Medical and academic narrowmindedness block progress

@Jeoffry Gordon posted:

Thanks for your considered response and good advice. From my perspective our neglect of children is a cultural attribute of long standing. We live in a society whose original sin is slavery not inequality. The right of the owner to rape slaves (with a by-product of more child chattel to sell) is well established historically, if not discussed in polite circles. We also live in a society currently fueled by libertarian or neoliberal corporate mercantilism.  Basic to this system of social management is the desire to invest as little as possible in social services. It is little known that in 1918 and 1924 the Supreme Court twice found federal child labor laws unconstitutional as it stood up for real American values to allow the exploitation of children. Now instead of trying to figure out how to help families flourish we are ensconced in a society with fundamentalist religious values in conflict with humanitarian, compassionate caring just shy of the point of violence. I am afraid that off loading responsibility for parenting and value education to the schools is not a functional alternative.

"I am afraid that off loading responsibility for parenting and value education to the schools is not a functional alternative." ...

I believe it's likely the only alternative to the dysfunction presently and seemingly increasingly prevalent.

Rather than being about "off-loading responsibility for parenting and value education," child-development science curriculum should be about understanding: Teaching our young people the science of how a child’s mind develops and therefor its susceptibility to flawed or dysfunctional daily environments, notably family life.

If nothing else, such child-development science curriculum would offer students an idea/clue as to whether they’re emotionally/mentally compatible with the immense responsibility and strains of parenthood.

The best gift a child can receive is a healthy, properly functioning brain thus mind for life. But general society misperceives thus treats human procreative ‘rights’ as though we’ll somehow, in blind anticipation, be innately inclined to sufficiently understand and appropriately nurture our children’s naturally developing minds and needs.

In the book Childhood Disrupted it’s written that even “well-meaning and loving parents can unintentionally do harm to a child if they are not well informed about human development” (pg.24).

Regarding early-life trauma, people tend to know (perhaps commonsensically) that they should not loudly quarrel when, for instance, a baby is in the next room; however, do they know about the intricacies of why not? Since it cannot fight or flight, a baby stuck in a crib on its back hearing parental discord in the next room can only “move into a third neurological state, known as a ‘freeze’ state … This freeze state is a trauma state” (pg.123).

This causes its brain to improperly develop. It’s like a form of non-physical-impact brain damage. Also, it’s the unpredictability of a stressor, and not the intensity, that does the most harm. When the stressor “is completely predictable, even if it is more traumatic — such as giving a [laboratory] rat a regularly scheduled foot shock accompanied by a sharp, loud sound — the stress does not create these exact same [negative] brain changes” (pg.42).

Perhaps in great crises, every parent would go all out in an attempt to make their child feel secure; however, in stable times those parents may not notice their more-subtle dysfunctional rearing. For instance, a parent’s prolonged silent yet nevertheless noticeable anger towards his/her young child can, if frequently practiced, leave the growing child with a strong sense of vulnerability; for, the perceptive child relies on the parent(s) for survival and is therefore susceptible to hunger, etcetera, if the angry parent’s protection/provisions are withdrawn.

Furthermore, how many of us were aware that, since young children completely rely on their parents for protection and sustenance, they will understandably stress over having their parents angry at them for prolonged periods of time? It makes me question the wisdom of punishing children by sending them to their room without dinner.

@Audrey Stillerman posted:

Responding with, and on behalf of, my co-authors Kevin Sherin, MD MBA MPH and David Niebuhr, MD MPH MSc.

Dr. Gordon, thank you for starting a conversation about our Open Access paper which includes the ACPM Position Statement on ACEs.  We agree 100% that a national priority is preventing, mitigating, and treating childhood maltreatment as well as all forms of adversity across the socioecological spectrum. We also agree that the science of trauma and healing is a key part of medical education and practice.  In fact, our paper begins, ends, and makes many points along the way to emphasize exactly that.  It is intended to be a call to action. Here are some examples.

