Also the lion's share of incidental ACEs 0-5 are not the big T Traumas, like gun violence, but the small t traumas like mal-attachment and 'benign' neglect, and most Americans are in a lot of denial about the effects of things like mother baby separation on themselves and their kids.
I agree with everything. Itâs just that will Kaiser in California or McLaren in Michigan or Prisma in South Carolina give general doctors an extra 15 minutes to talk about the relational impact of the ACE Score? Idk...Most of us at this point are employees, we will do whatever we are told to do but if itâs all crammed into a 15 minute time slot.... the resilience building component might just be a printed handout from healthy children.org on building self-esteem as mentioned on the AVA blog which for my patients, end up mostly in the trash can. The ultimate outcome is that patients will be asked very personal questions with no real resource or follow up and though Dr. Felitti has no problems with ACE questions embedded in a 150 question intake of older adults... things are different when asking 10 ACE questions of kids or parents in a small setting in the Peds office. I have selectively asked about ACEs for over 10 years. Iâm not sure itâs a good idea to take something that can be so sensitive and force it to fit into an assembly line screening process. .
I also donât like being forced to collect something so personal from my parents / child patients that will then be sent to the government as a billing code (99219 - 3 or less ACEs 99220 -4 or more ACEs) hooked to the childâs DOB and Medicaid number with no reparative resource to offer.
PS Tina: a value of counting ACEs -- people in rank denial of having been relationally abused (for example, parentified or neglected) would probably still report Y or N to"fact" ACEs like parental alcoholism, and the # would indicate a deeper look at the overall situation. The inquiry should be to understand the **relational** impacts of the trauma in the home.
When you think about it, the 10 ACEs are the various main branches of the tree and the trunk of the tree is the RELATIONAL IMPACT on the child-- parental loss and dysfunction.
When parental addiction, incarceration, depression, death, spousal abuse, etc occur, they ALL lever away the attentional and relational abilities of the child's mother (or even loss of the mother altogether). Even a random trauma like a flood might generate PTSD in parents, and the relational impacts to a small child of a Mom with PTSD are huge.
I think the 10 ACEs are a decent sorting hat if doctors then the drill down to the impact on development.... what age was the child when relationally felled by this ACE in the family.
And the follow up should be things like DBT, therapy, and mentoring for vulnerable moms, and supports and encouragements for the functional dyad. Things like apps which remind you to carry your baby or sing a song to them. Breastfeeding support. Slings.
In a larger way we need to explain the WHYs of an ACE's impact: they rob kids of proper attachment and good-enough parenting
Tina , I think counting ACES is valid for traumatic events-- anyway much moreso than it is for Developmental Trauma. But Developmental Trauma is the one that is more devastating and that we have some control over by articulating different values as a society.
The worsening psychological health of kids is absolutely palpable in medicine. In the last 3 years practicing, I had more visits for psychological and behavioral concerns than medical. There were so many, my nurse started calling me a social worker and not a doctor. It will only continue like this. No changes or transformations will ever be made when everyone has an ACE Score and knows their number. It seems to me, this âScoreâ is simply a way to normalize what isnât normal or conducive to healthy development. No score of any kind and no pediatric doctor can magically create the kind of mother-infant experience that is biologically required for healthy child psychological, physiological, emotion or social development. There are critical time periods in human development and there are critical experiences.
Iâm going into deep contemplation and reflection. I have one idea... maybe itâs too far fetched. I need to think about this more but I donât give up. I hope others see this and start contemplating too. Has your life changed with an ACE Score? Were you able to recover from childhood wounding because you know your ACE Score? Youâve got your ACE Score, now what? How does knowing what an ACE Score is prevent children from getting a high ACE Score? Is is all about an ACE Score or is there something that kids need to prevent them from getting a high ACE Score? What is it that kids need to prevent them from getting a high ACE Score? How do we give this to kids to prevent them from getting a high ACE Score? Is there some developmental experience that kids need that if absent puts them and their children at risk of accruing a high ACE Score? Are we on the right track when our efforts are directed at doctors collecting an ACE Score? Do we minimize the psychological and developmental effects of #ACEPrecursors on kids who donât have a high ACEScore? What #ACEPrecurssors put kids at risk for developing a high ACEScore?
I mostly hear about getting an ACE Score for pediatrics. Iâm not convinced that getting an ACE Score actually gets to the root of the problem. Iâm certainly not convinced that having pediatric doctors get an ACE Score will transform outcomes for kids.
It is so upsetting to me that we are LOSING, as a culture, so many developmental REQUISITES for children of our species, and it is causing so many problems, and yet nobody seems deeply aware of this. Part of this is that we are all only able to glimpse the 'snapshot' of a brief timespan of our own life rather than the span of human history.
I am 58 years old. I was a kid in the 60s and 70's and graduated HS in 1979. I REMEMBER the reality of nearly-unheard-of child mental illness. This was not an undercount-- this was reality. (Granted I grew up in an affluent area, and some of these problems were already becoming entrenched in very poor areas.) I also remember going to a very competitive college and my peers were NOT riddled with anxiety. They did not need safe spaces and trigger warnings. Literally, there were 2 part time counselors at a school of 5000 kids back then. Nobody was medicated. I remember SAHMs-- and in addition, my two homemaker grandmothers played a strong role in my life. When I and my generation die, this cultural knowledge will be GONE. How do we pass on a cluster of skills we don't know exist anymore? What will happen to the intergenerational transmission of nurture??
