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Mitigating the Impact of ACEs and the Toxic Stress Response During and After COVID-19


As the world begins to come out of living through a global pandemic, it is increasingly clear that the effects of COVID-19 run far deeper than what we see on the surface and what we initially imagined. Communicable disease outbreaks (such as COVID-19), natural disasters and Adverse Childhood Experiences (ACEs) impact both physical and mental health, including increased risk factors for cardiovascular, metabolic, immunologic, and neuropsychiatric health over the lifespan.

One of the reasons for the increased mental health risks during this pandemic is the disruption of access to mental health care and the resources needed to maintain good mental health. Together, the repeated and persistent exposure to these biological stresses with the diminished access to care and resources contribute to what is known as the toxic stress response. 

Read on to learn more about the correlation between COVID-19 and Adverse Childhood Experiences (ACEs) and what can be done to minimize the impacts. 

What are Adverse Childhood Experiences or ACEs?

The term Adverse Childhood Experiences or ACEs comes from the landmark 1998 study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, which provides scientific evidence for the connection between childhood adversity and the risk for poor physical, mental, behavioral, and social outcomes later in life. The study discovered that ten adversities within three domains — abuse, neglect, and/or household dysfunction — had the strongest relationship with poor life outcomes. The more adversity one experiences prior to their 18th birthday, and without intervention, the more likely it is that they will carry the unresolved trauma into adulthood and often into the next generation.

The original ACE study also spurred research into the mechanisms that contribute to life challenges as a result of adversity. They learned that toxic stress, or prolonged exposure to adversity without adequate buffering, can lead to significant changes in the developing brain, endocrine and immune systems, and even impact the ways our genes encode DNA.

While the ACE Study demonstrated that the original ten categories of adversity had a strong relationship with poor life outcomes, there’s a growing body of research documenting the impact of other stressful events on the developing brain. These social determinants of health can be measured through the Pediatric ACEs and Related Life Events Screener (PEARLS). Experiences such as racism and discrimination, neighborhood violence, the death of a parent, and food insecurity also increase the risk for toxic stress. This leads one to consider what other types of adversities might result in a toxic stress response, especially as we face the pandemic and its related challenges. 

Dr. Nadine Burke Harris Quote | Western Youth Services

While some life stress is expected, prolonged exposure to toxic levels of stress and adversity is what creates challenges for the developing brain of children. Instinctively, our bodies are equipped to be under stress for about 15 minutes at a time, long enough to fight, flee, or freeze. When a child is exposed to significant and recurring adversity, it has an impact on both the brain and the body in potentially unhealthy ways.

Unresolved trauma is ever-present in our world. Understanding the direct correlation between ACEs and the occurrence of mental health concerns such as depression, anxiety, and PTSD is vital as we intervene to provide buffering to children and adults, and families.

The science, and especially the neuroscience related to the original Adverse Childhood Experiences Study and the more recent PEARLS really connects the dots between adversity, toxic stress, and mental health conditions that manifest in children and continue into adulthood.   Understanding the problem better means that we know more than ever before about how to design solutions

The reality is that people need emotional support now more than ever, so it’s vital that we understand the science behind ACEs and toxic stress and rely on strategies for building resilience as we promote healing in this and future generations.

ACEs and The Long-Term Effects of COVID-19

COVID-19 has caused a great deal of disruption in our world. Many children and families have been profoundly affected with increased anxieties, altered routines, finances jeopardized,  sickness, and deaths of loved ones. Their whole existence seems upside down, and that can feel very scary. Fears and reactions can range from worrying about a grandparent’s health, sadness from canceled extracurricular activities or missing the simple act of playing with friends. The high level of stress and anxiety that people are feeling is pervasive.

Typically with children, their behavior is an indicator of the impact of the stress they see around them. Issues with self-regulation, irritability, and withdrawal are all common symptoms. Some children manifest this toxic stress response in physical ways as well. They experience stomach aches, sleep issues, headaches, and other symptoms, which can all be stress-induced.

Because their brains and bodies are still developing, it is critical that we mitigate the effects of an overactive stress response due to ACEs and related life events. The impact of COVID-19 may be amplified for children who already have experienced trauma.

While COVID-19 presents a unique challenge because so much is outside our control, we can do things to help recognize and mitigate some of the stress that we’re feeling.

Mitigating ACEs: Look for the Signs

One of the best steps you can take to help mitigate ACEs and the toxic stress response is to increase your awareness of the possible signs someone may be exhibiting due to stress.

In particular, children are challenged to find words to explain how they’re feeling and likely can’t express why they feel the way they do. It’s up to those of us around them to be on the lookout for any changes in behavior, demeanor or red flags that show something is wrong. 

