How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED

Summary

El guion del video revela cómo el trauma infantil aumenta drásticamente el riesgo de las principales causas de muerte en EE. UU., afectando el desarrollo cerebral, el sistema inmunitario y hasta la forma en que se lee y transcribimos el ADN. El estudio Adverse Childhood Experiences (ACE) muestra una relación dosis-respuesta entre el trauma y los resultados de la salud, lo que desafía la perspectiva médica tradicional y propone un enfoque más amplio de prevención y tratamiento.

Takeaways

• 😀 La exposición a traumas infantiles incrementa significativamente el riesgo de las principales causas de muerte en Estados Unidos.
• 😢 En altas dosis, los traumas infantiles afectan el desarrollo cerebral, el sistema inmunológico y hormonal, y la transcripción del ADN.
• 🏥 Los médicos no están entrenados adecuadamente para el cribado rutinario y el tratamiento de traumas infantiles.
• 👶 Los traumas severos como el abuso, la negligencia y crecer con padres con problemas mentales o de dependencia afectan profundamente a los niños.
• 📊 El Estudio de Experiencias Adversas en la Infancia (ACE) mostró que los ACEs son comunes y tienen una relación dosis-respuesta con resultados de salud negativos.
• 😔 Las personas con altos puntajes ACE tienen mayores riesgos de enfermedades crónicas, depresión, suicidio y otras condiciones graves.
• 🧠 Los traumas afectan áreas clave del cerebro, como la corteza prefrontal y la amígdala, influyendo en el comportamiento y la salud mental.
• 💡 La ciencia muestra cómo la adversidad temprana altera el sistema de respuesta al estrés, afectando la salud física incluso sin comportamientos de alto riesgo.
• 🛠 La clínica de San Francisco utiliza un enfoque multidisciplinario para tratar y prevenir los efectos del estrés tóxico en los niños.
• 🚨 Los ACEs representan una crisis de salud pública no abordada adecuadamente, pero se puede replicar el éxito de otras campañas de salud pública con compromiso y determinación.

Outlines

00:00

🩺 El impacto de la adversidad infantil en la salud

En la década de los 90, el CDC y Kaiser Permanente descubrieron que ciertos traumas en la infancia aumentaban significativamente el riesgo de padecer las principales causas de muerte en EE.UU. Estos traumas afectan el desarrollo cerebral, el sistema inmunológico y la forma en que se transcribe el ADN, resultando en un mayor riesgo de enfermedades cardíacas y cáncer pulmonar. Sin embargo, los médicos no están capacitados para detectar y tratar rutinariamente estos traumas. El discurso destaca cómo el trauma infantil severo, como el abuso, la negligencia o crecer con padres con enfermedades mentales o dependencias, puede tener efectos devastadores en la salud.

05:03

📊 Estudio de experiencias adversas en la infancia

El estudio de Experiencias Adversas en la Infancia (ACE) realizado por el Dr. Vince Felitti y el Dr. Bob Anda reveló que estas experiencias son muy comunes y están fuertemente correlacionadas con problemas de salud. El estudio mostró que el 67% de la población había tenido al menos una experiencia adversa y el 12.6% cuatro o más. Además, los resultados mostraron una relación dosis-respuesta, donde a mayor puntuación de ACE, peores eran los resultados de salud, como mayor riesgo de EPOC, hepatitis, depresión y suicidio. Estas experiencias afectan áreas cruciales del cerebro y el cuerpo, incrementando el riesgo de comportamientos de alto riesgo y enfermedades graves.

10:04

🧠 Cómo el estrés afecta al cerebro y la salud

El estrés crónico y repetido afecta significativamente el desarrollo cerebral y corporal de los niños. Este estrés continuo activa el eje hipotalámico-pituitario-adrenal, que regula la respuesta de lucha o huida, pero cuando se activa constantemente, puede ser perjudicial. El discurso explica cómo este tipo de estrés puede alterar estructuras cerebrales como el núcleo accumbens, la corteza prefrontal y la amígdala, y cómo incluso sin comportamientos de alto riesgo, el estrés temprano puede aumentar la probabilidad de enfermedades cardíacas y cáncer. Este conocimiento llevó a la creación del Centro de Bienestar Juvenil en San Francisco para prevenir y tratar los efectos del estrés tóxico.

