In our neighborhoods, schools, grocery stores, and playgrounds, communities are important in supporting individual and family resilience. Understanding that each person’s life history impacts who they are, how they develop relationships, and how they respond to opportunities is critical in creating healthy and safe communities.
A framework of five protective factors that promote optimal development and strong families includes:
Read more about the Protective Factors… and in this Parent Brochure.
In the Adverse Childhood Experiences Study, the Kaiser-Permanente (KP) Health Maintenance Organization (HMO) and the US Centers for Disease Control and Prevention (CDCP) collaborated in surveying over 17,000 HMO members about their experience of a variety of adversities as 0-18 year olds and their subsequent health histories. They found a strong relationship between the number of ten categories of adversities experienced ((physical abuse, emotional abuse, sexual abuse, physical and emotional neglect and experience of parental domestic violence, substance abuse, incarceration, mental illness, and separation/ bereavement) and risk of a variety of negative behavior and health outcomes, including “the leading causes of morbidity, mortality and disability in the USA: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking and alcohol and drug abuse.”
Initially eight and then ten categories of adversity were included in the study because of their high prevalence in the KP weight reduction program: five directed toward children (physical abuse, emotional abuse, sexual abuse, and, later, physical neglect, emotional neglect) and five household issues (domestic violence to mother, separation, substance abuse, incarceration, significant psychiatric illness). Although other risk factors such as poverty, political and cultural trauma, etc. also affect illness and wellness, they were not analyzed in the ACE Study of KP members.The number of adversity categories experienced in childhood significantly predicted negative health and behavior outcomes, but it did not appear to matter much which categories were involved. The number of experiences within categories was not counted.
Healthy, strong families relationships are foundational to young people's growth, learning and well being. These relationships build strong social and emotional strengths that kids use throughout their lives. Keep Connected
Understanding healthy brain development, supporting a teen's ability to cope with stress, supporting effective parent and adult communication and building resilient teens all support moving teens toward healthy young adulthood. parentandteen.com
Most people who are exposed to trauma or adversity do not develop negative outcomes, hence it will be important for the field to better understand what protects them and what tips a person from being resilient to being impaired (and what can assist them in reversing this). However, as the ACE studies are based on a count of adverse experience categories, rather than on how many categories still bother the individual, further research asking questions both about what was experienced and what still bothers a person is recommended to clarify this.
The following table presents three stress response systems available to humans. Each may be adaptive in the short run, however, chronic activation of the first two may lead to negative health outcomes in the long run.
|Three stress response systems:||...which have short and long-term outcomes|
|“Fight or Flight” is the most commonly understood. The sympathetic autonomic system prepares to mobilize for action (increasing respiration, heart rate, blood pressure; releasing of adrenalin and insulin; suppressing inflammation and immune response).||If fight, flight, or action are needed this can be adaptive. If prolonged, this can contribute to cardio-vascular problems, insulin elevation and resistance, autoimmune disorders, It may affect sleep, hyperarousal, anxiety, depression, and motivate unhealthy coping.|
|“Freeze” is a backup strategy, if fight/flight is not successful or available (e.g. for weaker ages, gender, or situations). The body immobilizes, may feel numb, or may dissociate.||In the short run this may be adaptive, but if too intense (shock) or chronic (helpless) this can also be costly for the body or motivate unhealthy coping.|
|Social Engagement (or “be Friend”) is recently receiving attention. It involves the parasympathetic autonomic system and is associated with health maintenance and using social communication and problem-solving to deal with stress.||This system can dampen ‘fight or flight’ and inhibit ‘freeze’, decreasing their negative effects. It can contribute to resilient functioning and health maintenance.|
Neurological Impacts of Stress
Within pregnancy and the early years after birth, the brain structures and connections for dealing with stress are built in part by physical development and partly through practice—we “use it or lose it”—and what we use depends on our environment. Children exposed to adversity are likely to practice fight/flight/freeze reactions and build brains that are ‘on alert’ for danger, quick to react behaviorally and emotionally, and less likely to think ahead about choices and consequences or engage socially in problem-solving. The brain chemicals that prepare for stress response in the short run (e.g. cortisol) can be toxic over the long run, interfering with development of brain regions. Traumatic stress may overwhelm memory systems for danger and safety, making it difficult to learn from experience, failing to isolate past from present experience (flashbacks), etc.
