Psychopathology

4.3 Assignment: Adverse Childhood Experiences

Getting Started

Every student of psychology should know about the adverse childhood experiences (ACEs) study and the persuasive results it produced. The ACE study started in 1985 and involved researchers from the Centers for Disease Control and Prevention (CDC) and more than 17,100 members of the Kaiser Permanente’s San Diego care program.

The study showed that children exposed to adverse experiences, such as physical, emotional, or sexual abuse, neglect, or having a substance-abusing parent, for example, had a significantly increased risk of chronic disease, learning problems, relationship distress, and mental illness later in life.

You might be thinking it is common sense to link a person’s troubled home life as a child to later life problems. For example, a child who grows up in a substance-abusing home is more likely to abuse substances in adolescence or adulthood. A child who is physically abused is at greater risk for becoming an angry person who takes out their rage on others when they are older. You don’t have to be a psychologist to make these logical connections.

But the ACE study gave the mental health community hard facts on this correlation. For example, the study (and many subsequent ones since the original) has shown that adverse childhood experiences are common. Here are some of the specific findings: Two out of every three people (67 percent) in the United States have had at least one of these adverse experiences in childhood. Twenty percent have had three or more, and one in eight have had four or more ACEs. A child who experiences four or more ACEs prior to age 18 is 12 times more likely at a later point in time to attempt suicide, seven times more likely to become an alcoholic, and ten times more likely to become addicted to drugs. Those with a high number of ACEs are also more likely to be violent, have learning difficulties, have multiple marriages, be chronically depressed, and die prematurely.

The ACEs study is arguably the most important research on the relationship between trauma and mental and physical health we have. The implications are profound. A study of trauma would not be complete without including exposure to this material.

In this assignment, you have the opportunity to explore the ACE study and think critically about the implications of such weighty data. Exposure to this material will help heighten your awareness of these issues so that, as you enter the profession of psychology, you can be an agent of influence to curb this epidemic of adverse experiences for children and the long-term consequences it has for these children and for the entire society.

Upon successful completion of the course material, you will be able to:

· Explore the implications of the ACE study to the larger problem of trauma and mental health issues in today’s society.

Resources

· Textbook:  Modern Psychopathologies: A Comprehensive Christian Appraisal

· Article: Did You Know Childhood Trauma Affects Nearly Half of American Children?

· Video: Nadine Burke Harris—How Childhood Trauma Affects Health Across a Lifetime

Background Information

To complete this assignment, first read the chapter from the textbook, “Problems Arising from Trauma,” then watch the video, which is a TED-style talk by one of the most important and prominent voices speaking about ACEs today. Then read the article on child exposure to trauma. Going through the resources in that order will build the base of knowledge you will need to complete this assignment.

Instructions

1. Read Chapter 10, “Problems Arising from Trauma,” in your textbook.

2. Review the video,  Nadine Burke Harris—How Childhood Trauma Affects Health Across a Lifetime .

a. A transcript is available on the website.

3. Review the article,  Did You Know Childhood Trauma Affects Nearly Half of American Children? .

4. Write a three- to four-page paper that addresses the following:

a. What is your response to the statistic in the article that nearly half of the U.S. population of children have experienced at least one of the ten ACEs?

b. What do you think the implications are for these children and for the mental health of our society as these children grow up?

c. If you had the influence and ability to implement one major initiative on a national level to address this tragic trend of childhood ACEs, what would it be? Explain in detail.

d. Suggest one application of how you could be a positive influence to advocate for the safety and respectful treatment of children within the realms that you currently live.

5. Elaborate fully in your responses. Be sure to cite your sources in  APA Style  format in the text of your paper and in a reference page at the end.

4.2 Discussion: Sexuality and Gender

Getting Started

There have been many topics that have been discussed with passion, vehemence, and even violence down through the generations. Racial and ethnic issues, homosexuality, gender equality, and many other human experiences have been hotly debated and addressed by those in the public forum of the social and behavioral sciences as well as by those behind closed doors in our personal lives. These days, any discussion that pertains to sexuality and gender has the potential to be explosive. It’s difficult to hear dialogue on these issues without political and policy concerns being discussed. That is true even when it comes to how the DSM-5 approaches diagnoses about sexuality and gender, which we’ll get to shortly. But issues of sexuality and gender are not limited to politics and policy. These issues elicit strong emotional responses from many people; there is a wide variety of viewpoints. Our goal in this discussion is not to come to a definitive answer on any of these issues but, rather, to discuss how these issues are classified (or not) as mental health disorders.

