Trauma is a word that happens to other people. As humans, we generally try to empathize with the victim, offer support and solutions, and quietly thank our lucky stars it has not impacted our own little worlds.

That was my take on trauma, until it raised its ugly head in our middle class, well educated, and perfectly comfortable lives. Perhaps that is your take on trauma too. As we learn more about the impacts of trauma on children, we come to understand the real adverse impact it can have on their future lives and how common it is. Today, it is really important that we understand what childhood trauma is, what causes it, and what we can do to diminish its impact.

Adverse childhood experience (ACE) is a phrase that you may or may not have heard, but you don’t fully understand what it means and what it can do to children. Adverse childhood experiences are traumatic events that occur during childhood. There is an emerging body of knowledge and understanding that early childhood trauma can have an impact on our children and their developing brains and bodies.

The Adverse Childhood Experiences Study

Between 1995 and 1997, Kaiser Permanente, a large health insurance company in the United States, decided to conduct a survey of over 17,000 patients who were seeking treatment for physical ailments. They wanted to find out if their experiences of childhood had any impact on their health and well-being as adults.

The participants were located in the Southern California region and interestingly nearly 80% had education beyond high school. The survey asked them to reflect on their childhood experiences and their current health status and behaviors.

There were 10 questions, grouped into 3 main categories: abuse, neglect, and household challenges. Each adverse experience identified earns one ACE point. At the conclusion of the questionnaire, the number of adverse experiences equaled the ACE score.

A fleeting glance at these 3 categories could lead us to think that these things only happen to the poor, uneducated, and unemployed. And while in some cases, folks unfortunately walking in those shoes certainly are more adversely affected, the ACE study actually found that over 2/3 of the study participants, nearly 10,000 people, had actually experienced at least one ACE. Remember the initial participants were generally educated and employed. Even more shocking was that more than one in five of these participants had experienced 3 or more ACEs during their childhood.

List of adverse childhood experiences

So what exactly are these adverse childhood experiences and what impact do they have? Before we dive headfirst into exploring the range of childhood experiences that can be deemed negative, it is important to remember that each individual is different and their ability to show resilience in the face of adversity is different too. But more about that later.

Abuse

Remember the traumas were divided into 3 categories. Abuse was the first group of traumas. And it comes as no surprise that emotional, physical, and sexual abuse are the 3 subheadings.

1. The emotional abuse question sought to capture those who had experienced a parent, step parent, or other adult living in the home, to have sworn, insulted, put down or made the child feel frightened or fearful of being physically harmed. Today we could extend this type of abuse to include bullying and racism even though it does not occur within the home.
2. Physical abuse was again at the mercy of adults who lived in the home. The parameters included being pushed, grabbed, slapped, having things thrown directly at the child or being hit so hard there were marks left or injuries caused.
3. And finally sexual abuse again targeted those in the home, extended family, friends, or a stranger who were five years older than the child. It was deemed sexual abuse if the child was touched, fondled, made to masturbate or any type of penetration attempts.

Household dysfunction

Challenges in the home were divided into equally depressing realities.

4. Domestic violence against the mother or stepmother by her husband or boyfriend was first on the list. This included poor women being grabbed, slapped, bitten, hit, had things thrown at her or being hurt by a knife, a gun or other weapons by her husband, boyfriend or partner.
5. And if this isn’t woeful enough participants, were asked about substance abuse in the household including alcohol and street drugs. Fast forward 25 years and one could include the inappropriate use of prescription medication too.
6. And of course mental illness was on the list too. Depression and a range of other illness falling under this banner was also identified as a trigger for trauma. An attempt at suicide was included in this category too.
7. Breakdown of the family unit also was identified as an ACE with the inclusion of divorce and separation. A death of a family member would now also sit in the group.
8. And if life wasn’t hideous enough, one could always collect another ACE if a family member was in prison.

Neglect

And finally neglect, including physical and emotional neglect:

9. Participants were asked whether, when they were children, they didn’t have someone looking out for them and their needs, including safe places to stay, food to eat, clean clothes, and someone in a fit and healthy state to look after them.
10. They were also asked about whether they remembered feeling unloved and unsafe and if their family made them feel insecure and not supported. If participants couldn’t identify significant others in this category, then they scored an ACE.

Adverse childhood experiences can happen to anyone

The 3 main headings of trauma do not just impact those who live in neglectful homes. My sister recently lost her husband to Sudden Adult Death, leaving her a widow with a 2 year old son. Her son, at his grand old age, notched up an ACE. My daughter’s friend’s mother died a few months ago of cancer. She was loved, she was well taken care of, but she lost a parent suddenly. She notched up an ACE too.

The daily news rushes through the daily horrors occurring around the world, not allowing us to give them more than a cursory thought. I ask you to think about the family in war-torn Syria who have lost their home, the children who were born in refugee camps, or the children who became active child soldiers. They too are knocking up ACEs, one child at a time.

Adverse childhood experiences know no borders, as this series of articles will show you. Even though the initial ACEs study was conducted in an affluent part of the United States, our writers on 5 continents have all directly experienced or witnessed adverse childhood experiences.

Childhood trauma can impact the life outcome of your child

As mentioned earlier, the more ACEs one accumulates, the more likely one is to experience negative health and wellbeing outcomes. So what does this really mean and what kind of long-term health impacts can it have on people? I wish I could coat it in fairy dust and casually tell you, dear reader, that it actually has no impact, but that unfortunately would be a lie.

Adverse childhood trauma can significantly impact the life outcomes of children in so many ways. The most common and immediate injuries, of course, are those physical injuries that the children sustain. The punches, burns, and broken bones. Those are the injuries we see. Little brains can sustain injuries too. Injuries that impact emotional and behavioral regulation, developmental delays or regression, verbal and memory development to name a few. But the most insidious impacts are the long-term impacts that last across the lifespan, even into old age.

Resilience factors offer protection

With all this grim reading, it is easy to become overwhelmed and feel helpless, but there is always hope. Children and young people demonstrate differing and amazing degrees of resilience and respond in different ways.

As bystanders, we can choose to be active in supporting these children to develop resilience. While they may live in traumatic and chaotic homes, you can make a difference. You may be their friend’s mom, who provides kindness and food without questions or judgment. You may be the teacher who gives that little bit more care and knows that equal is not always the same. You may be the grandparent that has them a few nights a week, just because you know they need a decent meal and a safe place to sleep. You could just be that friendly face that smiles at one of these precious little humans. These small gestures go a long way in slowly helping repair that damaged brain and hopefully alter the trajectory for that child who is the victim of their circumstance.

Sadly adverse childhood trauma is not going away anytime soon. What is changing, however, is what we know about it. With knowledge comes power. The medical and education professions are starting to take note of the research, which in time will effect policy and practice. With knowledge, all of us can contribute to making changes.

If you still aren’t convinced how important it is to confront this problem early on, watch this TED talk on adverse childhood experiences and read all the articles in this series: