What Does It Take for Traumatized Kids to Thrive?
About a decade ago, Washington State embarked on an early social experiment to educate people about the impacts of stress on children. The results are starting to show.
Paine High School was a shambles when Jim Sporleder arrived to serve as its new principal in the spring of 2007. Housed in a run-down, brown-brick building with metal security screens on its windows, the “alternative” secondary school served 77 of Walla Walla, Washington’s most challenging students. And for years, by nearly all accounts, it had served them exceedingly poorly.
About half of Paine’s students had been ordered to attend the school by a judge; most of the rest had been ejected by the city’s mainstream high school due to behavioral problems. Students weren’t the only hard cases that wound up at Paine; troublesome teachers and feckless administrators also had a history of being diverted there by the district, according to a 2007 city-funded report on the school. Members of the staff referred to their workplace—a dysfunctional campus with a broken intercom system and no hot lunches—as the district’s “dumping ground.”
Sporleder, moreover, was arriving at an especially difficult time: the previous principal was relocated midyear, and the school was “on a downward spiral,” as one student reported at the time.
A thickset, towering man with a gray goatee and a deliberateness to his speech and movements, Sporleder immediately set about establishing what he called “discipline with dignity”—a measured, automatic enforcement of the rules—on a campus given to frequent angry classroom outbursts, rampant truancy, and occasional gang violence. Then he announced a contest, open to the entire student body, to rename the school; Paine, he figured, could use a clean break with the past.
The students eventually settled on the name Lincoln and chose a phoenix as their new mascot, as if to rise from the ashes by power of suggestion. But by Sporleder’s reckoning, the moment that really transformed Walla Walla’s alternative high school came three years later.
One day in the spring of 2010, Sporleder made a three-hour trek north to Spokane to attend a workshop given by a molecular biologist. He was encouraged to make the trip by a community organizer affiliated with the Washington Family Policy Council, a state agency that had become unusually galvanized by a recent body of research. Sporleder was one of many educators, social workers, law enforcement officers, and other community leaders who were being sent to similar conferences around Washington with state dollars, all as part of a large-scale campaign to educate people about the impacts of trauma and stress on children.
For Sporleder, the workshop—with keynote speaker John Medina, a scientist and the author of a best-selling book called Brain Rules—was nothing short of a conversion. As soon as he got back to Lincoln, he began changing his methods, especially when it came to discipline. His old approach, which relied heavily on automatic suspensions, went out the window. Then he brought in a trainer to teach everyone on his staff, from instructors to secretaries, about the science of trauma and resilience. Bit by bit, he and his staff remade Lincoln to address what he now saw as the real force driving his students’ behavior: chronic stress.
Between 2009 and 2011, suspensions at Lincoln fell by 85 percent; expulsions dropped from 50 to 30. In the same period, the school’s graduation rate nearly tripled. By the time I met Sporleder in 2012, the student body had swelled from 77 to nearly 200—the result of students actually opting to transfer to what had once been the district’s “dumping ground.” It’s hard to say exactly what’s driving these transformations. But it’s striking that Sporleder himself—a former volleyball coach, and not a trained scientist—largely attributes Lincoln’s turnaround to a new understanding of the science of stress and the brain.
THE PAST 10 YEARS or so have seen an explosion of academic interest in what scientists call the non-cognitive aspects of what it takes to become a thriving, successful person. In particular, a growing stream of research has begun to investigate how adversity—either acute trauma or the chronic, toxic stress of a harsh environment—affects the developing brain, and why some young minds exhibit resilience in the face of such adversity, while others do not. Last year, the best-selling book How Children Succeed by Paul Tough brought popular buzz to the emerging field, inspiring columns by David Brooks in The New York Times and discussions on national radio and TV. In February, the Department of Education issued a report titled “Promoting Grit, Tenacity, and Perseverance,” on some of the non-cognitive skills being discussed by an increasing number of researchers.
While most of this research is still fairly theoretical, Washington State is one of the few places where it has been applied, if roughly, on a large scale. About a decade ago, the state embarked on an early, uncontrolled social experiment in disseminating and implementing this set of urgent but still-forming ideas about the mind. “I would say that Washington is the clear front-runner,” says Jane Kretzmann, the director of the Project for Babies at the Center for Early Education and Development at the University of Minnesota. So at the beginning of the school year, I traveled to Walla Walla to see what was really going on at Lincoln, and what the rest of the country might learn from Washington’s experiment.
