In this introduction to Adverse Childhood Experiences, you'll learn about the 4 R's of trauma-informed care, understand the impact that trauma has on a young person's life and get some practical tips to support children and adolescents to build resilience after trauma.
What are ACEs and their impact?
The Adverse Childhood Experiences (ACEs) study is one of the world’s most important public health studies, yet few people outside the field of mental health know about it. It was 1985 when at an unassuming obesity clinic in San Diego that Dr. Vincent Felitti made the startling accidental discovery that a large proportion of his patients had been sexually abused as children.
Felitti’s incidental finding turned into a 25-year quest involving more than 17,000 participants ultimately providing more understanding about the lives of millions of people who use biochemical coping methods – including food, alcohol, drugs, violence, work, sex – to escape intense fear, anxiety, depression, and anger.
Felitti’s final results would go on to reveal that ACEs were very common - across all socio-economic demographics - and that these experiences are linked to every major chronic illness and social problem with which the United States grapples and which cost billions of dollars each year.
In Australia, an estimated 72% of children have been exposed to at least one ACE, with a higher rate in some vulnerable Australian populations. ACEs are described as any stressful event or circumstance that children may experience during their childhood including abuse, neglect, and other major stressors such as divorce, a parent’s substance abuse, or witnessing violence in the home. Exposure to ACEs can result in developmental delays, lower educational attainment and social and emotional maladjustment. The greater the number of ACEs a child is exposed to the greater their risk of developing chronic and cardiovascular conditions in adulthood, such as stroke, respiratory disease, diabetes, and cancer. There is also greater probability of health risk behaviours and problematic social functioning such as drug use, aggressive behaviour, teenage pregnancy, depression, suicidal ideation and attempted suicide.
Two decades after his study was published, the world still knew little about ACEs and their impact on later health and functioning. And then a game changing moment happened and the cause suddenly gained an iconic ‘champion of champions’ who would help educate the public.
In March 2018, Oprah Winfrey appeared on CBS’ 60-Minutes program where she he spoke to Dr. Bruce Perry, the world's leading expert on early trauma, and discussed with him why we should all be reframing the question of "What's wrong with that child?" to "What happened to that child?"
This question is the essence of ACE-informed approaches and all of a sudden, those of us who work in the field of child mental health and trauma-informed care had the megaphone we needed to let the world know of the significant role early adversity and trauma plays in an individual's life. Because when Oprah talks about something so passionately, the world sits up and listens.
What support is available for young people with ACEs?
Established in 2005, KidsXpress is a specialist mental health organisation that sought to address the lack of services available to children who were living with the effects of ACEs. Using the therapeutic benefits of art, music, drama and play, their nationally accredited Expressive Therapy program supports children towards restored socio-emotional health and wellbeing, while their Trauma-Informed Education Services help build the capacity of educators to better recognise and respond to trauma-impacted children.
Today, Dr Felitti’s ACEs questionnaire has grown from a 10-item survey with a simple scoring system that attributed one point for each category of household dysfunction and abuse, to include experiences such as bullying, bereavement, medical trauma, migration or discrimination relating to race, gender or sexual orientation. Community adversity such as the COVID-19 pandemic and natural disasters (bushfires, floods, storms) are also considered an ACE.
A strong and growing body of evidence shows that trauma can affect brain structures linked to learning, and control of emotions and behaviour. These effects make it difficult for children to learn, make friends and develop positive relationships with teachers. Psychologically, they’re vulnerable to anxiety and depression; behaviourally, they are prone to the extremes of withdrawal or challenging behaviours in the classroom and on the playground. None of these outcomes bodes well for school success. Without support, by Year 9, these trauma-impacted students may be up to 5yrs behind their unimpacted peers.
As such, education institutions around the world have acknowledged that a trauma-informed approach towards their students is essential in successfully addressing the broadening spectrum of adverse childhood experiences. And because teachers can’t know which student is experiencing adversity (girls in particular tend to hide their symptoms of trauma) a whole-school approach ensures all students are benefitting.
Supporting young people through trauma-informed care
When a teacher or any other individual who works with a child is trauma-informed, it doesn’t mean that they’re trained to treat trauma, but rather that they understand the impact that trauma has a on a child’s life. Similarly, there is evidence that suggests strong mentoring relationships can also help students to build resilience after experiencing trauma.
This can be achieved by adopting the four R’s of trauma-informed care when supporting a child:
1. Realising the widespread impact of trauma and understanding the potential paths of recovery
2. Recognising the signs and symptoms of trauma in the students they support
3. Responding by fully integrating knowledge about trauma into practice
4. Resisting re-traumatisation
Practically, this looks like
- Keeping consistently calm and working in a relaxed and focused state.
- Being attuned and aware of children’s nonverbal signals such as body language and tone of voice. These signals tell you how much and what types of activity and learning the child can currently handle.
- Being focused and present in the moment. Pervasive mistrust of others is a key characteristic of children who have experienced trauma and by showing them that they have your full attention at all times shows them that they can develop secure relationships with other adults.
- Being predictable and sticking to a routine. Trauma-impacted children can view the world as a dangerous and unreliable world and so being predictable in your actions and routine will help them feel safe.
- Don’t be triggered by children’s emotions. Don’t let children’s emotions escalate your own: requires you to remain in control of your emotions and of your expression of them. Trauma-impacted children can find it difficult to regulate their emotions. If they become aggressive, frustrated or overly excited, our own emotions can also spiral, leading to an escalation in the situation and triggering further trauma responses.
Given the prevalence of ACEs in our country, promoting a trauma-informed approach in all our dealings with children and youth offers them the best possible opportunity to function successfully in the world as adults.
Hear more about KidsXpress and what a trauma-informed approach looks like when working with young people in our recent podcast episode with Margo Ward, KidsXpress Founder and CEO.