ACEs Connection

Healthy, happy kids grow up to create a healthy, happy world.

Part Two of Six: Dr. Andrew Garner: Peering into the Black Box of Toxic Stress

Here is part two of our six part series that focuses on the keynote talk by Dr. Andrew Garner.  You also can read more about the Summit at our website under "News from the Summit" and "What's Happening."


One of the highlight's of the Summit was the Lifetime Achievement Award that Drs. Sandra Bloom and Dave Corwin presented to Frank Putnum - a psychiatrist, author and one of central founders of the Developmental Traumatology field.  In recognizing his achievements, Dr. Bloom said, "Dr. Frank Putnam's contribution to our field is enormous.  Frank helped open the door to the possibility that protecting and helping children will prevent their later dysfunction and disease.... Frank is one of the great scientific pioneers and heroes in our present struggle to prevent, identify, and to heal the harms of childhood trauma and adversity. "  Dr. Putnum was unable to attend the event but sent a note -


"I am very touched and moved that so many people want to reach out to me and let me know that I have been important to them or made a difference in some way.  I'm humbled by that.  I am very sorry that I can't come to Philly.  Please convey my extreme regrets to everyone that I am not able to attend the Philly celebration - but it isn't about you or me - it is about the children.  So instead of me, I urge you to use the time to celebrate everyone's work that contributes to decreasing ACEs.  Best regards, Frank."  

Dr. Putnum's 22 minute discussion of the significance of the ACE Study to the field is posted at the AVA website along with the brief policy maker and educational edits of the ACE Study DVD. .  They are free and in the public domain on the AVA Vimeo site which you can access by scrolling down the main page and selecting the V icon for Vimeo.


I hope you find "Peering Into the Black Box" informative!




Martha Davis

Executive Director, Institute for Safe Families


Peering into the Black Box between ACEs and Adult Health:



ACEs are not destiny.


Traumatic experiences in childhood-witnessing violence, living with a drug-addicted parent-do have lifelong consequences for health and behavior, physician Andrew Garner told participants in May's National Summit on Adverse Childhood Experiences (ACEs) held in Philadelphia. But just as the human brain can be hurt, Garner said, it can also be healed.


Garner is Associate Clinical Professor of Pediatrics at Case Western Reserve University School of Medicine and Chair of the American Academy of Pediatrics' (AAP) Leadership Workgroup on Early Brain and Child Development.


"Advances in basic developmental science and the ACEs study are forcing us to reconsider the childhood origins of lifelong health and disease- and to get things right the first time instead of trying to repair things down the line," he said. "It's not about doom and determinism, but about trying to understand what's going on inside the proverbial black box between childhood adversity and poor adult outcomes."


To do that, Garner unpacked the "black box" of toxic stress. A certain amount of "positive stress"-that is, the kind of stress a child experiences when facing a math test or singing solo in the church choir-is healthy because it builds motivation, confidence and resilience, he said. Positive stress is brief, infrequent, mild and assuaged by "social-emotional buffers" such as supportive adults.


Toxic stress is the opposite: long-lasting, frequent, intense and lacking the social and emotional supports to help children cope. That kind of stress, which floods the nervous system with cortisol, can also inflict long-lasting change in gene expression, brain architecture and immune response.


The emerging science of epigenetics looks at how environment and experience "turn the switch" on certain genes, Garner said. In that way, the "ecology" of a person's early childhood can become biologically embedded. Developmental neuroscience is showing that the brain also changes in response to toxic stress, especially during the childhood and teen years.


Garner explained how some individuals may seek unhealthy ways of "turning off" relentless stress, using alcohol, drugs or promiscuous sex in a process called "behavioral allostasis." Those behaviors then lead to greater emotional and health risks.


Because body and brain, environment and behavior are so intimately connected, Garner said, it no longer makes sense to draw a line between mental and physical health. Instead, pediatricians, social workers and early childhood educators should focus on "healthy versus unhealthy development," providing both enrichment to build new skills and strategies to prevent, remove and treat the sources of toxic stress. He noted that after-the-fact interventions such as cognitive-behavioral therapy, are effective but also costly and scarce. It makes more sense, Garner said, to teach positive parenting skills that prevent toxic stress from occurring in the first place.


Garner advocated a public health approach to ACEs that would require the collaboration of child protection workers, juvenile justice officials, early intervention services, educators, medical homes, the faith community, child care centers, recreation leagues and others. The focus would be on decreasing stress and building coping skills for all children, with targeted interventions for those deemed "high risk" and evidence-based treatment for kids already showing symptoms of toxic stress.


"Do we continue to treat disease, the unhealthy lifestyles that lead to disease, or the toxic stress that triggers unhealthy lifestyles?" Garner asked. "Or can we actively build resilience, helping children figure out how to turn off their stress response in a healthy way?"


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