The Adverse Childhood Experiences (ACE) study (Felitti et al., 1998) was first conducted in 1995-1997 by the CDC and Kaiser Permanente medical professionals in southern California. It gave medical and mental health professionals a significant glimpse into how trauma and early childhood experiences affect us as humans as we grow and develop. The original study looked at 17,000 individuals over the course of several years and found a stunning correlation between emotional experiences as children and emotional, physical, and mental health as adults (Felitti et al., 1998).
What are ACEs and how are they assessed?
As depicted in the graph above, ACEs are incidents of abuse, neglect and household dysfunction. The questionnaire assesses how many of these types of experiences a child has endured – for each type of experience, they score one ACE. It’s not necessary for children to be the direct victims of domestic abuse for the effects to impact them; in fact, one of the ACE questions is whether or not you have witnessed your mother or step-mother being physically abused.
What are the lifelong health implications of ACEs?
The study found that those with more ACEs are at higher risk for health and mental conditions, and these findings have been replicated since. For example, children exposed to four or more types of ACEs are:
- twelve times more likely to commit suicide
- more likely to engage in risky behaviour such as drinking and drugs.
- 390% more likely to develop chronic obstructive pulmonary disorder COPD than a person who has 0% (Felitti, 2002).
People look at these numbers, and their initial response is – yes, well trauma causes terrible behaviour or bad choices. Therefore, people who engage in risky behaviours, such as smoking, are more likely to have health conditions, such as COPD. That makes sense.
But what was striking about this research is that it showed that the increased risk of COPD did not stem from smoking; instead, it appears to be a physical response from the body related to the stress of early childhood trauma. According to Adna and colleagues (2008), the impact of smoking vs not smoking was minimal. What made more of a difference was the number of ACEs a person had!
There is a long list of other increased health-related issues, likelihoods, percentages and risk factors that have been discovered concerning adverse early childhood experiences, and these alone could fill an article, but that is not what this article is about.
I use this example because the link between COPD and ACEs has been thoroughly vetted. Lopes et al. (2020) performed a meta-analysis of nineteen studies. Their results showcase just how much of an adverse effect these traumatic experiences have on young individuals regarding their health. The brains of children who endure high levels of stress regularly without the buffering effect of a loving, supportive caregiver experience overactive stress responses, including impairment of executive functioning skills and increased cortisol levels, which then have adverse effects on the body’s organs and systems (Waehrer et al., 2020).
The Importance of One Caring Stable Adult
Having one caring stable adult in a child’s life who looks out for them can help shield them from these traumatic life events (Murphy & Sacks, 2019) (Brockie et al., 2018). However, for many of these children in high-poverty, high-crime and low-income areas, a responsive caregiver will likely be an educator or early childhood care provider. When educators and caregivers are trained and educated to help guide and support these children, the outcomes are incredibly beneficial.
Studies have shown that children who are supported and cared for have better health and have increased self-esteem. They also have better inter and intrapersonal skills, resiliency and are less likely to engage in risky behaviors such as drinking, drugs, smoking underage sex (Murphy & Sacks, 2019) (Stormshak et al., 2019) (Thomas et al., 2017).
The Importance of Trauma-Informed Staff in Schools
If you look at young children in the school setting who exhibit delays in reading, cognition, speech or physical abilities, early intervention is the next logical step. Educators are in an excellent position to step in, refer, diagnose and assist these children because they have been trained to notice the signs and signals of various learning disabilities. The same needs to be done for trauma.
As Murphy & Sacks (2019) state, “In many communities, these services are lacking or inadequate, underscoring the importance of schools as a frontline setting for addressing trauma and other mental health concerns.”
Schools in general are a perfect setting to access and assess children with trauma; however, in order to implement these practices, not only do schools need trauma-informed staff but they also need more support staff, better resources and extra assistance from external psychology services.
Additionally, schools should be supported to create after-school programs, create mentor opportunities and teach social-emotional skills. Schools and communities could also be supported to educate parents on the signs of trauma and its effects on children. Research has shown when schools and communities work together to help families and their children, the adverse effects of ACEs can be mitigated.
