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Day 2: Soda, cigarettes and trauma: How Adverse Childhood Experiences alter brain chemistry, cultivate unhealthy habits and prompt premature death

Patients would carry soda into Dr. Gerard Clancy’s office, with cigarettes tucked away for after therapy.

Often victims of abuse or violent crime, they would seek soothing but risky behaviors to cope.

Overweight. Chronic pain. Chronic obstructive pulmonary disease. Type II diabetes. His former patients will die younger than they should, he said.

Clancy conducted therapy sessions until he became president of the University of Tulsa in 2016. At his psychiatry clinic, he saw firsthand how a lifetime of unhealthy habits wear on a person suffering post-traumatic stress disorder after a serious threat to his or her well-being.

“It dates back as much as anything to their behaviors and how they live their lives daily,” said Clancy, who remains a prominent leader in Tulsa’s mental-health network. “They walk in with the biggest QuikTrip thing of sugary Coca-Cola as possible. And as soon as they’re done seeing me, they go outside and smoke.

“Part of that is how their brain has been wired.”

Tulsa is at the forefront of revolutionary research to unlock a deeper knowledge of how social, behavioral, physical and environmental factors may affect brain development and health. Oklahoma is No. 1 in the nation in youths up to age 17 who have experienced two or more Adverse Childhood Experiences, according to the 2017 National Survey of Children’s Health conducted by the U.S. Census Bureau.

Trauma at a young age can negatively alter or stunt cognitive development, creating undesirable genetic changes that may even be passed onto future generations, some studies show.

Referred to as Adverse Childhood Experiences, ACEs include household dysfunction, neglect, abuse, poverty, crime, substance abuse and mental illness. Research is showing ACEs to be strong predictors of cognitive, behavioral and physical health, and mental wellness problems.

The initial question no longer is a superficial and judgmental, “What’s wrong with this kid?” Trauma-informed experts are nuanced, mining for answers by posing the more enlightening query, “What’s happened to him or her?”

ACEs are the common thread underlying behaviors that, from a logical standpoint, don’t make sense because they are knowingly harmful to the person, said Jennifer Hays-Grudo, director for the Center for Integrative Research on Childhood Adversity in Tulsa.

Things like smoking. Drinking to excess. Drugs.

“At the time, these behaviors were solutions to a larger problem,” Hays-Grudo said. “The larger problem is the fact that either you are a child being abused or neglected and feeling hopeless, or you’re an adult who didn’t develop the ability to soothe and regulate your emotions when you’re stressed.

“And in fact, your body didn’t develop the ability to help you do that. You might want to do that, but your body is programmed to get upset and stay upset because life is dangerous. That’s what your body learned as a child.”

Examples of long-term ramifications include premature death in adults, according to a study published in 2009 in the American Journal of Preventative Medicine.

Participants were questioned in 1996 and 1997 about potential ACEs under eight categories. People with an ACE score of 6 or higher were found to have died nearly 20 years earlier on average than those with no ACEs.

As transformative as germ theory was more than a century ago, ACEs appear poised to have a global effect.

Hays-Grudo noted how germ theory prompted wholesale changes in hospital policies and procedures to block the transmission of germs. Doctors no longer simply used the same instruments from patient to patient like during the Civil War.

The ongoing paradigm shift in how trauma affects developing brains has reverberated through scientific circles for two decades and now is beginning to filter more into public consciousness and practice.

Hence the more nuanced and illuminating question, “What’s happened to him or her?”

Suffering adolescents pursue risky but soothing behaviors

Children raised in traumatic environments grow up chasing instant and soothing behaviors. Think smoking or drinking or sex.

Depicted in an eight-stack pyramid, the unproven but promising theory describes how Adverse Childhood Experiences influence a person’s functioning and well-being from conception to death.

The pyramid’s base is generational embodiment or historical trauma, followed by social conditions and local context. ACEs disrupt neurodevelopment, which then leads to social, emotional and cognitive impairment. In turn, health-risk behaviors are adopted and cultivate disease, disability and social problems. Early death tops the pyramid.

Clancy, who also serves on the Laureate Institute for Brain Research advisory board, said the best interruption points to stop harmful programming of the brain are at home. But often those environments are chaotic.

So the next best option is schools, which must be a neighborhood’s anchor and safe place, Clancy said.

