Adverse childhood experiences (ACEs) (बचपन के प्रतिकूल अनुभव) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. In this introduction to ACEs, we will explore the key components of adverse childhood experiences, their effects on individuals and communities, and the importance of trauma-informed approaches to support those who have been impacted. Together, we can strive to build a healthier and more resilient future for the generations to come.
Adverse childhood experiences Definition
The concept of adverse childhood experiences refers to various traumatic events or circumstances affecting children before the age of 18 and causing mental or physical harm.
Adverse childhood experiences Types
There are 10 types of ACEs:
- Physical abuse: Any intentional act that causes physical harm through bodily contact.
- Sexual abuse: Any forceful, unwanted, or otherwise abusive sexual behavior.
- Psychological abuse: Any intentional act that causes psychological harm, such as gaslighting, bullying, or guilt-tripping.
- Physical neglect: Failure to help meet the basic biological needs of a child, such as food, water, and shelter.
- Psychological neglect: Failure to help meet the basic emotional needs of a child, such as attention and affection.
- Witnessing domestic abuse: Observing violence occurring between individuals in a domestic setting, such as between parents or other family members.
- Witnessing drug or alcohol abuse: Having a close family member who misused drugs or alcohol.
- Mental health problems: Having a close family member or otherwise important individual experience mental health problems.
- Imprisonment: Having a close family member or otherwise important individual serve time in prison.
- Parental separation or divorce: Parents or guardians separating or divorcing on account of a relationship breakdown.
Health outcomes due to Adverse Childhood Experiences
With one in four children experiencing or witnessing a potentially traumatic event, the relationship between ACEs and poor health outcomes has been established for years. With multiple adverse childhood experiences being equal to various stresses, and adversity. Children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems. Negative childhood experiences can alter the structural development of neural networks and the biochemistry of neuroendocrine systems and may have long-term effects on the body, including speeding up the processes of disease and aging and compromising immune systems.
Further research on ACEs determined that children who experience ACEs are more likely than their similar-aged peers to experience challenges in their biological, emotional, social, and cognitive functioning. Also, children who have experienced an ACE are at higher risk of being re-traumatized or suffering multiple ACEs. The amount and types of ACEs can cause significant negative impacts and increase children’s risk of internalizing and externalizing. Additionally, behavioral challenges can arise in children exposed to ACEs including juvenile recidivism, reduced resiliency, and lower academic performance.
Adults with ACE exposure report having worse mental and physical health, more serious symptoms related to illnesses, and poorer life outcomes. Across numerous studies, these effects go beyond behavioral and medical issues and include damage to DNA, higher levels of stress hormones, and reduced immune function. The effects of ACEs go beyond just physical and behavioral health with studies reporting that people with high ACEs scores showed less trust in government COVID-19 information and policies.
It is thought that all adult depression results from something happening in childhood. That could be things like aversive childhood experiences that lead to depression, or if something that happens in adulthood that leads to depression tends to stem from something that happened in childhood as well. It seems that the main things that led children to have adult depression are their parent’s mental health issues and childhood neglect.
Due to many of the early life stressors caused by exposure to ACEs, there are noted changes in the body in people with ACE exposures compared to people with little to no ACE exposure. This is most evident in structural changes in the brain with the hippocampus, the amygdala, and the corpus callosum being important study targets.
These areas of the brain are more vulnerable than others due to the higher density of glucocorticoid receptors in these regions of the brain. Multiple effects have been noted including diminished thickness, reduced size, and reduced size of connective networks in the brain.
ACEs have been linked to numerous negative health and lifestyle issues into adulthood across multiple countries and regions including the United States, the European Union, South Africa, and Asia. Across all these groups researchers have reported seeing the adoption of higher rates of unhealthy lifestyle behavior including sexual risk-taking, smoking, heavy drinking, and obesity.
The associations between these lifestyle issues and ACEs show a dose-response relationship with people having four or more ACEs who have significantly more of these lifestyle problems. Physical health problems arise in people with ACEs with a similar dose-response relationship. Chronic illnesses such as asthma, arthritis, cardiovascular disease, cancer, diabetes, stroke, and migraines show increased symptom severity in step exposure to ACEs.
Mental health issues have been well known in the face of childhood trauma and exposure to ACEs is no different. According to a large study conducted in 21 countries nearly one in three mental health conditions in adulthood are directly related to an adverse childhood experience.
Multiple mental health conditions were found to have a dose-response relationship with symptom severity and prevalence including depression, attention-deficit hyperactivity disorder, anxiety suicidality, bipolar disorder, and schizophrenia. Depressive symptoms in adulthood showed one of the strongest dose-response relationships with ACEs, with an ACE score of one increasing the risk of depressive symptoms by 50% and an ACE score of four or more showing a fourfold increase. Later research also demonstrated that ACE scores are related to increased rates and severity of psychiatric and mental disorders, as well as higher rates of prescription psychotropic medication use.
