What Adverse Childhood Experiences can tell us about trauma and the importance of safeguarding.
“… being raised with a parent, a mother and a father that I had, was the reason I had mental health [difficulties], because my mum and dad were always beating the crap out of each other and taking drugs and drink. So I didn’t get the right start. It’s like a baby tree, an oak, but if you nurtured it every year, it’s going to be a beautiful oak. But if it’s not had the right start, it’s not going to be a perfect oak.” Parent/Carer
As a safeguarding consultant, I don’t need convincing about the importance of safeguarding children, but in recent years startling evidence has emerged of the connection between childhood trauma and poor child and adult outcomes. The research has led us to a deeper understanding of what have become now known as ‘Adverse Childhood Experiences’ (ACEs) and the significant role these events play in our lives. ACEs come in many forms, from physical and mental abuse to neglect and household dysfunction. In 1998, American researchers published a ground-breaking study that investigated the impact of ACEs on physical and mental health problems in over 17,000 adults. During the study, the adults were given a survey asking about 10 different types of ACEs and if they had experienced them prior to the age of 18. The study showed a direct and emphatic correlation between ACEs and future health complications (including risk of stroke, heart disease, depression, severe obesity, diabetes, suicide, cancer, chronic lung disease, sexually transmitted disease and even broken bones). It also showed that childhood trauma was very common, even in employed white middle-class, college-educated people with great health insurance, and that people usually experience more than one type of trauma.
For a great account of how the research came about unexpectedly in a Californian obesity clinic see: https://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/
What ACEs do you have?
There were only 10 types of childhood trauma measured in original study, because they happened to be the most common amongst its participants; those traumas were also well studied individually in the research literature. There are, of course, other types of adverse childhood experiences, including community and environmental ACEs such as racism, bullying and community violence, and recently researchers have begun to include these experiences as ACEs, too, because they create the same biologic changes as the original 10 ACEs. For the purposes of simplicity though, these are the questions used in the original study.
Prior to your 18th birthday:
1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
No___If Yes, enter 1 __
2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
No___If Yes, enter 1 __
3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
No___If Yes, enter 1 __
4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
No___If Yes, enter 1 __
5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
No___If Yes, enter 1 __
6. Were your parents ever separated or divorced?
No___If Yes, enter 1 __
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
No___If Yes, enter 1 __
8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
No___If Yes, enter 1 __
9. Was a household member depressed or mentally ill, or did a household member attempt suicide? No___If Yes, enter 1 __
10. Did a household member go to prison?
No___If Yes, enter 1 __
Now add up your “Yes” answers: _ This is your ACE Score
__________________________
Now that you know your ACEs, what does it mean?
The higher your ACE score, the higher your risk of health and social problems. As your ACE score increases, so does the risk of disease, social and emotional problems. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; attempted suicide, 1,220 percent.
Note: The most important thing to remember is that the ACE score is meant as a guideline: if you experienced other types of toxic stress over months or years, then those would likely increase your risk of health consequences, depending on the positive childhood experiences you had.
What causes this?
When children are overloaded with stress hormones as a result of being exposed to ACEs, they’re in flight, fright or freeze mode. They can’t learn in school. They often have difficulty trusting adults or developing healthy relationships with peers (i.e., they become loners). To relieve their anxiety, depression, guilt, shame, and/or inability to focus, they may also turn to easily available biochemical solutions – nicotine, alcohol, marijuana, methamphetamine – or activities in which they can escape their problems – high-risk sports, proliferation of sex partners, and work/over-achievement. (e.g. nicotine reduces anger, increases focus and relieves depression, alcohol relieves stress.) Using drugs or overeating or engaging in risky behaviour leads to consequences as a direct result of this behaviour. For example, smoking can lead to COPD (chronic obstructive pulmonary disease) or lung cancer. Overeating can lead to obesity and diabetes. In addition, there is increasing research that shows that severe and chronic stress leads to bodily systems producing an inflammatory response that leads to disease.
In addition, toxic stress can be passed down from generation to generation. The field of epigenetics shows that we are born with a set of genes that can be turned on and off, depending on what’s happening in our environment. If a child grows up with an overload of toxic stress, their stress-response genes are likely to be activated so that they are easily triggered by stressful situations that don’t affect those who don’t grow up with toxic stress. They can pass that response onto their children.
What can we do?
