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Translating Developmental Science to Address Childhood Adversity

      Abstract

      Demystifying child development is a defining element of pediatric care, and pediatricians have long appreciated the profound influences that families and communities have on both child development and life course trajectories. Dramatic advances in the basic sciences of development are beginning to reveal the biologic mechanisms underlying well-established associations between a spectrum of childhood adversities and less than optimal outcomes in health, education and economic productivity. Pediatricians are well positioned to translate this new knowledge into both practice and policy, but doing so will require unprecedented levels of collaboration with educators, social service providers, and policy makers. Pediatricians might recognize the negative impact of family-level adversities on child development, but developing an effective response will likely require the engagement of community partners. By developing collaborative, innovative ways to promote the safe, stable, and nurturing relationships that are biologic prerequisites for health, academic success, and economic productivity, family-centered pediatric medical homes will remain relevant in an era that increasingly values wellness and population health.

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      References

        • Richmond J.B.
        Child development: a basic science for pediatrics.
        Pediatrics. 1967; 39: 649-658
        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) study.
        Am J Prev Med. 1998; 14: 245-258
        • Anda R.F.
        • Felitti V.J.
        • Bremner J.D.
        • et al.
        The enduring effects of abuse and related adverse experiences in childhood—a convergence of evidence from neurobiology and epidemiology.
        Eur Arch Psychiatry Clin Neurosci. 2006; 256: 174-186
        • Finkelhor D.
        • Shattuck A.
        • Turner H.
        • et al.
        Improving the Adverse Childhood Experiences Study Scale.
        Arch Pediatr Adolesc Med. 2013; 167: 70-75
        • Marie-Mitchell A.
        • O'Connor T.G.
        Adverse childhood experiences: translating knowledge into identification of children at risk for poor outcomes.
        Acad Pediatr. 2013; 13: 14-19
        • Campbell F.
        • Conti G.
        • Heckman J.J.
        • et al.
        Early childhood investments substantially boost adult health.
        Science. 2014; 343: 1478-1485
        • Campbell F.A.
        • Pungello E.P.
        • Burchinal M.
        • et al.
        Adult outcomes as a function of an early childhood educational program: an Abecedarian Project follow-up.
        Dev Psychol. 2012; 48: 1033-1043
        • Walker S.P.
        • Chang S.M.
        • Vera-Hernandez M.
        • et al.
        Early childhood stimulation benefits adult competence and reduces violent behavior.
        Pediatrics. 2011; 127: 849-857
        • Schweinhart L.H.
        • Monte J.
        • Xiang Z.
        Lifetime Effects: The High/Scope Perry Preschool Study Through Age 40.
        High/Scope Press, Ypsilanti, Mich2005
        • Bethell C.D.
        • Kogan M.D.
        • Strickland B.B.
        • et al.
        A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations.
        Acad Pediatr. 2011; 11: S22-S33
        • Minkovitz C.S.
        • Strobino D.
        • Mistry K.B.
        • et al.
        Healthy Steps for Young Children: sustained results at 5.5 years.
        Pediatrics. 2007; 120: e658-e668
        • Dubowitz H.
        • Lane W.G.
        • Semiatin J.N.
        • et al.
        The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population?.
        Acad Pediatr. 2012; 12: 259-268
        • Shonkoff J.P.
        • Garner A.S.
        • Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
      1. Simon RL, Beach SR, Barr AB. Differential susceptibility to context: A Promising Model of the Interplay of Genes and the Social Environment. In: Kalkhoff W, Thye SR, Lawler EJ, eds. Biosociology and Neurosociology (Advances in Group Processes, Volume 29) Emerald Group Publishing Limited, pp.139–163.

