Survey Finds Teen, Young Mothers at one Social Service Agency Have Alarmingly High Childhood Trauma Scores

"We still live in a world where young moms are bad girls who made bad choices," says Jeannette Pai-Espinosa, president of the National Crittenton Foundation, which, with its 27 agencies, serves teenage and young women, many of whom are pregnant or parenting. But in the context of many of these girls' lives, she says, "becoming pregnant makes sense in the context of their lives and families."

How is that possible? Some alarming data from a pilot study released recently at a briefing in Washington, D.C., shows that teenage and young mothers who are Crittenton clients have experienced up to seven times the levels of childhood trauma of a normal population. This goes a long way to explaining why they might become addicted to drugs, end up pregnant and/or drop out of school.

Of 253 young mothers, most of whom were 19 or under and some who were as young as 10, one out of two  grew up in a home where they endured at least four types of severe and chronic childhood trauma, such as significant verbal abuse, emotional neglect, or living with a parent who was addicted to alcohol or other drugs or who was depressed or mentally ill. Line up any 10 of these teenage girls and young women, and four have been sexually or physically abused, have seen their mothers treated violently or have lost a parent through abandonment or divorce.

To understand why these numbers boggle the mind -- and why it's not surprising that these girls and young women have a hard time making healthy choices -- you have to know a little about the CDC’s Adverse Childhood Experiences Study (ACE Study), and how trauma affects kids' brains.

The ACE Study -- a groundbreaking epidemiological study that links childhood trauma with adult onset of chronic disease, as well as life-altering social and emotional problems -- looked at the incidence of ten types of childhood trauma in 17,000 people in San Diego. Five types were the usual suspects -- sexual, verbal and physical abuse, and emotional and physical neglect. Five were family dysfunctions -- a parent who's mentally ill or an alcoholic or addicted to other drugs, loss of a parent through divorce or abandonment, a family member in jail, and witnessing a mother being battered.

These adverse experiences are severe and chronic, which are reflected in the questions. Here are three:

• Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her? Or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

• Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you? Or act in a way that made you afraid that you might be physically hurt?

• Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

Even in this group of mostly white, middle and upper-middle class, college-educated people with good jobs and great health care – they all belonged to Kaiser Permanente -- childhood trauma was surprisingly common. A whopping 70 percent of the 17,000 people in the ACE Study had experienced at least one type of trauma, resulting in an "ACE score" of one; 87 percent of those had more than one. You can think of the ACE score as a cholesterol score for childhood toxic stress. You get one point for each type of trauma. The higher your ACE score, the higher your risk for health, emotional and social problems. Things start getting serious around an ACE score of 4.

The effects of complex trauma -- an ACE score of 4 or more -- results in four times the risk of emphysema or chronic bronchitis; two times the risk of hepatitis; more than four times the likelihood of depression; 12 times the risk of suicide. Eighteen states have done their own ACE surveys and found similar results.

The Crittenton study [CrittentonACEresults] was the first to look at a group of people who'd already ended up in the social service or criminal justice systems, or were having obvious problems coping. In this case, the group was 916 teenage girls and young women who are Crittenton clients, including 253 who are mothers. Of the mothers, 58.4% self-identified as youth of color or bi/multiracial, according to the study, while 41.7% were white. To calculate their ACE score, they each filled out a 10-question survey.

Compared to the mostly white, middle-class San Diegans, not only were the trauma levels of these girls and young women 1.5 to 7 times higher....

…..but, more significant, a much greater percentage had ACE scores of 4 or higher:

The stories of these girls and young women boil down to this: Their home lives are so destructive, so chaotic and so dangerous that they are too traumatized, too depressed, and too lost to be able or to know how to make healthy choices. Research on children's developing brains confirms this.

Toxic stress from ACEs physically damages a child’s developing brain. This was determined by a group of neuroscientists and pediatricians, including neuroscientist Martin Teicher and pediatrician Jack Shonkoff, both at Harvard University, neuroscientist Bruce McEwen at Rockefeller University, and pediatrician Bruce Perry at the Child Trauma Academy.

Children with toxic stress live much of their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. With brains overloaded with stress hormones and unable to function well, they can’t focus. They fall behind in school, or fail to develop healthy relationships with peers, or are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work and over-achievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.

"This is something we've known intuitively, but now can show with the data," says Pai-Espinosa. The foundation plans on expanding the pilot study to all Crittenton facilities across the U.S. The CDC is also reviving the ACE Study, which has languished for the last few years, in the Division of Violence Prevention in the Injury Center, according to a CDC spokesperson. They also plan on integrating an ACE module into the National Intimate Partner and Sexual Violence Survey.

What the data from the Crittenton study underlines is what Dr. Robert Anda, one of the co-founders of the ACE Study has often said: Adverse childhood experiences in this country have led to a "chronic public health disaster" that, without intervention, is passed on from parent to child, from generation to generation.

And it’s not just the girls and young women with high ACE scores who end up as teen or young parents. Males with an ACE score of 5 were more likely than males with an ACE score of zero to impregnate a teenager, according to ACE Study results published in Obstetrics and Gynecology in 2002.

