According to the Centers for Disease Control and Prevention (CDC), it’s estimated that roughly one in five children have a diagnosable mental health condition. It’s also estimated that one in six adults have experienced at least four of what are known as adverse childhood experiences or ACEs. ACEs increase the risk of experiencing mental health issues. The good news is that risks can be lowered!
For those of us who work in child-facing professions, understanding the nuances of ACEs is critical to providing the support our children need, and that begins with understanding what the risks are, how their impacts manifest, and what we can do to help.
Read on to learn more about ACEs and why we are leveraging resources to mitigate the effects to ensure that all Californians have what they need to thrive.
What are Adverse Childhood Experiences?
The term adverse childhood experiences originated from a seminal study back in the late 1990s. The study was a collaboration between the CDC and Kaiser Permanente and it looked at 17,000 adults who were experiencing health issues. Participants were asked questions that focused on their childhood, and answers were grouped into three categories: abuse, neglect, and family dysfunction.
The study found a strong connection between the number of ACEs and the increased risk of both mental and physical health issues. Using these data they identified ten types of adversity across these three categories — all of which were correlated to poor life outcomes. The good news is that this can be changed.
It was this study, coupled with further research, that uncovered the neuroscience related to ACEs. The science shows a clear line between adversity, toxic stress, and mental health conditions that manifest in children and continue into adulthood.
What they noticed during the original study was that the higher number of adverse childhood experiences someone had, the greater their health risks. Whether it was physical health issues like cancer and lung diseases or mental health issues such as depression, anxiety, or post-traumatic stress disorder, each ACE increased their risk factors in a stepwise fashion. The higher the number of ACEs the higher the level of risk. But the connection to brain science also means that we know more about how to effectively intervene to improve health and wellbeing,
The Effects of Adverse Childhood Experiences
When we look at measuring adversity in childhood for each event of ten specific ones that a client experiences, they are given a score of one on the ACE scale, leaving them with a final score ranging from zero to ten.
The ten experiences are:
- Verbal abuse
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Divorce or separation
- Physical abuse of a parent
- Alcohol or drug abuse by a parent
- Mental illness of a parent
- Incarceration of a parent
While it’s easy to assume that some of these experiences are more impactful than others, it’s important to note that in fact, no one event is likely to be more predictive of risk than the other. The issue isn’t the adversity, but instead the impact that adversity has on the developing brain. The toxic stress response created by prolonged and repeated exposure to adversity – especially during critical periods of development – is what can increase overall health risk factors.
Knowing that a child is exposed to ACEs, understanding the toxic stress response, and realizing the potential impact are all critical pieces of information that lead us toward a better understanding of what safeguards and buffers need to be put in place to mitigate risk. It opens the door to helping children move along a more positive trajectory with the right support systems in place.
ACEs impact each child differently however some common ways they manifest include:
- Learning and behavior problems
- Difficulty with self-regulation
- Sleep issues
- Chronic physical ailments such as headaches or stomach issues
Be an Advocate for Those Dealing with ACEs
The number one factor for mitigating the effects of adverse experiences for children is having at least one stable, dependable adult who believes in them. But the other categories of help are important as well. That’s why the key to intervention is understanding what resources are available to you and your community.
When working with children who’ve had adverse childhood experiences, the good news is that with intervention, the risks can be lowered. A key facet of intervention includes helping the children we work with to cultivate and calibrate resiliency. We can think of resiliency as being like a scale that tips towards the positive. As we add positive factors, they counterbalance adversity.
The ‘Help that Helps’ framework from the ACE Interface Master Trainer Program is another way to cultivate resilience by building supportive relationships. This four-step framework is one of the practices we teach to our clients.
- This step stresses the importance of staying connected to others. All children need at least one stable, dependable, caring adult who believes in them.
Receiving practical help
- This step focuses on receiving practical help like help with homework, or day-to-day activities. It also includes being taught how to identify emotions and how to pause and press the RESET button.
- This step is all about reciprocal support of others, creating a community of people that help each other to make life easier through shared responsibilities, such as carpools, and other communal activities.
- This step is about having access to professional help, learning to reach out when you need support. Reducing stigma, finding the resources available in your area, or helping someone in your reciprocal community find help.
Leveraging ACEs Resources
While exposure to adverse childhood experiences can have a profound impact on overall physical and mental health, intervention can make a significant impact on the short and long-term outcomes.
By understanding the impact of ACEs and how we can mitigate their effects, we can provide those we work with the tools and resources they need to have a brighter future.
Do you work in a child-facing profession and are looking for additional support regarding ACEs? Here are some resources.
Western Youth Services focuses on advancing awareness, cultivating success, and strengthening communities through integrated mental health services for children, youth, and families. We would love to hear from you and see how we can work collectively to ensure that all Californians thrive.
Our RESET Toolbox is a collection of no-cost training and resources designed to help children build resilience and to provide resources for adults with children in their care to help them do so.
In early 2020, the California Surgeon General and DHCS launched the ACEs Aware Initiative. This initiative focuses on providing reimbursement for Medi-Cal providers for conducting ACE screenings on children and adults under the age of 65.
These screenings ask questions to identify the potential for future health impairments, based on known risk factors. Plus, the initiative is designed to ensure providers not only have the appropriate tools, training and resources to include ACEs screening in their assessment process, but the training and resources to know how to incorporate the knowledge of ACEs and toxic stress response into their patient care plans.
Different screening tools are used for children/adolescents and adults. The Pediatric ACEs and Related Life-events Screener (PEARLS) is used to screen children and adolescents ages 0 – 19. The ACE Questionnaire for Adults is used to screen adults. The tools are available in 17 languages and in both de-identified and identified formats. For more information, visit the ACEs Aware Screening Tools web page.
The CDC also offers a variety of information, tools and resources for those looking to learn more about ACEs and how to advocate for the children they work with.
As always, we are here to help!
Lorry Leigh Belhumeur, Ph.D.
Chief Executive Officer
Western Youth Services