For Some Kids, This Last Year Qualifies As An Adverse Childhood Experience (ACE)

Kids have been asked to sacrifice a lot this last year. In-person school, playdates with their friends, travel and sporting activities, and fun extras like trips to the movies. On top of all that, many have been trapped inside with parents facing their own stressors: trying to work from home, keeping businesses afloat, and even just paying the bills after work has dried up.

Our kids have been soaking it all in, taking on plenty of that stress themselves. For some, the experience of adjusting to Covid-19 life has been a truly traumatic event. The kind it may take years for them to fully recover from.

Understanding ACEs

The term ACEs, or Adverse Childhood Experiences (ACEs), comes from the landmark 1998 ACEs Study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente,” Lorry Leigh Belhumeur, Ph.D., recently explained. As a licensed psychologist and Chief Executive Officer at Western Youth Services, much of her career has been shaped around reexamining mental health in the context of Adverse Childhood Experiences.

She said the study backed up the link between childhood adversity and the risk for poor physical, mental, behavioral, and social outcomes later in life. It discovered and outlined 10 types of adversity within three domains (to include abuse, neglect, and/or household dysfunction) that were most strongly correlated with poor life outcomes.

“The science, and especially the neuroscience, related to ACEs really connects the dots between adversity, toxic stress and mental health conditions that manifest in children and continue into adulthood.”

The following qualify as a typical ACE:

  • 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

For each of the above events a child experiences, they are given an additional score of 1 on the ACE scale, with the final score ranging between 0 and 10.

“Children who experience four or more ACEs find themselves at significantly higher risk of involvement in the criminal justice system and poor economic outcomes, as well as a host of other health and mental health outcomes,” Belhumeur explained. “Compared to those who have experienced zero ACEs, children with four or more ACEs are 2.7 times less likely to graduate and 3.1 times more likely to get arrested as a juvenile. Later in life, those with four or more ACEs are 2.8 times more likely to be charged with a felony and 2.0 times less likely to hold a skilled job,” she shared, citing a 2015 study published by the American Academy of Pediatrics (AAP).

One of the things researchers learned, according to Belhumeur, is that toxic stress (such as that sustained by exposure to multiple ACEs) can actually contribute to changes in the developing brain, endocrine and immune systems. She said ACEs can even impact the ways our genes encode DNA.

“While the ACE Study demonstrated that the original 10 categories of adversity had a strong relationship with poor life outcomes, there is a growing body of research documenting the impact of other stressful events on the developing brain,” she explained.

In other words: even if an event doesn’t neatly align with one of the 10 recognized ACE categories, if it is traumatic enough, it could lead to similar outcomes.

“Experiences such as racism and discrimination, neighborhood violence, death of a parent and food insecurity also increase the risk for the toxic stress response that is also associated with prolonged and persistent exposure to ACEs,” Belhumeur said.

Examining 2020 and Covid-19 Through an ACEs Lens

One of the concerning aspects of 2020 is the fact that reports of child abuse and neglect were down across the country. While that may seem like a good thing, experts (including Belhumeur) fear it wasn’t that incidents of abuse were actually down, but rather that fewer cases were being caught and reported by school officials who typically have more access to kids outside their family home.

With most kids learning from home, abuses may have been taking place without the eyes of school officials to identify those events.

But even absent unreported cases of abuse and neglect, Belhumeur said many children and families have experienced increased anxieties, altered routines, jeopardized finances, and the sickness and deaths of loved ones in light of Covid-19.

“Their whole existence seems upside down, and that can feel very scary,” she explained. “Fears and reactions can range from worrying about a grandparent’s health, sadness from cancelled extracurricular activities and missing the simple act of playing with friends. The high level of stress and anxiety that people are feeling is pervasive.”

This is concerning, she said, because children are uniquely vulnerable to the effects of an overactive stress response due to the fact that their brains and bodies are still developing. This is especially true for those who already have a history of ACEs, and may already be sensitive to life stressors as a result.  