Between 2009 and 2011, suspensions at Lincoln fell by 85 percent; expulsions dropped from 50 to 30. In the same period, the school’s graduation rate nearly tripled.
THE SINGLE PIECE OF research that has most influenced Washington’s efforts is something called the Adverse Childhood Experiences study, a set of findings published in 1998. The ACE study—as those who cite it religiously refer to it—grew out of research on smoking. In the 1980s, a doctor at the Centers for Disease Control and Prevention named Robert Anda was analyzing why some smokers tended to quit in response to public health messages and why others didn’t. In one study, Anda’s research team found that people with a history of depression were more likely to start smoking, and less likely to stop.
The discovery made Anda wonder whether researchers were missing other links between emotional and physical health. Around the same time, Vincent Felitti, a researcher and physician at Kaiser Permanente, stumbled on a similar phenomenon while working on a weight-loss program for obese patients. Many of the patients who dropped out of the program and put weight back on, he found, had a history of sexual abuse.
So Felitti and Anda teamed up and devised something they called the Adverse Childhood Experiences survey. They then set about administering it to 17,000 of Kaiser’s clients in San Diego. The short take-home survey asked the Kaiser patients whether certain things had happened to them before age 18. Had their parents divorced? Had they lived with someone who had abused substances? In all, the survey asked about 10 kinds of adverse experiences.
If anything, Anda and Felitti expected that respondents would dramatically underreport their histories of childhood trauma. But the results shocked the two doctors. “The information was just mind-boggling,” Anda recalls. Twenty-one percent of respondents said they had experienced sexual abuse; 28 percent had suffered physical abuse; 23 percent had grown up with divorced or separated parents, and 27 percent had lived in a household with an adult who was abusing substances. Respondents were assigned an ACE score from zero to 10, with 10 referring to the most childhood trauma. Barely more than a third had an ACE score of zero. And in most cases, patients had experienced not one but multiple adverse experiences. What’s more, these patients came from a demographic that was not especially at risk for early adversity: Most of them were middle- and upper-class San Diegans, 75 percent white and 93 percent high school graduates.
But the most powerful thing about the ACE data turned out to be its predictive power. Because Kaiser patients receive all of their health care within one large system, which in turn collects massive amounts of data on them, Anda and Felitti were able to correlate patients’ responses to the survey with information about their long-term health. Not surprisingly, they found that childhood trauma casts a long shadow over a person’s happiness: the higher someone’s ACE score, the greater his or her chances of eventually performing poorly in the workplace, taking antidepressants, and committing suicide. But childhood trauma didn’t just affect mental health. As a person’s ACE score increased, so did his or her chances of eventually being diagnosed with cancer, heart disease, liver disease, and emphysema. Sometimes these physical ailments stemmed from the risky behaviors that people with histories of childhood adversity were prone to: injecting drugs, smoking, having sex with many partners. But even absent those bad habits, patients who had been exposed to stress and trauma at an early age were simply far more vulnerable to disease.
For Felitti and Anda, the ACE study revealed a previously invisible, dramatic undercurrent in public health. Ultimately, an ACE score of six or higher translated to an average 20-year drop in life expectancy. Smoking, by comparison, cut life expectancy by 10 years. To the two doctors, the whole panorama of American public health efforts—against cancer, drug addiction, heart disease—suddenly looked like an attempt to mow down dandelions without striking at their roots. The ACE study, Anda felt, showed conclusively that household dysfunction wasn’t just “someone else’s problem.”
Anda thought the next step was clear: a national public health campaign around the issue, something on the order of “This Is Your Brain on Drugs.” He has spent much of the past 15 years evangelizing for just such an effort. An intense-looking, clean-cut man with bags under his eyes, Anda takes upwards of 30 trips around the country a year to spread the word about ACEs. “I know the TSA agents,” he says.
At times, Anda can seem to be advocating the most quixotic of human endeavors: a public health campaign against adversity itself. But that’s not really what Anda is proposing. Public health education can be a powerful thing: if large numbers of people internalize a robust enough new mental model of how the body works, then the logic of everyday life changes; behavior shifts. The germ theory of disease got us all to wash our hands. The ACE theory of disease is unlikely to keep us all from getting divorced; but on the margins, it could change the way people act. And just as important, if experts, institutions, and policies come to frame public health issues as problems of childhood trauma and stress, then resources will flow toward studying how these problems work, how to prevent them, and how to mitigate their effects once they’ve happened.