Kristin Atchley, former executive director of counseling at the Oklahoma Department of Education, said educators often have viewed in-school suspension and other punishment as appropriate ways to correct “bad” or “difficult” kids.

Actually, the “problem” students need wraparound services to help them cope and heal — not overly punitive measures, she said.

For example, Atchley said educators must be mindful of a kindergartner who is caught stealing from another student. Schools can’t punish young children who learn to steal as a survival mechanism, she said.

And that mindset must extend to other adverse behaviors that arise from ACEs to truly help struggling children.

“If our policies and procedures are saying the day a kid comes to school high they are out, we are not being restorative,” Atchley said. “And we are not getting that kid the actual services they need.”

PACEs

Carrying a high ACE score doesn’t mean that a dire trajectory is set in stone.

Scientists already know how to counteract harm imparted by ACEs, which is especially critical early on because rewiring the brain becomes increasingly difficult as time passes.

PACEs — protective and compensatory experiences — are known to act as buffers or insulators against trauma, as well as promote healing. Most prominent is the unconditional love of a parent or mentor.

Other mitigating factors for trauma are strong friendships, mindfulness, exercise or physical activity, and hobbies or clubs. Think sports, band, 4-H, scouts, church, a coach or teacher.

PACEs provide opportunities to build the brain architecture that allows a person’s body to calm physiologically and learn positive habits and behaviors in the present and carry them into the future, said Hays-Grudo, of Tulsa’s Center for Integrative Research on Childhood Adversity.

“Children with high ACEs and no PACEs have a very difficult time in life because they don’t have the opportunity to develop the skills and the competencies — the psychological skills, the social skills and even the cognitive learning skills — to compensate for the abuse and neglect that has compromised how their brains develop,” she said. “ACEs are not a death sentence. I know many people with high levels of ACEs who live very happy and productive and good lives.

“And that’s generally because they also had many other good things going on in their lives.”

Strong predictors of behavioral, health problems

Strengthening the science supporting the ACE pyramid is paramount for researchers. And Tulsa is an important outpost in this endeavor, garnering national recognition.

Amanda Morris, a regents professor of human development at OSU-Tulsa, said the ACE test is a better predictor of health and behavioral outcomes than almost any other method. The power is derived from looking at myriad early stressors encompassed by household dysfunction and maltreatment.

“Those 10 items predict not only health but mental health outcomes,” Morris said. “And the rates at which they are predicting are better than many other simple measures and methods looking at one factor.”

Morris also is a researcher involved in the landmark Adolescent Brain Cognitive Development study. The Laureate Institute for Brain Research in Tulsa is one of 21 sites across the United States charting social, behavioral, physical and environmental factors that may affect brain development and health.

Nearly 12,000 subjects ages 9 or 10 were enrolled in the ABCD study, with 742 in Tulsa. Entry closed in October, with researchers set to track the participants for 10 years.

“So many studies are just one time point,” Morris said. “Sort of the chicken and the egg: what’s causing what? This allows us to look at cause and effect and change over time.”

Researchers regularly conduct intensive surveys, neurocognitive assessments and brain imaging to try to answer questions about influences in a more robust manner, she said.

The study doesn’t directly collect ACEs. But it does seek insights into stressors that would be categorized as ACEs.

What’s happening within brain

Consider the legs of a child who suffered from polio.

Even when cured of the crippling disease, the developmental opportunity or period for those muscles was lost, Hays-Grudo said. So polio survivors had to use leg braces for the rest of their lives, despite the absence of the disease.

“We see some of the same effects in the brain,” Hays-Grudo said. “There are sensitive periods where if the brain does not get the kind of stimulation it’s expecting as a human being — as a species, we expect certain things to happen in development — if it doesn’t happen, it’s much more difficult later on.

“It can happen. The brain can make up for it later, but there’s a lot of difficulty.”

Therein lies the importance of early childhood development.

Stress is a natural response to help keep a person alive in an emergency. The body pumps out cortisol and adrenaline, placing a person in a heightened state to achieve feats not usually within his or her ability.

But Hays-Grudo said the chemicals over a long time become corrosive. The chemicals are meant as a short-term response to protect the body or help it cope.

The levels are supposed to decrease and normalize once the threat subsides. But if the stressors are consistent, a person may stay in a hyper-vigilant state.

