The Dark Truth About How Addiction & Mental Illness Cause ACEs in Kids

I'd like to welcome everybody to today's presentation of the impact of addiction and mental illness on children and how it can create aces. I'm your host, Dr. Donnelly Snipes. In today's presentation, we are going to define aces. We're going to explore why uncontrolled addiction or mental illness in the household or even in the family are considered ACEs or Adverse Childhood experiences. We'll discuss what that means for assessment and treatment of the individual, the identified patient, as well as their children. In teaching addictions counseling, a lot of times we talk very generally about the impact of addiction and mental illness on the family, but I think it's really important to sort of single out the impact of addiction and mental illness on children. Children. So adverse childhood experiences are events that cause the child to feel unsafe and powerless to escape or resolve the issue. When children are children, they can't just pack up and move out. They can't just tell somebody, you know, to straighten up and fly right. That's not how it works. And it's generally not received well. So children often feel distress and they don't know how to get out of it. They don't know what to do. Some of them may contemplate telling a teacher or another adult, but then a lot of times they also contemplate what the consequences of that would be. So they end up keeping, keeping stuff to themselves and feeling trapped in a chaotic environment. 68% of people identify as having experienced at least one adverse childhood experience. When we get down to what they are, you're going to look at it and go, well, yeah, that's probably true. 18% of people identify as having experienced four or more. And, and again, when we get down there, you're going to see how one, any one of the ACEs can contribute to the development of, of several other of the aces if it goes unaddressed. Which is why people who have experienced four or more aces a lot of times report their households or their home environments to be very chaotic, very distressful because there was a lot of stuff going on. The greater the number of ACEs, the greater the risk of physical stress related and mental health, including addiction issues. Physical issues related to stress include hypertension, include diabetes, include cardiovascular disease, autoimmune disorders. There's a lot of issues that develop physically when our auto autonomic nervous system. Sorry. Goes on the fritz. So we're going to talk more about that too. ACEs impact the child's ability to get their basic needs met. And in my classes we talk about the pieces model. Today we're just going to talk about peace. But what that stands for is physical, interpersonal, emotional, cognitive and environmental needs. And we all have these needs and we're going to go through what. Some examples of those physical needs include safety. Somebody is not hurting me. Imagine that they need to get those physical needs met and other needs. Other physical needs include food, medical care and just a routine to help maintain their circadian rhythms, which is really important for helping regulate that autonomic nervous system. Interpersonal needs include safety. I need to feel safe when I interact with you. I need to feel like you are not going to harm me. I need to feel a sense of love and belonging. I need to be able to develop relationship skills and self esteem and the ability to trust others. And those all go in the interpersonal needs. And when caregivers are distracted or overwhelmed by their own stuff or by stuff that's going on in the family, sometimes they're not able to be consistently present for the child and to help address these things and help them develop these skills. Emotional safety and needs include identifying and understanding emotions and helping the child develop tools to manage distress. We're going to talk about the mnemonic idea later for helping children identify the feeling down regulate so they can get into their wise mind, evaluate their options and act in a way that responds best to the situation. Cognitive and safety needs include autonomy, initiative, industry, or a sense of competence and identity. And some of you who have just gotten out of undergrad, if you are with us early in your career, are going to recognize these as Erickson's stages of psychosocial development. People need to be able to feel safe having their own thoughts, taking initiative and trying to do things that they want to do and becoming the person that they hope they can be. And you could put some of these under interpersonal, but you know, a lot of it has to do with how they're viewing the world and whether people are telling them what you're thinking, what your plans are. They're wrong. And that is a violation of their cognitive safety and then environmental safety and needs. People need safe, stable housing and in children's case, transportation. They need to know that they're going to be able to get from one environment to the other and in a timely fashion. They need to know that they're going to get their needs met. And I refer you back to Maslow's hierarchy of needs where the base of the hierarchy is your physical needs and then the second level is your safety needs. The third level is love and belonging. If people aren't getting their physical needs met. If people don't feel safe, they're going to be in this persistent state of fight or flee. And that persistent state of fight or flee is going