The Stress of It All…

I just finished a book called, How Children Succeed: Grit, Curiosity, and the Hidden Power of Character by Paul Tough. At the same time I have been familiarizing myself with a study called, “Adverse Childhood Experiences (ACE): Relationship of Childhood Abuse and Household Dysfunction To Many Leading Causes of Death in Adults”, which was published in 1998 and has generated significant further research. Both give insight into the profound impact exposure to toxic stress has on the ability to be successful in life.

What was learned from the ACE study: over 17,000 Kaiser Permanente (a large health insurance manager out west) members voluntarily participated to find out about how stressful or traumatic experiences during childhood affect adult health. The volunteers were from all walks of life: rich and poor, urban and rural, ethnically diverse. 63% had experienced at least one category of childhood trauma. Over 20% experienced 3 or more categories of trauma, which include:
1. emotional abuse 6. witnessed mothers being treated violently
2. physical abuse 7. grew up with someone using alcohol and/or drugs
3. sexual abuse 8. grew up with a mentally-ill person in household
4. emotional neglect 9. lost a parent due to separation or divorce
5. physical neglect 10. grew up with a household member in jail or prison

For each one a volunteer said yes to, one point was assigned, and this was called the ACE score. ACEs seem to account for one-half to two-thirds of the serious problems with drug use; increase likelihood that girls will have sex before the age of 15; and that boys or young men will be more likely to impregnate a teen girl. ACEs are associated with mental health disorders such as depression, hallucinations and PTSD – I think that is what we would suspect. However, what is surprising is that when the numbers are corrected for substance abuse, the ACEs still correlate strongly with obesity as well as pulmonary, heart and liver disease. As in – the stress of these events, if not addressed, directly contribute to physical illness. ACEs are also thought to be the trigger for autoimmune disorders, and the more vague disorders of fibromyalgia and chronic fatigue syndrome.

As a primary care provider who has often been frustrated with the lack of response to treatment of chronic illness, this resonates strongly with me – we weren’t asking the right questions to get at the core of the issue!

Now to the book. When working with youth who grow up in dysfunctional poor urban settings like Camden, ACE scores tend to be off the wall. I have been discussing this with Jodina at UP, and off the top of her head she added up ACE scores for some of the youth she knows – she was getting scores of 10 or more. It’s consistent with what I wrote in an earlier post about the stress survey I was giving the high school students. The author Tough states,

We know from the neuroscientists and the psychologists that students growing up
in these homes are more likely to have high ACE scores and less likely to have the
kinds of secure attachment relationships with caregivers that buffer the effects of
stress and trauma; this in turn means they likely have below-average executive-
function skills and difficulty handling stressful situations. In the classroom, they are
hampered by poor concentration, impaired social skills, an inability to sit still and
follow directions, and what teachers perceive as misbehavior.

You can ratchet up all academic resources you want – if we are not addressing the impact of the toxic stress our students have experienced, they are not going to retain the knowledge necessary to succeed in life.

The good news is that just being heard helps. Kaiser Permanente found that when they incorporated the ACE questionnaire into the history they asked of the patients, and then simply acknowledged the “yes” answers, office visits decreased by 35%! That’s amazing. But I have experienced that over the years as well – patients felt better just by my validating whatever concern they brought to me.

So our youth need to be given the opportunity to be heard. Parents need education about forming secure relationships with their children – according to Tough’s findings, at any age this can make a significant difference. And educational programs can work to increase executive function as well as focus on character strengths to build resilience. Tough’s book gives specific examples of programs in the US which have been successful in supporting impoverished youth right through attainment of college degrees.

This is going to be the basis of much of the work I do this year, thanks to your support, dear readers.

If you would like to read more about the ACE study, go to – fascinating stuff that likely affects many of us.


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