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Course credit for "Childhood Adversity and Toxic Stress in Medical Care: Promoting Health and Healing Throughout the Lifespan"


Dr. Beth Grady, a pediatrician at South San Francisco Clinic, developed a course called: "Childhood Adversity and Toxic Stress in Medical Care:  Promoting Health and Healing throughout the Lifespan". 

She did the presentation on June 15, 2016, and the webinar was posted on June 22, 2016. The termination date for the webinar is June 22, 2019.

Instructions for earning 1 AMA PRA Category 1 CreditTM for this enduring material:

  1. Watch the video of the presentation, which can be accessed via this link:
  2. Complete the post-test below, answering at least three of the four questions accurately.
  3. Email the post-test to
  4. If at least three of the four questions are answered accurately, you will receive a CME certificate for 1 credit.

Post-Test Questions

  1. Explain some of the evidence presented demonstrating the long term effects of stress experienced during development. Discuss 2 relevant studies. 
  1. Describe two or more clinical manifestations of toxic stress
  1. List two questions you can use in screening for ACEs.
  1. List one or two things you plan to do if one of your patients (child or adult) screens positive for ACE(s).


Anda RF, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry BD, Dube SR, Giles WH. The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology.   Eur Arch Psychiatry Clin Neurosci. 2006 Apr;256(3):174-86.

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 1998;14:245–258.

Shonkoff  et al, Pediatrics. 2012; 129:e232-e246

Tottenham, N. Social scaffolding of human amygdala-mPFC circuit development, Social Neuroscience, (2015) 10:5, 489-499.

Schwaiger M et al, Altered Stress-Induced Regulation of Genes in Monocytes in Adults with a History of Childhood Adversity. Neuropsychopharmacology. 2016 May 11. doi: 10.1038/npp.2016.57. [Epub ahead of print]

Palma-Gudiel H. Maternal psychosocial stress during pregnancy alters the epigenetic signature of the glucocorticoid receptor gene promoter in their offspring: a meta-analysis. Epigenetics 2015;10(10):893-902.

O’Mahoney et al, Neuroscience. 2015 Oct 1. Early-life adversity and brain development: Is the microbiome a missing piece of the puzzle?

Gee, Dylan G. et al. Early Developmental Emergence of Human Amygdala–prefrontal Connectivity after Maternal Deprivation. Proceedings of the National Academy of Sciences of the United States of America 110.39 (2013): 15638–15643

Berntsen D, Johannessen KB, Thomsen YD, Bertelsen M, Hoyle RH, Rubin DC. Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan. Psychol Sci. 2012 Dec;23(12):1557-65. doi: 10.1177/0956797612457389. Epub 2012 Nov 5.

ACEs questionnaire:

Dubowitz H, Feigelman S, Lane W, Kim JW. Pediatric primary care to help prevent child maltreatment: The Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009;123:858–864. doi:10.1542/peds.2008-1376

AAP Trauma Toolbox for Primary Care:

Resilience Tools

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