The Hero of Stress

I recently had the opportunity to work with a pediatric neuropsychologist, Dr. Anne Uecker, on a project looking at the effects of adverse childhood experiences (ACEs) on cognitive abilities in school aged children. She noticed that her patients’ scores were not falling into the normal distribution but instead showing a variety of unexpected outcomes. Dr. Uecker wondered if this could be partially explained with ACEs, which are categorized under abuse, neglect, or household challenges.

Before my time with Dr. Uecker I had never heard of ACEs so I did what any good intern would do, I watched a TedTalk. More specifically Nadine Burke Harris’ “How Childhood Trauma Affects Health Across the Lifetime.” Dr. Harris is a pediatrician, 1st Surgeon General of California, and all around rock star who dedicates her life to developing a plan to change the outcome of those affected by ACEs. Needless to say she immediately became my new hero.

So how does this happen?

The typical response to stress involves the activation of the sympathetic nervous system through the HPA axis. https://www.researchgate.net/figure/Role-of-stress-induced-activation-of-HPA-axis-cortisol-and-sympathetic-nervous-system_fig3_269808355

When most healthy individuals become stressed, the body reacts by activating a network of responses to keep you safe and efficiently. Stressors activate the HPA axis, which in turn releases cortisol from the adrenal glands and initiates the sympathetic nervous system. In doing so heart rate increases, pupils dilate, blood pressure goes up, a whole host of things. But on the contrary digestion decreases, tissue repair halts, growth is postponed, which is a valuable redirection of resources and energy when trying to stay alive.

Adverse childhood experiences do more than cause stress at one point in your life, but can actually lead to poorer health outcomes later on. Dr. Harris’ work is founded on a 1998 study conducted by Felitti and colleagues, that showed incredible links between childhood events and health outcomes later in life. Researchers found a graded relationship between number of ACEs and adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. While the initial stress response is needed in some cases, these actions can lead to poor overall health most likely due to this prolonged stagnation of the body’s typical immune response.

Good News!

Nadine Burke Harris’ goal is to provide all children in the United States with ACE assessments and healthcare programs by 2028. https://centerforyouthwellness.org/advancing-clinical-practice

Not everyone who experiences chronic stress or early childhood stressors. Lots of researchers are finding ways in to promote resilience in populations exposed to early traumatic life events. Masten and colleagues have concluded that the best way to promote resilience in children with early life adversity is through social support. Dr. Harris seemed to have the same idea when she founded the Center for Youth Wellness with the vision of screening every child in the United States for ACEs by 2028 with the hope of providing them with the best healthcare to undo and prevent future ACEs.

 

 

Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study Felitti V.J., Anda R.F., Nordenberg D., Williamson D.F., Spitz A.M., Edwards V., Koss M.P., Marks J.S. (1998)  American Journal of Preventive Medicine,  14  (4) , pp. 245-258.

Masten, A., Best, K., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2(4), 425-444. doi:10.1017/S0954579400005812

Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont (Pa. : Township)), 4(5), 35-40.

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