Childhood trauma is all too common. Nationwide, more than 30 million children have experienced at least one form of it – and when we looked at the science and learned that persistent childhood adversity increases young people’s risk of developing a broad range of diseases, we realized there was a unique role for us to play. We launched The Resilience Effect in December 2017 as our philanthropic initiative to take on childhood adversity and build lifelong health in the Bay Area.

We’ve long admired those that are dedicated to improving children’s healthcare here in California, and Dr. Nadine Burke Harris is a leading voice in the movement. We’re hopeful that her new role as California’s first-ever surgeon general will catalyze action at the scale we need to address childhood adversity. As an early advisor of The Resilience Effect, we invited Dr. Burke Harris to our campus last year to discuss the impact of childhood trauma in our communities, what the science can tell us, and why she’s glad Genentech got involved through The Resilience Effect. You can read the full interview below.

We know that issues of this magnitude cannot be solved alone. We’re thrilled not only by Dr. Burke Harris’s appointment as surgeon general, but by the momentum that’s building to improve the lifelong health of children across California.

HOW DID YOU FIRST GET INVOLVED IN THE WORK TO ADDRESS CHILDHOOD TRAUMA?

Dr. Nadine Burke Harris: Ten years ago, at my pediatric clinic in San Francisco, teachers, social workers and parents were bringing me child after child with concerns of A.D.H.D. (attention deficit hyperactivity disorder). “This child is having terrible behavior problems. Lots of difficulties with impulse control. Can you put him on Ritalin?” But as I examined my patients, I noticed that the highest rate of behavioral problems was occurring in kids whose parents had drug addictions or mental illness, or those subject to violence at home.

At the same time, I was seeing patients like a girl I was treating for asthma. When I asked, “What are your asthma triggers?” her mom said, “My daughter’s asthma acts up every time her dad punches a hole in the wall.”

When I dug into the science, I found that, for most of these kids, the problem wasn’t run-of-the-mill A.D.H.D or asthma. We understand that the root of the problem is the dysregulated stress response, or what the American Academy of Pediatrics now recognizes as “toxic stress.”

WHAT IS TOXIC STRESS AND HOW DOES IT IMPACT CHILDREN?

Dr. Nadine Burke Harris: Research shows that early traumatic experiences can cause a prolonged stress response that ultimately leads to increased risk of diseases, including heart disease, diabetes and cancer. Known as “adverse childhood experiences” (ACEs), these can include abuse, neglect, growing up with a parent who was mentally ill or substance dependent, or parental separation or divorce.

Childhood adversity affects kids’ sleep, learning and health. A person who has four or more adverse childhood experiences has about double the risk of heart disease, 2 1/2 times the risk of stroke, double the risk for cancer, 11 times the risk of Alzheimer’s and 30 times the risk of suicide.

WHAT IS THE SCIENCE BEHIND CHILDHOOD TOXIC STRESS?

Dr. Nadine Burke Harris: When we’re exposed to something stressful or scary, our bodies release stress hormones. When the “fight-or-flight” response is activated over and over, it changes the way our brains and our immune systems function, and ultimately the way our DNA is read and transcribed.

When the original research on childhood adversity was done by Kaiser Permanente and the Centers for Disease Control 20 years ago, people saw the strong association between childhood adversity and these diseases, but they didn’t understand why.

On magnetic resonance imaging, we can now see that kids exposed to high doses of adversity have measurable differences in the size and functioning of the amygdala, the fear center in the prefrontal cortex, which is responsible for executive functioning; and in the hippocampus, which is responsible for learning and memory.

In folks exposed to high doses of adversity as kids, we see these changes within the brain, as well as increased chronic inflammation and risk for autoimmune diseases like lupus, rheumatoid arthritis, or asthma. Science has filled in the blanks, so we know that even our cells are aging faster because of childhood adversity.

FROM A CLINICAL PERSPECTIVE, HOW DO WE CHANGE THE TRAJECTORY FOR CHILDREN EXPOSED TO TRAUMATIC EXPERIENCES?

Dr. Nadine Burke Harris: Now that we understand the root of the problem, we can begin to interrupt the pathways that lead to poor health. It starts with early detection; every pediatrician should be screening for ACEs, but only 4 percent do. Kids in the 0 to 5 age range are particularly susceptible to the impacts of adversity because their brains and bodies are just developing. The earlier we intervene, the less expensive, less intensive and more effective intervention is likely to be.

We are also learning a lot about interventions that work. One of the key ingredients for keeping the body’s stress response out of the toxic stress zone is a healthy, buffering caregiver. So, we need to educate parents and caregivers about the impact children’s environments and exposures may be having on their health. We also know that if caregivers are able to manage their own stress, their kids have much better outcomes.

Good old-fashioned mental health care also helps. In research studies, certain types of interventions, including child-parent psychotherapy, can help get the body’s stress response back on track. Sleep, exercise, nutrition and mindfulness also help reduce stress hormones, reduce inflammation, enhance neuroplasticity and delay cellular aging. We designed our services at the Center for Youth Wellness with this in mind — and we are studying our approach to understand what works best.

WHAT KEEPS YOU EXCITED ABOUT THIS WORK?

Dr. Nadine Burke Harris: Oh my goodness! We are in a critical inflection point. Eight years ago, I would go into a room of 1,000 people and and I’d ask, “How many folks have heard of this before?” Literally three hands would go up. Two years ago, I gave a talk at the White House and I asked the same question, and every hand in the room went up. A new generation of scientists, teachers, doctors — people across disciplines — are recognizing the science, and leading the way. So, I believe that 20 years from now, we are going to be having a totally different conversation.

WHY IS IT IMPORTANT FOR A COMPANY LIKE GENENTECH TO BE INVOLVED?

Dr. Nadine Burke Harris: I’m psyched about Genentech getting involved in this. Genentech is all about scientific rigor. That’s what we need right now. It says so much that a scientific giant like Genentech believes that we have an important opportunity to impact the health of our next generation’s children. That’s really powerful.