Transcription:

Alyne Ellis: Sometimes bad things that happen to us as children can affect us as adults. And we may not even realize this is happening, influencing how we feel now. In response, we may feel sad or depressed, anxious, or often just really off-kilter. Luckily, one can get help here to tell us more is Jennifer Redding, the Executive Director of Behavioral Health at UM Upper Chesapeake Health.

This is the Healthy Hero podcast from UM Upper Chesapeake. I'm your host, Alyne Ellis. Welcome, Jennifer. Thanks for joining me today.

Jennifer Redding: Thank you for having me.

Alyne Ellis: Let's begin with the term ACE. Tell me what that stands for and then let's talk a little bit about some of the things that can cause this problem.

Jennifer Redding: So ACEs stands for adverse childhood experiences and it was developed from a study that occurred in the mid 1990s. Through Kaiser Permanente, approximately 17,000 adults were surveyed in San Diego, California about their exposure to 10 types of childhood trauma.

Alyne Ellis: What are some of the types of childhood trauma we're talking about?

Jennifer Redding: So they're really broken down into three categories. There's abuse, there's neglect, and then there's what they call household dysfunction. So you can imagine any sort of physical, sexual, or emotional abuse, physical or emotional neglect, which is what I think we traditionally think about as childhood trauma, but they also incorporated something called household dysfunction, which a couple of examples would include whether your mother was treated violently, whether there was a household member that was abusing substances, whether there was untreated mental illness in your household, parental separation or divorce and, finally, if there was a household member that was incarcerated,

Alyne Ellis: Also people who could be sick. Is that correct?

Jennifer Redding: That wasn't exactly a category. When you say sick, certainly not physical illness, but they stressed untreated mental illness.

Alyne Ellis: Now within those three categories, when we break them down, how common is each one?

Jennifer Redding: Well, what they have found-- and so it's interesting, back in 2015, Maryland did a similar study and wanted to get information and data specific to Maryland. And what we found was that in Maryland, the data was pretty similar to the original ACEs study back in the '90s. And so roughly, the largest category that was prevalent in Maryland was those who had individuals in their household that abused substances. And what was also interesting and what matched the original study was in Maryland about 24% of the individuals surveyed had experienced three or more ACEs.

So you're doing screen, essentially they are a 10 ACEs. And so you can have a score from zero to 10. And to be quite honest, you only have to have experienced that event one time. It didn't matter. It wasn't weighted on whether you'd had exposure to physical or sexual abuse or any of the other items more than once. As long as you had experienced that event one time, it counted towards your ACE score. So again, a score of zero to 10, 10 being the highest score that you could possibly achieve. And so in Maryland, three or more ACEs, 24% of the individual surveyed had experienced those.

Alyne Ellis: Now experiencing something like this can really trigger problems later in life. And I'm wondering if you could talk a little bit about what's some of the ways these horrible triggers manifest themselves.

Jennifer Redding: Sure. What the study found was that ACEs are very common. ACEs frequently occur together. What they found is when there's one type of ACE, there's an 87% chance that there's going to be at least one other type of ACE that child has experienced in their lifetime. And so when the number of ACEs increases, you can imagine the number of health and behavioral health impacts. And so some examples would be folks who are smoking, abusing substances. As we get older into adulthood, there's absenteeism and poor work performance, lack of physical activity, risky sexual behavior, instability in relationships. So some things that, you know, you wouldn't normally associate with experiencing childhood trauma.

As far as what was interesting about the ACE study though, was that for the first time, it really helped to connect the dots as far as the physical health issues as well, that had never been really studied or connections have never been made. And so what they were finding is the higher your ACE score was as a child into adulthood, these folks were dealing and are dealing with obesity, diabetes, COPD, depression, all sorts of other health issues that folks don't normally associate with mental health and childhood trauma. So that's what's made it incredibly interesting.

And from a preventative standpoint, we want to prevent as many ACEs as possible because it impacts individuals into adulthood. And so that's what's fascinating about this information and what creates hope for us in the behavioral health field, because we're oftentimes working with adults who have all sorts challenges. And if we can get in front of that, that is even more hopeful and exciting, you know, to prevent some of impact.

Alyne Ellis: The other thing that can happen is some experience can trigger these reactions you're talking about. Can you talk a little bit about that?

Jennifer Redding: Sure. So the whole understanding about ACEs is that it's a chronic exposure to toxic stress. And so when as a child, and even as an adult, we're exposed to toxic stress over prolonged periods of time, it impacts the brain. So just to give you a little bit of information, the brain is equipped to deal with some pretty intense stress for about 20 minutes. If that stress occurs longer than 20 minutes, the brain, which really strives for equilibrium and balance is going to have to adapt. And so that's when our brain chemistry changes, because the brain isn't judging whether something is good or bad, it's just striving for that balance or that equilibrium.

And so after 20 minutes of extreme, toxic stress, which any of these ACEs that I've described can cause, the brain is going to adapt, the brain chemistry is going to change. And so that's where it becomes challenging. If this happens over and over again through a child's life or even through an adult's life, you can imagine, you know, the brain is just trying to adapt and cope and so that's where then some challenges happen.

