when they experience aces they have a hard time trusting others it impacts their

9:43self-esteem because it disrupts their attachment makes sense they would experience more loneliness

9:50they have increased hpa axis dysregulation well if they're hypervigilant all the time

9:57if they're stressed out all the time then their hpa axis is going to be up regulated most of the

10:04time i won't say all the time and that is going to contribute to what we've talked about before

10:11with glucoracoid resistance with hpa axis dysfunction and emotional dysregulation

10:19so that you know again it makes sense when people have this hpa axis dysregulation we

10:27need to remember that that usually results in emotional dysregulation which often results in

10:34reduced impulse control when people go from being you know okay kind of white knuckling it holding

10:41it together to feeling completely out of control a lot of times their behaviors become very reactive

10:50again totally makes sense so we need to start remembering that behavior is communication

10:58when we are dealing with a child or even an adult because a lot of times the adults

11:05still have these symptoms they've never learned how to address them they haven't been

11:12they've never felt safe you know they grew up recognizing or believing that the world

11:18is a dangerous place that they are isolated that they're not good enough poor attachment

11:24they grow up to be adult that doesn't just magically fix itself so unless they have done a

11:29whole lot of self-help work or gone to a therapist a lot of times we are going to be seeing adults

11:35with these same symptoms so we want to look at their symptoms as information

11:42as communication people who experience aces as children evidence functional alterations

11:50in key stress and emotion-associated brain regions particularly the anterior cingulate cortex

11:58the amygdala and the hippocampus all right we know the amygdala if you've done any research at all on

12:06emdr or trauma you know the amygdala is involved in threat and fear processing so there are changes

12:13in the amygdala in people who experience aces they've they've done the brain scans they've

12:20shown that people who experience them actually do have changes in volume the hippocampus

12:28remember our hippocampus is so important it's involved in the hpa axis the hip

12:35and and uh i'm sorry the hypothalamus is in the hpa axis but the hippocampus also

12:41shrinks and the hippocampus is also involved in fear processing initially

12:48when people are exposed to aces the amygdala volume increases

12:54makes sense because the fear think about as the fear grows the amygdala grows however over time

13:04those neurons start to die off because it becomes neurotoxic the environment there's too

13:10much glutamate in the in that area starts killing off neurons so with persistent distress over the

13:17course of years the amygdala actually shrinks in volume it doesn't mean that that alters people's

13:25fear or responsiveness but we do need to understand that there are changes in in the brain

13:33these brain regions the hippocampus the anterior cingulate cortex and the amygdala are particularly

13:39susceptible to damage from trauma which triggers the hpa axis because the hpa axis remember dumps

13:48glutamate our main excitatory neurotransmitter and when glutamate is present for too long and in

13:55too high of a concentration it actually starts to you know kill off neurons so these areas that have

14:04high densities of glucoracoid receptors you know they are the ones that we know usually get flooded

14:11with glutamate and so when these areas do get flooded and they stay flooded kind of like you

14:18know when an area floods you know in neighborhood floods eventually you know the houses start to

14:24crumble and eventually the brain cells start to die off and the brain starts to adjust

14:32interestingly exposure to specific types of aces selectively affect the sensory systems which were

14:42involved in perceiving the trauma so they have found for example that if a child hears the

14:51their their parents fighting if the child hears something that's traumatic to them then

14:58their auditory processing and their hearing may actually become impacted will be altered

15:05um as opposed to you know other senses generally the hearing becomes a little bit more acute

15:12because now the the brain is saying okay you know i picked up on that threat by hearing it so

15:19i need to make sure that i hear all threats henceforth and forevermore

15:24mental disorders in individuals with ace exposure tend to have more severe symptomatology increased

15:32risk of comorbidity and are less likely to respond to standard treatments so think about why

15:38that might be if somebody you know has traumatic experiences when they're a child and they start to

15:49have brain changes as a result of glucoracoid resistance and hyper vigilance hpa axis activation

15:56whatever you know it's hard for them to it's hard enough to grow up and deal with life on

16:03life's terms but then put this albatross around their neck so to speak and it makes it even harder

