Science Friday - The Evolving Science Of How Childhood Trauma Shapes Adults | Butterfly Memories

Episode Date: March 20, 2025

The framework of Adverse Childhood Experiences started with an unexpected finding over 30 years ago. How is our approach changing? We know that experiences from our childhood, both good and bad, shape who we become as adults. But, understanding what kinds of early experiences have staying power into adulthood and the wide range of impacts they can have is an emerging science.In the 1980s, Dr. Vincent Felitti ran a weight loss clinic in San Diego, California. He noticed that some patients who regained weight were more likely to have experienced sexual abuse in childhood.This eventually led him to conduct research on a larger scale to better understand the correlation between what he and his colleagues dubbed adverse childhood experiences, or ACES, and mental and physical health challenges later in life.This same 10-question survey Dr. Felitti gave participants in the 1990s is still used by researchers and clinicians to assess childhood trauma. But recently, some psychology experts have begun to question how accurately the ACES framework identifies trauma in diverse populations, since it was originally developed for a mostly white and affluent study population.Host Flora Lichtman talks with Preeti Simran Sethi, science writer and Rosalyn Carter Mental Health Journalism fellow, about her reporting for Science Friday about adverse childhood experiences.Also, to see more butterfly stories from our listeners, visit our story from last week. Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Flor Lichten. Today on the podcast, how childhood trauma shows up in adulthood. This message that we hear, if you have a trauma, you're going to have all these poor health outcomes. And while that message can be true, it's not a guarantee. Just a heads up that our next conversation covers a sensitive subject, trauma. We know that the experiences from our childhood, the good and the bad, shape who we become adults. But understanding what kinds of early experiences have staying power into adulthood and the wide range of impacts they can have is an emerging science. Here to tell us more is Prithee Simran

Saiti, a science writer and Rosalind Carter Mental Health Journalism Fellow who's been reporting on Asian mental health. Preeti, welcome to Science Friday. Thank you, Flora. So today we're talking about studying the effects of negative childhood experiences. You know, basically, trying to understand the impact of childhood trauma. When did people start digging into this question scientifically, like trying to understand it on a population level? Well, I mean, back in the 19th century, scholars like Freud theorized about the impacts of childhood trauma on adults,

but it wasn't studied in large groups of people until the 1980s. And the first researchers to do so didn't set out to study childhood trauma at all. They were actually studying obesity. Back in 1980, a doctor in San Diego named Vincent Feliti, who was chief of the Department of Preventative Medicine at one of America's biggest healthcare companies, started a clinic to help people lose weight. And it really took off. But then this strange thing kept happening. Patients would successfully lose weight and then... They were finding this really unusual trend where women who were losing a consistent amount of weight. And actually, we're doing really well in terms of the intervention, were often the ones.

who were dropping out of the study and were then gaining the weight back. That's Christine Fork, an assistant professor of family medicine and community health in the Perlman School of Medicine at the University of Pennsylvania. So Felitti dug in to try to understand what was going on. And as he was talking to patients, a few shared that they had been sexually abused. And they thought those experiences might be tied to their weight gain. So the clinic decided to ask all incoming patients if they'd have, had a history of sexual trauma.

And the response was what Felitti describes as overwhelming. What do you mean? Over half of the nearly 300 patients he and his colleagues interviewed had experienced childhood sexual trauma. And for Context, Flora, one in four girls and one in 20 boys in the United States are estimated to have experienced childhood sexual abuse. Those are staggering statistics. Yeah.

Felidis started to think about what happened to his patient. as kids and how it was still having an impact. And he shared those insights at an obesity conference in Atlanta in 1990. A scientist from the CDC who heard the presentation was like, these findings are potentially groundbreaking, but you need to broaden the study. Not just obesity patients do this with a broader population. And so Felitti and his colleagues did just that. Over the span of two years in the mid-90s, they interviewed thousands and thousands of patients going through health assessments at Kaiser Permanente, and they ask them 10 yes or no questions.

Here's Christine again. And those items include things like sexual abuse, physical abuse, emotional abuse, physical and emotional neglect, as well as items that we would consider household dysfunction, like living with a parent who has a mental illness or has been incarcerated, using substances, things like that. It's hard to conceive of this now, Flora, but up until the Felitti study,

connections around how profoundly maltreatment when we're kids can impact us later in life hadn't been made in any systematic way. So what did researchers take away from this study? Well, first it showed childhood traumas with the researchers called adverse childhood experiences are correlated with a wide range of physical and mental health issues. And just as important, the study highlighted how many folks have experienced childhood trauma. The researchers had listed 10 adverse childhood experiences, and the majority of adults surveyed said they'd experienced at least one. About 17% of folks said they'd experienced four or more of the 10. Okay, wow. So a lot of people have had these experiences.

