As I was reading the Sunday Albuquerque Journal (01.21.18), I spotted an article by Amy Linn that caught my eye. The main title is: “Human Road Kill.” The subtitle reads: “Suffering early trauma, many N.M. kids face devastating consequences.” Turns out that Ms. Linn writes for Searchlight New Mexico, a group whose tagline is: “Bringing Accountability to New Mexico.” The article I read in the Journal was an abbreviated version of a much longer article contained on the Searchlight NM web site. Click on this link to read the full article. Ms. Linn’s article is part of a series of investigative articles entitled Raising New Mexico. I contacted Searchlight NM and asked if I could reprint Ms. Linn’s Journal article (the shorter version). Acting executive editor, Sara Solovitch, gave me the OK as long as I provided the proper credits and links to the article (which I have done above). Ms. Solovitch also asked that I tell my readers that “Searchlight New Mexico is a nonprofit, nonpartisan media organization that seeks to empower New Mexicans to demand honest and effective public policy.” With no further ado, here’s the Journal article I read (with links from the Searchlight NM web site version). I’ll have a few observations at the end.
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Today, everyone should be talking about ACEs [adverse childhood experiences]. That’s the view of a growing legion of experts who regard childhood trauma as one of the most profound and urgent public health challenges in the country.
Hundreds of studies link adverse childhood experiences to a huge array of diseases, mental illnesses and lifelong problems. An ACE is defined as one of 10 kinds of trauma, including all the things that happened in Linda’s life [profiled in a separate article in the series], and more. Among them: sexual, physical or psychological abuse; emotional or physical neglect; mental illness, drug or alcohol abuse, domestic violence; an absent parent or incarcerated household member.
Exposure to these assaults at a young age can alter brain architecture, interrupt neurocircuitry, damage endocrine and immune systems and have lifelong harmful impacts on health and the human condition, potentially for generations to come.
The “toxic stress” of trauma can impair learning and emotional regulation, undermine social functioning and even change the signature of DNA.
An October 2017 report from the John Hopkins Bloomberg School of Public Health found nearly 30 percent of New Mexico children had two or more ACEs—the fourth highest rate in the country. A 2016 study by the New Mexico Sentencing Commission established a clear connection between traumatic experiences and juvenile delinquency. Among all 220 teens held in detention in 2011:
- Every one of the girls — 100 percent — had two or more ACEs; for boys the rate was 96 percent.
- Nearly 90 percent of both sexes had four or more ACEs, the point at which future health risks can become dire.
- Nearly 25 percent of the girls experienced nine major traumas, almost the entire ACEs catalogue. A parent beat them so hard it left marks. They saw their mother punched or threatened with a gun. They’d been raped, molested, verbally abused or constantly humiliated. Someone at home was alcoholic or drug addicted. They’d gone hungry.
The study underscored what could be called an ACEs-to-prison pipeline.
“You’re basically creating a group of kids who are going to have lifelong learning problems — they’re basically going to be like human roadkill on the economic highway,” says primary care physician Andrew Hsi, who co-wrote the report with specialists like George Davis, former director of psychiatry for New Mexico’s Children, Youth and Families Department.
But if this picture appears unremittingly bleak, the bigger message is that all early childhood experiences are powerful. Positive experiences are as determinative as negative ones. They build resilience and give children “protective factors” that help them thrive.
Even children who suffer severe adversity can develop resilience, according to Harvard University’s Center on the Developing Child, a national leader in toxic stress and brain research. Resilience is built upon healthy early parenting and bonding [read “secure attachment”], which make infants feel safe and nurtured.
“Loving the baby, kissing, holding, massaging, breastfeeding: The baby understands that language,” says Sanjeev Arora, a UNM physician and founder of Project ECHO, which brings high-quality medical treatment to remote parts of the state and worldwide. “The entire human experience is very intricately linked to feelings of security and lack of fear.”
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I invite you to read the full version of this article over at the Searchlight NM web site. Allow me to provide a few follow-up observations.