to override their ability to focus on developing relationships and self esteem and all that other stuff that we're hoping children are able to do. If these videos are helpful, please remember to like subscribe and share. That is the best thing you can do for this channel to help us grow, to help us reach more people. If you need CEUs, we offer unlimited CEUs for $59 at allce.com so let's delve into those adverse childhood experiences. What they have been defined as by the study that was done. Gosh, I guess it's been about 15 years ago now. Death, especially suicide, is an adverse childhood experience. Now think of it from a kid's standpoint. Wow. Yeah. If somebody dies, that is traumatic. Children often don't have greater concepts of what happens after death. It's just all of a sudden somebody was here, especially caregiver was here, sibling was here, and then all of a sudden they were poof. Gone. Oh my gosh. That makes me feel anxious. I think even with adults, in a lot of cases when death happens, there is a certain amount of existential anxiety that occurs. We've developed the ability to deal with that. A child may not Suicide is particularly adverse in in terms of the impact on the child, and especially if the child feels like it's their fault or they should have been able to stop it. Divorce is an adverse childhood experience, and some people will argue this until the cows come home. Divorce in and of itself is not necessarily a bad thing. Sometimes the best thing that can happen for that child is for the two caregivers to separate because they're at each other like, you know, rabid cats. I don't know, however, even if it is the best thing when one caregiver goes away, when one caregiver is kicked out of the house, so to speak, the child may start to wonder, well, if I start to argue with mom, am I going to get kicked out too? The child may feel anxious about whether they're going to be divorced, if you will. And it's really important that we work with the chil child or children to help them understand what's going on between adults and what's going on between adult and child. That we love them. We may not always like their behaviors, but we love them. And home will always be a place that they can come back to or that they can be incarceration of household members. If care one caregiver gets incarcerated, then obviously you're losing their support, you're losing their financial income, you're losing a variety of things, and you're maybe even gaining stress. Be worrying about the person who's incarcerated or additional bills as a result of lawyers fees or whatever abuse, experiencing it or witnessing it. And it can be physical abuse, it can be emotional abuse, it can be financial abuse. But experiencing or witnessing it is obviously something that is going to leave a child feeling unsafe and powerless. Neglect and abandonment are is the next one. And when we talk about neglect and abandonment, what we're talking about is not meeting the child's needs. Those peace needs that we went through, physical, interpersonal, cognitive, emotional, environmental. We need to be aware that neglect is not just not changing a baby's diaper all day long. Wow, that's neglectful. There are lots of different forms of neglect and lots of different needs children have. And when they don't get their needs met, they often feel rejected or abandoned. If they can't count on their caregiver to be consistent and responsive, then it causes them to feel anxious because again, if they have a need and their caregiver is not meeting it, it's not like they can go down to the grocery store and get food because there's nothing in the refrigerator. It's not like they can drive themselves to the doctors because they don't feel well. So the child on some primitive level recognizes when we're talking about really young children especially recognizes that they're unsafe when they are crying for an extended period of time and caregiver doesn't respond. There's nothing they can do to get caregivers attention. That is terrifying to a child. Now I have a space here because substance abuse, uncontrolled substance abuse and mental illness are both also adverse childhood experiences. And again, it's when they're uncontrolled, people can be in recovery and it's not going to negatively impact those around them. But what we're talking about is uncontrolled. But I do want you to reflect for a minute on how substance abuse can lead to death, suicide, divorce, incarceration, abuse or neglect. I want you to think about how people with a mental illness, major depressive disorder, for example, or generalized anxiety, they're so anxious all the time that they can't see straight. They're constantly in fight or flight. Think about how that might end up leading to death, divorce, abuse or neglect. Now mental illness may or may not lead to incarceration it depends on how they're coping with it. But mental illness is often self medicated with substance abuse. So you can see how it's really easy to develop a, an environment in which there are multiple aces. Can people go experience these adverse experiences and emerge relatively unscathed? Yes, but it requires that their caregivers are consistent, responsive, attentive to their needs, they're encouraging and they make sure that there is a safe home base for the child to be as well as to talk about their concerns and their fears and to get their needs met. So all of these are inter. Inter. All of these cause adverse childhood experiences. I also want you to recognize