        • Suderman M.
        • McGowan P.O.
        • Sasaki A.
        • et al.
        Conserved epigenetic sensitivity to early life experience in the rat and human hippocampus.
        Proc Natl Acad Sci U S A. 2012; 109: 17266-17272
        • Ellis B.J.
        • Essex M.J.
        • Boyce W.T.
        Biological sensitivity to context: II. Empirical explorations of an evolutionary-developmental theory.
        Dev Psychopathol. 2005; 17: 303-328
        • Boyce W.T.
        • Ellis B.J.
        Biological sensitivity to context: I. An evolutionary-developmental theory of the origins and functions of stress reactivity.
        Dev Psychopathol. 2005; 17: 271-301
        • Bakermans-Kranenburg M.J.
        • van Ijzendoorn M.H.
        Gene–environment interaction of the dopamine D4 receptor (DRD4) and observed maternal insensitivity predicting externalizing behavior in preschoolers.
        Dev Psychobiol. 2006; 48: 406-409
        • Bakermans-Kranenburg M.J.
        • Van IJzendoorn M.H.
        • Pijlman F.T.
        • et al.
        Experimental evidence for differential susceptibility: dopamine D4 receptor polymorphism (DRD4 VNTR) moderates intervention effects on toddlers' externalizing behavior in a randomized controlled trial.
        Dev Psychol. 2008; 44: 293-300
        • Obradović J.
        • Bush N.R.
        • Stamperdahl J.
        • et al.
        Biological sensitivity to context: the interactive effects of stress reactivity and family adversity on socioemotional behavior and school readiness.
        Child Dev. 2010; 81: 270-289
        • Belsky J.
        • Pluess M.
        Beyond diathesis stress: differential susceptibility to environmental influences.
        Psychol Bull. 2009; 135: 885-908
        • Shonkoff J.P.
        Building a new biodevelopmental framework to guide the future of early childhood policy.
        Child Dev. 2010; 81: 357-367
        • Garner A.S.
        • Shonkoff J.P.
        • Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics
        Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health.
        Pediatrics. 2012; 129: e224-e231
        • Labonte B.
        • Suderman M.
        • Maussion G.
        • et al.
        Genome-wide epigenetic regulation by early-life trauma.
        Arch Gen Psychiatry. 2012; 69: 722-731
        • Szyf M.
        • Bick J.
        DNA methylation: a mechanism for embedding early life experiences in the genome.
        Child Dev. 2013; 84: 49-57
        • McGowan P.O.
        • Sasaki A.
        • D'Alessio A.C.
        • et al.
        Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse.
        Nat Neurosci. 2009; 12: 342-348
        • Roth T.L.
        • Lubin F.D.
        • Funk A.J.
        • et al.
        Lasting epigenetic influence of early-life adversity on the BDNF gene.
        Biol Psychiatry. 2009; 65: 760-769
        • Blair C.
        • Granger D.A.
        • Willoughby M.
        • et al.
        Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood.
        Child Dev. 2011; 82: 1970-1984
        • American Academy of Pediatrics
        Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
        3rd ed. American Academy of Pediatrics, Elk Grove Village, Ill2008
        • Eggbeer L.
        Expanding the boundaries of pediatric primary care to support the development of infants, toddlers and their families.
        Zero to Three. 1995; 16: 1-7
        • American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention
        Policy statement—role of the pediatrician in youth violence prevention.
        Pediatrics. 2009; 124: 393-402
        • American Academy of Pediatrics Leaderships Workgroup on Early Brain and Child Development
        The first 1,000 days: Bright Futures examples for promoting EBCD.
        (Available at:) (Accessed February 2, 2015)