“It is increasingly clear that the effects of Covid-19 run far deeper than what we see on the surface and what we initially imagined,” she went on to say. “Communicable disease outbreaks (such as Covid-19), natural disasters and childhood adversity impact both physical and mental health, including increased risk factors for cardiovascular, metabolic, immunologic, and neuropsychiatric health.”

So yes, the experiences kids are having in the midst of this worldwide pandemic could potentially lead to the same outcomes as traditional ACEs.

“Again, it is the prolonged and persistent unbuffered exposure to adversity that leads to the toxic stress response and the associated higher levels of risk for poor outcomes,” Belhumeur explained.

What Parents Can Do

Lindsay Braman, MACP, is a psychoeducator and mental health illustrator. She explained that parents helping their kids through sustained trauma has to start with recognizing the symptoms of that trauma.  

“Behavior challenges, new or worse anxiety symptoms, regression, new difficulties with focus/attention, or a shift in attachment—such as becoming very clingy or suddenly very aloof—may be clues that children are experiencing trauma as a result of the many challenging experiences of 2020,” she said.

Belhumeur added that the following symptoms may be signs your child is struggling:

  • Difficulty with self-regulation
  • Irritability
  • Stomach aches
  • Sleep issues
  • Headaches

If you recognize some of these physical symptoms or behavior changes in your child, it may be time for you to act.

“The degree to which children experience elements of 2020 and Covid-19 as trauma will likely depend on how the difficult experiences of 2020 were metabolized within their family,” Braman said. “If parents or caregivers are emotionally or physically unavailable to a child due to the economic, emotional, or health challenges of 2020, children may experience the impact of that loss as trauma.”

So the first thing to do as parents is analyze your own response to the current situation. Is it possible your manifestations of stress have been impacting your child? If so, it may be prudent to reach out to a mental health professional yourself and start gaining the tools that will help you to process and heal in a healthy way.

Beyond that, Braman said researchers are actively working to develop an understanding of how to best counteract the negative impacts of ACEs. In fact, a 2019 study out of Johns Hopkins University was the first large-scale study to identify Protective Childhood Experiences (PCEs).

“These experiences are connected to improved mental health and social connectedness in adults,” Braman said. “Kids who experience many PCEs during childhood become adults better able to seek support and get care, which improves outcomes even for kids with many ACES.”

Identified PCEs (illustrated by Braman) include:

  • Being able to talk about feelings with family
  • Feeling supported by family in difficult times
  • Participating in community traditions
  • Feeling as though one belongs in high school
  • Feeling supported by friends
  • Feeling as though at least two non-parent adults truly care
  • Feeling safe and protected by adults at home

“Simple things parents can do to promote PCEs include preserving family traditions (even if they need Covid-19 modifications), talking with kids about their feelings, and helping kids stay connected to supportive adults outside the home,” Braman said.

Belhumeur pointed out that it’s also a good idea to have conversations with kids that help them to identify their own feelings in age-appropriate ways.

“You may need to give them some choices, such as asking if they are sad, worried, or afraid, based on what you see,” she explained. “Understand that they’re likely emotional about what’s happening, just like adults are, so it’s essential to validate positive or negative feelings and let them know it’s OK to feel their emotions, whatever they may be.”

She provided the following tips for embarking upon those discussions:

  • Be calm, understanding, and sensitive to their feelings.
  • Ask what they feel and what questions they have.
  • Correct any inaccurate information they share.
  • Talk about the “why” of what’s happening—especially why they can’t do their normal activities. Use age-appropriate language and do your best not to use fear as a motivator.
  • Focus on what they can control (like washing their hands or wearing a mask).

“Exposure to ACEs is not a life sentence, even though there is evidence that exposure increases risk for negative outcomes,” Belhumeur said. “It’s really exposure to ACEs without intervention that increases risk.”

That intervention, she explained, can take may forms. “Having a social support system and access to practical help, as well as access to physical and mental health and related resources are all considered to help people overcome the impact of ACEs.”

Perhaps most importantly, having parents that listen, that care, and that want to help is likely one of the best protective factors children can have.

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