Only in this century have science and society come to understand the mental and physical repercussions of a rough childhood.

But 18 years after publication of the groundbreaking Adverse Childhood Experiences study and multiple follow-up studies, few resources yet exist to help children contend with or avoid the troubling list of childhood adversity — sexual, verbal and physical abuse; neglect; poverty; community violence; and bullying, among others.

These exposures cumulatively scar a child’s brain and body for a lifetime.

And that’s where Bruce Rabin is stepping in.

The noted University of Pittsburgh and UPMC immunopathologist often referred to as “Dr. Stress” is redirecting his long-time voluntary mission of helping people manage stress to help reduce adversity in children’s lives, much of which occurs in their own homes.

Dr. Rabin, 75, said he will resign his professional positions on Jan. 3 to focus on projects he’s working to launch in the Wilkinsburg School District with the project already underway in a charter school, where he’s led the faculty in a stress-coping program that’s now being offered to students, individually or in groups, with plans to extend the program to parents.

A primary goal is teaching students how stress affects the brain then alters the hormonal composition of the body, with long-term potential for physical and mental diseases. For many students, learning how to manage stress is necessary before they successfully can tackle reading, writing and arithmetic.

“They know that there will always be stress in their lives and that by altering how the brain responds to stress, the quality of their mental and physical health can be improved,” Dr. Rabin said. “There has been a wonderful response to the program.”

Improving the quality of health in coming generations requires a reduction or elimination of mental, physical and sexual abuse and neglect of young children. It’s not enough simply to try reversing the harmful effects that abuse produces.

Babies can begin life with health, cognitive and behavior challenges from exposure in utero to stress hormones of overly anxious mothers. Initially Dr. Rabin refrained from discussing the issue in fear of raising stress levels in expectant mothers.

The better option, he said, is to help pregnant mothers and children to develop behaviors and techniques to remain calm and think clearly when the person gets upset. “I now feel it is a disservice not to speak about it,” he said.

Dealing ACEs

The 1998 Adverse Childhood Experiences (ACE) study found “a graduated relationship between the breadth of exposure to abuse, or household dysfunction during childhood, and multiple risk factors for several of the leading causes of death in adults.”

That link between childhood exposures and mental, psychological and physical illness was apparent in the study of 9,500 adults, with four or more ACES during childhood resulting in up to 12 times the risk for alcoholism, drug abuse, depression and suicide, with a two- to four-fold increase in smoking and poor self-rated health. Those who experienced adversity as children also had more sex partners and sexually transmitted diseases with higher levels of physical inactivity and severe obesity.

The study also found that ever higher ACE scores progressively increased the risk in adulthood of heart disease, cancer, chronic lung disease, skeletal fractures and liver disease.

Seven categories of adverse childhood experiences “were strongly interrelated and persons with multiple categories of childhood exposures were likely to have multiple health risk factors later in life,” the study concluded.

Upon learning of the study, Nadine Burke Harris, a noted San Francisco pediatrician, said she altered her practice significantly at her clinic, leading to creation of the Center for Youth Wellness in 2011 to help children reduce the mental and physical health damage of stress.

“What we see every day is a lot of kids diagnosed with attention deficit hyperactivity disorder,” she said. “When we really understand what’s going on for most of these children, we find very high rates of exposure to early adversity” such as domestic violence and caregivers with substance abuse problems.

Through treatment, children failing in school improved their grades, were better able to control asthma and manage their weight, among other health benefits.

“This is not to say that any of this is easy,” Dr. Harris said. “We’re talking about some of the intractable challenges in our society with mental illness and communities with violence in the streets. These are big issues. With early detection with effective interventions, we see kids with much better outcomes. I think it is absolutely critically important to break the inter-generational cycle of adversity.”

She now has a Pittsburgh connection as one of the five 2016 recipients of the Heinz Award for her nationally recognized pioneering work in diagnosing and treating stress-based problems in children.

Childhood adversity, she said, causes fundamental changes in development of the brain, the immune and hormonal systems, and misbehavior can be symptomatic. So teachers should work to determine the source of misbehavior then help rather than punish children.

“I would echo the words of a former president of the American Academy of Pediatrics that this is the greatest unrecognized public health crisis facing our nation today,” Dr. Harris said. “Now that we understand the biology behind how this happens, I see a huge opportunity for use to change outcomes in the future.”

Family stress

Dr. Rabin — who’s taught stress management to city firefighters, city school teachers and even newspaper reporters, among many others throughout the region — said home-based stress leaves a child feeling unsafe with continuous discomfort, chronically raising stress hormone levels and leading to behavioral problems and learning difficulties.

Ultimate impacts include depression, diabetes and heart disease with a shortened duration and quality of life.

“So when they begin kindergarten, such children already are at a disadvantage in comparison with children who have not experienced increased levels of stress early in life,” he said. “Stress is not just a word” but instead represents “a change in the quality of mental and physical health and life.”

People who survived childhood adversity can have successful careers but many are never again happy or content, he said.

With that in mind, Dr. Rabin said he’s hoping his “small but effective” program at the schools, in time, will inspire similar programs elsewhere.

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

First Published: October 11, 2016, 4:00 a.m.
Updated: October 11, 2016, 4:36 a.m.