16:12compound that when they have disrupted attachment they don't feel safe they feel lonely they have

16:18poor self-esteem you can see how they may have more severe symptoms they often

16:27remember we talked about increased hpa axis dysregulation because of that extended exposure

16:35to distress we tend to see hpa axis dysregulation and emotional dysregulation which is often

16:43perceived as more severe symptomatology you see more self-injurious behavior

16:48more addictive behavior more numbing uh even more aggressive and violent behavior because the people

16:57go from a state of you know like i said kind of holding it together to terrified or enraged

17:06they tend to be less likely to respond to standard treatments because a lot of times our standard

17:13treatments are singular in focus we focus on cognitions we focus on environments we focus

17:21on self-esteem when we need to recognize that there have been physiological changes in this

17:29individual and there have been alterations in their developmental course over time

17:36because they were not able to uh flourish like youth who hadn't been exposed to aces in adults

17:48ace exposure is associated with a wide range of physical disorders including obesity dysregulation

17:55of the immune system autoimmune disorders abnormal pain perception with and without underlying causes

18:05stress itself just the the emotion stress or the physiological reaction stress

18:13can sensitize nocioceptive neurons in the spinal cord which result in comparable changes in pain

18:19perception and related behavior basically that's saying that when people are under a lot of stress

18:26there are actually changes in the perceptiveness of the neurons which make them more um pain

18:33intolerant that the pain is more palpable more intense for people so let's look at let's think

18:41about why these physical disorders may occur going back to that hpa axis the hypothalamic pituitary

18:48axis dumps glutamate norepinephrine tells us that we need to that we need to fight or flee

18:57also it dumps cortisol and cortisol is a steroid in the short term

19:04cortisol is meant to suppress inflammation and suppress our immune system it's not time to devote

19:12energy to repair and immunity it's time to devote energy to fight or flee so it makes sense that

19:21the immune system in in short term would be suppressed however when that system goes wonky

19:29when it becomes dysregulated then it also causes subsequent dysregulation of the immune system

19:37the person starts actually having increased levels of pro-infla pro-inflammatory cytokines are

19:44inflammatory molecules throughout the body we know that stress increases pro-inflammatory cytokines

19:52we know that pro-inflammatory cytokines increase auto are associated with autoimmune disorders

19:59and are also associated with increases in symptoms of clinical depression

20:08they also have disruptions in the intestinal microbiota and the mucosal immune system

20:14and i did a video on gut health oh gosh about two years ago where we talked about the impact

20:22of stress on the gut and our gut is where a lot of our neurotransmitters are actually made

20:29and interestingly if you want to think about the gut is the factory the gut communicates with the

20:36brain and vice versa through the vagus nerve when people are stressed think about what happens when

20:43you're stressed a lot of times when people are stressed it's not time to rest and digest

20:48so what does the body do it tries to expel that food as quickly as possible so it's going to push

20:55the nutrients out the alterations in the nutrients the alterations in the neurotransmitters cause

21:00alterations in the intestinal microbiota and that can cause alterations in the body's ability to

21:09actually create the neurotransmitters that we need to feel happy and healthy so it's you know it's

21:16all interconnected uh people who have an unhealthy gut have more difficulty regulating some of their

21:26um regulating some of their neurotransmitters and actually pat you're getting ahead of me

21:32because we're going to talk about covid in just a minute there is a 200 to 400 percent

21:40increased risk of heart disease cancer chronic lung disease skeletal fractures depression

21:47diabetes and pre-diabetes which by the way they have started realizing or thinking that diabetes

21:54is actually in many cases an autoimmune issue and liver disease so it's important to recognize

22:02that the stress on the body the free radicals caused by emotional distress can really wreak

22:13havoc on everything the alterations in hormone levels gonadal hormones thyroid hormones

22:20stress hormones all kinds of hormones in addition to alterations in the neurotransmitters also wreak

22:27havoc on the body serotonin for example it's not just your happy chemical serotonin is involved in

22:36blood pressure heart rate um gastrointestinal motility it's involved in pain perception our

22:43neurotransmitters are involved in so much more than just mood it's important to recognize that

