There Needs to be More Discussions About Awareness, Prevention, and Healing from Adverse Childhood Experiences (ACEs)

[Image Description: "CHILDREN'S EXPOSURE TO ADVERSE CHILDHOOD EXPERIENCES IS THE GREATEST UNADDRESSED PUBLIC HEALTH THREAT OF OUR TIME. -ROBERT BLOCK, AMERICAN ACADEMY OF PEDIATRICS" is in center-aligned white letters on a long black letter board with beige wooden bordering standing on a black display stand on a flowered tablecloth on a white bureau. The image also has a black and white filter.]





CONTENT WARNING: I would like to mention that I am not a medical doctor, psychologist, psychiatrist, or therapist and I am sharing this content for educational purposes only. Social media should never be used as a substitute for mental nor medical health care. If you suspect that you or loved one needs any professional help for mental health, it is okay to get help, and I highly recommend seeking help from a medical doctor, psychologist, therapist, and/or other professional who is qualified to do so.

TRIGGER WARNING: If you are affected by childhood trauma, this blog post may be triggering. If you need support right now, please seek help from a therapist or other mental health professional or call the National Suicide Prevention Lifeline at 1-800-273-8255 or text "HOME" to the Crisis Text Line at 741741 if you live in the USA or text "CONNECT" to the Crisis Text Line at 686868 if you live in Canada.









    When children are exposed to adversity, this means that they experienced or witnessed traumatic events that can affect their daily lives. Sometimes children experience such severe trauma that it feels like something else is going on. Adverse Childhood Experiences (ACEs) also known as childhood trauma are any traumatic experiences that occur during childhood at any time between birth to before turning eighteen years old. ACEs can negatively impact mental and physical health. These traumatic events can include but not be limited to the following:

  • Child abuse (physical, sexual, emotional, psychological) by a parent/guardian or anyone else
  • Child neglect (physical, medical, emotional, educational) by a parent/guardian or anyone else
  • Growing up with a household member who struggled with mental illness, substance addiction, or attempted suicide
  • Domestic violence
  • Parental separation or divorce
  • Incarceration of a household member
  • Biological parent loss through death, divorce, abandonment, or other reason
  • Death of another family member or friend
  • Severe illness (e.g. cancer) or injury (e.g. Traumatic Brain Injury aka TBI, limb loss, paralysis)
  • Automobile accidents
  • Natural disasters
  • War
  • Terrorism
  • Gun violence
  • Poverty
  • Hunger
  • Discrimination against disabilities, race, ethnicity, religion, language, etc.
  • Bullying
    The above things are commonly viewed as either a social concern referred to social services or mental health concern that is eligible to be made as a referral to mental health services. According to the United States Department of Health and Human Services, more than 3.7 million cases are referred to Child Protective Services (CPS) every year. In 1995 to 1997, a researcher named Dr. Vince Felitti from Kaiser Permanente and another researcher named Dr. Bob Anda from the Centers for Disease Control and Prevention (CDC) developed and conducted the ACEs Survey. To do so, Dr. Felitti and Dr. Anda "asked 17,500 adults about their history of exposure to ACEs" (Harris 2014). Their purpose for this was to investigate the commonality of childhood trauma and its impact on mental and physical health. Dr. Felitti and Dr. Anda's data showed that "sixty-seven percent of the population had at least one ACE and 12.6 percent, one in eight, had four or more ACEs" (Harris 2014). This means that everyone experiences at least one type of childhood trauma. In addition, some people have an increased risk of experiencing more ACEs. Studies have shown that this is "linked to the historical, social, and economic environments in which some families live" (CDC 2023).

    The ACEs Survey contains a total of ten closed questions that ask about different types of traumas for individuals to answer about their own experiences at home or elsewhere during their childhood. Each question that is answered "yes" receives a score of 1 following the "Yes" answers being added up at the end to determine the total score. The higher an ACE score increases the likelihood of the potential risk for chronic mental and physical health concerns. This is because high adversity affects the structure and functioning of the developing brains and bodies of children.

