Translating cutting-edge research on childhood trauma into clear, accurate narratives is no easy feat—especially when scientists themselves are still defining what’s “normal.” For her Knowable Magazine investigation “Unseen Scars of Childhood Trauma,” Colorado-based freelance science journalist Amanda Keener tackled this challenge head-on, exploring how adverse childhood experiences leave biological fingerprints that researchers are only beginning to decode. The story began with a simple question during foster parent training: can intervention actually reverse trauma’s impact on health?

We sat down with Keener to discuss the answer to that question and more.

*This interview has been edited for length and clarity.

What initially drew you to the topic of childhood adversity and biomarkers?

My husband and I were receiving training to be foster and adoptive parents, and one of the things we learned about was trauma’s impact on health. I had heard about Adverse Childhood Experiences (ACEs) but didn’t know much about them. The trainer showed us a TED talk by Nadine Burke Harris — the surgeon general in California. In it, she talks about the biological effects of ACEs and the Kaiser Health Study that first made these groundbreaking associations between childhood trauma and later life illness.

I was taking notes and wondering: if foster care can be considered an intervention, from a science-y perspective, does this intervention change those outcomes? If you intervene when a child has ACEs in childhood, do you change health outcomes later? Are these associations between ACEs and health reversible, can it be undone? So, I just started looking into it, I wanted to know biologically what can happen.

We were also learning a specific parenting approach (called Trust-based relational intervention), and I was curious whether one could measure, on a biological level, how a child was responding to that kind of trauma-informed parenting or any type of intervention? And would those physical changes have long term impacts on the child’s health?

What was the most surprising or unsettling thing that you uncovered about how childhood trauma shapes people that you weren’t expecting to uncover, or that changed the way you view the topic?

The epigenetic part was the most distressing. I think colloquially, we hear a lot about epigenetics and trauma. Epigenetics is a field that studies how the genome gets changed by your environment. There are lots of different forms of epigenetic markers but the one that people talk about the most would be, basically a chemical tag on a gene that sort of controls how much that gene will be turned on or off. Some of those marks can be passed down, and I was surprised to learn just how much work had been done on human cells, finding epigenetic marks on the DNA that were correlated to trauma. I was familiar with the mouse work. And that’s pretty stark, you know, the effects are really easy to see. But humans are complicated. I came across more epigenetic stuff than I expected to. Also, at the time, I was under the impression that all these epigenetic changes would be passed on to progeny, which in some cases may be true, but not across the board by any means. But that was upsetting to me at the time — the idea that ACEs impact more than one generation.

I also came across studies on shortened telomeres due to neglect – telomeres are strands of code the ends of the DNA  — if they’re long that’s correlated with a longer life, if they’re short, it’s correlated with a shorter life. When you read that, you’re like, oh my gosh, you get traumatized, and then also your life is shorter, and this is horrible. It was kind of upsetting and felt so unfair. But then when you dive deeper, you find out it’s not that cut and dry.

I also found a lot of hope talking to sources about protective factors. There’s been more research done since then on those protective factors, such as positive relationships with adults, which can buffer the impact of ACEs. Also, a lot of this work is done on a population scale, so you need to be careful about applying it on an individual basis. I just remember when I was reporting that thinking that people in this field are extremely optimistic and humble about what can be known and what we do know, and what we should do with it.

Another surprise to me was the research finding that different types of adversity have varying effects on biomarkers. It makes sense, of course, but when you’re first learning about this stuff, you might think adversity equals stress which equals harm to the body. But the reality is that the body adapts (or maladapts) to different sources of chronic stress or adversity in different ways.

What would you say to the lay person trying to understand how trauma impacts epigenetics? 

I would point to the animal data, which shows differences in epigenetic marks among mice that were licked and cared for versus those that weren’t. And then I’d talk about efforts to identify similar patterns in humans (using cheek swabs, blood, and even brain tissue). There is evidence of changes to certain genes, but the impacts are not nailed down yet. I’d also note that these changes are likely reversible (with interventions like therapies, diet, exercise, etc), and researchers are still studying all of this: Which changes are important? Which should we focus on reversing, and how can we do that?

Would you say it’s fair to say that research on epigenetics shows trauma can be passed down from generation to generation?

I’d say I’m not the person to answer this. I had thought that at the time, but it wasn’t part of my article, and the data were not strong enough to come to that conclusion. There’s been more work since then as illustrated here.

Overall, it’s just the fact that trauma marks your genes, it just felt so invasive, children are not in control of their environment, and then it actually affects them on this really deep level. And it’s not just emotional, it’s also biological, and that interacts with emotional. I remember when I was interviewing Nicole Bush for the article, she talked about how her work was important because, if we could demonstrate these associations on a biological level, when you’re talking to policy makers or stakeholders about things hurting people’s feelings, it’s not just a hypothetical “that’s bad” conversation, it’s about it being toxic to our biology. That is more objective and actionable.

What was the biggest roadblock that you encountered in writing or researching this piece? And how did you overcome it?