22:50when those things neurotransmitters go offline it's going to impact the person biopsychosocially

23:03experiences now what we talk about when we're thinking about adverse childhood experiences

23:09include family violence intimate partner violence and child abuse or neglect

23:15those are the two that were screened for in the aces survey now it doesn't mean that these are

23:21the only adverse childhood experiences we remember in the beginning of the presentation we defined

23:29adverse childhood experiences pretty broadly but the ones that they

23:33tested or evaluated in the survey included intimate partner violence child abuse or neglect

23:41mental illness in the family members in in a parent addictive behaviors in a care parent or

23:50caregiver and then family instability or parental separation that is caused by jail death divorce

23:59job you know anything that takes a caregiver away especially the primary caregiver for an extended

24:07period of time can contribute to adverse childhood experiences now does that mean that every person

24:14who is a child of someone who is in the military or someone who travels a lot for work is going to

24:23experience this as an adverse childhood experience no because those people while they may not be

24:32physically present there are a lot of ways that for example soldiers still

24:38communicate with their family still make sure that they stay in touch in connection

24:43with their loved ones while they're overseas while they're deployed

24:48divorce is the same way not every divorce is equal some of them are very amicable and

24:56the children have sufficient resources and sufficient supports to buffer against

25:02uh the negative impact of changes that are happening in their life

25:09now as pat pointed out the rise of aces during covid has been we're expecting meteoric

25:19we know unfortunately just by looking at the records to date that there have been

25:24significant increases in substance misuse there have been significant increases

25:31in intimate partner violence and child abuse and neglect and mental illness in the caregivers

25:39okay so what does that mean you know unfortunately in some cases a lot of people have been

25:49the opposite of separated during covid and that has contributed to some of this distress

25:55because they've been kind of locked down together which can cause stress among people especially if

26:02there's crowding there's been a lot of poverty a lot of people who are out of work a lot of people

26:07who aren't used to being home all day long there's been a lot of frustration and that all those all

26:15become risk factors for violence abuse neglect anxiety depression addiction so covet has been

26:26just absolutely awful in my opinion on the future of a lot of the people a lot of the youth of today

26:39because this is the environment that they've grown up in or spent a year now you think well it's only

26:46been eight months and you know by the time we get the vaccine out maybe it'll be a year a year

26:52and a half you know what's the big deal well when you're 10 that's a 10th of your life when you're 5

27:01that's 20 of your life you know when you're a kid that is a really freaking long time

27:08okay so let's look at you know in what ways does this contribute to distress how are these things

27:16adverse if you will and you know obviously witnessing violence is going to be threatening

27:24for a lot of people you know if you see a caregiver abusing another caregiver

27:29you know that is anxiety provoking you feel powerless to protect your caregiver

27:35and you know that you can't survive without your caregiver so that's you know really stressful um

27:44but it also impacts attachment so let's think about attachment remember we've talked before

27:49about the mnemonic device craves in order to form healthy attachment relationships have to

27:56be characterized by consistency you know the caregiver is uh there you know is consistent

28:04in their responses it's not one day it's going to make me mad another day i won't care one day

28:09i love you the next day you know i could take you or leave you they're consistent they're responsive

28:16when the child is emoting you know good or bad the parent or caregiver is responsive to the child

28:27if the child is in distress the caregiver is there to provide support and to model self-soothing

28:35behaviors to help the child learn the skills that they need to de-escalate if the child is

28:42happy of course the caregiver is also being responsive can be happy with the child can

28:50you know mimic and support the happiness so responsiveness is important even with

28:56happy feelings we don't want it the person is not consistent and responsive if they only respond

29:03when the child's in distress and ignore the child the rest of the time which takes us to attention

29:10children need to feel like they are deserving of your attention and when a person is struggling

29:18with mental health or addictive issues a lot of times they have difficulty putting one foot in

29:24front of the other let alone paying attention to the child so a lot of times the child is

29:32emotionally neglected and and or ignored

29:37validation is important remember the the child's feelings are the child's feelings and they are

29:43normal and natural and we need to accept them just like we try to teach ourselves to do