    Trauma can alter, disrupt, and cause delays in brain development in many ways. Trauma impacts the nucleus accumbens, which is "the pleasure and reward center of the brain that is implicated in substance dependence" (Harris 2014). It causes delays in the development of the prefrontal cortex, which is the part of the brain that is responsible and essential for "impulse control and executive function, a critical area for learning" (Harris 2014). To elaborate, trauma survivors with Post-Traumatic Stress Disorder (PTSD) have a decreased amygdala and hippocampus, which often shows up on magnetic resonance imaging (MRI) scans. The amygdala is a small part of the brain that is responsible for processing emotions, sensing danger, and responding to threats. The hippocampus "processes emotions and memories" (Therapy in a Nutshell 2022). The amygdala "also links your emotions to many other brain abilities, especially memories, learning, and senses. When it doesn't work as it should, it can cause or contribute to disruptive feelings and symptoms" (Cleveland Clinic 2023). In the aftermath of trauma, the amygdalas of people with PTSD tend to be on "high alert" and constantly look for and misinterpret certain people, places, and things as threats (Hagan 2019). In regards to the hippocampus, "stress hormones essentially kill off cells" in this part of the brain causing difficulty with differentiating "between the past and the present" (Therapy in a Nutshell 2022). "These changes in the hippocampus can also contribute to short-term memory (STM) loss but the connection between the hippocampus and the amygdala gets stronger. So, essentially, this maintains that fear response over time" (Therapy in a Nutshell 2022).

    As a result of how childhood trauma affects brain development, it can cause difficulties with social-emotional and cognitive developmental skills. It can cause a decline or difficulty in academic and workplace performance along with building potential. It is common for educators, parents/guardians, and/or anyone who works with children or witnesses children's behavior concerns to make the biased assumption that the child has "bad behavior"; however, this is usually due to a lack of knowledge about behavioral health or ignorance of science. Contrary to popular belief, there is actually no such thing as "bad children." Children's behavior concerns are a sign of communicating a struggle or unmet need even when they are challenging behaviors. It is also important to acknowledge that not all behavior concerns are misbehaviors. A child who struggles with holding a pencil correctly or cries when they are afraid are behavior concerns as well. When children exhibit behavior concerns, they are either angry, hurt, tired, lonely, scared, confused, or impulsively expressing their feelings and needs in the only way in which that they know how.

    So, professionals and parents/guardians need to provide the developmentally appropriate (DAP) interventions, other resources, and skills to support children with any behavior concerns. Consequences for misbehaviors should always start out as lectures about the importance of positive behaviors to provide learning experiences, warnings, and educate about natural consequences. Some of the misbehaviors that these consequences can be used for include but are not limited to schoolwork refusal, selective listening, or the beginning of bullying. Logical consequences for the purpose of discipline should only be used when misbehaviors show up with the presentation of violence, touching other individuals inappropriately, discrimination, slurs, or continuous teasing with the intent to humiliate and/or shame. All types of bullying should be taken seriously at all times and schools need to also have zero tolerance policies for bullying as a Trauma-Informed Care and Education approach. While it is important to prevent bullying and other negative situations, it is important for authority figures to handle the situation to the best of their ability so that accountability for the situation is taken. When authority figures use protocols to handle any mistreatment, this can contribute to healing journeys of trauma survivors. Even when misbehaviors are a result of trauma, this should not be used as an excuse for unacceptable behaviors. Boundaries should be set and required to be followed by children of all backgrounds. Another thing to be careful about when associated with childhood trauma survivors of bullying is teasing. Teasing is a common display of affection for some people; however, someone who was made fun of during childhood at school or home may take teasing that is meant to be playful personally due to their struggles with social-emotional skills. In childhood, many were not allowed to express their discomfort. In the event that a childhood trauma survivor is offended by your innocent, playful teasing, explain your intent while also validating their lack of receptivity to this humor instead of insisting that they "need to take a joke" or "lighten up."