the impact of ACEs on caregivers who experience them. They experience negative effects from being exposed to these things and then they become caregivers as a result of ACEs. People often don't develop the coping skills and interpersonal skills and resiliency skills, skills that someone who didn't have exposure to ACEs is able to develop. Because when people are in fight or flight, their brain is actually programmed to not worry about learning. Right now we need to get safe. And until the person gets safe, it's going to be a lot harder to learn anything. And going back to Maslow's hierarchy, it's going to be hard to work on developing relationships and self esteem and skills when you're hungry, when you're tired, when you're afraid all the time. Intergenerational trauma can actually be passed down. If mom experienced, was as a child, experienced divorce abuse, neglect and substance abuse in her family of origin, then she may have not developed in a healthy direction. She may not have developed the skills and tools she needed and as a result she ends up with some level of mental illness, cptsd. And when she tries to parent, when she has kids, she's already got one, at least one of the aces right there. She is parenting with an uncontrolled mental illness and obviously there could be other issues that arise. So let's think about this. How does substance abuse or other mental illness cause the other aces? How does substance abuse cause death or suicide? We recognize this, we see this frequently, unfortunately. Accidental overdoses, intentional overdoses, somebody who relapses and is so filled with regret that they commit suicide. We see people who don't feel like they can ever recover. We see people who are in recovery a little bit, but they're, they're still going through post acute withdrawal or they've got underlying issues they haven't addressed and it's just too painful because now they're not numbing the trauma. There are a lot of reasons why we might see death in somebody who is abusing substances, divorce, substance use, or misuse. And we'll just do mental illness with it since we're somewhat short on time. When there is substance abuse or mental illness in the caregivers, then you're more likely going to have conflict and that conflict may end up resulting in divorce, especially with substance abuse. Again, not so much with mental illness. When there is substance abuse, there's a greater likelihood of incarceration. It could be due to the addiction itself or due to behaviors that the person engages in while they're under the influence or in order to access their addiction of choice. For example, somebody who has a wicked gambling problem may get arrested because they were doing something a little shady to try to make money. Or somebody who is a sex addict may get arrested because of, you know, engaging in some behaviors that were technically illegal. So we do want to recognize that substance abuse and mental illnesses can cause other aces. If caregivers had a substance issue, an addiction issue, or a mental illness, we really need to screen intensely, if you will, for the other adverse childhood experiences and how the person perceived those. We also want to recognize that the other aces can lead to substance abuse and mental illness. If the family's going along just fine in their own estimation, and older sibling commits suicide, how do you think that's going to impact the caregivers? How do you think it's going to impact their ability to be responsive to the remaining child? Because they are overwhelmed with their distress? And it the same thing is true if older sibling has, gets in a car wreck and, and dies suddenly or something else, it doesn't have to be suicide. But obviously when a child dies before the parents, that's out of order. And we call that complex trauma. And there's a whole bunch of other stuff that goes along with it. Divorce can cause people to lean toward substance abuse in order to numb their depression, their anxiety, their grief. And some of that can end up leading to dysregulation of all those neurotransmitters and the autonomic nervous system. And the person developing mental illnesses, anxiety, depression in particular as a result of their experience or the experience itself, result in prolonged grief disorder. Incarceration of household members can cause distress in the remaining caregiver and which can lead to self medicating with substance abuse. Abuse abuse. In households where there is abuse, a lot of times there's already substance abuse, but we'll assume there's not a lot of times, the victim of the abuse, the target of the abuse may develop anxiety, trauma related disorders, depression, and that again makes them feel unsafe. They're so busy trying to figure out how to survive that it's hard to focus on the child. Now let's look at the impact of these things on the child. And I mentioned this a little bit earlier, death in a child's family. As I said, children don't really have a understanding of what death is and a lot of us don't. But as adults we've developed ways to deal with our death anxiety or our existential anxiety. In a child, they may be afraid to go to sleep, they may be afraid to be away from the parent. So they may start developing separation anxiety and these things can start dysregulating the, the body of the child leading to anxiety disorders, depressive disorders, etc. We talked earlier a little bit about divorce and how children, when there is divorce in the family, they may feel unsure when there