Dr. Robert Block, former president of the American Academy of Pediatrics, has been widely quoted as saying, “Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.” That is a statement that many would agree holds true at this very moment, and one that cannot be ignored.
April is child abuse prevention month, and there is no better time to raise awareness around the long-lasting effects of child abuse, neglect, and other types of childhood trauma. This article will explain Adverse Childhood Experiences, share relevant findings from the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, and explore how to put science into practice in order to mitigate the impact of early adversity and toxic stress.
What are Adverse Childhood Experiences?
Adverse Childhood Experiences or ACES are traumatic early life events that can lead to negative health outcomes as adults. Much of what we know about ACEs stems from the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, conducted between 1995 and 1997, which examined 10 types of childhood trauma and their impact on long-term health and well-being. Researchers identified three categories of childhood trauma: abuse, neglect, and household dysfunction. The findings were shocking.
The study concluded that the more adversity one experiences earlier in life, the greater the risk of significant physical, emotional, and social consequences in the future. Now, you may be thinking – Why is that so shocking? A difficult upbringing being linked to hardships down the road, what is groundbreaking about that? Well, it is the prevalence at which ACEs occur, and in turn the impact that has on the population. Studies are often criticized for their self-selecting biases, however this investigation challenges that concern. The 17,000+ study participants were predominantly white, middle- and upper-middle class; most were college-educated and had stable jobs and heath care. They represent a group that we don’t typically associate with adversity, showing that trauma has no boundaries and is more common than we think.
Let’s break it down…
Everyone has an ACE score of 0 to 10, with each type of trauma counting as one regardless of the number of times it occurs.
According to the study, nearly two-thirds (64%) of adults have experienced at least one type of childhood adversity. ACEs increase the risk of: chronic disease and health issues, mental illness, engaging in risky behaviors (smoking, substance misuse, and unsafe sexual activity, for example), inadequate social skills, poor academic achievement and/or work performance, and intimate partner violence. The study also showed that ACEs cluster, meaning that if you have one there is a good chance (87%) that you have another. Almost 40% of participants reported two or more ACEs and roughly 12.5% experience 4 or more ACES. The higher your ACE score, the worse the outcomes.
When you look at each type of trauma and look at the prevalence of specific ACEs, the most dominant ACE experienced by participants was physical abuse (28%), followed closely by having a family member with a substance use disorder (27%). However, it is important to note the type of trauma does not impact the outcome per say. To the brain stress is stress; therefore, it doesn’t matter what type of adversity you face, the health consequences will be the same.
When a child experiences trauma, their cognitive functioning and ability to cope with tricky and icky (technical terms) emotions are compromised. Repeated exposure to traumatic events in childhood or prolonged adversity without appropriate adult/caregiver supports negatively affects the way the brain develops and functions; this is known as toxic stress. Toxic stress can be harmful on one’s physical and mental health, yielding undesirable outcomes later in adolescence and adulthood.
Why does this occur? Stressful or traumatic events early in life have a direct impact on a child’s brain development. The brain experiences rapid changes during the first five years, especially from birth to age three. During this informative time, the brain and its neural pathways are susceptible to external factors. While occasional stress is part of a child’s healthy development, chronic stress can negatively affect learning, growth, and behavior. This is in large part due to the overload of stress chemicals and their influence on the brain. When we feel threatened, the body activates our stress response systems and releases stress hormones (e.g., adrenaline and cortisol). Stress reactions and chemicals are meant to protect us, but too much can have the opposite effect. Enter toxic stress. Extended activation of stress response systems in early childhood can disrupt the structure of the brain and the way it communicates with the body, which can lead to major health issues in the future.
The brain is constantly changing in response to the environment; it is kind of like a chameleon in that way. This adaption is key to facilitating positive change in the face of toxic stress. Creating safe, stable, nurturing relationships and environments are critical to mitigate and prevent the consequences of childhood adversity. While ACEs have the potential to be long-lasting, they don’t have to be; we have the tools to help children thrive in the face of adversity and go on to meet their full potential.
A strong (and continuously growing) literature base has demonstrated that building resilience can help negate stress-induced changes in the brain. Resilience is the “process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress”. Experts in the field of child trauma convey that one of the biggest determinants in being resilient is having nurturing and supportive relationships with adults in one’s family and community. Dr. Bruce D. Perry, a childhood trauma guru, considers “the more healthy relationships a child has, the more likely he will be to recover from trauma and thrive.” And it’s true, adult-child relationships play a significant role in helping children cope with challenges. If stress reactions are time-limited and buffered by protective adult relationships, a child is able to recover and learns how to adapt in difficult situations. That is why high-quality, evidence-based parent education, home visiting programs, and parenting practices are so important. These interventions emphasize the power of familial relationships, caregiver bonding, and positive social interactions. Just as critical are protective factors and their role in strengthening families and preventing trauma. Studies have shown, and continue to investigate, the ways in which different protective factors promote optimal child development. And while intervention can occur at any time – there is no magical cut-off age – there is clear evidence that shows the earlier the better.
