Childhood adversity & lifelong health: From research to action
Childhood adversity is a significant root cause of chronic illness and early death. Prevention, mitigation, and Tx of toxic stressors must be part of our paradigm of care.
PRACTICE RECOMMENDATIONS
› Refer eligible patients to an evidence-based perinatal home-visiting program and all parents to an evidence-based parenting program to prevent childhood adversity. A
› Consider screening adult patients and parents for their own history (and their children’s history) of childhood adversity. B
› Recommend trauma-focused cognitive behavioral therapy and eye-movement desensitization and reprocessing as first-line treatments for adversity and trauma. A
› Consider prescribing yoga, neurofeedback, and other neuromodulatory modalities to treat the consequences of childhood adversity and trauma. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Although clinical translation is still unfolding, the risks of implementing promising prevention and treatment strategies are low, the stakes are high, and the potential benefits are vast. Therefore, we as family physicians can—must—learn and incorporate the science of childhood adversity, neurobiology, and life course into our training, research, and clinical paradigm and practice; we can do that by embedding this framework throughout our training and continuing education in formal didactics, case discussions, hands-on skill-building, scientific investigation, and patient care.
We must make our offices and hospitals trauma-informed; connect patients with resources to meet basic needs and with home-visiting and parent education programs; educate patients about the impact of protective and adverse factors on health; provide and practice self-regulation training in our offices or by referral; and advocate for equity.
Using these strategies, family physicians will play a crucial role in the prevention, mitigation, and treatment of the root cause of disease and society’s deepest individual and collective suffering.
CORRESPONDENCE
Audrey Stillerman, MD, ABFM, ABIHM, ABOIM, Office of Community Engagement and Neighborhood Health Partnerships, 808 South Wolcott Street, Room 809, Chicago, IL 60612; ajstille@uic.edu.
ACKNOWLEDGMENT
Patricia Rush, MD, MBA, and Adrienne Williams, PhD, reviewed the manuscript of this article.