In this study, did they find these experiences correlated to any impacts in adulthood? They did. That initial analysis showed adults who experienced four or more of those traumas as kids, were twice as likely to develop heart disease, three times more likely to have clinical depression, five times more likely to develop an addiction to alcohol, and 17 times more likely to attempt suicide. It's what researchers call a dose response. The more adverse experiences you have, the more likely you are to have a whole range of health issues. Wow. I mean, that's really shocking. And no one had ever measured this before? Nope. You know, to me, it's,

kind of crazy that an obesity doctor kind of randomly stumbled into this finding that opened up this new, you know, field of clinical study. It is. And what I shared just isn't even the full list. Later studies have shown a higher number of childhood traumas, increased chances of chronic lung and liver disease, and certain cancers. Plus, increased levels of PTSD, sexually transmitted infections, homelessness, incarceration, criminal behaviors, relationship challenges, and a shortened lifespan. All right, so obviously these are all just correlations. How well do scientists understand the how? The mechanism of how these childhood experiences might lead to these outcomes. Well, researchers are trying to build on that foundational research,

first and foremost, to understand just that. What are the mechanisms? But the work is also being used to inform public policy and somewhat controversially as a diagnostic tool in clinical, clinical settings. Wait, why is it controversial? Well, doctors and therapists ask their patients to fill out the adverse childhood experiences survey as part of intake. Some do. California has actually launched an initiative to encourage it. But Felitti's co-collaborator in the original study, Robert Anda, and others, have argued that the adverse childhood experiences survey isn't standardized

and was never meant to be used to diagnose or screen folks for future risk. Leading researchers in childhood trauma told me that it doesn't make sense to overload the health care system by assessing a bunch of people for trauma without any way to alleviate it. Until psychologists can develop effective interventions for the childhood harms they identify and ensure the people who have experienced those traumas have proper support, they say it's better to focus on building up the data set to understand more clearly how traumatic events in childhood linked to adverse impacts in adulthood and to develop policies and other interventions that hopefully will keep those traumas from happening in the first place. So what do we still need to learn? What did we not get from the initial study?

That first Felitti study was big and really was groundbreaking, but it drew from a pretty homogenous group. Here's Christine again. This was done on the West Coast, and it was primarily white participants, middle class, insured, highly educated, and they also were coming to seek medical care. Okay, gotcha. I mean, we know that leaning on one demographic is a pervasive problem in science and medicine generally. Like, you know, women are underrepresented in clinical trials. And so dosing is in many cases based on male bodies. Exactly. And beyond gender, the majority of psychological research is done within what are known as weird populations. Weird's an acronym that stands for people who come from Western, educated, industrialized, rich, and democratic countries.

One study showed that less than 3% of folks who participate in psychological studies are from Africa, Asia, Central and South America, or the Middle East. But, I mean, those are the people who make up the majority of the global population. And another stuff that really stood out to me was that an American undergraduate student is 4,000 times more likely to be selected as a subject for research than a non-Westerner. And that's a problem because research done on Westerners is often assumed to be universal, which really overlooks important differences in cultures, histories, and life experiences. I mean, and it seems like there are a ton of variables, you know, between person to person,

including people's life experiences, which aren't easily captured on a 10-question survey. Yeah, I'm going to get personal for a minute here, if that's okay. Please do. A couple years ago, I was given the adverse childhood experiences survey, that original one Felida and his colleagues developed, that still used more than any other survey. Those 10 questions, remember, focus on physical and emotional neglect or harm, sexual violence, substance abuse, the incarceration of a family member, or the separation or divorce of a parent. Now, by that assessment, I looked pretty okay. But there were all these other things that had happened to me as a kid. being an immigrant, having to learn American culture and dealing with racism and xenophobia, feeling the financial stressors that my parents were under. That did have an impact, but they weren't even named. In the population Felita and his team were working with, mostly white, mostly well-off, insured, those issues didn't come up, but in other settings it did. In other people, it does. Christine Fork and her colleague Peter Cronholm, who's a professor of family

Medicine at the University of Pennsylvania headed up a research team that took a different, more expansive approach to assessing childhood traumas. How do you mean? Well, for starters, instead of interviewing adults, they surveyed a racially and socioeconomically diverse group of young people. And they expanded the types of traumas included in the survey. Here's Peter. We had decided to try to measure things related to witnessing community violence living in unsafe neighborhoods, the experience of bullying or discrimination. and experience with the foster care system. So what did they find?

One big finding is that different kinds of traumas are linked to different kinds of health outcomes. For example, some of the additional challenging childhood experiences that they added tended to be associated with at-risk behaviors and mental health rather than physical health. The expanded list also offered new insights into the repercussions of experiences that weren't part of that original study,

like bullying. Researchers now know bullying can have effects equivalent to maltreatment by a parent. But in the mid-1980s, they didn't know that. So, Laura, the questions that are asked matter. And when you're studying trauma, how the questions are asked also matters. Let me give you an example I heard from psychologist Xinjiang, who wrote the book Asian-American psychology and psychotherapy. She uses the term ACEs to reference adverse childhood experiences.