15:05

🏥 La importancia de la detección y tratamiento de ACE

El Centro de Bienestar Juvenil en San Francisco implementó el cribado rutinario de ACE en todos los niños durante sus exámenes físicos regulares. Conociendo los riesgos asociados a altos puntajes de ACE, el centro proporciona un tratamiento multidisciplinario que incluye visitas domiciliarias, coordinación de cuidados, atención de salud mental, nutrición y medicación cuando es necesario. Además, educan a los padres sobre los impactos del estrés tóxico. A pesar de la gravedad del problema, hay esperanza si se aborda con un enfoque de salud pública adecuado. El discurso concluye enfatizando la necesidad de valentía para enfrentar este problema y la importancia de reconocer que afecta a todos.

Highlights

In the mid-'90s, the CDC and Kaiser Permanente discovered that childhood trauma dramatically increased the risk for seven out of 10 of the leading causes of death in the United States.

High doses of childhood trauma affect brain development, the immune system, hormonal systems, and even DNA transcription.

Doctors today are not trained in routine screening or treatment for childhood trauma.

Childhood trauma includes severe or pervasive threats like abuse, neglect, or growing up with a parent who has mental illness or substance dependence.

The Adverse Childhood Experiences (ACE) Study found that ACEs are incredibly common, with 67% of the population having at least one ACE and 12.6% having four or more.

There is a dose-response relationship between ACEs and health outcomes: the higher the ACE score, the worse the health outcomes.

An ACE score of four or more is associated with a higher risk of chronic diseases like COPD, hepatitis, depression, and suicidality.

Exposure to early adversity affects brain areas like the nucleus accumbens (implicated in substance dependence), the prefrontal cortex (necessary for impulse control and executive function), and the amygdala (the brain's fear response center).

Even without engaging in high-risk behavior, those exposed to high doses of adversity are more likely to develop heart disease or cancer due to the brain's and body's stress response system.

Children are especially sensitive to repeated stress activation, affecting brain structure and function, the immune system, hormonal systems, and DNA transcription.

The Center for Youth Wellness in San Francisco screens every child for ACEs and provides multidisciplinary treatment to reduce adversity and treat symptoms.

Education for parents about ACEs and toxic stress is crucial, just like education on covering electrical outlets or lead poisoning.

Addressing ACEs and toxic stress is viewed as a public health crisis requiring a movement for routine screening and multidisciplinary treatment.

Adverse childhood experiences are considered the single greatest unaddressed public health threat facing the nation today.

The importance of recognizing and addressing childhood trauma is underscored by its widespread impact across different socioeconomic and demographic groups.

Transcripts

In the mid-'90s,

the CDC and Kaiser Permanente

discovered an exposure that dramatically increased the risk

for seven out of 10 of the leading causes of death in the United States.

In high doses, it affects brain development,

the immune system, hormonal systems,

and even the way our DNA is read and transcribed.

Folks who are exposed in very high doses

have triple the lifetime risk of heart disease and lung cancer

and a 20-year difference in life expectancy.

And yet, doctors today are not trained in routine screening or treatment.

Now, the exposure I'm talking about is not a pesticide or a packaging chemical.

It's childhood trauma.

Okay. What kind of trauma am I talking about here?

I'm not talking about failing a test or losing a basketball game.

I am talking about threats that are so severe or pervasive

that they literally get under our skin and change our physiology:

things like abuse or neglect,

or growing up with a parent who struggles with mental illness

or substance dependence.

Now, for a long time,

I viewed these things in the way I was trained to view them,

either as a social problem -- refer to social services --

or as a mental health problem -- refer to mental health services.

And then something happened to make me rethink my entire approach.

When I finished my residency,

I wanted to go someplace where I felt really needed,

someplace where I could make a difference.