I was a new Mom in 1990. The "mommy wars" were in full swing. I remember the arguments. SAHMs felt dissed because the job of hands on mothering was considered optional/delegatable, and many of us knew intuitively it was NOT. We are finding out we were correct. On a society wide basis, when you remove the breastfeeding, modeling, attachment, external co-regulation and carrying implicit in dyadic care, you remove too many requisites.
The rate of secure attachment ought to be 100%. Just because it has not ever been measured at this level does not mean otherwise. We may not have been alive for it but I do know the stats for those born in 1900 were about a 2% chance of mental illness in their lifetime. Compare that to now. I am certain if you were to measure the secure attachment rates amongst attachment-parenting moms and their kids you would 95%+ not 30%.
I grew up inside a far-more-mothered cohort. Less-mothered millenials no longer have a mentally healthy society as a lived experience or reference point. Things like severe anxiety in grade school have been normalized because the existence of damaged kids is widespread now. But there is nothing normal about it. We who remember a different time must hold our ground, and re-establish nurture for American children.
Just like Frank Putman, MD was fired from NIH for researching dissociation and child sexual abuse.
(PS: dissociation is real by the way and itâs not right that highly traumatized patients arenât educated on dissociation or evaluated for it because you cannot recover until you get a handle on your dissociation and on integrating distinct personality states and rapid switching of states that results from dissociation. All doctors should know about dissociation and state-dependent functioning because this is what many adults who were highly traumatized as kids are suffering from and the switching is a major factor in intergenerational transmission and disorganization in infancy. You canât treat what you donât recognize and the patient canât recover from what they canât understand and donât realize is happening to them.)
Here is a little segment from an interview with ISTSSD one year ago.
âThen two things happened that Iâve never quite understood.
One was that the National Association of Social Workers prevailed upon the U.S. Congress to allocate a one-time sum of $40 million for research on child maltreatment. Congress also mandate that the NIH Director brief Congress on what NIH was doing about child maltreatment. As I was the only one at NIH who knew anything about child maltreatment, they dragged me over to the NIH Directorâs office. I worked with his staff for weeks to write the Directorâs remarks to Congress. I was thrilled that the NIH Director was going read my comments into the Congressional record when he testified. In reality it was just placed in Congressional record âĶ It just part of an informational package they sent over to Congress. At one level I thought, now we are finally getting recognition. The NIH Director is paying attention. Boy, was I wrong!
The other thing was that I gave a public presentation at the NIH on our sexual abuse research. Afterward, a group of people came up to me. They told me about what sounded like a child sexual abuse ring, based on the NIH campus. It was all hearsay, but I took it to a District Attorney whom I had worked with on other cases.
Shortly thereafter, they arrested and charged a NIH Nobel Prize winner named Daniel Carleton Gajdusek, who was known for the discovery of Kuru. At the trial he clearly got a very special plea deal. He was allowed to first resign from the NIH and therefore keep his government pension. Although at least 40 children were known to be involved, he was only charged with one minor count. He served a short time in prison. On release, he was picked up at the prison gate by a limo and flown to Paris. He lived the reminder of his life in Europe as an unrepentant paedophile.
Frank Putnam, Screen shot, from interview â 19th February 2019
WM: What year was this Frank?
FP Roughly about 1995/1996. (Gajdusek was arrested in April, 1996). After that I was suddenly in big trouble. I got a terrible internal scientific review. They decided to terminate all child abuse research at NIH. I was fortunate to be able to transfer the prospective longitudinal study to my former project manager, Jennie Noll, who continues to direct it from Penn State University. But it was impossible to save all the data, records, and biological samples etc. A lot was lost.
Fortunately, I found a very good position elsewhere. In many ways it was one of the better things that happened to me career -wise, but at the time it was devastating to lose control of that work and become a persona non grata.
Now I believe that this was in retaliation for causing the arrest and conviction of a NIH Nobel Prize winner. I moved to Cincinnati Childrenâs Hospital in July 1999, where, as a Professor of Paediatrics, I worked on developing child abuse treatment and prevention programs.â
I would love to interview him too. He's a brilliant man-- who was FIRED from the NIH for the heresy of promoting the importance of the mother baby bond.
One of these days, Dr. Hahn, it will be common knowledge that parenting and parenting education is more important than almost anything else.
And that has to include time for the mother to breast feed and carry her baby. You know, we pediatric doctors get absolutely zero training in how important any of this is and then we are to go out into the world to help mothers care for their infants. Parents believe we know what they need to know and they ask us for advice. But we canât tell mothers what they desperately need to know and what they deserve to know because almost none of us know either.
I think I want to interview Dr. Prescott. I know he is pretty old now and maybe he is too old to interview but I think itâs worth a try and it is obvious that he is passionate about this and he cares deeply. Iâm wondering what others think might be some good questions, if I can contact him?
