Adverse Childhood Experiences (ACEs) is a term used to describe specific traumatic events that occur before the age of 18.

They can include direct experiences which are things that are directly done to a child and indirect experiences which relate to the environment in which the child is brought up in.

There is significant and growing research that traumatic experiences during childhood have a huge impact on individual health and wellbeing.

ACEs can create harmful levels of stress known as toxic stress, which can cause changes in the development of the brain and the hormonal, nervous and immune systems.

Bessel Van der Kolk covers the impact of adverse childhood experiences in his book ‘The Body Keeps Score’, notably child abuse and neglect, on the developing brain. Self regulation is learned from early caregivers through mirror neurons, empathy, and imitation.

Early trauma changes the way the brain is wired and ‘neither drugs nor conventional therapy’ has show the necessary ability to change the brain. We have the evidence through neuroscience and most powerfully gathered by this author, to show that the majority of child mental health issues stem from trauma.

Toxic Stress

We all experience stress every day.  A stressful event can trigger a flight or fight response – the feeling you get when your body is flooded with adrenaline and you are ready to run away or fight the threat.  

Usually this response leads to a short term stress, the threat subsides or something positive happens to restore the stress levels and make the person feel safe again. In these situations, no harm is done, and in some cases the extra adrenaline surge is helpful.  

However, if the threat never goes away or there is no safe haven or appropriate support then the ongoing stress response can become harmful. This is when stress tips over into becoming toxic stress.

Behaviour

You can’t see when someone is experiencing toxic stress and feeling permanently under threat. However, it’s likely to affect the way they respond and behave. Therefore on the outside they may look and behave like the image, when in actual fact, on the inside they are feeling unsafe, anxious, frightened, confused and undervalued and unloved.

People who have experienced ACEs and trauma, are more likely to find the small things in everyday environments trigger high stress levels. 

The most commonly measured ACEs are:

Abuse

Physical, sexual or emotional

Neglect

Emotional or physical

Household or Parental Issues

Mental illness, substance misuse, absent relative, witnessing domestic abuse, and parental separation.

Other types of ACEs

Bullying

Poverty

Financial insecurity

Peer rejection and having no friends

Experience of discrimination including racism

Bereavement of a sibling, relative or pet

Community violence

Food insecurity

Being a care leaver or involved within the care system

Being exposed to community violence

Refugees and asylum seekers

Critical Illness

Being criminally exploited

Being a young carer

Over time, this can result in a disruption in social, emotional and behavioural problems.

Individuals who have ACEs are more likely to develop risk taking behaviours such as drug or alcohol misuse, self – harm, smoking, dietary problems, potential involvement with crime and anti- social behaviour in adolescence.

These behaviours act as coping mechanisms and in later life increase the risk of ill health and disabilities, social problems, low productivity and some cases early death.

Not everyone with ACEs will experience the same health harmful outcomes or go on to struggle in adulthood.

How common are Adverse Childhood Experiences

Research from ACEs surveys in the US, UK and elsewhere tells us ACEs are incredibly common yet rarely asked about.

Many of us will know of someone or be involved with someone who has experienced or been affected by ACEs.

In the English National ACE Study, nearly half (47%) of individuals experienced at least one ACE during their childhood with 9% of the population having four or more ACEs (Bellis et al, 2014).

In general, children who experience ACEs are more likely to have a parent who has also experienced ACEs. The potential negative impacts of ACEs can be substantial and can even be passed down through the generations.

ACE’s can lead to unhealthy lifestyles

Experiencing ACEs and toxic stress are linked to harmful health behaviours behaviours and the development of diseases later in adult life. This can have negative, long-lasting effects on physical and mental health and wellbeing. These effects characterise a number of major public health, social and economic issues across communities.

