This examining health inequities series is created as a part of being a student in Examining Health Inequities at the University of Alabama at Birmingham, where I am challenged to examine health inequities and provide my own opinion.
Summary and assessment of Adverse childhood experiences, allostasis, allostatic load, and age-related disease
Summary
Childhood maltreatment does more than just impact a child when they are young or alter their perception of the world. A large amount of evidence supports the claim that these adverse childhood events change a child biologically, specifically in the nervous, endocrine, and immune systems. These three systems play a critical role in how a person interacts with the world and maintains their own homeostasis.
As humans our bodily is regularly fighting for homeostasis largely through the process of allostasis. Allostasis involves the nervous, endocrine, and immune systems producing chemical messengers like cortisol and adrenaline that impact how the body responds to different environments. When a person, specifically a child in this case, receives maltreatment or an adverse life event there is a high likelihood of allostatic overload occuring. This will look like the body and physiological systems being unable to properly cope with the event that the child may be experiencing. This cumulation of traumatic events and stress has been shown to physically alter a child’s physiological systems, ultimately impacting how they interact with the world long-term.
Importance of this information to society
The CDC estimates that at least 1 in 7 children experienced abuse or neglect within the last year, including the death of nearly 2,000 children due to abuse and neglect in 2020 in the United States. This study is important to society due to its ability to strongly articulate how impactful childhood maltreatment is and a child’s physiological system and the way that they interact with the world. This is not just creating an adverse event that a child will “grow up from” due to overcoming adversity; instead this event has physically altered how this child experiences and interacts with the world.
The alteration of a child’s physiological systems is what can significantly contribute to the “cycle of abuse”. One third of parents that were abused as children go on to abuse their own children. This continues a cycle of reducing the potential utility of people across a community, eliminating a future healthcare professional, lawyer, community advocate, or future leader, all because of abuse that altered someone physiologically. Additionally, the CDC estimates that child abuse and neglect cost the United States $592 billion dollars in 2018. These are resources that could be re-invested in the community, improving the livelihoods of these families that have suffered from abuse or neglect.
Strong supporting evidence
This study was strong from the onset through the initial thorough explanation of how the nervous, endocrine, and immune systems are the most involved physiological systems related to allostasis or allostatic overload. There were multiple studies cited that involved each of the physiological systems individually as well as how they all interact together. The studies related to how these three physiological systems interact was very compelling in understanding that any adverse event that a child experiences could have a detrimental impact to multiple parts of a child’s physiological systems even if they were not initially involved.
Additionally, there were sections dedicated to age-related diseases and behavior that provided strong evidence in connecting the impact in studies to the age-related diseases or behavior. These pieces of evidence were very helpful in supporting which parts of the physiological systems were going to be most heavily impacted and how that would alter a child’s engagement with the environment in the future.
Weak supporting evidence
While there was strong evidence throughout the study, there were also multiple opportunities where the study could have significantly improved. First, the study consistently referenced adverse events or maltreatment of a child as the reason for the physiological event. There was an opportunity to share deeper information on what the specific event was and how that impacts the child differently. I would have interest in understanding differences between events like neglect, or physical abuse, or sexual abuse as examples. Differentiating these types of events helps to prioritize focus on counter-measures.
The study effectively introduced the ideas of allostasis and allostatic overload to someone who has never studied the topic, however the physiological studies referenced for immune, endocrine, and nervous systems were very technical and had some challenging medical information that could be challenging for someone without a medical background to fully understand.
Additionally, the article failed to reference other life events that could influence the physiological systems for a child. There was an opportunity to explain the impact of other life events like living near pollution, drinking low quality water, or other environmental factors that could also impact the physiological systems.
Erik Angus 