The Science of Stress and Childhood Resilience

COURT HOUSE – In the late 1990s Vincent Felitti, of Kaiser Permanente’s Department of Preventive Medicine, and Robert Anda, of the Centers for Disease Control and Prevention, conducted a study that resulted in what many call a breakthrough in public health understanding.
The study began as Felitti worked to understand the underlying causes of obesity and grew into a large-scale epidemiological study of the links between adverse childhood experiences and adult disease.
On Nov. 12, Michael McKnight, of the Cape May County Office of Education, and Middle Township Police Chief Christopher Leusner held a community discussion on the research and what it means for the township and the county.
The evening featured the documentary “Resilience: The Biology of Stress and the Science of Hope,” a KPJR 2016 film that presents the history of the study and demonstrates the core concept of a strong causal relationship between adult health risk behavior and disease to exposure to childhood emotional, physical and sexual abuse, along with household dysfunction during childhood.
Before the Adverse Childhood Experiences (ACE) study, this link had not been previously described or understood, leaving one of the major risk factors of disease invisible to the health care community.
The goal of the evening was increased awareness. McKnight and Leusner emphasized the need to “spread the word” about ACE as an important step in the evolution of policies and treatments that can counter the negative impact it is having on youth.
McKnight began with statistics that graphically described the problem.
Each day in America, McKnight said:
* Leaves 45 children or teens dead or injured from gunfire.
* 311 children are arrested for drug crimes.
 * 1,854 children are confirmed as abused or neglected.
* Almost 3,000 students drop out of high school.
* 12,816 students are suspended in the country’s public schools. 
* Seven children commit suicide.
The number of children born into poverty is rising. In 2016, 40 percent of Cape May County students qualified for free or reduced lunch. McKnight said that number is higher in 2018. Advocates for Children of New Jersey ranks Cape May County 19th out of 21 counties in family and child economics and 21st in safety and well-being.
While such rankings can be argued, the reality they depict is of a population of children in the county whose childhood is characterized by stress and fear, and for many abuse and neglect.
What the ACE study showed, and what subsequent public health research has confirmed, is that levels of what is termed “toxic stress” has a long-term influence on mental and physical health leading to adult dysfunction, criminal behavior, addictions, and disease.
The study provided a new lens through which the public can view the causal factors behind many seemingly disparate social problems. 
The understanding of the impact of this research on law enforcement, health care, education, and social services is still evolving.
A priority is increasing public awareness of a killer that has long been invisible: childhood toxic stress.
The research identified 10 areas of ACE including:
•    Physical abuse
•    Emotional abuse
•    Sexual abuse
•    Physical neglect
•    Emotional neglect
•    Exposure to domestic violence
•    Household substance abuse
•    Household mental illness
•    Parental separation or divorce
•    Incarcerated household member
Findings showed that children can be exposed to multiple forms of adverse experiences and that the higher the ACE score, the higher the risk for health, social and behavioral problems throughout life.
Exposure to four of the ACE categories increases the likelihood of problems in school by 32 times. It also increases the risk of alcoholism, drug abuse and depression by 12 fold.
Research has also shown that exposure to childhood trauma has obvious and visible impacts on physical development.
Physical changes to brain development can occur during a child’s developmental years.
Without an understanding of the impact of adverse childhood experiences, public health has been concentrated on the treatment of the symptoms rather than the causes. 
Lack of impulse control and behavior regulation are often by-products of a complex network of experiences where even the individual exhibiting the behaviors does not understand the deeper root causes.
ACE is often referred to as the greatest public health crisis the public never heard of. It leads society to invest heavily in dealing with the outcomes like heart disease, addiction or criminal actions and very little in prevention.
The county and the national public health community are only now developing therapies, resilience building techniques, screening protocols, and coping strategies.
The awareness also leads to changes in how health professionals, social services staff and law enforcement deal with certain behaviors.
Leusner said that police officers are receiving special training. While they still must enforce the law and protect the public safety, they can be more sensitive to the whole individual and especially to children trapped in dysfunctional households.
McKnight indicated that teachers are also receiving training so they can better recognize what they are dealing with on a daily basis. An effort to “surround” youngsters with support in the ninth grade is underway.
One proven response with a record of success is to somehow introduce a caring and understanding adult into the child’s life. That can be a teacher, a coach or any one of many individuals who have a relationship with the child.
Attendees were encouraged to consider volunteering in a mentoring program.
While one tactic is to attempt to deal with the children suffering from toxic stress, another is to work through social services, public policy, and community involvement to alter the environments that give rise to toxic stress. 
A change will not come quickly, but the first step is awareness of the childhood roots of adult dysfunction and disease.
Childhood is a time of development and challenge.
The discussion led by McKnight and Leusner shows that the public can deal with adverse childhood experiences in real time or later suffer the consequences and expense of dealing with their outcomes. 
To contact Vince Conti, email vconti@cmcherald.com.