What it may look like in children: Children may be impulsive, aggressive or defensive, anxious, reactive, seem hyperactive, and have difficulty focusing in the classroom. Heightened arousal may make it difficult for them to get enough sleep, resulting in sleep deprivation symptoms. Readiness for social competence may be weak. They may seek to manage their arousal level, painful sensory memories, etc. with self-medication (nicotine, alcohol, illicit drugs, cutting, etc.)
Biological Impacts of Stress
Chronic activation of the fight/flight system (being “bothered”) may result in chronic obstructive pulmonary disorder, coronary artery disease, insulin-related problems (diabetes), autoimmune disorders, cancer, etc. Research estimates that chronic or cumulative stress may shorten one’s lifespan by nearly twenty years.
What it may look like in children: Children may have difficulty regulating mood and behavior, be irritable or aggressive, be anxious or withdrawn, show growth delay, experience sleep difficulty and deprivation, have difficulty managing social interaction, have difficulty with attention control, etc.—which may interfere with attachment, social competence, and academic achievement that could otherwise serve as protective factors and support resilience development. This may lead to inappropriate or excessive psychiatric medication or to self- medication with substance use.
Psychological Impacts of Stress
How we see and think about ourselves and the world includes expectations about safety, confidence, self- esteem, and meaningfulness. ACEs can undermine or overwhelm these expectations, leaving us feeling chronically unsafe, hopeless, helpless, shamed, etc. Thoughts may focus on life being unfair, meaningless, and unforgivable. When these expectations about self and others continue into adulthood, the stress responses at the neurological, biological, and social levels are perpetuated. The relationship between ACEs and alcohol, nicotine, and substance abuse indicates that dependence is not just the result of biological exposure to an addictive substance. Reorganizing incorrect thoughts and expectations may reduce stress and the promotion of resilience expectations may protect against stress.
What it may look like in children: Children may wrongly conclude from ACEs that they are at fault or that the scope or longevity of problems will be catastrophic, and feel ashamed, anxious, helpless, depressed, angry, etc. They may learn to avoid situations that upset them, interrupting social competence development or derailing maturation. Even as they do gain greater competence, they may fail to update these expectations and, as a result, may carry them into adulthood. Before developing language, infants and toddlers may experience and remember trauma non-verbally. They may develop a self-image or sense of competence consistent with fight/flight/freeze coping which could be self-fulfilling and interfere with prosocial personality development. Children may develop dissociative responses (e.g. shifting between different roles or personalities) that are protective, but which complicate social interaction, learning and maturing. In relation to parents who struggle with their own trauma histories, children may develop disorganized or insecure attachments.
Social Impacts of Stress
Children who experience adversity or victimization are more likely to encounter social environments that can multiply stressful interactions. Their fight/flight/freeze stress responses are likely to be misinterpreted by others in social settings as misbehavior rather than as attempts to cope; such that they encounter discipline rather than support. They may fail to develop social competence that could protect them from further trauma. Their families may be affected by the ACEs in ways that interfere with their ability to protect and promote resilience in children.
What it may look like in children: Children with ACEs may be picked on or may emerge as bullies. Although discipline may be ineffective in managing stress responses, they may experience multiple encounters with punishment before being excluded from academic or social settings. Children may be separated from families, placed in foster care, and though physically safe may feel psychologically unsafe and have difficulty regaining a sense of well-being and permanence; contributing to a chronic stress response. They may experience multiple caregivers across foster or kinship care. They may seek out inappropriate company, become exposed to substance abuse or illegal activity, etc. Families and community settings may struggle to deal with their extra- ordinary needs, associated with ACE exposure.
Data from the National Child Traumatic Stress Network and the Family Research Laboratory indicate that many children exposed to cumulative trauma or victimization will show negative health and behavior outcomes, even before they reach the age of 18. Yet the majority of these children do not develop the significant health and behavior outcomes identified in the ACE Study. How might that happen and how can this be extended to the more vulnerable children? Many children experience family and community settings that are “good enough” to protect them from the impact of trauma and to support adequate resilience development and healthy coping. Interventions are emerging which help prevent children and families from being overwhelmed by their exposure to one or more ACEs.
Opportunities to prevent ACEs include:
The #1 predictor …that a child will develop socially, emotionally, cognitively, etc. is the parent’s self- understanding, or how you have made sense of your own…experiences, good or bad…It’s never too late to make sense of your life and what happened to you.
From a lecture at Parents as Teachers National Conference, 4-5-07.