It started with a study about weight. In 1996, Dr. Vincent Felitti, founder of Kaiser Permanente’s Department of Preventive Medicine, had designed a program to help people shed pounds, and it was working. Except for one thing. Participants, even those successful at losing weight, kept dropping out.
Felitti wanted to find out why.
The problem, he later discovered, was that participants’ obesity was the result of something more deep-seated than a simple desire to eat. So when they lost weight, it triggered a reaction: anxiety, fear, depression.
For many, the attention they received — or perceived to receive — once they lost weight caused great discomfort because the weight had served as a type of protection. It prevented them from being desirable to the opposite sex or from being the object of attention.
For many of these adults, the protection was a response to the abuse and neglect they had experienced as children.
So the Adverse Childhood Experiences study was born. Felitti collaborated with Dr. Robert Anda from the U.S. Centers for Disease Control and Prevention to survey 17,000 adults in San Diego, Calif. They were mostly white, college-educated, middle- and upper-middle class, with jobs and great health care.
Specifically, Felitti and Anda looked at 10 types of childhood adversity: emotional, physical and sexual abuse; emotional and physical neglect; and different types of family dysfunction — such as a parent treated violently, a mentally ill or substance-abusing parent, loss of a parent through abandonment or divorce, and a family member in prison. Almost two-thirds of the participants in the study experienced at least one adverse childhood experience — or, ACE.
The study found that one in six people had an ACE score of 4 or more, and one in nine had an ACE score of 5 or more. The more adverse experiences people experienced in childhood, the more it increased their risk of drug abuse, depression, anxiety, heart disease, obesity, cancer, diabetes, autoimmune disorders and being violent or a victim of violence.
How did the correlation come about?
Chronically stressful or adverse experiences cause children to experience what is known as “toxic stress.” The physical and mental reaction to that stress can lead to developmental, emotional and physical delays in children and long-term health conditions in adults. Those conditions can include overeating, smoking, abusing alcohol and other substances, inappropriate sex, hoarding, overspending and workaholism.
This means that childhood victims of abuse, which numbered more than 4,000 in Maine in 2012, according to the Maine Children’s Alliance, are at increased risk of poor behavioral and health outcomes.
Not everyone exposed to adversity in childhood develops negative outcomes, of course. Often that’s because someone helps them develop resilience. Findings from the ACE study show that what happens to people in childhood, negative and positive, has a profound affect on who they become in adulthood.
Though many people think kids do not understand what happens to them or will forget negative experiences, the ACE study teaches us that these experiences are embedded in their biology and brain and that we should pay more attention to childhood.
When public health experts or kindhearted doctors ask questions such as, “Why don’t you eat right and exercise?” and give advice about goal setting and putting colorful foods on the dinner plate, they miss an important piece of the puzzle.
A question that is more to the point is: “What have you experienced in your life that smoking, drinking, eating (insert unhealthy behavior here), etc., is helping you with?”
To sit with a friend, not just a patient or a client, and ask: “What happened to you? How did it shape who you are today?” means so much more than asking, “What’s wrong with you?”
If it seems like something you’d never ask anyone else, take a moment and ask yourself.
Think back to the family member who let you borrow money for a bus ticket, or the friend who took long walks with you and listened, or the teacher or mentor who encouraged you to fill out that college application. Everyone responds differently to the experiences in their lives, and the ACE study shows that these experiences can have profound effects on our long-term well-being and that people can foster incredible strength and resilience in others.
Thurgood Marshall, the first African-American justice on the U.S. Supreme Court, said, “None of us got where we are solely by pulling ourselves up by our bootstraps. We got here because somebody — a parent, a teacher, an Ivy League crony or a few nuns — bent down and helped us pick up our boots.”
Moving on from trauma and adversity is not done in isolation. Resilience, the personal strength to bounce back from adversity, is fostered and strengthened with the help of other people and the opportunity to change.
How did you get to where you are? Who bent down and helped pick up your boots?
What kids say
The facts about Maine’s kids reveal there can be a happy ending. In the most recent Maine Youth Risk Behavior Survey, 20 percent of high school students said they got help from their friends when they felt sad or hopeless in the past year, and 6 percent got help from their parents or other adult relatives.
Those 26 percent have strong people in their lives who act as a support system to help them buffer the effects of stress.
More good news: 52 percent of high school students reported that they had not felt sad or hopeless in the 12 months preceding the survey.
And now the not–so-good-news: 15 percent did not get help when they felt sad or hopeless. What happens to this 15 percent? How does their story end?
The survey data also reveal that 57 percent of high school students and 60 percent of middle school students agree that they matter to other people in their communities. Mattering means someone cares; it means being seen by another person. And when youth are experiencing stress, having caring community members matters.
In contrast, if youth feel as if they don’t matter, they will be less connected to other people. Isolation increases their stress and a sense that they have to handle everything on their own. Feeling as if they matter is a direct reflection of the people around them — parents, family, friends, teachers, after-school providers and others who see them each day and know who they are.
These people help them build resilience, and resilience can strengthen them in times of stress.
It takes a village
There is a group in Maine called the Maine Resilience Building Network. Its members around the state connect communities that are working to educate people about adverse childhood experiences and resilience. Members include the Maine Academy of Pediatrics, the Maine Infant Mental Health Association, the GEAR Parent Network and more.
One goal is to bring people together to learn about the powerful role each individual can have in the life of a child to counter the effects of stress and adversity. The group also teaches adults about making connections between early childhood experiences and adult health so we can begin to change, works with education and community systems to stop traumatizing already traumatized children and adults and build resilience in individuals, families and communities instead.
Not only does each one of us matter, but the experiences we’ve had along the way matter. And for those of us whose early experiences still impinge our lives, it matters that we are seen.
Leslie A. Forstadt is an associate extension professor with the Maine Cooperative Extension specializing in human development. She is co-facilitator for the Maine Resilience Building Network.