Wear and tear develops on the body and can result in auto-immune or heart diseases, as well as cancer, Hays-Grudo said.

“If this is happening in developing systems, it has a much worse effect and more enduring effect than if it happens to adults,” Hays-Grudo said. “Because now the brain is expecting this, and the brain is not getting exposed to other experiences that would allow other parts of the brain to develop.”

Scientists are learning how deep these alterations can go through “inherited epigenetics.”

Hays-Grudo described epigenetics as the chemicals that sit on top of our DNA and attach to its strands.

Epigenetics essentially act as on-off or dimmer switches that make it more or less likely for DNA to be replicated to create cells, Hays-Grudo said.

“When you turn off that process, you turn off some of the production of chemicals needed, for example, for brain cell regeneration — new neurons,” Hays-Grudo said. “It also may turn off receptors for all of the cortisol that you’re pumping out when you’re stressed, and then the cortisol doesn’t leave the body. You just stay stressed.

“So these epigenetic changes to certain DNA structures have given us a clue why some of these experiences last all the time. Why they literally change the body’s DNA blueprint for how to react to stress, and these changes can be passed across generations.”

Generational costs of trauma

Researchers repeatedly subjected adult male mice to mild foot shocks after introduction of an odor — fear conditioning. The conditioned males were mated with unconditioned females.

The Emory University scientists were examining offspring inheritance of a parent’s exposure to trauma. Or, simply put, trauma that transverses generations.

They found that two successive generations (children and grandchildren) exhibited behavioral sensitivity to the odor, with an enhanced representation of the odorant receptor’s pathway.

The offspring weren’t conditioned to fear the odor, nor did they learn the behavior from the conditioned male parent because they were separated. Evidence indicated the odor fear was passed biologically, with epigenetic marks that might be the basis for the inheritance.

The study was published in 2013 in Nature America.

Similar links are beginning to be established in humans.

A team of researchers studied 32 Holocaust survivors — interned in a concentration camp, witnessed or experienced torture, or had to flee or hide during World War II — and their adult children for biological effects of stress.

The scientists compared them against demographically similar control subjects who lived outside of Europe during the war, meaning they weren’t exposed to trauma from the Holocaust.

They found genetic alterations associated with Holocaust trauma present in both parents and their children that couldn’t be attributed to the offspring’s own traumatic experiences or psychopathology.

Morris, the OSU-Tulsa regents professor involved with the ABCD study, described ACEs as more of a social problem. A person can’t “catch them” like a sickness by talking about them, she said.

Openly dealing with ACEs rather than repressing trauma is a means to heal and recover. A public health and prevention approach, along with policy changes, are keys to halt the spread of ACEs, she said.

“So the science is really an important part of the story here. Why? Because it predicts these health and behavioral outcomes better than almost any other measure we have,” Morris said. “And the root of it is family dysfunction and things that we know — it’s difficult — but we know how to target and help families. Through resources. Through building good parenting skills and relationships.

“It’s not like a communicable disease. It’s a thing we can fix.”


News
Day 2: PACES: An adult to trust. Tulsa grief therapist Jessica Orvis turns child counseling into art form

Jessica Orvis is telling you about her work with children, her efforts to blunt their trauma, when you notice her tattoos. Is she making a statement?

No. She is providing an outlet to connect with these children.

“A lot of times with kids, you have to build rapport and you have to have buy-in,” she says, peering at a design on her forearm that looks like a science class diagram.

She can tell the kids affected by trauma, the ones with high ACE (adverse childhood experience) scores, about their brain cells and neurotransmitters. But it is better to show them.

She’ll use her tattoos and explain: “These are pathways. You lose your temper and go straight to fighting; your aggression and testosterone and adrenaline ones will be fatter. Right here. We’re going to put that one on a diet and get another one healthier. We’re going to exercise it and use it. Next time you’re mad, we’re going to do this instead. If you do it enough times, it’ll get fat, and the fat one will get skinny.

“These colors are serotonin and oxytocin and dopamine. Those are the things that get you addicted and get you happy or depressed. What are the ones we need to get fat, healthier? What are the ones you need to muscle up? We want less of the colors like the depression. We want more serotonin. In your brain, this is what’s happening.

