The Impact of Childhood Adversity - ACEs

Approximately one year ago at an area resource teacher meeting, I was introduced to the concept of Adverse Childhood Experiences (What are ACEs?). We watched Dr. Nadine Burke Harris’ TED Talk on how childhood trauma affects health across a lifetime:

Childhood trauma isn't something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain.

In our course readings, I found it fascinating to read about the origins of the ACE Study and how it was derived from treating patients for obesity who also had links to traumatic experiences such as sexual abuse and other types of abusive childhood experiences. Dr. Felitti and Dr. Anda were the two co-principal investigators. Felitti (2019) states, “The purpose of the ACE Study was to determine the prevalence of ACE in a general population and how they played out in adults decades later” (p. 788).

As an educator, I think that it is extremely important to be aware of the fact that many of our students are facing childhood adversity. Through our course work and the Brain Story Certification course, we have learned that a supportive, responsive adult with a positive relationship with the child in question can actually help to buffer and reduce some of the effects of toxic stress and ACEs.

In a recent interview with Dr. Nadine Burke Harris, she advocates for teachers to have the proper training to be able to recognize the symptoms of an overactive stress response in order to improve outcomes for students through early detection and intervention:

Well, what it starts with is training for every teacher, every police officer, every judge, every lawyer, every mom, every dad, every aunty, every uncle to be able to, number one, for example recognize that when a child is or a young person is showing up in school and they may be showing symptoms of an overactive stress response, right, so they may be having different — difficulty with impulse control or an angry outbursts or something along those lines. Instead of being responded to with more anger, negative, punitive policies and responses, we start to — we can ask the question of this young person instead of what is wrong with you, what happened to you, right. We can have the opportunity for educators to recognize their opportunity to be a nurturing buffer to that young person.

Furthermore, Dr. Burke Harris is now advocating to screen every student for trauma before they enter school. She states, “The opportunity ahead of us is about a true intersection of health care and education” (Gaines, 2019). I think that this is a revolutionary proposal that would not only help students, but it would help teachers to know how to teach to the students, with a compassionate understanding of their background. Many students with a trauma background present with symptoms of ADHD and other disorders, when in fact, it is the ACEs that they have experienced in the past that is causing their behaviours.

References

Burke Harris, N. (2014, June). How childhood trauma affects health across a lifetime [Video file]. Retrieved from https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare

Felitti, V. (2019). Origins of the ACE Study. American Journal of Preventive Medicine, 56(6), 787-798. 

Gaines, P. (2019, October 11). California's first surgeon general: Screen every student for childhood trauma. Retrieved October 15, 2019, from https://www.nbcnews.com/news/nbcblk/california-s-first-surgeon-general-screen-every-student-childhood-trauma-n1064286?fbclid=IwAR2qZIpD0czErLMuKFc0cMSlBzuuRdecUpg9Kp-ayGhLENuAp_BHj71Ayp4

PBS. (2019). Nadine Burke Harris on the Impact of Childhood Adversity. Retrieved October 15, 2019, from https://www.pbs.org/wnet/amanpour-and-company/video/nadine-burke-harris-on-the-impact-of-childhood-adversity/?fbclid=IwAR1suwUzQXr1CWzjPbc8U7jDxAnuZlVUQJ1zjTSwOjvDKn8FoQvH2Mg4qLU

What Are ACEs? And How Do They Relate to Toxic Stress? (n.d.). Retrieved October 15, 2019, from https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

Brain Story: Module 7 - Interventions Addressing Child Maltreatment & Neglect

In the Brain Story Certification, Module 7, video 4, Patricia Van Horn, PhD speaks about Child-Caregiver Interventions for Traumatized Children. She speaks about three main principles that underlie child-parent psychotherapy:

  1. In the first five years of life, it’s the attachment system that organizes children’s response to threats and danger.

  2. When very young children have emotional and behavioural problems, those problems are best addressed in the context of the child’s caregiving relationship.

  3. When treatments benefit caregivers as well as children, the trajectory of healthy development can continue long after the intervention ends.

The main goal of child-parent psychotherapy is to restore a child who’s been exposed to toxic stress to a positive developmental trajectory. Through her work and research, she found that child-parent psychotherapy was effective, even for children who had four or more adverse childhood experiences. (What are ACEs?)

This got me thinking about the role teachers play, not as a child’s main caregiver, but as people who are integral to their students’ development and who form strong attachments. Many students have emotional and behavioural problems at school, and we know that the student-teacher relationship needs to be strong for learning to be optimized. Students need to trust their teachers and respect their direction and choices. Students learn life skills at school and these skills certainly factor in to healthy development that may continue long after students leave grade school.