The role of the teacher in the life of a child with trauma
Teachers are often one of the first defence lines protecting children from harmful situations and children who are escaping trauma or abuse often turn to school and educators as a positive force. Thousands of at-risk children can slip through the cracks when educators lack the proper training and knowledge. We conducted market research in February 2021 and found that almost 90% of teachers did not receive appropriate training in trauma and also didn’t feel confident in identifying symptoms or supporting a child who has experienced trauma.
Because, early intervention and prevention are the most efficient ways to negate the adverse effects of ACEs (Murphy & Sacks, 2019; Waehrer et al., 2020), we developed a 10-hour online training Working With Children Who Have Experienced Trauma specifically for education staff. Upon completion of this course, learners will have a comprehensive understanding of trauma, why symptoms are often misdiagnosed and what strategies need to be used with these children.
Now, due to COVID-19, more than ever, children are suffering through traumatic experiences. Worryingly, a recent article by Evans et al. (2020) reported that while domestic violence has increased, some domestic abuse organizations saw a drop in calls by more than 50%, indicating that victims are less likely to report abuse with their partner in the home. For children, this is further compounded by lack of play opportunities and increased social deprivation, which are new factors that have been introduced by the pandemic lockdowns.
The unfortunate truth is that trauma is much more common than we would like to think; most studies point to approximately half of the population having one or more ACE in their past (Felitti et al., 1998; Murphy & Sacks, 2019). These staggering statistics alone indicate educators need to be better prepared to recognize and help children as they experience trauma.
While there is never going to be a one size fits all set of technique, providing educators with trauma-informed training increases children’s odds in this game of life. Support from trained adults will give children the tools to navigate through their experiences with the buffering adult that research is integral to coping with and defeating trauma.
Felitti V. J. (2002). The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal, 6(1), 44–47.
Adna, R. F, Brown, D. W., Dube, S. R., Bremmer, J. D., Felitti, V. J, Giles, W. H. (2008) Adverse Childhood Experience and Chronic Obstructive Pulmonary Disease in Adults. American Journal of Preventative Medicine, 34(5), https://doi.org/10.1016/j.amepre.2008.02.002
Waehrer, G. M., Miller, T. R., Silverio Marques, S. C., Oh, D. L., & Burke Harris, N. (2020). Disease burden of adverse childhood experiences across 14 states. PLoS ONE, 1. https://doi.org/10.1371/journal.pone.0226134
Murphey, D., & Sacks, V. (2019). Supporting Students with Adverse Childhood Experiences: How Educators and Schools Can Help. American Educator, 2, 8.
Evans, M. L., Lindauer, M., Farrell, M. E. (2020). A Pandemic within a Pandemic — Intimate Partner Violence during Covid-19. New England Journal of Medicine 383, 24, 2302–2304. https://doi.org/10.1056/NEJMp2024046
Felitti, V. J., Anada, R. F., Nordenberg, D., Edwards, V., Koss, M. P., Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Deaths in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14, 4. https://doi.org/10.1016/S0749-3797(98)00017-8
Brockie T. N., Elm J. H., Walls M.L. (2018) Examining protective and buffering associations between sociocultural factors and adverse childhood experiences among American Indian adults with type 2 diabetes: a quantitative, community-based participatory research approach. BMJ Open 2018, 8. doi: 10.1136/bmjopen-2018-022265
Lopes, S., Hallak, J., Machado de Sousa, J. P., & Osório, F. L. (2020). Adverse childhood experiences and chronic lung diseases in adulthood: a systematic review and meta-analysis. European journal of psychotraumatology, 11, 1, 1720336. https://doi.org/10.1080/20008198.2020.1720336
Stormshak, E., Caruthers, A., Chronister, K., DeGarmo, D., Stapleton, J., Falkenstein, C., DeVargas, E., & Nash, W. (2019). Reducing Risk Behavior with Family-Centered Prevention During the Young Adult Years. Prevention science: the official journal of the Society for Prevention Research, 20(3), 321–330. https://doi.org/10.1007/s11121-018-0917-2
Thomas, P. A., Hui, L., Umberson, D., (2017). Family Relationships and Well Being. Innov Aging. 2017 Nov; 1(3): igx025. Published online 2017 Nov 11. doi: 10.1093/geroni/igx025