“Adverse childhood experiences (ACE) profoundly affect health and well-being across the lifespan1, contributing to significant morbidity and mortality2, and present opportunities to enhance prevention, mitigation, and treatment frameworks and strategies.3 Evidence is emerging that ACEs are both a cause and a consequence of health disparities.” 4,5

“…the high prevalence of ACEs and evidence of their deleterious effects on morbidity and mortality as well as healthcare utilization and costs make ACEs a worthy target for prevention and mitigation strategies.” 2,6,7,9

“Health professionals have an ethical and moral responsibility to respond to health needs based on the best available evidence. ACPM accepts this responsibility and calls for evidence-based population and clinical measures to prevent and mitigate childhood adversity and trauma, as well as ongoing program evaluation and research that will either support or refute current position statements.”

The evidence-informed ACPM recommendations summarized below also align with the priorities you raise and are consistent with the recommendations of other professional and governmental organizations (AAP, AAFP, AHA, ASTHO, CDC, and USPHSTF).  ACPM recommends:

• Population level surveys and research for ACEs and protective factors (e.g., positive childhood experiences) as well as for lifestyle, behavioral factors, and social drivers of health, such as CDC’s BRFSS.
• Sensitive trauma inquiry to explore adversity, trauma, and positive childhood experiences such as supportive relationships in adults/families/children in the context of therapeutic relationships and shared decision-making.
• Training all health care teams about the impact of childhood experiences on health across the lifespan and putting protocols and systems in place which support evidence-based trauma-informed, resiliency-informed, healing-centered care and referral for other indicated behavioral and social services, such as perinatal home-visiting and parenting programs.
• Public and private payer and health plan incentives for universal precautions, a trauma-informed approach, and appropriate evidence-based trauma-specific treatment for individuals with a history of childhood trauma and adversity
• Supporting state and county level initiatives to reach Healthy People 2030 goals to improve the health and well-being of children with evidence-based resources so children get timely developmental screenings, recommended health care services, as well as family, school, and neighborhood-level interventions, such as home visitation programs and parental interventions
• Funding research about prevention, mitigation, and treatment of adversity and trauma as well as about protective factors and positive childhood experiences that support development of health and resilience. This research may include development, implementation, and assessment of validated and generalizable assessment instruments as well as longitudinal intervention studies with a variety of study designs
• Conducting rigorous evaluation of full spectrum trauma-informed care implementation efforts as well as of effective trauma specific interventions to treat patients with a history of significant trauma and adversity

Our review methodology included an umbrella review of systematic reviews along with a review of governmental and professional society recommendations. We integrated the findings from these two reviews as much as possible.  Please note that an umbrella review is a review of systematic reviews, not a meta-analysis.  We acknowledge that our review had limitations: 8 year time period, English language-only studies, some, but not all, databases, etc. While we agree that there are promising single studies, such as the examples you raise and others (guaranteed income programs, home monitoring rather than incarceration of parents, and more), single studies were not eligible for inclusion in our research design. We did, however, note positive findings or positive trends from our umbrella review whenever they existed, and we raised other promising examples in our discussion.  Below are some of our conclusions.

“While there are some encouraging findings from these studies, the current evidence is too limited to draw firm conclusions about the benefits of primary care (e.g., pediatric and maternal-child health) or public health (community nursing and social services) approaches to prevent adverse child experiences based on the heterogeneity of strategies and outcomes reviewed.”

“School-based mental health promotion programs had a clearly positive impact and yielded improvements in student resilience and individual protective factors, such as increased frequency of use of coping skills, reduction in internalizing behaviors, and improved self-efficacy in post-assessment studies.32 Nonetheless, there appears to be limited evidence for the effectiveness of most of the interventions studied for children and young people who have experienced childhood adversity. The strongest evidence is for the effectiveness of CBT for mental health outcomes in children who have been sexually abused. The evidence on other interventions and populations is less clear, but there are positive findings.”31

Unfortunately, most of the studies were rated low or critically low quality, which means that we as a public health and preventive medicine community , in addition to as a nation, must prioritize well-designed implementation and evaluation of enhanced protective factors and prevention and mitigation of adversity.

The only place it appears we have differences is in relation to ACE screening in the individual clinical encounter.  While we did not recommend ACE screening in individual patient encounters, we did not recommend not thinking about or talking about childhood experiences with individual patients.  Instead we advocated for a Universal Precautions approach and/or  Sensitive Trauma Inquiry in the context of positive relationships and shared decision-making. Below is the position of the authors and many, many other researchers, including Robert Anda, David Finkelhor, Craig McEwen, Kat Ford and more, based on the available evidence.