are. When there's substance abuse and mental illness, the child learns what they live. And if the child learns to cope by, through addictive behaviors, then that's what they're going to develop. If a caregiver is engaging in addictive behaviors to cope with life, then they're probably not able to teach healthy coping skills because if they had them, they'd use them. Additionally, the caregiver with substance abuse or mental illness may have difficulty attending to the child. So we have this child sitting here who has these feelings, these emotions, these needs that are not getting met. What do you think that's going to do to their mental health? What do you think that's going to do to their physical health? Thinking about how these events impact the caregiver and, and we just, we talked about those. But I really do want to emphasize the impact of substance abuse and mental illness on the caregiver. Creating an environment in which the child feels unsafe and powerless. When the child feels unsafe and powerless, then they are not going to be able to focus in school. Well, let's, let's look at some of these issues. Physically, how is it going to impact the child? If they feel unsafe and powerless to escape, they're going to have difficulty sleeping. They're often going to experience circadian rhythm disruptions or which is not just sleeping but hormones and everything else. They may develop inflammation and autoimmune disorders. They may get sick more easily. They may have difficulties with physical development even if they're eating a healthy diet because they're not processing the food. Well, when we're in fight or flight. We're not in rest and digest. So fight physically. When a child is is exposed to aces. When a child is in a chaotic environment in which they don't feel safe, they're going to have physical issues. And all of these physical issues contribute to the development of emotional, cognitive, interpersonal issues as well. So when a child feels unsafe and powerless interpersonally, it's hard to feel a sense of love and belonging when the very people who brought you into this world are not paying attention to your needs. When there it seems like there is nobody to help you stay safe, to help you survive. It's hard to feel loved. A lot of times in environments where there is addiction and or mental illness, the caregivers have difficulty creating an environment that's consistent and feels safe to the child and again has difficulty even recognizing when the child's in distress. They're not trying to be neglectful. They just can't see the forest for the trees. Relationship skills don't get developed. We know that secure attachment helps people develop the ability to to identify their thoughts, wants and needs, to communicate their thoughts, wants and needs, to set and maintain boundaries. And that's wonderful. But if there's not somebody there to sit down with Johnny and say, hey Johnny, it seems like you're really anxious about school this year. Let's talk about what's causing you to feel anxious and help Johnny walk through the process of exploring his thoughts about school and his concerns and his fears about school. Help Johnny process the facts in this context. Help Johnny develop skills for distress tolerance because we're not born with those. And help Johnny choose how to best move forward. Not going to school is not an option. So what skills can caregiver help Johnny develop to feel less anxious about school and more able to move forward. And maybe it means going to counseling because it's, you know, out of the caregivers pay grade, so to speak. All right, that's fine, but at least that's responsive emotionally. We need to make sure that children can identify and understand their emotions and have those tools to manage distress. And when the caregiver can't manage their own distress, it's going to be hard for them to notice or respond to the child. That leaves a child who doesn't develop these essential cognitive behavioral tools. It leaves a child who doesn't develop their emotional iq, so to speak, and their social skills. When we don't have those things, we feel unsafe in our own skin because our emotions are all over the place and it feels like you know, oh my gosh, I can't control them. I don't know how to let go of this grief. I don't know how to deal with this anxiety and I don't know where to turn. I don't have anybody who's ever helped me. So then we start to see mood disorders develop in the child. We know that sleep deprivation contributes to a whole host of cognitive issues and difficulty in managing emotions. And when children are in an unsafe environment, when they're not sure if caregiver is coming home, when they're not sure if caregiver is going to be alive tomorrow, when they're not sure if caregivers angry at them. Because caregivers in a bad mood. Remember children personalize everything. You're in a bad mood, must be my fault. They can't think, well, you're in a bad mood because dad did this, that and the other. It's just, you're in a bad mood, must be my fault or I should be able to fix it. Children believe they have a lot more control than they do. And when they can't fix it, then they start feeling anxious, they start feeling incompetent. That negatively impacts their self esteem. When, when they can't fix it, then they may feel guilty and that makes it harder. Guilt is self anger, which means that stress response is going to keep on going, which means the body is not going to downregulate into deep sleep. They may sleep, but