Adverse Childhood Experiences
By Albert B. Kelly
I was talking with an acquaintance recently about childhood
in today’s world in comparison to a typical childhood of a couple of
generations ago and we both came to the conclusion that things were a lot
easier then or at least it seemed that way. Keep in mind that this conclusion
came from two guys who entered the world during the Eisenhower administration
for what that’s worth. The subject of ACEs came up. I was not really familiar
with ACEs, which in this context stands for “Adverse Childhood Experiences”.
In a nutshell, it’s the idea that what happens to children
in the first decade or so of their lives continues to impact their physical health
throughout the remainder of their days. As the word “adverse” suggests, these
life experiences are negative and can include emotional abuse or neglect,
physical or sexual abuse, household substance abuse, household mental illness,
parental separation through divorce or death, or an incarcerated household
member. It can also include a daily environment filled with fear and danger;
poverty, drive-by shootings, or gang violence.
Looking a little deeper, I learned that these adverse
experiences might come in the form of a single traumatic incident, but that they
just as often encompass an environment where the trauma is slow and cumulative,
a sort of death by lesser traumas, perhaps with chaos or loss, expressing
itself in a defensive crouch that becomes the resting position each day for years
of a child’s life.
The CDC recognizes ACEs as an important public health issue
and multiple organizations from the American Academy of Pediatrics (AAP) to the
Robert Wood Johnson Foundation have studied the role of ACEs on individuals,
families and communities and they’re a good starting place for information and resources
to help understand and deal with ACEs.
Two things that stood out to me about Adverse Childhood
Experiences; the first is that overwhelming stress in childhood leaves physical
impacts courtesy of the psychological and secondly that ACEs and the resulting stress
is not confined to any one ethnic, racial, or income group- it’s not
necessarily a respecter of persons, though the incidences are higher for those
living in poverty.
We’re not talking about normal stress, meaning the stress that
generally makes us more resilient and stronger as people, but the type of
stress that the AAP calls “toxic stress” which they describe as a “strong,
frequent, or prolonged activation of the body’s stress response systems”.
As I think about this description, I conjure up that
cocktail of adrenaline and cortisol that surges through us in times of fear,
trauma, or danger. To imagine it, I tried to recall the moment I locked up the
breaks and swerved to avoid hitting oncoming traffic or those hours in the
patient lounge waiting to find out if my loved one made it off the operating
table. For you it might be some other thing that put your heart in your throat
and those “butterflies” in your gut while pushing your blood pressure off the
charts.
Imagine this level of stress in a developing child that never
eases or stops. Researchers know that the genes involved with the
neuroendocrine system which regulates eating, drinking, metabolism, blood
pressure and certain behaviors are strongly influenced by our experiences. When
a child’s body grows and develops under conditions of toxic stress, changes to
these genes can occur and cause changes in the developing brain and researchers
are connecting those dots between these changes in childhood and adult heart
disease, alcoholism, obesity, mental health, and drug use among others.
This matters because while most parents and families intuitively
understand the damage and destruction that occur from physical and sexual abuse,
it can be easy to underestimate or simply ignore so many other factors,
especially if daily life is consumed with simply surviving. Sometimes it takes
a herculean effort to keep our worries, fears, hurts, resentments, bitterness,
or bad habits from becoming our children’s burden, but that too is part of
protecting them and breaking the generational cycle of health and other problems
that run in too many families.
In New Jersey, Cape May and Cumberland Counties were ranked
lowest in safety and well-being according to the AAP. To make progress, we’ll
need our schools and healthcare organizations to focus us more on identification
and early intervention of ACEs through screenings and assessments both to
protect children and ease burdens on the healthcare system and our public
assistance safety net.