Trauma in the United States is a public health crisis. The National Council for Behavioral Health states that 70% of American adults have dealt with some form of trauma in their life1. Even as the conversation around mental health has become normalized, a perceived stigma still prevents many from seeking out formalized treatment. One of the most effective preventive and treatment strategies is one of the most simple: play. Particularly for children who have experienced trauma, play can be a straightforward introduction to the process of reversing the impacts of that trauma.
The work of California Attorney General Nadine Burke Harris highlights the way play and sports engagement can serve as helpful interventions. While serving as director of the Bayview Child Health Center in San Francisco, Burke Harris began to note a troubling relationship between childhood trauma and poor health outcomes, both short-term and long-term. She repopularized the term Adverse Childhood Experiences (or, ACEs) in order to categorize and report these traumatic events and their impacts. ACEs were originally described in a 1998 study as falling into three domains: abuse, neglect, and household dysfunction. Every traumatic experience increases an individual’s ACE score by 1, up to 10. The study concluded that these adverse experiences have a direct relationship to risk factors for “several of the leading causes of death in adults.”2 Burke Harris was seeing the same epidemic in her office. For example, her team conducted a review of patient charts available through the clinic and found that children with an ACE score of four or more were “twice as likely to be overweight or obese as a child with zero ACEs.”3 In Burke Harris’ eyes, this was a crisis that was mostly invisible to the nation at large.
Unsurprisingly, the impacts of racism in this country extend to its youngest children. Studies have shown Black, Hispanic and LGBTQ children have a much higher prevalence of ACEs compared to their white peers. Poor and uneducated children across races are more likely to have higher ACE scores as well4. In a country where Black and Hispanic poverty rates average about 20% (compared to about 11% for non-Hispanic whites), this intersection of race and class means children already saddled with the burden of racism must also wage the difficult and expensive war against poverty5. All of this combines to create extremely traumatized populations in marginalized communities. In fact, the World Health Organization notes that “common mental disorders are about twice as frequent among the poor as among the rich,” and that a lack of education and job opportunities also have an overwhelmingly negative impact on mental health6. From childhood experiences to insufficient opportunity access as adults, so many people are deprived of the help they deserve to lead a healthy life
Importantly, the long term impacts of ACEs are often hard-coded into an individual’s genetic material. As Burke Harris puts it in her book, The Deepest Well, “...when a four-year-old experiences chronic stress and adversity, some genes that regulate how the brain, immune system, and hormonal systems respond to stress get turned on and others get turned off, and unless there is some intervention, they’ll stay that way, changing the way the child’s body works and, in some cases, leading to disease and early death.”3 These traumatic experiences can hijack a person’s ability to cope with stressors, making them more likely to see the negative health impacts of an overactive stress response, like poor sleep and difficulty focusing. This makes the importance of early and informed interventions even more apparent.
In terms of developing a framework for a beneficial intervention, Stephen Porges’ work on Polyvagal Theory is particularly helpful. Polyvagal Theory incorporates the importance of the vagus nerve (remember the Wanderer Nerve?) in moderating emotional and behavioral responses to trauma. Disrupted vagal function as a result of trauma can lead to negative behavioral outcomes, including overexcitation of the sympathetic nervous response. Porges notes that play and sports can, in the proper context, provide a therapeutic route to activating the sympathetic nervous system in a safe and controlled manner7. This establishes a neurological basis for improving the negative impacts of childhood abuse outlined by Burke Harris’ work on ACEs. If you can create a safe and controlled environment for children to experience play, play can operate as a therapeutic intervention for trauma.
Thankfully, there are already people in the Mid-Atlantic region incorporating these ideas to the benefit of their community. Paulette Branson is the Director of Sports, Fitness and Health programs at the University of Pennsylvania’s Netter Center for Community Partnerships. She works throughout the year to develop and enact programs to engage students across Philadelphia with sports and fitness. The programs that Branson runs fill a critical role in the communities that she works in - not only do they offer a route for play and sports, but she focuses much of her work on developing physical literacy and a deeper understanding of the interconnectedness of sports and peer interactions throughout life. Branson shared with me some of her thoughts regarding the positive impact sports can have. She directly relates traumatic experiences in life with losing in sports: both are unfavorable events that can leave lasting impacts on an individual, but the more guided environment provided by sports can “significantly impact one's ability to learn from, deal with and move beyond the trauma - all while being willing to get help and utilize others for support.”
In West Philadelphia specifically, Branson sees access to a diverse array of sports as a major challenge, but the Cross-Grade Sports program that she oversees looks to solve that challenge. Cross-Grade Sports combines Philadelphia high school students, Netter Center staff, and Penn students each summer, in part, to “have fun through sports and fitness, create team goals, plan together, reflect together and ultimately build powerful, long-term relationships regardless of background.”
Particularly during the current public health crisis, Branson sees play as a necessary source of fun: “What we do in our leisure time impacts our wellness and overall well-being, and if we don't play, stress will consume us.” During a pandemic, the necessity of outdoor leisure time is so much more apparent, and simultaneously less accessible, but “people NEED to get outside,” Branson says, “even if it’s walking or riding a bike.” The benefits of play extend to all of us, not just traumatized individuals, and we should all take time to note how moments of play can help us cope with whatever we may be dealing with.
References:
- National Council for Behavioral Health. “How to Manage Trauma.” National Council for Behavioral Health, May 2013.
- Felitti, Vincent J, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, vol. 14, no. 4, May 1998, pp. 245–258, 10.1016/s0749-3797(98)00017-8.
- Nadine Burke Harris. The Deepest Well : Healing the Long-Term Effects of Childhood Adversity. Boston, Marine Books/Houghton Mifflin Harcourt, 1 Jan. 2019.
- Merrick, Melissa T., et al. “Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States.” JAMA Pediatrics, vol. 172, no. 11, 1 Nov. 2018, p. 1038, learningcommunityds.org/wp-content/uploads/2018/09/Aces-Study_JAMA_Pediatrics_17Sept2018-1.pdf, 10.1001/jamapediatrics.2018.2537.
- United States Census Bureau. “American Community Survey.” 2018.
- World Health Organization. “Mental Health, Poverty and Development.” 2007.
- Porges, Stephen W, and Deb Dana. Clinical Applications of the Polyvagal Theory : The Emergence of Polyvagal-Informed Therapies. New York, W. W. Norton & Company, Inc, 2018.