If Anda’s crusade has found purchase anywhere, it is in the Evergreen State, thanks in large part to the Family Policy Council. The council was created by former Governor Booth Gardner in the late 1980s to address a whole kitchen sink of issues facing families and children: dropping out, domestic abuse, gang violence, addiction, and so on. For years, the organization played a game of Whac-A-Mole, as specialists in each type of adversity fought over funding. “When I heard about the ACE study,” says Laura Porter, director of ACE Partnerships in the state’s Department of Social and Health Services, “it was like all of a sudden the puzzle pieces from a complex picture came together.” Since then, Anda and Felitti’s work has essentially become the Family Policy Council’s organizing principle.
The effects have been significant. In 2010, the Washington legislature, inspired by ACE research and by data gathered by the council, passed an amendment that allows judges to consider alternative sentencing options for parents convicted of non-violent crimes. The state, the thinking goes, has a clear interest in preventing certain adverse childhood experiences (growing up with an incarcerated parent) from being passed on to the next generation. Washington also funds a program that hands out ACE surveys to parents with addiction problems—but with a twist. Rather than filling out the survey about themselves, the parents are asked, in a group setting, to mark down which ACEs—exposure to domestic violence or divorce or abuse, for instance—they hope to shield their children from. Then the parents come up with specific plans for how to do so, and work with their peers in the group to hold each other accountable.
But the main work of the Family Policy Council has essentially been to make ACE awareness go viral across the state. In addition to setting up summits and talks and training programs, the Council established cells of citizens and social service workers, called Community Public Health and Safety Networks, in 42 towns and cities across the state, Walla Walla prominent among them.
ONE AFTERNOON LAST AUGUST I visited a homeless shelter for teenagers in Kennewick, Washington, about an hour’s drive west of Walla Walla. There I met a young mother whom I’ll call Jessica, who told me about her upbringing (an abusive dad who would punish her if she dropped a glass; a jumpy, inconsistent mother who was prone to disappearing acts) and the harrowing circumstances that had led her to take the drastic step of moving to a shelter with her newborn son.
When Jessica had to step out of the room to soothe her baby, the shelter’s executive director, Sue Delucchi, caught my eye. “Did you notice her flat affect?” she asked.
I hadn’t been able to identify what was so strange about Jessica’s speech, but there it was. There had been no emotion in her voice as she told me her unsettling story. Her numbness was symptomatic, Delucchi explained, of sustained stress and a history of trauma. “When you start learning about trauma and the brain,” Delucchi said, “you start to see everything through that lens.”
“We call it ‘speaking the language of ACEs,’” says Mark Brown, the director of a youth mentoring organization in Walla Walla. Together with Theresa Barila, the community organizer who encouraged Jim Sporleder to attend the 2010 workshop in Spokane, Brown runs the Children’s Resilience Initiative, a local program that received a grant from the Bill & Melinda Gates Foundation to educate the people of Walla Walla about ACEs and toxic stress. Just over two years ago, Brown and Barila began using informal surveys to gauge their progress. In September, they canvased a middle school and a local farmers’ market to see how many people were aware of the ACE study. (About 27 percent, more than a five-fold increase from when the program started.)
While the ACE study has proved to be a powerful instrument for delivering epiphanies, Anda and Felitti’s research says virtually nothing about the mechanisms through which stress wreaks havoc on the brain and the body—and how those effects might be mitigated. For that, people in Washington State and elsewhere have turned to a mounting body of research by pediatricians and neuroscientists that is beginning to fill in the picture of what happens in the stress-wracked developing brain.
Occasional bouts of stress in childhood, it turns out, can be healthy, boosting immune responses and building up a capacity for resilience. But sustained, chronic stress—or too many repeated shocks of unpredictable acute stress, such as exposure to abuse or violence— can actually damage parts of the developing mind that are crucial for memory, learning, cognition, planning, impulse control, and judgment. Specifically, the prefrontal cortex and the hippocampus are among the areas of the brain most sensitive to the stress hormone cortisol, whose release overrides some of those higher functions.
