Children Living in Stressful Environments

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• Children Living in Stressful Environments
• A Resource Kit
• June 2008

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Children Living in Stressful Environments

• The health, productivity and creativity of a
  society are renewed each generation through its
  children. The society that understands and acts
  on this will succeed the society that does not
  is doomed to fail.
• Bruce D. Perry, M.D., Ph.D.,
• Senior Fellow, The Trauma Academy
• in The Real Crisis of Katrina

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Children Living in Stressful Environments

• Children of Alcoholics/Addicts (COAs)
• Children With Fetal Alcohol Spectrum Disorders
  (FASD)
• Children in Families With Mental Health Disorders
• Children in Families With Disabilities, HIV, or
  Chronic Illness
• Children Who Have Been Abused/Witnessed Abuse
• Children of Military Personnel/Veterans or Who
  Live on/Close to Military Bases
• Children of Divorced or Absent Parents/Orphaned
  or Foster Children
• Children of Immigrants or in Bicultural Families
• Children Who Have Experienced Disasters
• Children Who Are Homeless

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Children Living in Stressful Environments

• What we are calling stressful environments are
  sometimes referred to as adverse childhood
  experiences, or ACEs.
• CDC and Kaiser Permanente partnered on an ACE
  study of 17,000 Kaiser health plan subscribers
  from 1995 to 1997 analysis of the data is
  ongoing. Some findings will be included in this
  discussion.

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Children Living in Stressful Environments

• are at increased risk for substance abuse,
  mental disorders, and other serious problems,
  including physical illness.
• Although many demonstrate resiliency, and gain
  valuable skills and lessons learned, many others
  may develop serious problems of their own.

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Children Living in Stressful Environments

• may grow up to repeat similar patterns, carrying
  the cycle of addiction and other trouble to
  future generations.
• For example, children of alcoholics (COAs)

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Children of Alcoholics (COAs)

• are between 4 and 10 times more likely to
  become alcoholics themselves than are children
  who have no close relatives with alcoholism.
• are more likely to begin drinking at a young
  age and to progress to drinking problems more
  quickly.
• Source NIAAA. (January 2006). Alcohol Alert No.
  67. Underage drinking Why do adolescents drink,
  what are the risks, and how can underage drinking
  be prevented?

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Early Drinking and Adolescent Development

• Given recent research indicating the negative
  impact of alcohol use on neurodevelopment of
  adolescents, the relationship of ACEs (Adverse
  Childhood Experiences) to early initiation of
  alcohol use is particularly worrisome.
• Robert F. Anda, M.D., M.S., Co-Principal
  Investigator, CDC-Kaiser Permanente ACE survey

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Childhood Trauma Risks

• More than 35 percent of children exposed to a
  single traumatic event will develop mental health
  problems such as PTSD.
• They are at lifelong elevated risk for such
  physical problems as heart disease, diabetes, and
  hypertension.
• As adults, they have increased rates of divorce,
  unemployment and school failure, depression,
  PTSD, alcoholism, and drug abuse/dependence.
• Source Perry, B., M.D., The real crisis of
  Katrina. National Association to Protect
  Children. Child Trauma Academy.

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Substance Abuse Links Many Problems

• Substance abuse is often a link between problems
  in the lives of parents and other caregivers.
• Substance abuse is often a factor in stressful
  environments affecting children and a link
  between such environments.

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Co-Occurring Problems

• As serious problems may co-occur in an individual
  life, so may a child experience multiple
  stressful environments.
• Children who live in a stressful environment are
  more likely to experience additional adverse
  consequences in their lives the more of these
  they experience, the more likely they will turn
  to alcohol, tobacco, and other drugs or develop
  mental health problems and/or other serious
  problems.

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Adverse Childhood Experiences

• The ACE study looked at
• Childhood abuse
• Emotional
• Physical
• Sexual
• Neglect
• Emotional
• Physical

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Adverse Childhood Experiences

• the rest of the ACE study list
• Growing up in a seriously dysfunctional household
  as evidenced by
• Child witnessing domestic violence
• Alcohol or other substance abuse in the home
• Mentally ill or suicidal household member
• Parental marital discord (as evidenced by
  separation or divorce)
• Crime in the home (as evidenced by having a
  household member imprisoned).

