Therapy for Black Girls

Session 432: The Impacts of Adverse Childhood Experiences (ACEs)
Host: Dr. Joy Harden Bradford
Guest: Dr. Nadine Burke Harris
Date: October 8, 2025

Episode Overview

This session explores the deep, lifelong impact of Adverse Childhood Experiences (ACEs)—including abuse, neglect, and exposure to violence—on both individual health and broader societal outcomes. Dr. Nadine Burke Harris, California’s former (and first!) Surgeon General, shares her pioneering work in bringing ACEs and toxic stress to the center of public health policy. The conversation bridges neuroscience, health disparities (especially in Black communities), implementation policy, and practical tools for prevention and healing.

Key Discussion Points and Insights

1. Why Childhood Trauma Is a Public Health Priority

• Bringing ACEs Mainstream: Dr. Burke Harris recounts her journey to making ACEs a state-level priority and connecting juvenile justice reform with health equity.
  • "I sat down with Governor Newsom before I took the role and said I wanted adverse childhood experiences and toxic stress be an area of focus... He said, 'I'll do you one better. We're moving the Department of Juvenile Justice under the Department of Health.'" (05:16)
• Impact at Scale: Since 2020, California has trained nearly 50,000 providers to screen for ACEs, resulting in over 4 million screens. (06:59)

2. What Are ACEs and How Do They Impact Health & Society?

• Definitions and Prevalence: The original CDC/Kaiser study identified ten ACE categories (including abuse, neglect, household dysfunction). Two-thirds of people have at least one, one in eight have four or more. (08:24)
• Science of Stress: ACEs are "dose-dependent"—more ACEs mean higher risk for diseases (e.g., heart disease, diabetes), mental illness, substance dependence, and incarceration. (09:35)
• How ACEs Affect the Brain: Early, repeated stress can rewire a developing child's stress response, affecting impulse control and emotional regulation.
  • "Prolonged activation of the stress response... is what leads to these increased risks of physical, mental, and behavioral health disorders." (11:03)
• Juvenile Justice Link: Over 90% of children in Florida's juvenile justice system had at least one ACE; 50% had four or more. Addressing root causes is critical. (11:38)

3. Racism, Discrimination, and ACEs

• Limitations of Original ACEs: The original study did not consider discrimination as an ACE due to the population studied.
• Science Nuance: While not an ACE by original criteria, exposure to racism or discrimination is a risk factor for toxic stress and dysregulated stress response.
  • "It is a risk factor for the development of a dysregulated stress response, which many now refer to as the toxic stress response... We have to be rigorous with the science because the treatment is the same." (13:03-15:17)

4. The Biology of Stress: Regulated vs. Dysregulated Response

• Fight or Flight in Action: Dr. Burke Harris illustrates how seeing a threat triggers adrenaline and cortisol, increasing heart rate and blood sugar, while turning off our prefrontal cortex (impulse control).
• Chronic Stress Dangers: Chronic, unbuffered stress in children breaks the 'stress thermostat,' leading to difficulty calming down, increased reactivity, or physiological issues (like illness or weight gain). (16:37-22:47)
  • "You can see [dysregulation] in behavior, in metabolism, in immune response." (21:45)

5. Defining Toxic, Tolerable, and Positive Stress

• Everyday vs. Toxic Stress:
  • "Everyday stress is normal... toxic stress is associated with changes in brain architecture, immune, and hormonal systems." (25:03)
• Three Types:
  • Positive: Typical, necessary stress, quickly resolved
  • Tolerable: More intense, but with adequate support and care, the body recovers
  • Toxic: Overwhelming or chronic stress, without support, leads to lifelong risk
  • "Early detection, early intervention, and nurturing, buffering care can prevent the development of the toxic stress response." (27:21-28:33)

6. Early Detection & Systemic Change

• Screening Recommendations: In California, providers now screen annually for ACEs during routine visits—before symptoms appear—and can refer for wraparound services even without a mental health diagnosis.
  • "Here we have a system that required someone to be harmed before they get care... So now, with four or more ACEs, a child can access services paid by Medicaid." (28:59-32:55)

7. ACEs in the Black Community

• The Strong African American Family Study: Some Black individuals with high ACEs have no mental health symptoms yet show higher "allostatic load" (stress at the cellular level), putting them at greater risk for chronic diseases.
  • "For many of the folks [in the Black community] who don't have mental health symptoms, they get no care... Our systems need to get better." (33:46-38:22)
• Cultural Insights: "John Henryism" - presenting as strong while suffering severe internal tolls.

