The effects of childhood trauma resonate throughout a person's life, influencing their physical, mental, and emotional well-being. A pivotal study by Kaiser Permanente and the Centers for Disease Control (CDC) examined 9,508 individuals to understand the impact of Adverse Childhood Experiences (ACEs). This ten-question assessment revealed the profound consequences of early trauma and highlighted the need for effective interventions.
Understanding ACEs
The assessment measured eight types of ACEs: emotional, physical, and sexual abuse; physical and emotional neglect; and family disruptions such as incarceration, mental illness, substance abuse, intimate partner violence, divorce, and parental separation. Each type of adverse experience a respondent encountered added a point to their ACE score. The results were alarming. Individuals with four or more ACEs were four to twelve times more likely to face health issues, substance abuse, depression, and suicide attempts. They were also significantly more likely to smoke, have poor self-image, engage in risky sexual behavior, and suffer from sexually transmitted diseases.
The Long-Term Health Risks
Those with high ACE scores are at a greater risk for numerous diseases, including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. One in six adults has experienced four or more ACEs, which are linked to five of the top ten causes of death in the United States. A staggering 61% of Americans have at least one ACE, while 16% have four or more. High ACE scores are also associated with lifelong pathology and increased dysregulation during stressful events, such as the COVID-19 pandemic.
Developmental Trauma and the Brain
Children repeatedly exposed to trauma may meet the criteria for developmental trauma, characterized by disruptions in primary caregiving, chronic caregiver dysregulation, community violence, and various forms of abuse. These traumatic events impact brain structure and function, leading to potential neurobiological impairments. The brain develops rapidly in the first four years of life, making early ACEs particularly disruptive. Trauma during these critical periods can cause lasting changes in brain organization and function.
The brain's development follows a sequential path, beginning with the medulla and progressing through the pons, diencephalon, limbic system, and cortex. Interruptions during early developmental stages can cause more profound disruptions than adverse experiences later in life. Trauma can lead to a persistent state of hypervigilance, with the brainstem becoming oversensitive and overreactive, often resulting in behaviors like dissociation and hypervigilance as normal survival responses.
Prevention and Treatment
While numerous prevention plans aim to reduce ACEs for future generations, few treatment recommendations address developmental trauma. The CDC's ACE prevention plan focuses on education about ACE-associated health conditions and leveraging community resources like coaches, schools, and mental health workers.
Felitti, the lead researcher of the ACE study, recommended treatments such as eye-movement desensitization and reprocessing (EMDR), Ericksonian hypnotherapy, and psychoeducation from websites like ACES Too High and ACES Connection. Reading materials like "The Body Keeps Score" by Bessel van der Kolk and "Scared Sick" by Robin Karr-Morse also offer insights into healing from trauma.
However, these treatments often overlook developmental delays. Effective trauma treatment must address the brain's development from the bottom up. Interventions should begin with the medulla, targeting self-regulation skills through rhythmic, repetitive, and somatosensory activities such as nature walks, dance, drumming, sports, massage, trauma-informed yoga, play, tactile therapies, and art therapies. After addressing brainstem deficits, treatments can then focus on the diencephalon, limbic system, and neocortex.
The Need for a Comprehensive Protocol
Despite the availability of assessment tools like the Neurosequential Model of Therapeutics (NMT), which maps delays in neurosequential brain development, there is no standardized therapy addressing these neurodevelopment gaps. Current treatment plans must evolve to include comprehensive protocols that target neurodevelopmental trauma effectively.
The high incidence of ACEs and their association with severe health outcomes underscore the urgent need for standardized treatment protocols. Research must continue to develop and refine these models, ensuring they address the complex and lifelong effects of childhood trauma.
Conclusion
The legacy of childhood trauma can shape a person's entire life, but with the right interventions, healing is possible. By understanding ACEs and developing targeted treatments, we can mitigate the profound impacts of early adverse experiences and help individuals lead healthier, more fulfilling lives. Dr. Dunkin has written a theoretical treatment plan to address the five levels of the brain that are impacted by developmental trauma and high ACE scores. Stay tuned for this series and learn how we address the medulla, pons, diencephalon, limbic system, and the cortex.