        • Zuckerman B.
        Promoting early literacy in pediatric practice: twenty years of Reach Out and Read.
        Pediatrics. 2009; 124: 1660-1665
        • Brazleton T.B.
        • Sparrow J.
        Touchpoints, Birth to Three.
        2nd ed. Da Capo Press, New York, NY2006
        • Zuckerman B.
        • Parker S.
        • Kaplan-Sanoff M.
        • et al.
        Healthy Steps: a case study of innovation in pediatric practice.
        Pediatrics. 2004; 114: 820-826
        • Mendelsohn A.L.
        • Huberman H.S.
        • Berkule S.B.
        • et al.
        Primary care strategies for promoting parent–child interactions and school readiness in at-risk families: the Bellevue Project for Early Language, Literacy, and Education Success.
        Arch Pediatr Adolesc Med. 2011; 165: 33-41
        • Mendelsohn A.L.
        • Valdez P.T.
        • Flynn V.
        • et al.
        Use of videotaped interactions during pediatric well-child care: impact at 33 months on parenting and on child development.
        J Dev Behav Pediatr. 2007; 28: 206-212
        • Goyal N.K.
        • Teeters A.
        • Ammerman R.T.
        Home visiting and outcomes of preterm infants: a systematic review.
        Pediatrics. 2013; 132: 502-516
        • Moss E.
        • Dubois-Comtois K.
        • Cyr C.
        • et al.
        Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: a randomized control trial.
        Dev Psychopathol. 2011; 23: 195-210
        • Bloomfield J.
        • Rising S.S.
        CenteringParenting: an innovative dyad model for group mother–infant care.
        J Midwifery Womens Health. 2013; 58: 683-689
        • Mittal P.
        Centering parenting: pilot implementation of a group model for teaching family medicine residents well-child care.
        Perm J. 2011; 15: 40-41
        • Perou R.
        • Elliott M.N.
        • Visser S.N.
        • et al.
        Legacy for ChildrenTM: a pair of randomized controlled trials of a public health model to improve developmental outcomes among children in poverty.
        BMC Public Health. 2012; 12: 691
        • Substance Abuse and Mental Health Services Administration
        Communities That Care Curriculum.
        (Available at:) (Accessed February 2, 2015)
        • US Department of Education; Office of Innovation and Improvement
        Promise Neighborhoods: purpose.
        (Available at:) (Accessed February 2, 2015)
        • Cohen J.
        • Kelleher K.
        • Mannarino A.
        Identifying, treating, and referring traumatized children: the role of pediatric providers.
        Arch Pediatr Adolesc Med. 2008; 162: 447-452
        • Dubowitz H.
        • Feigelman S.
        • Lane W.
        • et al.
        Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) model.
        Pediatrics. 2009; 123: 858-864
        • Dubowitz H.
        • Lane W.G.
        • Semiatin J.N.
        • et al.
        The Safe Environment for Every Kid model: impact on pediatric primary care professionals.
        Pediatrics. 2011; 127: e962-e970
        • Garg A.
        • Butz A.M.
        • Dworkin P.H.
        • et al.
        Improving the management of family psychosocial problems at low-income children's well-child care visits: the WE CARE project.
        Pediatrics. 2007; 120: 547-558
        • National Child Traumatic Stress Network
        Traumatic stress: resources for professionals.
        (Available at:) (Accessed February 7, 2015)
        • Chamberlain L.B.
        The amazing brain: apps for raising happy healthy children.
        (Available at:) (Accessed February 7, 2015)
        • American Academy of Pediatrics
        Trauma toolbox for primary care.
        (Available at:) (Accessed June 17, 2015)
      2. HealthLeads. Available at: https://healthleadsusa.org/. Accessed February 7, 2015.

