A DvT-based clinical assessment of toxic stress in young children

2020 ◽  
Vol 7 (2) ◽  
pp. 207-221
Author(s):  
David Read Johnson ◽  
Renée Pitre ◽  
Catherine Davis
Keyword(s):  
Young Children ◽  
Clinical Assessment ◽  
Assessment Procedure ◽  
Toxic Stress ◽  
Ethical Considerations ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Physical Threat ◽  
Prior Experiences

A clinical assessment procedure is described for identifying possible sources of toxic stress among young children (ages 3–10), using a semi-structured modification of Developmental Transformations. This modification consists of improvisational play combined with a pre-determined sequence of roles symbolic of common adverse childhood experiences of neglect or emotional or physical threat. While conducting this procedure, the therapist carefully observes the client’s responses within the play to note the presence of play disruptions (e.g. hesitation, shift of scene and/or emotional arousal). These shifts may arise from prior experiences that remain distressing to the client and might merit further exploration. A review of the literature concerning toxic stress and assessments of children (particularly those that are play-based), along with an illustration of the clinical assessment, are presented. Strategies for follow-up and early intervention possibilities are highlighted. Key ethical considerations of this procedure are also discussed.

Adverse Childhood Experiences and Obesity Among Young Children with Neurodevelopmental Delays

2020 ◽  
Vol 24 (8) ◽  
pp. 1057-1064 ◽  
Author(s):  
Krista Mehari ◽  
Sandhyaa S. Iyengar ◽  
Kristin L. Berg ◽  
Jose M. Gonzales ◽  
Amanda E. Bennett
Keyword(s):  
Young Children ◽  
Adverse Childhood Experiences ◽  
Childhood Experiences ◽  
Adverse Childhood

scholarly journals Associations of Adverse Childhood Experiences with Executive Function and Brain-Derived Neurotrophic Factor

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1034-1035
Author(s):  
Cindy Tsotsoros ◽  
Madison Stout ◽  
Misty Hawkins
Keyword(s):  
Executive Function ◽  
Adverse Childhood Experiences ◽  
Cognitive Tasks ◽  
Neurocognitive Performance ◽  
Brain Health ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Beta Coefficient ◽  
Neurotropic Factor

Abstract Adverse childhood experiences (ACEs) may predict markers of neurocognitive performance (i.e., executive function; EF) and brain health/plasticity (i.e., brain-derived neurotropic factor; BDNF). This pilot examined the magnitude of effects between: 1) ACES and EF performance, 2) ACEs and BDNF levels, and 3) EF performance and BDNF levels. We hypothesize that higher ACEs will be associated with poorer EF scores and lower BNDF levels and that lower EF scores will be associated with lower BDNF levels. Given the pilot nature of the study, an emphasis is placed on effect size vs. significance. Participants were 36 middle-aged women enrolled in the NICE SPACES trial (age=31.4 years, BMI=34.2, racially minoritized=37.9%). ACES were quantified using the 10-item Adverse Childhood Experiences Scale. EF was measured using the fluid cognition composite from the NIH Toolbox – Cognition Battery. BDNF was estimated using proBDNF levels estimated from serum collected via venipuncture. Higher ACEs levels were not directly associated with EF scores (b = 0.03, p = .854); but did show a meaningful negative beta coefficient with BDNF levels (b = -0.34, p = .053). EF scores and BDNF showed a positive coefficient that did not reach significance (b = .26, p = .122). In a modest pilot of middle-age women, higher ACEs were associated with lower BDNF, indicating greater adversity in childhood is linked to lower neurotrophins levels in adulthood. The lower BDNF levels may help explain poorer performance on cognitive tasks. Larger follow-up studies in more powered samples are warranted given the size of detected coefficients.

scholarly journals Implementation of the adverse childhood experiences conversation in primary care

2019 ◽  
Vol 37 (3) ◽  
pp. 355-359 ◽  
Author(s):  
Victoria Bodendorfer ◽  
Afton M Koball ◽  
Cary Rasmussen ◽  
Judy Klevan ◽  
Luis Ramirez ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Childhood Experiences ◽  
Mandatory Reporting ◽  
Toxic Stress ◽  
Childhood Experiences ◽  
Provider Perspectives ◽  
Adverse Childhood ◽  
Alternative Approach ◽  
Stress And Health ◽  
Provider Surveys

Abstract Background Research has focused on screening for adverse childhood experiences, rather than provision of education as a part of routine anticipatory guidance. An adverse childhood experiences ‘conversation’ is one method that has not been studied empirically but represents a complimentary or alternative approach to screening which could overcome many existing barriers. Objectives This study aims to examine parent/guardian and provider acceptability/feasibility of the adverse childhood experiences conversation during well-child visits in primary care. Methods Providers engaged in a conversation with parents/guardians of patients during well-child visits in a family medicine residency clinic. Parents/guardians and providers were surveyed following the visit to examine acceptability and feasibility. Quarterly assessments to further examine provider perspectives were completed. Data were collected for 1 year. Results In total, 238 parent/guardian and 231 provider surveys were completed. Most parents/guardians felt positively (76%) about and comfortable (81%) with the information discussed and 97% felt that the conversation should be had with their primary care provider specifically. Most providers (71%) indicated that parents/guardians were receptive to the conversation, that the conversations took 1–2 minutes (60%) and that there were few disclosures of adversity (9%), none of which required mandatory reporting. Conclusions Results suggest that the adverse childhood experiences conversation is well received by parents/guardians and providers and is feasible to implement into primary care. The conversation could be used as a complimentary or alternative method to screening to further spread knowledge of toxic stress and health, provide resources for families and promote resilience.

scholarly journals Addressing Adverse Childhood Experiences: It’s All about Relationships

Societies ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 115
Author(s):  
Paula Zeanah ◽  
Karen Burstein ◽  
Jeanne Cartier
Keyword(s):  
Community Violence ◽  
Family Caregiving ◽  
Adverse Childhood Experiences ◽  
Protective Role ◽  
Toxic Stress ◽  
Adult Health ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Global Prevention ◽  
The Impact

Recognition that economic, environmental, and social adversity affects health is not new; adversity may result from social determinants such as poverty, community violence, or poor nutrition; from within the family/caregiving environment; or interactions between these complex environs. However, compelling new research demonstrating the profound impact of cumulative early adversity and toxic stress on development and adult health is leading to the mobilization of global prevention and intervention efforts to attain and assure better health for populations across the world. In this paper, we begin with a global population perspective on adversity and discuss priorities for global health. We then turn to studies of adverse childhood experiences to consider current understanding of how early experiences impact brain development and short- and long-term health. Factors that build resilience and buffer the effects of toxic stress and adversity are described, with emphasis on the foundationally protective role of safe and nurturing caregiving relationships. We discuss the implications of these findings in terms of community health and present a participatory research paradigm as a relationship-based method to improve community engagement in identifying and mitigating the impact of adverse childhood experiences on health.

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