3.6 Adverse Early Childhood Experiences
Overview
As you review this material, reflect on how you think the social determinants of health align with the DOHaD paradigm and the influence of the exposome on phenotype development?
- Life history, sociology, and biology combine to create lifelong prospects for health and social success at the earliest stages of life.
- The branch of social epigenetics examines the impacts of health disparities on genetics or how inequities literally “get under our skin.”
- Focusing on improving environments can change our biology and disease trajectory for future generations.
Adverse Childhood Experiences
Adverse childhood experiences (ACEs) are common and can have lasting, negative effects on health and well-being. They can also negatively impact education and job opportunities.
Children and families thrive when they have access to safe, stable, nurturing relationships and environments. These relationships and environments are essential to creating positive childhood experiences and preventing adverse childhood experiences. The harmful effects of ACEs can affect everyone in our communities, and everyone can help prevent and reduce their impact.
What are adverse childhood experiences?
Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include (Merrick et al., 2019):
- Experiencing violence, abuse, or neglect.
- Witnessing violence in the home or community.
- Having a family member attempt or die by suicide.
Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with (Merrick et al., 2019):
- Substance use problems.
- Mental health problems.
- Instability due to parental separation.
- Instability due to household members being in jail or prison.
The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination (Cain et al, 2022; Experiencing discrimination, 2021; Font et al, 2016; Smith-Grant et al., 2022).
Quick facts and stats
ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs (Swedo et al., 2023).
Three in four high school students reported experiencing one or more ACEs, and one in five experienced four or more ACEs. ACEs that were most common among high school students were emotional abuse, physical abuse, and living in a household affected by poor mental health or substance abuse (Swedo, et al. 2024).
Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs.1 Preventing ACEs could reduce suicide attempts among high school students by as much as 89%, prescription pain medication misuse by as much as 84%, and persistent feelings of sadness or hopelessness by as much as 66% (Swedo, et al. 2024).
Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live (Sedlak et al., 2010; Font et al., 2016). ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work (Swedo et al., 2023).
ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States (Bellis et al., 2019).
Outcomes
ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide (Ciciolla et al, 2021; Diamond-Welch et al., 2020; Merrick et al., 2020; Mersky et al., 2019; Miller et al., 2021; Read et al., 2019; Sulaiman et al., 2021).
ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress (Jones et al., 2020). Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune system, and stress-response systems (Clements et al., 2024; Ross et al., 2021; Yu et al., 2022).
Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, job stability, and depression throughout life (Clements et al., 2024). These effects can also be passed on to their own children (Narayan et al., 2017; Schofield et al., 2018). Some children may face further exposure to toxic stress from historical and ongoing traumas, including experiences of racial discrimination.
Concept in Action
Video source: Harris, N. B. (2014, September). How childhood trauma affects health across a lifetime [Video]. TED Talks. https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?subtitle=en
Prevention
Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences. Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence. Creating safe, stable, nurturing relationships and environments for all children prevent ACEs and help all children reach their full potential. These relationships and environments are essential to creating positive childhood experiences.
Risk factors
Individual and family risk factors
- Families experiencing caregiving challenges related to children with special needs (for example, disabilities, mental health issues, chronic physical illnesses) (Crouch et al., 2019a).
- Children and youth who don’t feel close to their parents/caregivers and feel like they can’t talk to them about their feelings (Priyam, P., & Nath, 2021).
- Children and youth with few or no friends or with friends who engage in aggressive or delinquent behavior (Biglan et al., 2017).
- Families with caregivers who were abused or neglected as children (Schickedanz et al., 2018).
- Families with young caregivers or single parents (Crouch et al., 2019b).
- Families with low income (Giovanelli & Reynolds, 2021).
- Families with adults with low levels of education (Hughes et al., 2017).
- Families experiencing high levels of parenting stress or economic stress (Crouch et al., 2019b)
- Families with caregivers who use spanking and other forms of corporal punishment for discipline (Afifi et al., 2017).
- Families that are isolated from and not connected to other people (extended family, friends, neighbors) (Calvano et al., 2021).
- Families with high conflict and negative communication styles (Lackova Rebicova et al., 2020).
Community risk factors
- Communities with high rates of violence and crime (Lopez-Tomayo et al., 2022).
- Communities with high unemployment rates (Manyema et al., 2019).
- Communities where neighbors don’t know or look out for each other and there is low community involvement among residents (Khanijahani & Sualp., 2022).
- Communities with few community activities for young people (Bledsoe et al., 2021).
- Communities with unstable housing and where residents move frequently (Barnes et al., 2021).
- Communities where families frequently experience low socioeconomic status and food insecurity (Manyema et al., 2019).
- Communities with high levels of social and environmental disorder (Gentner & Leppert, 2019).
Protective factors
Individual and family protective factors
- Families who create safe, stable, and nurturing relationships, meaning children have a consistent family life where they are safe, taken care of, and supported (Asmundson, 2019; Luther, 2019)
- Children who have positive friendships and peer networks (Guo et al., 2021; Luther, 2019; Narayan et al., 2018)
- Children who do well in school (Bethell et al., 2022; Goetschius et al., 2021; Liu et al., 2020; Narayan et al., 2018)
- Children who have caring adults outside the family who serve as mentors or role models (Bellis et al., 2022; Narayan et al., 2018).
