Blogging NTI: Vincent Felitti Shows that Early Experiences Do Matter Later in Life
The seeds of many of our most common and intractable public health problems are sown early in life through adverse experiences that surface years later as chronic disease, addiction, and destructive behavior, Dr. Vincent Felitti told a packed house at the NTI luncheon plenary.
Dr. Felitti described the Adverse Childhood Experiences (ACE) study, which looked at the early experiences of over 17,000 adults and found they were powerful predictors of adult health, functioning, and well-being, and thus the leading determinants of the health and the social well-being of the nation.
Before Dr. Felitti spoke, Executive Director Matthew Melmed introduced a special friend of ZERO TO THREE and infants and toddlers. Steven Hicks, Special Assistant for Early Learning to Education Secretary Arne Duncan, brought greetings from the Secretary and underscored the Department’s recognition of the importance of the earliest years in laying foundations for later success in school. The recently announced Office of Early Learning, the first such office at the Department, is evidence of this interest and support. Mr. Hicks told the audience the recipients of the new grants for the Early Learning Challenge would be announced soon. He expressed the hope that the process of developing applications for the grants would spur states that don’t receive grants to continue efforts to build a stronger early learning system, aided by materials such as ZERO TO THREE’s Race to the Top Early Learning Toolkit.
When Dr. Felitti took the stage, he described the main categories of adverse experiences, noting that the subjects of the study were middle-class—“they are you and me,” he said—a fact that makes many people uncomfortable and evokes resistance to confronting these problems as a society and finding solutions. The experiences the study cataloged include psychological and major physical, sexual abuse, emotional and physical neglect, alcohol and drug use, loss of a biological parent, depression and mental illness, mother treated violently, and a household member who had been imprisoned.
The study team created an ACE score based on how many categories of events a person had experienced as a child. Only a third had no experiences in these categories, and more than a fourth had experienced three or more. As the number of early adverse experiences rises, so does the likelihood of later adult outcomes such as addiction and chronic depression. Dr. Felitti said that what presents as the problem may actually be somebody’s attempted solution. He pointed out that what we look at as intractable public health problems—smoking, drug and alcohol abuse, excessive eating leading to obesity—are often the adult’s attempt, in the words of one adult who spoke on camera, to block emotions and memories of early experiences.
Dr. Felitti showed the pyramid of consequences of the early adverse experiences which form its base: disrupted neurodevelopment; social, emotional and cognitive impairment; adoption of health-risk behaviors; disease, disability, and social problems; and, at the top of the pyramid, early death. He noted that just talking with individuals who have had early adverse experiences has a value to those people, but primary prevention is the only feasible approach for the broad population.
Following the formal speech, Dr. Felitti generously conducted a 90 minute break-out session composed solely of a question and answer period. Again, the room was filled as conference attendees asked him to expand on his earlier comments and told their own sometimes moving stories about the power of the ACE score in identifying and addressing the needs of at-risk young children. At the end of the session, Dr. Felitti mentioned the value of involving adults who have had adverse experiences in expressing them theatrically, through plays about “somebody else”. He threw out an idea for a play that seems to have relevance and potential power as we think about how to tell policymakers the story of the consequences of early childhood adversity: If you had a baby, and someone said to you that you had 18 years to get that baby into a penitentiary—how would you do this? The ACE study shows the path. As infant-toddler advocates, we have to work to take a different road.
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