Are you intrigued by how early life experiences can shape our health? Interested in the groundbreaking ACE Study and its implications? Want to discover how a doctor and a mother navigated personal loss, professional setbacks, and community skepticism to pioneer a new approach in child health?

The Deepest Well: Healing the Long-Term Effects of Childhood Adversity

As Nadine Harris, the author, walked into the exam room at Bayview Child Health Center, she was greeted by the colorful surroundings and a young smile from Diego, a seven-year-old who appeared much younger. 

Diego's chart confirmed Nadine's suspicion—his growth was significantly behind. His health issues were compounded by eczema, asthma, and a possible ADHD diagnosis. But the real heart of his challenges was revealed by his mother, Rosa. Through her tearful recounting, Nadine learned of a traumatic incident when Diego was four, involving abuse by a tenant. This trauma seemed to ripple through Diego's life, affecting his school performance and possibly his health. 

Bayview, a neighborhood fraught with adversity, was where Nadine had set up a clinic to address health disparities. Here, challenges like poverty, violence, and environmental toxins were the norm. Despite improved access to health care, Bayview children faced daunting health issues, mirroring the struggles of their environment. 

Nadine's quest to understand the link between adversity and health led her to the ACE Study, an eye-opener showing that adverse childhood experiences were common and correlated with severe adult health issues like heart disease and cancer. This study, conducted in middle-class San Diego, revealed that adversity's impact on health was independent of socioeconomic factors—challenging prevailing assumptions.

This revelation was akin to Nadine's father's approach to science, seeing beyond the surface. It echoed her experiences in the Hayes lab, where she learned how stress hormones could drastically affect development. The ACE Study connected these dots, showing that childhood adversity could have a biological impact, akin to stress hormones on tadpoles, affecting lifelong health. 

With this newfound understanding, Nadine's focus shifted. She realized the potential to change the trajectory of children's health by addressing adversity early on. The ACE Study not only validated her observations but also ignited a sense of urgency and hope. She knew that tackling these issues in Bayview could set a precedent for addressing similar challenges everywhere.

Can Addressing Childhood Trauma Early On Transform Lifelong Health?

Walking down Mission Street in San Francisco on a chilly December night, Nadine found herself in the midst of a terrifying incident. A red car had slowed down near her, and the sound of gunfire echoed in the air. Her friend Michael initially dismissed it as firecrackers, but a sense of unease quickly set in. They soon discovered a young man had been shot, and Nadine's medical instincts kicked in. 

Nadine tried to help, but sadly, he didn't survive. The experience left Nadine shaken, with her body reacting to stress in unexpected ways. Every time she heard a car backfire or saw a red car, she was transported back to that night.

This response, Nadine learned, was part of our body's stress-response system, an evolutionary mechanism designed to keep us safe. When faced with danger, our brain triggers the release of stress hormones like adrenaline and cortisol, preparing us for fight or flight. But when this system becomes overactive, it can lead to health issues, as seen in conditions like PTSD.

Years later, Nadine dived into the ACE Study, which examined the impact of adverse childhood experiences on health. She realized that the stress-response system could be dysregulated by early adversity, leading to long-term health problems. Children who experience significant stress without adequate support can suffer from what is known as toxic stress, affecting their brain development and increasing the risk of diseases.

In her clinic, Nadine began to see the effects of toxic stress in her patients. One case that stood out was Trinity, an eleven-year-old girl with a high ACE score and symptoms of ADHD. A thorough examination revealed an underlying condition—Graves' disease—linked to her stress. Treating both her medical condition and the underlying stress improved her situation significantly.

Understanding the biological mechanisms of stress, including the role of the brain's fear center, the amygdala, and the protective telomeres at the end of our DNA, has been critical in addressing these health issues. Research shows that stress can alter our DNA expression through epigenetic changes, potentially affecting health across generations.

The more Nadine learned, the more she realized the importance of early intervention and the potential to change long-term health outcomes by addressing toxic stress. Despite setbacks, like a challenging presentation to hospital CEOs, the science of ACEs and stress-response systems continues to drive her commitment to improving children's health and breaking the cycle of adversity.

From Streets to Studies: Unraveling Stress with the ACE Study

Leaving a hospital council meeting, Nadine was lost in thought and didn’t notice a woman until she called out, “Excuse me, Doctor?” It was the woman who had been pouring coffee during Nadine's presentation. “That’s me you were talking about up there. I’ve got every single one of those ACEs,” she said, referring to Adverse Childhood Experiences. Her name was Marjorie, and her words were a revelation. She thanked Nadine, and Nadine realized that if we didn’t have a clinical protocol to address ACEs, it was time to create one.

