Saturday, August 30, 2014
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How to turn 'What's wrong with you?' into 'What happened to you?'

A growing body of research is pinpointing how childhood trauma changes the developing brain. And a Philadelphia organization is working to translate new findings from research into practice.

How to turn ‘What’s wrong with you?’ into ‘What happened to you?’

A Philadelphia organization is working to translate new findings on trauma from research into practice. "CAPPD" is designed to help grownups help children raised on trauma.
A Philadelphia organization is working to translate new findings on trauma from research into practice. "CAPPD" is designed to help grownups help children raised on trauma.

Earlier this month, the Centers for Disease Control and Prevention released the results of a study estimating the economic burden of child maltreatment in the United States. The conclusion: each case costs the nation $210,012 over the child’s lifetime. With an estimated 580,740 cases annually, this comes to $124 billion a year (a conservative estimate).

To arrive at this figure, the authors synthesized results from a number of studies that compared the experiences of adults who were and were not mistreated as children according to wages; use of health care; imprisonment or other involvement with criminal justice systems, and other measures.

For example, one study found that adults who were abused or neglected as kids earned about $5,000 less per year than those who were not (controlling for other background characteristics). Another study found that individuals with histories of child maltreatment were 59% more likely to be arrested as juveniles and 28% more likely to be arrested as adults.

Why would mistreated kids grow up to earn less money and be more involved with the criminal justice system than their counterparts? It’s matter of science.

A well-established and growing body of evidence tells us the developing brain is an extraordinarily adaptive organ. When a child is raised in an environment with toxic levels of stress, the structure and chemistry of his or her brain evolves accordingly. So a child who is wired for survival in a hostile environment may have a tough time focusing and behaving as expected in a classroom.

The developing brain, however, is malleable not just in response to adversity. Nurturing, positive, and trusting relationships with adults can repair damage done and reshape the brain’s neuro-architecture in a way that is advantageous to the child—as well as society.

Unfortunately, not many people know this. Out of ignorance or lack of patience, adults often label mistreated children as “bad,” have tumultuous interactions, and further reinforce maladaptive neuro-networks—sending kids off on troubling life trajectories, which they follow into adulthood.

This is something the Philadelphia-based group Multiplying Connections is working to change.

According to Natalie Levkovich, executive director of the Health Federation of Philadelphia and a founding member of the steering committee, Multiplying Connections—now a project of the federation—was started in 2004 by a group of leaders in the city’s health and human service agencies who wanted to translate emerging science about the impacts of trauma on human development from research to practice.

This past week, the child-focused organization released a tool that distils practical information from complex science and presents it in the most simple of forms—a five letter acronym (behavioral health people love acronyms). CAPPD, according to Multiplying Connections Director Leslie Lieberman, “provides a simple tool to help adults remember the five best things that Dr. Bruce Perry”—a neuroscientist and leading expert on childhood stress—“says they can do to promote positive development when interacting with children.”

The term can be used in more than one way. Grownups who “do” CAPDD, for example, can help children “be” CAPPD. Here’s what the letters stand for:

  • Calm: Children are reactive and emotional beings, and this might especially be the case among children with histories of trauma. Staying composed yourself, and bringing the child back to a calm state, aids the functioning of his or her neocortex—a part of the brain responsible for conscious thought, complex thinking, and language.
  • Attuned: The brain encodes and stores trauma non-verbally, which is different from how it handles other experiences. So it is important to connect with traumatized children on an emotional, rather than cognitive, level and to be attuned to their non-verbal cues.
  • Present: Children have a knack for sensing when you don’t have their attention. Since positive, secure relationships are critical to restoring healthily brain development in kids with traumatic pasts, it‘s important that adults stay present during interactions.
  • Predictable: Mistreated children often operate at a heightened level of arousal—poised for fight-or-flight. Predictable and repeated positive interactions can help foster feelings of safety and enable the restoration and development of healthy neuro-networks.
  • Don’t let Children’s Emotions Escalate Your Own: This might be the most challenging one, but also the most important. Numerous stimuli can activate a child’s response to prior trauma—triggering feelings of fear and a loss of behavioral control. It is precisely during these times— when children would most benefit from trustworthy adults modeling how to manage their emotions—that the grownups get pulled into the child’s drama and lose emotional control themselves.

Experts say that understanding the physiological consequences of trauma on human development transforms the question of “what’s wrong with you?” to “what happened to you?” This is a conversation that Multiplying Connections is having to help bring about change in Philadelphia.

It is one that we would like to have here as well. If you work with kids, as a parent or a professional, do you see their past traumas showing up later as cognitive and behavioral problems? What strategies have you found to address them?

Read our previous posts related to the Adverse Childhood Experiences (ACE) Study -- about how childhood trauma impacts health and development into adulthood here, here, here, and here.


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What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MPH Research Director, Drexel Center for Nonviolence and Social Justice
Janet Golden, PhD Professor of history, Rutgers University-Camden
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