There is hope
It’s true that the findings from the ACE Study don’t leave you feeling warm and fuzzy. In fact, at this point, you may be wondering if there is any hope or if we are all doomed. Fear not! This is actually the exciting part (hear me out…).
The ACE Study findings are paving the way for innovative solutions to a public health crisis. It’s cutting across sectors and systems to bridge services and advocacy, and encouraging individuals and groups to collaborate and communicate like never before. From pediatricians to social workers, people in communities nationwide (and internationally) are using ACEs science to join forces and better the lives of children and families. Here are just a few examples:
- The Center for Youth Wellness developed an ACEs screening questionnaire and protocol for pediatric care providers to target more effective early intervention strategies.
- In Manchester, NH, a joint-response team a – Adverse Childhood Experiences Response Team (ACERT) – is bringing together law enforcement, mental health professionals, and community providers to respond to the service needs of children who have been exposed to violence.
- Lincoln High School in Walla Walla, WA incorporates ACEs into their work with students, more specifically their approach to school discipline.
- Trauma-free NYC, a university-community partnership, aims to raise awareness of ACEs and design and promote training and learning opportunities for the larger NYC community.
- Community members and practitioners in Raleigh, NC came together to watch a film about the science of ACEs, Resilience, and have an in-depth discussion around how systems can better address children who have experienced trauma.
A call to action
In her 2014 TED talk on childhood trauma, Dr. Nadine Burke Harris closed in saying, “The single most important thing that we need today is the courage to look this problem in the face and say, this is real and this is all of us. I believe that we are the movement.” Indeed we are. We are the change makers that can combat the effects of childhood adversity. Knowing what we now know, how do we move forward?
Continue to raise awareness
We must continue to raise awareness, not just of the long-term outcomes assocaited with childhood trauma, but also the power of early intervention. Recently, 60 Minutes did a piece on the impact of childhood trauma, highlighting the impactful work of organizations like SaintA and Nia Imani Family, Inc.. The eye-opening conversation was facilitated by Oprah Winfrey…yep, Oprah. The importance of stories like these in mainstream media cannot be understated. We know that when Oprah talks, people listen. Look at the traction that this one segment has gotten over the past month. It’s been invigorating.
Want another example? Sesame Street collaborated with the Robert Wood Johnson Foundation to launch an initiative to help children manage traumatic life experiences. Who better to take on the task than the beloved Sesame Street Muppets? The characters are loved by children and adults alike. An array of research-driven materials have been created through the partnership and are available to children, parents, and professionals. The content is truly original and inspired – it even includes Muppets modeling coping strategies – and emphasizes the power of resilience in the face of adversity.
Now, recognizing that we all don’t have access to Oprah, Big Bird, or a national TV network (wouldn’t that be awesome though?), it is important to take to the platforms we do have at our disposal to spread our message. Post an article on your organization’s Facebook page, email your colleagues, tweet at your community partners…Connecting with diverse audiences ignites new and ongoing conversations around where we are, what we know, and what we can do.
Trauma-informed care is no longer the exception, but instead the expectation. It’s about reframing the conversation from “What’s wrong with you?” to “What happened to you?” There are a great deal of resources out there that provide excellent guidance on becoming trauma-informed, both in clinical practice and at the organizational level. Here are a few that you may want to check out:
- ChildTrauma Academy
- Child Welfare Information Gateway – Trauma-Informed Practice
- National Child Traumatic Stress Network (NCTSN)
- National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC)
Promote shared learning
Many in the field have been advocating for the implementation of programs and policies that address ACEs, calling for more data and additional research to better target prevention efforts and supports. The fact is that while the ACEs may be new to some, others have been implementing innovative trauma-informed, resilience-building practices in their everyday work to create positive change. We have presented a few examples, but there are many more being spearheaded by individuals, organizations, systems, and communities nationwide. Shared learning is crucial to creating and maintaining a movement.
Be part of the movement
And with that…we want to hear from you. What do you think about the ACE Study and the findings? How are you addressing the needs of children and families who have experienced trauma? Are you implementing innovative trauma-informed practices at your organization?
Share your thoughts in the comments below!