Why adverse childhood experiences don't have to define your adulthood

0:02 A listener production, Welcome to another episode of Crappy Are Happy Today. What I want to talk to you about is something that actually came up in an episode that I did recently, an interview that I did with Rick Morton. You may have listened to that episode. It was about Rick's experience and the book that he wrote called My Year of Living Vulnerably, and Rick shared about his early childhood experience traumatic experiences that he had during childhood. Rick and I share the opinion that most of the problems that we see in the world, that we witness in the world, all can be boiled down to one common denominator, and that is childhood trauma or early adverse experiences. And it prompted me to want to create this solo episode to talk a little bit more about that and the impact that early childhood experiences have on our physical and our emotional wellbeing. So, if you have not ever heard of the ACES study, the Adverse Childhood Experience Study, that is what I want to share with you today. You may be familiar with it, maybe you know some of what it's about, but you don't really know where it came from or what the implications of that study were.

1:16 So I would love to share that with you. I was a little reluctant to talk about this because it can seem kind of depressing. Truth be told, it can feel a little bit depressing when you realize what some of the long term implications are of early childhood experiences. Of course, as children, we don't have any real control over these things that we experience and the implications they have for our physical and mental health many many many years down the track. But this is crappy to happy. So I will also share with you the positive impact of positive childhood experiences and the role that they can play in counteracting I guess some of these negative consequences of difficult childhood experiences. So start of the ACES. So back in the nineteen nineties, the ACES survey was first conducted.

2:05 There's an interesting backstory to how this came about. So doctor Vincent Feliti was running an obesity clinic. He was getting really frustrated because a lot of his patients were experiencing really good results. They were losing weight, and these were people who were at significant health risk because of how overweight they were. Following his program, they were getting results. But then what was happening was they were suddenly dropping out, and many of them were very quickly regaining a lot of the weight that they had lost. He was getting really frustrated that well, in particular, that people were dropping out of the program, and so he started to dig into what was going on, and long story short by a slip of the tongue. One day, when he was asking some routine questions of one of his patients, he asked her about her first sexual experience, or what age she was, or what she weighed I think, and she said that she weighed forty pounds, and then it came out that she had actually been sexually abused as a child, and he was quite struck by this, And then he started asking other patients and they had a similar response.

3:01 So he found out a lot of these people who were experiencing difficulties with their weight, they had often very suddenly gained weight. He noticed this in their personal histories. These weren't people who gradually put on weight each year and each decade. There was often a very sudden turn around it where they suddenly put on weight. And also as they started to lose weight and they started to have results, then they were either dropping out or piling the weight back on, and the more he explored this, the more he found out that this was quite common and there was a very clear link between gaining weight or holding on to excess weight or not wanting to lose weight, and having experience of sexual abuse in childhood. So essentially, what he found and what his patients began to tell him once he started to ask them about this, was that for men, they were less likely to be bullied often they had had early traumatic experience as a child as well, they were less likely to be bullied if they gained a lot of weight if they were a larger person, And for women they were much less at risk of unwanted sexual attention if they were overweight, and they very explicit stated this that being overweight and being considered to be physically less attractive to the opposite sex was how they stayed safe. Doctor Feliti then teamed up with another guy, doctor Bob Arnder, and they went ahead and conducted the Adverse Childhood Experiences Survey to find out what other long term effects what they were seeing as health problems in adults were actually underpinned by early traumatic experiences. They surveyed seventeen thousand people initially, and they asked them questions about a range of particular adverse experiences

