During my two years off from medical school, I've been volunteering as a court appointed special advocate for children in the foster care system. And I’ve spent a lot of time reading about how these kids' experiences could affect the rest of their lives.
The seminal research on this happened in the late ‘90s using data from more 17,000 Kaiser patients. What the researchers found was that patients who reported more adverse childhood experiences were more likely to suffer from such long-term medical conditions as heart disease, liver disease, stroke, diabetes and chronic obstructive pulmonary disease – diseases that no one thought were related to childhood abuse or neglect. These same patients were also at higher risk of depression, financial stress, smoking and suicide. As I read this research, I kept thinking: What’s the link? And what can we do?
Those in the field have come up with a list of ten adverse childhood experiences (including such things as emotional abuse and neglect, physical abuse and neglect, sexual abuse, and mental illness in the household), and according to the research, the more of these that a child is exposed to, the more impairment that they'll sustain in their social, emotional and cognitive development. More studies are needed, but researchers think the way this happens on a biological level is that the stress response system gets up-regulated. This means that the child’s body responds to any small stress as though it is a big stress, and the child goes about his or her day unable to concentrate, relax or feel safe.
The next step is that these children grow into adults that are more likely to adopt high-risk behaviors. Again, more research is needed, but so far our understanding is that children who grow up learning that they deserve to be treated poorly can carry that into their behavior as adults. It doesn’t mean that they choose to hurt themselves but rather that they find themselves in situations that may not be safe. For example, a child who grows up in a traumatic home may run away from home as a teenager, end up sleeping in a dark alley and get sexually assaulted.
The adults that these children have grown up to become are now more likely to have long-term medical illnesses, disability, and social problems. This link is clear in the research and well understood. And the next step is that people with multiple medical problems tend to suffer from an early death.
So what can we do?
A recent review of the literature identified things that patients and health-care providers can do to help. Aside from prevention, which is an area I work in as a court appointed special advocate, all is not lost for adults who grew up with difficult lives. Cognitive behavioral therapy has been shown to be the most effective tool to help these adults. Other tools that can help are expressive writing and mindfulness based meditation.
The good news is that healing can occur. People who have experienced trauma can recover their ability to relax and feel safe when they have repeated positive experiences. This could be by building up their confidence in themselves with playing musical instruments or sports, or it can be by building their confidence in other people. Repeatedly having positive interactions with classmates, co-workers or neighbors can be processed by the brain as evidence of the goodness in the world.
After working with foster children for two years, I believe more than ever in our ability to heal. And I feel hopeful that the children I've worked with can grow up to be functional adults with meaningful, fulfilling lives.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Natalia Birgisson is a fourth-year medical student at Stanford. She is in her second year off and writing her first novel, which is described on her site.
Photo by Randy Heinitz