I'll give you an example. Right now, we're in a COVID pandemic, so kids aren't in the classroom. But prior to that, when kids were sitting in the classroom, obviously the expectation is that a child sits at his or her desk, pays attention to the teacher, follows instructions. Well, a kid that has been exposed to adverse childhood experiences and toxic stress, their brain, if they've had any sort of exposure, which is trying to adapt, has a hard time sitting still. Because you can imagine if you're, fearing for your wellbeing, your safety, you become hypervigilant. And what that means is you're having a hard time sitting still. You want to move, you want to constantly be surveying your location and your scene.

And so a lot of times, kids that have been exposed to early childhood trauma look as if they have attention deficit issues. And so a lot of kids are getting diagnosed or their teacher is saying they have ADHD, attention deficit hyperactivity disorder, and some of those kids very well might, but what is important to understand is kids that have been exposed to trauma, adverse childhood experiences, their brains have adapted to help them survive, but sometimes that survival doesn't work well in traditional settings, such as a classroom where they're expected to sit quietly and still and pay attention because, you know, their brain is programmed themselves to try to survive.

But just to kind of give folks an understanding, another example, same thing, say child has been exposed to a number of adverse childhood experiences early on. They grow up, they've adapted they've navigated life. But what's interesting is sometimes there are certain professions that folks who have experienced childhood trauma can thrive in. So if you can imagine your brain is programmed to be hypervigilant. You're always surveying the scene. You're on alert. You're ready to kind of jump in and protect yourself or others if need be. Some of our folks that work in the emergency department, some of our first responders.

It's interesting and there's no judgment there how we adapt and work with what we are given in our brains. And sometimes those first responders who have learned to always be on alert, thrive and work really well, because of the changes in the brain chemistry,

Alyne Ellis: Well, it's really interesting, but of course, sometimes people don't thrive with this and either experienced depression or anxiety, as you've mentioned, or sleeping disorders. What kind of help is available? How can the crisis center, for example, help?

Jennifer Redding: You bring up a good point. And that's what I definitely want to highlight. Something that we kind of say in the field is that ACEs are not destiny. It's simply information. So sometimes, when folks hear about adverse childhood experiences, they want to understand and better understand their own childhoods.

And so for some, hearing that information and hearing the potential long-term effects can be very overwhelming and frightening. And so what I'm here to say is that the information I'm talking about today is simply information. And just because an individual has experienced any number of adverse childhood experiences, it does not mean they are doomed or they're destined to any or all of these negative health impacts.

There's absolutely hope. There's absolutely things that can be done. Specifically here at the Klein Family Harford Crisis Center, we have licensed clinicians and therapists and psychiatry providers who understand trauma, who can help folks work through whatever it is that they've experienced, whether it was early in life or even, you know, currently.

Oftentimes, individuals who've been exposed to adverse childhood experiences have all sorts of things going on and it plays out in different ways whether it's depression or anxiety and just having a hard time functioning in life. Not to mention the life that we're living right now with the COVID pandemic, it's completely disrupted all of our routines. I was talking to some folks the other day and these are folks that have adapted and are high functioning individuals, professionals, and they're just having a hard time doing the basics, you know, getting up, going to work, taking care of their children.

And I think, with routine and structure, most of us kind of get into a routine and can deal with life, but then you throw in a pandemic where all of our structure and our normal routines are disrupted and it really can be triggering.

And so we're seeing a lot of people come into the crisis center who had never received any sort of behavioral health support or treatment in the past because they're just having a hard time coping with life.

Alyne Ellis: So through medication and counseling, some of these triggers and ways of coping can be changed is what I think I hear you're saying.

Jennifer Redding: We always try to start with therapy. Medication is absolutely a resource, but not usually the first we go to. And for those who are impacted by substance use, we have peer recovery specialists who are folks that have kind of gone through a similar plight, but who have sought recovery and have stopped using substances and can sometimes relate to individuals better than others. So we have whole host of treatment professionals so that folks can get the support that they need.

Alyne Ellis: And it sounds like that support will ward off further depression or withdrawal, other things that might get much worse because it's not treated.

Jennifer Redding: Yeah. I think a lot of times folks feel like their experience is their own and that no one else is going through what they're going through. And what I'm here to say is that there are a lot of people who are struggling right now. It takes so much courage, but it's so important to reach out and ask for help because this doesn't have to be the way life is led forever.

There is hope. There is help. And we can absolutely help folks connect the dots and work through whatever it is they're experiencing.

Alyne Ellis: Well, thank you very much, Jennifer. This is particularly hopeful right now at this period of time and we really appreciate you speaking with us.

Jennifer Redding: Thank you for the opportunity.

Alyne Ellis: My guest has been Jennifer Redding, the Executive Director of Behavioral Health at UM Upper Chesapeake Health. For more information, please visit UMUCH.Org/behavioralhealth. I'm Alyne Ellis. Thank you for listening.