August 1, 2018 A Revolutionary and an Illuminate

 

Keynote Address, GLR Week in Philadephia
Nadine Burke Harris, MD, MPH, FAAP
A pioneer in the field of medicine, pediatrician Dr. Nadine Burke Harris is a leader in the movement to transform how we respond to early childhood adversity and the resulting toxic stress that dramatically impacts our health and longevity. By exploring the science behind childhood adversity, she offers a new way to understand the adverse events that affect all of us throughout our lifetimes. Dr. Burke Harris’ TED Talk, “How childhood trauma affects health across a lifetime,” has been viewed more than 3 million times.

“A revolutionary and an illuminate” is how Dr. Dayna Long described Dr. Nadine Burke Harris while introducing her as the Keynote Speaker at GLR week in Philadelphia.  It didn’t take long for the assembled group to discover why.

Dr. Burke Harris electrified the audience with her call to action, “We need to stop asking what is wrong with this child, and start asking what has happened to this child.”  She shared the science of Adverse Childhood Experiences (ACEs) and their effect on the developing brains and bodies of children.  ACEs are stressful or traumatic events, including abuse and neglect. They may also include household dysfunction such as witnessing domestic violence or growing up with family members who have substance use disorders.  High doses of adversity not only affect brain structure and function, but they also affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed. Science shows us that ACEs are strongly related to the development and prevalence of a wide range of health problems throughout a person’s lifespan, including dramatically increased risk for 7 out of 10 of the leading causes of death in the United States.

For decades pediatricians and clinicians working in economically challenged neighborhoods have noticed an uptick in ADHD, asthma, obesity, depression, dental issues, behavior disturbances, teen pregnancy, and immune disorders.  They were treating symptoms, and not necessarily having much success in doing so … treating the same patients over and over for numerous complaints.  That is where the Adverse Childhood Experiences Study comes in. It was done by Dr. Vince Felitti at Kaiser and Dr. Bob Anda at the CDC, and together, they asked 17,500 adults about their history of exposure ACEs. Those include physical, emotional, or sexual abuse; physical or emotional neglect; parental mental illness, substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you get a point on your ACE score.

Then, they correlated these ACE scores against health outcomes. They found two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes.

By making ACEs scores part of taking a complete medical history, Dr. Burke Harris, and others like her, have discovered many symptoms displayed in her pediatric office can be traced back to a root cause, childhood trauma.  By treating the cause, rather than the symptoms, astounding, life-changing progress can be made.

Dr. Burke Harris urged all of us to use this knowledge to imagine and implement a new future, a future where early identification and intervention are part of routine medical care.  Instead of spending trillions of dollars on the treatment of chronic illness, we will instead invest in prevention, giving families and communities the knowledge and tools to create safe, healthy, and healing environments for our children.

We all can participate in creating this new future by making sure our medical professionals are using the ACEs screening tool, by advocating for every single child to be screened for ACEs, and by continuing to educate everyone who comes in contact with children to think in a new way, asking not, “What is wrong with this child?” But instead, “What has happened to this child?”