Start by having a conversation, and help them identify and name their feelings in an age-appropriate way.  To get them to open up, it may be helpful to offer up choices, such as asking if they’re sad, worried, afraid, based on what you see. Understand that they’re likely emotional about what’s happening, just like adults are, so it’s essential to validate their full range of feelings and let them know it’s okay to feel all of their emotions, whatever they may be.

Some tips for these discussions include:

  • Be calm, understanding, and sensitive to their feelings.   
    • speak in a calm tone
    • demonstrate understanding and sensitivity to feelings by mirroring
    • not being overly reactive.
  • Ask what they are feeling and what questions they have.
  • Correct any inaccurate information they share.
  • Talk about the “why” of what’s happened — although we are starting to get back to life the fear is real that the virus might come back, that they may need to go back into isolation again. Use age-appropriate language and do your best to stay positive, and not use to fear as a motivator.
  • Focus on what they can control (like continuing to wash their hands or even wearing a mask if it’s comforting for them).

School lunch | Western Youth Services

Mitigating ACEs: Establish Routines and Stick to Them

As we start to get into a daily routine again, establish and stick to a routine that feels “normal,” which can help offset feelings of fear and worry.

When building a routine, getting input from everyone involved is a great way to get buy-in and help children feel involved. Much of their stress can stem from feelings of boredom or anxiety, so allowing them to feel some control over their circumstances and including activities they enjoy can help combat those feelings.

In times of stress and uncertainty, a little bit of familiarity can go a very long way. By establishing and sticking to a routine, you’re creating something that feels “normal,” which can help offset feelings of fear and worry.

When building a routine, getting input from everyone involved is a great way to get buy-in and help children feel involved. Much of their stress can stem from feelings of boredom or anxiety, so allowing them to feel some control over their circumstances and including activities they enjoy can help combat those feelings.

Mitigating ACEs: Stress Busting Strategies for Kids

When creating a schedule, build in stress busters to build resilience and navigate through adversity.

The graphic below is from the California Surgeon General’s Playbook, and is a resource from the ACEs Aware initiative led by Dr. Nadine Burke Harris, California Surgeon General, and Dr. Karen Mark, Medical Director of the Department of Health Care Services. They’ve set a bold goal to cut ACEs and toxic stress in half in one generation and as a recipient of ACEs Aware grants, WYS is working to ensure their vision is realized.

Safe, stable, and nurturing relationships and environments in which children feel safe emotionally and physically can protect children’s brains and bodies from the harmful effects of stress. You can help your child be healthier by managing your own stress response and helping your child do the same. Healthy nutrition, regular exercise, restful sleep, practicing mindfulness, building social supports, and getting mental health care can help to decrease stress hormones and prevent health problems.

Visit the ACEs Aware website for more resources for families, including:

  • California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids during COVID-19
  • A stress relief playbook to help you understand what to look out for and what you can do to protect your family’s health.
  • Positive Parenting & COVID-19: 10 Tips to Help Keep the Calm at Home – English Version – Spanish Version
  • Young Children at Home during the COVID-19 Outbreak: The Importance of Self-Care
  • Information from ZERO TO THREE about why self-care is not selfish or indulgent—it’s how we keep ourselves well to ensure we are physically, emotionally, and mentally capable of being there for our young children.
  • Getting Children Outside While Social Distancing (in English and Spanish)
  • Teens & COVID-19: Challenges and Opportunities During the Outbreak (in English and Spanish) 
  • Good Sleep Habits (in English, Spanish, and Portuguese)
  • Using Mindfulness to Rescue Toxic Stress (in English, Spanish, and Portuguese)

At WYS, we’re also finding new ways to support our community, including through the RESET Toolbox that’s designed to aid children and teens in building resiliency.  There are trainings and resources for parents and caregivers, teachers, community members, and it’s filled with useful ways to navigate through these challenging times. 

Get the Support You Need to Build Resiliency

Every time you counter toxic stress, you have an opportunity to build resilience. It’s almost like trading up. By incorporating some of the easy techniques and habits we’ve shared into your day, you strengthen your resilience. When taught to children, they can form lifelong habits.

Taking a proactive and preventative approach to mental and physical wellness is always the preferred route. By better understanding how COVID-19 can create ACEs,  and how you can mitigate certain factors, you’ll be better prepared to support yourself and others.

As always, we are here to help!

Lorry Leigh Belhumeur PhD, CEO of Western Youth Services on Blog - Western Youth Services [WYS) Orange County - the hub of mental health care and wellness solutions for kids in Orange County, CA

Lorry Leigh Belhumeur, Ph.D.
Chief Executive Officer
Western Youth Services
Pronouns: She/Her/Hers

ACEs Aware Grantee Logo

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