Doctors screening for ACEs have seen reduction in drugs given to children
From an article in North Coast Journal
Dr Mike Mangahas, a pediatrician at Open Door Community Health Clinic in Eureka, California has seldom prescribed medications to children with serious behavioral issues. Instead, he's using information from a survey about patients' childhood traumas — known as Adverse Childhood Experiences, or ACEs - to inform a more holistic model of care.
"I have been prescribing a lot less psychotropic medications and it's been easier to tease out, for example, if I should start a kid on ADHD medication or not," Dr Mangahas said. "So, if a child screens positive for ACEs and behavioural health concerns, I'll be very conservative and work on supporting exercise, nutrition, relationships and stress-busting stuff first, and if that's not working or there's significant impairment at home or school, then that's when I start medication. For me, it's made it a lot easier for me to feel comfortable not jumping to meds."
Dr Evan Buxbaum and his team are doing the same at another clinic, taking a more holistic approach with an understanding of the underlying causes of many medical conditions.
"Understanding the root cause of symptoms and being able to address the toxic stress in the child's life is a paradigm shift in paediatrics and allows us to start to address the whole child in a way that simply treating symptoms doesn't," Dr Buxbaum said.
Over the past five years, there has been a shift in paediatrics as providers increasingly understand how both childhood trauma and toxic stress affect child development. Systems and practices are changing to be more empathetic and understanding, as the state Surgeon General's Office is working to reduce extreme levels of toxic stress, urging doctors and providers to find patients who may be at risk of toxic stress by determining what childhood traumas they've experienced.
"In paediatrics, we are concerned with developmental milestones and the factors in a child's life that affect their development and growth," Dr Buxbaum said. "We all had that moment of recognition that we were under-emphasizing adverse childhood experiences in the consideration of childhood wellness and diseases."
The Center for Youth Wellness found that the North Coast counties have the highest rate of childhood trauma in California, with roughly 75 percent of residents having experienced one or more ACEs and 30 percent having experienced four or more.
School systems are now enacting more empathetic approaches to discipline, while other organizations are creating more resources for families and kids in need, for example group counselling and mentors for students.
One of the best ways to create a trauma-informed practice that treats the underlying problems that can lead to poor health in adulthood is to directly ask children what they've experienced using a survey. More than 20,500 California clinicians have been trained to give and use the survey.
"Once we started to recognize the degree to which adverse childhood experiences affect growth and development, performance in school, frequency of illness, ability to bounce back from illness and overall well-being, we recognized the importance of identifying and following, over time, these ACE scores," Dr Buxbaum said. "It has dramatically affected our practice. It has dramatically improved our practice in that at every visit we have the opportunity to address those root causes that prevent children from thriving."
Dr Buxbaum said he rarely receives negative reactions from parents and caregivers when he asks them about these traumas. "We thought we were going to experience a lot of pushbacks," he said. "These are very personal questions, and they speak to the deepest traumas in families — sometimes the traumas that people don't even talk about among themselves. But it's been surprisingly rare that people have been unwilling to talk about these questions. ... Most parents open up and are really very willing to discuss the issues that come up. It's been rare that people push back and don't want to be vulnerable."
Instead, Dr Buxbaum said, it initiates important conversations. They discuss the impact these experiences have on children, the science of toxic stress and what it does to growth and development. Then they address which traumatic experiences the child has been exposed to and if the trauma or life event calls for a referral to any outside organization. The survey results are private and stay in patients' medical charts. The only data that's sent to the state simply indicates when an ACEs screening is performed.
The most important part of asking patients about childhood trauma is what comes after: referrals to the proper services, whether that's teaching children coping skills, a behavioural therapist, parenting classes at a family resource centre, sibling support groups or a food pantry.
According to the state, more than half a million children and adults across California have been screened for childhood trauma, meaning more than 500,000 Californians have now had a conversation with their providers about how toxic stress affects their health and well-being, and hopefully, been connected with the mental health and social services they need to live a less stressful life.
For Dr Buxbaum, the entire process of talking to his patients about childhood trauma and stress has been enlightening. "The effects of early childhood trauma are profound, and we're increasingly aware of the degree to which these early childhood experiences affect health and well-being throughout our entire lives," he said. "I believe that by screening for and identifying adverse childhood experiences early, we can begin to identify and treat the root causes of significant suffering. ACE screening and the recognition of how trauma affects us, really is a paradigm shift in paediatrics and in medicine as a whole."
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Children with neurodevelopmental disabilities UK Government: "ADHD, is the most common behaviour disorder in the UK. Estimates of prevalence appear to have risen over time, although this increase is, at least in part, associated with increased recognition and diagnostic practices. Estimates of prevalence also vary depending on the diagnostic criteria used. Using broader mental disorder diagnostic criteria, it is estimated to affect 3–9% of school-aged children and young people. A narrower criteria suggests a prevalence of 1–2%." .
Are we looking for root causes or just treating the symptoms?
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From an article in North Coast Journal, 21/06/2022