29:48accept our feelings non-judgmentally and then figure out what's this feeling

29:53telling me and what should i do with it but it's important to validate a lot of times people who

30:02struggle with emotional dysregulation who grow up in environments that are invalidating

30:08develop a shame and have difficulty coping with emotions because their caregivers were always

30:15saying you know just get over it or you're overreacting and dismissing their feelings

30:21it is so important to validate the child's feelings and then to explore the child's

30:26feelings with them and help them again figure out what to do next how to self-soothe validate and

30:33be responsive attachment also requires and will put these two together encouragement and support

30:41and they're different support is a caregiver that's there to you know

30:47be there if the child steps out of their comfort zone and you know fails at something

30:54or it doesn't go the way they they want it to a supportive caregiver is there to welcome

30:59welcome them back say you know you got this i love you i'm here for you encouragement

31:06is when the caregiver is encouraging kind of nudging the child outside of their comfort

31:12zone going you can do this you know first grade is going to be really exciting high school is going

31:17to be really exciting you know try out for the cheerleading squad if that's what you want to do

31:23so consistency responsive responsiveness attention validation encouragement and support are all

31:31essential for raising a happy healthy child but when there is family violence when there is

31:37family mental illness and i'm talking about in the nuclear family or when there's family instability

31:44this may not always happen and remember children especially children under the age of 9 or 10

31:51are very egocentric so if they're not getting these needs met they often perceive it as their

31:57fault you know what did i do why is my why does my parent hate me they also think in dichotomous

32:04terms it's either love or hate it's not you know why is mom a little off today so it is important

32:11to recognize how adverse childhood experiences impact the youth's ability to develop their

32:19self-esteem and to form later attachments if they never experienced secure attachment they're going

32:25to have a hard time forming secure attachment we also have seen an increase in aces with technology

32:34media and social media the media is always you know bombarding people's houses um and and i'm

32:43not just talking about news i'm talking about you know all different kinds of television shows and

32:48those sorts of things but media and social media can contribute to mental health or mental illness

32:57anxiety depression in caregivers social media unfortunately i'm seeing a frustrating increase

33:08in families in which one or one or both caregivers is so involved in their social media that they

33:18you know they come home from work they plop down on the couch and they ignore the family for

33:22the rest of the night because they are too busy scrolling and you know that contributes obviously

33:29to a lack of consistency responsiveness attention validation encouragement and support so we do want

33:37to look broader more broadly than just you know necessarily blaming the caregivers you know there

33:46is a lot of stuff and i encourage you to look back at broughton brenner's model of um socioecono

33:55socioecological influences and especially in that microsystem there are a lot of factors that can

34:02contribute to stress that leads to violence stress that leads to abuse or neglect mental

34:10health or addictive behaviors and even criminal acts um death and and i'm not talking about murder

34:18i'm talking about you know somebody having a coronary because they're so stressed out and their

34:23blood pressure goes through the roof or their diabetes is uncontrollable because they have um

34:32they're under so much stress right now because stress impacts blood your ability to control your

34:36blood sugar we also want to recognize that unless there is intervention for the majority of people

34:44who experience traumatic injury from adverse childhood experiences

34:49they will likely go on to have children and not be able to form those attachments

34:56they will likely go on to have children you know if they have children and they will still have

35:03mental health issues that they're dealing with they'll be at high risk for addictive behaviors

35:08there may be family instability because they never resolve their own issues which is going to

35:16end up causing aces in their children so it's intergenerational unless we break the cycle

35:24risk factors in the child and i'm not blaming the child you know don't get me wrong children

35:31are do the best that everybody does the best that they can but we do recognize that there

35:36are certain characteristics in children that make them at higher risk for abuse

35:43one of them um proposed by dr sears and i can't remember his first name right now is being a high

35:51needs child and a high needs child generally from the time they start breathing air are intense and

35:59demanding they don't just whine they don't cry they wail um and and obviously we want to rule

36:07out any physiological causes my son had um gastric reflux when he was little and he would wail

36:16after he would eat and you know burp him and whatever until we realized that he had gerd

