Adverse Childhood Experiences (ACEs) is an ongoing, collaborative investigation led by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente’s Health Appraisal Clinic and focuses on the prevalence and impact of ACEs on adults in the United States (Cprek et al., 2020). ACEs originated in the medical field but have been extensively studied across disciplines, including psychology (Portwood et al., 2021). The ACEs movement has expanded and consists of researchers and individuals who apply practices and policies based on ACEs science to transform our communities. ACEs are a major global health problem, and the CDC (2021) reported 61% of adults report at least one ACE. The public health crisis of experiencing a variety of ACEs costs billions of dollars each year, and the long-term consequences lead to 1.9 million potentially preventable cases of heart disease and 21 million occurrences of avoidable depression” (Longhi et al., 2021). It is essential to make a social change within ACEs because of the detrimental effects on the children and adults within our community. This blog aims to highlight the effects of ACEs on children throughout their lifespan and how resiliency can help decrease the harmful effects of ACEs. I will also explain psychology’s role and ethnic inequalities regarding ACEs and resilience.
What Are ACEs?
The term ACEs refers to a variety of potentially stressful and traumatic experiences such as physical, sexual, and emotional abuse; physical and emotional neglect; exposure to adult incarceration, mental illness, substance abuse, or violence in the household; and parental divorce, poverty, exposure to community violence, bullying, racial discrimination, and separation from immigrant parents (Portwood et al., 2021). Birth through 5 years old is a critical period for brain development and affects cognitive, emotional, and social competencies. When children are repeatedly exposed to adversity, they develop a prolonged stress response that hinders their brain development and increases the risk of negative outcomes in adulthood. Two decades of ACEs research have shown negative physical and mental health outcomes across the life span, with harmful effects observed in childhood, adolescence, and adulthood (Portwood et al., 2021). The negative physical and mental health outcomes that are associated with ACEs include smoking, obesity, physical inactivity, depression, suicide attempts, addiction, sexual promiscuity, heart disease, cancer, stroke, COPD, chronic pain, diabetes, skeletal fractures, and poor academic performance (Cprek et al., 2020). Children exposed to stressful and traumatic events at a younger age have higher rates of PTSD, social and emotional problems during childhood, and more significant negative health impacts across their lifespan. ACEs have been found to have a dose-response relationship; the more ACEs an individual experiences, the higher the risk for health and social problems throughout their life (Srivastav et al., 2020). Research has shown that resilience mitigates the effects of ACEs.
What’s the Role of Resilience?
Resilience is the adaptive ability to cope with adversity and trauma (Poole et al., 2017). Research on resiliency has focused on how individuals adapt to adversity (Longhi et al., 2021). Children with strong resilience levels have healthier outcomes, including lower rates of maladaptive behaviors and stress symptomatology (Elmore et al., 2020). Early research has shown that individuals who feel support and competent within their community and family experience less adversity than those in a negative environment. Supportive relationships play an essential role in resilience across the lifespan (Elmore et al., 2020). A study conducted by Poole et al. (2017) showed resilience moderated the relationship between ACEs and depression; resilience was seen as a buffer. Resilience in children can mediate the effects of ACEs on some mental health conditions. It is essential to know what types of resilience are important to increase for the youth and adults in our community. Increasing the support in resiliency will improve the quality of life for individuals, which will improve our community. When we focus on empowering our community, we can influence changes in community norms and culture (Longhi et al., 2021). Increasing support for resiliency will help buffer the negative effects caused by stressful and traumatic events.
What Role Does Psychology Play in ACEs and Resilience?
Psychology plays a role in ACEs, resiliency, and health outcomes. Psychologists can contribute their findings, ensuring that the best science available is effectively translated into practice around ACEs (Portwood, Lawler, & Roberts, 2021). Many psychologists have contributed work towards the resiliency theory. Resiliency theory is based on ecological frameworks and suggests that multiple systems interact to impact the course of development, and that resilience is continuously evolving within individuals and systems (Crandall et al., 2019). Psychologists have found that resilience applies to families, economies, ecosystems, and organizations (Longhi et al., 2021). Resilience theory describes how promotive factors may counteract and protect against the negative effects of adversity (Zimmerman, 2013). Resilience theory provides a logical framework for protective factors acting as a buffer to ACEs and encouraging positive youth development.