So I came to work for California Pacific Medical Center,

one of the best private hospitals in Northern California,

and together, we opened a clinic in Bayview-Hunters Point,

one of the poorest, most underserved neighborhoods in San Francisco.

Now, prior to that point,

there had been only one pediatrician in all of Bayview

to serve more than 10,000 children,

so we hung a shingle, and we were able to provide top-quality care

regardless of ability to pay.

It was so cool. We targeted the typical health disparities:

access to care, immunization rates, asthma hospitalization rates,

and we hit all of our numbers.

We felt very proud of ourselves.

But then I started noticing a disturbing trend.

A lot of kids were being referred to me for ADHD,

or Attention Deficit Hyperactivity Disorder,

but when I actually did a thorough history and physical,

what I found was that for most of my patients,

I couldn't make a diagnosis of ADHD.

Most of the kids I was seeing had experienced such severe trauma

that it felt like something else was going on.

Somehow I was missing something important.

Now, before I did my residency, I did a master's degree in public health,

and one of the things that they teach you in public health school

is that if you're a doctor

and you see 100 kids that all drink from the same well,

and 98 of them develop diarrhea,

you can go ahead and write that prescription

for dose after dose after dose of antibiotics,

or you can walk over and say, "What the hell is in this well?"

So I began reading everything that I could get my hands on

about how exposure to adversity

affects the developing brains and bodies of children.

And then one day, my colleague walked into my office,

and he said, "Dr. Burke, have you seen this?"

In his hand was a copy of a research study

called the Adverse Childhood Experiences Study.

That day changed my clinical practice and ultimately my career.

The Adverse Childhood Experiences Study

is something that everybody needs to know about.

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

to what they called "adverse childhood experiences," or 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 would get a point on your ACE score.

And then what they did

was they correlated these ACE scores against health outcomes.

What they found was striking.

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.

For a person with an ACE score of four or more,

their relative risk of chronic obstructive pulmonary disease

was two and a half times that of someone with an ACE score of zero.

For hepatitis, it was also two and a half times.

For depression, it was four and a half times.

For suicidality, it was 12 times.

A person with an ACE score of seven or more

had triple the lifetime risk of lung cancer

and three and a half times the risk of ischemic heart disease,

the number one killer in the United States of America.

Well, of course this makes sense.

Some people looked at this data and they said, "Come on.

You have a rough childhood, you're more likely to drink and smoke

and do all these things that are going to ruin your health.

This isn't science. This is just bad behavior."

It turns out this is exactly where the science comes in.

We now understand better than we ever have before

how exposure to early adversity

affects the developing brains and bodies of children.

It affects areas like the nucleus accumbens,

the pleasure and reward center of the brain

that is implicated in substance dependence.

It inhibits the prefrontal cortex,

which is necessary for impulse control and executive function,

a critical area for learning.

And on MRI scans,

we see measurable differences in the amygdala,

the brain's fear response center.

So there are real neurologic reasons

why folks exposed to high doses of adversity

are more likely to engage in high-risk behavior,

and that's important to know.

But it turns out that even if you don't engage in any high-risk behavior,

you're still more likely to develop heart disease or cancer.

The reason for this has to do with the hypothalamic–pituitary–adrenal axis,

the brain's and body's stress response system

that governs our fight-or-flight response.

How does it work?

Well, imagine you're walking in the forest and you see a bear.

Immediately, your hypothalamus sends a signal to your pituitary,

which sends a signal to your adrenal gland that says,

"Release stress hormones! Adrenaline! Cortisol!"

And so your heart starts to pound,

Your pupils dilate, your airways open up,

and you are ready to either fight that bear or run from the bear.

And that is wonderful

if you're in a forest and there's a bear.

(Laughter)

But the problem is what happens when the bear comes home every night,

and this system is activated over and over and over again,

and it goes from being adaptive, or life-saving,

to maladaptive, or health-damaging.

Children are especially sensitive to this repeated stress activation,

because their brains and bodies are just developing.

