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Adverse Childhood Experiences (ACEs) and
Child Development

 CONTENTS

(links to source documents are in the postings below)

1. New! Adverse childhood experiences are different than child trauma, and it’s critical to understand why - Child Trends
2. New! 2019 Prevention Resource Guide - U.S. DHHS  Children’s Bureau
3. New! Substance Abuse and Infant/Toddler Foster Care Increases  - Child Trends
4. New! Substance Abuse and Foster Care - Child Trends
5. The Lifelong Consequences of Early Childhood Adversity and Toxic Stress American Academy of Pediatrics 
 
6. ACES: National and State Prevalence Data - Child Trends
7. Child Maltreatment Data Report 2017 - U.S. DHHS
8. Child Maltreatment in New York - K&F Consulting
9. Types of Trauma - National Child Traumatic Stress Network 
10. Function and Self-Regulation Skills - Institute for Child Success
11. Ecological, Biological Developmental Studies on Self-Regulation - U.S. DHHS
Adverse childhood experiences are different than child trauma, and it’s critical to understand why
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April 12, 2019

By Jessica Dym Bartlett and Vanessa Sacks

Child Trends

"Legislators, caregivers, and the media increasingly recognize that childhood adversity poses risks to individual health and well-being. The original Adverse Childhood Experiences (ACEs) Study has helped raise public awareness about this critical public health issue. However, as the use of ACEs questionnaires for identifying potentially harmful childhood experiences has gained popularity, it is important to understand how ACEs differ from other commonly used terms, including childhood adversity, trauma, and toxic stress.+

Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious threat to a child’s physical or psychological well-being. Common examples of childhood adversity include child abuse and neglect, domestic violence, bullying, serious accidents or injuries, discrimination, extreme poverty, and community violence. Research shows that such experiences can have serious consequences, especially when they occur early in life, are chronic and/or severe, or accumulate over time. For example, the effects of childhood adversity can become biologically embedded during sensitive periods of development and lead to lifelong physical and mental health problems. However, adversity does not predestine children to poor outcomes, and most children are able to recover when they have the right supports—particularly the consistent presence of a warm, sensitive caregiver.

Adverse childhood experiences (ACEs)—a term coined by researchers Vincent Felitti, Robert Anda, and their colleagues in their seminal study conducted from 1995 to 1997—are a subset of childhood adversities. The researchers asked adults about childhood adversities in seven categories: physical, sexual, and emotional abuse; having a mother who was treated violently; living with someone who was mentally ill; living with someone who abused alcohol or drugs; and incarceration of a member of the household.

Researchers found that the more ACEs adults reported from their childhoods, the worse their physical and mental health outcomes (e.g., heart disease, substance misuse, depression). The term ACEs has since been adopted to describe varying lists of adversities. The current ACEs study funded by the Centers for Disease Control and Prevention, for example, includes parental divorce or separation and emotional and physical neglect; other studies have added experiences of social disadvantage (e.g., economic hardship, homelessness, community violence, discrimination, historical trauma).

No ACEs lists or screening tools identify all childhood adversities, but those that do not include adversity related to social disadvantage are likely to overlook children in specific racial or ethnic groups, who are disproportionately affected. It is equally important to assess each child’s well-being to inform the type(s) of services that would most benefit that child. Gaining a full picture of a child can avoid overtreatment of children who have been exposed to ACEs but are functioning well.

Trauma is one possible outcome of exposure to adversity. Trauma occurs when a person perceives an event or set of circumstances as extremely frightening, harmful, or threatening—either emotionally, physically, or both. With trauma, a child’s experience of strong negative emotions (e.g., terror or helplessness) and physiological symptoms (e.g., rapid heartbeat, bed-wetting, stomach aches) may develop soon afterward and continue well beyond their initial exposure. Certain types of childhood adversity are especially likely to cause trauma reactions in children, such as the sudden loss of a family member, a natural disaster, a serious car accident, or a school shooting. Other childhood adversities (e.g., parental separation or divorce) tend to be associated with more variability in children’s reactions and may or may not be experienced by a child as trauma. Childhood trauma is associated with problems across multiple domains of development. However, trauma affects each child differently, depending on his or her individual, family, and environmental risk and protective factors. For example, two children who experience the same type of adversity may respond in distinct ways: One may recover quickly without significant distress, whereas another may develop posttraumatic stress disorder (PTSD) and benefit from professional help (for example, the services and supports that comprise trauma-informed care).