Additionally, epigenetic transmission may occur due to stress during pregnancy or interactions between mothers and newborns. Maternal stress, depression, and exposure to partner violence have all been shown to have epigenetic effects on infants.
Globally knowledge about the prevalence and consequences of adverse childhood experiences has shifted policymakers and mental health practitioners towards increasing, trauma-informed and resilience-building practices. This work has been over 20 years in the making bringing together research implemented in communities, education settings, public health departments, social services, faith-based organizations, and criminal justice.
As knowledge about the prevalence and consequences of ACEs increases, more communities seek to integrate trauma-informed and resilience-building practices into their agencies and systems.
Indigenous populations show similar patterns of mental and physical health challenges as other minority groups. Interventions have been developed in American Indian tribal communities and have demonstrated that social support and cultural involvement can ameliorate the negative physical health effects of ACEs.
Other community examples exist, such as Tarpon Springs, Florida which became the first trauma-informed community in 2011. Trauma-informed initiatives in Tarpon Springs include trauma-awareness training for the local housing authority, changes in programs for ex-offenders, and new approaches to educating students with learning difficulties.
Adverse childhood experiences Education
ACE exposure is widespread globally, one study from the National Survey of Children’s Health in the United States reported that approximately 68% of children 0–17 years old had experienced one or more ACEs. The impact of ACEs on children can manifest in difficulties focusing, self-regulating, and trusting others, and can lead to negative cognitive effects.
One study found that a child with 4 or more ACEs was 32 times more likely to be labeled with a behavioral or cognitive problem than a child with no ACEs. Another study found that students with at least three ACEs are three times as likely to experience academic failure, six times as likely to have behavioral problems, and five times as likely to have attendance problems. The trauma-informed school movement aims to train teachers and staff to help children self-regulate and to help families that are having problems that result in children’s normal response to trauma. It also seeks to provide behavioral consequences that will not re-traumatize a child.
Literacy about Adverse childhood experiences
ACEs in childhood and adolescence can affect literacy development in many ways. Children who have faced trauma encounter more learning challenges in school and higher levels of stress internally. Building literacy skills can be negatively impacted both by the lack of literacy experiences in the home, missing parts of early-childhood education, and by actually altering brain development. Some techniques can be employed by educators and clinicians to try and remediate the effects of adverse experiences and move children forward in their literacy and educational development.
ACEs affect parts of the brain that involve memory, executive functioning, and attention. The parts of the brain and hormones that register fear and stress are in overdrive, whereas the prefrontal cortex, which regulates executive functions, is compromised. This impacts impulse control, focus, and critical thinking. Memory is also a struggle as there is less capacity to process new input. The stress of ACEs creates a state of “fight, flight, or freeze” which leaves children unavailable for learning. The ability to process new information or collaborate with peers in school is eclipsed by the brain’s necessity to survive the stress experienced in their environment outside of school. The inconsistency and instability of the home environment alter the many cognitive processes necessary for effective literacy acquisition.
Social service providers—including welfare systems, housing authorities, homeless shelters, and domestic violence centers – are adopting trauma-informed approaches that help to prevent ACEs or minimize their impact. Utilizing tools that screen for trauma can help social service worker direct their clients to interventions that meet their specific needs. Trauma-informed practices can also help social service providers look at how trauma impacts the whole family.
Trauma-informed approaches can improve child welfare services by openly discussing the trauma and addressing parental trauma. The New Hampshire Division for Children Youth and Families (DCYF) is taking a trauma-informed approach to their foster care services by educating staff about childhood trauma, screening children entering foster care for trauma, using trauma-informed language to mitigate further traumatization, mentoring birth parents and involving them in collaborative parenting, and training foster parents to be trauma-informed.
Health care services
Screening for or talking about ACEs with parents and children can help to foster healthy physical and psychological development and can help doctors understand the circumstances that children and their parents are facing. By screening for ACEs in children, pediatric doctors and nurses can better understand behavioral problems. Some doctors have questioned whether some behaviors resulting in attention deficit hyperactivity disorder (ADHD) diagnoses are reactions to trauma. Children who have experienced four or more ACEs are three times as likely to take ADHD medication when compared with children with less than four ACEs.
Screening parents for their ACEs allows doctors to provide the appropriate support to parents who have experienced trauma, helping them to build resilience, foster attachment with their children, and prevent a family cycle of ACEs. For people whose adverse childhood experiences were of abuse or neglect cognitive behavioral therapy has been studied and shown to be effective.
Some public health centers see ACEs as an important way (especially for mothers and children) to target health interventions for individuals during sensitive periods of development.
Resilience and resources
Resilience is the ability to adapt or cope in the face of significant adversity and threats such as health problems, and stress experienced in the workplace or home. Resiliency can moderate the relationship between the effects of ACEs and health problems in adulthood. By being able to use emotion regulation resources such as cognitive reappraisal and mindfulness people can protect themselves from the potential negative effects of stressors.
Resilience and access to other resources are protective factors against the effects of exposure to ACEs. People and children who have fostered resiliency have the skills and abilities to embrace behaviors that can foster growth.
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