In 2008, their clinic was among the few screening children for ACEs. They began focusing on evidence-based treatment models for toxic stress. One of the most effective interventions they found was child-parent psychotherapy (CPP), pioneered by Dr. Alicia Lieberman. Her work emphasized the importance of real conversations about trauma, even with very young children.

Nadine saw the impact of this firsthand with a patient named Charlene and her baby, Nia. Charlene, struggling with postpartum depression, found support through CPP. With the help of Dr. Todd Renschler, she learned to respond to Nia’s needs, and their relationship improved. Despite setbacks, Charlene’s dedication and the therapy’s support helped Nia thrive.

Nadine's efforts expanded to include an obesity-treatment program, integrating mental health support with physical activity and nutrition counseling. They even introduced a mindfulness program inspired by the Mind Body Awareness Project, which had positive effects on stress management and overall well-being.

The idea of a larger center devoted to ACEs came to light after Nadine's conversation with Kamala Harris, then the district attorney of San Francisco. She suggested that Nadine start a center to address these issues comprehensively. Daniel Lurie of the Tipping Point Community helped fundraise, and soon they had the resources to create the Center for Youth Wellness (CYW).

Starting CYW wasn’t easy. They faced opposition from community members suspicious of their intentions. But with the overwhelming support of their patients and their families, they persevered. At a pivotal planning commission meeting, parents and supporters spoke passionately about the positive impact they had on their lives. Their testimonies and the sea of green stickers in support of CYW led to a unanimous vote in Nadine's favor.

The creation of CYW was a testament to the power of community and the importance of addressing toxic stress to improve health outcomes. It confirmed that with the right support and interventions, we could break the cycle of adversity and create a healthier future for children and families.

How Did Kamala Harris and Community Support Revolutionize Child Wellness?

Dr. Robert Guthrie might not be a household name, but in Nadine's world, he's right up there with the likes of JFK Jr. Guthrie’s pioneering work in newborn screening has saved countless lives. Nadine first heard of him as a medical student learning about the crucial blood test done on newborns, which can detect life-threatening diseases long before symptoms appear.

Guthrie’s journey began in 1947, when his son John was born with a significant mental disability. Devastated by the lack of answers, Guthrie dedicated his life to preventing mental disabilities. His mission intensified when his niece Margaret was diagnosed with phenylketonuria (PKU), a genetic disorder that leads to severe brain damage if untreated. 

Margaret's condition fueled Guthrie’s determination to find an early detection method. He developed a test using a few drops of blood that could identify PKU before it caused irreversible damage. His relentless advocacy led to the mandatory screening of all newborns for PKU, a practice that now saves thousands of lives annually.

Guthrie's legacy inspired Nadine to think about universal screening in her own practice. At the Center for Youth Wellness, they face complex cases of toxic stress in children, often linked to adverse childhood experiences (ACEs). 

One such case was Lila, a bubbly two-and-a-half-year-old with an ACE score of seven. Her score indicated a high risk for health and developmental issues, but her condition was initially overlooked because she appeared healthy on the surface. Through multidisciplinary care, including child-parent psychotherapy and nutritional support, Lila's health improved significantly.

Lila’s case reminded Nadine of the importance of universal screening, much like Guthrie’s work. By identifying and addressing toxic stress early, we can prevent long-term damage and help children reach their full potential.

Guthrie's story, along with others like Sue Sheridan’s fight for universal bilirubin screening, highlights the power of early intervention and advocacy. These pioneers show that with determination and the right tools, we can make a significant impact on public health. It’s a lesson Nadine carried in her work, striving to ensure every child has the chance to thrive.

Dr. Robert Guthrie: The Unsung Hero Saving Newborn Lives

Dinner with Caroline seemed to spark a whirlwind of opportunities for Nadine to promote ACE impacts and treatments. Nadine found herself keynote speaking at the American Academy of Pediatrics’ first national conference on toxic stress and briefing leaders at the White House. The topic of how ACEs affect biology was gaining traction, even reaching circles that had never discussed it before.

At a New York City conference in 2016, Nadine eagerly anticipated a productive discussion on universal ACE screening. However, after stepping out to pump milk for her newborn, Nadine returned to find the atmosphere tense. Jeannette Pai-Espinosa, president of the National Crittenton Foundation, informed Nadine that some attendees were upset, fearing ACE screening would label low-income children of color as brain-damaged. Despite Nadine's efforts to communicate that ACEs affect all communities, there was significant misunderstanding.

Nancy Mannix from Alberta, Canada, shared her experience with similar skepticism but highlighted the importance of ACE screening. She recounted how Alberta’s integration of ACE awareness into health and policy had revealed profound effects on health outcomes, driving significant changes in their approach.

