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Oprah will be shining a spotlight on the astonishing lifelong health effects of adverse childhood experiences (ACEs) this Sunday on 60 Minutes, and parents, teachers and doctors should all be paying attention.
“It’s important to let the public know how widespread the impact of adverse childhood experiences can be on physical and mental health outcomes. And that these experiences set trajectories early on that are very hard to change as people get older,” says Andrea Gonzalez, psychologist and assistant professor at Offord Centre for Child Studies.
So what are adverse childhood experiences? ACEs fall under three categories: abuse, neglect, and family or household challenges. These stressful experiences may include: parental separation or divorce; living with caregivers who have mental illness or addictions; sexual abuse; verbal abuse; having an incarcerated caregiver; emotional neglect; and witnessing or experiencing domestic violence.
And how do ACEs affect a child? When kids grow up in a chaotic or stressful environment, or go through an exceptionally traumatic life event, this has a significant biological impact on their developing brain and stress-response system. Having chronically high levels of stress hormones—always being in fight, flight or freeze mode—rewires those areas of the brain tied to emotional regulation, memory and learning.
And as the traumatized child gets older, even into adulthood, emotional reactions to stressors can be disproportionate to the real or perceived situation. Kids who have experienced adverse childhood events may have ongoing learning, behavioural and health struggles in school, at home, and out in the world, long after the original trauma has passed.
How exactly can ACEs impact future health? The US Centers for Disease Control (CDC) has linked childhood trauma to an increased risk, decades later, for seven of the 10 top causes of death in adulthood, including--perhaps predictably--drug and alcohol addiction, and more surprisingly, lung disease, heart disease and cancer.
Where's the evidence? The link between disease and the toxic stress created by adverse childhood experiences was validated in CDC’s landmark Adverse Childhood Experiences Study (ACE Study), which draws on data from over 17,000 adult subjects, all of whom had health insurance and most of whom were college-educated and middle class.
Subjects in this study responded to ten questions about their life before the age of 18, such as:
"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 afraid that you might be physically hurt?"
"Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?"
"Were your parents ever separated or divorced?"
Then subjects tallied up their "Yes" responses to arrive at an ACE score out of ten. Research began in two waves, in 1995 and 1997, and the medical condition of subjects has been monitored since then. In the more than two decades since the research began, it has been found that the higher a person's ACE score is, the more likely they are to have a chronic (or even life-threatening) illness, decades after they experienced childhod trauma. According to the Aces Too High news site, founded by health and science journalist Jane Ellen Stevens:
"Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years."
How do I find out my child's (or my own) ACE score? Today anyone can take an online quiz to get their ACE score. It can be used by caregivers, educators and medical professionals as a tool to determine if a child (or adult) may need therapeutic support and a preventative approach to potential medical concerns.
So what if my kid has already experienced adverse childhood events? Or what if I did. Are we doomed?! Absolutely not! But Andrea Gonzalez, psychologist and assistant professor at Offord Centre for Child Studies, offers this cautionary advice for before you self-test:
“My concern is if someone discovers their ACE score is four or higher [indicating], they might have a negative bias toward what their future might look like. But it’s not inevitable that what you experience in childhood will be transmitted to your parenting styles and skills,” she says, adding she would like to see “resiliency” questions asked that don’t appear on the ACE quiz, like: Did you have a protective caregiver in childhood? Do you have a supportive life partner in adulthood?
Studies show that having just one supportive adult in their life--even a teacher, a coach or an aunt or uncle--can help mitigate the impact of ACEs for a child and foster their resiliency.
Should I tell my kid's school about difficult life events they've experienced? Yes! More and more schools in North America are training educators how to teach from a trauma-informed perspective. The methods can sometimes seem counter-intuitive, but the results can re-shape a child's future.
The documentary Paper Tigers (available for home and institutional screenings) shows the power of having supports in place for kids grappling with toxic stress. It chronicles how an alternative high school developed a trauma-informed approach to education and discipline, without judgement or punishment. Rather the school created an in-school suspension program, where kids who came from rough circumstances got a lot of attention from staff and extra help with homework. And these kids were seen by paediatricians and mental health counsellors at school too. Some big changes happened over the next few years: the physical fights that had broken out routinely dropped by 75 percent, and the graduation rate climbed five-fold.
Should I also talk to our family doctor about ACEs? Again, yes! That way they can screen for possible medical conditions and health concerns early on.
The health care community is slowly becoming more progressive, says Nadine Burke Harris, a San Francisco, Calif.-based paediatrician and author of The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.
“We are beginning to understand how to interrupt the progression from early adversity to disease to early death … When we recognize this to be a public health crisis, we can begin to use the right tool kit to come up with a solution … This is treatable,” she says in her excellent TED Talk, which has had close to 5 million views on the Ted Talks site and YouTube combined.
It will take a team approach, says Leonard Greenwood, a psychologist at the Child Protection Centre, Winnipeg Regional Health Authority.
“A comprehensive medical health history, and mental health services provided by professionals who recognize and understand developmental trauma are starting to be recognized as a needed part of health teams’ response to chronic illness (diabetes, pain, eating disorders),” he says.
Lisa Highfield, founder of London, Ont.-based agency Healing Hearts, who works with families in crisis, also wants to see more doctors embrace this comprehensive approach and to become more attuned to the problem:
“I feel many doctors aren’t aware of the impact of trauma. It's not visible. We tend to look at peoples’ outward behaviour instead of underlying issues, such as brain development or learned behaviour from living in an abusive environment.”
Any advice on supporting my trauma-affected child, as a parent? “Educate yourself first. Learn to understand the why of your child’s behaviour instead of fixating on the behaviour itself. Know the child is doing his or her best and explore why they struggle. Many times, "bad" behaviour is a call for help. But we punish a child, missing the opportunity for them to feel heard and missing the opportunity to offer healing,” says Highfield.
When parents are reaching out to agencies or therapists, they should ask if they are aware of the ACE study and if they have a trauma-informed counselling approach too, Highfield recommends.
Can you recommend further resources? The Centre for Effective Discipline provides information on the effects of corporal punishment on children and alternatives and offers free, downloadable parent support and training materials.
Child Welfare League of Canada, promotes the well-being of vulnerable youth and also offers on its site downloadable pamphlets on positive discipline and parenting.
And the Offord Center for Child Studies provides information on child mental health problems and influences that shape children’s’ health and well-being.
Oprah says she hopes emerging dialogues on trauma could be a "game-changer." And we do too!
Tune into Oprah's 60 Minutes segment on ACEs, Sunday, March 11 at 7:00 p.m. ET/PT