What are adverse childhood experiences?

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Recently, we’ve been hearing lots of discussion in the media about traumatic childhood experiences, and rightfully so. Just a few months ago, an armed student at Santa Fe High School fatally shot 10 people and injured 13 others – right in our own backyard. This will be a community in need for many years, and many of the surviving students will need trauma- and grief-informed intervention as they move forward with their lives.

To put it simply, Adverse Childhood Experiences (ACEs) are traumatic events a person experiences during their childhood. These traumatic events are broken into three different categories: abuse, neglect and household dysfunction. Research in the field of ACEs has expanded over the past 20 years to include adults and children of all demographics. One consistent finding is traumatic experiences during early childhood can affect development, behavior and overall health for a lifetime.

The Centers for Disease Control and Prevention (CDC) conducted the original ACE Study in conjunction with Kaiser-Permanente in Southern California during the 1990s. Over 17,000 adult patients were surveyed on their childhood experiences with questions such as the following:

• Did a parent or other adult in the household often swear at you, insult you, put you down or humiliate you? Or, act in a way that made you fear being physically hurt?
• Did you often feel as if you didn’t have enough to eat, enough clean clothes or anybody to protect you? Or, were your parents too drunk or high to take care of you and/or take you to the doctor when you needed care?
• Were your parents ever separated or divorced?

Once the study was concluded, the resulting data were very interesting. Approximately half of the respondents were women and the average age of the group was in the 50s. Over 70 percent of the respondents were white, and over 70 percent of the respondents had at least some college education. Two-thirds of the respondents reported experiencing at least one ACE, while 12 percent reported experiencing four or more ACEs. The researchers discovered the more ACEs a person experienced during childhood, the greater the person’s risk was for developing severe, chronic behavioral and physical health problems, such as hypertension, substance abuse disorder, suicidal ideation and cancer. Interestingly, each behavioral and physical health outcome was independently related to experiencing childhood trauma. Research also suggests experiencing four ACEs can shorten life expectancy by 10 years, while six ACEs can shorten life expectancy by 20 years.

We’ve learned ACEs can affect physical and mental health by causing the body to produce high levels of stress hormones for long periods of time. This prolonged exposure to stress hormones is referred to as “toxic stress,” which causes changes in the nervous system, immune system, endocrine system and even DNA. In fact, evidence suggests if a child experiences ACEs prior to the age of 2, their brain, immune system and DNA are altered. Even if the child has no conscious memory of the trauma later in life, his or her organs remember. Toxic stress affects the regions of the brain responsible for self-control, thinking, problem-solving, learning, memory retention and decision-making, causing them to lose nerve connections and become smaller. Conversely, toxic stress causes the regions of the brain responsible for emotional regulation, sensing danger and the fight/flight/freeze responses to increase in neural connections and grow larger. As a result, a person who has experienced significant childhood trauma might have difficulty paying attention, making decisions, thinking clearly, learning and remembering, especially in stressful situations. This can place a child at risk for developing learning disabilities, difficulty paying attention at school and exhibiting issues with behavior and self-control. A child who has experienced multiple ACEs may react to triggering events by fighting, running away (flight) or shutting down (freezing). These reactions might be misinterpreted as attention-deficit/hyperactivity disorder (ADHD), defiance or resisting adult authority when, in fact, the child’s brain is responding reflexively to stress.

So far, ACE studies were conducted in 40 states across the nation. We now know that, nationwide, one-third of Americans have experienced at least one ACE by the age of 8, half of Americans have experienced at least one ACE by adolescence and two-thirds of Americans have experienced at least one ACE by adulthood. Recent data suggests 22 percent of children have experienced two or more ACEs in the state of Texas. This places children at risk for developmental disabilities, behavior disorders and chronic medical conditions.

Evidence suggests one important method for helping children overcome the effects of early childhood trauma involves building resilience. Resilience is the ability to bounce back from adversity. Dr. Kenneth Ginsburg, an adolescent medicine physician from the Children’s Hospital of Philadelphia, wrote the book “A Parent’s Guide to Building Resilience in Children and Teens: Giving Your Child Roots and Wings,” in which he described the 7 Cs of Resilience:

• Competence: This is the feeling of knowing you can handle a situation effectively.
• Confidence: A child’s belief in his/her own abilities is derived from competence.
• Connection: Developing close ties to family and community creates a solid sense of security that helps lead to strong personal values and prevents alternative destructive paths to love and attention.
• Character: Children need to develop a solid set or morals and values to determine right from wrong and to demonstrate a caring attitude toward others.
• Contribution: Understanding the importance of personal contribution can serve as a source of purpose and motivation.
• Coping: Learning to cope effectively with stress will help a child be better prepared to overcome challenges in life.
• Control: Children who realize they can control the outcomes of their decisions are more likely to realize they have the ability to bounce back.

I look forward to exploring further ACE-related topics through the blog. Together, we can help our children develop into healthy, productive and well-adjusted citizens.

To find your nearest Texas Children’s Pediatrics location, click here. If you’re interested in learning more about the Trauma and Grief Center at Texas Children’s, click here.