The complexity. And the fact that I wanted some objective answers, I wanted some firm data, and it was harder to find than I thought, partially because some things are just not well-defined yet. Researchers are trying to find biomarkers for trauma or toxic stress. But we don’t yet know what levels qualify as “normal” for all of these biomarkers. So, there is a lot of work to do to establish typical levels of certain biomarkers and how each is affected by ACEs. Especially looking at kids, that adds a whole other level of complexity, because a lot of these blood tests for things like CRP or cortisol for example are  based on adults. The people I was talking to were still doing those studies on what’s normal and what’s not, but at the same time, other people were measuring these things in kids with or without trauma histories, without quite knowing what the numbers meant.

The other big challenge was deciding what was worth reporting on, because there are lots of findings out there, but for some of them, we don’t even know what they mean yet. And of course with a topic like this, where do you stop? You can keep going and going. I ended up trying to apply a lens of timeliness, like, what’s happening now, and let that determine what to cut. Always asking the question: how will this matter to readers?

Your article outlines public health implications: screening for ACEs, biomarkers, interventions. What do you hope people reading this will do?

At the time, my goal was to spread the word that adversity affects biology. But then, as I was reporting, I also felt a desire to show where there was hope and to highlight the work being done to address this problem. For example, I would hope that a foster parent would read it and seek out a program, or a study, or something like the ones that Phil Fisher or Nicole Bush were doing–studies looking at blood biomarkers in caregivers and kids before and after different sorts of therapy and caregiver training.

I would hope that the average person who knew that there were ACEs in their history would add it into their consideration of their overall healthcare, bring it up to their doctor and seek out how they can get involved. Overall, it’s about people reading it and being encouraged to take action in their own lives, however that might look.

Some updates in their work specifically since this article went out that I love include: Fisher published on this intervention called MTFC-P (Multidimensional Treatment Foster Care for Preschoolers), which impacted cortisol levels in children and is now working on Stanford’s FIND program, is a video-coaching intervention for caregivers of children ages 0-5 that uses edited clips of everyday interactions to improve early childhood development outcomes. Meanwhile, Nicole Bush is working with the Child Trauma Research Program at UCSF and recently published this interesting and topical piece: Intervening After Trauma: Child-Parent Psychotherapy Treatment Is Associated With Lower Pediatric Epigenetic Age Acceleration.

If you were to follow up on the story in 5 years, are there things that you would specifically want to investigate further, or research that want to check in on the status of to see if there’s been research or progress?

Progress on research into protective factors. And how they’re changing the biomarkers that people are looking at to measure toxic stress. I’d check on the status of the JPB Research Network’s research on toxic stress, or the HERO study, where they were trying to come up with a panel that could be used clinically.

One thing I didn’t get to delve into was data on what makes some people more or less susceptible to the impacts of toxic stress. There are studies out there on how having different variants of some genes impact the body’s responses to trauma. I wasn’t able to fit it in though, so I’d want to look into that.

Do you have any advice for turning really dense science into compelling narratives without dumbing it down and turning off the scientific readers among your audience?

Don’t be afraid to learn the nitty-gritty yourself, understanding that time is almost always the barrier. But a lot of scientists are also teachers, so, if you show curiosity, you might be able to find one or two who will kind of hold your hand a little and teach you the nitty-gritty biology. I find that I will then feel more confident explaining things in lay terms if I actually understand the real biology behind it. Sometimes even big-name outlets summarize biology and or science facts very incorrectly. I like to understand what I’m writing about, and I like to clarify with my sources if it’s a field that I’m not familiar with. This was a little bit harder, just because it’s an evolving and emerging field. But overall, don’t be afraid to learn the details, and then come up with your own metaphors and your own ways of describing them.

I like to tell people biology is pretty much just vocabulary. It’s like learning a new language. So, we’re not supposed to use jargon in science writing, but I think it’s fair and okay to teach one or two terms in your article. I feel that it shows the readers a little bit of respect and reduces the feeling of being on the outside of the scientific enterprise, looking in, or being talked down to. After all, science, especially this kind of science, is about all of us.

Then, always, keep the reader in mind. I’ll often write the first draft of a dense science-y paragraph with a focus on accuracy and detail and then rewrite parts of it with the reader in mind. Another thing I do is imagine I’m explaining the story to a friend or relative. This helps with the “why does this matter” and the “why now” questions because those are basically the first things you tell someone when you start telling a story. This practice also often helps me with the structure—it reveals what background a reader actually needs in order to appreciate a new piece of science, and what questions naturally arise as the story is told. At times it’s helped me home in on the main focus of the piece.

Is there anything else that you want to touch on about your process, or anything else that you think would be helpful for people?

Another thing I always do when I’m interviewing: I ask my sources for names of other researchers in the field who are doing similar work or who totally disagree with them. Or if during our conversation we run into a black box or something, I’ll say, who’s trying to answer that question? And they can help send me there.

I use PubMed a lot. I like to just really make sure that I’ve sort of saturated myself, so that I’m not missing any big advances in the area I’m covering. Sometimes, what is considered a big advance to people in the field might not actually be the thing that’s in the headlines. Sometimes you need to ask. And then, when I start seeing and hearing the same studies or themes recurring, then I’m like, okay, I feel like I’m not missing anything important to my story.