“They can see what I mean,” Orvis said. “They can make sense of it.”

Three years ago, Orvis made her first visit to Kendall-Whittier Elementary as part of the Healing Hearts Club, the Tristesse Grief Center’s six-week program for area public school students who have encountered trauma.

“They were haywire,” Orvis says of the children she first encountered. “I thought, ‘Oh my god, I don’t want to work with kids.’ I went back the next week, and they said, ‘We were hoping you would come back.’

“I said, ‘You were? You guys didn’t listen to anything.’

“‘You were so nice and you asked us questions about us and you let us talk.’

“I was like, ‘OK.’ I didn’t realize what I had done. I had no idea.

“By the third week, they asked me, ‘How many more times do you get to come?’ They were telling me things. ‘Do all moms do this? How come my dad does this?’ They had a grown-up for a whole hour who would talk to them and hear them. They were my little angels in disguise.

“Now, I can’t ever walk away from them.”

Orvis goes into schools throughout Tulsa. She goes to Union, Jenks and Bixby. Occasionally, she goes to Muskogee. She has been called to go to Stillwater and as far away as Missouri.

As an outreach therapist for the Grief Center, she sees students who have lost loved ones or had classmates commit suicide. She lets them ask questions and tell her things, like at Kendall-Whittier. She helps.

“Wednesday, I went to three different schools,” Orvis said. “They pull out the kids; we sit for an hour. Some are teenagers. We process and work with coping skills. Then it’s on to another school with first- and second-graders, and we color and do activities. Then I might go and do a continuing education unit where I educate a community on how to work with kids that have been through it.”

This is what resilience looks like. A child experiencing trauma has it in her to cope or power through. Sometimes, all it takes is a triggering mechanism, like a caring, stabilizing adult.

Sometimes, it takes a therapist with really cool tattoos.

“If anybody is going to be resilient, it’s a kid,” Orvis said. “There are days I hear things and my mind is just blown. What these kids have seen or have been told ...

“Then that same kid will give me a fist bump on their way out of a session or ask for my card when their friends aren’t around. They’re starving for somebody, and if they can find that person — there’s a lot of us out there — it can help tremendously.”


State-and-regional
Oklahoma's seismicity is in a four-year decline, but the likelihood of a damaging earthquake remains high

Oklahoma is well on pace for a fourth straight annual drop in seismicity, despite a May earthquake near Medford with a magnitude 4.5 — tied for the state’s 13th largest ever.

There have been 27 earthquakes of magnitude 3.0 or greater in the first half of 2019. That is 72% fewer than at this time in 2018 (97) and 433% fewer than 2017 (144). But the rate remains substantially higher than the historical activity of two or three a year at 3.0 magnitude before induced seismicity took hold.

The most in a year was 903 in 2015, of which 27 were at least magnitude 4.0.

State Seismologist Jake Walter said Oklahoma, particularly the north-central area, still has a high likelihood for a damaging quake in the next several years based on the observed seismicity.

So Oklahomans shouldn’t be complacent or think seismic activity has returned to more normal levels that have been seen in the past.

“If you take the last five years and compare the number of 3.0s in Oklahoma relative to the number of 3.0s in California, Oklahoma has had more earthquake activity than the state of California,” Walter said.

He said researchers are still unraveling the finer points of how man-made earthquakes work.

For example, there was a recent magnitude 2.7 quake near Cushing. The question becomes: Was it an aftershock from the 5.0 in November 2016, or is it from continued wastewater injection even though the disposal now is in a shallower formation?

State regulators have imposed volume caps on the deepest disposal wells in a 15,000-square-mile area of interest prone to induced seismicity. Some well operators have avoided the restrictions by plugging back wells into shallower formations or moving activity into other areas.

“There’s still a lot to be done to understand induced seismicity, and what we learn will better inform regulators and the public and enhance public safety in general,” Walter said.

A project the Oklahoma Geological Survey is conducting compares aftershock zones in the state.

Walter said large earthquakes near Pawnee, Cushing and Cherokee had fewer aftershocks than Fairview. He explained that the Oklahoma Corporation Commission reacted more strongly and swiftly to the others and not Fairview because the Fairview quakes were much farther from disposal wells.

“There’s still a load of research questions we’re trying to answer because I think some of these answers might assist the OCC in intelligently regulating induced seismicity and protecting the public,” Walter said.