High doses of adversity not only affect brain structure and function,

they affect the developing immune system,

developing hormonal systems,

and even the way our DNA is read and transcribed.

So for me, this information threw my old training out the window,

because when we understand the mechanism of a disease,

when we know not only which pathways are disrupted, but how,

then as doctors, it is our job to use this science

for prevention and treatment.

That's what we do.

So in San Francisco, we created the Center for Youth Wellness

to prevent, screen and heal the impacts of ACEs and toxic stress.

We started simply with routine screening of every one of our kids

at their regular physical,

because I know that if my patient has an ACE score of 4,

she's two and a half times as likely to develop hepatitis or COPD,

she's four and half times as likely to become depressed,

and she's 12 times as likely to attempt to take her own life

as my patient with zero ACEs.

I know that when she's in my exam room.

For our patients who do screen positive,

we have a multidisciplinary treatment team that works to reduce the dose of adversity

and treat symptoms using best practices, including home visits, care coordination,

mental health care, nutrition,

holistic interventions, and yes, medication when necessary.

But we also educate parents about the impacts of ACEs and toxic stress

the same way you would for covering electrical outlets, or lead poisoning,

and we tailor the care of our asthmatics and our diabetics

in a way that recognizes that they may need more aggressive treatment,

given the changes to their hormonal and immune systems.

So the other thing that happens when you understand this science

is that you want to shout it from the rooftops,

because this isn't just an issue for kids in Bayview.

I figured the minute that everybody else heard about this,

it would be routine screening, multi-disciplinary treatment teams,

and it would be a race to the most effective clinical treatment protocols.

Yeah. That did not happen.

And that was a huge learning for me.

What I had thought of as simply best clinical practice

I now understand to be a movement.

In the words of Dr. Robert Block,

the former President of the American Academy of Pediatrics,

"Adverse childhood experiences

are the single greatest unaddressed public health threat

facing our nation today."

And for a lot of people, that's a terrifying prospect.

The scope and scale of the problem seems so large that it feels overwhelming

to think about how we might approach it.

But for me, that's actually where the hopes lies,

because when we have the right framework,

when we recognize this to be a public health crisis,

then we can begin to use the right tool kit to come up with solutions.

From tobacco to lead poisoning to HIV/AIDS,

the United States actually has quite a strong track record

with addressing public health problems,

but replicating those successes with ACEs and toxic stress

is going to take determination and commitment,

and when I look at what our nation's response has been so far,

I wonder,

why haven't we taken this more seriously?

You know, at first I thought that we marginalized the issue

because it doesn't apply to us.

That's an issue for those kids in those neighborhoods.

Which is weird, because the data doesn't bear that out.

The original ACEs study was done in a population

that was 70 percent Caucasian,

70 percent college-educated.

But then, the more I talked to folks,

I'm beginning to think that maybe I had it completely backwards.

If I were to ask how many people in this room

grew up with a family member who suffered from mental illness,

I bet a few hands would go up.

And then if I were to ask how many folks had a parent who maybe drank too much,

or who really believed that if you spare the rod, you spoil the child,

I bet a few more hands would go up.

Even in this room, this is an issue that touches many of us,

and I am beginning to believe that we marginalize the issue

because it does apply to us.

Maybe it's easier to see in other zip codes

because we don't want to look at it.

We'd rather be sick.

Fortunately, scientific advances and, frankly, economic realities

make that option less viable every day.

The science is clear:

Early adversity dramatically affects health across a lifetime.

Today, we are beginning to understand how to interrupt the progression

from early adversity to disease and early death,

and 30 years from now,

the child who has a high ACE score

and whose behavioral symptoms go unrecognized,

whose asthma management is not connected,

and who goes on to develop high blood pressure

and early heart disease or cancer

will be just as anomalous as a six-month mortality from HIV/AIDS.

People will look at that situation and say, "What the heck happened there?"

This is treatable.

This is beatable.

The single most important thing that we need today

is the courage to look this problem in the face

and say, this is real and this is all of us.

I believe that we are the movement.

Thank you.

(Applause)