“Along with other experts, the authors are concerned that ACE scores may be misappropriated as a screening or diagnostic tool to infer individual client risk and misapplied in treatment algorithms that inappropriately assign population level risk for health outcomes from epidemiologic studies to individuals. Such assumptions ignore the limitations of the ACE score. Routine ACE screening may also retraumatize individual patients and clients who are not yet ready to disclose their personal histories of adversity. Therefore, programs that promote ACE screening and treatment of individuals with high scores should receive the same rigorous and systematic review of the evidence of their effectiveness according to the standards applied to other screening programs by the U.S. Preventive Services Task Force (USPSTF).”

We welcome the opportunity to discuss more and hope you’ll take another look at the manuscript.  We look forward to working together on our mutual goal of enhancing positive experiences and preventing, mitigating, and treating the consequences of childhood adversity for all.

Thank you for your extensive response. It was without a doubt easy for me to recognize the ACPM's heartfelt and sincere concern for the issue of child abuse and neglect and your enumeration of the still small rays of light being thrown on the subject. I find no reason to debate the many points you raise and endorse your hopes for more and better future knowledge, but I still am dismayed by this position paper for the following reasons:

1. The ACEs questionnaire or its derivatives serves a vital role with individual patients in clinical medical practice because it allows entree into a hidden prevalent area (1 in 5 or 6) where people are at risk of having experienced trauma which may contribute to physical, mental or social pathologies throughout the life span. In children this may lead directly to intervention in serious ongoing circumstances such as concurrent abuse or suicidal ideation. In adults it may allow better interventions in physical illness or different approaches to therapy of mental illness (see recent evolution of "conversion hysteria" to "functional neurologic disease.") While you discourage using ACEs routinely in individual patients, you offer no better approach to this clinical challenge.

2. I have the greatest respect for the contributions of Finkelhor, Anda, and McEwen, but I would point out that none of them is a clinician with experience of facing a suicidal child, a depressed patient and missing the existential trauma they endured and learning of their tragic solution too late.

3. Your sceptical approach to clinical individual screening adds one more barrier to educating the vast majority of clinical medicine practitioners who are ignorant or avoidant of the significance of abuse or neglect trauma in childhood.

4. While it is true that epidemiology cannot be applied to the individual patient, it is certainly a bed rock of evidence based medicine. No one promoted cholesterol as a cause of heart attacks until after the Framingham Study. Now we treat high cholesterol as a "cause" of heart attacks, but we all know that is an epistemological short cut. I lived through the tobacco wars where the epidemiology was fiercely questioned and I have had 90 year old patients who chain smoke, but I have no doubt that smoking causes lung cancer and emphysema and in the clinic act on this knowledge. Child maltreatment is much more prevalent and its trauma is much more pathogenic and the ACPM should act on these verities and not be bound by needed but extraneous nuances necessary to improve the science.

@Frank Sterle Jr. posted:

"Medical and academic narrowmindedness block progress" .... So what else is new?

Ionce read an ironic quote from a children’s health academic that, “You have to pass a test to drive a car or to become a … citizen, but there’s no exam required to become a parent. And yet child abuse can stem from a lack of awareness about child development.”

By not teaching child development science along with rearing to high school students, is it not as though societally we’re implying that anyone can comfortably enough go forth with unconditionally bearing children with whatever minute amount, if any at all, of such vital knowledge they happen to have acquired over time? It’s as though we’ll somehow, in blind anticipation, be innately inclined to fully understand and appropriately nurture our children’s naturally developing minds and needs.

A notable number of academics would say that we don’t.

Along with their physical wellbeing, children’s sound psychological health should be the most significant aspect of a parent’s (or caregiver’s) responsibility. Perhaps foremost to consider is that during their first three to six years of life (depending on which expert one asks) children have particularly malleable minds (like a dry sponge squeezed and released under water), thus they’re exceptionally vulnerable to whatever rearing environment in which they happened to have been placed by fate.