Back in 2005, I attended a lecture by Sir Richard Bowlby, John Bowlby’s son. Sir Richard presented us with a list of ACEs that he saw closely associated with the development of insecure attachment in children:
- drug and alcohol abuse
- mental illness
- mental, physical, or sexual abuse
- parental rows (fights)
- family breakdown
- low education
- unwanted pregnancy
- unsupported parent under the age of 18
- insensitive parenting
- homelessness and neither parent employed
According to the information that Sir Richard presented, a child experiencing two or more of these ACEs has a much greater chance of developing insecure attachment than children who experience maybe only one ACE. Sir Richard went on to make a rather controversial comment: “Children receiving inappropriate day care combined with insecure attachment, start life with two risk factors.” Sir Richard defined “inappropriate day care” as follows:
- Such frequent turnover of daycare staff that a baby or toddler does not have the opportunity to form an enduring secondary attachment bond to the carer.
- Care provided by so many different carers each day that, again, a baby or toddler cannot form an enduring secondary attachment bond to any of them.
- A baby or toddler forming an attachment bond that is so close that the carer becomes the child’s primary attachment figure in place of the person raising the child (usually the mother).
- Children who spend too much time in a daycare setting each week such that both primary and secondary attachment relationships (if they exist at all) are put at risk.
Sir Richard allowed that the novelty of a day care setting along with separation from a child’s primary attachment figure, can cause increased stress levels in children even if they are securely attached. Increased levels of stress can lead to increased levels of the stress hormone cortisol. Increased levels of cortisol over extended periods of time can have a corrosive effect on brain development and the functioning of the immune system (pulling from work by Dr. Allan Schore here).
So, yes, we should be talking about ACEs. However, talking about ACEs outside the context of Bowlbian attachment theory makes no sense to me. Note that in the Searchlight NM article secure attachment is referred to in oblique ways using words and phrases like “bonding,” “resilience,” “feelings of security,” and “lack of fear.” Why refer to attachment in such an oblique fashion when Bowlby’s theory (supported by decades of research data) has been with us for over 60 years? Bowlby began his over 30 years of work looking at the connection between an early history of insecure attachment and juvenile delinquency. However, current researchers talk about this connection as if it were something new. This represents no less than a breakdown of the scientific method whereby advances are made by building on scientific foundations, not reinventing the wheel.
If we simply accept the neurobiology framework—ACEs can affect brain development—then we are left with neurobiological interventions, that is to say, change or rewire the brain (neuroplasticity being all the rage). If we accept Bowlby’s attachment theory framework, then interventions center on moving children (and adults) in the direction of secure attachment. Changing the brain is an individual endeavor in that most brain scientists believe that the brain (and its extension of mind) is in the individual. In contrast, Bowlby looked at attachment (and attachment security) as existing on a continuum that held both the individual and society. Here’s a quick example.
I recently read the book Hillbilly Elegy by attorney J.D. Vance. Vance is very open about his hillbilly upbringing. At one point in his book, Vance brings up the topic of ACEs. Vance writes: “Psychologists call the everyday occurrences of my and Linsay’s life [his sister] ‘adverse childhood experiences,’ or ACEs. ACEs are traumatic childhood events, and their consequences reach far into adulthood.” A bit further along Vance brings up a report that was released by the Wisconsin Children’s Trust. According to this report, “Among the working class, well over half had at least one ACE, while about 40 percent had multiple ACEs” (quoting Vance). Vance gives us this “bottom line”: “This is really striking—four in every ten working class people had faced multiple instances of childhood trauma. For the non-working class, that number was 29 percent.” Vance and his sister both had six ACEs. It is hard to look at ACEs without bringing in such things as demographics, culture, socioeconomic status, and even immigration status.
ACEs are a systemic problem that has to be addressed at the level of society. Sure, individuals need and deserve help, but prevention starts at the societal level. Here are the only two books that I know of that look at the topic of ACEs at the level of society using Bowlby’s attachment theory as a background:
- The Politics of Uncertainty—Attachment in Private and Public Life by Peter Marris (1996)
- The Politics of Attachment—Towards a Secure Society edited by Sebastian Kraemer and Jane Roberts (1996)
Notice that both of these book are from the mid-1990s, over 20 years ago! I’m not aware of any other books on this topic. There should be dozens of books on the subject. With school shootings an almost everyday occurrence (like the one at a Kentucky school yesterday that killed two and wounded eighteen), it is high time we dusted off Bowlby’s theory of attachment and put it back in the service of shedding light on the source and treatment of ACEs in our society. We have the data (as the above points out); we have the theory (Bowlby’s theory of attachment); what we need now is action. Let’s not talk about attachment in such oblique ways; let’s bring Bowlbian attachment theory to the fore full steam ahead. If effective public policy is what you are after as far as treating the issue of ACEs, then Bowlby’s trilogy on attachment is essential reading.