How do Adverse Childhood Experiences impact people’s adult lives?

In the 1990s, the American Centers for Disease Control (CDC) discovered a childhood exposure which dramatically increases the likelihood of negative physical and mental health outcomes in later life.

This exposure contributes to a whole array of social, personal and health problems among individuals affected. In high levels, it stifles social, emotional and cognitive development and hormonal systems; it can even alter the person’s very DNA.

What the CDC identified wasn’t an agent or a chemical, it was what they termed Adverse Childhood Experiences (or ACEs for short). ACEs are generally categorised into three groups: abuse, neglect, and family/household challenges.

The study that coined the term ACE discovered these events were far more common than previously thought. Two-thirds of the 17,000 participants, surveyed over two years, reported at least one ACE. One in five reported three or more ACEs.

The CDC discovered that as ACEs pile up, the risks of over 21 negative health and wellbeing outcomes later in life increase dramatically. These outcomes run the gamut from alcoholism and drug abuse to suicide and a two-to-four fold increase in smoking and poor self-rated health. ACE survivors were more likely to end up in abusive relationships and to be abusers, too.

The cycle of abuse

The CDC study, now considered a landmark in how we understand child abuse and neglect, plays a central role in a new documentary titled ‘Resilience’, directed by James Redford, son of Robert Redford.

By largely focusing on the work of Dr Nadine Burke Harris, Redford’s film zooms in further on how repeated stress from abuse, neglect or parents struggling with substance abuse has an almost concussive impact, staying with the victim long after it may have subsided.

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Even forgotten trauma can take its toll. It’s a matter of ongoing scientific conjecture, but research is uncovering how traumatic memories can ‘hide in the brain’. These repressed memories can lead to psychiatric issues in later life.

The science of ACEs is still being ironed out, but the concept is gaining wide acceptance. A 12 month ACE study by the Welsh NHS found that children who endure four or more ACEs are more than twice as likely to be diagnosed with a chronic disease in later life.

Their report also linked ACEs to an increase of substance abuse and mental wellbeing in adults. Abuse casts a pall over people’s lives. As the original CDC study notes, when ACEs pile up, the likelihood of sexual and intimate partner violence increases too. In this way, the tragic cycle of abuse continues.

Close to home

This cycle of abuse and neglect will be familiar to social workers in the UK; working against it can feel like treading water.

The figures from authorities seem to back up this narrative. While we don’t know exactly how many children have experienced child abuse, government statistics do tell us how many children have been identified as needing support or protection.

In England alone, over 390,000 children received support from children’s services in 2016. This figure has remained fairly constant since 2010. But while these figures have plateaued, government statistics show the number of child protection plans in effect continues to rise.

The promise and limitations of hair strand testing

As Nadine Burke Harris points out in Resilience, professionals on the front line are often caught in a cycle of only treating the symptoms, never getting to the root cause: but there is a difficult balance to be struck.

Taking major steps, like removing a child from a parent’s custody, offer a delicate challenge for social care professionals. A correct call to remove a child from a dangerous situation can save their life, and it would go a long way to eliminating the root cause (i.e. an abusive parent or guardian). It would also inhibit the insidious long term harm of ACEs.

But it can be difficult to arrive at the truth, particularly in cases involving substance abuse (recognised by the NSPCC as a leading factor in abuse and neglect cases): it’s hard to ascertain whether a parent is being truthful about their drug and alcohol use.

This is why social workers are making wider use of hair strand testing to profile patterns of drug and alcohol use: it is a powerful and accurate tool. As a UK High Court judgment in September reaffirmed in September this year: “The science involved in hair strand testing for drug use is now well-established and not controversial”.

But, as we’ve always explained, hair strand testing is not a panacea. Our tests provide part of a picture. They are an insight into whether someone is being truthful about their drug and alcohol use. Ultimately, the test’s value (and the evidence it provides) lies with the skilled professional interpreting it.

Drug or alcohol consumption is not simply a black-or-white issue, and there are times at which a positive result may not tell the whole story. The details of use and the interpretations can be less clear.

Towards closer cooperation

The effectivity of testing rests on combining our results with the wider details of the case at hand. This means the onus is on social workers to brief testing labs with full details on what exactly they’re trying to find.

After the Welsh NHS’s ACE study was published, the lead author Professor Mark Bellis emphasised the need for a “joined up approach” to prevent “ACEs and support adults whose health is suffering because of childhood trauma”.

“That is why we are working with our key partners, including the Welsh Government, police, local authorities, charitable and voluntary sector organisations,” Bellis said.

The fight against ACEs won’t be won by acting alone. By coordinating our responses and crafting a cohesive portrait in cases of abuse, many more children in need can be saved from the devastating, lifelong consequences of ACEs.

If you would like to know more about how Cansford Labs can help social workers, take a look at our free ebook on how we work with authorities.