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    Childhood trauma survivors may also struggle with self-esteem, attentional difficulties, sense of safety and belonging, anxiety, depression, social withdrawal, loneliness, and fear of abandonment. Being lied to or abandoned can trigger the wound of being unable to trust. When someone knows that they have been lied to, this can bring up feelings of being gaslit. "Being ignored can be linked to the fear of abandonment or neglect. For example, eating a meal with someone on their phone can trigger the wound of being ignored" by bullies, a parent/guardian, caregiver, or other authority figure who was responsible for their well-being (Stars Insider 2023). Being interrupted can trigger the wound of being talked over by caregivers and treated like our words did not matter. Instead of being able to move forward, childhood trauma survivors may become confrontational or even aggressive. In this case, everyone involved in supporting trauma survivors should provide validation of their feelings and reassurance of who will not abandon them. Trauma survivors should also be encouraged to surround themselves around as many positive people as possible and get involved in extracurricular activities. If and when childhood trauma survivors are lonely in the aftermath of losing people, they should be encouraged to go to public places. While not knowing anyone there can be also be very lonely, being surrounded by people reduces social isolation somewhat. Healthy relationships and extracurricular activities can be positive distractions "instead of withdrawing from the world" (Broadwell 2023).


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    According to the National Center for PTSD, "about six out of every 100 people will experience Post Traumatic Stress Disorder (PTSD) at some point in their lives" (NIMH 2023). Contrary to popular belief, however, not everyone who experiences trauma develops PTSD. It is common for people to have temporary or permanent symptoms associated with PTSD also known as post-traumatic stress or toxic stress without meeting the criteria of a PTSD diagnosis. Two of the most common symptoms of PTSD are flashbacks and nightmares are triggered by something that reminds individuals of their trauma. PTSD flashbacks can be best described as re-experiencing the traumatic event again when mentally transported back in time. As a result of their traumatic flashbacks being triggered, people with PTSD or symptoms associated with PTSD may show fight, flight, freeze, or fawn trauma responses "to avoid a threat" (Barrett 2023). The brains of individuals with PTSD or symptoms associated with PTSD view "the world as a threatening place" and constantly causing the body and mind to repetitively react to that and be hyper alert for a threat to happen (Barrett 2023). This is because adversity causes people with post-traumatic stress to struggle with unpredictability. For example, children with divorced or separated parents/guardians may struggle with "uncertainty about how their lives or schedules will change" (Broadwell 2023). Children who are physically neglected or whose families struggle with hunger crises may worry about when their next meal will be. Children who are bullied at school may worry about when they will be insulted, humiliated, or physically hurt next. For some, waiting is not just a test of patience –– it's a trigger echoing a history of uncertainty or instability. If childhood trauma survivors experienced unreliable care or lived in perpetual anticipation, they might have developed intolerance to uncertainty.

    This is why it is so important for any family members, educators, and service providers to provide childhood trauma survivors with predictable routines to support them. Predictable routines can contribute to the healing journeys of traumatized individuals because the brain's predictions need to change. According to the notable neuroscientist, Lisa Feldman Barrett, "those predictions are what construct your experience of your body in the world, and you have to find a way to break that cycle" (Barrett 2023). The consistency, structure, and familiarity of routines will provide comfort. While it is common for childhood trauma survivors to struggle with traumatic predictions, flashbacks, and rumination and what happened will always stay with them, they are capable of healing. That does not mean that PTSD will be cured or "go away"; it just means that their trauma is not all that they are. They can seek out multiple interventions and treatments to become resilient and move forward instead of "moving on" to not let their trauma control their lives completely. These common interventions and treatments include but not limited to Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) Therapy, yoga, medication, and mindfulness meditation can help with this.


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    In addition, high exposure to trauma can affect "the immune system, developing hormonal systems, and even the way that our DNA is read and transcribed" (Harris 2014). The threat of childhood trauma can be "so severe or pervasive that it literally gets under individuals' skin and changes their physiology" (Harris 2014). The ACEs Study data results showed that "for a person with an ACE score of four or more, their relative risk of chronic obstructive pulmonary disease (COPD) was two and a half times that of someone with an ACE score of zero. For hepatitis, it was also two and a half times. For depression, it was four and a half times. For suicidality, it was twelve times" along with an "increased risk for smoking, alcoholism, and drug abuse, fifty or more sexual partners, greater likelihood of sexually transmitted diseases (STDs), challenges with physical inactivity, and severe obesity" (Harris 2014; ACE Response 2023). "A person with an ACE score of seven or more had triple the lifetime risk of lung cancer and three and a half times the risk of ischemic heart disease, the number one killer in the United States of America" and a 20-year difference in life expectancy" (Harris 2014). People with any ACE scores have an increased risk for suicidal thoughts and suicide attempts at different ranges as well as "broken bones, lung disease, liver disease, multiple types of cancer, and early death" (ACE Response 2023). Other physical health risks as a result of ACEs can include but are not limited to insomnia (that presents itself as acute or chronic; difficulty with falling and staying asleep), migraines, asthma, diabetes, high blood pressure, "poor cardiovascular health", "rheumatoid arthritis, systemic juvenile arthritis, fibromyalgia," HIV/AIDS, other chronic or terminal illnesses, or short life expectancies (Mock & Arai 2011; Schultz 2018).