        • Wissow L.
        • Anthony B.
        • Brown J.
        • et al.
        A common factors approach to improving the mental health capacity of pediatric primary care.
        Admin Policy Mental Health. 2008; 35: 305-318
        • Agency for Healthcare Research and Quality
        Interventions addressing children exposed to trauma: part 2—trauma other than child maltreatment and family violence.
        (Available at:) (Accessed February 2, 2015)
        • Slopen N.
        • McLaughlin K.A.
        • Shonkoff J.P.
        Interventions to improve cortisol regulation in children: a systematic review.
        Pediatrics. 2014; 133: 312-326
        • Cook A.
        • Spinazzola J.
        • Ford J.
        • et al.
        Complex trauma.
        Psychiatr Ann. 2005; 35: 390-398
        • Copeland W.E.
        • Keeler G.
        • Angold A.
        • et al.
        Traumatic events and posttraumatic stress in childhood.
        Arch Gen Psychiatry. 2007; 64: 577-584
        • Enlow M.B.
        • Blood E.
        • Egeland B.
        Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life.
        J Trauma Stress. 2013; 26: 686-694
        • Miller L.E.
        Perceived threat in childhood: a review of research and implications for children living in violent households.
        Trauma Violence Abuse. 2015; 16: 153-168
        • McDonald M.K.
        • Borntrager C.F.
        • Rostad W.
        Measuring trauma: considerations for assessing complex and non-PTSD Criterion A childhood trauma.
        J Trauma Dissociation. 2014; 15: 184-203
        • van der Kolk B.
        Developmental trauma disorder.
        Psychiatric Ann. 2005; 35: 401-409
        • Scheeringa M.S.
        Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children.
        Am J Psychiatry. 2008; 165: 1237-1239
        • Stolbach B.C.
        • Minshew R.
        • Rompala V.
        • et al.
        Complex trauma exposure and symptoms in urban traumatized children: a preliminary test of proposed criteria for developmental trauma disorder.
        J Trauma Stress. 2013; 26: 483-491
        • Dvir Y.
        • Ford J.D.
        • Hill M.
        • et al.
        Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities.
        Harv Rev Psychiatry. 2014; 22: 149-161
        • Ford J.D.
        • Grasso D.
        • Greene C.
        • et al.
        Clinical significance of a proposed developmental trauma disorder diagnosis: results of an international survey of clinicians.
        J Clin Psychiatry. 2013; 74: 841-849
        • American Academy of Pediatrics
        The Medical Home Approach to Identifying and Responding to Exposure to Trauma.
        (Available at:) (Accessed June 17, 2015)
        • Holmes A.
        • Wellman C.L.
        Stress-induced prefrontal reorganization and executive dysfunction in rodents.
        Neurosci Biobehav Rev. 2009; 33: 773-783
        • Bronfenbrenner U.
        • Ceci S.
        Nature–nurture reconceptualized in developmental perspective: a bioecological model.
        Psychol Rev. 1994; 101: 568-586
        • Johnson S.B.
        • Riley A.W.
        • Granger D.A.
        • et al.
        The science of early life toxic stress for pediatric practice and advocacy.
        Pediatrics. 2013; 131: 319-327
        • Dantzer R.
        • O'Connor J.C.
        • Freund G.G.
        • et al.
        From inflammation to sickness and depression: when the immune system subjugates the brain.
        Nat Rev Neuroscience. 2008; 9: 46-56
        • McEwen B.S.
        • Gianaros P.J.
        Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease.
        Ann N Y Acad Sci. 2010; 1186: 190-222
        • Coe C.L.
        • Lubach G.R.
        • Schneider M.L.
        • et al.
        Early rearing conditions alter immune responses in the developing infant primate.
        Pediatrics. 1992; 90: 505-509
        • Weathers F.W.
        • Keane T.M.
        The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma.
        J Trauma Stress. 2007; 20: 107-121
        • Heneghan A.
        • Stein R.E.
        • Hurlburt M.S.
        • et al.
        Mental health problems in teens investigated by US child welfare agencies.
        J Adolesc Health. 2013; 52: 634-640
        • Webb E.
        Poverty, maltreatment and attention deficit hyperactivity disorder.
        Arch Dis Child. 2013; 98: 397-400
        • National Child Traumatic Stress Network
        Child welfare trauma training toolkit: the invisible suitcase.
        (Available at:) (Accessed January 4, 2014)
        • Hartman R.G.E.
        • Folcarelli C.
        The National Child Traumatic Stress Network policy brief.
        (Available at:) (Accessed January 8, 2014)
      3. National Child Traumatic Stress Network. National Child Traumatic Stress Network empirically supported treatments and promising practices. Available at: http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices. Accessed June 6, 2015.

        • Caspi A.
        • McClay J.
        • Moffitt T.E.
        • et al.
        Role of genotype in the cycle of violence in maltreated children.
        Science. 2002; 297: 851-854
        • Bradley E.H.
        • Elkins B.R.
        • Herrin J.
        • et al.
        Health and social services expenditures: associations with health outcomes.
        BMJ Qual Saf. 2011; 20: 826-831
        • Conti G.
        • Heckman J.J.
        The developmental approach to child and adult health.
        Pediatrics. 2013; 131: S133-S141
        • Shonkoff J.P.
        Protecting brains, not simply stimulating minds.
        Science. 2011; 333: 982-983
        • Shonkoff J.P.
        • Boyce W.T.
        • McEwen B.S.
        Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention.
        JAMA. 2009; 301: 2252-2259