The Upside of Adverse Childhood Experiences
By: Angélica Montalvo Santiago, Ph.D.
What are ACEs?
Throughout my training years as a psychologist, I heard about the Adverse Childhood Experiences (ACEs) time and time again. The focus was usually geared towards understanding the impact of factors associated with early exposure to trauma, however, I later understood that there was more to this. ACEs are negative events in a child’s life that can have lasting effects on health and well-being. The phrase came about during the CDC-Kaiser Permanente Adverse Childhood Experiences Study, published in 1998. The study looked at how childhood trauma affects long-term health (Mayo Clinic, 2018). ACEs were categorized as 10 potentially traumatic events including: physical, verbal, and sexual abuse; physical and emotional neglect; incarceration of a family member; having a family member with alcohol or substance abuse problems; having a family member with a mental illness; witnessing domestic violence; and losing a parent to divorce/separation.
Why should everyone know about ACEs?
The ACEs study revealed that an estimated 62% of adults surveyed across 25 states reported that they had experienced at least one ACE during childhood, 40% had two or more ACEs, and 12% had four or more ACEs (CDC, 2019). The study found that these experiences can increase the risks of injury, sexually transmitted infections, maternal and child health problems, teen pregnancy, involvement in sex trafficking, and a wide range of chronic diseases and leading causes of death. For instance, a person with an ACE score of 4 or more is twice as likely to have heart disease and cancer, seven times more likely to have an addiction, and 12 times more likely to attempt suicide (CDC, 2020).
Rewiring of the brain
One of the most popular phrases tied to trauma over the past years is that it “rewires the brain,” but what does that mean exactly? It means that connections between neurons in the brain are changing. Everything we learn is stored in the brain, and the brain cannot store information if it doesn't physically change in some way. In this sense, the brain is constantly being rewired (Kornell, 2011). This is not to say that all brains are expected to be “wired” equally, but there are typical patterns of development that are altered due to trauma. Traumatized brains look different from non-traumatized brains in three predictable ways (Sweeton, 2017):
The Thinking Center is underactivated
The Emotion Regulation Center is underactivated
The Fear Center is overactivated
This implies that a person who experiences adverse/traumatic events in their early years may have more difficulty thinking clearly in later years and may take longer to process their thoughts. Their ability to pay attention, focus, and concentrate may be negatively impacted, which ultimately affects decision-making. Their ability to label and manage emotions may also be impaired. This is often evidenced by having trouble detaching from people or things tied to strong emotions or being easily triggered by phrases such as “let go” and “move on.” Additionally, they may be prone to experience chronic stress, fear, irritation, and extreme sensitivity to their surroundings (Sweeton, 2017).
What is the upside to these outcomes?
In my years of clinical practice, I have seen numerous clients who report one or more ACEs and somehow are able to “manage,” “get by,” “push through,” “let go,” or “move on” without falling victims to the statistics. Researchers may refer to them as outliers because they don’t seem to follow the trends predicted for them. Some refer to themselves as lucky, blessed, or as a miracle.
This led to my interest in the upside or what I like to call the gains in loss. I use this concept to help clients identify what it is that they have been able to learn, take away, or gain from their process of loss, while validating their trauma. Trauma itself and the ACEs may be considered as types of losses. As a child and family therapist, part of my job is to help my clients in the process of identifying the parts of themselves that have shut down, due to loss from trauma, and guide them to find the parts of themselves that have grown resilient. We may then focus on the protective factors that buffer the negative effects of risk and decrease the likelihood of negative life outcomes.
How do we grow resilient?
The term resilience refers to the process of adapting well in the face of adversity, trauma, tragedy, threats or significant stress (APA, 2014). According to resilience expert, Katie Rosanbalm, in order to build resilience, there are two other crucial “R” words: relationships and regulation. She says if caregivers learn “how to build the warm, nurturing relationships AND how to create the structure and skill-building to support child regulation, these two together go a long way to building resilient kids (and ultimately resilient adults) with positive outcomes” (White, 2017).
Recommendations for treatment
The CDC recommends that professionals, agencies, and communities take the following approach to prevent ACEs:
· Strengthen economic supports for families
· Promote Non-Violent Culture
· Help kids have a good start by paving the way for them to reach their full potential
· Teach skills to help parents and youth handle stress, manage emotions, and tackle everyday challenges
· Connect youth with caring adults and activities
· Intervene to lessen immediate and long-term harms
What is in your power?
Although some recommendations may sound farfetched for the general population at times, there are many options that are in your control.
- The first step is for everyone in our communities to gain a better understanding of these experiences.
- Talk to your healthcare and mental health provider about ACEs.
- Remain open to the idea of screening and monitoring when given questionnaires to fill out at the doctor’s office.
- Become aware of the stigma and self-stigma (process in which a person with a mental health diagnosis becomes aware of social stereotypes and internalizes them) related to seeking mental health counseling and reflect on how it may negatively impact access to treatment.
- Seek help and accept the help; this may include individual, couples, or family therapy work, integrated with medical care and community supports.
American Psychological Association. (2014). The road to resilience. Washington, DC: American Psychological Association. http://www.apa.org/helpcenter/road-resilience.aspx
Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf
Centers for Disease Control and Prevention (2020). Preventing Adverse Childhood Experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html
Kornell, N. (2011). It "Rewires Your Brain?" Think Again. Psychology Today. https://www.psychologytoday.com/us/blog/everybody-is-stupid-except-you/201112/it-rewires-your-brain-think-again
Mayo Clinic. (2018). Overcoming adverse childhood experiences. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/overcoming-adverse-childhood-experiences
Sweeton, J. (2017). How to Heal the Traumatized Brain. Psychology Today. https://www.psychologytoday.com/us/blog/workings-well-being/201703/how-heal-the-traumatized-brain