36:24he would obviously have indigestion really bad and he would cry and it wasn't just a cry it was

36:29i will every breath he would take in this big breath and just let it out until he was like

36:35purple in the face and then he'd take in another breath and do it again it was heart-wrenching

36:43so obviously we want to make sure that parents who have high-risk children are

36:50ruling out or high-needs children are ruling out any physiological causes of the high needs-ness

36:58if you will but these children tend to come out of the womb intense and demanding you know they will

37:06cry you know and and like i said it's a whale it's not just your normal you know baby cry they tend

37:13to be inconsistent and unpredictable what works to soothe them on monday may not work on tuesday

37:21heck what works on monday morning may not work on monday monday afternoon so that contributes to the

37:26parent having difficulty consoling the child and we know that a crying baby can you know be very

37:34frustrating and stressful after a while and the more stressed parents get the baby picks up on

37:40it the more stressed baby gets so increases their crying it's just this negative cycle

37:46but it also contributes a lot of times to a sense of parental helplessness and hopelessness if they

37:52can't figure out how to soothe their child and that often leads to distancing from the child it's

38:00like okay i can't attach i i can't do it i don't know what to do which takes us back to disrupted

38:07attachment high needs children also tend to be extremely sensitive small noises will startle

38:16them and it's not just a you know startle like this when they're startled they are freaked out

38:22they go from zero to two hundred they emotionally dysregulate if you wanna think about it that way

38:28but they also tend to be very sensitive to minute changes in temperature lighting sound you know

38:35not all of those things but some of those things and they are often unable to self-soothe

38:41now it's important to recognize that a high there are high needs children who are neurotypical okay

38:49but there are there are also high needs children who are neuro atypical

38:55children with disabilities are at a higher risk for again experiencing adverse childhood

39:01experiences so let's just talk before we go there let's think about this high needs child

39:09thinking about how a highly demanding inconsolable child that you know we have difficulty helping

39:17them we have difficulty bonding with them how might that contribute to violence between partners

39:25you know we see probably one parent getting frustrated with the other parent you know

39:31there's a lot of frustration and it can cause you know difficulty among the caregivers

39:37how can it can contribute to child abuse or neglect well we talked about that

39:42you know it can contribute to unfortunately shaken baby syndrome it can contribute to just putting

39:49junior in their crib and saying let them cry it out um and when when junior actually has a problem

39:58when junior doesn't know how to self-soothe so there are a lot of issues that may happen in there

40:05it can contribute to depression and hopelessness in caregivers and it can contribute to addictive

40:13behaviors in caregivers who may feel like the only way that they can cope with this child

40:20is by self-soothing themselves with substances of some sort so there can be a lot of

40:30issues among the caregivers as a result of a high needs child and so it's really

40:38important that parents who have high knees children have a lot of support in dealing with

40:45the unique needs of that child so let's go down to children with disabilities unfortunately

40:52children with disabilities children who are not born quote perfect may con

40:58may be at higher risk of abuse and neglect because the parents are angry and that is just

41:05heart-wrenching to think that that could be but unfortunately the research plays it out that way

41:12autism spectrum disorders are unique uh because children with asds

41:19a lot of times are not diagnosed when they are infants when they are really young you know

41:25they're older before they're diagnosed at least you know a lot of times toddler age or older

41:32but a lot of times children who are on the autism spectrum are very sensitive just like a high needs

41:40child to touch to other even caregiving behaviors and caregiving behaviors you know parents may

41:49be trying to you know swaddle the child to help them feel safer so maybe they'll stop

41:54crying they're trying everything but what they don't realize is they're actually traumatizing

42:00the child because their ba their their touch their sound their rocking may be

42:06perceived you know at an intensity much greater than what the parent really realizes so it feels

42:15aggressive it feels painful to them in some ways and so children with autism autism spectrum

42:23disorders are actually at higher risk for what i call inadvertent um adverse childhood experiences

42:33distressed reactions just like in the high needs child distress reactions in caregivers of

42:39children with autism spectrum disorders may cause distancing and a sense of futility in

42:45a caregiver who doesn't understand why they can't help johnny self-soothe why they can't