Key coping mechanisms include:

 Smoking tobacco or e- cigarettes 

Drinking alcohol

Taking drugs

Unprotected sex

High risk sexual behaviour

Anti – social behaviour and criminal involvement

Self – harm

Overeating or undereating

Gambling

ACEs are likely to lead to a variety of adverse health and social problems in life

Brain Development

• Brain abnormalities, including smaller brain sizes and less efficient processing
• Changes in gene expression (epigenetics)
• Impaired stress response

Physical Health Conditions

• Heart Disease
• Cancer
• Respiratory Disease
• Type 2 Diabetes
• Obesity
• Sleep disorders
• Sexual Transmitted Infections
• Shorter life span
• Poor immune system
• Common childhood health problems such as headaches

Cognition

• Speech and language delays
• Difficulty paying attention
• Difficulty problem – solving
• Impaired readiness to learn
• Frequent school absenteeism
• Low academic attainment

Emotions

• Difficulty controlling emotions
• Limited self – coping  skills
• Challenge recognising own emotions
• Increased sensitivity to stress
• Shame and guilt
• Low self- esteem and self  – efficacy

Mental Health

• Depression
• Anxiety
• Negative self – image / low self – esteem
• Suicidality
• Post-traumatic stress disorder (PTSD)

Behaviour

• Poor self – regulation
• Poor diet
• Social withdrawal
• Drug and alcohol misuse
• Smoking tobacco or e-cigarettes
• Early sexual initiation
• Unplanned teenage pregnancy
• Criminal behaviour
• High usage of health and social services
• High usage of the police and justice systems

Relationships

• Poor attachment
• Poor socialisation and understanding of social interactions
• Difficulty forming social relationships
• Family relationship breakdown or problems
• Intergenerational cycles of abuse and neglect

Can we prevent ACEs?

Yes! Early intervention to prevent ACEs and the worst effects of ACEs is key.

The first 1000 days (pregnancy up to a child’s second birthday), pre-school, primary school age and teenage years are critical windows for intervention. However, mitigation can continue into adulthood, for example help with coping strategies and mental wellbeing support.

However, it is important to recognise that is never too late to address the impact of trauma and that different individuals will require different kinds of support.

How can ACE be treated?

Building resilience has been shown to help people prevent and overcome many of the problems arising from childhood adversity and trauma. Supportive personal relationships with trusted adults and a sense of safety in the community are essential for people to flourish.

Resilience is the ability to adapt well in the face of adversity.

Research has found that having a relationship with at least one trusted adult – parent, siblings, wider family networks, teacher and professionals can provide the buffering needed to overcome the effects of ACEs and toxic stress.

An easy way of thinking about resilience is visualising a seesaw or a scale. Protective factors on one side counterbalance the negative outcomes on the other.

By building resilience through promoting protective factors such as relationships, community support and coping skills, we can help people tip the scale towards more positive outcomes even when there is a heavy burden imposed by ACEs on the negative outcome side.

Resilience isn’t a personality trait, some people have instinctive resilience but it is a skill that we can all learn to practice and strengthen throughout life. 

The impact of the feeling under threat, all the time, can cause people to develop coping strategies that help to deal and manage with the stress temporarily. These coping strategies, if repeated over time, can increase the risk of physical, mental and social health problems in later life.

Research shows us that people understanding ACEs helps them to deal with them. But we can only do that if we are willing to talk about them.

An opportunity to talk openly about ACEs in a safe space can provide a therapeutic effect.

A way communities and organisations can help with ACEs is becoming trauma-informed. This means incorporating knowledge of ACEs and trauma into everything we do and taking into account an individual’s early life experiences.

Summary

• ACEs are traumatic experiences that occur before the age of 18 years.
• ACEs can be categorised into direct experiences that affect the child directly and indirect experiences that occur in the environment in which the child is brought up in.
• There is a wide range of traumas outside the original 10 ACEs that organisations and communities need to consider when thinking about ACEs.
• The outcomes associated with ACEs are not inevitable, the cycle of adversity can be broken through hope and building resilience.
• Resilience is the ability to adapt well in the face of adversity.
• The most important factor to building resilience is having a relationship with at least one trusted adult during childhood.