How Understanding Adverse Childhood Experiences (ACEs) Can Help Schools to Support Students Better

How Understanding Adverse Childhood Experiences (ACEs) Can Help Schools to Support Students Better

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This blog highlights the ACE Study's significance in understanding youth mental health issues. It explores how childhood adversities affect individuals across their lives, especially during school years. Suggestions are offered for K-12 schools to address these concerns effectively, emphasizing the importance of informed support for students' well-being.

Intro: Adverse Childhood Experiences Study

Concerns about children’s and adolescents’ mental health and wellbeing have been growing for some time now, as declared in a joint emergency statement by the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association. Related childhood experiences of trauma have been framed as a public health issue, and this has been illustrated poignantly by the Adverse Childhood Experiences (ACE) Study.

The ACE Study was considered landmark research when the results were reported in the late 1990s. The study identified key adverse experiences that can affect children negatively, not only early in life, but throughout the lifespan. The findings arrived on the important informational heels of:

Thus, the ACE Study helped to alter the landscape of emerging new understandings about the effects of trauma on the autonomic nervous system and the brain.  

While mental health professionals have long understood the emotional effects of psychosocial trauma, the then-blossoming insights from the ACE Study extended that understanding to include important physiological effects as well. In addition, the ACE Study contributed to framing the trauma-related implications of environmental, social, and cultural influences.

The ACE Study is particularly significant, according to the Centers for Disease Control and Prevention, because it has been one of the largest inquiries into:

  • Child abuse and neglect,
  • Harmful aspects of challenged households, and
  • The impact of adversity on the health and wellbeing of individuals later in life.

It remains relevant, because the study’s findings continue to inform and shape public policy related to child and adolescent mental health and wellbeing. This blog aims to describe the ACE Study, to examine how it sheds light on the effects of adversity during childhood and across the lifespan, and to offer relevant suggestions to schools.

What Is the ACE Study All About?

The Adverse Childhood Experiences (ACE) Study was conducted from 1995 to 1997, by the Centers for Disease Control and Prevention (CDC) and Kaiser-Permanente, a large managed healthcare system. The study followed the insights of a group of physicians, whose patients’ reports led them to formulate the original hypotheses that grounded the research. Data were collected from over 17,000 patients, who completed confidential surveys related to:

  • Childhood experiences
  • Health status at the time of the survey
  • Behaviors associated with healthcare, healthcare seeking, and wellbeing

The original ACE study identified the following most common ACEs:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Intimate partner violence
  • Violent treatment of the mother
  • Substance misuse within the household
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member

The results were stunning, as they identified categories of childhood adversity that were linked with neurological, psychosocial, and health disparities, as well as with the potential for early mortality. The specific categories of adverse childhood experiences have been visualized as upwardly sequential levels in the ACE model, represented as a pyramid that has been associated with the ACE Study, as seen in the figure below.

The Adverse Childhood Experiences (ACE) Pyramid represents the conceptual framework for the ACE Study.

It is important to note that the original ACE pyramid was altered recently to reflect two additional layers of social influence, added at its base. These include the generational embodiment of historical trauma, the very bottom rung of the pyramid, with social conditions and local context identified in the layer just above. These are critical influences, as they represent the preexisting social and cultural conditions into which a child is born and can serve as determinants for experiences from birth onward. They emphasize the strong impact that racial trauma and living conditions circumscribed by poverty or community violence can have on an individual’s life.

Following upward movement in the pyramid, if a child experiences adversity, there is greater likelihood of disrupted neurodevelopment, which in turn may entail associated social, emotional, and cognitive impairment. An individual on this developmental trajectory may be more likely to adopt health behaviors that are risky, like smoking, drug abuse, poor nutritional choices, and so on. Adoption of health risk behaviors may incur a greater propensity for disease, disability, and social problems, which then may reduce life expectancy. The major takeaway is that adverse childhood experiences can have serious health consequences.

Many follow-up studies have been conducted since the original ACE Study. The data have been consistent and reliable in showing the robust relationship between increased instances of ACEs and poor health outcomes in adulthood. The data also have persistently shown that large numbers of American children, nearly half, are exposed to ACEs. These results are stark and must be addressed. But at the same time, it is important to realize that naturally occurring resilience in the family or in the environment, as well as timely and appropriate interventions, can mediate the effects of adversity. For these reasons, socially responsible public health programs and school-based trauma-informed efforts must be put into place.

How Is Childhood Adversity So Problematic?

The Substance Abuse and Mental Health Services Administration identifies ACEs as stressful or traumatic events. These include abuse and neglect and can happen in children’s lives between ages 0 through 17. The occurrence of ACEs in a child’s life can have a profound influence during childhood and across the lifespan. ACEs also can have an impact on future health, wellbeing, and potential opportunity. ACEs have been linked to many negative health outcomes as well as to unfavorable psychosocial and behavioral results.