Understanding the profound effect that ACEs have in our lives, and acknowledging how common they are across our populations, can seem overwhelming and negative. But actually the implications of the research are overwhelmingly positive. We know that brains and lives are somewhat plastic. Resilience research shows that the appropriate integration of resilience factors — such as asking for help, developing trusting relationships, forming a positive attitude, listening to feelings — can help people improve their lives. Now that we understand how toxic stress affects the minds and bodies of children, we can see with real clarity exactly why holistic safeguarding is so important. Ways to prevent toxic stress include:
- Provide a nurturing, safe and stable environment.
- Help children learn to cope with adversity.
- Reduce a child’s ACE exposure.
Experts say there are essentially seven core ideas to help develop and foster resilience in children:
- Competence – Building their understanding of their skills.
- Confidence – Helping kids grow a true belief in their own abilities.
- Connection – Connecting children with other people, schools and communities to further build their support system.
- Character – Helping them comprehend a clear sense of right and wrong, and teaching them moral values.
- Contribution – Offering children a chance to contribute to the well-being of others. They learn that giving service feels good and then feel more confident to ask others for help as well.
- Coping – Discovering a variety of healthy coping strategies to prevent children from dangerous “quick fixes” to stress.
- Control – Teaching children to make decisions on their own so they can experience a sense of control.
Resources and news about ACEs and childhood trauma:
Public Health Wales have a really useful short animation about ACEs (first appeared 2017): https://www.youtube.com/watch?reload=9&v=YiMjTzCnbNQ (5.43 minutes)
In January 2021, the Guardian reported research published in the journal Child Abuse and Neglect on the impact of eight adverse experiences on just under 9,000 children. The team found that while about a third of the children had experienced none of the eight types of adverse events by the time they were three, a third had experienced at least one type, and about a sixth had experienced three or more types. Parental depression, harsh parenting and physical punishment were the most commonly reported of the adverse events. Taking into account factors such whether the children were living in poverty, the team found the adverse events studied were associated with both behavioural and mental health problems: Smacking children may have lasting impact, research suggests
In March 2021, the NSPCC published an evaluation of the Sharing the Science programme that aims to help professionals and families understand child brain development and how it can be affected by early adversity. Professionals, parents, carers and young people who took part found the programme helpful and relevant. Read the report: Sharing the Science evaluation NSPCC Learning has updated content on how childhood trauma affects child brain development to include a booklet on sharing the brain story and an animation on the metaphors used. Read the booklet and watch the animation: How childhood trauma affects child brain development
Also in March 2021, what has been described as a ‘once-in-a-generation review of the future of childhood in England’ was launched by the new children’s commissioner for England Dame Rachel de Souza. She said: “As we emerge from the Covid pandemic, this is the moment for something big for children to recognise the sacrifices they have made. I have seen first-hand the effect of this crisis on young people’s hopes and dreams, and sometimes our answers simply have not been good enough. Our response to the trauma of the Second World War was to create a blueprint for a social service system and a National Health Service that improved our lives. We have the chance to do the same again now for children. There is a huge opportunity to remake our social settlement which won’t come again for decades, and we must seize it.” An online survey will be distributed to schools, youth custody organisations, CAMHS in-patient units, children’s homes and advertised on social media and children’s charities, and face-to-face interviews and focus groups will be conducted with children who are under-represented and harder to reach.
In January 2021, research published by Children and Young People Now found that nine out of ten female young offenders are victims of abuse. Just under a third (63 per cent) of young female offenders, aged between 16 and 24 have been victims of rape and/or domestic abuse. In addition, 15 per cent of young women in the same age group have been involved in sex work. Read the article here: https://www.cypnow.co.uk/news/article/nine-in-ten-female-young-offenders-are-victims-of-abuse-research-finds
In September 2020 last year, UK Trauma Council was launched, drawing together a wide-range of individuals and organisations with expertise in childhood trauma. It has three strategic objectives:
- To create a platform the drive UK wide collaboration in order to harness expertise and experience across sectors
- To develop and disseminate accessible, trusted, evidenced-based resources and guidance
- To become a UK hub for learning, training and policy guidance.
Their first resource is ‘Childhood Trauma and the Brain’ here: https://uktraumacouncil.org/resources/childhood-trauma-and-the-brain
And finally, Mandy Parry Training firmly endorses Emma Spillane, who continues to offer training and consultancy to schools and other settings on childhood trauma to Bristol, South Glos, and beyond. As a trainer, I can testify that Emma inspired some of the most glowing testimonials I have ever read.
‘With the year we’ve just had, never has this training felt more relevant. The principles and strategies shared in Emma’s training will be beneficial to all students who’ve faced adversity and the staff supporting them. You may recognise Emma as she has delivered sessions for Mandy Parry Training as an Associate. She has recently launched a brand new website, and I encourage you to go take a look: www.emmaspillane.co.uk‘