8. Adult Survivors: Recognizing and Healing From ACEs

• Personal Disclosure: Dr. Burke Harris shares her own history with ACEs (39:06), noting the challenge of "unlearning" coping mechanisms rooted in chaotic early environments.
  • "If you grow up where intimacy is mixed with chaos or violence, our nervous system can become wired to that. Therapy is key to relearning safety." (41:32)
• Tools for Healing:
  • Safe, stable, and nurturing relationships
  • Mindfulness and meditation ("strengthens the parasympathetic nervous system..." 43:00)
  • Daily exercise and nature time
  • Sleep, nutrition, co-regulation with others or the environment
• Resource: Dr. Burke Harris’s book, The Deepest Well, for deeper exploration (45:00).

9. The Pandemic’s Impact

• COVID and ACEs: The pandemic was a mass stressor, heightening toxic stress risk for children globally; rates of anxiety and depression in youth doubled worldwide from 2019 to 2021.
  • "We saw that stress-related health conditions increased... severity and hospitalization rates from child maltreatment went up." (48:21-51:14)
• Policy Actions: Early detection and support systems are essential during societal crises.

10. Policy Recommendations for ACEs

• The Prevention Continuum:
  • Prevent ACEs and risk factors like discrimination
  • Early detection (routine, universal screening)
  • Early intervention (services before serious symptoms)
  • Evidence-based treatment
• Cost: ACEs and related issues cost the U.S. $14.1 trillion annually. (53:00)
• Bipartisan Opportunity: Prevention and intervention make fiscal sense across the political spectrum. (54:00)

Notable Quotes & Memorable Moments

• On Policy Innovation:
  "If our systems are set up to make [good work] more difficult, then we won't get to those transformative outcomes our communities need." — Dr. Burke Harris (06:19)

• On Science Rigor:
  "I love to come with hardcore analysis that really stands up to people trying to punch holes in it." — Dr. Burke Harris (15:07)

• On Shifting the Landscape:
  "At the time I started screening for ACEs in 2009... I'd speak to a room and only three people would raise their hands. Now, there’s real transformation." — Dr. Burke Harris (56:32)

• On Personal Motivation and Hope:
  "My own experience of ACEs made it intolerable to just leave folks to fend for themselves... There is so much hope. The science is clear: we can improve outcomes." — Dr. Burke Harris (39:06, 58:23)

Timestamps for Key Segments

• 00:00–04:16: Introduction
• 04:17–06:59: Dr. Burke Harris’s journey & first steps as Surgeon General
• 07:39–12:15: Defining ACEs and their societal impacts
• 12:15–16:15: Discrimination as a risk factor, not an official ACE
• 16:15–22:47: Stress response biology explained
• 24:56–28:45: Toxic vs. everyday stress and resilience
• 28:45–33:25: Early detection, evidence-based intervention, policy wins in California
• 33:25–38:35: ACEs research in Black communities, “John Henryism”
• 39:06–45:41: Adult survivors, healing modalities, and personal disclosure
• 47:53–51:40: ACEs in the COVID era, global trends, urgency for systems change
• 51:40–56:28: Policy and prevention, cost and opportunity, public health response
• 56:28–59:44: Dr. Burke Harris on hope, systems change, and resources

Where to Connect and Learn More

• Instagram: @Dr.BurkeHarris (“Gardening is my self-care! It brings me so much joy.”)
• Website: nadineburkeharris.com
• Book: The Deepest Well
• Full episode & more resources at: therapyforblackgirls.com/session432

Final Thoughts

This conversation highlights the critical need to move from awareness of childhood adversity into systemic, policy-driven prevention and healing. Dr. Burke Harris’s blend of science explanation, advocacy, and personal passion makes this episode essential listening for clinicians, advocates, parents, and anyone invested in collective and individual well-being.

For more, follow @TherapyForBlkGirls and join their online community.