One wonders how much immense long-term suffering might have been prevented had the parent(s) of a future mass shooter or tyrant received, as high school students, some crucial child development science education by way of mandatory curriculum? After all, dysfunctional and/or abusive parents, for example, may not have had the chance to be anything else due to their lack of such education and their own dysfunctional/abusive rearing as children. Meanwhile, people will procreate, some prolifically even, regardless of their questionable ability to raise their children in a psychologically functional/healthy manner. ...

Additionally, if we’re to proactively avoid the eventual dreadingly invasive conventional reactive means of intervention due to dysfunctional familial situations as a result of flawed rearing—that of the government forced removal of children from the latter environment—we then should be willing to try an unconventional means of proactively preventing future dysfunctional family situations: Teach our young people the science of how a child’s mind develops and therefor its susceptibilities to flawed parenting.

Don’t we owe our children and future generations this much, especially considering the very troubled world into which they never asked to enter?

Certainly, some will argue that expectant adults can easily enough access the parenting experience and advice of other parents in hardcopy and Internet literature, not to mention arranged group settings. However, such information may in itself be in error or misrelated/misinterpreted and therefor is understandably not as beneficial as knowing the actual child development science behind why the said parental practice would or would not be the wisest example to follow.

As for the likely argument that high school parenting courses would bore thus repel students from attending the classes to their passable-grade completion, could not the same reservation have been put forth in regards to other currently well-established and valued course subjects, both mandatory and elective, at the time they were originally proposed?

In addition, the flipside to that argument is, such curriculum may actually result in a novel effect on student minds, thereby stimulating interest in what otherwise can be a monotonous daily high-school routine. (Some exceptionally receptive students may even be inspired to take up post-secondary studies specializing in child psychological and behavioral disorders.)

In any case, such curriculum could be wholly useful, regardless of whether the students themselves plan to or go on to procreate. For one thing, child development and rearing curriculum would make available to students potentially valuable knowledge about their own psyches and why they’re the way they are.

Physical and mental abuse commonsensically aside, students could be taught, according to the most widely accepted science, the potentially serious psychological repercussions of the manner in which they as parents may someday choose to discipline their children (e.g. guilt punishment: “See what you did!”); therefore, they may be able to make a much more informed decision on the method they choose to correct misbehavior, however suddenly mentally clouded they may become in the angry emotion of the moment.

And being that their future children’s sound mental health and social/workplace integration are at stake, should not scientifically informed parenting decisions also include their means of chastisement?

Our young people are then at least equipped with the valuable science-based knowledge of the possible, if not likely, consequences of dysfunctional rearing thus much more capable of making an informed choice on how they inevitably correct their child’s misconduct.

It would be irresponsibly insufficient to, for example, just give students the condom-and-banana demonstration along with the address to the nearest Planned Parenthood clinic (the latter in case the precautionary contraception fails) as their entire sex education curriculum; and, similarly, it’s not nearly enough to simply instruct our young people that it’s damaging to scream at or belittle one’s young children and hope the rest of proper parenting somehow comes naturally to them.

Such crucial life-skills lessons need to be far more thorough. But due to what apparently are reasons of conflicting ideology or values, such child-development-science curriculum will not be implemented in most school districts, as morally justified as such curriculum would be.

Thanks for your considered response and good advice. From my perspective our neglect of children is a cultural attribute of long standing. We live in a society whose original sin is slavery not inequality. The right of the owner to rape slaves (with a by-product of more child chattel to sell) is well established historically, if not discussed in polite circles. We also live in a society currently fueled by libertarian or neoliberal corporate mercantilism.  Basic to this system of social management is the desire to invest as little as possible in social services. It is little known that in 1918 and 1924 the Supreme Court twice found federal child labor laws unconstitutional as it stood up for real American values to allow the exploitation of children. Now instead of trying to figure out how to help families flourish we are ensconced in a society with fundamentalist religious values in conflict with humanitarian, compassionate caring just shy of the point of violence. I am afraid that off loading responsibility for parenting and value education to the schools is not a functional alternative.

Responding with, and on behalf of, my co-authors Kevin Sherin, MD MBA MPH and David Niebuhr, MD MPH MSc.

