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Adverse Childhood Experiences (ACEs) 

Not sure exactly which tangent I'll explore in this thread. For those who are unfamiliar with the description used in the content warning or who may have missed it in my earlier thread, this short talk by Nadine Burke Harris is the best brief introduction to ACEs I've found anywhere. If you have seen it (or read the transcript) take a moment to do so.

ted.com/talks/nadine_burke_har

Adverse Childhood Experiences (ACEs) 

I think I want to begin by noting that childhood adversity, trauma, and toxic stress in this context are not narrowly focused only on abuse and neglect.

It's theoretically possible to be somewhere in the higher risk group (4+ ACEs) without having experienced any childhood abuse or neglect.

Given what the other 5 adversities say about the household, it's unlikely, but it is theoretically possible.

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Adverse Childhood Experiences (ACEs) 

Abuse, of course, violates the integrity of a child's self, their being, and often their body. And it's most often inflicted by a caregiver or trusted adult so it carries the added weight of creating a sense of separation from the caregiver, which compounds the damage.

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Adverse Childhood Experiences (ACEs) 

I like the fact that the ACEs carefully tease out emotional neglect as something separate and distinct. Too often, childhood emotional neglect is lumped in as "emotional abuse and neglect" and then only the abuse portion is ever discussed.

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Adverse Childhood Experiences (ACEs) 

Jonice Webb's work, captured in "Running on Empty" and its sequel, "Running on Empty No More" bring to light the hidden elements of childhood emotional neglect, mostly felt as an absence, the things you don't remember from your childhood because they didn't happen. She has a questionnaire to bring elements of the hidden to light.

drjonicewebb.com/cen-questionn

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Adverse Childhood Experiences (ACEs) 

All 10 ACEs create an ongoing environment for the child in which they increasingly lack reliable caregiver support. We are highly social creatures who learn how to be human from our caregivers during an extended period where we are also utterly dependent on them. Threats to that environment activate a child's fight or flight mechanisms, are felt as an existential threat, even in the absence of overt harm to the child.

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Adverse Childhood Experiences (ACEs) 

Activation of the body's stress response (often known as fight/flight/freeze) sets off a firestorm of chemicals as the body prepares to defend itself. And when it happens, the body remembers.

Bessel van der Kolk's decades of research at the Trauma Center, much of it captured in "The Body Keeps the Score" is something I highly recommend.

However, a child's body is still developing and repeated activation alters the course of that development.

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Adverse Childhood Experiences (ACEs) 

Our stress response system is extremely complicated. Nadine Burke Harris outlines some of the key players in her book. I won't pretend a deep understanding myself.

But it includes the amygdala, the prefrontal cortex, the hypothalamic-pituitary-adrenal axis, sympatho-adrenomedullary axis, hippocampus, and noradrenergic nucleus in the locus coeruleus.

And yeah, if your eyes glaze over that's normal. It's a lot for me and I've even read about some in the past.

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Adverse Childhood Experiences (ACEs) 

She provides a simplified lay description of each in her book that I found pretty good. But honestly? You get the essence of the function of each from the video of her talk.

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Adverse Childhood Experiences (ACEs) 

Here's where the definitions of positive, tolerable, and toxic stress become critical.

"Positive stress response is a normal and essential part of healthy development, characterized by brief increases in heart rate and mild elevations in hormone levels. Some situations that might trigger a positive stress response are the first day with a new caregiver or receiving an injected immunization."

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Adverse Childhood Experiences (ACEs) 

"Tolerable stress response activates the body's alert systems to a greater degree as a result of more severe, longer-lasting difficulties, such as the loss of a loved one, a natural disaster, or a frightening injury. If the activation is time-limited and buffered by relationships with adults who help the child adapt, the brain and other organs recover from what might otherwise be damaging effects."

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Adverse Childhood Experiences (ACEs) 

"Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity -- such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship -- without adequate adult support. (cont.)"

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Adverse Childhood Experiences (ACEs) 

"This kind of prolonged activation of the stress-response systems can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into adult years."

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Adverse Childhood Experiences (ACEs) 

Both positive and tolerable stress experiences are normal and necessary for the healthy development of a person's stress response system.

With every ACE, the risk of tolerable stress sliding into toxic stress increases. Remember, the single greatest factor that can keep stress tolerable for a child is support from a loving caregiver. ACEs represent ways those supports can be stripped from a child.

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Adverse Childhood Experiences (ACEs) 

There is one statistic that captures the essence of the lifetime impact of ACEs.

"The life expectancy of individuals with ACE scores of six or more is twenty years shorter than it is for people with no ACEs."

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Adverse Childhood Experiences (ACEs) 

For children and ACE score of four or more means they are thirty-two times more likely to have learning or behavior problems. A lot of those kids today are being referred for ADHD diagnosis, but since the underlying issue for some of them isn't ADHD, intervention and treatment isn't helpful. Treating the wrong thing rarely works.

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Adverse Childhood Experiences (ACEs) 

Okay, so what changes in a child? When the amygdala is repeatedly triggered by chronic stressors, it begins reacting to things that aren't objectively 'scary' and can grow enlarged. (Brains are more complicated than a simple correlation like that.) It starts sending out false alarms.

