By Jane Crecco, Training and Support Specialist – Recruitment Training and Support Center (FCSN)
The first Adverse Childhood Experiences (ACE) study was conducted by the Centers for Disease Control (CDC) and Kaiser Health Plan between 1995 and 1997. Since then, it has become widely accepted that stressful and traumatic childhood experiences are indicators of social, emotional, and cognitive impairments. Recent breakthroughs in neurobiology have confirmed that ACEs disrupt and alter the early development of a child’s “brain architecture.” In the long-term ACEs impact a number of health outcomes and increasingly negative social fallout.
In the last couple of years, new risk factors have been added to the list of specific adverse family experiences (see, in particular, the National Survey of Children’s Health1 ). Perceived discrimination, being a witness or victim of neighborhood violence, and socioeconomic hardship were all added to the ACE survey questions. The data collected are troubling and profound.
New research in epigenetics is also adding to the mix of distress for children with multiple ACEs. Epigenetics is the process by which outside experiences alter gene expression. Recent research shows that a stressful upbringing changes the structure of multiple genes. This change is passed on to subsequent generations, even those without ACEs. This can negatively impact the stress response of developing children.2
A new policy brief published by The Future of Children: Princeton-Brookings3 discusses some promising new programs aimed at helping families facing chronic stress, particularly those in areas of high poverty or homelessness. The data show that this is necessary. In 2012, more than six million (22%) of children under age six in the United States lived in poverty. Almost 50% of all children lived in low-income families (income less than 200% of the federal poverty level).
These programs embrace a safe and supportive early environment for children at risk for ACEs. Home-visitation programs, starting during early pregnancy, offer great hope. Pediatricians can establish their offices as “medical homes” to ensure that young families have a primary source of care in which periodic health and behavioral assessments take place. Money is needed – ongoing federal assistance can significantly ease the financial stress of young families. High quality child care is also essential. Head Start-Trauma Smart, a new initiative being piloted in Kansas City, is showing tremendous success by providing at-risk kids access to warm, responsive, child-centered teachers who provide safe, supportive and predictable environments in early learning.
These programs demonstrate the views of one of the original ACE study researchers. Robert Anda recently commented on new findings based on his work, stating that, “until now, the persistent effects [of ACEs] were ‘hidden’ from the view of both neuroscientists and public health researchers. This is no longer the case. In fact, with this information comes the responsibility to use it.4”
1The NSCH is a telephone survey conducted by the National Center of Health Statistics at the Centers for Disease Control under the direction and sponsorship of the federal Maternal and Child Health Bureau. Child and Adolescent Health Measurement Initiative (2013). “What’s new in the 2011/12 National Survey of Children’s Health?” Data Resource Center, supported by Cooperative Agreement 1-U59-MC06980-01 from the U.S. Department of Health and Human Services, Health Resources and Services Administration.
2Dubovsky, Steven, M.D. “Emerging Perspectives: Epigenetics-A Mechanism for the Impact of Experience on Inheritance.” NEFM Journal Watch Psychiatry. October 18, 2010.
3Ross A. Thompson and Ron Haskins, “Early Stress Gets under the Skin: Promising Initiatives to Help Children Facing Chronic Adversity,” Policy Brief Spring 2014, The Future of Children Princeton: Brookings, Princeton, NJ, Spring 2014, http://www.futureofchildren.org
4Robert Anda, “The Health and Social Impact of Growing Up With Adverse Childhood Experiences: The Human and Economic Costs of the Status Quo.” A complete bibliography of ACE Study publications is available online at http://www.cdc.gov/nccdphp/ace