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>> Our brains develop and change throughout life,
enabling us to learn and do new things
and to adapt at every age.
But childhood, and early childhood in particular,
is the most sensitive and critical period
for brain development.
As a child interacts with the world, their experiences,
both positive and negative, stimulate the brain,
causing it to form neural pathways that lay the foundation
for lifelong cognitive and behavioral functioning.
>> I like to think of brain development as the brain is
like a, the site of a town so you can lay out roadwork.
You're laying down roads according to,
in the brain's case, according to experiences.
So you have an experience and your brain laid down a path.
And the more you have that experience,
the bigger that path is going to get and the stronger,
and then it's paved, it becomes a real road in a highway.
And you're laying out the gridwork
of the town according to your experiences.
And that's very much like the brain development.
The more you have experiences,
the stronger those electrical circuits are going to be.
And that's going to shape the way you think,
and act, and view the world.
>> Safe, stable, nurturing relationships
and environments provide the context
for healthy brain development
when children have ample opportunities
to learn and explore.
In this setting, children acquire a range of experiences
that stimulate different parts of the brain allowing
for healthy, balanced development.
Some degree of adversity and stress is a normal
and essential part of human development
that can help children learn how to react to future challenges.
But a child who's repeatedly exposed to adversities
like abuse, neglect, or unstable relationships
and environments may experience what's known as toxic stress
and this can disrupt brain development.
>> Our experiences literally shape the way our brain is
developing and the brain architecture.
So if you have a baby, a very young baby,
who cries when they're hungry and mother comes over
and feeds the baby and helps the baby settle down,
the baby goes back to sleep, that happens, what,
five, ten times a day.
And that is laid down as electrical circuits are laid
down in the brain and so the baby learns that you cry,
you get fed, you sooth, and you go to sleep.
And that experience is sort of coded into the brain,
just like any other experience.
So good experiences help the brain develop in a certain way.
And if you have adverse experiences,
that same baby cries, and cries, and cries
and the parents are addicted to opiate drugs, let's say.
And they ignore the baby.
The baby is left alone for ten hours in the dark.
That baby's brain is still developing
but it's developing in a different way.
Their experience is much different
and so it is developing in a way that says, "You can cry,
and cry, and cry and escalate
that stress response as much as you want.
Nothing is going to happen."
And the interpretation of that is not only is the brain
realizing that they're not going to get soothed,
but the child learns, and this is laid down in the brain,
the child learns that the world is an unsafe place,
that they are insignificant.
There's no one out there to help them.
And that is all laid down in the brain as well.
>> There are different forms of stress
that any individual is exposed to.
There's positive stress
that oftentimes is very short term but, you know,
it's something that everybody experiences.
So even if you said, you know, waking up in the morning,
going to work, going to school, that's, you know,
one form of stress, very short term but something
that your body has to adjust to.
You can have very neutral forms of stress
that are a little bit longer term but things in which,
you know, there are resources and support that help you adapt
to it, whereas there's other kinds of things
that are more long term kinds of negative stress and that's
where toxic stress really fits into.
Things in which person doesn't have,
or an individual does not have the kind of resources
and support to try to deal with it and it has a negative effect
in a long term consequences on that particular individual.
So it's toxic in the sense
of the body responds to that stress.
You know, one of the things
that is produced is a hormone called cortisol
and that constant production of cortisol has a negative effect
on brain development, on neurological development,
and on other kinds of organs and tissues in the body.
>> When we experience stress or encounter a threat,
the brain triggers the body to produce hormones
that activate a stress response, or what's often referred
to as the fight or flight response.
In a moment of crisis, this response is necessary
and potentially life-saving.
But stress can become toxic
when the stress response system is activated frequently
or for prolonged periods of time.
If a child is constantly afraid, her body and brain will remain
on high alert, preparing her to react should a threat return.
Her body will continually produce stress hormones
and the stress response system will remain activated
in her brain, drawing energy away from other neural pathways
in need of development or maintenance.
In a child experiencing toxic stress, parts of the brain
that might be weakened are those regulating complex functions
like emotional self-regulation, social interactions,
and abstract thinking.
This may have consequences throughout life and can result
in social, behavioral, and cognitive challenges.
>> Toxic stress implies a certain level of adversity
and that often occurs early in life, within childhood.
So children who have experienced adverse childhood experiences
have been found through very diligent research to be
at increased risk for a number of long term problems
when they reach adolescence and adulthood,
and these problems really span multiple domains.
They can be behavioral problems, emotional problems,
and physical problems.
So if you think about it,
children who have had early adversity are at higher risk,
much higher risk for major depression and suicidality,
for anger management problems, for delinquency
and high risk behavior, for dropping out of school,
for teen pregnancy, for runaway behavior, for adult criminality,
and for liver disease, and lung disease,
and heart disease among other things.
So it has a profound long term impact potentially.
>> And yet the brain is capable of healing and changing.
Effective treatments can help those affected
by early adversity and give them a chance to heal from traumas
and learn new ways to interpret and react
to stressors and other stimuli.
Fortified by this information,
we can shift the conversation away from one that blames
and punishes people for inappropriate reactions
and behaviors that developed in childhood due
to adversity and trauma.
Instead, we can champion the need for expanded services
and opportunities that help people overcome early adversity.
And we can focus on ways to prevent abuse, neglect,
and other challenges before they occur.
>> I don't want to imply that any child
who experiences early adversity is on a mission
where they inevitably will experience these adverse affects
long term.
That's not the case at all.
Many kids are resilient and so they are able
to overcome this adversity very early on
and prevent the long term effects.
Some adults will experience those long term effects
but there are ways that we can help the adults.
And very often -- I work at a child sexual abuse clinic --
and very often our parents will come in, the mother will come in
and say, "My daughter was sexually abused," and it comes
out while I'm talking to her
that she was sexually abused as well.
She never got therapy.
So for 20 years she's been living with this experience
and hasn't told anyone.
That's not too late.
She can still get help.
She can still get therapy.
She can still work through that.
She can still kind of overcome that and move on
and not have an increased risk of adversity.
There are other social programs that are helpful.
For example, programs that help people develop some
of those skills that maybe they didn't develop early on,
that the skills are related to planning,
controlling their emotions, and controlling their impulses,
and getting hold of that automatic response,
that jump to anger, getting hold of that, calming it down,
learning how to do that can help tremendously.
>> CDC is the nation's public health agency and as such,
are really interested in those factors, risk factors,
and protective factors, that influence health.
And it turns out that early adversity in the form
of violence and other adverse events has a profound impact
on health throughout the lifetime.
Mental health impacting infectious diseases
as well as chronic diseases.
So, as such, early adversity and the influence
of that is critically important
from the public health standpoint.
And it's strategic.
If we can reduce or eliminate early adversity,
we can have an enormous impact on health
of the U.S. population and, in fact,
people around the world during the course
of their entire lives.
>> In lesson two, you'll learn
about the CDC-Kaiser Permanente Adverse Childhood Experiences
Study and about findings from the study that can aid
in our efforts to prevent and treat ACE's.