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Adverse Childhood Experiences (ACEs) 

And yes, I have considered the studies of autistic children @Schusfuster asked about this morning. Correlation is a tricky thing. Is the increased reaction by autistic kids and enlarged amygdala a cause? Or is it the result and basically the same cause as what we see here.

See anything I write about how hostile the world is to an autistic child. And definitely read my thread on ABA, the "therapy" for autistic kids today.

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Adverse Childhood Experiences (ACEs) 

I realized the way I wrote that may have been unclear. I think the path the researchers are on, that an enlarged amygdala associated with [something, something] AUTISM makes a child more sensitive, flips the cause and effect. If not, their methodology cannot show it.

Rather, I believe the more plausible explanation is that autistic kids demonstrate the normal physiological effects we would expect with any child experiencing chronic stress response activation.

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Adverse Childhood Experiences (ACEs) 

And as I sit here trying to be more aware of my body, something with which I'm still struggling after two and a half years of therapy, I realize my jaw is clenched, my heart rate has increased, my chest is tighter, and breathing differently.

It's not a traumatic stress response. Those tend to be more staticky for me. It's not fear. I'm pretty sure I'm angry.

And that makes sense. Autistic kids still aren't *seen*, at least not as full humans.

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Adverse Childhood Experiences (ACEs) 

The locus coeruleus controls the brain's version of adrenaline. When it's dysregulated, a person is prone to increased anxiety, arousal, and aggression.

I like this phrasing.

"It can also seriously mess with your sleep-wake cycles by overloading your system with hormones that tell it to remain vigilant because (hello!) a bear is in your cave."

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Adverse Childhood Experiences (ACEs) 

@tmorizot hrm. So bullying is not abuse?

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster I have no idea what you're asking. I've discussed my experience of "bullying" (my experience doesn't really fit the traditional, narrower sense of the term) elsewhere, though perhaps not on this platform. It's a form of normally peer-based violence (physical and/or verbal/emotional) and is traumatic at any age.

It's not an ACE and limited research to date has pointed toward it and other factors being amplified or mitigated by household.

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster In other words, the impact of factors outside the household when they've tracked them (bullying, extreme poverty, racism, gun violence in neighborhood) do not show an independent dose-related risk increase in health outcomes. They tend to vary with the core 10 ACEs. There is a quarter century of large scale population data across many studies at this juncture. It's a lot of data. I've barely scratched the surface myself.

Adverse Childhood Experiences (ACEs), bullying 

@tmorizot so, how my home life supported me (or didn't) especially in a context of undiagnosed autism, just created fertile ground for the bullying, rather than vice versa?

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster I may do a thread on my experience in that area at some point because long before diagnosis, I was never comfortable with the language and context of "bullying". The way it was described in discussions with others, in literature, and in media didn't fit what I remembered experiencing. Post-diagnosis, I think I understand why. But that's more particular to my particular childhood autistic experience.

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster In general terms, though, a child who both has active loving caregiver support and who understands they can rely on it can experience both direct intervention to lessen bullying and support to mitigate its effects. Research is early, but that's the working hypothesis I see about why it's impact seems to be dependent on the core ACE score rather than independent as they are.

Adverse Childhood Experiences (ACEs), bullying 

@tmorizot yeah, I was told to ignore the bullies and they would lose interest. This did not occur.

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster "Bullies" were the background noise of my childhood. I was pretty good at managing them, so much so they are there but don't impinge much on my memory. They were like an obstacle course I had to navigate every single day from the day I first started school. It's the hostility and attacks from my "friends" and the hostility, passive or active, of adults that stand out for me.

Adverse Childhood Experiences (ACEs), bullying 

@tmorizot I was definitely bullied at length. But I also tend to perceive raised voices as anger / shouting, and conflict makes me lock up, which probably developed out of my home life.

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster Yeah. Hyper-sensitivity to conflict flows from a host of places for me. I tend to work through and talk about the ways ACEs impacted me, my current experience of complex PTSD, and my autistic experience separately because it's the only way I can tackle the gordian knot. Until my ASD diagnosis, it was all just a huge mass with which I never could do anything but try to bear up under it.

Adverse Childhood Experiences (ACEs), bullying 

@Schusfuster But as I remember writing recently, they aren't separate things. First, of course, my autistic experience defines how I perceive the world and pervades all aspects of the ways I process it and respond to it. I was the autistic child who experienced it all. So my actual interwoven experience is that of the abused, autistic child living in a hostile and chaotic environment.

Adverse Childhood Experiences (ACEs) 

@tmorizot how does this intersect with studies of increased amygdala response and development in autistic children, leading to a greater / easier incidence of PTSD like symptoms from lesser circumstances?

Adverse Childhood Experiences (ACEs) 

@Schusfuster ACEs aren't about PTSD. The changes in a child's brain and body run even deeper than that. That's what the research in that area is showing. PTSD is also a problem, especially complex childhood PTSD and "The Body Keeps the Score" delves deeply into that area. PTSD is mostly related to a combination of activation of the stress response system at any age combined with the inability to act in any way, real or perceived.

Adverse Childhood Experiences (ACEs) 

@Schusfuster Also, as Davidson notes in the On Being interview I discussed yesterday, an enlarged amygdala is also associated with increased altruism. (He specifically referenced a study of people who donated kidneys to unrelated people.) That seems to be associated with greater empathy, a heightened ability to feel the suffering of others.

Brains are complicated.

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