Big, potentially traumatic events create greater risk of health and behavior problems for the children who experience them, even into adulthood, according to a Child Trends report released this week.
It also found nearly half of children have had at least one such adverse experience.
Economic hardship is the most common adverse childhood experience with nearly a quarter of kids growing up in homes where parents at least sometimes struggle to provide adequate food and housing. The next most common ACE was having parents who split up.
Other ACEs in the study were living with someone who abused drugs and/or alcohol; living with someone who had mental illness or was suicidal; seeing or being victimized by neighborhood violence; being abused within the home; living with a mom or dad who had been incarcerated; or having a parent one lived with die.
"I think what's striking is how common these experiences are" said Vanessa Sacks, the study's lead author.
Children who experience those traumas may grow up to be adults with physical or mental health complaints, as other research has said. The Centers for Disease Control and Prevention has a list of long-term fallout from negative childhood experiences that includes substance abuse, depression, heart or liver disease, intimate-partner violence, sexually transmitted diseases, obesity, smoking, suicide attempts and unintended pregnancies, among others.
Researchers for the Child Trends report branched out from well-documented health impact to look at whether ACEs also negatively influence behavior.
About 15 percent of older kids, 12 to 17, had experienced at least three of the adverse events: "These youths are not doing as well as their peers," Sacks said.
About half of those kids were not engaged in school and more than one-fifth repeated a grade. They were also more apt to argue or bully others, she said.
Among all the kids, including the younger ones, 10 percent had experienced at least three adverse events. About 40 percent of the parents said they'd been contacted about problems in school, and Sacks called that another "striking indicator of well-being."
Multiple negative experiences confer what appears to be cumulative damage.
Diana Kramer, a relationship coach in New York City, sees adults who grew up with a common ACE: divorce. Many of them "have problematic perceptions of relationships. There is always some implication, never a healthy one," she said.
Sacks said adults "need to be aware these experiences can be powerful and traumatic. If you already know a child has been exposed to one, prevent ongoing exposure. Also make sure the child has access to mental health care, to a close caring adult and the support they need."
The researchers used nationally representative data from the 2011-12 National Survey of Children's Health that included interviews with more than 95,000 adults regarding one of their children's experiences. Because it was based on a parent's report and his or her assessment of behavior, Sacks said it's possible researchers missed some ACEs parents were not aware of. The researchers didn't try to determine whether certain experiences are more negative than others for well-being.
The just-released report also looked at geographic patterns and found trauma experienced by children varies greatly from state to state. Sacks used the example of drugs and alcohol use — experienced by more than 1 in 10 kids nationally. In Montana, the number is 1 in 5; in Georgia, it's less than 1 in 10, she said.
Alcohol or drug abuse, neighborhood violence and mental illness within families were commonly reported in each state.
Kids in Connecticut, Maryland and New Jersey were the least likely to have experienced the adverse events the surveyed examined — 60 percent never had those experiences. On the other hand, Oklahoma kids were in the top quartile for each of them. For kids in Washington, D.C., neighborhood violence came in second only to economic hardship.
Among adolescents ages 12-17, in Mississippi, 15 percent witnessed domestic violence at home, while in Maine close to 1 in 5 lived with someone who had mental illness. More than one-fourth of Arizona children have lived with someone who abuses alcohol or drugs, while in Kentucky 15 percent have lived with a guardian who did jail time.
"We all have ACEs. What impacts one child severely may be no big deal to another," said Carrie Krawiec, a family therapist in Troy, Michigan, who was not involved in this research. "Genetics/biology/temperament plays one part in how a person manages difficult challenges, but in my practice I have realized another is how a person 'narrates' their life. If a person's story sounds like 'nothing good ever happens to me' or 'life is too hard,' then that storyline impacts their mood — and their future."
Someone who sees their life in a more positive or empowered light will feel better about it and the future, she said, including people who feel they overcame challenges or grew because of an experience.
"I think it is important to recognize that ACEs or trauma are different for each person. Some people may only have severe symptoms after suffering something incredible like a rape, whereas others may be troubled by a severe storm or a bad dream," she said. "... Some people may have many subtle tremors through their life, like lots of bullying or verbal abuse and some may have one big, earth-shattering event."
"Children growing up use their experiences to make sense of the world around them. They might learn adaptive behaviors to survive, so to speak," said Brian Donovan, a marriage and family therapist in Grand Terrace, California, also not part of the research. "When they grow up, they can sometimes carry these maladaptive behaviors into their own lives."
He describes clients who saw or experienced abuse at home and learned if they shared their feelings, they'd be hit.
"Now, as adults, they may use some of these same behaviors in their relationships," he said. "They hold things back from their spouse because they are afraid of their spouse's reaction."
Donovan said childhood experiences can contribute to anxiety, fear and depression and may lead to substance abuse or eating disorders in some people.
They are not insurmountable, he said.
"Human beings are incredibly resilient and very capable of overcoming problems from their past," he said. "... It is important that individuals do not blame their problems or issues on parents or past experiences."
In counseling sessions, he talks with adults about ACEs in their pasts to get insight and to help them move forward, but not to excuse problem behaviors that resulted.
Kramer said parents especially have power to intervene and help manage the impact early. One theory of substance abuse, for example, suggests some people are born with a gene that predisposes them, but certain environments activate it. Parents who know that may help their children avoid circumstances likely to activate addiction.
The report, which was funded by the Annie E. Casey Foundation, says pediatricians, juvenile justice court and school staffs all need more training to intervene effectively.
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