PBS高端访谈:对遭受毒性压力的儿童重视不足（在线收听）

JUDY WOODRUFF: You have heard them all: Wear your seat belt. Don't smoke. Don't drink and drive. These are all pieces of advice that we're accustomed to hearing. But they have become second nature only because of effective public health campaigns. It takes time and persuasion to change behavior. Tonight, pediatrician Nadine Burke Harris shares her Humble Opinion on what she sees as a grave threat to many children, one she believes has been misdiagnosed and overlooked.

DR.NADINE BURKE HARRIS, Author, "The Deepest Well": Ten years ago at my pediatric clinic in San Francisco, teachers, social workers and parents were bringing me child after child with concerns of ADHD. As I examined my patients, I noticed that the highest rate of behavioral problems was occurring in the kids whose parents had drug addictions or mental illness, or those who were subject to violence at home. When I dug into the science, what I found was that, for most of these kids, the problem wasn't run-of-the-mill ADHD. For most of my kids, the real problem is what the American Academy of Pediatrics now recognizes as toxic stress. Ultimately, it all boils down to our flight-or-fight response, what happens in our bodies when we experience something scary. But when activated too often, like with repeated abuse or neglect or parental addiction, it can change the structure and function of children's developing brains. It can affect their hormones, the immune system, even the way DNA is read and transcribed. And it dramatically increases the risk of both behavioral and health problems in childhood and in adulthood. Toxic stress affects white kids, black and brown kids, rich, poor, urban, rural. In other words, it can affect anyone, and it can happen anywhere. But, right now, only 4 percent of pediatricians in the U.S. are screening for toxic stress. Most haven't received any training on how to identify kids who are at risk. This has to change. Too many children with behavioral symptoms of toxic stress are being labeled with ADHD and given stimulants without any identification of the root cause. And many kids show no behavioral symptoms at all. Yet they are still more than twice as likely to go on to develop asthma, autoimmune disease, heart disease and cancer. And their life expectancy can be cut short by decades. More than 34 million American children have had at least one adverse childhood experience, like witnessing violence at home or being sexually molested. We need every medical professional in this country to be equipped with the right tools for universal screening. When identified early, doctors, educators and caregivers can help reverse the biological effects of childhood trauma. Together, we can give every child a shot at a healthy life.

JUDY WOODRUFF: Important advice from Nadine Burke Harris.

茱蒂·伍德瑞夫：所有这些你都听过：系好你的安全带。不要吸烟。严禁酒后驾车。这些都是我们习以为常的忠告。但是，由于公共健康运动奏效，它们已成为了第二天性。改变行为需要时间和说服力。今晚，儿科医生纳丁·伯克·哈里斯与我们分享观点，在她看来，这对许多孩子来说简直是致命威胁，她相信这件事一直以来都为人们误解和忽视。

纳丁·伯克·哈里斯医生，《最深陷阱》作家：十年前我在旧金山开了一家儿科诊所，老师、社会工作者以及父母会带着那些被认为患有多动症的孩子来我这里就诊。当我给病人做检查时，我发现那些父母吸毒或患有精神疾病的儿童，行为问题发生率最高或那些遭受家庭暴力的儿童。当我钻研于此的时候，我发现，对于大多数孩子来说，问题不在于简单的多动症。对我的大多数孩子来说，真正的问题是现在美国儿科学会所认识的“毒性压力”。最终，这一切归结为，当我们的身体遭遇可怕事情时，我们的“战斗还是逃跑”反应。但是，如果刺激频繁发生，像反复施虐、忽视或父母酗酒吸毒，就可能影响儿童脑结构及功能发育。它会影响他们的荷尔蒙、免疫系统，甚至影响到DNA的读取和转录。它极大地增加了儿童在其儿童期及成年期的行为健康问题发生风险。“毒性压力”影响广泛，涉及白人、黑人及棕色人种，富人、穷人、城里人和农村人。换句话说，它可以影响到任何人，它可能发生在任何地方。但目前，在美国，正在筛查毒性压力的儿科医生只有4%。大多数人没有接受过任何关于如何识别风险儿童的培训。这种情况必须得到改变。太多有毒性压力症状的孩子被贴上多动症的标签，他们受到刺激，然而造成此结果的根本原因却从未得到识别。许多孩子根本没有表现出任何行为异常。然而，他们罹患哮喘、自身免疫疾病、心脏病及癌症的可能性仍超过（正常情况的）两倍。他们的寿命可以缩短几十年。 至少有过一次不良童年经历的美国儿童超过3400万名，比如目睹家庭暴力或性骚扰。我们需要这个国家的每一位医疗专业人士，配备合适的工具，对“毒性压力”进行普遍筛查。如果及早发现，医生、教育工作者及护理人员就可以帮助扭转童年创伤所造成的生物结果。共同努力，我们可以给每个孩子一个健康生活的机会。

茱蒂·伍德瑞夫：来自纳丁·伯克·哈里斯的重要建议。