Early Assessment

Early Assessment

By |2015-10-13T03:26:19+02:00October 13th, 2015|Research Reports|11 Comments

Research Report

October, 2015

Marye O’Reilly-Knapp

A pediatrician from the Children’s Hospital of Philadelphia , Roy Wade Jr, MD has expanded his clinical practice with his research. He is examining the impact of violence, crime and racism on his patients’ health. He states that social factors need to be considered because of their importance in health factors or morbidity. Wade’s work builds on the landmark study ACE (Adverse Childhood Experiences) that concluded that traumatic events experienced in childhood generated worse health later in life. Such health problems included: substance abuse, mental illness, diabetes, cancer – as well as dropping out of school and living in poverty.

As clinicians some of this information is not new to us. We know that with unmitigated stress the amygdala is affected as well as other regions in the brain. We also have a greater understanding of brain development in the child and the importance of early relationships. What is novel in Wade’s work is that he is creating a systematic way to identify the traumatic event in the child so that pediatricians can assess for early trauma. A study done with his colleagues included 119 adults ages 18 to 26. Focus groups were used to list adverse childhood experiences – “events emotionally difficult to deal with and cause stress”. The top five identified were: single-parent homes, neighborhood crime, community violence, death, and discrimination. He has been awarded a grant to continue his work in developing a tool kit to be used in primary care practices and agencies interested in child welfare.

Knowing the social components that influence the child’s growth can assist those working with children in predicting health outcomes. More importantly, problems can be identified in childhood and solutions facilitated rather than later in adulthood. Early interventions could greatly reduce the effects of untreated, long-term trauma and enhance physical and psychological health.

Note:

Since 2009 I have been involved in the research reports. This note is to inform you that this will be my last report. I did not want to just stop and leave you wondering what happened so I am doing this final report. I want to thank those who supported this venture. I will see you in Milan! Marye

Evaluación temprana

Informe de investigación

Octubre de 2015

Marye O’Reilly-Knapp

 

Un pediatra del Hospital Infantil de Filadelfia, Roy Wade Jr., doctor en medicina, ha expandido la práctica clínica con su investigación. Está examinando el impacto de la violencia, la delincuencia y el racismo en la salud de sus pacientes. Afirma que los factores sociales deben ser tenidos en consideración debido a su importancia en los factores de salud o morbilidad. El trabajo de Wade se basa en el estudio sin precedentes sobre las EIA (experiencias infantiles adversas) que concluye que los eventos traumáticos experimentados en la infancia generan un deterioro de la salud en el futuro. Estos problemas de salud incluyen: abuso de sustancias, enfermedades mentales, diabetes, cáncer, y también abandono escolar y situaciones de pobreza.

Como clínicos, parte de esta información no es nueva para nosotros. Sabemos que con el estrés no mitigado, la amígdala se ve afectada, así como otras áreas del cerebro. También disponemos de una mayor comprensión del desarrollo cerebral infantil y de la importancia de las relaciones tempranas. Lo que es novedoso en la obra de Wade es la creación de una forma sistemática para identificar el evento traumático en el niño; de este modo, los pediatras pueden evaluar el trauma temprano. Un estudio, realizado junto con sus colegas, incluyó a 119 adultos de edades entre 18 a 26 años. Los grupos focales se utilizaron para enumerar las experiencias adversas en la infancia - "eventos emocionalmente difíciles de tratar y que causan estrés". Los cinco primeros identificados fueron: hogar mono-parental, delincuencia en el vecindario, violencia en la comunidad, muerte y discriminación. Se le ha concedido una beca para continuar su trabajo desarrollando un set de instrumentos que se emplearán en los centros de atención primaria y en los organismos interesados en el bienestar infantil.

Conocer los componentes sociales que influyen en el crecimiento infantil, puede ayudar a aquellos que trabajan con niños a predecir los resultados sanitarios. Más importante, los problemas pueden ser identificados en la infancia y soluciones facilitadas en esa etapa, en lugar de más tarde durante la adultez. Las intervenciones tempranas pueden reducir en gran medida los efectos del trauma prolongado no tratado y mejorar la salud física y psicológica.

Nota: Desde el 2009 he estado involucrada en los informes de investigación. Esta nota es para comunicaros que este será mi último informe. No quería dejarlo de golpe y que os preguntarais qué pasó, así que estoy haciendo este informe final. Quiero da las gracias a los que apoyaron esta iniciativa.

¡Os veré en Milán!

