The Child Health Continuum

Wellness vs. Adverse Childhood Experiences

One of the common threads throughout Social Work is how no one is an island, a stand-alone, nor an independent unit, but is co-existing and co-participating within society as a whole. Therefore, it is essential to look at all of the members of a community as valuable and to help the struggling to regain the strength within themselves, and not to forget that if they are not supported, the effect it can have on the individual and society as a whole. One of the most impactful topics is of how adverse childhood experiences (ACE) effect wellness. This is a brief look at defining the health continuum in adults and children, how adverse childhood experiences can occur anywhere along that continuum, which can lead to children getting involved with the courts and foster care.

Before one can understand what is abnormal, it is essential to define what is normal, both physically and mentally. The principles of the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health.” (who.int) Thus, one is said to be on a health continuum, where wellness is more than the absence of disease. This process is called the Illness-Wellness Continuum, which is meant to work in harmony with the treatment paradigm.

The Illness-Wellness Continuum was first developed in 1972 by Dr. John Travis from U.S. Public Health Service Hospital in Baltimore, Maryland. The treatment paradigm involves being sick vs. absence of illness, which indicates wellness. The Illness-Wellness Continuum is more than being not sick but enjoying life. The treatment paradigm, which includes options like medications, surgery, psychotherapy, can alleviate symptoms of diseases. The wellness paradigm can move one toward higher levels of wellness and is not meant to replace the treatment paradigm, but to work in harmony with it. Treatment is still required for the sick, but it shouldn’t stop there, one should continue trying to achieve higher degrees of wellness: Wellness is not a static state. It is not so much where one is on the continuum, but the consistent actions toward improving, which does not mean never being sick again.

Defining good health can be complicated. Physical health is anything pertaining to the body. Mental health would refer to people’s cognitive and emotional well-being. Simply stated, good health would be a combination of both physical and mental health and would be exhibited in a person who does not have any physical or mental disorders.

Child health is even more specific. Concerning child health, it is a continuum which starts at conception continuing to the prenatal period and birth, then progressing to infant/toddler/school age developmental, physical, cognitive and social milestones, and ending at adulthood. If a child falls off of the health continuum at any point, the results can be called adverse childhood experiences (ACE). In 1998, the Kaiser Health Facility in Los Angeles did a study of ACE initially in 17,000 people. The study showed that early stress predicted chronic health problems in adults by compromising immune systems and speeding up disease processes causing premature aging.

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The ACE Study measures ten types of childhood traumas. Five are personal, including physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members, including one who is incarcerated, an alcoholic, experiencing domestic violence, or has a mental illness, and the disappearance of a parent through divorce, death or abandonment.

An evidence-based screening test was created to measure the number of these ACE traumas that an individual child has experienced. The test results in an overall ACE score that summarizes the number of ACE a child has suffered. Using the ACE score, one can identify likely effects on physical (various cancers, diabetes, heart and lung diseases) and emotional health (alcoholism, drug abuse, depression). A high ACE score can indicate the likely presence of these physical and mental effects that can culminate with the early death of twenty years younger than the average population.

Although some stress benefits and prepares children for future challenges, trauma and chronic, constant stress can affect developing brains. Trauma causes the amygdala, the brain’s alarm system, to engage, triggering the fight or flight mechanism, referred to as the autonomic nervous system. It is important to note that adults and children experience stress differently. Adults can regulate initial reactions to stress using coping mechanisms from previous experiences, but these coping mechanisms have not yet developed in children. Unresolved stores of stress-related hormones released by the brain’s activated amygdala during stress stimulate diseases.

Children do not always remember every adverse experience, but their bodies do, which can cause long-term harm to physical and mental health, and they do not just “get over it” when they become adults. There are four ways trauma can overload a child’s developing system. These four ways are stress hormones increases, immune system changes, neurological changes, and epigenetic changes.

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According to Harvard University’s Center for the Developing Child, the first change is the hormones. These include the often referred to as the “stress hormones,” cortisol and adrenaline. These hormones that help one’s response to danger, and have the most significant impact during brain development, especially if they remain at high levels for long periods. The second change is a compromised immune system. The results are increased susceptibility to infections, allergies, and inflammatory reactions. The third change is possible neurological deficits, which can involve vision, hearing, language, and cognitive ability. The final change is regarding epigenetics since one’s environment, and stress levels affect which genes turn on and off. Although there are undoubtedly many negative aspects of adverse childhood experiences, prior to the ACE Study, people with high ACE scores often reported various physical and mental health issues, but they lacked a concise way to communicate the impact of these experiences. Knowing one’s ACE score has subsequently streamlined communications with their health care providers, resulting in Trauma-Informed Care. Another benefit is that besides a freeing feeling from recognizing that all of these seemingly unconnected physical and mental health issues occurred from adverse childhood experiences, knowing one’s ACE score can increase one’s self-understanding and can improve the effectiveness of treatment, including therapy, if necessary.

An exciting aspect of the brain’s self-healing is called neuroplasticity, which is the rewiring and development of new coping skills. One of the best ways to heal from trauma is from resilient thinking. Resiliency is learned, and people can be taught to bounce back from adversity, accept change, actively move towards goals, self-nurture using exercise, nutrition, getting adequate sleep. The good news is that through the knowledge that the body and brain had been harmed by the biological impact of early emotional trauma, one can move toward reducing early adversity. ACE scores do not have to be a life sentence. Even if one has been set on high reactive mode for decades or a lifetime, it can still be dialed down. Additionally, the knowledge of ACE scores can be incorporated into public policy to prevent childhood trauma, promote resiliency to improve physical and mental health. For children, having a resilient parent, or consistent caregiver, who understands good parenting and child development, can be protective.

 

About Dr. Allegra Alexandra Powell MD

Dr. Allegra Alexandra Powell MD is a Physician and Social Activist with a passion for education, who holds five degrees and is a member of the Phi Theta Kappa Honor Society and was recently inducted into the National Society of Collegiate Scholars. As an AmeriCorps member and volunteer with several nonprofit organizations, Dr. Powell’s work in the community supports children and the fight against hunger.

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