4:35 that were commonly reported. They didn't just pluck these ten items that were on the survey, and there were things like physical abuse, sexual abuse, having a parent who had a substance problem, alcohol problem, witnessing domestic violence, having a parent in prison. So these were the ten survey items. Basically, there were ten items on the original ACES survey, and they came up with those ten items because of what they were being commonly told, kinds of experiences that seemed to be the most commonly reported amongst their patients at the CDC and in the Kaiser Permanente, which is this health clinic. Now, the interesting thing about these seventeen thousand people and what they reported was that these were predominantly white, middle class, well educated, well employed people. And prior to this, most of the interest in early trauma and the impact that that had on psychological wellbeing or problem behaviors was mostly focused on poorer communities, lower socioeconomic and disadvantaged kind of community. So this really shone a light on the fact that the population, the group of people that were well off doing well in life succeeding in life, very white, middle class that they were reporting pretty high levels of early childhood adversity. So in fact, what they found was that sixty one percent of adults reported at least one of these aces. They found that most people didn't have

6:07 just one. Usually if there was one, there was more than one. They didn't usually happen in isolation. Over eighty percent had two or more ACES, and sixteen percent had four or more. What they also found was with the higher number of ACES, the more significant health risk for these adults. If you had four or more ACES, you were basically twice as likely to experience heart disease, around twice as likely to be diagnosed with cancer, two and a half times more likely to have a stroke, four times more likely to have chronic bronchitis or mphysema, six times more likely to have diabetes. And then there are the psychological issues, So four and a half times more likely to have suffered from depression in the past twelve months, twelve times more likely to have attempted suicide, seven times more likely to have an issue with alcohol problem with alcohol, and ten times more likely to have injected drugs. So I think what we probably intuitively understand is that if you've had a difficult childhood, if you've grown up in a dysfunctional family, if there has been alcoholism, if you've been abused as a child neglected, if you've witnessed domestic violence, if you've had a parent with a mental health issue and alcohol issue. These are all of the kinds of things that are on the ACES seven. Oh, by the way, parental separation or divorce is one of them, So that might account for the fact that over sixty percent of

7:38 people have had at least one. We intuitively kind of understand that that is more likely to lead to having more emotional psychological issues. You're more likely to experience depression or anger or anxiety later in life, and therefore this is likely to lead to risky health behaviors. You're more likely to drink, you're more likely to smoke, You're more likely to use food for self soothing or or comfort eating, stress eating, those kinds of things that we kind of connect with early childhood adversities. But what they found was even after they controlled for those risky health behaviors, even when they took the people out who had never smoked, who weren't over eating, or using food or using substances, or drinking too much. Those people still had significantly increased risk of health issues heart disease, stroke, cancer. These early childhood experiences were impacting health outcomes many many years down the track, even in the absence of risky health behaviors that you might associate typically with early childhood trauma. So that's kind of interesting and kind of a little bit scary for a lot of people, right what they think, what they've ascertained. And there's been many, many, many studies done since that original ACES survey, and the results are pretty much the same. No matter where they survey people, they find these same sorts of rates of ACES in the population. But what we know now is that early childhood stress affects children's developing brains and bodies. It absolutely affects children's brain development. Therefore, that impacts how well children

9:09 can pay attention in class. We know that there are links between early trauma and ADHD, and we'll talk about that in another episode. Absolutely, because the rates of ADHD diagnosis are just phenomenal at the moment. So when little children during those formative years, and most children have experienced these aces prior to the age of three if they have experienced them. But in those really early years, when children exposed to issues at home, if they're exposed to abuse and neglect, or parnal alcoholism, or domestic violence, all of those things, their little bodies are flooded with stress hormones, with cortisol and adrenaline. Stress hormones are designed to help us, to prepare us to be able to fight off an attacker or to run. And if those stress hormones have nowhere to go and they stay circulating in your body, and if that threat is ever present, you're living in an environment where there is toxic stress, chronic unrelenting stress.

10:06 And that is what we're talking about here, toxic childhood stress. So it's not a one off event, it's not a one off traumatic experience. This is an environment where this threat is ever present and that stress is ever present. Then that impacts little bodies, and it puts stress on every system in your physical body. So it impacts immune system, it impacts metabolic system, it impacts respiratory system. Every part of your developing little brain and body is impacted by that, and that can have long lasting negative consequences to your health. In addition to increased risk of unhealthy behaviors, smoking, drinking, all of those sorts of things, depression, anxiety, which are going to predispose you to be turning towards substances nicotine, alcohol.