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Adverse Childhood Experiences

• The effects of ACEs are long-term, powerful,
  cumulative, and likely to be invisible to health
  care providers, educators, social service
  organizations, and policy makers because the
  linkage between cause and effect is concealed by
  time, the inability to see the process of
  neurodevelopment, and because effects of the
  original traumatic insults may not become
  manifest until much later in life.

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Key Findings of the ACE Study

• More than one in four respondents grew up with
  substance abuse.
• Two-thirds had at least one ACE, or adverse
  childhood experience.
• More than 1 in 10 reported 5 or more ACEs.
• 81 percent reported at least one additional ACE.
• ACEs are a major hidden engine underlying
  preventable risk factors for HIV.
• ACEs greatly increase the risk of adult alcohol
  abuse or marriage to an alcoholic.

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Engine Driving HIV Risk Factors

• Risk factors for HIV/AIDS
• Injected drug use
• Fifty or more lifetime intercourse partners
• Ever having an STD
• All increase dramatically as the ACE Score
  increases, thus creating a hidden engine
  underlying HIV risks, according to the ACE
  studys author.

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Key Facts About COAs

• Approximately one in four children is exposed to
  family alcoholism or addiction or to alcohol
  abuse before age 18.
• Source Grant B.F. (2000). Estimates of U.S.
  children exposed to alcohol abuse and dependence
  in the family.
• Research has documented that children with
  substance-abusing parents are more at risk than
  their peers for alcohol and drug use, delinquency
  and depression, as well as poor school
  performance.
• Source SAMHSA Office of Applied Studies. (March
  2006). Children of substance abusers children at
  risk because of parental substance abuse.

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Key Facts About COAs

• Children of alcoholics (COAs) are between 4 and
  10 times more likely to become alcoholics than
  children from families with no alcoholic adults.
  
• Source Office of the Surgeon General. (2007).
  The Surgeon Generals Call to Action To Prevent
  and Reduce Underage Drinking, 2007. U.S.
  Department of Health and Human Services.

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Key Facts About Children With Fetal Alcohol
Spectrum Disorder (FASD)

• FASD occurs in about 10 per 1,000 live births, or
  about 40,000 babies per year, according to
  estimates published in 2001.
• Source FASD Center for Excellence. (2004). The
  Language of Fetal Alcohol Spectrum Disorders.
  Substance Abuse and Mental Health Services
  Administration.

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Key Facts About Children With FASD

• In these 2001 estimates, fetal alcohol syndrome
  (FAS), the most recognized condition in the
  spectrum, was estimated to occur in 0.5 to 2 per
  1,000 live births.
• Source FASD Center for Excellence. (2004). The
  Language of Fetal Alcohol Spectrum Disorders.
  Substance Abuse and Mental Health Services
  Administration.

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Key Facts About Children in Families With Mental
Health Disorders

• About 31 percent of women and about 17 percent of
  men have a 12-month prevalence of at least one
  psychiatric disorder (not including substance
  abuse). Of women in this group, 65 percent are
  mothers 52 percent of the men are
  fathers.Source CMHS. (July 2001). Critical
  issues for parents with mental illness and their
  families summary. Substance Abuse and Mental
  Health Services Administration.

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Key Facts About Children in Families With Mental
Health Disorders

• Children of parents who are mentally ill are at
  increased risk for emotional, mental health, and
  behavioral problems and for alcohol and drug
  abuse.
• Source CMHS. (July 2001). Critical issues for
  parents with mental illness and their families
  summary. Substance Abuse and Mental Health
  Services Administration.

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Key Facts About Children in Families With
Disabilities, HIV, and Chronic Illness

• At least 8 million, or 11 percent, of families in
  the United States with children under 18 have one
  or more parents with a disability.
• Source Olkin, R. (1999). What psychotherapists
  should know about disability.
• About 1.4 million children between the ages of 8
  and 18 in about 906,000 households nationwide
  assist a disabled or ill family member.
• Source National Alliance for Caregiving.
  (September 2005). Young caregivers in the U.S.
  Findings from a national survey.