Marye

 

Traducción de Angela

Rapport de recherche

Octobre 2015

Marye O’Reilly-Knapp

Evaluation précoce

Roy Wade Jr est médecin pédiatre au Children's Hospital de Philadelphie. Ses travaux de recherche lui ont permis d'élargir sa pratique clinique. Il travaille notamment sur l'impact de la violence, des délits et du racisme sur la santé de ses patients. Il déclare que les facteurs sociaux doivent être pris en considération en raison de leur importance pour les facteurs de santé ou de morbidité. Le travail de Wade s'appuie sur l'étude phare ACE (adverse childhood experiences, expériences néfastes dans l'enfance) qui conclut que des évènements traumatiques durant l'enfance conduisaient à une plus mauvaise santé plus tard dans la vie. Parmis ces problèmes de santé on trouve l'usage de drogues, la maladie mentale, le diabète, le cancer, et également la déscolarisation et une grande précarité. Pour nous cliniciens une partie de ces informations n'est pas nouvelle. Nous savons que l'amydale et d'autres zones du cerveau sont affectées en cas de stress très important.

Nous avons également une meilleure compréhension du développement du cerveau de l'enfant et de l'importance des premières relations. Ce qui est nouveau dans le travail de Wade, c'est qu'il met en place un système d'identification  de l'évènement traumatique chez l'enfant qui permet au pédiatre d'identifier le trauma précoce. Avec ses collègues il a conduit une étude de 119 adultes âgés de18 à 26 ans. Ceux ci ont été invités à catégoriser des expériences de l'enfance difficiles - "des évènements difficiles à gérer et qui ont été facteurs de stress". Les cinq premiers facteurs nommés ont été: une famille monoparentale, un quartier à forte délinquance, la violence communautaire, la mort et la discrimination. Wade a reçu un financement afin de poursuivre ses travaux pour développer un outil utilisable par les généralistes et les agences intéressées par la protection de l'enfance.

La connaissances des aspects sociaux ayant une influence sur la croissance de l'enfant peut aider ceux qui travaillent avec des enfants à anticiper des problèmes de santé. Plus encore, des problèmes identifiés dans l'enfance peuvent être traités plus tôt. Des interventions précoces pourraient réduire considérablement l'impact de traumatismes  non traités sur du long terme et ainsi améliorer la santé physique et psychologique.

Remarque:

J'assure le suivi des rapports de recherche depuis 2009. Je voulais vous informer afin que vous ne vous posiez pas de questions, que ce compte-rendu sera le dernier. Je remercie toutes les personnes qui m'ont soutenue dans ce projet. Je vous verrai à Milan. Marye.

 

(Pauline Daver)

Assessment Precoce

Martedì 13 Ottobre 2015

Report di ricerca

Ottobre 2015

Marye O’Reilly-Knapp

Un pediatra dell’Ospedale dei Bambini di Philadelphia, Roy Wade Jr, MD, ha ampliato la sua pratica clinica con la sua ricerca. Egli sta esaminando l’impatto della violenza, della criminalità e del razzismo sulla salute dei suoi pazienti. Egli afferma che i fattori sociali devono essere considerati per la loro importanza come fattori di salute o di morbilità. Lavoro di Wade si basa sullo studio fondamentale ACE (Esperienze Infantili Avverse) che hanno concluso che eventi traumatici vissuti nell’infanzia hanno generato una salute peggiore più tardi nella vita. Tali problemi di salute includevano: abuso di sostanze, la malattia mentale, il diabete, il cancro - così come l’abbandono della scuola e il vivere in condizioni di povertà.

In quanto medici, alcune di queste informazioni non sono una novità per noi. Sappiamo che in caso di stress assoluto l’amigdala ne è influenzata così come altre regioni del cervello. Abbiamo anche una maggiore comprensione dello sviluppo del cervello nel bambino e dell’importanza delle relazioni precoci. Quello che è nuovo nel lavoro di Wade è che egli sta creando un modo sistematico per identificare l’evento traumatico nel bambino in modo che i pediatri possano valutare il trauma precoce. Uno studio condotto con i suoi colleghi includeva 119 adulti tra i 18 e i 26 anni. I focus group sono stati usati per elencare esperienze avverse infantili – “eventi emotivamente difficili da affrontare e causa di stress”. I primi cinque che sono stati identificati sono: famiglie con un solo genitore, la criminalità di quartiere, la violenza della comunità, la morte e la discriminazione. Egli ha ricevuto una borsa di studio per continuare il suo lavoro nello sviluppo di un kit di strumenti da utilizzare nelle pratiche di cure primarie e le nelle agenzie interessate al benessere dei bambini.