Some aces like child abuse and neglect are incredibly high among Asian American communities. We're talking figures upwards of 80% of the population, and yet the opposite message keeps getting repeated. So this to me is a fascinating case study of racial bias and research and finding what we expect to see. So what I mean is that there's this stereotype of Asian Americans as being successful, not having problems. even despite the fact that we have large-scale studies that say rates of abuse and neglect are actually quite high among Asian-Americans. I asked her why there was such a disconnect. So it turns out some of the few studies that indicate low rates of aces relied largely

on cases of abuse being reported to authorities like a medical provider or child protective services or in some cases the research as parents. if their children have experienced abuse. But when it comes to Asian Americans, relying on these kinds of reports, is extremely faulty because Asian-Americans are the least likely to report things to authorities, and it ignores cultural values like they need to preserve space

and a reluctance to disclose trouble in the family. If you don't ask appropriate questions in a culturally sensitive way, get these pervasive misconceptions that distort the understanding of trauma, in diverse populations. And that has larger ramifications from how health care providers approach and care for patients to the kinds of resources that are allocated to entire communities. That's why I really appreciate Peter's perspective and humility. For the field to evolve, I think we have to really have an open mind in terms of sort of thinking about what constitutes stressors in people's lives and recognize that it likely varies dramatically.

And also, as Christine says, outcomes may vary. It comes across as gloom and doom, right? This message that we hear, if you have a trauma, you're going to have all these poor health outcomes. And while that message can be true, it's not a guarantee. So we see many people that have a number of ACE exposures, yet they go on to live healthy, happy, long lives. Which researchers are now trying to understand. They're investigating the flip side of adversity. So the flip side of adversity, say more.

The way positive childhood experiences, the love and care we get when we're young, can help mitigate the traumatic experiences that we go through. You can read all about it at sciencefriday.com slash childhood. That's science friday.com slash childhood. Preeti, thank you. Thank you, Flora. Preeti Simran Satie is a science writer and Rosalind Carter, Mental Health Journalism Fellow, who's been reporting on Asian mental health.

After the break, you should. shared some butterfly encounters with us that belong in the permanent collection. And got out of a long relationship and the fact that I have a butterfly, it really did feel incredibly special. Stay with us. So last week, we asked you to call and tell us about butterfly encounters that made your heart sore or maybe even brought a little due to your eyes. We loved hearing from you and wanted to share a few of our favorites. Up first, Tim from Portland with a frightening. close encounter. One day I was heading home and my commute I did my bike and it was a nice,

beautiful sunny day and there was something like big and white, like baseball sized about chest height. And my first thought was like somebody throwing a baseball right at me. So I freak out and I'm like, you know, and then the baseball laughed its wings and almost disappeared and I realized it was a butterfly. Next up is Hana. With a story. from Prague in the middle of winter. So it's very cold, there's some snow even, and one day there's this butterfly that appears in my new apartment. And it's plain white with yellowish color at the bottom of the wings, and it's got a few black spots. So a sort of fairly common butterfly if you're out in the

country in the summer, but not in the middle of the winter in a flat. And she was just hanging around on the floor. Sometimes she was hanging on the window cell. And, And I was just feeding her sort of dilute agave nectar. Classic roommate behavior eating your food. Exactly. Yeah. How did you interpret the butterfly? Did you take it to be an auspicious sign?

Oh, yeah. Because it was a really transformational period for me. I got out of a long relationship. This was my first apartment. That was just me. And the fact that I have a butterfly, it really did feel incredibly special. Next up is Rachel. With a butterfly encounter from Arizona.

where she was giving a talk at a conference while dealing with some heavy personal stuff. It was pretty intense and overwhelming because I had recently lost my mother. I was honestly shredded. So I said to myself, I need to do something to find my peace or I'm going to have a heart attack. And so I started looking around. And the second I saw it, Butterfly Wonderland, I was like, that's where I need to go. Like a butterfly vivarium? Yes.

I walked into the space and I was just like, oh, wow, my mom would really, really love this. And I wish she were here. I wish she was with me. And I was just standing there in this little corner tucked away. And this little tiny butterfly landed just about three inches from my nose. And I didn't even think. I just sort of reflexively said, hi, Mom. Which is, you know, slightly insane.

And I just said I miss you. I just felt like she was right there with me. It's really a beautiful story. Thank you for sharing it. You're welcome. And thanks to everyone for calling. Want to keep fluttering your wings? Go to science friday.com slash butterfly.

to check out some butterfly photos our listeners shared. That's scienceriday.com slash butterflies. And that is about all we have time for. Lots of folks helped make this show happen, including Danielle Johnson. Jason Rosenberg. Rasha Eredi. Shoshana Bugsbaum.

I'm Flora Lichtman. Thanks for listening.