- Families where caregivers can meet basic needs of food, shelter, and health services for children (Narayan et al., 2018; Liu et al., 2020).
- Families where caregivers have college degrees or higher (Merrick et al., 2018; Nabors et al., 2021)
- Families where caregivers have steady employment (Liu et al., 2020; Merrick et al., 2018).
- Families with strong social support networks and positive relationships with the people around them (Bethell et al., 2019; Bethell et al., 2022; Guo et al., 2021; Letourneau et al., 2020; Luther, 2019; Narayan et al., 2018).
- Families where caregivers engage in parental monitoring, supervision, and consistent enforcement of rules (Bethell et al., 2022; Bethell et al., 2019; Guo et al., 2021; Liu et al., 2020).
- Families where caregivers/adults work through conflicts peacefully (Bethell et al., 2022; Bethell et al., 2019; Nabors et al., 2021).
- Families where caregivers help children work through problems (Bethell et al., 2022; Bethell et al., 2019; Nabors et al., 2021).
- Families that engage in fun, positive activities together (Bethell et al., 2019; Nabors et al., 2021).
- Families that encourage the importance of school for children (Liu et al., 2020).
Community protective factors
- Communities where families have access to economic and financial help (Dietz, 2017; Sege et al., 2017).
- Communities where families have access to medical care and mental health services (Dietz, 2017; Sege et al., 2017)
- Communities with access to safe, stable housing (Sege et al., 2017)
- Communities where families have access to nurturing and safe childcare (Sege et al., 2017).
- Communities where families have access to safe, engaging after school programs and activities (Dietz, 2017)
- Communities where adults have work opportunities with family-friendly policies (Dietz, 2017).
- Communities with strong partnerships between the community and business, health care, government, and other sectors (Dietz, 2017).
- Communities where residents feel connected to each other and are involved in the community (Narayan et al., 2018; Dietz, 2017).
Concept in Action
Watch Moving Forward (3 mins) on YouTube
Video source: Centers for Disease Control and Prevention (CDC). (2020, February 24). Moving forward [Video]. YouTube. https://www.youtube.com/watch?v=FJDwe2RkOqo
Why prevention is important (CDC, 2024)
Every child possesses incredible potential for health, well-being, and making a positive impact. When we prevent ACEs, we also prevent potential later involvement in violence, substance use, depression, and suicidal behavior. We also reduce the risk of other health challenges like cancer, diabetes, and heart disease.
All children deserve the best chance at lifelong health and well-being. Preventing, identifying, and responding to ACEs is the most powerful way to achieve this. Working together, we can help create neighborhoods, communities, and a world in which every child can thrive.
Neurodevelopment
Neurodevelopment is the process by which the brain and nervous system grow and mature, particularly during early life. The growing brain is extremely susceptible to inputs from the environment, particularly during critical periods. During these times, factors such as attachment and environmental influences play a crucial role in shaping brain architecture and function. Secure attachment and a nurturing environment promote optimal cognitive, emotional, and social development, while adverse conditions, such as neglect or stress, can disrupt neurodevelopmental pathways, leading to long-term implications for behavior and mental health.
Neurodevelopment and the importance of strong parental attachments
Review the four videos by using the interactive slide show, or click to watch on YouTube in the text version.
Neurodevelopment and the importance of strong parental attachments (text version)
Source: created by Andrea Gretchev, CC BY-NC 4.0 except where otherwise noted.
The first 1000 days is not the only critical period. Adolescence is also a period of vulnerability. Learn how early experiences and genetic predispositions can impact the develop of psychiatric disorders later in life.
Video source: Dr. Dan Siegel. (2013, November 8). Dr. Dan Siegel – BRAINSTORM: Adolescence, opportunity, vulnerability, and pruning [Video]. YouTube. https://www.youtube.com/watch?v=T2GIYxEbDg4
Resilience
What does resilience have to do with genetics? Resilience is a protective factor.
Watch InBrief: The Science of Resilience (2 mins) on YouTube
Video source: Center on the Developing Child at Harvard University. (2015, April 22). InBrief: The science of resilience [Video]. YouTube. https://www.youtube.com/watch?v=1r8hj72bfGo
Attribution & References
Except where otherwise noted, this content is reused from Adverse Childhood Experiences (ACEs) by the CDC, available for use with attribution and disclaimer. The following pages are reused:
Adaptation & use notes: Updated references have been added to original source material to enhance student learning. Use of CDC material does not imply endorsement by CDC. Material is otherwise available on the CDC website free of charge.
Updated References
CDC. (2024, October 8). Preventing adverse childhood experiences. . Adverse Childhood Experiences (ACEs). https://www.cdc.gov/aces/prevention/index.html
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Ross, K. M., Cole, S., Sanghera, H., Anis, L., Hart, M., & Letourneau, N. (2021). The ATTACH™ program and immune cell gene expression profiles in mothers and children: A pilot randomized controlled trial. Brain, Behavior, & Immunity-Health, 18, 100358. https://doi.org/10.1016/j.bbih.2021.100358
Yu, Z., Cole, S., Ross, K., Hart, M., Anis, L., & Letourneau, N. (2024). Childhood adversities and the ATTACH(TM) program’s influence on immune cell gene expression. International Journal of Environmental Research and Public Health, 21(6), 776. https://doi.org/10.3390/ijerph21060776
References from original source
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