If the body is continually stressed over a long period, cortisol production can get out of control. Kids in this situation carry what the biologist Bruce McEwen calls an “allostatic load”—sort of a chemical version of carrying a balance on a credit card. This carryover stress can render children by turns numb or hypervigilant, prone to flash floods of cortisol at the slightest trigger. The layman’s term for the latter behavior is “going into fight or flight mode,” though John Medina, the molecular biologist who conducted the workshop that Jim Sporleder attended in Spokane, says the instinct to flee is more common than the one to throw a punch. “Most stress responses cause blood to flow to your thighs so you can run,” Medina says. “The brain wants the body to leave—it doesn’t want to sit through pre-algebra. It’s a little like gunning a car at 110 miles per hour with the brakes on.” Whatever the case, one thing is clear: a mind in such a state doesn’t learn.
So far, researchers have found a few ways to somewhat mitigate the long-lasting damage from toxic stress, but only one way to preempt it. In 2004, the neuroscientist Michael Meaney published a landmark study that looked at the behavior of rats. He showed that rat pups whose mothers paid more attention to them by extensively licking and grooming their pups after they were exposed to stress (they were taken out of their cage) fared better in the long term than those that received little licking and grooming. Both groups were exposed to the same amount of stress, but the well-licked and -groomed rat pups went on to become considerably more social, better at navigating mazes, less aggressive, healthier, and longer-lived. Even at the level of gene expression, these pups derived lifelong benefits from what researchers call “secure attachment” to their mothers, a phenomenon that is paralleled in humans. With secure attachment—a loving, safe, consistent bond—children swamped by stress can return to normal far more quickly. (The Nurse Family Partnership, a non-profit that pairs mothers with nurses who make home visits during the first two years of a child’s life, depends heavily on this principle.)
John Medina often gives talks to the general public; parents, he says, are usually most interested in asking his advice on how to get their children into a good college. Test prep? Violin lessons? Baby Einstein? “You want to give your kids the best shot?” Medina asks. “I’ll give you the research answer: The single greatest academic predictor that exists is the stability of the home.” To some parents, this might sound like a relief. But when you consider that 41 percent of American families live from paycheck to paycheck—just one large medical bill or blown transmission away from bankruptcy—and that about 16 million Americans have a problem with alcohol abuse, it really isn’t much consolation.
“You want to give your kids the best shot? I’ll give you the research answer: The single greatest academic predictor that exists is the stability of the home.”
THE TYPICAL STUDENT AT Lincoln High School, it turns out, has an ACE score of 4.5. An ACE score of four is where things get hairy. The likelihood of contracting hepatitis is 240 percent higher than normal; of contracting chronic pulmonary lung disease, 390 percent higher than normal; depression, 460 percent; suicide, 1,220 percent. The school’s students are also disproportionately poor—about 74 percent qualify for free or reduced-price lunches through the federal government, 20 percentage points higher than the school district average—and they are somewhat more likely to belong to a minority. The closer you look, the more it seems as if Lincoln is a school for kids with adversity problems more than behavior problems.
In just three days at the school, I met a kid who was addicted to heroin before the age of 16. One who was raped by a family member at 14. Another who had done long stints in juvenile detention. I heard about emotional abuse, years in foster care, depression, gang violence. At one point during my visit I overheard a skinny, anxious-looking boy boast to his teacher that he’d just gotten out of juvenile detention and that he expected to be back within several months. Moments later, the swagger ebbed from his voice and he explained that “juvy” is where he goes to “get healthy.” The boy’s home life, explained Brooke Bouchey, Lincoln’s intervention specialist, is probably more stressful than detention.
When I met him in person for the first time, Jim Sporleder had a crude drawing of the human brain hanging on the door to his office; he was using it to give spot lessons to students about the location of the hypothalamus, how cortisol works, and how stress affects executive-functioning skills. He also keeps a picture of a target on his desk; in the center of the image is a green bull’s-eye, encircled by yellow and then red rings. When a student who has acted up is sent to his office, Sporleder brings out the target. Point to where you are, he says. Are you in the red? In the yellow, coming down? Sporleder waits until the student is in the green zone, stress free and calm, before starting a conversation with the student about his or her behavior. He knows he won’t be able to get through to a student whose brain is flooded with cortisol.
