En una pieza reciente en el programa de televisión 60 Minutos, Oprah Winfrey discutió trauma infantil - resaltar públicamente los efectos duraderos del abuso y la adversidad en la infancia. La propia Oprah es una sobreviviente de abuso infantil.
Las experiencias adversas de la infancia, comúnmente llamadas ACE, incluyen presenciar conflictos verbales o físicos entre los padres y tener un padre con una enfermedad mental o problema de abuso de sustancias. También incluyen la separación de los padres, el divorcio y el encarcelamiento y la experiencia de negligencia o abuso (sexual, físico o emocional) como un niño.
ACE son comunes. Aproximadamente 60 por ciento de la población general Informe haber experimentado al menos uno antes de la edad de 18. Más del ocho por ciento de la población informa que tiene cuatro o más ACEs.
La investigación ha encontrado consistentemente que cuanto más adversas experiencias de la infancia tiene una persona, mayor es su riesgo de problemas de salud posteriores.
Nuestra grupo de investigacion investiga cómo las ACE afectan la salud física y psicológica de las mujeres durante el embarazo. Estudiamos cómo las adversidades son "heredadas" o pasado de padres a hijos, y cómo se pueden reducir los riesgos de ACE en mujeres embarazadas.
Nuestro último hallazgo sugiere que cuando las madres que han experimentado ACE se sienten apoyadas por las personas que las rodean, su riesgo de complicaciones en el embarazo se reduce sustancialmente. En esencia, sentirse apoyado por amigos y familiares puede contrarrestar los efectos negativos de tener ACE.
De la enfermedad hepática a la muerte temprana
Las experiencias adversas de la niñez aumentan los riesgos de muchos problemas de salud más adelante en la vida. Estos incluyen problemas de salud mental como depresión, abuso de alcohol y drogas e intentos de suicidio.
Por ejemplo, una persona que ha experimentado cuatro o más ACE es cuatro veces más probabilidades de experimentar un problema de salud mental than someone who has not.
Las personas con a high number of ACEs may even be at risk for early death.
Toxic stress and the body
When children are exposed to abuse and adversity, they experience heightened levels of stress without a strong support system to help them through these difficult experiences. This is often referred to as “toxic stress.”
This stress is different from the tolerable types of stress that can help with development — such as learning to make new friends, going to a new school or taking a test.
Experiencing high levels of toxic stress during abusive or traumatic experiences can alter how our brain and body process future experiences and stressful events. Toxic stress impacts how we think and learn.
How does this happen? Toxic stress can cause excessive “wear and tear” on the body. It primes our system to be hyper-sensitive to stressors. This wear and tear builds up over time and can lead to both physical and mental health problems throughout our life.
When adults become parents, the effects that ACEs have had on their own body, mind and behaviour can influence how they experience their pregnancy and their pregnancy health. It can affect how they are able to interact with, and care for, their children.
Babies with developmental delays
In our work, we’ve shown that mothers who experience a higher number of ACEs are more likely to have gestational diabetes and hypertension.
They are also more likely to deliver a baby who is born too small or too soon or needs intensive care.
Even if the baby is born full term, children born to mothers with ACEs are at risk of developmental delay. For each additional maternal ACE, there is an 18 per cent increase in the risk that their child will be identified as delayed.
Ultimately, we have found that the effects of adversity can be passed down from one generation to the next.
However, with the right supports in place, our work also reveals that mothers can show remarkable resilience to adversity.
Compassion is protective
What helps promote resilience in the face of stress and adversity? How do we help families triumph over past experiences?
For some, even just being aware of how past adversities and traumas can impact their current functioning, including physical and mental health, is an important first step. This can start the road to recovery. Some people may benefit from additional counselling and professional support to launch them into a brighter future.
For others, it’s the compassionate response they receive when they talk to someone about their early experiences.
Oprah Winfrey and others have wisely encouraged people to replace saying “what’s wrong with you?” with “what happened to you?” — to allow for a more compassionate and understanding approach to individual experiences, including trauma and adversity.
Oprah describes her main protective factor from adversity as school, and pinpoints certain teachers who encouraged her intellectually and creatively. School and caring teachers helped her to feel valued and gave her a sense of belonging, helping heal the emotional wounds of abuse.
How to foster resilience
Supportive relationships are indeed a key ingredient for change. Support from friends, family, spouses or neighbours can boost the quality and security of life for people.
Community supports also matter. For example, our work suggests that when women participate in low-cost community programs and recreation, such as story time at the library, and when they can be encouraged to develop or engage in social support networks, their children do better.
Investing in families with young children makes financial sense too. Strategies that help new parents develop supports and parenting skills have a particularly high return on investment — improving outcomes for parents, children and their families and avoiding later, higher-cost interventions.
Whether we have been affected by ACEs or not, we can all play a role in fostering resilience by being the buffering support to our friends, family members and neighbours.
Utilizando a trauma-informed approach to patient care, health professionals can also play a central role simply by supporting and listening to patients burdened by childhood adversity.
The silver lining is that ACEs don’t define who we are or who we can become.
With supports, people who have endured ACEs can achieve emotional and physical well-being. It is compelling to realize that many people struggling with past adversity can identify support from teachers, neighbours, spouses and friends as instrumental in overcoming their adversities.
Each and every one of us can help make a difference in someone’s life.
Individuals are encouraged to speak to a physician or health care professional if they have concerns about how their adverse experiences might be impacting their functioning. For helpful resources and information on the science of early adversity visit The Alberta Family Wellness Initiative or Harvard University’s Center on the Developing Child.
Acerca de los Autores
Sheri Madigan, Profesora Asistente, Cátedra de Investigación de Canadá en Determinantes del Desarrollo Infantil, Instituto de Investigación del Hospital Infantil de Alberta, Universidad de Calgary; Nicole Racine, Postdoctoral Research Fellow, Universidad de Calgary, and Suzanne Tough, , Universidad de Calgary