it's not good sleep, it's not quality sleep. And environmentally, if the child doesn't feel like they've got safe, stable housing, if the caregiver isn't noticing that the child feels unsafe, and this could include bullying and stuff, whether that's interpersonal or environmental, wherever you want to put it. If the caregiver is not able to help the child get to school or back up to physical needs, make sure the child has clean clothes to go to school in. How does that impact the child's self esteem and how does that impact the child's ability to form relationships and even want to reach out to others? If they're wearing something that they wore three day, three days in a row, they may, you know, recognize that they're different and, and that makes them feel ostracized. When there's a substance abuse or mental illness, it is strongly advised to screen the child for ACEs. If you are seeing a, an adult who has a mental illness or an addiction issue or both, we need to screen for, we need to identify whether there are children in the home who may be struggling with adverse childhood experiences. And we obviously don't want to put it this way. You know, you've. You've got depression, so we need to screen your kid to make sure that you're not hurting them. Obviously, that's not what we're going to say, but we need to talk with the caregiver, the identified patient, about how, how are your kids doing? How do they seem to be sleeping? How. How are they doing in school? You know, keep it kind of light. But, but recognizing if there are behavioral issues that it may be related to the caregiver's mental illness or addiction issue and addressing it accordingly. Helping the caregiver figure out, you know, behaviors, communication. What is Johnny saying to you when he does that? What is he asking for? What is he needing? And helping ch caregivers become more responsive to their child's needs. Helping the caregiver develop skills and tools to be more mindful, aware and responsive of their own needs will also be helpful. So they can say when they come home after a bad day and they're angry, hey, Johnny, I had a really bad day today and I need to go take a timeout for a few minutes and I really want to spend some time with you. And this has nothing to do with you and I'll be fine. I just need some time. Okay, so the, the caregiver knows that they are just oozing stress and they have tools that they've developed, whatever those tools are, to try to manage that distress and get in a better frame of mind. And they know that they need to do that so then they can come out and be present. For Johnny, the adverse childhood experiences and the perception of those experiences must be screened to identify potential symptoms that may be originating as a response to trauma. Trauma and, and I would say adverse childhood experience. Well, let me back up. Trauma is anything that leaves somebody feeling unsafe and powerless. Traumatic injury occurs when the person never regains a sense of safety and personal power. People who've experienced adverse childhood experiences ACEs may have experienced the trauma of any of these things. And they may have had the support they needed from family and friends, etc to regain their sense of safety and empowerment. Or not. And it's the or not that causes people to end up developing complex post traumatic stress disorder or PTSD and being cognizant of this. Once people develop a traumatic stress disorder, a lot of times they have difficulty focusing because they don't feel safe. They stay in persistent fight or flee. They feel anxious a lot of the time. They may also Feel helpless and hopeless a lot of the time. So you got the mental illness, you know, that's bubbling up and then they may start self medicating with addictive behaviors. They may not, but they may. We'll just, you know, consider that for this example. And it's important not to identify something and say, okay, we're going to treat this, we're going to treat your alcohol addiction, we're going to help you sober up and then we're going to give you skills and tools to deal with cravings. Well, that's wonderful. But if the person started drinking so they didn't have to think about the traumas they'd experienced, then they're not going to stay sober for very long. We, I would estimate that a lot of 80%, maybe or more of people's mental health issues often originated from trauma. It could be trauma in childhood or trauma in adulthood, but from, from trauma. And until we help people integrate that in a way that makes sense to them and they can feel safe and empowered, they're going to be struggling with it and they're going to have difficulty regulating their emotions, they're going to have difficulty sleeping well, they're going to have difficulty in each piece of their life. If somebody experienced death, for example, a sudden death in their family, we want to explore that with them. Maybe it was somebody that, or an incident that really didn't hit them hard. Okay, you know, that's fine. If your perception was it was no big deal, that's one thing. If, if grandpa is at Christmas dinner and has a heart attack, you know, that's traumatic. And there are a lot of triggers that go, go around that, you know, Christmas, Christmas dinner, maybe just dinner. And coping with that memory might be really difficult. And so examining in what ways is trauma promoting the anxiety, the sense of hopelessness, the addiction is going to be really important. We also want to help the person develop skills and