Toxic stress can occur when a child experiences adversity that is extreme, long-lasting, and severe (e.g., chronic neglect, domestic violence, severe economic hardship) without adequate support from a caregiving adult. Specifically, childhood adversities, including ACEs, can over-activate the child’s stress response system, wearing down the body and brain over time. This overactivation is referred to as toxic stress and is the primary way in which adversity damages a child’s development and well-being. The extent to which a child’s stress response to adversity becomes toxic and leads to serious health and mental health problems in adulthood also depends on the child’s biological makeup (e.g., genetic vulnerabilities, prior experiences that have damaged the stress response system or limited healthy gene expression) and the characteristics of the adverse events or conditions (e.g., intensity, duration, whether a caregiver caused the child harm).

The increased public understanding that childhood adversity, including ACEs, can cause trauma and toxic stress—and, in turn, have a lasting impact on children’s physical and mental health—presents an important opportunity to turn this awareness into action. For example, caregivers and other practitioners can learn about and implement trauma-informed care in child and family service systems. However, we must also take caution to avoid an exclusive focus on ACEs at the expense of understanding the full range of childhood adversity and considerable variation in children’s responses to it. Otherwise, we risk allowing some of the most vulnerable children who are in need of support to fall through the cracks while pathologizing and overtreating other children who do not need services.

2019 Prevention Resource Guide 
U.S. Department of Health and Human Services’ Children’s Bureau
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April 10, 2019 
"The 2019 Prevention Resource Guide plays an important role in these efforts—offering support to community service providers as they work with parents, caregivers, and children to prevent child maltreatment and promote social and emotional well-being. To do so, the Resource Guide focuses on protective factors that build on family strengths and promote optimal child and youth development. Information about protective factors is augmented with tools and strategies that help providers integrate the factors into community programs and systems. Agencies, policymakers, advocates, service providers, and parents alike will find resources in this guide to help them promote these important elements within their families and communities."
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Substance Abuse and Infant/Toddler Foster Care Increase
Child Trends
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March 12, 2019

"Nationally, nearly 105,000 children from birth to age 3 entered foster care in federal fiscal year (FY) 2017. Experiencing maltreatment can negatively affect children at any age, but the implications for infants and toddlers are especially severe. Abuse and neglect during early developmental stages can permanently alter brain functioning, which has lasting effects into adulthood. Effective prevention and intervention approaches are critical to averting such harm."

"Infants and toddlers are twice as likely as older children to enter foster care. In the last 10 years, the rate of foster care entries for infants and toddlers has far exceeded the rate for older children and has driven the overall increase in foster care entry rates. In FY 2017, the rate was more than double, with 6.6 per 1,000 children ages 3 and younger entering foster care, compared to 2.8 for ages 4 to 17."

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1-in- 3 Children Entered Foster Care in 2017 Because of Parental Drug Abuse
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February 27, 2019
In federal fiscal year (FY) 2017, the rate of children entering foster care due to parental drug abuse rose for the sixth consecutive year to 131 per 100,000 children nationally—a 5 percent increase from the previous fiscal year and a 53 percent increase since FY 2007. Of the 268,212 children under age 18 removed from their families in FY 2017, 96,400 (36 percent) had parental drug abuse listed as a reason for their removal.
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“The Lifelong Effects of Early Childhood Adversity and Toxic Stress” – An Ecobiodevelopmental Framework

 

Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health.

The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood.