In addition, ACE Study results show that women – married or not -- with high ACE scores were more likely to have unintended pregnancies. And the risk of fetal death is linked to underlying ACEs, not just because it’s a teen pregnancy.

It's not just a tragedy of human suffering, it's also an economic disaster, noted Kathy Szafran, chief executive

Every year, Crittenton Services in West Virginia serves 1,200 children, young women and families from 18 counties. If they had the resources, says Szafran, they could serve the thousands of others who need help in the state's 37 other counties.

But there's good news. With intervention, support and understanding, someone with a high ACE score can reduce her or his risk for chronic disease, violence and/or depression. Three women -- each with an ACE score of 8 -- provided the evidence at the briefing: their own lives.

What people should know about teens who get pregnant: "Girls are driven to make choices because of factors in their environment. And unless you find those causes, we can't get rid of what's affecting us."

Her reaction to the ACE survey: "I wasn't surprised that I had an 8. But I couldn't believe that professionals didn't have some kind of way to measure this before. It's so important to have this assessment -- it's a window into our background. It's an empowerment tool." When she learned that her daughter has an ACE score of 7, and her son, a 5, "it was heartbreaking. I wanted to do everything to protect them from trauma. At least I know that I can do some intervention before triggers come up."

About the changes in her life: "It feels good to share. It feels good to know that because someone was able to able to invest in me, I'm here. I finally understand the meaning of the success I've had. I'm able to enjoy it, instead of looking at myself with loathing, or feeling vulnerable and fearful. Those feelings aren't there anymore."

What people should know about teens who get pregnant: "This does not occur in a vacuum. All the things that impacted me, most people can't understand. When you're dealing with a girl who's been raped, molested, beaten viciously by parents -- any one of those makes it difficult to maneuver through childhood. Take 8 of those, it becomes a mountain."

Her reaction to the ACE survey: "To be perfectly candid, my very first thought was: Why isn't this common sense to everybody? How can you have people exposed to these kind of traumas, and not expect higher rates of substance abuse, mental illness, the inability to get a good education or employment? I was not surprised by my score at all." Her oldest son, Elijah, has an ACE score of 6. "I directly attribute that to when I was 21, I was still lost. He was exposed to domestic violence. His score is not a surprise. But here's the key thing: I wish I'd known about this ACE assessment years and years ago. To see that my 14-year-old has an ACE Score of 6 made me cry. If I would've known - it would have helped me more present, realize that this is impacting my children. I have a wonderful relationship with all of my sons. But they were exposed to things I wish they had not been."

About being aware of how her childhood trauma was affecting her and her sons: "My level of awareness was nonexistent. When I was  raising my 3 sons -- as a 21-, 22-,  and 25-year-old -- I had no assistance from their dads. (Each boy has a different father.) When I was an undergrad, I was on welfare, had section 8 (assisted housing), Medicaid, food stamps. I was so busy just surviving that how my trauma from the past was impacting my kids was not even on my radar. They were 10 months, 3 years and 5 years old when I graduated."

What people should know about teens who get pregnant:  "If you're neglected and raised in a household where you don't know the people and you're not connected to them, you don't know what real love is. People with these backgrounds don't know what real love is. They give themselves to people who they think love them. They share themselves with people who show them any form of affection."

Her reaction to the ACE survey: "Well, I wasn't that surprised about my score. It made me revisit the things that had occurred in my life. It opened my eyes to just how much trauma I experienced as a teen. It helped me put closure and helped me get over the trauma." Her 21-year-old son's score is a 3, while her 13- and 5-year-old children's ACE score is a one. She attributes the difference to them being spaced so far apart. "I became a more responsible person as my healing progressed. That's why I believe their scores weren't as high as mine. The oldest, the thing that he saw was typical abuse and drug use. It's horrible to think he experienced that."

Learning about the effects of adverse childhood experiences has helped her understand the father of her oldest son when he verbally abused her after she decided not to have an abortion, and abandoned her. "He called me names. He said, "How do I know it's mine?" I told him I hadn't been with anyone else -- that he was my boyfriend. He told me that just because he had slept with me didn't mean he was my boyfriend." Now she realizes that he had also come from an abusive family, and knew no better. Speaking as much about her own parents as his, she says: "Some parents just don't care about their children because they don't know how to care."

What she hopes people learn from her story: "I believe that the frontline people who have direct contact with these young ladies -- the social workers, correction officers, house parents…the ones they pay to babysit us (she chuckles) -- if they think these are good girls who made a difficult decision, they'd have a better impact. They should ask them why -- Why are you so angry? Why are you upset? These girls have lived through things that most adults couldn't even handle."

Orellana, Becker and McCartha "are exceptional, but they're not exceptions," says National Crittenton Foundation president Espinosa. "A lot of people don't get that."

The girls and young women whom Crittenton serves, as well as girls who end up in the juvenile justice system aren't bad girls; they're hurt girls. Says Pai-Espinosa: "If they have support, they can heal."