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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe Adverse Childhood Experiences Study is a long-term research effort started in the 1990s to understand the impact of childhood trauma on health, social, and economic outcomes. The study is a collaborative effort between the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and Kaiser Permanente\u0027s Health Appraisal Clinic in San Diego, California. Three presenters reviewed how the too-often invisible nature of childhood trauma can change a child\u0027s epigenome early in life, leading to physical and mental health problems throughout the child\u0027s lifetime.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emood disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Echild \u0026amp; adolescent anxiety disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esubstance-related disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Adverse Childhood Experiences Study is a long-term research effort started in the 1990s to understand the impact of childhood trauma on health, social, and economic outcomes. The study is a collaborative effort between the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and Kaiser Permanente\u0027s Health Appraisal Clinic in San Diego, California. Three presenters\u2014Joy A. Lauerer, DNP, PMHCNS-BC, Medical University of South Carolina, Columbia, South Carolina, USA, Colleen C. Williams, DNP, FPMHNP-BC, Sea Mar Community Health Centers, Mount Vernon, Washington, USA, and Kathleen C. Gaffney, PMHCNS, CPNP, University of Tennessee Health Science Center, Memphis, Tennessee, USA\u2014reviewed how the too-often invisible nature of childhood trauma can change a child\u0027s epigenome early in life, leading to physical and mental health problems throughout the child\u0027s lifetime.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe study included 26 229 individuals in 5 states who were interviewed by phone using the 2009 adverse childhood experience (ACE) module of the Behavioral Risk Factor Surveillance System. The study results indicated that 59.4% of the respondents had at least 1 ACE and 8.7% had \u2265 5 ACEs. ACEs were linked to a range of negative health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality [CDC. \u003Cem\u003EMMWR Morb Mortal Wkly Rep.\u003C\/em\u003E 2010]. ACEs have also been associated with self-reported sleep disturbances in adulthood [Chapman DP et al. \u003Cem\u003ESleep Med.\u003C\/em\u003E 2011] and a higher incidence of being a smoker [Ford ES et al. \u003Cem\u003EPrev Med.\u003C\/em\u003E 2011] or having frequent headaches [Anda R et al. \u003Cem\u003EHeadache.\u003C\/em\u003E 2010]. The ACE pyramid shows the progression of the adverse childhood event from conception to death (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/44\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Adverse Childhood Experience Pyramid\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-608942572\u0022 data-figure-caption=\u0022Adverse Childhood Experience Pyramid\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/44\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/44\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/44\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15149\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EAdverse Childhood Experience Pyramid\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from CC Williams, DNP, FPMHNP-BC.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from \u003Cem\u003EAm J Preventive Med\u003C\/em\u003E, Vol 14, Felitti VJ et al, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Pages 245\u2013258. Copyright (1998), with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003E\n            \u003Cem\u003EEpigenetics\u003C\/em\u003E refers to influences on the phenotype operating above the level of the genetic code itself that includes DNA methylation, covalent histone modification, and noncoding RNA. Evidence suggests that epigenetic remodeling occurs during early development in response to environmental events to produce individual differences in gene expression of specific traits. These functionally relevant modifications to the genome do not involve a change in nucleotide sequence [Bagot RC, Meaney MJ. \u003Cem\u003EJ Am Acad Child Adolesc Psychiatry.\u003C\/em\u003E 2010]. The embryonic physiologic changes created by negative events can change the chemistry that encodes the genes in brain, cardiac, ocular, auditory, and skeletal cells resulting in birth defects. The effects of maternal stress are not confined to the first generation but can extend over multiple generations [Matthews SG, Phillips DI. \u003Cem\u003EExp Neurol.\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAlcohol use during pregnancy can be thought of as an early ACE, affecting developmental processes from conception onward. Alcohol can interfere with the normal proliferation of nerve cells, the formation of axons, the pathways of biochemical and electrical signals within a cell, the regulation of calcium levels in the cell, and the expression of certain genes that produce or regulate cell growth, division, and survival. Alcohol produces the most serious neurobehavioral effects in the fetus, yet only 1 in 6 adults has ever had a health professional ask them about alcohol use [CDC. CS244613B. 2014]. Fetal alcohol spectrum disorders (FASDs) affect an estimated 40 000 newborns each year in the United States and are the leading known cause of preventable intellectual disability. Besides intellectual problems, FASDs can cause poor coordination, hyperactive behavior, problems with sleep and sucking, reasoning and judgment skills, and vision and hearing and can create difficulties with social relationships. However, nurses should be aware that early detection is critical and that people with FASDs can grow, improve, and function well with proper support.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003E\n            \u003Cem\u003ENeuroplasticity\u003C\/em\u003E refers to the ability of the neural pathways and synapses to change in response to changes in behavior, thinking, emotions, and the environment. Such neuroplasticity is evident in epidemiologic and neurobiological data showing that childhood stress has a dose-response-like relationship with impairment in brain structures and functions as well as outcomes [Anda RF et al. \u003Cem\u003EEur Arch Psychiatry Clin Neurosci.\u003C\/em\u003E 2006]. Posttraumatic stress disorder (PTSD) is associated with changes in the medial prefrontal cortex, hippocampus, and amygdala areas of the brain. Stress is also related to aggressive behaviors in school-aged children when the child reacts aggressively due to a negative worldview and faulty brain development. The fight, flight, or freeze response is expressed as aggressive behavior.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIf there is no intervention, the effects of trauma and chronic stress can affect every development stage, including the child\u0027s emotional attachments, behavioral control, cognition, and self-concept. Overeating, substance abuse, depression, mood disorders, and suicide attempts are common as the stressed child ages into adolescence and adulthood. Early intervention is best, but each developmental stage offers an opportunity for intervention.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ENurses should be informed and should provide care with a trauma-informed approach based on emerging research from the fields of genetics, epigenetics, and the promise of neuroplasticity. This can start with a thorough psychosocial history that includes asking questions regarding prenatal exposure to alcohol, drugs, and environmental stressors. The ACE and resilience questionnaires can be used to establish a baseline. Change and healing can be promoted with body-, cognitive-, and trauma-focused therapies. Teaching self-care, self-regulation, and coping skills can improve patient self-control. Brain neuroplasticity allows the healthy as well as the impaired to benefit from cognitive training programs. Psychopharmacology is available that can target neurotransmitter dysregulation, stabilize mood, correct metabolic disorders, and ameliorate PTSD nightmares and depression. Nurses need to teach that all emotions can be managed, negotiated, and integrated as part of the healing experience.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EWith this expanded knowledge, nurses can and must assess for a history of prenatal alcohol exposure and childhood trauma and then diagnose and treat using individualized, person-centered, evidence-based practice. The objective should be to promote resilience and empower individuals to improve their health outcomes, despite the lack of rigorously evaluated programs.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/44\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlv6q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlv6q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}