Dr. Pamela Cantor’s experience post-9/11 in New York City revealed that children in impoverished areas showed the most trauma symptoms, not those closest to Ground Zero. This led her to establish Turnaround for Children, which focuses on integrating ACE science into school practices to create a supportive learning environment. Despite challenges, including stagnant test scores, Turnaround’s comprehensive approach began showing promising results.

The pushback Nadine encountered made her realize the resistance stemmed from a fear of labeling and misunderstanding the universal impact of ACEs. A powerful moment at a Precision Public Health Summit, where Jenee Johnson passionately advocated for the community’s needs, crystallized Nadine's understanding. The science of ACEs connects us all, transcending individual suffering and showing that a united, science-based approach can lift everyone.

This rising tide of understanding and addressing childhood adversity has the potential to uplift all communities, breaking the cycle of toxic stress and creating healthier futures for all children.

Can ACE Awareness Truly Transform the Lives of All Children?

It was a typical afternoon at the Bayview Child Health Center, and Nadine was ready to see her first patient in the butterfly room, named for its whimsical decor that brings a smile to anyone who enters. Nadine's patient, Diego, was a familiar face, a sixteen-year-old dealing with the challenges of adolescence compounded by a high ACE score. Over the years, they've helped him manage asthma and eczema, but his past continues to cast long shadows.

Diego's recent struggles echoed deep-seated traumas. His father's deportation left a void, compounded by the sudden disappearance of contact—a harsh reality of his undocumented status. This, coupled with the responsibility of being "the man of the family," weighed heavily on his young shoulders. His mother's fierce love and the clinic's consistent support helped him navigate these turbulent waters.

But life in a challenging neighborhood meant that adversity was never far away. A friend's tragic death triggered a familiar spiral, yet with Nadine's team's coordinated care and Diego's resilience, he found his footing again. He left the clinic that day with a plan—therapy, soccer, and a focus on his dreams of becoming a lawyer.

Reflecting on Diego's journey, Nadine couldn't help but draw parallels with her own family's story. Nadine's brother Evan's stroke was a stark reminder of the silent, pervasive effects of childhood adversity. His survival, thanks to an experimental procedure, underscored the urgent need for more research into ACEs and their lifelong impacts.

As a doctor and a mother, Nadine has faced her own battles with adversity, particularly after the heart-wrenching loss of her son, Ziggy. The grief was overwhelming, but with the support of her family and community, she found her way back, driven by the mission to break the cycle of toxic stress for others.

In the decades since, the movement to address ACEs has grown. From routine screenings in prenatal care to public education campaigns, society has begun to shift. We may still be in the early stages, akin to the "hand-washing" era of germ theory, but the groundwork is laid for a future where resilience is built into the fabric of our communities, and childhood adversity is no longer a sentence passed down through generations. 

As Nadine looks to the future, she sees a world where the understanding of toxic stress transforms lives, not just in clinical settings but across global communities. It's a vision of hope, healing, and a relentless commitment to nurturing the potential within every child, just like Diego.

Breaking the Cycle of Toxic Stress: From Diego's Journey to a Global Movement

The environment plays a crucial role in shaping children's health outcomes. Addressing health disparities in neighborhoods like Bayview, which face significant adversity, is paramount. It's not just about providing access to healthcare but understanding the deeper connection between childhood adversity and long-term health. 

The ACE Study is pivotal, revealing that adverse childhood experiences can lead to severe health issues later in life, regardless of socioeconomic status. This understanding shifts focus to early interventions, recognizing the biological effects of stress and trauma on development.

The impact of toxic stress on health becomes clear, particularly in cases where children exhibit symptoms related to stress. Addressing these underlying issues through evidence-based treatment, like child-parent psychotherapy, can significantly improve health outcomes. 

The creation of the Center for Youth Wellness exemplifies the power of community support in breaking cycles of adversity. Universal screening for toxic stress, inspired by pioneers in early medical screening, highlights the importance of early detection and intervention.

The journey involves overcoming resistance and misunderstanding about ACEs and their universal impact. It's about transcending fears of labeling and instead embracing a science-based approach to uplift all communities. The vision is a future where resilience is built into communities, transforming lives globally. Addressing toxic stress isn't just a clinical challenge; it's a commitment to nurturing potential within every child and breaking generational cycles of adversity.

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The Deepest Well: Healing the Long-Term Effects of Childhood Adversity

Nadine Burke Harris

7 Key ideas

18 MINS

4.9 (1.1k)

Are you intrigued by how early life experiences can shape our health?
Interested in the groundbreaking ACE Study and its implications?
Want to discover how a doctor and a mother navigated personal loss, professional setbacks, and community skepticism to pioneer a new approach in child health?

Are you intrigued by how early life experiences can shape our health?

Interested in the groundbreaking ACE Study and its implications?

Want to discover how a doctor and a mother navigated personal loss, professional setbacks, and community skepticism to pioneer a new approach in child health?