tools to identify safety in the present. And when they're reacting from trauma versus from past trauma versus from something that's going on right now. Mental illness is one of those things that in, in the ACEs study they said in a caregiver. But I think it's important to recognize that if Johnny's in this household and Johnny's sibling has conduct disorder or ADHD or, or something else, then Johnny's sibling may be taking a lot of the caregivers time in and attention, trying as they try to figure out how to help the sibling cope. And they try to cope with any fallout, you know, behavioral issues or Whatever from the sibling's mental health issue. So Johnny may feel like he's left out in the cold. Nobody cares what's going on with him because he's fine. Therefore I think we are overlooking a lot of chaos and trauma in the family, a lot of adverse childhood experiences when we limit ourselves to saying it has to be mental illness in the parent. If there is a grandma who has Alzheimer's disease and maybe grandma doesn't even live in the house, but there's a lot of stress because grandma's not in a long term care facility yet and there's a lot of stress in the family trying to figure out how to afford long term care, trying to figure out how to keep grandma safe. Again, that's devoted or directing caregivers attention away from Johnny towards a mental illness. Now yeah, we're all going to have stuff happen in our families and one of the things that we need to encourage caregivers to do is to make sure that they, they live in the, and they're attending to grandma and they're attending to Johnny, they're attending to older siblings and they're giving some attention to Johnny and, and it's important to find that balance. We want to evaluate people who've had as adverse childhood experiences through a trauma informed lens. Recognizing the impact of trauma on all pieces of their life and the reciprocal impacts. Whether we're talking about a child who's currently experiencing ACEs or, or an adult who's presenting with a substance abuse issue, who is who, who has a history of ACEs. We need to evaluate all pieces of their life in order to make sure that we create a comprehensive treatment plan. And this is my soapbox, I go on it a lot going on it. Again, we don't pay enough attention to the physical aspect. So sleep and circadian rhythms are so important. I've got videos on both of those things on the YouTube channel. But when those things are out of sync or inadequate, it contributes to systemic inflammation. It contributes to constant activation of the stress response. It contributes to difficulty focusing, difficulty with attention contributes to inflammation and illness and autoimmune conditions. Diabetes. Diabetes has an autoimmune component. But diabetes is also a stress related illness for a lot of people. Why? Because when we're stressed, each time we get stressed, a wave of stress goes over us. Our body dumps blood glucose to give us energy to fight or flee. Then eventually we start having difficulty using that blood blood glucose. So we may develop insulin resistance, we may develop, you know, pre diabetes which can eventually progress and pain. Although Pain almost never occurs without some sort of inflammation. It can, and people can feel pain. Fibromyalgia, for example, doesn't always have inflammation. With it, people can feel greater pain when their stress response gets out of whack. We want to recognize this for children, too. Children who've experienced ACEs may have more somatic complaints than children who haven't experienced ACEs. Because their neurotransmitters are even further out of balance, they're more susceptible to dysregulation of the neurotransmitters, which means they also may feel more pain. When serotonin goes down, endogenous opioids often go down and pain perception often goes up. Doesn't mean they're making it, doesn't mean they're lying about it. It means they actually feel more pain. What didn't hurt a month ago hurts now. Not minimizing these symptoms is really important and recognizing what do we need to do for this child to help them feel safe in their environment so they can get some good sleep, so they can start healing their HPA axis and their autonomic nervous system, so they can start strengthening that vagus nerve and setting their circadian rhythms. What interventions? And obviously, as counselors, we're not going to make these recommendations, but referring back to the pediatrician for any sort of nutritional interventions that the child may need in order to feel better, in order to address some of the issues they're having. It could be, for example, a vitamin D deficiency. We know that vitamin D deficiency is linked to increased inflammation. We know that vitamin D deficiency is also linked to increased depression. And for some children, they may not be ingesting enough vitamin D or it may be passing through their system too quickly. For people who live in, for the most part, the whole northern hemisphere, but especially above the. I don't remember what the line, what exactly degree it is, but from Tennessee northwards, there's more than half of the year that we don't get enough sunlight coming through to actually give us sufficient vitamin D. Especially if we're not outside, like all day long. And which is why a lot of people in the US and in Canada are actually vitamin D deficient. The same is true for children. Think how much time they spend in school each day versus time outside. I'm a child of the 80s. When we came