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County focuses on reducing number of adults traumatized in childhood


Research shows traumatic childhood events have lasting impacts that go well into adulthood.

Before the late 1990s, substance abuse or divorce in the household weren’t considered long-term issues for children, said Anne Soule, the director of family support services for the Mental Health Association of Frederick County. But a study launched in 1998 introduced health experts to the concept of adverse childhood experiences (ACE) — dysfunction or abuse experienced at a young age that can have lasting influences on adult health.

“It created a paradigm shift in how the medical community views sedentary lifestyles in adults and disease in adults,” Soule said. “They found a very high correlation between adult health and early exposure to these experiences, and learned that they could predict health outcomes in adults into their 50s and 60s and 70s based on what happened to them when they were a child.”

Soule has spent years examining the long-term effects of ACEs, as has Lynn Davis, the director of the Child Advocacy Center of Frederick County. But even the longtime family health experts were surprised by new data from the Centers for Disease Control and Prevention that showed the prevalence of those experiences in Frederick County.

“It is always surprising to people when I talk about the numbers of children affected,” Davis said. “We have so many good things here, it’s hard to realize that some of our children are really suffering.”

According to the data — collected in 2015 through the CDC’s Behavioral Risk Factor Surveillance System — 27.2 percent of Frederick County adults experienced three or more ACEs before age 18, compared with 24.1 percent of adults in Maryland overall.


(Continued from A1) Of those adults, 40.9 percent reported emotional abuse during childhood, while 30.2 percent reported household substance abuse. Data wasn’t collected for several categories of ACE — including physical and sexual abuse — but parental separation or divorce and household mental illness were also reported by a significant percentage of residents.

Those numbers are meaningful, Soule and Davis said, largely because of the adverse effect that ACEs can have on adult life. Nearly three-quarters of intravenous drug users have four or more ACEs in their background, according to Davis. People with four or more ACEs are also two times more likely to smoke, seven times more likely to be an alcoholic and 12 times more likely to attempt suicide, Soule said.

“If a child is exposed to toxic stress, that serves to damage the architecture of the brain,” Davis said. “It changes the structures and the way they develop, and then, as the child gets older, it changes the way the brain functions.”

Making ACEs a priority

More and more frequently, experts are acknowledging that ACEs can also have wide-ranging influence on community health, including rates of addiction and workforce viability, Soule and Davis said. In Frederick County, the experiences were considered important enough to be made a top local health priority at a summit held by the Health Department in September. Many of the top goals for the ACEs work group include increasing awareness of the issue, but Soule and Davis said they would also like to see increased investment in high-quality, affordable child care for working parents.

“Safe child care is essential, especially when we have parents trying to hold down two or three parttime jobs to make it,” Davis said. “They’re on shift work, and it is not affordable, actually, to find off-hours child care. And so parents are relying desperately on any friends, family, to try to piece that together, which doesn’t leave the predictable routine that children need to grow.” Along with poverty — which can be exacerbated by unaffordable child care, Soule said — peer isolation and bullying are now included as adverse experiences, as are exposures to violence in the home and community. The original 1998 study on ACEs listed 10 categories, including physical, emotional and sexual abuse, household addiction or mental illness, separation or divorce and the incarceration of a family member.

While previous attitudes encouraged people to “get over” childhood experiences, Davis explained that toxic stress can take a physical toll on the brain. Overall, children exposed to negative events and maltreatment in the first three years of life develop 10 to 20 percent less brain volume as they grow. Negative events can affect the limbic system and prefrontal cortex in children and teens, affecting the ability to focus, learn and moderate impulses. “If teens are exposed to parental verbal aggression, for instance — emotional abuse — that harms development and can even reduce verbal IQ,” Davis said. “Throughout our whole childhoods, exposures can be very damaging to a brain. And to potential. We’re reducing potential at every step if we’re harming the brain and not providing recovery opportunities.”

Identifying those most at risk

Poverty tops the list of factors that put children at risk for experiencing several of these long-lasting traumas, according to various studies cited by Malcolm Furgol, chairman of the ACEs work group. Furgol also serves as director of community impact for the United Way of Frederick County.

Financial strain can force families to sacrifice on the key resources that help provide safe, healthy environments for their children, Furgol said Thursday.

For example, low-income families with parents who work full time might not be able to afford a certified, high-quality child care program, he said.

Across the state, the number of family child care providers fell 18 percent from 2010 to 2014, according to a 2016 report by the Maryland Family Network. The number of commercial programs remained flat within that time frame.

As availability decreased, costs rose by 11 percent from 2010 to 2014, the report stated.

Rising costs pose a particular challenge for the families whose yearly earnings fall below the basic cost of living, identified in a separate report published earlier this year by the United Ways in Maryland. The report highlighted issues of availability and affordability of child care for low-income families. About 32 percent of Frederick County’s 89,084 households in 2014 earned less than what was needed to cover basic costs of living, the report stated. That’s any family of two adults and two children that earns less than $69,216, based on the report’s defined “survival budget.”

That same family spent about 23.1 percent of its monthly expenses on child care, based on a $6,311 monthly budget for necessities including food, transportation and housing.

Furgol named increasing the number of child care providers, as well as subsidies available to low-income families, as two ways to help this atrisk population pay for the kind of care that can prevent childhood traumas.

Minorities and immigrant families who do not speak English also face a higher likelihood of adverse childhood experiences, Furgol said.

Raising awareness

Before the community can begin to address the problem, it needs to know what to look for. Raising awareness was one of the four goals identified by the ACEs work group, according to information provided by Furgol.

Local outreach efforts combined with increasing attention and research about the severity of the problem on a national scale have already taken hold, according to Furgol. Cathy Nusbaum, coordinator of early childhood education and the Judy Center for Frederick County Public Schools, named recent training for the district’s pre-K and kindergarten teachers as an example of the increased awareness. The school system has also taken steps to teach its educators how to look for and work with students who may have suffered from these adverse childhood experiences. For example, she said teachers should respond to students who are acting out not by asking “what’s wrong with you?” but by asking “what happened to you?” and understanding the underlying causes for their misbehavior. “It really has become a national crisis, and it’s important for our schools and our staff to understand that,” she said. Nusbaum is also assisting the ACEs work group through her role as co-chairwoman of the Interagency Early Childhood Committee, which is part of the Frederick County Office for Children and Families.

Both she and Furgol emphasized their efforts as a work in progress. The ACEs work group has identified timelines to achieve each of its goals, and aims to have tangible results by 2020, according to Furgol. “We have a long way to go, but we’ve started the conversation,” Nusbaum said.

Follow Kate Masters on Twitter: @kamamasters.

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