10:54 You know, when you get to be a teenager and you start discovering all of those things, unhealthy or risky sexual behaviors, all of those kinds of things. So in addition to those health risks, just the stress on your body what we call the allostatic load for stress load on your internal organs and your system is going to have long term health consequences. Just on that. By the way, there has been some discussion and people will often say the ten items that were included in the original ACES survey were probably quite limiting, really, and I can tell you what they were, in fact, I'll tell you right now. But they didn't, for example, take into consideration things like racism, being in foster care, being bullied, living in an unsafe neighborhood, and all of these things we know a traumatic for children and for adults. Later, separately, there was a project called the Philadelphia ACES Project, and the Philadelphia ACES Project expanded the original questions and included six additional items such as growing up in foster care, living in an unsafe neighborhood, being discriminated against, experiencing bullying, And based on those additional questions, they found that more than eighty percent of people had experienced at least one So the original TENK questions, we know that over sixty percent two thirds roughly of the population have experienced at least one ACE and more than eighty percent have experienced two or more. When you expand the definition and you add those extra items, than the numbers shoot right up. So most people in the population

12:27 have experienced at least one and usually more. They usually do not occurred on their own the original ten Because I know that you're interested, were prior to your eighteenth birthday? Did a parent or other adult did they swear at you and salt you, put you down, humiliate you, make you feel afraid? Did they push, grab, slap, or throw something at you hit you so hard it left a mark or an injury. Did an adult or a person at least five years older than you touch or fondle you in a sexual way? Did you ever feel that nobody in your family loved you or thought that you were special? You didn't feel like people were looking out for you. Did you often or very often not have enough to eat, have dirty clothes, had no one to protect you? So that is a question relating to neglect.

13:17 Were your parents separated or divorced? Was your mother or stepmother very often pushed, grabbed, slapped, basically domestic violence? Did you live with somebody who was a problem drinker, alcoholic, or who used street drugs. Was a household member depressed or mentally ill? Did a household member ever attempt suicide? Did a household member ever go to prison? So I guess one important thing just to note here on that if you weren't aware of the ACIS study, if you weren't aware of the negative and very significant health implications of those early childhood experiences, then that's useful information to have. Usually we go to the GP and we have a check up, we have a health check and they ask if there's any family history of heart disease, if there's a family history of high blood pressure. I'll ask you all of these questions because that is a way that they assess your risk, the increased likelihood that you might have one of these health issues. But they're typically not asking you about your early childhood experiences. I don't recall a GP ever asking me whether there was domestic violence or alcoholism in my family. I don't recall them ever asking if one of my parents ever went to prison.

14:22 I mean, we're just not screening for these things. And I think that one reason why the researchers in this area are so keen to get this information out there and to get more people to understand this is because if we can start changing things at a societal level of we can start screening for these things in our public health systems, in our schools and our childcare centers, then maybe we can start to put things in place to turn around what some of the negative implications of this, which brings me to positive childhood experiences. As I said, this is crapy to havevy and this is all very depressing, but I think it is really really also important to understand. If you know that you have two, three, four of these boxes, and many many people do, then this remember that a lot of this, a lot of this negative health consequences are a stress response. This is the way your body and your nervous system has responded to stress.

15:16 You're geared up to be on the lookout for danger. We've talked about that, We've talked about the window of tolerance and the way that this impacts your nervous system regulation, your ability to manage your own nervous system arousal, your emotional arousal. And so if we know this, then we can actively work to put things into place to manage our own stress. We can look for healthy upcoping behaviors. Understanding that we are at increased risk of unhealthy coping behaviors. You're more likely to be looking for substances or food, or be not engaging as much in physical activity. All of the things that we know, we can actually turn around and we can actually start to find better and more healthy ways to manage our own emotions, and we can lose some of the self judgment and the self criticism.