Dr. Gordon, thank you for starting a conversation about our Open Access paper which includes the ACPM Position Statement on ACEs.  We agree 100% that a national priority is preventing, mitigating, and treating childhood maltreatment as well as all forms of adversity across the socioecological spectrum. We also agree that the science of trauma and healing is a key part of medical education and practice.  In fact, our paper begins, ends, and makes many points along the way to emphasize exactly that.  It is intended to be a call to action. Here are some examples.

“Adverse childhood experiences (ACE) profoundly affect health and well-being across the lifespan1, contributing to significant morbidity and mortality2, and present opportunities to enhance prevention, mitigation, and treatment frameworks and strategies.3 Evidence is emerging that ACEs are both a cause and a consequence of health disparities.” 4,5

“…the high prevalence of ACEs and evidence of their deleterious effects on morbidity and mortality as well as healthcare utilization and costs make ACEs a worthy target for prevention and mitigation strategies.” 2,6,7,9

“Health professionals have an ethical and moral responsibility to respond to health needs based on the best available evidence. ACPM accepts this responsibility and calls for evidence-based population and clinical measures to prevent and mitigate childhood adversity and trauma, as well as ongoing program evaluation and research that will either support or refute current position statements.”

The evidence-informed ACPM recommendations summarized below also align with the priorities you raise and are consistent with the recommendations of other professional and governmental organizations (AAP, AAFP, AHA, ASTHO, CDC, and USPHSTF).  ACPM recommends:

• Population level surveys and research for ACEs and protective factors (e.g., positive childhood experiences) as well as for lifestyle, behavioral factors, and social drivers of health, such as CDC’s BRFSS.
• Sensitive trauma inquiry to explore adversity, trauma, and positive childhood experiences such as supportive relationships in adults/families/children in the context of therapeutic relationships and shared decision-making.
• Training all health care teams about the impact of childhood experiences on health across the lifespan and putting protocols and systems in place which support evidence-based trauma-informed, resiliency-informed, healing-centered care and referral for other indicated behavioral and social services, such as perinatal home-visiting and parenting programs.
• Public and private payer and health plan incentives for universal precautions, a trauma-informed approach, and appropriate evidence-based trauma-specific treatment for individuals with a history of childhood trauma and adversity
• Supporting state and county level initiatives to reach Healthy People 2030 goals to improve the health and well-being of children with evidence-based resources so children get timely developmental screenings, recommended health care services, as well as family, school, and neighborhood-level interventions, such as home visitation programs and parental interventions
• Funding research about prevention, mitigation, and treatment of adversity and trauma as well as about protective factors and positive childhood experiences that support development of health and resilience. This research may include development, implementation, and assessment of validated and generalizable assessment instruments as well as longitudinal intervention studies with a variety of study designs
• Conducting rigorous evaluation of full spectrum trauma-informed care implementation efforts as well as of effective trauma specific interventions to treat patients with a history of significant trauma and adversity

Our review methodology included an umbrella review of systematic reviews along with a review of governmental and professional society recommendations. We integrated the findings from these two reviews as much as possible.  Please note that an umbrella review is a review of systematic reviews, not a meta-analysis.  We acknowledge that our review had limitations: 8 year time period, English language-only studies, some, but not all, databases, etc. While we agree that there are promising single studies, such as the examples you raise and others (guaranteed income programs, home monitoring rather than incarceration of parents, and more), single studies were not eligible for inclusion in our research design. We did, however, note positive findings or positive trends from our umbrella review whenever they existed, and we raised other promising examples in our discussion.  Below are some of our conclusions. 

“While there are some encouraging findings from these studies, the current evidence is too limited to draw firm conclusions about the benefits of primary care (e.g., pediatric and maternal-child health) or public health (community nursing and social services) approaches to prevent adverse child experiences based on the heterogeneity of strategies and outcomes reviewed.”

“School-based mental health promotion programs had a clearly positive impact and yielded improvements in student resilience and individual protective factors, such as increased frequency of use of coping skills, reduction in internalizing behaviors, and improved self-efficacy in post-assessment studies.32 Nonetheless, there appears to be limited evidence for the effectiveness of most of the interventions studied for children and young people who have experienced childhood adversity. The strongest evidence is for the effectiveness of CBT for mental health outcomes in children who have been sexually abused. The evidence on other interventions and populations is less clear, but there are positive findings.”31

Unfortunately, most of the studies were rated low or critically low quality, which means that we as a public health and preventive medicine community , in addition to as a nation, must prioritize well-designed implementation and evaluation of enhanced protective factors and prevention and mitigation of adversity.