Let’s focus on the most common gender-related disorder mentioned: gender dysphoria. According to the American Psychiatric Association (publisher of the DSM-5), “Gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.” The DSM-5 states that “gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant  distress associated with the condition.”

But this current definition is a revision of what the previous edition of the DSM stated. The DSM-4 contained no diagnosis known as gender dysphoria. In its place was a diagnosis named gender identity disorder. The previous diagnosis of gender identity disorder and its replacement diagnosis of gender dysphoria both refer to someone who is not content with his or her biological gender and strongly identities with, and wants to be, the opposite gender. The difference is that the drafters of the new DSM-5 wanted to emphasize the importance of “distress” rather than just identity. In other words, a person is not given the diagnosis of gender dysphoria just because they strongly identify with their non-biological gender. They must experience “distress” about that identification to warrant the diagnosis. Again, the DSM-5 states it: “Gender nonconformity is not in itself a mental disorder.”

This naturally brings up the question about how we go about drawing that line between what is considered a true mental health disorder and what is a person’s preference. Put it in another context: How about a person who lives in a cardboard box under a bridge, begs for money on a daily basis, eats out of dumpsters, and never bathes? Is this person mentally ill? What if he or she is not “distressed” by that lifestyle and freely chooses it? These are difficult questions that don’t have easy black-and-white answers.

Amid all these complex issues, we need to add the Christian worldview into the mix. Our worldview is the lens through which we see the world. It is also the lens through which we see ourselves. It’s what shapes our values, and our values shape our choices. Our worldview should inform our viewpoints on these contemporary issues.

In this discussion, you will have an opportunity to think more deeply about these issues specifically as they relate to the issue of gender dysphoria and whether that DSM-5 definition clarifies or confuses the diagnostic discussion.

Upon successful completion of the course material, you will be able to:

· Compare traditional and biblical views on gender dysphoria.

Resources

· Textbook:  Modern Psychopathologies: A Comprehensive Christian Appraisal

· Article: The Christian Response to Gender Dysphoria

Background Information

To prepare for this discussion, first read Chapter 12 in the textbook. Then read the assigned article to help inform your ideas about the issues covered in this discussion.

Because these issues can be particularly sensitive ones, even within a Christian community, please show respect and consideration to one another as you express your views. You are free to state your opinions and share biblical perspectives, but do so in a way that fosters dialogue and critical thinking in an atmosphere of love.

Please note: Because this is a controversial topic, be sensitive to the comments of others that may differ from your beliefs and/or experiences as you engage in the discussion forum for this activity with your peers.

Instructions

1. Read Chapter 12, “Problems of Sexuality and Gender,” in your textbook.

2. Read the article,  The Christian Response to Gender Dysphoria .

3. Navigate to the Discussion page and respond to the following prompts:

a. How do you respond to the statement in the DSM-5 that gender dysphoria is not in itself a mental disorder?

b. What is your response to the follow-up statement that the critical element of gender dysphoria is not its presence but whether is causes  significant distress to the person in question?

c. What is your assessment of the assigned article, “The Christian Response to Gender Dysphoria”?

4. Your initial post:

a. Should be between 400 to 500 words.

5. Your postings should also:

a. Be well developed by providing clear answers with evidence of critical thinking.

b. Add greater depth to the discussion by introducing new ideas.

4.4 Assignment: Taking the ACEs Test

Getting Started

In the previous assignment, you learned that two thirds (67 percent) of Americans have experienced at least one adverse experience in childhood. These are not isolated incidents but represent patterns. For example, the first question on the ACE test asks:  “Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you? Or act in a way that made you afraid that you might be physically hurt?”

Notice the prefacing of the words “often or very often” before describing the behavior in question. These are carefully chosen words that try to distinguish between the normal ruptures in relationships that occur in most households and the chronic patterns that create large, permanent chasms in family relationships. For example, let’s say a child clumsily knocks over his milk at dinner. His father, who is stressed out from his job, overreacts to the situation with strong anger, calls his child “stupid,” and sends him to his room. If that type of reaction on the father’s part happens frequently, that would be considered an adverse childhood experience (ACE). But if this type of reaction rarely happens and is uncharacteristic of how the father usually responds, it would not be considered an ACE. Homes where ACEs are uncommon are characterized by warmth, apologies, dialogue, forgiveness, empathy, and sharing of feelings.

