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It was the third ear infection for the nine-month-old and he had also had two bouts of pneumonia.
Molly and Ryan were young parents, but completely doting and caring, and to me they seemed as close-knit as the Cleavers.
Two weeks later when I saw that both kids were on my schedule for their physicals, I smiled instantly.
Molly’s only concern was Lila’s growth.
According to the paperwork, Lila had an ACE score of seven and her nine-month-old brother’s score was five.
“So you’ve heard of ACEs before?” I asked, a little perplexed. “No, but when I read about it on the piece of paper, it made total sense.” She confirmed that her kids’ ACE scores really were seven and five.
Her dad had times when he would be away from the house, and it seemed like when he was away, her weight would pick up a little bit, but when he came back, it would fall off again.
There has definitely been a lot of stress in our house.”
If it wasn’t for the ACE scores, no one would have suspected that Lila and her brother were at such high risk for so many health and developmental problems. Possibly they might have
gotten some attention if they’d started to show behavioral problems in preschool, but even in that case, it’s likely they would have been diagnosed with ADHD and been funneled down the medication path.
the underlying problem would likely have gone undetected and untreated.
Guthrie had shown that the only way to radically move the needle on patient outcomes is to screen universally, because otherwise you are relying on chance:
early intervention is needed to treat the condition successfully, but what about ACEs and toxic stress? It’s actually just as clear.
come), but the later we start, the more intensive (and expensive) the treatment
Cellular plasticity, however, is a change in the number of brain cells that are talking to each other, the difference between one person shouting and a whole stadium shouting.
cellular plasticity happens most rapidly in the first years of life. About 90 percent occurs by the time a child turns six, but the rest of it stretches out until about age twenty-five.
Babies are born with an oversupply of brain cells and the brain also goes through a pruning process.
Our experiences, both positive and harmful,
determine which brain pathways are activated and continue to strengthen over time. In that sense, early experiences literally shape the brain.
But if we can identify kids who are at high risk for toxic stress early enough, we can intervene in time to take advantage of high levels of both synaptic and cellular plasticity.
hormonal changes occurring in adolescence, pregnancy, and new parenthood open up windows of neuroplasticity that are believed to be additional sensitive periods.
All of these hormones stimulate synaptic plasticity, biochemically enhancing the ability to learn and adapt to one’s environment. These times represent special opportunities for healing, moments when enriching experiences have an even better shot at being “wired in.”
We call this our “de-identified” screen because it doesn’t identify the individual ACEs,
our experience in Bayview told us that our patients faced other adversities that repeatedly activated their stress-response systems.
Informed by these insights, we reworked our screening tool to include other factors that we believe may also increase the risk for toxic stress.
Community violence Homelessness Discrimination Foster care Bullying Repeated medical procedures or life-threatening illness Death of caregiver Loss of caregiver due to deportation or migration In our teen screener, we also include the following: Verbal or physical violence from a romantic partner Youth incarceration
data suggests that if a child grows up in a stressful community environment but has a well-supported
supported and healthy caregiver, he or she is much more likely to stay in the tolerable stress zone as opposed to the toxic stress zone.
Lila’s screen, all I saw was that her score was a seven plus zero (seven for the traditional ACE score and ze...
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brought Lila’s case to multidisciplinary rounds with a recommendation that she start child-parent psychotherapy.
within the first twenty-four hours of Cal’s life, his skin started to turn yellow. Sue and her husband were told not to worry, as jaundice was quite common in infants.
Even though a blood test existed to measure bilirubin levels, it wasn’t used routinely.
parents were simply given a pamphlet as they left the hospital that suggested putting the baby near a window for sunlight. Nowhere in the pamphlet did it say that jaundice could lead to brain damage.
Finally, he was admitted to the hospital and started on phototherapy. However, the treatment of Cal’s jaundice didn’t begin until it was too late.
Cal had displayed all of the classic signs of kernicterus, a condition that occurs when bilirubin gets too high and crosses the blood-brain barrier, leading to severe brain damage. Sheridan literally watched as her baby’s brain was being overcome by neurotoxicity that could have been prevented. It was an experience that would haunt her for the rest of her life.
the disorder meant that he developed cerebral palsy, hearing loss, crossed eyes, and speech impairment, among other abnormalities, and would need care for the rest of his life.
the urgency of Cal’s condition wasn’t recognized until the damage was done.
She hit the road to campaign for universal bilirubin screening,
we made our screening protocol available for free online.
how to screen, what to do with a positive screen, and how to advance the care of children with toxic stress faster.
We have to continue to refine the protocols, catch problems early, and treat our most vulnerable patients with everything we’ve got.
I realized how being in the company of people with big dreams was feeding my resolve to do something similarly big about ACEs.
I continued to see one particularly vexing issue: media reports invariably presented toxic stress as if it happened only in poor neighborhoods.
every article I received contained some version of “the toxic stress of poverty.”
“I think the problem is that it’s just so behind the scenes in other communities. I mean, my dad was an alcoholic, and it was really brutal. But he could hold down a job, so no one knew.”
but what struck me was how hidden it had been.
“Look, this is going to be hard to hear, but your child is lacking the protections of childhood,” he said. “What does that mean?” Caroline asked. “He’s being exposed to psychological trauma. He needs a more peaceful, less stressful environment. We believe that is what’s contributing to his ADHD.”
Nick ignored everything but the term ADHD, and while he was great about making sure Karl got his Ritalin, he told her the rest of what the doctor said was bullshit.
Caroline was disturbed that her son seemed “totally zombified.”
When Caroline started having what she thought were panic attacks in the middle of the night, she began to wonder if maybe she was the problem.