When the student is ready to talk, Sporleder begins by looking beyond whatever incident prompted the trip to his office. What’s going on with you lately? he routinely asks. This doesn’t seem like you. It’s amazing, he says, how quickly students open up; they readily admit to problems at home, and to taking those problems out on their teachers. After a conversation like this, he says, students ask to go back to the classroom to apologize. Sporleder still metes out punishment—inappropriate behavior must incur consequences, after all—but says he asks students to tell him what they’d prescribe. Often, he says, they’re much harder on themselves than he might have been.
Given Lincoln’s checkered history and its students’ emotional burdens, I was surprised at how, well, normal the school seemed. There were perhaps more lip piercings, green heads of hair, and tattoos per capita. But, if anything, the atmosphere felt more like that of a sleepaway camp than a typical high school. It’s a cliché, but students at Lincoln seemed to know they weren’t alone, if only because trauma, stress, and household dysfunction were so out in the open as matters of discussion and concern. When I interviewed several students in the cafeteria, they spoke openly about their troubled home lives while classmates sat within earshot munching on their lunches (which have been improved since Sporleder became principal).
In many ways, Lincoln has become a therapeutic institution as much as an educational one. The school has a full clinic attached to it, where students can receive free medical services and counseling. In addition to the standard curriculum, students learn the basics of resilience: self-regulation, impulse control. And with teachers, they might discuss insight into their own psychology (for instance, the boy’s remark about juvenile detention being where he goes to “get healthy”) as readily as their coursework.
Given the emphasis that researchers place on “secure attachment” to a parent, it was striking to me how much kids used the word “family” when they talked about Lincoln. The school made them feel like “part of [a] family,” some said. “In a family,” one young woman told me, “nobody gets left behind.” Sporleder talks the same way: “I’m not shy about saying that we tell our kids we love them,” he says. “We’re a family. The kids here are getting love and two meals a day.”
WHEN I ASKED THE staff at Lincoln about the secret of their success, I was frequently met with the warning “There is no list,” and the frustratingly vague phrase “It’s about a paradigm shift.” Teachers at Lincoln insisted that other schools could use their methods, but it was difficult to describe exactly how to package the changes they’ve made for export. Such a broad paradigm shift in institutional culture is hard to imagine implementing in, say, inner-city schools with thousands of students apiece. The progress at Lincoln is remarkable, but it’s difficult to isolate which variables are really driving it, and whether they can be replicated elsewhere.
Still, word has gotten out about the school. Last April, an online publication for educators ran an article about Lincoln’s transformation, and Sporleder’s inbox was quickly inundated with hundreds of messages. This year, a film crew led by James Redford (son of Robert) is filming a documentary on campus. At the same time, the current enthusiasm for brain-based approaches to education—ones that are sensitive to toxic stress—has led an increasing number of education officials and academics from other states to call Washington and ask for guidance.
To some in the state, the enthusiasm is a bit premature. “It baffles me sometimes when we get calls from people around the country asking us to come and train them,” says Natalie Turner, the researcher who trained Lincoln’s teachers. “We don’t know that we have the answer yet.”
Researchers are, as a rule, instinctively wary of practitioners and popularizers getting ahead of good science. Philip Fisher, a research psychologist at the University of Oregon who studies the dynamics of resilience in children who have undergone trauma, is hesitant about the vogue for invoking mechanistic understandings of the brain—especially given how incomplete our understanding of those mechanisms is. Fisher’s work, for instance, involves measuring cortisol and brain activity using saliva as subjects perform tasks designed to improve cognitive difficulties, a highly controlled and precise experimental model—one that stands in stark contrast to the rough drawing of a brain that once hung on Jim Sporleder’s door.
But at the same time, Fisher realizes that the rising tide of popular interest in stress and its effects, and the early efforts of people like the staff at Lincoln, will ultimately help the cause of his research. Growing awareness, per Robert Anda’s crusade, will translate to more funding for research, which will allow people to understand what parts of Washington’s approach are working. And as it happens, the Family Policy Council (whose state funding has been partially phased out) was deliberate in proceeding with speed. In social service work, says Laura Porter, the usual way to test new ideas is to develop cookie-cutter programs, conduct double-blind trials, and then measure the efficacy of various interventions over time. But given the stakes, the council decided there wasn’t time for all that. For the students at Lincoln, at the very least, the risk will have been worth it.
Laura Tillman is a journalist based on the Texas-Mexico border. Her writing has appeared in The New York Times and The Wall Street Journal.