The U.S. Geological Survey the past three years has produced a short-term hazard forecast for induced seismicity that put Oklahoma’s risk in some areas on the same level as the shakiest parts of California.

The federal agency didn’t do a forecast for 2019. A USGS spokesman said the agency is unlikely to do another one in the future.

“The reason is because that induced seismicity has been decreasing every year since we did our first forecast back in 2015-2016, and as such, we’re moving on to different priorities,” said Drew LaPointe, a USGS public affairs specialist. “The long-term forecast we’ll be releasing in the next few weeks for 2019 mentions this decrease in activity as well, but not in great detail.”

Walter said that viewpoint represents a lack of federal interest in long-term monitoring of induced seismicity in the central U.S.

He also called it a significant public relations matter for Oklahoma. Businesses looking to relocate here and insurance companies have contacted Walter to better understand the seismic hazard.

The USGS forecast for 2018 showed a broadening of the area considered to be at an elevated risk.

“So unless it gets updated, that document isn’t representative of the seismic hazard as it exists today,” Walter said.


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Crime-and-courts
Summer break brings uptick in fraudulent unemployment claim at some school districts across the state

School’s out for summer, and some fraudsters with stolen identity information apparently see that as an opportunity to cash in.

School districts across the state, including some in the Tulsa area, are reporting a sudden uptick in fraudulent unemployment claims for people still employed in schools. State officials say such claims have soared nationally since a massive data breach in September 2017 at one of the nation’s largest credit reporting companies exposed the personal information of 145.5 million U.S. consumers.

Union Public Schools reported receiving nearly 30 such claims in the past two weeks, compared to less than 20 in a typical year.

“One day last week, 20 claims came through in one minute. They appear to be taking advantage of the fact that it’s a holiday week and people are out (of the office),” said Jay Loegering, executive director of human resources at Union. “Some school districts close for a couple of weeks or a month during the summer, and if you don’t respond within a certain period of time, those funds automatically get paid out.”

Oklahoma State School Boards Association represents 370 of Oklahoma’s 512 school districts on unemployment claims.

“Based on what we know, there has been a tremendous increase this year, going from almost none to large amounts,” said Brandon Carey, an attorney at OSSBA. “Since January, we have received 337 fraudulent claims for districts we represent, compared to 10 in a typical year previously.”

The Oklahoma Employment Security Commission gives employers a 10-day window to respond to unemployment claims before payments could be sent out. That has had school officials and employees at OSSBA working for them on these matters scrambling.

“What we do is make sure we are responding quickly. A lot of times these are individuals currently working for districts who have had their information stolen. The district needs to contact the employee quickly and get them to write out a statement that can be sent to OESC fraud hotline,” Carey said.

And even if there is obviously flawed information on the claim, such as mismatched Social Security numbers and names or even misspelled names, Loegering said the state has paid out on some fraudulent claims.

“We have to answer each one of these like it’s a true claim,” he said. “We have to pull employment records and we’re getting written statements from employees that they are still employed with us. We have been instructing our employees to file police reports because the employee would be earning income that’s reported to IRS that they don’t know about and didn’t receive — so there are consequences both for employer and employees.”

Government entities, including public schools, pay the actual costs of unemployment benefits for their eligible, former employees through reimbursement to the state insurance fund.

“All districts get a quarterly statement of unemployment payments. We are emphasizing the need to respond quickly if they have any indication that this is fraud to contact the fraud hotline and closely review their quarterly statements,” said Carey. “For our members, we do a lot of that work for them. It has been really busy. The bigger districts were getting most of the fraudulent claims earlier in the year. That seems to be spreading, and there has been an uptick in the Tulsa area and those suburban districts.”

Shalonda Sanders, compliance director at the state Employment Security Commission, said the agency has been implementing new safeguards to try to prevent and identify possible fraud.

“We started noticing it late last year. It’s really been a national trend, unfortunately,” said Sanders. “It’s these gangs of people in different states — Florida, Georgia, Michigan and even in New York and some in California — through the dark web they’ve identified and gotten access to people’s information and are trying to access unemployment and other places where they can get money.”

She added: “We want the community to be aware and our employers could help us by communicating with us as quickly as possible to prevent fraudulent claims being paid out.”


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