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Key Facts About Children in Families With
Disabilities, HIV, and Chronic Illness

• After living with an ill parent, about 80,000
  children in the United States have been orphaned
  by AIDS.
• Source Rotheram-Borus, et al, (2001). An
  intervention for parents with AIDS and their
  adolescent children. American Journal of Public
  Health.

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Key Facts About Children Who Have Been
Abused/Witnessed Abuse

• Physical assault, physical neglect, contact
  sexual abuse, and supervision neglect before
  sixth grade are all linked with drug, cigarette,
  and alcohol use violence and depression.
• Source Dube, S.R., Anda, R.F., et al. (February
  2002). Exposure to abuse, neglect, and household
  dysfunction among adults who witnessed intimate
  partner violence as children Implications for
  health and social services. Violence and Victims
  17.

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Key Facts About Children Who Have Been
Abused/Witnessed Abuse

• Intimate partner violence is common 9 in 10
  children who live in homes where there is
  intimate partner violence see or hear it.
• Source CMHS. (December 2000). When parents need
  help first. Helping your children navigate their
  teenage years A guide for parents. Substance
  Abuse and Mental Health Services Administration.

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Key Facts About Children of Military
Personnel/Veterans

• At any one time, over half a million children
  have one or more parents who are deployed on
  military assignment.
• Source American Psychological Associations
  Presidential Task Force on Military Deployment
  Services for Youth, Families and Service Members.
  (February 2007). The psychological needs of U.S.
  military service members and their families A
  preliminary report.
• Youths who become emotionally distressed as a
  result of a parents military deployment are at
  increased risk for substance abuse.
• Source Office of Applied Studies. (2007).
  Results from the 2006 National Survey on Drug Use
  and Health National findings. Substance Abuse
  and Mental Health Services Administration.

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Key Facts About Children of Military
Personnel/Veterans

• Youths in military families and communities are
  exposed to a different substance use environment
  than that found in civilian life.
• Source Bray R.M., Hourani L.L., Rae Olmsted
  K.L., et al. (December 2006). 2005 Department of
  Defense survey of health related behaviors among
  active duty military personnel. RTI International
  prepared for the Assistant Secretary of Defense
  (Health Affairs).

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Key Facts About Children of Divorced, Absent
Parents/Orphans or Foster Children

• About 40 percent of children in the United States
  are children of divorced parents 20 to 25
  percent of them show signs that they are not
  dealing well with this change in family structure
  and are at risk for negative outcomes, including
  substance abuse.
• Source SAMHSA Family Guide. Divorce counseling
  may help prevent teen substance abuse.

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Key Facts About Children of Divorced, Absent
Parents/Orphans or Foster Children

• In 2005, an estimated 680,000 youths (2.7
  percent) aged 12 to 17 had ever been in foster
  care and had higher rates of need for substance
  abuse treatment than youths who have never been
  in foster care.
• Source SAMHSA Office of Applied Studies.
  (February 18, 2005). The NSDUH Report. Substance
  use and need for treatment among youths who have
  been in foster care.

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Key Facts About Children of Immigrants or in
Bicultural Families

• While new immigrants are less likely to engage in
  substance use than the U.S.-born population,
  those who had been here for 10 years or longer
  reported similar drug use to native-born
  residents.
• Source SAMHSA. (February 2003). Acculturation
  increases risk for substance use by foreign-born
  youth. SAMHSA News.

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Key Facts About Children of Immigrants or in
Bicultural Families

• Children of immigrants are the fastest-growing
  segment of the U.S. population under age 18.
• Source Migration Policy Institute. (December
  2003). Poverty grows among children of immigrants
  in the U.S.
• 68 percent of children in immigrant families live
  with parents who have been in the United States
  for 10 or more years.
• Source Foundation for Child Development. (April
  2007). Children in immigrant familiesThe U.S.
  and 50 states National origins, language, and
  early education.

