Pediatricians screening for ACEs (Adverse Childhood Experiences) can change a child’s life. And yet, according to the Academic Pediatrics [Journal] 2016;16:154–160 article, Do Pediatricians Ask About Adverse Childhood Experiences, “Only 2% of pediatricians reported that they were very familiar with the ACEs study, 9% were somewhat familiar, 13% were vaguely familiar, and 76% were not at all familiar….” My intention with this post is to raise awareness and share resources on the importance of pediatricians screening for ACEs.
Adverse Childhood Experiences (ACEs) Explained
ACEs comes from the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking research that looked at how 10 types of childhood trauma affect long-term health. They include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated, and witnessing a mother being abused.
Subsequent ACE surveys include racism, witnessing violence outside the home, bullying, spanking, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, witnessing a father or other caregiver or extended family member being abused, involvement with the criminal justice system, attending a school that enforces a zero-tolerance discipline policy, etc.
The Toxic Stress Impacts of ACEs
The impact of ACEs on a child is related to the toxic stress consequences of trauma. As you’ve gathered reading the above, trauma takes many forms: neglect, sexual assault, physical abuse, emotional abuse, parental divorce, and growing up with a parent who has an untreated substance use disorder or mental illness, to name a few. But thanks to the CDC-Kaiser ACE Study, there is now solid research to help us understand the brain impacts of trauma (aka adverse childhood experiences), which in turn helps us better understand the physical impacts of trauma, as well. These brain impacts are related to toxic stress and the way toxic stress changes how the brain works, wires, and maps. The physical and emotional ailments and quality of life outcomes of toxic stress include: anxiety, depression, stomach ailments, skin disorders, sleep problems, neck/back/shoulder pain, and inflammatory diseases, to name a few. I urge you to watch Nadine Burke Harris, MD’s TedMed Talk > How Childhood Trauma Affects Health Across a Lifetime
Additional resources explaining the impacts of toxic stress, including the neurobiology of toxic stress and the health effects of toxic stress, include:
- The American Academy of Pediatrics’ article,“Adverse Childhood Experiences and the Lifelong Consequences of Trauma
- Harvard University’s Center on the Developing Child’s, “The Impact of Early Adversity on Children’s Development.“
- Jane Steven’s, “ACEs Science 101>ACEs Science FAQs.”
How Pediatricians Screening for ACEs Can Change Lives – Not Only a Child’s, but a Parent’s, Too
As you’ve learned viewing and reading the above resources, the consequences of ACEs often presents in the pediatric practice as a physical ailment, such as obesity, asthma, sleep difficulties, headaches, depression, anxiety or a behavioral disorder, such as cutting or an eating disorder. Given thirty-eight percent of children in every state have at least one ACE, (34 million children!) according to an analysis of the 2016 National Children’s Health Survey by the Child & Adolescent Health Measurement Initiative (CAHMI) at the Johns Hopkins Bloomberg School of Public Health, using the physical ailment as the cue there’s likely something deeper that’s causing the physical ailment, namely ACEs, the pediatrician can change that child’s life.
Not only will a pediatrician’s screening for ACEs help the child, but it will also help their parent understand ACEs and their impacts so the parent can make necessary changes to help their child.
As importantly, it can help the parent look at their own ACEs. As the American Academy of Pediatrics explains in their PDF, “Adverse Childhood Experiences and the Lifelong Consequences of Trauma,”
Adults who have experienced ACEs in their early years can exhibit reduced parenting capacity or maladaptive responses to their children. The physiological changes that have occurred to the adult’s stress response system as a result of earlier trauma can result in diminished capacity to respond to additional stressors in a healthy way. Adverse childhood experiences increase the chance of social risk factors, mental health issues, substance abuse, intimate partner violence, and adult adoption of risky adult behaviors. All of these can affect parenting in a negative way and perpetuate a continuing exposure to ACEs across generations by transmission of epigenetic changes to the genome.
With these understandings, parents can be directed to resources that can help them overcome their ACEs’ impacts and change their parenting to reduce the impacts of their own ACEs on their child. For more on this, visit ACEs Connection’s Parenting With ACEs Community.
“Medical care alone cannot ‘fix’ any of these, but we need to know about them, because even the simple act of acknowledgement can be an important first step in addressing them [emphasis added].
In addition to the resources cited throughout this post, you may wish to check out:
- Center for Youth Wellness
- American Academy of Pediatrics (AAP) > Clinical Assessment Tools
- What’s Your ACE Score? Visit “Got Your ACE Score?” on ACEsTooHigh.com
©2018 Lisa Frederiksen