So how do we, as teachers, gain the trust of our students? It doesn’t have to be complicated. Even the smallest of interventions, such as greeting your students at the door in the morning, can go a long way. The key is to find an intervention that builds trust. In our course readings, the book Making Space for Learning has several suggestions for intervention currently used by teachers. Here are a few that stood out to me for working with traumatized children (with some personal examples):

  • Give consideration to the benefit of the student being placed in another class on days where a casual replacement teacher is in attendance. The other class would be taken by a teacher with whom the student has an established connection.

  • Build in regular resources that enable the teacher to spend one-on-one time listening, talking and/or drawing with the student.

  • Provide explicit commentary, modelling or coaching of strategies to manage stressful situations. Model and discuss your own calming strategies within the classroom.

  • Provide a range of methods to reinforce behavioural expectations, including visual, auditory, sensory, words and pictures. (I use the CHAMPS classroom management strategy)

CHAMPS classroom management strategy. The teacher simply moves the round magnet to the expectation.

CHAMPS classroom management strategy. The teacher simply moves the round magnet to the expectation.

  • Do a check-in at the start of each week and each term: “What do you remember from last week/term? What stands out? Why? What would you like to be the same this week/term? Why would you like to be different?” This allows for a quick social / emotional check to see how students are feeling and guarantees a check-in period. You could do this daily as well. Here is what I use for this purpose:

These are just a few examples that are universal in design and could be used as interventions, not only for students with a trauma background, but for all students. Best practice benefits all students and will help to form strong student-teacher relationships based on trust.

References

Edutopia. (2019, May 17). 60-Second Strategy: Do Now Sheets. Retrieved October 14, 2019, from https://www.edutopia.org/video/60-second-strategy-do-now-sheets

What Are ACEs? And How Do They Relate to Toxic Stress? (n.d.). Retrieved October 15, 2019, from https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

Types of Stress & Teaching Children

In Module 5 of the Brain Story Certification, three types of stress are explained. The first, called positive stress, is beneficial because it prepares the brain and body for stressful situations later in life. The second, called tolerable stress, is triggered by more serious events, however support from caregivers can buffer the severity of the stress response, help keep stress levels regulated, and should not cause any lasting damage to the child’s brain and body. The third type of stress is toxic stress which occurs during repeated exposure to bad situations, like abuse. If there are no supportive adults to help buffer the stress response, the hormone levels in the body stay dangerously high. Toxic stress can cause serious health problems later in life such as an increased sensitivity to stress, increased levels of inflammation, and glucocorticoid resistance.

staircase

Students bring varying levels of stress to school every day. Teachers notice when a student is behaving differently than they usually do, and in my experience, this is usually an indication that the student has some underlying stress in their life. Research has proven that negative, stressful experiences can weaken brain architecture. Teachers and schools provide safe spaces for students and it is essential that schools continuously work to maintain a caring learning environment because even extreme stresses will be tolerable stresses if they are adequately buffered by supportive caring adults. This starts with forming positive relationships with students so that they feel confident to let teachers know that they are struggling. In my classroom, I have a Mental Health check-in poster where students can privately indicate how they are doing from, “I’m great!” to “I need a check-in”. This has been very effective for my students and for me as I can keep a pulse on the stress levels in my classroom and can offer support or referrals to services that they may need such as counselling. Relationships are formed and strengthened and I believe that I am able to buffer at least some of their stress.

Lightbulb Moment

The Boy Who Was Raised as a Dog - Dr. Bruce Perry

Chapter 2 - For Your Own Good

In chapter 2, Dr. Perry writes about the responses of traumatized children and how they are often misinterpreted. I found the discussion around what is “normal” to youth who have been through trauma a lightbulb moment for me as a teacher. For example, many times the homes of traumatized youth are chaotic and unpredictable and when these youth are in a calm and safe situation, such as a school and classroom, they are actually fearful. Because of this fear, some youth may behave defiantly and destructively in an effort to recreate the environments that they are used to. Traumatized youth may be used to such things as screaming and harsh discipline and they feel more comfortable with what is familiar to them.

lightbulb moment

Cue lightbulb moment! Over the years, teaching middle school, I have taught students who I know have lived, and in some cases, are living traumatic, chaotic lives. More often that not, these students are disruptive, loud, have difficulty following directions, and rarely complete school work. Many of them display symptoms consistent with Attention Deficit Hyperactivity Disorder and/or Oppositional Defiant Disorder, however, their behaviours are actually a result of the trauma that they have endured and not a disorder. Teachers cannot ignore these behaviours and what ends up happening is that the student is disciplined. At times, a teacher may reach the point of frustration where their voice raises and they feel provoked by the student which results in an escalated, chaotic situation; just what the student wants whether they know it or not.

It is crucial for teachers to understand and be aware of the students in their classrooms who have a history of trauma . Teachers must cultivate strong relationships with these students and give them a chance in the classroom setting. This requires adjusting expectations. Teachers must consider empathy and acceptance as well, and help all of our students learn alongside each other.