42:52you know when they touch the child the child cries i mean how rejecting must that feel

42:58if they don't understand what's going on we do need to educate the public you know obviously

43:06if the caregivers don't know that the child is on the spectrum then they probably haven't begun

43:12therapy and all that stuff yet so it's important to educate the public about the early signs that

43:20a child may be neuroatypical so they can get early intervention for one but also so they can prevent

43:29the disrupted attachment and other adverse childhood experiences there was also a significant

43:37association between ace score so the number of adverse childhood experiences adhd and moderate

43:45to severe especially moderate to severe adhd which makes sense all of it makes sense when you step

43:55back from it but children who have moderate to severe adhd they have difficulty remembering they

44:01may seem like they're being oppositional they may seem distracted that can be very frustrating for a

44:07parent who again doesn't understand that it's not willful behavior it is neurological behavior and

44:15and so early intervention early identification of adhd behaviors is really important to

44:24protect uh and buffer against the development of adverse childhood experiences

44:33risk factors for caregivers to perpetrate aces so this is what we're looking at in in caregivers

44:40who may become perpetrators and i don't like the word perpetrators but i couldn't

44:45think of another one affectively and these characteristics contribute to um all of the

44:54adverse childhood experiences that we listed above family instability

44:58interpersonal violence addiction and mood disorders low self-esteem all right so we need to

45:06do some outreach psycho-education we need to do what we can to help people figure out

45:13uh how to increase their self-esteem why their self-esteem is low and how to increase it

45:20people with low self-esteem tend to be at higher risk for depression anxiety fear of abandonment

45:26and even some personality disorders parental low academic achievement and low verbal iq

45:34well you know that makes it harder to get a job that's actually going

45:38to pay the bills so people who have low academic achievement and low verbal iq

45:43often have difficulty getting uh or or often are in uh a poor socioeconomic condition

45:53low verbal iq also may contribute um and this also goes along with low emotional

46:01intelligence may contribute to the person being unable or have having difficulty communicating

46:09their thoughts feelings wants and needs so even if they feel they can they may not be able to

46:15actually get it out which contributes to them feeling frustrated powerless

46:20under misunderstood angry and resentful mood disorders anger anxiety and depression um

46:30have all increased under covet but they are risk factors for family instability family violence and

46:41mood and addictive disorders so prevention and early intervention services are essential what

46:48can we do what can we do with um brief inter intervention services in doctor's offices in

46:57pediatricians offices what can the pediatric staff do to screen for mood and addictive disorders in

47:05parents where else can we screen for these things how can we increase parents families

47:14health literacy so they actually may start recognizing mood disorders within themselves and

47:23understand the steps they can take to reach out for help most people don't they've been depressed

47:30for as long as they can remember they may not realize that oh hey this isn't quote normal you

47:35know i can feel better than this so making sure that people are aware of the signs and symptoms

47:42is important but also making sure they know how to access help and making sure that help

47:47is available in your community with covid now one of the benefits of covid has been people are

47:54are embracing or accepting of technology a lot more readily so people who live in rural areas

48:03are actually being more willing or being feeling more able to access

48:09behavioral health services borderline or anti-social personality traits and conduct

48:15problems make caregivers more likely to uh perpetrate aces well people who grew up

48:25or people who develop borderline or anti-social personality often not always but often

48:32grew up in a very traumatic environment so they often were exposed to aces themselves

48:39which their their method of coping with life their method of survival was to develop some of these

48:51personality disordered behaviors when you look at the symptoms and you put yourself in the

48:57place of a five or a six-year-old and you look at those symptoms and you go okay i can see how

49:02that behavior might make sense um i can see how for example with borderline personality disorder

49:09the ability to what they call turn on a dime where it's either i love you or i hate you well that's

49:16how little kids think you know they think in dichotomies and people who experienced trauma at

49:24a very young age often have difficulty progressing past that without assistance without intervention

49:32so we do want to make sure that they have access to effective treatment

49:37marsha linehan has done amazing things with dialectical behavior therapy and to

49:45help people with borderline personality disorder lack of non-violent social problem-solving skills