home from school, we went outside, we played ball, we hang, hung out with our friends, whatever. There wasn't a whole lot. We only had four channels on the television. I know, I'm a dinosaur. But these days, kids come home and there's a thousand channels on the television. There's computers, there's computer games, there's all kinds of stuff that keeps them inside. Finding a way to encourage them to get more outside time can be helpful for not only setting circadian rhythms, but also helping them increase their vitamin D and other things interpersonally. A child whose caregiver has an addiction or mental illness is probably going to experience some low self esteem because their caregiver isn't meeting their needs and they're like, why, why am I not enough? Etc, so the child may not feel very good about themselves. If the caregiver has mental illness or addiction issues, they may not be able to be emotionally and physically, physically present again to create that consistent, responsive, attentive environment where the child, where the caregiver notices when a child feels upset and helps them process those emotions. So the child may start feeling incapable of processing their emotions. Their, their motivation may start to go low as their nerve autonomic nervous system gets disregulated. They're not going to develop those good relationship skills. They're not meeting those lower two levels of needs, so they're going to have difficulty forming healthy friendships. And they're probably going to develop some level of insecure attachment because secure attachment is created when the environment they're growing up in is consistent, attentive to their needs, responsive, encouraging and safe. And that is not what describes a household where there are multiple aces. As I said before, and I feel like I need to keep saying this because I don't want to pathologize something that doesn't need to be pathologized. Some people can experience adverse childhood experiences and because their environment is consistent, attentive, responsive, encouraging and safe, they process it just fine, thank you very much, and move on. What we're really looking at is the situation in which the child is, doesn't have that, so they continue to feel unsafe. Emotional issues we need to look at is, are whether the identified patient as well as the child is just are dysregulating. When they get upset, do they go from flat to furious or flat to frantic when they get upset, is it just a tsunami? There's no middle ground. If so, okay, that gives us a clue that their autonomic nervous system's probably out of whack, so to speak. And there are tools we can help them develop in order to start healing their autonomic nervous system and feeling safer. So they don't go from, you know, putting one foot in front of the other, just kind of flat to terrified. When something happens, they can feel fear and they can respond to it effectively by again, that mnemonic idea. Identify how they're feeling. I feel anxious down regulate whether that's through grounding techniques or deep breathing or whatever skill works for them. Explore what's going on and the response options and then act in the way that best meets your needs. We need to remember that children who were raised in environments where there was chaos, where there were aces and un unresolved aces, they developed schema or the way they perceive the world and what they anticipate about what's going to happen next. All of those schema were formed through a trauma lens. All of those schema were formed through the lens of somebody who felt unsafe. I raised rabbits, Angora rabbits for a while and Angora rabbits to get their fur. I know this is a side, but I always get people who get angry. Angora rabbits to get their fur, to make yarn. You brush them and then three or four times a year as they shed, you brush them and you harvest the fur. You, you don't harm them at all. I wouldn't ever harm one of my little friends, but I used to range the Angora rabbits and rabbits by their very nature are prey animals. So when a rabbit sees me, even though I'm kind of like the personification of Elmira from Tiny Toons, I just want to love him and hug him and squeeze him and pet him and pet him. The rabbit doesn't recognize that. The rabbit doesn't recognize that I've got its best interest at heart because it's viewing me. It's expecting me to be a predator based on prior learning, based on prior experiences, based on, based on, you know, it's ancestors, prior experiences. It anticipates constantly being vulnerable, so it perceives the world as much more threatening than maybe it really is. And understanding that, understanding that children may have a lot of anxieties or frustrations or difficulty trusting themselves or others, not because you're not trustworthy, but because they don't feel safe. Because what they expect is going to happen is based on their prior experiences. And we need to talk with them about, all right, tell me what beliefs you have that are making you feel anxious in this situation or making you expect this outcome. And then we can process those and help them differentiate the past and then modify those schema. Piaget talked about assimilation and accommodation. I can never remember which one is which. But in one way, you take new information and you change your belief systems to integrate that new information. And that's what we need to help people do. Recognizing that back then your perceptions may have been spot on. Let's look at now, now that you are