The only place it appears we have differences is in relation to ACE screening in the individual clinical encounter.  While we did not recommend ACE screening in individual patient encounters, we did not recommend not thinking about or talking about childhood experiences with individual patients.  Instead we advocated for a Universal Precautions approach and/or  Sensitive Trauma Inquiry in the context of positive relationships and shared decision-making. Below is the position of the authors and many, many other researchers, including Robert Anda, David Finkelhor, Craig McEwen, Kat Ford and more, based on the available evidence.

“Along with other experts, the authors are concerned that ACE scores may be misappropriated as a screening or diagnostic tool to infer individual client risk and misapplied in treatment algorithms that inappropriately assign population level risk for health outcomes from epidemiologic studies to individuals. Such assumptions ignore the limitations of the ACE score. Routine ACE screening may also retraumatize individual patients and clients who are not yet ready to disclose their personal histories of adversity. Therefore, programs that promote ACE screening and treatment of individuals with high scores should receive the same rigorous and systematic review of the evidence of their effectiveness according to the standards applied to other screening programs by the U.S. Preventive Services Task Force (USPSTF).”

We welcome the opportunity to discuss more and hope you’ll take another look at the manuscript.  We look forward to working together on our mutual goal of enhancing positive experiences and preventing, mitigating, and treating the consequences of childhood adversity for all.

@Robert Olcott posted:

Perhaps it's again time to reinstate the 'Consumer Majorities' required by the National Health Planning and Resources Development Act of 1974 (Public Law 93-641) - before the Reagan administration gutted funding for that type of 'Government-Mandated Citizen Participation'. And possibly begin using the World Health Organization's 'WHO ACE International Questionnaire'--which was used in WHO's study of the world's healthiest children (the USA ranked only 25th in that study).

“The way a society functions is a reflection of the childrearing practices of that society. Today we reap what we have sown. Despite the well-documented critical nature of early life experiences, we dedicate few resources to this time of life. We do not educate our children about child development, parenting, or the impact of neglect and trauma on children.”

—Dr. Bruce D. Perry, Ph.D. & Dr. John Marcellus

“This is the most important job we have to do as humans and as citizens … If we offer classes in auto mechanics and civics, why not parenting? A lot of what happens to children that’s bad derives from ignorance … Parents go by folklore, or by what they’ve heard, or by their instincts, all of which can be very wrong.”

—Dr. Alvin F. Poussaint, Professor of Psychiatry, Harvard Medical School

"Medical and academic narrowmindedness block progress" .... So what else is new?

Ionce read an ironic quote from a children’s health academic that, “You have to pass a test to drive a car or to become a … citizen, but there’s no exam required to become a parent. And yet child abuse can stem from a lack of awareness about child development.”

By not teaching child development science along with rearing to high school students, is it not as though societally we’re implying that anyone can comfortably enough go forth with unconditionally bearing children with whatever minute amount, if any at all, of such vital knowledge they happen to have acquired over time? It’s as though we’ll somehow, in blind anticipation, be innately inclined to fully understand and appropriately nurture our children’s naturally developing minds and needs.

A notable number of academics would say that we don’t.

Along with their physical wellbeing, children’s sound psychological health should be the most significant aspect of a parent’s (or caregiver’s) responsibility. Perhaps foremost to consider is that during their first three to six years of life (depending on which expert one asks) children have particularly malleable minds (like a dry sponge squeezed and released under water), thus they’re exceptionally vulnerable to whatever rearing environment in which they happened to have been placed by fate.

One wonders how much immense long-term suffering might have been prevented had the parent(s) of a future mass shooter or tyrant received, as high school students, some crucial child development science education by way of mandatory curriculum? After all, dysfunctional and/or abusive parents, for example, may not have had the chance to be anything else due to their lack of such education and their own dysfunctional/abusive rearing as children. Meanwhile, people will procreate, some prolifically even, regardless of their questionable ability to raise their children in a psychologically functional/healthy manner. ...