Conoscere le componenti sociali che influenzano la crescita del bambino può aiutare coloro che lavorano con i bambini nel predire i risultati in termini di salute. Ancora più importante, i problemi possono essere identificati durante l'infanzia e le soluzioni facilitate piuttosto che più avanti in età adulta. I primi interventi potrebbero ridurre notevolmente gli effetti dei traumi a lungo termine non trattati e migliorare la salute fisica e psicologica.

Nota:

Dal 2009 sono stato coinvolta nei rapporti di ricerca. Questa nota è per informarvi che questa sarà il mio ultimo report. Non volevo proprio smettere e lasciarvi con la preoccupazione di cosa fosse accaduto, così sto facendo questo report finale. Voglio ringraziare coloro che hanno sostenuto questa iniziativa. Ci vediamo a Milano! Marye

(traduzione a cura di Isabella Nuboloni)

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11 Comments

  1. Sandra Watson 13/10/2015 at 8:21 am - Reply

    Marye, thank you for your research contributions over the past 6 years. The research Roy Wade Jr is doing is very exciting and I appreciate you providing a Research Report I will have to go look him up now and then and see what more he comes up with with regard to early interventions, great research.
    Once again thank you Marye, see you in Milan !!
    Sandra

    • maryeoreilly 04/02/2016 at 4:45 pm - Reply

      Thank you to all have supported me and those of you who have commented on the research reports. For the last few months I have had difficulty getting onto the blog. Now can do so and am glad I can now reconnect with all of you. Now going to pay my dues!
      Love to all, Marye

  2. Angela 13/10/2015 at 8:14 pm - Reply

    GRACIAS!!!!!!!

    Thanks for all you have done, Marye. And all your generosity!

    A big HUG!!!!!

  3. neilrobertson 13/10/2015 at 8:51 pm - Reply

    Dear Marye,
    Thank you for your wonderful contributions and sharing your learning and experiences. Am already looking forward to Milan!.
    A similar study discussing the impact of ACE on serotonin transporter genes and susceptibility to later life depression and suicidality states:
    ..this study is one of the best demonstrations that the “s” allele is neither a risk gene nor a “bad” gene, but rather a “plasticity” gene—one that makes an individual more sensitive to his or her childhood environment. If that environment is safe and nurturing, it appears that somehow this safety is introjected such that later disappointments, stresses, or depressions do not bring the individual to the brink of suicide.

    On the other hand, if the childhood environment is harsh, a propensity toward high-risk behaviors is fostered (the “s” allele under these circumstances is associated with earlier sexual activity and more substance use,for example.) The full article can be accessed via http://www.psychiatrictimes.com/major-depressive-disorder/serotonin-transporter-gene-whats-new

  4. leighbettles 13/10/2015 at 11:16 pm - Reply

    Hello Marye,

    Thank you for the inspiring reports that you have written.

    Warm regards
    Leigh

  5. mercedes 17/10/2015 at 6:48 pm - Reply

    MANY thank you very much, Mary ….. !!!!!!
    … for sharing your readings, discoveries, reflections, learning ….
    I will miss your posts ….
              An affectionate hug
                             Mercedes Pedreira

  6. jannetti 18/10/2015 at 6:27 pm - Reply

    Great job Marye! Thank you for the time that you have put into this project.

    Anthony

  7. wessel 08/11/2015 at 7:43 am - Reply

    Dear Marye,

    I want to thank you so much for all the interesting and essential work you offered.I had the great honour and pleasure to translate some of it in French for the blog and was very captivated by that.I certaily haven’t read all the research you did, before i joined the association, but what I read was allways adding at my understanding and knowledge.
    I am looking forward to be able to thank you in Milan,
    a warm embrace,

    Lily Wessel

  8. Karen Cesarano 09/11/2015 at 6:28 pm - Reply

    Dear Marye
    I too want to thank you for all the hard work you have put into the research reports during the years. I’ve experienced your commitment as solid, inspiring and consistent. I am aware that many times I have thought to thank you for all the work and research you have put into the reports and with regret I never have. I can imagine that sometimes posting your thoughts and work and receiving little if no response could have been somewhat disheartening for you, at least it would have been for me, and you didn’t give up, all my appreciation and acknowledgement Marye. Again thank you and look forward to seeing you again at the Conference in Milan
    Karen Cesarano

  9. Karen Cesarano 09/11/2015 at 6:29 pm - Reply

    Dear Neil
    Thank you for the link, really interesting
    Karen Cesarano

  10. arantza 02/05/2016 at 11:40 am - Reply

    Dear Marye
    Thanks very much for sharing your investigations, your contribution, your work on the research reports are very important and interesting. Thanks again and wishing to see you in Milan.
    A big and warm hug.
    Arantza Arrillaga

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