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  • August 05, 2020

    Assessing the Impact of Childhood Trauma

    Chronic and persistent adversity impacts development in children as they grow into adults. Melissa Ivens discusses adverse childhood experiences (ACEs) and reviews strategies that facilitate healthy development in children.

    Melissa Ivens

    According to the Centers for Disease Control and Prevention (CDC), adverse childhood experiences (ACEs) are traumatic events that occur in a person’s childhood.

    These events include:

    • experiencing violence, abuse, or neglect;

    • witnessing violence in their home or community; or

    • having a family member attempt or die by suicide.1

    Also included are aspects of a child’s environment that may undermine their sense of safety and stability, such as growing up in household with substance abuse, with a family member who has mental health issues, or experiencing home instability due to parental separation.

    A person’s ACEs score is determined by how many of these experiences they suffered as children.2

    Unfortunately, ACEs are common. According to the CDC, 61 percent of surveyed adults reported experience with 1 type of ACE and nearly 1 in 6 reported experiencing four or more types of ACEs.

    Negative Consequences

    The prevalence of ACEs presents an issue because of the negative consequences that have been linked to an increase in a person’s ACEs score.

    Melissa Ivens Melissa Ivens, Marquette 2020, resides in Milwaukee, and is interested in a guardian ad litem practice.

    Studies done by the CDC suggest that ACEs are linked to chronic health problems, mental illness, and substance abuse, and negatively impact education and job opportunities in adulthood. ACEs can lead to a number of different physical, psychological, relational, and economic adversities in those who experience them.

    ACEs increase a person’s risk “of injury, sexually transmitted infections, maternal and child health problems, teen pregnancy, involvement in sex trafficking, and a wide range of chronic diseases … such as cancer, diabetes, heart disease, and suicide.”3

    ACEs and associated conditions can also cause toxic stress, which changes brain development, and can affect attention, decision-making, learning, and response to stress. Children who grow up with toxic stress are likely to have difficulty forming healthy and stable relationships. They may struggle with finances, jobs, and depression throughout their life. These effects can also be passed to their children, and may be exacerbated by these children’s further exposure to toxic stress from historical and ongoing trauma due to systematic racism or the impacts of poverty.

    Six Strategies to Limit ACEs

    With all of the negative impacts that come from a person’s exposure to ACEs, it is important to try and limit the number of ACEs in order to prevent the negative impacts.

    According to the CDC, the best way to prevent ACEs is to create and sustain safe, stable, and nurturing environments for children to help them reach their full potential.

    The CDC has developed six different strategies for preventing ACEs by helping to create safe environments for children.

    First, strengthen economic supports to families. Research shows that parents who face financial hardship are more likely to experience stress, depression, and conflict in their relationships and family, which compromise parenting and increase the risk of ACEs for their children. Therefore, strengthening household financial security and having family friendly work policies can prevent ACEs by reducing parental stress and increasing stability, and thus reducing children’s exposure to ACEs, according to the CDC.

    Second, promote social norms that protect against violence and adversity. This strategy focuses on changing group-level beliefs that accept or allow indifference to violence and adversity. Norms to protect against violence include:

    • promoting community norms around a shared responsibility for the well-being of all children;

    • supporting parents through positive parenting techniques and safe discipline;

    • fostering healthy norms around gender, masculinity, and violence to protect against violence toward intimate partners, children and peers; and

    • enhancing connectedness to build resiliency in the face of adversity.

    By promoting these norms, children will be safer and less likely to experience ACEs. The CDC suggests that these new norms be achieved through public education campaigns, legislative approaches to reduce corporal punishment, bystander approaches, and efforts to mobilize men and boys as allies in the prevention of violence.

    Third, ensure a strong start for children by encouraging healthy relationships inside and outside the child’s family. These relationships play a role in healthy brain development as well as the development of physical, emotional, social, behavioral, and intellectual capacities.

    The CDC recommends early childhood home visitation as a method to prevent ACEs, because these programs can provide information, caregiver support, and training about child health and development. High quality child care and preschool enrichment programs also help children build a strong foundation for future development and strengthen connections between home and school environments.

    The fourth strategy, according to the CDC, is to involve children in skill-based learning. Research has shown that teaching children skills to handle stress, resolve conflicts, and manage their emotions can prevent violence victimization and perpetuation, as well as substance misuse, sexually transmitted infections, and teen pregnancy.

    Social emotional learning approaches are widely used in schools across the U.S. and aid in the development of interpersonal skills including communication skills, problem-solving, alcohol and drug resistance, conflict management, and coping. Safe dating and healthy relationship skills programs and parenting skills programs are also effective in increasing interpersonal skills and reducing ACEs, according to the CDC.

    The fifth strategy is to connect youth to caring adults who can serve as positive role models, according to the CDC. These mentors could include teachers, coaches, neighbors, extended family members, or community volunteers. After school programs and mentoring programs, like Big Brothers Big Sisters, After School Matters, and Powerful Voices help provide a buffer to current and past ACEs that a child may have experienced by providing positive networks and experiences. These programs also teach children important skills and aid in their development which will help them in the future.

    The last strategy developed by the CDC is to intervene to lessen immediate and long-term harms of ACEs. In order for this strategy to work, it is important to recognize the signs of a child dealing with ACEs. These children may show signs of behavioral and mental health challenges. They also may be irritable, depressed, act out, have difficulty concentrating, and show other traumatic stress symptoms.

    Breaking the Cycle of Adversity

    Timely access to assessment, intervention, and effective care and treatment for children and families where ACEs have already occurred mitigates the health and behavioral consequences of ACEs, strengthens children’s resilience, and breaks the cycle of adversity.

    Enhanced primary care is the first step in lessening the harms of ACEs, because primary care physicians are in the best position to identify problems and refer children and families to appropriate treatments and services.4

    In her TED Talk, Dr. Nadine Burke Harris discusses the importance of effective primary care that incorporates all the above strategies with medical treatment and services. These services and treatments that mitigate harms and prevent future ACEs include victim-centered services, therapeutic treatments, and family centered treatment approaches for substance use disorders.5

    The State Bar of Wisconsin PINNACLE® and the Children and the Law Section are presenting the live webinar Trending Topics in Juvenile Justice Reform & Practice 2020 on Tuesday, Sept. 1, 2020. Scholarships and tuition discounts are available to section members. Visit's Marketplace for full details.

    This article was originally published on the State Bar of Wisconsin’s Children & the Law Section Blog. Visit the State Bar sections or the Children & the Law Section web pages to learn more about the benefits of section membership.


    1 What are adverse childhood experiences,

    2 There is a test available on the National Public Radio website from March 2, 2015, where you can determine your ACE score and also get a better idea of the factors that go into determining your score.

    3 What are adverse childhood experiences.

    4 Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence,

    5 Id.


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