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Reversal of Misfortune

A clear-eyed look at a child's home life can aid recovery from early troubles.

Pediatrician Nadine Burke Harris Photo courtesy of Center for Youth Wellness

As a pediatrician working in San Francisco’s poorest neighborhood, Nadine Burke Harris noticed that kids who experienced personal hardship, including abuse, neglect, and exposure to violence, had the most worrisome health problems. Connecting the inputs and outcomes, she traced the way early trauma affects health—not just in childhood but throughout the lifespan. Burke Harris is the author of The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.

Q: What single change can most help at-risk children?

The most effective treatment I’ve seen for little kids is child-parent psychotherapy, wherein a clinician works with the child and caregiver at the same time and the focus is on the relationship. It’s freaking amazing. A little girl named Lila came to me for a routine exam when she was almost three. Her growth chart showed that she was below the third percentile for height, weight, and head size, but I couldn’t find any possible reason why. Then I saw that her ACE (Adverse Childhood Experience) score was 7, which is high. To me, that pointed to the most likely reason she wasn’t growing: toxic stress.

Her mother told me that her dad had been in rehab and that, when he was at home, it seemed as if Lila didn’t eat as much or gain weight. I thought her body might be producing more stress hormones than the average child and that this was interfering with her growth. I said to her mom, ‘You have the power to biologically buffer your daughter’s stress response, and in order to do that, we’re going to give you the tools to help you take care of yourself and set strong boundaries.” That’s what child-parent psychotherapy does—helps parents create a safe environment for the child while addressing their own challenges. Six months later, Lila was at a healthy place on the growth curve.

The change in my medical practice has been profound. Before I understood this work and the science of adversity, it often felt as if I was spitting in the wind trying to help my patients. Now I’m so much more hopeful. We may not be 100 percent successful with every kid, but there are a lot of Lilas. By working really hard to get to the root of their challenges, we’re seeing how intervening changes their outcomes. Adversity is not destiny.