What We Know About Adverse Childhood Experiences (ACEs)
Adverse childhood experiences (ACEs) include a range of stressful or traumatic experiences that infants and children may be exposed to during their development. These include physical, sexual and emotional abuse, neglect, family violence, mental illness, substance abuse, parental separation, and parental incarceration.
Since the Adverse Child Experiences Study was undertaken in 1998, there have been questions about the accuracy of some of the predictors and concern that important variables such as peer rejection, poverty, exposure to violence outside the home, and poor academic performance might also be very significant.
Nevertheless, there is widespread consensus that “exposure to violence, sexual abuse, and emotional mistreatment are harmful and likely to have long-term health effects” (David Finkelhor et al., 2013).
Multiple Adverse Childhood Experiences
Almost two thirds of adults in the United States and England, and between a third and a half of Canadians are estimated to have, at least, one adverse childhood experience which suggests that people are resilient and few of us have idyllic childhoods. What is most significant is the finding that multiple adverse experiences are problematic, that there is a strong relationship between the number of adverse childhood experiences and later social, emotional, cognitive, and physical impairment.
Four or more ACEs are associated with 11 times the level of intravenous drug use, 14 times the number of suicide attempts, and 4.5 times the likelihood of depression. People with four or more types of adversity are 14 times more likely to have been a victim of violence and 15 times more likely to have committed violence compared to people with no reported ACEs. With each additional ACE, the risk for negative outcomes increases exponentially.
Some Stress is Inevitable and Healthy
Stress is a normal response to threatening and challenging events. In optimal doses, the adrenaline discharged by the body in response to stress improves physical and mental functioning. It charges up the system. Children may experience stress when they move to a new home or school, participate in a competitive event, or are required to give a presentation. This type of stress is usually healthy because it promotes growth, competence and confidence.
Toxic Stress
Very intense stress can create anxiety which interferes with learning and performance, and can result in a child becoming withdrawn, avoidant, or developing stomach aches or headaches. High levels of stress that are chronic can become ‘toxic’ such that the stress can have a lasting effect on physical and mental health.
At the most extreme levels, where children experience fear and terror as a result of abuse, family violence or war, children may become traumatized, which means they live in a constant state of vigilance, react to minor provocations in extreme ways, or become numb, frozen, and preoccupied; or they may vacillate between these states. Many traumatized children cannot play, cannot learn, and without help, have extremely poor outcomes.
Chronic Stress and Learning
Children experiencing high levels of stress due to poverty or family violence frequently have deficits in language, memory, and general academic ability. When children are preoccupied with concerns about safety, they are unable to concentrate or process new information. They may be aggressive, defiant, or have little frustration tolerance. What may seem like a behavioural problem could be a manifestation of acute stress. These children require a great deal of one-on-one support to engage in learning.
Antidotes to Stress
Fantasy Play
For all children, play is their way to deal with stress, to express emotions, to take different perspectives, and to problem solve. ‘Make believe’ or fantasy play allows children to construct the world as they would like it to be, to wield power, to bestow favours, and to exact revenge. When children engage in fantasy play with other children they learn turn taking, negotiation, and cooperation with others.
Outdoor play
When children play outdoors, they learn new physical skills such as running and climbing and they learn to navigate within their natural environment. They begin to anticipate danger and to develop confidence in their bodies, as well as self-esteem. Moreover, nature inspires pretend play which, in turn, facilitates social and cognitive development.
Labeling and Regulating Emotions
Children need words to express their feelings, and strategies to manage their feelings, both positive and negative. Just as with too much frustration or anger, too much excitement can be dysregulating and lead to distress. Abundant research suggests that children learn to identify and manage their emotions most effectively within a safe relationship with a regulating adult.
Developing a Coherent Narrative
Both adults and children need to know their stories. They need to understand what happened to them and why they have difficulties and distress. Often, children who are victimized think they are responsible for their suffering and the suffering of those close to them, and grow up believing they are less lovable and less deserving than others. Commonly, trauma creates confusion regarding memories and children with several adverse experiences may be unclear about events which took place, when they took place, or even if they occurred. Uncertainty about the facts of their childhood compounds self-doubt and self-blame. Some form of therapy is often required for traumatized individuals to develop a coherent autobiography.
Music
In two recent meta-analyses of 79 independent studies, music was found to have a significant effect on both psychological stress-related symptoms including nervousness, restlessness, and feelings of worry, and physiological stress-related symptoms including heart rate and blood pressure.
Pets
There are a growing number of studies which show the positive effects of having pets, particularly dogs. Healthy people, people with disabilities, and people experiencing mental health challenges find great companionship, comfort, and stress reduction from owning and caring for a dog.
Stress is Inevitable, Toxic Stress is Not Inevitable.
Adversity is inescapable. Childhood is not the idyllic, innocent, or stress-free time of life that adults tend to romanticize. Growing up involves pain, frustration, failure, and disappointment, just like adulthood. The difference is that children lack the resources to problem solve, to soothe, and to make things better. They need loving adults to protect them and teach them the skills necessary to be healthy and resilient. Parents who suffered from severely adverse childhoods, however, frequently do not have the resilience or requisite skills to look after themselves, let alone their children. In order to prevent the intergenerational repetition of trauma, we have to make mental health and family health more of a priority. Blaming parents is simply not effective or useful. Universal daycare and full day kindergarten….would be a very good start.
Resources
Annual Report of the Director of Public Health, United Kingdom National Health System, 2018.
Tracie Afifi, Harriet MacMillan, Michael Boyle, Tamara Taillieu, Kristene Cheung & Jitender Sareen, Child Abuse and Mental Disorders in Childhood, Canadian Medical Association Journal, June, 2014, p.186.
David Finkelhor, Anne Shattuck, Heather Turner, and Sherry Hamby, Improving the Adverse Childhood Experiences Study Scale, Journal of the American Medical Association Pediatrics, Vol 167 (No.1) January 2013.
Paris Goodyear-Brown, Trauma and Play Therapy: Helping Children Heal, Routledge, New York and London, 2019.
Jennifer Hays-Grudo and Amanda Sheffield Morris, Adverse and Protective Childhod Experiences: A Developmental Perspective, American Psychological Association, 2020.
Martina de Witte, Anouk Spru, Susan Van Hooran, Xavier Moonen, & Geert-Jan Stams, Effects of music Interventions on stress-related outcomes: a systematic review and two meta-analyses, Health Psychology Review, July, 2019.
Michelle M. Perfect, Matt R. Turley, John S. Carlson, Justina Yohanna & Marla P. Saint Gilles, School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990-2015, School Mental Health: A Multidisciplinary Research and Practice Journal 8 (1), 7-43.
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.