49:52well we need to make sure that from the time they're knee-high to a grasshopper you know we

49:58add in the curriculum in daycare in kindergarten in elementary school all the way up through

50:06that we are integrating non-violent social skills and problem-solving skills into the curriculum

50:13into the health curriculum into you know whatever curriculum

50:18behaviorally people who are aggressive or delinquent as youth tend to be more

50:23likely to be aggressive and be at risk of mood and addictive disorders as adults

50:32people who are heavy alcohol or drug users tend to be more at risk of

50:39behavioral disinhibition violence and mood and addictive disorders just because you use

50:46heavily doesn't mean you're addicted but they are more at risk behavioral

50:52control and impulse poor behavioral control and impulsiveness goes along with that dysregulation

50:59we talked about a lot of people who have impulsivity and poor behavioral control

51:06excuse me have been exposed to trauma as a child and or may also have

51:13some other issues going on uh people who have adhd tend to be much more impulsive

51:19and have difficulty with behavioral control and a history of being physically abusive

51:26if you've done it in the past you're more likely to do it in the present environmentally poverty

51:34and i put unemployment and underemployment together because people can be employed and

51:40just still not making enough money to be able to rub two nickels together at the end of the week

51:45what can we do we need in our communities to have programs that teach financial literacy

51:52how can i stretch my dollar as much as i can what do i need to do so i don't end up under you know

51:59forty thousand dollars of credit card debt at twenty percent interest literacy literacy if a

52:06lot of people who uh struggle with unemployment or underemployment often um not often but may

52:15have difficulty with actual literacy they may have struggled in school they may have difficulty

52:21filling out job applications so we do need to make sure that people have access to literacy services

52:28job opportunities and education about job opportunities a lot of people think of job

52:36opportunities the old way which is you've got to go in and hand in your resume and you know

52:42interview and all that stuff well that's true for a lot of jobs like restaurants and stuff

52:48however in today's day and age there are also a lot of work from home

52:51opportunities so caregivers who are living at home or who are obviously they're living

52:57at home caregivers who are at home with their children may be able to find some online uh

53:05legit work from home opportunities that they're able to engage in and that is

53:10been another blessing of kovid i'm sorry but a lot of organizations have figured out that hey

53:17this work from home thing might actually work for some of our people and then we can downsize our

53:23office and not spend as much there family-friendly work policies are ideal but you know um

53:32let's worry about getting jobs out there first and people need access to their basic mazlovian needs

53:39nutrition housing medicine medical rese medical services and educational resources we need to make

53:48sure those are available i should have put dental there too because dental is big free clinics are

53:54are important for some people making sure that medicaid is available i am uh a strong proponent

54:02of the medicaid expansion and you know think what you will but i think it is really important

54:09for a lot of people's health to be able to make sure that they actually can afford health care

54:18lack of institutions relationships and norms that shape a community's social interactions

54:24in rural areas for example there may not be much to do there may not be community centers there

54:30may not be places where people congregate except for maybe one or two churches and you know the

54:38grocery store parking lot which means there's not a lot of connectedness there's not a lot of

54:45um interaction and supporting of one another

54:49lacking access to those basic uh needs you know i i did talk about and that has become an issue as

54:56well as poverty as a result of kovid um because a lot of people are in jeopardy of losing their

55:03housing and have had difficulty getting their basics poor neighborhood support and cohesion

55:11when we have support support is a great buffer against stress if you've got neighborhood support

55:17if you are feeling really stressed out you may be able to have a neighbor you know watch your child

55:25for two hours so you can take a bath in peace and regroup if you don't have support and cohesion

55:33where you're helping each other out then you may feel like you're you're very isolated and that is

55:39it's really hard to live in an isolated state weak community sanctions against interpersonal violence

55:48you know people knowing it goes on but not saying anything so you know kind of condoning it

55:55easy access to alcohol or drugs cult cultural norms that support aggression

56:00and community violence and we need to figure out the best way to address some of these things

56:07relationally and i'm going to go through these last couple things really quick because i know

56:12we're heading the end of our at the end of our hour isolation is a big one like i was just saying