Additionally, if we’re to proactively avoid the eventual dreadingly invasive conventional reactive means of intervention due to dysfunctional familial situations as a result of flawed rearing—that of the government forced removal of children from the latter environment—we then should be willing to try an unconventional means of proactively preventing future dysfunctional family situations: Teach our young people the science of how a child’s mind develops and therefor its susceptibilities to flawed parenting.

Don’t we owe our children and future generations this much, especially considering the very troubled world into which they never asked to enter?

Certainly, some will argue that expectant adults can easily enough access the parenting experience and advice of other parents in hardcopy and Internet literature, not to mention arranged group settings. However, such information may in itself be in error or misrelated/misinterpreted and therefor is understandably not as beneficial as knowing the actual child development science behind why the said parental practice would or would not be the wisest example to follow.

As for the likely argument that high school parenting courses would bore thus repel students from attending the classes to their passable-grade completion, could not the same reservation have been put forth in regards to other currently well-established and valued course subjects, both mandatory and elective, at the time they were originally proposed?

In addition, the flipside to that argument is, such curriculum may actually result in a novel effect on student minds, thereby stimulating interest in what otherwise can be a monotonous daily high-school routine. (Some exceptionally receptive students may even be inspired to take up post-secondary studies specializing in child psychological and behavioral disorders.)

In any case, such curriculum could be wholly useful, regardless of whether the students themselves plan to or go on to procreate. For one thing, child development and rearing curriculum would make available to students potentially valuable knowledge about their own psyches and why they’re the way they are.

Physical and mental abuse commonsensically aside, students could be taught, according to the most widely accepted science, the potentially serious psychological repercussions of the manner in which they as parents may someday choose to discipline their children (e.g. guilt punishment: “See what you did!”); therefore, they may be able to make a much more informed decision on the method they choose to correct misbehavior, however suddenly mentally clouded they may become in the angry emotion of the moment.

And being that their future children’s sound mental health and social/workplace integration are at stake, should not scientifically informed parenting decisions also include their means of chastisement?

Our young people are then at least equipped with the valuable science-based knowledge of the possible, if not likely, consequences of dysfunctional rearing thus much more capable of making an informed choice on how they inevitably correct their child’s misconduct.

It would be irresponsibly insufficient to, for example, just give students the condom-and-banana demonstration along with the address to the nearest Planned Parenthood clinic (the latter in case the precautionary contraception fails) as their entire sex education curriculum; and, similarly, it’s not nearly enough to simply instruct our young people that it’s damaging to scream at or belittle one’s young children and hope the rest of proper parenting somehow comes naturally to them.

Such crucial life-skills lessons need to be far more thorough. But due to what apparently are reasons of conflicting ideology or values, such child-development-science curriculum will not be implemented in most school districts, as morally justified as such curriculum would be.

Perhaps it's again time to reinstate the 'Consumer Majorities' required by the National Health Planning and Resources Development Act of 1974 (Public Law 93-641) - before the Reagan administration gutted funding for that type of 'Government-Mandated Citizen Participation'. And possibly begin using the World Health Organization's 'WHO ACE International Questionnaire'--which was used in WHO's study of the world's healthiest children (the USA ranked only 25th in that study).

This is the first post I have read in PACEs for years now. I appreciate Dr. Gordon's comments. He is willing to challenge conventional leadership with facts, data and well reasoned opinion. I have a few core beliefs that I share and allow others to consider whether they have similar beliefs. First, I believe a concept referred to as the Stockdale Paradox. It was named and popularized in Jim Collins book titled Good to Great. In its essence, it states that we must accept the brutal realities of our existence, but have enduring hope that we will prevail in the end. Childhood Inflicted Trauma is a brutal truth for our generation. A second concept I share is that of the 10th Man (I use person but Man was used in the source I borrow it from). A 10th Person is obligated to take the same information as the first nine, if they come to the same conclusion, and argue the opposite position. It does need to be well reasoned, and in honest debate, there are always opposite positions. I believe Dr. Gordon effectively fulfills both in his post, which I appreciate. It shares information I did not have before, and states cogent reasons for opposing the position of ACPM. Thank you Dr. Gordon.

Agreed. It feels like ACPM's statement does more to tamper interest in addressing ACEs than the loud call to action that is desperately needed in our health care system.