in a safe place, let's look at this person compared to that person and start developing schema that are not, that are seen through a lens of safety and empowerment instead of one of threat and vulnerability. Children who are exposed to ACEs as a result of substance use or mental illness have difficulty learning new things or changing perceptions due to their persistent stress response, autonomic nervous system activation. They don't feel safe. Now, they may not be terrified, but there's always this undercurrent of hypervigilance and feeling unsafe, even in therapy. And we know that we're safe people. You know, we're there to help, we want to help, but the child doesn't know that the child hasn't had that experience. And it's really important to help people feel like they're able to be authentic and communicate with us about their perceptions, their thoughts, their feelings in session, and anything that's making them uncomfortable. A lot of times patients are very reticent to, to comment on something that's making them feel uncomfortable. And we need to empower them to be able to advocate for themselves. When people are in that fight orf flight state and I, this is no surprise. Their attention, attention is skewed toward threats. It's not skewed towards the safe people in their environment. They're looking for the threats. They're looking for the people in the lunchroom that are looking at them and snickering behind their back. They're looking at, they're looking for those threats. And we need to help them. And Linahan talks about this in, in dbt. We need to help them look and see the entire picture, turn their attention, sometimes intentionally turn their attention to notice the good things. We're not ignoring the bad things, but we're noticing or balancing those out and noticing it's not all bad. There's some good over here. Until they can do that, they're going to feel unsafe until they can recognize that there is some safety, which feeling this way leads to impaired attention deficits and impaired executive functioning, that ability to problem solve, to plan, to organize, to follow through environmentally for the child when they've been exposed to ACEs and they are going to have difficulty feeling safe, they're going to potentially have trouble in school, which can lead to later job instability and housing instability. It's important to consider not just the proximal or immediate impact of, of mental illness and addiction on the child, but also how is that going to affect them in the long term if it doesn't get resolved? Treatment begins with creating safety and a sense of hope and empowerment for both the identified patient, the caregiver with the mental illness or the substance use issue, and the child address current trauma symptoms in each piece of life which we just discussed. Actually, addiction or mental illness in the family often causes the caregiver to be distracted or overwhelmed by the identified patient. The identified patient may even be the caregiver. So they're distracted by themselves, they're distracted by their own stuff. Example, Sam is a stay at home caregiver and drinks a lot to numb the pain of Chris's explosive anger or workaholism and verbal abuse. So Sam in this case is both potentially the identified patient as well as the caregiver. Abuse and neglect rarely occur in families unless there's mental illness or substance use. It happens, but more often than not, when we start really getting honest, there is underlying trauma, mental illness, or addictive behaviors. It may not be substances, it may be gambling, it may be sex, it may be porn, but there's something the mental illness or addiction may cause abuse and neglect, or be a consequence of it, or both. So mental illness and substance abuse can cause abuse and neglect, Abuse and neglect can cause mental illness and substance abuse and abuse and neglect can cause mental illness and substance abuse, which can further exacerbate the mental illness and the substance abuse. So it they're interrelated, we can't separate them. Children chronically exposed to ACEs usually develop insecure attachment. And I say chronically because, like I said, if it's a divorce and the child has that consistent, attentive, responsive, encouraging and safe environment, they're going to be fine. If they don't integrate that, what, what happened in a way that they feel safe and empowered, then they're being chronically exposed to that sense of unsafeness and powerlessness. As adults, they often develop mental illness or substance abuse, and as parents, they are often unable to create a consistent, attentive, responsive, encouraging and safe environment. Hence the intergenerational nature of trauma. I got you in one minute. Under the wire. Are there questions? Moon Soothing? The autonomic response is identify the feeling down, regulate. Evaluate the situation and your options and act in a way that best helps you use your energy to move toward your rich and meaningful life. I would say that people who survived ACEs and and were provided the environment that helped them effectively integrate them and feel safe and empowered. You know, in the moment are probably in the minority. So there are a lot of people, a lot of people with CPTSD who may not even realize it right now because they continue to feel the undercurrents of what they experienced as a child, and they continue to feel the aftershocks of being unsafe and powerless as a child. All right, everybody, thank you for being here, and have an amazing day.