DR. ROBERT BLOCK: A pediatrician’s perspective on ACEs, resilience

 

As an academic and clinical pediatrician with over 40 years of experience, I was impressed and amazed when I first heard Dr. Vince Felitti speak about his ground-breaking work on Adverse Childhood Experiences (ACEs), first published in 1998.  For the last several years a multitude of professionals have been working on the clinical (practical) application of his work, and more have been learning about the genetics, brain chemistry, and other scientific explanations for his findings. 

The core of the findings makes sense: if children are exposed to adversity, they are at much greater risk for diseases like heart disease, cancer, substances abuse, and many others.  Although the association of adversity with brain health (often commonly referred to as “mental” health) makes sense, the effects of adversity on other organs – creating higher risk for diseases, was ground-breaking. 

Over the last several years, many professionals have been developing ways to combat adversity by stressing resiliency among children. We all experience stress as both children and as adults.  A fair amount of stress is normal, and learning to cope with it is an essential part of “growing up.” This allows us to develop resiliency. A simple definition of resiliency is the ability to “bounce back,” or to tolerate excess stress without developing adverse reactions. Do you remember “the little engine that could” from your childhood?  “I think I CAN, I think I CAN,” the engine says, as he climbs a high mountain.  Children are naturally resilient, but there is a limit to what they can tolerate.  It is vital for parents and professionals working with children to help them develop resilience-developing skills, so the children can develop in positive ways.  

The challenge to assist children in their development of resiliency is a primary responsibility of parents, but parental behaviors are often the causes of adversity.  So, it is incumbent on others to recognize the need to assist children, to teach them about ways to develop resiliency.  This is a role for relatives, teachers, religious leaders, physicians, and many others who interact with children – especially very young children.  Also on this list of people who can significantly determine a child’s success or failure are politicians.  Governors and legislators must recognize the need to support optimal education, beginning at early ages, along with proper programs to support parents and support for children in state custody through no fault of their own.  Oklahoma, unfortunately, falls in the bottom percentiles for almost every facet of childhood, certainly education, but also nutrition, poverty, and many more. If we can focus on positive support for children, as exemplified by the Potts Family Foundation “25by25” initiative, perhaps Oklahomans can improve childhood and our state’s overall success.

It has been my mission to remind everyone that “All adults once were children.” Who we are as individuals and as a population of adults depends, to a very great extent, on who we have become during childhood and adolescence. I think we can, I think we can.

Robert W. Block, MD, FAAP, Tulsa, Professor and Chair Emeritus, The University of Oklahoma/University of Tulsa School of Community Medicine; and past President (2011-12) the American Academy of Pediatrics

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