Last week we looked at Adverse Childhood Experiences (ACEs) and saw that there is a strong relationship between the experience of traumatic or abusive situations in childhood and the health behaviors and health outcomes those individuals have as adults.

Last week we looked at Adverse Childhood Experiences (ACEs) and saw that there is a strong relationship between the experience of traumatic or abusive situations in childhood and the health behaviors and health outcomes those individuals have as adults.

Because the topics of trauma and abuse in children are so important, and because doing something about them -- while maintaining the freedoms guaranteed by our Constitution -- is so difficult, we would like to have proof that what is proposed as a solution is actually going to work. Unfortunately, we are prevented by the very freedoms just mentioned as well as by common decency, from obtaining such proof. In order to actually prove that any treatment is effective in a population it is necessary to divide the population into two groups that are similar, then manage them in exactly the same fashion except that one group receives the study treatment while the other does not. Because we cannot exert the kind of control necessary to have proof, in this case, we have to settle for evidence.

Beginning in the late 1960s a series of simple but fascinating study was begun, evaluating the ability of various children to delay gratification. The basic design is as follows: A 4-year-old child is introduced to an experimenter who then says that he must step out for a few minutes. They offer to give the child two marshmallows when the experimenter gets back, if they can wait, or the child can ring a bell to summon the experimenter back early and get a single marshmallow.

The aim is to measure how well different individuals can delay gratification at 4 years of age. The ability to delay gratification is related to the broader set of behaviors known as "self-regulation", and this in turn is tied to lots of behaviors that impact our health. These children, and many others in similar experiments around the world, were followed into adolescence and then into adulthood.

It turns out that the children that were good at waiting when they were 4 were described by their parents as significantly more competent socially and academically at 14 years of age, when assessed by statistically valid questionnaires. In some variations of the testing, seconds of delay time in preschool were significantly related to their Scholastic Aptitude Test (SAT) when they applied to college. In another study, each additional minute that a preschooler delayed gratification predicted a 0.2-point reduction in Body Mass Index (BMI) in adulthood.

Self-regulation and the "executive functions" of the brain are the very things that are adversely affected by ACEs that seem to be responsible for the negative outcomes later in life. Cognitive flexibility and working memory, the ability to hold information in the mine and use it, are principal components of the brain's executive functions. The more ACEs present in a child's life, the more likely it is that the child will be deficient in the skills of executive function and self-regulation.

The evidence suggests that by intervening to improve executive function and self-regulation, at least some of the effects of ACEs can be overcome. The Harvard Center for the Developing Child has excellent suggestions for doing just that at https://developingchild.harvard.edu/science/key-concepts. There you will find several short videos as well as literature for professionals and lay persons. These types of suggestions are for the people that are already involved in a child's life, however. What, if anything, can be done by people who are not parents? Providing treatment options for parents who suffer from addiction is one thing that can be effective. Also, making parenting classes available and supporting parenting classes, such as through work place policies that allow time for these activities, can be effective.

There are several suggestions at websites of the CDC (https://www.cdc.gov/violenceprevention/childmaltreatment/prevention.html) and the National Child Traumatic Stress Network (http://www.nctsn.org/). Parenting classes are most effective in an environment where attending these classes is seen as normal, not unusual or remedial. Indeed, the most important role of the community may be in setting the expectation that parenting is the most valuable job in the world, and no one is born knowing how to do it well. Therefore, training for that job is crucial.

Dr. Bundrant is the chief of staff at Ballinger Memorial Hospital. He is a member of the Health and Wellness Coalition of Runnels County which is comprised of health care professionals throughout the county. Members meet on the first Thursday of the first full week of the month.