16:00 I center Rick Morton, trauma is the root of all the problems. Self compassion is the root of all the answers to all the problems in the world. We've got to start being a little bit kinder to ourselves. We've got to start having some self compassion. We know that mindfulness and that meditation and yoga and having really strong supportive social connections, being able to talk to people about how you're feeling, going to therapy if that is what you need to do. But having solid emotional supports, being willing to share and be allow yourself to be supported by other people, building those healthy connections, incorporating healthy habits into your life, really proactively looking after your health and wellbeing physically and emotionally and psychologically, being able to put boundaries into place to protect your time, protect your energy, give yourself the thing that you need to manage your stress, knowing that potentially you're at greater risk of some of these negative health consequences. But the other thing is if you have a young person in your life. I think we all grew up hearing that children are resilient, children are adaptable, that you know what kids are like. They just get on with it and not think much. Really too much phases them. And therefore most of us gen X, Hello, you know, if you're not dying, don't bother coming to me crying to me. You're going to be fine. This is we were all kind of raised ourselves pretty much.

17:19 And so if you have little children and you now know, or if you're in the care of young people and you now know what some of the implications potentially can be of some of these negative experiences, and we can put things in place to support them so that they are not as great a risk. So positive childhood experiences can completely turn around the negative impact of adverse childhood experiences. So let me share with you what some of those positive childhood experiences are, because they are crucial, crucial to building resilience and helping to mitigate some of those negative damaging effects. So being able to talk to your family about your feelings. So no matter what is going on in the life of a young person, if they feel like they can talk to somebody about their feelings, then that is hugely beneficial. Oh, by the way, even if you experienced a lot of those adverse childhood experiences, if you had some of these positive ones, then that could go a long way to helping to reverse or to counteract some of those negative consequences. Enjoying participating in community traditions, so being involved in the community, having a sense of belonging in high school, so feeling like you had good friends in school, that you belong to a group. Really positive feeling supported by friends, having adults in your life outside your family who took an active interest in you and feeling safe and protected by an adult in your home.

18:46 So even if there was a threat or danger or somebody who was perhaps threatening or frightening to you, then having another adult who you felt you could turn to, who had your back, who was supporting you, protecting you, and who allowed you to expe your feelings. So if you are aware that there are young people who are having a hard time, then being able to put some of those things in place to offer them that support, somebody to take an interest, somebody to help them to share their feelings, to make them feel safe, that's going to go a long way to make sure that they grow up healthy and well, or as healthy and well as they can. So here's one kind of interesting stat So with young people who had experienced four or more ACES, who found themselves in trouble with the law, came into contact with the juvenile justice system. So those young people who had experienced four or more ACES had also experienced six positive childhood experiences, their likelihood of reconviction was twenty three percent lower. They're likely of rearrest was twenty two percent lower then compared with other young people who had four or more ACES, But did not have those positive childhood experiences. Another study in twenty nineteen found that adults that had higher counter ACES, so basically positive childhood experiences were associated with improved adult health, neutralized the negative impact of ACES on adult health, completely neutralized the negative health consequences.

20:18 There is positive news, it's not all bad news. So the takeaway, I guess is that number one, if you were not aware of the impact of adverse childhood experiences, I think it's really important that the more people be aware of that. If you know yourself, you have been exposed to more than one, which most people have been being aware of that, being aware of the potential negative consequences of that on your not just your mental health and your emotional health and your relationships and all of those things, but on your physical health, your increased risk of stroke, cancer, diabetes, and what you can do to manage your stress and put self care practices in place to lower that risk, and of course to counter some of those negative experiences with positive experiences, solid supportive social networks, good sleep, good nutrition, lots of self care, and lots and lots of self compassion. That is it for another solo episode of Crappy to happy by all means message me if you've got any questions about that. Like I said, we will talk about the links between Troum and Adhd in an upcoming episode and I really look forward to having that conversation. Thanks for listening. I can't wait to catch you on the next episode of Crappy to Happy listener,