April is Child Abuse Prevention Month #preventchildabuse #BeAConnection
We have already discussed ACEs, or Adverse Childhood Experiences. These are traumatic events that occur in childhood, such as emotional abuse, physical abuse, or sexual abuse, or difficulties in the family if they go on for an extended period of time such as family violence. These kinds of stresses can lead to levels of stress (“toxic stress”) that have long-term effects.
What is “toxic stress”? When a person is stressed it can cause increased levels of stress hormones, like cortisol or adrenaline. While these responses help us deal with a crisis, long term exposure can lead to inflammation or changes in your nervous system. When exposed to high levels of stress for long periods of time it can cause wear and tear on many organ systems, including the brain.
Is all stress the same? Stress can be broken down into 3 different types: positive, tolerable, and toxic. A positive stress happens briefly and is only mild to moderate in magnitude, like performing in a play or competing in gymnastics. When a caring parent is available to help a child deal with the stress it can actually help the child become more confident or adaptable. A tolerable stress is a situation outside of the normal childhood experience is more difficult or lasts longer, such as the death of a grandparent or damage from a hurricane. If a child has the support of caring adults, the risk of long-term consequences from this type of stress is reduced. Protective adults can help a child develop coping skills and sense of control. Toxic stress results from strong, long term activation of a child’s stress response without the support of a caring adult. Examples of toxic stress include the traumatic events that cause ACEs, such as abuse or neglect. This kind of stress can disrupt brain circuitry during important developmental periods of childhood.
Isn’t this true of adults as well? Children are especially prone to physical changes in the brain from toxic stress. Elevated stress hormones which last a long time can disrupt the structure of a developing brain. The amygdala, the body’s “fight or flight center,” can become overactive. This can lead to an increased state of constant fear and anxiety and can cause problems with mood control and memory. Toxic stress can also change to another part of the brain, the hippocampus, which can make it harder to tell if a situation is safe or dangerous, like in post-traumatic stress disorder. These changes in the structure of the brain can decrease the success a person has academically, socially or even medically much later in life.
What happens if my child is exposed to an adverse experience? Childhood adversity is common, with one of four adults stating that they experienced some kind of significant adverse experience as a child. There is a dose-response curve, meaning that the greater the exposure the greater the risk. Adults who had 4 or more different kinds of adversity were more likely to have problems. Results can be an increased risk of injury, (such as traumatic brain injuries, fractures, or burns), possibly due to increased risk-taking. ACEs can lead to increased risk of mental health problems like depression, anxiety, suicide, PTSD or drug/alcohol abuse. Adult women who were exposed to ACEs as children are at greater risk for unintended pregnancy, pregnancy complications, or fetal death. Even more surprising is that the risk of several diseases, such as HIV, STDs, cancer, and diabetes is increased. Opportunities for higher education or stable occupations seem to be more limited.
The negative effects of toxic stress and ACEs are vast and well documented. All hope is not lost though! When families, physicians, and communities work together then we can help prevent the negative impact that toxic stress and ACEs have on our children. We will be discussing protective factors against ACEs in a following article so stay tuned!
By Natalie Royer, DO, FAAP
Assistant Professor, Division of General Academic Pediatrics
Child Safety and Protection Team
University of Texas Medical Branch (UTMB)
Violence Prevention (ACES) - CDC.gov
The Lifelong Effects of Early Childhood Adversity and Toxic Stress - AAP PEDIATRICS
Week 1 ACEs Article: "What is all this Stuff about Adverse Childhood Experiences?" on 4/1/2021
More about Child Abuse Prevention Month - www.childwelfare.gov
UTMB Health Primary Care Pediatrics
AAP Schedule of Well-Child Care Visits & Benefits