(This paper) proposes a new role for pediatricians to promote the development and implementation of science-based strategies to reduce toxic stress in early childhood as a means of preventing or reducing many of society’s most complex and enduring problems, which are frequently associated with disparities in learning, behavior, and health. The magnitude of this latter challenge cannot be overstated. A recent technical report from the American Academy of Pediatrics reviewed 58 years of published studies and characterized racial and ethnic disparities in children’s health to be extensive, pervasive, persistent, and, in some cases, worsening. Moreover, the report found only 2 studies that evaluated interventions designed to reduce disparities in children’s health status and health care that also compared the minority group to a white group, and none used a randomized controlled trial design.

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Child Maltreatment Report 2017 – Federal Report

Child Maltreatment 2017 is the 28th edition of the annual Child Maltreatment report series. States provide the data for this report through the National Child Abuse and Neglect Data System (NCANDS). Key findings in this report include:

■ The national rounded number of children who received a child protective services investigation response or alternative response increased 10.0 percent from 2013 (3,184,000) to 2017 (3,501,000).

■ The number and rate of victims have fluctuated during the past 5 years. Comparing the national rounded number of victims from 2013 (656,000) to the national rounded number of victims in 2017 (674,000) shows an increase of 2.7 percent.

■ The 2017 data show three-quarters (74.9%) of victims are neglected, 18.3 percent are physically abused, and 8.6 percent are sexually abused. These victims may suffer a single maltreatment type or a combination of two or more maltreatment types.

■ For 2017, an estimated 1,720 children died of abuse and neglect at a rate of 2.32 per 100,000 children in the national population

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Measurement of Adverse Childhood Experiences 

We measured the prevalence of eight adverse childhood experiences (ACEs), consisting of whether the child ever:

1. Lived with a parent or guardian who got divorced or separated;

2. Lived with a parent or guardian who died;

3. Lived with a parent or guardian who served time in jail or prison;

4. Lived with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks;

5. Lived with anyone who had a problem with alcohol or drugs;

6. Witnessed a parent, guardian, or other adult in the household behaving violently toward another (e.g., slapping, hitting, kicking, punching, or beating each other up);

7. Was ever the victim of violence or witnessed any violence in his or her neighborhood; and

8. Experienced economic hardship “somewhat often” or “very often” (i.e., the family found it hard to cover costs of food and housing)

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Research Base on Prevention of Child Maltreatment and
New York State Maltreatment Data 
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National Child Traumatic Stress Network

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The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of frontline providers, family members, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS).
The following are hyperlinked to the source website. 

TRAUMA TYPES: Community Violence, Complex Trauma, Disasters, Domestic Violence, Early Childhood Trauma, Medical Trauma, Physical Abuse, Refugee Trauma, Sexual Abuse, Terrorism and Violence, Traumatic Grief

·POPULATIONS AT RISK

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What are Executive Function and Self-Regulation Skills?

In the public policy arena, interest in brain development has recently focused on executive function skills that enable adults to secure work and perform successfully and earn their way out of poverty, adolescents to make better decisions about their behavior, and children are able to follow directions and focus, take turns, and regulate their youthful impulses in preschool, kindergarten and elementary school classrooms. 

At age seven, some of the capabilities and brain circuits are remarkably similar to those found in adults.  Once these foundational capabilities for directing attention, keep rules in mind, controlling impulses, and enacting plans are in place, the subsequent developmental tasks of refining them and learning to deploy them more efficiently can proceed into the adolescent and early adult years as tasks grow increasingly complicated and challenging.  

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Ecological, Biological Development

Studies on Self-Regulation 

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A Review of Ecological, Biological, and Developmental Studies of Self-Regulation and Stress builds on the theoretical framework described in the earlier report. It reviews literature on the impact of stress on self-regulation development, addressing questions such as how lasting these effects may be, if there are particular periods of development that are more sensitive to its effects, and how individual differences moderate the impact of stress on self-regulation. The paper also examines data on environmental and contextual factors that may increase vulnerability to or protect children from the effects of stress.
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