56:19it's important that people have social supports that can help buffer them when

56:24they're having difficulty dealing with life on life's terms they may not even be angry at junior

56:30or whatever they may feel depressed or angry about something completely different but that is

56:36going to impact their interactions with their significant others including their children

56:44a desire for power and control in relationships can lead to more conflict

56:49attitudes accepting or justifying violence can also increase risk and we are seeing

56:57unfortunately an increase in attitudes that are accepting or justifying of violence if you and it

57:03can be emotional verbal violence if you go online and you look at you know people who intentionally

57:11go around and flame different people's posts poor interpersonal skills that are characterized by

57:17many conflicts fights tension and other struggles jealousy possessiveness and negative emotion

57:23within intimate relationships marital instability unhealthy family relationships and interactions

57:31witnessing interpersonal violence as a child history of experiencing poor parenting as a child

57:38poor parenting usually means poor attachment usually means difficulty forming future

57:44attachments and difficulty with self-soothing because they never learned those skills

57:51being a victim of physical or psychological abuse so aces and association with antisocial

57:57or aggressive peers so what can we do we need to provide safe stable and nurturing relationships

58:07nurture health and mental health we can do this with trauma-informed intergenerational practices

58:16in clinical settings early childhood care educational settings and community contexts

58:23we need to make sure that our current systems are adjusted

58:27to realize the widespread impact of trauma and the multiple paths of recovery recognize

58:34the signs and symptoms of trauma in clients but also in their families staff and others

58:39that they're involved with because they may not have experienced trauma

58:43but if their caregiver did then that may impact them and make them more risk for

58:51aces these systems need to respond by fully integrating knowledge about trauma into policies

58:57procedures and practice and seek to actively resist re-traumatization we can do this by making

59:05sure that our services provide a sense of safety so the clients know they're respected a sense of

59:11trustworthiness and transparency so clients feel informed peer support so clients feel connected

59:19collaboration and mutuality in goal setting and program development so clients feel respected

59:27empowerment voice and choice in what they do and how they do it so they feel respected and

59:33informed and a reflection or a representation of cultural historical and gender issues

59:43mindfulness-based mind-body approaches have been

59:46shown to reduce presenting symptoms by over 30 percent

59:49remember that mindfulness is the purposeful moment-by-moment presence and self-awareness

59:54of one's breathing body sensations emotions and or thoughts in a non-judgmental manner

1:00:01and it can be incorporated into approaches like biofeedback yoga tai chi hypnosis and meditation

1:00:11we also can seek to improve the parent-child relationship with a

1:00:15which they found to be a great buffer against traumatic injury when we help parents uh parents

1:00:23and children share ideas and discuss things that matter we help the parent recognize the

1:00:30importance of meeting most or all of the child's friends and participating in the child's events

1:00:36we provide the parent with tools to manage stress and aggravation with parenting and

1:00:43tools and skills to help them cope well with parenting and to improve their own mental health

1:00:50more than sixty percent of people have experienced adverse childhood experiences

1:00:54it's believed that the rate of exposure to aces has increased significantly during covid

1:01:00not everyone who experiences aces will develop traumatic injury

1:01:04but many will injuries related to ace trauma include borderline and anti-social personality

1:01:11disorder because they did experience significant trauma and those behaviors are often how they

1:01:20sought to survive mood disorders ptsd addictions autoimmune issues heart disease cancer lung

1:01:28disease liver disease increased difficulty in interpersonal relationships due to any or all

1:01:35of the above issues and an increased risk of becoming a perpetrator of aces in the future

1:01:44are there any questions

1:01:48i know i went off off track a couple of times because i really do think this is a um

1:02:00exciting topic or a important topic for us to know about and the research actually

1:02:07all the research that i cited and the pdf in your classroom the hyperlinks and the

1:02:12pdf will take you to the studies a lot of the research that i cited most of it has actually

1:02:18come in the in the past three to five years so you know we're really just starting to understand

1:02:25the impact and and recognize yes children are resilient but um they actually do experience more

1:02:35than more distress or more changes than we initially may have thought

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