    Research has also shown that the severity and/or overall occurrence of mental and physical health struggles as a result of traumatization from ACEs can depend on individuals' socio-economic status (SES). "An analysis of the interactions suggested higher SES is a potential protective factor for those with a history of trauma" (Mock & Arai 2011). For example, people with middle or high class SES who can afford and seek out therapy, doctors, and/or other necessary mental/medical health treatments to address their mental and physical health concerns from ACEs have the chance of a decreased risk of worse health concerns. They also have a chance of making progress in their healing journeys and living well with post-traumatic stress and physical health conditions whereas individuals from lower SES can have an increased risk of worsened health concerns if they cannot afford proper treatment to address them. The strength of their emotional support system affects the range or occurrence of their traumatization as well. To elaborate, strong emotional support systems can decrease the likelihood of any, worsened, or additional mental and physical health concerns and can even prevent ACEs or traumatization from ACEs altogether.

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    Overall, the severe impact of individuals' history of ACEs can continue into their adulthood. Medical authorities need to recognize the knowledge about how early exposure to adversity can cause lifelong effects as a public health crisis. Then, medical authorities can begin to use the correct resources to determine solutions because ACEs CAN be prevented. When doctors understand the mechanism of a disease and know not only which pathways are disrupted, it is their job to use this science for prevention and treatment. Preventing ACEs could lower the risk of the development of many mental and physical health conditions in individuals. "For example, by preventing ACEs, up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided" (CDC 2023).

    From my perspective as a trauma-informed teacher, I view knowledge about this social issue as very important. I was aware of the issue for many years prior to becoming a teacher; however, there are ways that traumatic events are affecting children that I did not know about until reading further research and learning more about the topic as part of course work, influencer work, and continuing education. From tobacco to lead poisoning to HIV/AIDS, the U.S. actually has quite a strong track record with addressing public health problems, but replicating those successes with ACEs and toxic stress is going to take determination and commitment. When we understand the mechanism of a disease and know not only which pathways are disrupted, it is our job to use this science for prevention and treatment. Everyone involved in supporting childhood trauma survivors should provide an emotionally and physically safe environment. Providing safety, stability, and nurturing relationships for all children and families can prevent ACEs and positively contribute to the healing journeys of childhood trauma survivors.

    Lastly, it is important to acknowledge that while it is important to educate people about the importance of speaking up, there are childhood trauma survivors are who internalize their hardships. They may be too afraid to self-advocate about their traumatic experiences due to fear of judgement or whether they will be believed or not. Even if they confide in other people about their traumatic experiences, they may internalize their mental and physical health trauma responses as well. This can be for a number of reasons, such as being in denial, fear that they will be judged or not be believed, not knowing that it is a health concern that needs medical or mental healthcare attention, or not knowing how to self-advocate about it. Difficulty with self-advocating about childhood trauma and trauma responses is especially common among young children and individuals whose disabilities cause them to struggle with social-emotional skills. That being said, everyone who takes care of and/or teaches children should use Trauma-Informed Care and Education approaches at all times because no one ever knows for sure who has and has not experienced trauma or all of the trauma that known trauma survivors have been exposed to. Using Trauma-Informed Care and Education approaches can also help to prevent traumatization during situations that may be potentially traumatic for some individuals or reduce traumatization from worsening. In conclusion, my favorite affirmation that resonates with this philosophy states the following: "Everyone is going through a rough battle that no knows anything about. So always be kind.