Pachter et al. (2017) reported ACEs as a framework that can cause collaborative, cross-sector action to address social determinants of health. Multisector, community-based networks that address ACEs and trauma and foster resilience (ATR networks) are rapidly increasing. ATR network activities have sponsored community-wide ACE awareness events that provide professional development and learning collaboratives, conducting ACE prevalence surveys, and advocating for trauma-informed organizational, system, and policy changes (Rog et al., 2021). ATR networks allow psychologists to offer their skills, contribute their specific knowledge, and offer their expertise with others in the community and help build and sustain a national movement to address ACEs and create more equitable and resilient communities.
ACEs harm the whole community, and our focus should be on community solutions. The CDC (2021) recommends educating states and communities on effective social and economic supports to address financial hardship and other conditions that put families at risk of experiencing ACEs. Policies are also critical for facilitating community and population-level efforts to prevent and mitigate the effects of ACEs and to decrease retraumatization among individuals exposed to ACEs (Hampton-Anderson et al., 2021).
Srivastav et al. (2020) stated that to improve health trajectories; society must improve the conditions in which people are born, live, work, and play. They also suggested a model that promotes resilience throughout the lifespan by creating protective factors at various levels and promoting equity to meet the needs of the diverse population. The empower action model aims to provide clear steps to prevent child adversity by implementing protective factors to build resilience and health equity across various life span levels. This model assists families, communities, coalitions, individuals who serve families, and policy advocates in developing a plan of action in their areas of influence. The empower action also includes the socio-ecological model because it recognizes the relationship among the various levels of influence on health. The socio-ecological model highlights the idea that social determinants influence health behaviors. Srivastav et al. (2020) also stated that it is essential to dismantle institutional racism by implementing intentional policies and practices across all systems that promote diversity and break down barriers to allow all individuals to meet their potential. When psychologist’s training and expertise are combined with other disciplinary perspectives, it can result in multilevel interventions that are evidence-based, contextualized to the needs of the community, and universal in their preventive approach (Rog et al., 2021).
How Does Ethnic Inequalities Impact ACEs and Resilience?
Race, gender, poverty, historical trauma, and other social determinants of health play a role in the impact of ACEs (Longhi et al., 2021). There has been little research on inequalities in the distribution of ACEs by race/ethnicity, gender, and economic status (Mersky et al., 2021). However, across all racial/ethnic groups, research has shown a strong association between ACEs and psychological symptoms/disorders such as depression, posttraumatic stress disorder, substance misuse, and suicidal behavior (Hampton-Anderson et al., 2021). Although ACEs can impact everyone, women, blacks, and members of several other racial/ethnic minority groups have a higher risk for health disparities (Portwood, Lawler, & Roberts, 2021). According to Mersky et al. (2021), research has shown non-Hispanic blacks and Hispanics report more ACEs than non-Hispanic whites, and racial/ethnic differences vary by type of ACE; for example, non-Hispanic whites are more likely to endorse many mental health and substance use problems than non-Hispanic blacks and Hispanics. The study conducted by Merksy et al. (2021) showed ACEs are more frequent among Blacks and Hispanics than Whites, but Whites report more ACEs in aggregate than Blacks and Hispanics.
Studies have shown that exposure to ACEs increases individuals’ perceived discrimination across race/ethnicity. A study conducted by Gangamma et al. (2021) showed racial minority groups and lower-income individuals reported greater perceived discrimination and psychological distress. This study shows the importance of sociocultural contexts psychological symptoms. Individuals with prior trauma may have a lower tolerance for everyday stressors and perceive more social rejection and exclusion. Perceived discrimination is the differential treatment of certain members of a society or the belief that negative attitudes, judgment, or unfair treatment are directed towards members of a specific group of individuals (Campbell et al., 2020) and is the appraisal of social rejection and is subtle (Gangamma et al., 2021). This perceived discrimination increases the risk for cardiovascular disease, alcohol and substance abuse, and poor health behaviors that lead to poor physical health. When ACEs and perceived discrimination are combined, they may exacerbate the stress response in individuals whose system is in a state of hyperarousal (Gangamma et al., 2021).
Overall, when children experience ACEs, it has a negative impact on physical and mental health. However, research has shown that resilience can act as a buffer to adversity and improve the quality of life (Poole et al., 2017). Growing programs that focus on ACEs and resiliency around the country will provide psychologists opportunities to act as agents of social change within their community (Rog et al., 2021).
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