So Dr. Fisher has a seminar on Neurofeedback that she is putting out currently called âThe Nature of Forgetting.â
I listened to the third session today. I have collected several old papers from the 1970âs about this stuff (the cerebellum and how it is associated with behavioral regulation). The information is there. Dr. Fisher is basically stating that she and possibly Peter Levine and others will push for NFB for the treatment because this is subcortical. It involves a bunch of midbrain-brainstem-cerebellar-frontal cortex structures wired for the expectation of a dangerous and violent world, and a world without maternal love and protection is indeed a dangerous and very often violent world. These lower brain structures and networks arenât responsive to cognitive control, certainly dissociation isnât and there isnât anyway to treat them besides Neurofeedback (at least not that anyone knows of so far). They are pre-verbal, pre-cognitive manifesting action before conscious control.
IDK - This stuff has been well know since the mid-1970âs and the best thing, really the only thing to do if turning this around is the goal is prevention which can only be done by promoting the maternal-infant bond. Anything else will continue this slide of what Dr. Perry has called âsociocultural devolution.â
In a dramatic series of experiments, Harry F. Harlow, a University of Wisconsin psychologist, has demonstrated what happens when baby rhesus monkeys are deprived of their mothers. Harlow placed an infant monkey in a cage with two inanimate mother substitutes. One, covered with terry cloth and equipped with bicycle-reflector eyes, was designed to feel and look somewhat like a real rhesus mother but had no apparatus for feeding the infant. The other "mother," made of unadorned chicken wire, was unattractive to touch but contained a baby's bottle from which the infant could drink milk. Harlow found that the infant rhesus clearly preferred to spend all of its time with the nonfeeding surrogate. Even when feeding from the chicken-wire "mother," the infant would cling to his terry-cloth favorite. Harlow concluded that in infant mother love, holding and cuddling are even more important than feeding. He also found that female monkeys who grew up with mother surrogates failed to develop maternal affection: they all seemed indifferent to their own children. Like parents who abuse their children, these monkey mothers frequently attacked, and sometimes even killed, their infants. Other researchers have recently traced three generations of human parents who batter and abuse their children. The only common characteristic of such parents, regardless of social or economic class, was that they themselves had suffered from lack of mothering and affection. Harlow wryly concluded a recent paper:
Hell hath no fury like a woman spurned. With love not given, love is not returned. The loveless female, human or macaque, In place of love will substitute attack.
Can such deprived, aggressive monkeys be restored to normalcy? Experiments in Harlow's laboratory indicate that rehabilitation is possible if it is done early enough. Young monkey mothers reared in isolation sometimes regain most of their normal maternal behavior when locked in a cage with their own babies. The infant clings to the mother so persistently, despite her efforts to push it away, that eventually the baby monkey begins to serve as a therapist. Similarly, some young male monkeys reared in isolation become less aggressive when forced to play with monkeys their own age or younger.
Research into the brains of monkeys raised in isolation is just beginning, but indirect evidence already hints that such treatment induces brain damage. In humans, brain waves with abnormal, jagged "spikes" are often a telltale sign of damage. Robert G. Heath and Bernard Saltzberg, researchers at Tulane University, have recorded such spikes in the brain waves of monkeys reared by Harlow. The spikes reflect abnormal electrical activity, particularly in the cerebellumâ
âWe have learned that those mental qualities which we call âhumanâ are not part of the constitutional endowment of the infant, and are not instinctive as are the characteristics of other animals, and will not be acquired simply through maturation. The quality of human love which transcends love of self is the product of the human family and the particular kinds of attachments that are nurtured there.â
- Selma Fraiberg
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Laura,
I want to thank you for directing me to the knowledgeable professors, authors, child advocates and teachers.
We canât reduce #ACE effects in a society by 1/2 in 1 generation or in 100 generations if we donât support, promote and protect the secure and loving relationship between babies and mothers.
If all children are carried, held, treated gently, and loved, we will radically reduce:
-anger, violence, abuse, obesity, drug addiction, mass incarceration, homelessness, poverty, special ed, misogyny, diabetes, heart disease, cancer.
How much would it be worth to society, to subsidize and mentor all at risk young moms and ensure a good launch to all babies, when it would save many billions over the lifetime of the children?
Doesn't $25K per baby look cheap against the costs of all these problems?
Lack of carrying and lack of physical pleasure and lessened attachment is THE original, culture-wide ACE that hurts most of us. This is likely to explain what is worst about daycare: very little movement and carrying for babies, and the concurrent lack of robust attachment and brain development.
If we want to start babies off on the right foot we need to know this info. If we want to help heal ACE damaged adults, this is key information.
0-3 is the template that plays on permanent repeat for life.
If we could find a way to show how biolgical / physiological disregulation in the presence of other human beings is the result, in a way that is entertaining, thought provoking and doesnât provoke defensive reactions.... I think maybe we could get somewhere.
Iâm putting all my brain power into trying to find a way. I canât think of anything more important to humanity.
A new kind of parenting education that reaches everyone, everywhere, all the time must be a part of the primary prevention of adverse childhood experiences.
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