To learn more about ACEs, you can click on the following links below:




In addition, to learn more about how childhood trauma and other types of traumas can affect social-emotional development and physical health in people of all ages, you may enjoy reading the following book:
    • The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma written by Bessel van der Kolk
    • Home, School, and Community Collaboration: Culturally Responsive Family Engagement: Third Edition written by Kathy B. Grant and Julie A. Ray
    • Infancy Through Middle Childhood: Child Development: Custom Second Edition written by Laura E. Levine and Joyce Munsch


    If you are affected by childhood trauma, you are not alone and there is hope. If you or someone you know needs support right now, call the National Suicide Prevention Lifeline at 988 or text "HOME" to the Crisis Text Line at 741741 if you live in the USA or text "CONNECT" to the Crisis Text Line at 686868 if you live in Canada.

    You can also visit The Mighty's suicide prevention resources page by clicking on this link: https://themighty.com/suicide-prevention-resources/






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                                                                         Citations

    1. ACE Response. (2023). ACE Study. http://aceresponse.org/who_we_are/ACE_Study_43_pg.htm

    2. Barrett, L. F. (2023). The neuroscience of trauma. (2023). https://bigthink.com/the-well/neuroscience-of-trauma/

    3. Broadwell, L. (7 Sept. 2023). How Divorce Affects Children, Age by Age. https://www.parents.com/parenting/better-parenting/understanding-the-long-term-effects-of-childhood-trauma/

    4. Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (Jun. 2011). The impact of adverse childhood experiences on an urban pediatric population. https://www.sciencedirect.com/science/article/abs/pii/S014521341100113X?fbclid=IwZXh0bgNhZW0CMTEAAR2Hp6Q7OhD2fEfh5v44EOL8BI0c_ibbcycDW8KqJwdEEkJhBA8hEqBfDqs_aem_AYaPqY9mZKb9PpO1oPr9ZgAE8aNx5fD0ZbLfGpNX1EPorbF3xypRmAbAPWxO5zpgxVOjTEEGXdeGI2Y--I02AfsK

    5. Centers for Disease Control and Prevention (CDC). (29 Jun. 2023). Fast Facts: Preventing Adverse Childhood Experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html

    6. Cleveland Clinic. (11 April 2023). Amygdala. https://my.clevelandclinic.org/health/body/24894-amygdala#:~:text=Your

    7. Hagan, E. (23 Oct. 2019). When Trauma Gets Stuck in the Body. https://www.psychologytoday.com/us/blog/in-the-body/201910/when-trauma-gets-stuck-in-the-body

    8. "How childhood trauma affects health across a lifetime | Nadine Burke Harris." YouTube. TED (17 Feb. 2015). https://www.youtube.com/watch?v=95ovIJ3dsNk&t=545s

    9. "How Trauma and PTSD Change the Brain." YouTube. Therapy in a Nutshell. (14 Apr. 2022). https://www.youtube.com/watch?v=wdUR69J2u6c

    10. Mock, S. & Arai, S. M. (31 Jan. 2011). Childhood Trauma and Chronic Illness in Adulthood: Mental Health and Socioeconomic Status as Explanatory Factors and Buffers. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153850/

    11. National Council of Juvenile and Family Court Judges (NCJFCJ). (24 Oct. 2006). Finding Your ACE Score. https://www.ncjfcj.org/publications/finding-your-ace-score/

    12. National Institute of Mental Health. (May 2023). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
    (N.d.). PTSD TREATMENT DECISION AID: THE CHOICE IS YOURS: SSRI/SNRI. https://www.ptsd.va.gov/apps/decisionaid/resources/PTSDDecisionAidSSRI.pdf

    13. Schultz, K. (18 Sept. 2018). Are Childhood Trauma and Chronic Illness Connected? https://www.healthline.com/health/chronic-illness/childhood-trauma-connected-chronic-illness

    14. Stars Insider. (5 Sept. 2023). Pet peeves that indicate childhood trauma. https://www.msn.com/en-us/health/other/pet-peeves-that-indicate-childhood-trauma/ss-AA1gg54Y?ocid=msedgntp&cvid=627fa5741b2944418d3b04b2686dec3d&ei=9

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