Poverty. Divorce. Incarceration. Emotional abuse. Avoiding discussion of these topics can be easy due to their sensitivity, but in creating safe spaces of discussion for these Adverse Childhood Experiences, we can take a first step in reducing them.

Adverse Childhood Experiences, more commonly known as ACEs, is a pressing topic that is garnering more and more attention in the health and medical fields due to the long lasting detrimental health effects that it has shown to have from the toxic stress that they impose on children. The term ACEs originated in a 1995 study by the Center for Disease Control (CDC) and Kaiser Permanente and has been generally defined as traumatic experiences during an individual’s childhood within their household. There are three types of ACEs: neglect, abuse, and household dysfunction. Examples of these can include parental incarceration, maternal depression, poverty, any type of abuse, mental illnesses, and more. The 1995 study also found that these experiences have strong correlations with risky health behaviors, chronic health conditions, low life potential, and early death later on life. The toxic stress that comes as a result of ACEs wears out the body and brain’s stress response systems, which can lead to these health issues. Not only will the trauma from these experiences affect a child’s health outcomes later on, but it is also key to note that the years of childhood are the most important for a person developmentally, and this toxic stress can affect a child’s social, cognitive, and emotional development and their attachments with other children and adults in their lives.

ACEs are more common than one may think, and awareness of their prevalence is a key first step in learning how to mitigate, reduce, and eventually, prevent them. One in six people across the United States has experienced four or more kinds of ACEs and 60% of Americans experience at least one adverse experience during childhood. Americans who had experienced ACEs were also at higher risk of dying from the five of the top ten leading causes of death; unsurprisingly, a majority of these causes are health-related, which calls to attention health disparities within marginalized communities that are most vulnerable and affected by the effects of ACEs. Higher rates of ACEs among children from BIPOC, low income, immigrant, and other marginalized communities indicate that ACEs disproportionately affect these historically marginalized communities more than others. Women, Native American, Alaskan Natives, and African Americans have a higher risk of experiencing four or more types of childhood traumas. This common trend goes to prove that there is a link between community trauma and childhood trauma, and that trauma can continue to be passed down to later generations of these communities if they do not receive the proper support and resources that they need. The general lack of resources, services, and opportunities within these communities is a significant factor, among many other structural factors, that has contributed to this greater vulnerability of these communities.

An ACE test assigns an individual a numerical score based on their exposure to ACEs as a child; this test can be given are often given at pediatrician’s offices or other spaces children occupy and is then used to connect them to appropriate resources. While it is a good foundational point to recognize ACEs, it does fail to take into account other factors. A couple points it does not account for is collective community ACEs or any positive experiences in early life that can potentially build resilience. This building of resilience is important as it can determine how severe the impact of ACEs can have on an individual. An example of this can be seen with an individual who had an aunt who helped to be that motherly figure in their life while their actual mother was incarcerated is a positive factor as compared to an individual in the same situation, but with no guiding adult figure. However, the Harvard Center on the Developing Child reports that the test has been updated recently to account for the impact of community trauma on children outside of their households, such as violence in the child’s community or experiences they may have had with racism or poverty. This

A combination of  both preventative and reactive approaches are necessary to mitigate the effects of childhood trauma. There are many ways to approach the prevention of ACEs, and physicians, namely pediatricians, are responsible to monitor the medical perspective on them to address the health ramifications that may occur as a result. For reactionary methods, making places that children often frequent become more trauma-informed. Dr. Anne Schuchat, the CDC’s principal deputy director claims that, “Clinicians are busy and may or may not incorporate ACEs into their practice, but we think it’s very important that they do.”. It is key to screen children for ACEs and other related trauma within the doctor’s office. Dr. Leony Go, a practicing pediatrician at Kaiser Permanente in Fremont, CA, says that, “It is important to acknowledge that in order to help the kids, we need to help the parents.” Supportive and nurturing relationships are key to ACE prevention, and a strong parental relationship can begin when parents receive the support that they need.

To prevent ACEs, the CDC recommends strengthening economic support for families, promoting social norms that protect against violence and adversity, ensuring a strong start for children, teaching skills, connecting youth to caring adults and activities, and interventions to lessen immediate and long-term harms. In her check-ups with her patients, Dr. Go will connect parents to appropriate resources according to their children’s ACE scores. These resources, such as First 5 and Healthy Children, are community resources meant to help provide the necessary support that the parents may need. It is also important to note that although an individual’s experience with ACEs may have a significant impact on their life, it does not necessarily define them or decide their future. It is possible to grow past this trauma, with the right support.

ACEs expand beyond healthcare and numerous social determinants of health are at play when investigating the prevalence of ACEs. In undergoing specific training to address ACEs, Dr. Go worked with and learned from people from other fields, such as psychology, social work, and general community work. These adverse experiences are not working alone; many are rooted in systemic inequities and issues that can affect whole communities. For example, an incarcerated parent can be an example of an ACE as it forcibly separates a child from their parent and prevents them from fostering a secure attachment to them; since policing is more prevalent in Black, Brown, and low-income communities, the children that live there will face the consequences of this over policing and it will show in their health and relationships, especially with their future children, later on in life. Thus, this is only one example that demonstrates a cycle that is perpetuated by a system that works to maintain these inequities and shows a need to address and reshape them for future generations. As previously stated, factors such as racism have been incorporated into the ACEs test; it has been proved that racism actually increases the amount of stress a person is under, a child especially, and affects not only the health problems that arise as a cause of this stress but also a child’s development and relationships. To develop a solution or intervention for these issues, it is important to address the root of the problem so as to avoid any “band-aid,” or temporary, solutions. Reactionary, “band-aid” solutions are important to help individuals who still suffer from the effects of ACEs and these can include trauma-informed schools and workplaces that work to provide the necessary for those who have experienced extensive ACEs. However, we should be working towards more preventative measures in the long term.

 ACEs share intersections with race, income, gender, and more. When addressing them, it is key to incorporate more than just a medical perspective. This can be done by, as Dr. Go said, providing more support for parents in communities that may be more susceptible to systemic violence like housing and food insecurity, lack of educational resources, inaccessibility to quality healthcare, overpolicing, and more. Creating discussion spaces and actively criticizing how the system can fail these communities is a key first step to addressing ACEs. From there, we can go on to work on community building and healing within groups that are most affected. It is time to begin making spaces for ACEs to give children the future they deserve.