ACEs can affect future violence in an individual’s life, both in terms of being a victim and being a perpetrator. It is not unusual, for example, that a child raised in a home where domestic violence has occurred then becomes an adult perpetrator of partner/family/child abuse. Alternatively, such a child may grow up to be an adult victim of domestic or partner abuse.

It also is not unusual for children raised in an abusive context either to act out aggressively or violently or to be numb or passive at school. This of course then raises associated questions about interrupted learning opportunities, which can affect the climate of the entire educational environment. The way in which existing ACEs can interfere with a child’s learning process is of particular importance to schools.

The National Center on Safe Supportive Learning Environments, the Trauma and Learning Policy Initiative, and the American School Counselor Association report that students who encounter traumatic incidences frequently experience the following:

  • Trouble focusing, concentrating, and learning
  • Memory deficit
  • Marred language capacity
  • Impaired organizational ability
  • Difficulty forming and sustaining relationships with teachers and peers
  • Being out of the classroom or missing school more often
  • Increasingly at risk of needing to repeat a grade
  • Diminished test scores
  • Lower GPAs
  • Greater likelihood of being suspended or expelled from school
  • Increased rates of being referred for special education

Adversity-related deficits, like those above, unfortunately impair or replace the requisite skill sets that children actually need, in order to be successful learners. Not addressing ACEs systemically and not constructing formal programming to mediate and eradicate ACEs is tantamount to setting children up for failure.

The CDC emphasizes that being mentally healthy in childhood is comprised of the following proficiencies:

  • Reaching developmental and emotional milestones
  • Acquiring appropriate social skills
  • Learning how to cope with problems

Such skill attainment assists with maintaining a more positive outlook and remaining more functional in life. The presence of ACEs can impede age/stage appropriate skill development, and the absence of such skills can lead to challenges, distress, and even mental disorders. The risk for experiencing a wider range of these negative outcomes becomes greater as the number of adverse incidences increases for a child.

Adding to the gravity of how early childhood adversity can affect health and opportunity across the lifespan, the recent World Happiness Report 2024 reveals that the US now ranks much lower than in previous reports. A key finding is that happiness in North America has declined acutely, primarily because younger people, aged 15-24, are now less happy than older age cohorts. This decline in happiness is one artifact of the upward spike in child and teen mental problems. Mental health professionals note that this has been ongoing, since around 2012 and is associated with the use of social media and smart phone technology.

What Can Schools Do?

Knowledge about ACEs is a powerful tool for school and district leaders. It enables K-12 schools to mitigate the impact of adversity on scholastic disruption by readjusting the learning climate and environment. Healthy and constructive adaptation to challenging circumstances can help to build resilience. This, in turn, can have positive effects on children’s cognitive and psychosocial capabilities.

One way to address childhood mental health and wellbeing issues lies in enabling children to reach their developmental and emotional milestones, to acquire healthy social skills, and to learn how to cope with or adjust to problems that arise. In an action guide aimed at school and district leaders, the CDC has suggested the following six school-based strategies that can help in this regard (the Guide provides corresponding sections):

These types of school-based strategies require systemwide perspectives. An essential overall systemic mediation involves creating safe and supportive learning environments that also:

  • Offer entry to non-stigmatizing mental health services
  • Provide accurate health education
  • Build relevant community partnerships

Such a systemic approach is of value to all students and has the potential to prevent some ACEs from even materializing. But for children who have experienced adversity, this approach can constitute a lifeline.

The National Education Association (NEA) advocates for actively addressing childhood trauma and supports creating trauma-informed K-12 school environments. Trauma-informed or trauma-sensitive schools provide a safe and secure learning environment, one in which students can focus on:

  • Learning
  • Developing
  • Problem-solving
  • Connecting with others in constructive ways

The National Center on Safe Supportive Learning Environments (NCSSLE) also endorses the construction of trauma-sensitive and trauma-informed learning environments. The NCSSLE provides resources that:

  • Explore key components for employing a trauma-sensitive approach
  • Identify ways of integrating trauma-informed practices into K-12 schools
  • Provide methods for incorporating trauma-sensitive practices into school discipline

NCSSLE emphasizes the importance of trauma-informed practices as a means for facilitating and assisting student success.

The National Child Traumatic Stress Network (NCTSN) provides a manual that details Psychological First Aid for Schools. The Network also offers a System Framework for Trauma-Informed Schools that identifies ten core areas for systemic trauma-sensitive transformation. Along with school-specific recommendations, NCTSN recommends resources and support for all school personnel in working with students who have experienced trauma. The NCTSN further suggests that the ten core areas of a trauma-informed school system can be useful for policymakers in promoting related policies at local, state, and national levels. The policy issue becomes crucial in acquiring the necessary funding to resource such important efforts.

Addressing the needs of the many children and adolescents who have experienced adversity and trauma may seem daunting. While the youth mental health crisis became acutely apparent during the COVID pandemic, this crisis has been building momentum for quite some time. But the possibility of making headway on this critical issue lies precisely in the arena of adopting a systemic perspective. K-12 schools across the country have been successful in using the types of programmatic efforts described here.

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