Unfortunately, far too many parents are not skilled in facilitating these relationship-enhancing interactions, especially when there is a rupture in the relationship. For virtually all of the families that fit the description of relationally unskilled, it’s not for lack of parental love for their children. It’s more often that the parents themselves had difficult upbringings and did not have these skills modeled or encouraged by their parents. You see, unresolved trauma from early life experience very often gets passed down to the next generation. It’s called intergenerational transmission of trauma and has big consequences.

That’s why it’s so important not only to know what ACEs are but to be able to screen for them when you suspect their presence. And, if you were to screen randomly, you would find about two of every three people would have at least one ACE. One in five would have three or more ACEs and 12 percent would have four or more. That’s a lot of wounded people who need to work through their trauma to break that cycle of intergenerational transmission for the next generation.

In this assignment, you have the opportunity to take the ACE test for yourself. It’s not intended to diagnose or prescribe anything. It’s only to heighten your awareness of your own childhood experiences and how some of those patterns might still be affecting you.

As a person going into the helping profession, it is vital that you are willing to take a closer look at your own life to see where you have vulnerabilities or, perhaps, even need help to be more whole. It is from that place of wholeness that you will then be most effective at being able to facilitate healing and wholeness in others.

Some may not be ready to take a look at themselves through that type of lens, so there is another option. This option is to take a more objective look at child adverse experiences without funneling it through your own experience. Either option is acceptable.

Upon successful completion of the course material, you will be able to:

· Assess one’s personal history as it relates to the presence of adverse childhood experiences.

Resources

· Textbook:  Modern Psychopathologies: A Comprehensive Christian Appraisal

· Article: Take The ACE Quiz — And Learn What It Does And Doesn't Mean 

Background Information

If you choose to take the ACE test, it involves using the inventory listed in the assigned article and keeping a manual tally on a piece of paper as you read through each question. There are ten questions in the survey, and each assesses one of the ten ACEs. You only need to respond yes or no to each question. Each question you respond yes to equals one ACE. At the completion of the questionnaire, add up the number of yes responses (maximum of ten) and that is your ACE score. Directions are provided in the article, as well as additional information for evaluating the results. This is Option One.

If you are choosing Option Two, you can ignore the ACE inventory and simply answer the questions for that option in the Instructions.

Instructions

1. Read Chapter 11, “Problems in the Development of the Self,” in your textbook,  Modern Psychopathologies: A Comprehensive Christian Appraisal.

2. Read the article “ Take The ACE Quiz — And Learn What It Does And Doesn't Mean .”

Your ACE score is  0

3. Choose either option One or Two from below.

4. Option One: Questionnaire

a. Complete the questionnaire located in the article "Got Your ACE Score?" and determine your score. Then answer the following questions:

i. Did your score reflect any ACEs? If so, how many?

ii. What connections do you see between the presence or absence of ACEs and any challenging or positive trends in your life? In other words, ACEs usually reflect challenges, and no ACEs usually reflect a pretty solid foundation for life patterns. What do you see in your score?

iii. What steps, if any, would you like to take to act on what you’ve learned from taking the ACE inventory?

5. Option Two: Opt out of the Questionnaire The ACE Inventory is a simple and effective tool that can be used for personal growth. But it asks a person to take a closer look at early life situations and relationships, so it may be difficult or less appealing to delve into that part of one’s life. If you are one of those people who would prefer an alternative, here’s another option for this assignment that addresses early life experiences and its relationship to trauma from a more objective point of view.

a. In place of taking the inventory, respond to the following questions:

i. What do you think the relationship is between early life trauma and the dramatic rise in addictive behaviors that we see in society today?

ii. Anyone who is abused, at any age, can suffer weighty consequences. Why is mistreatment of young children so damaging to their potential development?

iii. If you work in a social service realm after graduation, how comfortable will you be listening to and helping someone work through their early life trauma experiences?

6. Your response should be at least four substantive paragraphs, and you should elaborate fully in your responses.

7. Be sure to cite your sources in  APA Style  format in the text of your paper and in a reference page at the end.