Shedding Light on the Long Shadow of Childhood Adversity
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Shedding Light on the Long Shadow of Childhood Adversity . David Brent, MD & Michael Silverstein, MD, MPH. Conflict of Interest Disclosures. David Brent Guilford Press, royalties eResearch Technology, royalties UpToDate , Editorial Board Honoraria, Oxford Press Michael Silverstein

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Shedding Light on the Long Shadow of Childhood Adversity

David Brent, MD & Michael Silverstein, MD, MPH


Conflict of interest disclosures
Conflict of Interest Disclosures

  • David Brent

    • Guilford Press, royalties

    • eResearch Technology, royalties

    • UpToDate, Editorial Board

    • Honoraria, Oxford Press

  • Michael Silverstein

    Nothing to disclose


Objectives
Objectives

  • Review the strong association between childhood adversity and subsequent physical and mental disability

  • Describe possible etiologic pathways

  • Make recommendations for research, clinical care, and policy


Childhood adversity what is it
Childhood Adversity: What is it?

  • Poverty

  • Abuse, neglect, and exposure to domestic violence

  • Parent with untreated serious psychiatric disorder

  • Parental criminality

  • Associated with nearly every cause of premature mortality, decreased productivity, and increased health care costs


Adverse childhood experiences account for a large proportion of chronic health conditions
Adverse Childhood Experiences Account for a Large Proportion of Chronic Health Conditions*

*Felitti et al., 1998


Health and productivity
Health and Productivity* of Chronic Health Conditions*

*Anda et al., 2004


Health care costs and history of abuse
Health Care Costs and of Chronic Health Conditions*History of Abuse*

*Bonomi et al., 2007


Stress the hpa axis and inflammation
Stress, the HPA Axis, and of Chronic Health Conditions*Inflammation*

*Miller et al., 2009


The nature of nurture
The Nature of Nurture* of Chronic Health Conditions*

*Hackman et al., 2010


Epigenetic changes in the gr in abused suicide victims
Epigenetic changes in the GR in of Chronic Health Conditions*abused suicide victims*

*McGowan et al.,2009


Familial transmission of adversity
Familial Transmission of Adversity* of Chronic Health Conditions*

*Felitti et al., 2008


Poverty and child psychopathology before and after casino in a native american community
Poverty and Child Psychopathology Before and After Casino in a Native American Community*

Child symptoms

*Costello et al., JAMA, 2003


From: Children of Depressed Mothers 1 Year After the Initiation of Maternal Treatment: Findings From the STAR*D-Child Study*

*Pilowksy et al., 2008


Decreased Governmental Costs for Mothers Who Participated in the Nurse Family Partnership Intervention*

*Olds DL et al., 2010


Implications
Implications the Nurse Family Partnership Intervention

  • Research– mechanisms, how to prevent or attenuate, alternative approaches to treatments for those with history of ACE

  • Clinical care– assess, intervene in those variables that are malleable, engage, collaborative care

  • Policy– advocate for social policies and programs that can help families overcome adversity

  • Recognize that ACE exacts a severe cost on society– one we can invest in grappling with now-or cost we will all eventually bear in lower productivity, and greater health care costs


New zealand toast
New Zealand Toast the Nurse Family Partnership Intervention

To the cause that needs assistance

To the wrong that needs resistance

To the future in the distance

And the good that we can do

Mick Collins


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