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Key Facts About Children Who Have Experienced
Disasters

• Disaster is likely to worsen problems in children
  and their families.
• Source SAMHSA/CMHS/American Academy of
  Pediatrics. Psychological issues for children and
  families in disasters A guide for the primary
  care physician.
• Children who experience disaster and develop PTSD
  are at greater risk for developing substance
  abuse problems.
• Source NIDA. (February 2006). NIDA Community
  Drug Alert BulletinStress Substance Abuse.

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Key Facts About Children Who Have Experienced
Disasters

• Two years after Hurricane Katrina, 46,600
  children along the gulf coast still have mental
  health and behavioral problems.
• Source Columbia University Mailman School of
  Public Health/Childrens Health Fund. (December
  2007). The legacy of Katrinas children.

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Key Facts About Children Who Are Homeless

• An estimated 1.6 million youths are homeless each
  year, some for brief periods approximately
  200,000 youths each year live permanently on the
  street.
• Source SAMHSA OAS. (July 2, 2004.) The NSDUH
  Report. Substance use among youths who had run
  away from home.
• rates of substance use among runaway youth have
  been shown to be nearly double that of housed
  youths attending school
• Source Bender, K.A. and Thompson, S. (January
  14, 2006.) Alcohol use among a national sample of
  runaway/homeless youth.

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Key Facts About Children Who Are Homeless

• 48 percent of homeless youths reported
  significant alcohol use vs.19 percent of other
  youths, and 26 percent of homeless youths
  reported injection drug use about one-fifth
  reported that drug use contributed to their
  leaving home.
• Source Health Resources Services
  Administration. (2001). The health center
  program Program assistance letter Understanding
  the health care needs of homeless youth.

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The Good News

• children of substance abusing parents can and
  often do overcome the effects of these family
  substance abuse potentially damaging
  environmental and genetic factors.
• Source SAMHSA. 2003. Childrens program kit
  Supportive education for children of addicted
  parents.

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Many Children Overcome

• Even COAs in high-risk environments with other
  chronic sources of stressincluding poverty,
  racism, disrupted marriages, serious emotional
  problems, and histories of abuse and neglectare
  often able to overcome these painful beginnings
  and create healthy, fulfilling lives for
  themselves.
• Source SAMHSA/CSAP. (1992). The fact
  isalcoholism tends to run in families.

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Resilient Children of Alcoholics (COAs)

• may have increased resilience when they benefit
  from the efforts of supportive adults.
• Source SAMHSA/CSAP. (2003). Childrens program
  kit Supportive education for children of
  addicted parents COAs Important facts, 29.
• benefit tremendously from adult efforts to help
  and encourage them. Children who cope bestoften
  trace their sense of well-being to support from a
  nonalcoholic parent, family member, teacher, or
  other significant adult in their lives.
• Source SAMHSA/CSAT. Hot topics Children and
  addiction. DHHS Publication No. (SMA) 01-3544.

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Helping COAs

• Group programs facilitated by nurturing adults
  can reduce feelings of isolation, shame, and
  guilt among COAs and encourage positive peer
  influence and mutual support.
• Helping such children develop competencies like
  forming and sustaining close relationships,
  expressing their feelings, and problem-solving
  can increase their resilience.

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Strategies Should Help Children To

• Develop autonomy and independence.
• Develop a strong social orientation and social
  skills.
• Engage in acts of required helpfulness.
• Develop a close bond with a caregiver.
• Cope successfully with emotionally hazardous
  experiences.
• Perceive their experiences constructively, even
  if those experiences cause pain or suffering, and
  gain, early in life, other peoples positive
  attention.
• Develop day-to-day coping strategies.

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Selected SAMHSA Resources

• From http//ncadi.samhsa.gov
• SAMHSAs Childrens Program Kit (w/videos on
  DVD).
• SAMHSAs Native American Childrens Program Kit
  (w/videos on DVD).
• Plus
• SAMHSAs Family Guide to Keeping Youth Mentally
  Healthy and Drug Free
• http//www.family.samhsa.gov/

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Key Prevention Resources

• http//preventionpathways.samhsa.gov
• http//www.nrepp.samhsa.gov/
• http//preventionplatform.samhsa.gov/
• and your States National Prevention Network
  membership.

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And remember our good news