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April 23, 2018

3/21/2018 4:49:00 PM
Editorial: Addressing ACES, Caring for Children of Trauma

April was declared Child Abuse Prevention Month in 1983 by a presidential proclamation. Since then, April has been a time to acknowledge the import role that communities can play in helping to address child abuse.

The term “child abuse” has historically been applied to instances of direct or immediate physical or emotional attacks on or neglect of children. We believe the term can be expanded to include many things that traumatize or adversely impact a child, such as violence, divorce, death, poverty, and discrimination. Such adverse childhood experiences (ACES) can have long-lasting and devastating effects.

There have been many studies of ACEs using slightly different variations of what constitutes an adverse experience for a child. One recent study used the ACEs of experiencing extreme economic hardship, having parents who divorce or separate or having a parent die, living with someone who abuses alcohol or drugs or who is mentally ill or suicidal, witnessing or being the victim of neighborhood violence, witnessing domestic violence, and being treated or judged unfairly on the basis of race or ethnicity.

The impact of ACES was first assessed in the 1990s in a longitudinal study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente. The study, which recruited participants in 1995 and 1997, asked 17,500 adults about their exposure to 10 types of ACEs as children. The study found that people who were exposed to four of more ACEs were two-and-one-half times more likely to have chronic obstructive pulmonary disease than persons who had zero ACEs, were four times more likely to suffer from depression, were 12 times more likely to commit suicide. A person with seven or more ACEs was three times more likely to incur lung cancer and ischemic heart disease, a leading cause of death.

Everyone experiences adversity and stress. Experiencing moderate, short-lived stress is a normal part of life, and learning how to adjust to it is an essential feature of healthy development. But there is a dose effect. Adversity and stress become toxic when they are strong and frequent enough to trigger prolonged activation of the body’s stress-management system.

The brain architecture of a child is still developing, and when a child is exposed to toxic stressors, the foundation upon which future learning, behavior, and health are built are weakened, according to the Scientific Council on the Developing Child.  Children with toxic stress live much of their lives in a defensive mode, and their brains develop to cope or survive in a stressful environment. This impacts their ability to concentrate in a classroom and to focus on learning. They may fall behind in school, they may fail to develop healthy relationships with peers, or they may create discipline problems.

A recent research brief published by the Health & Medicine Policy Research Group and the ACEs Response Collaborative says, “ACEs are the root cause of many serious academic, social and behavioral problems that have the potential to prevent a child from receiving the full benefits of education.  Experiences of poverty, extreme discrimination and community violence as well as other traumatic experiences can also impair the development of the growing brain and body.  

These children, who may seem disruptive and aggressive, are victims of trauma. Compassionate, not punitive, measures are the way to address these behaviors.

Many communities are addressing ACEs and trauma with an aim to build resilience, and, importantly, in ways that do not simply magnify the problem. This requires new ways to address children’s needs in schools, in health facilities, in social service programs, and in the criminal justice system.

In Evanston, we are beginning to see evidence of this understanding about ACEs and how to try to mitigate their damage.

School Districts 65 and 202 are already attempting to address students’ needs in a holistic manner. They are partnering with agencies in the community to do so. The Evanston Cradle to Career initiative is considering overarching three-year goals, one of which focuses on childhood trauma and trauma-informed care. This is also on the radar of many social service agencies and health providers in the City.

With the uncertainty and divisiveness in the country, the State, and even in our beloved town, we all should be aware of how these events affect young, vulnerable, developing minds and psyches. And we should support the agencies that are trying to help these children become whole.







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