- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Mother treated violently
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
- Persistent exposure to one or more ACEs as a child or adolescent can cause prolonged activation of the body’s stress response to frequent, intense situations/events. This response triggers toxic stress. This toxic stress may affect many brain functions including memory, language, anxiety and fear management, thinking, impulse control, perceptual awareness, survival response management and attention.1
- Toxic stress impacts a number of neural systems including, but not limited to:
- STRESS PATHWAY – Disregulated HPA Axis, decreased hippocampal volume leads to anxiety, depression and impaired learning and memory.
- EMOTIONAL PROCESSING AND REGULATION – Decreased gray matter in the prefrontal cortex (PFC) and increased amygdala volume leads to hypervigilance and reduced attentional control.
- EVALUATION OF REWARD – Decreased reward response in ventral striatum leads to anhedonia, the inability to experience pleasure.
- CONNECTIVITY – Disrupted amygdala to ventromedial PFC pathway, decreased activity in the default mode network, and increased activity in salience networks leads to difficulty understanding the relevance of situations and how to respond.
To learn more, visit our “What Are ACEs?” page here.
- Toxic stress can have an impact across the entire genome, affecting not only genes that control the stress response, but also genes that are implicated in a number of adult diseases. The way we are taught to deal with stress has been shown to be a transferrable trait from generation to generation.2
- “A parent’s ACE score doesn’t have to be passed onto the child, but it most often does without some form of intervention.” Jeannette Pai-Espinosa, President, National Crittenton Foundation.
Seven core ideas to help develop and foster resilience in children:
- Competence – Building their understanding of their skills.
- Confidence – Helping kids develop a true belief in their own abilities.
- Connection – Connecting children with other people, schools and communities to further build their support system.
- Character – Giving our young people a clear sense of right and wrong, and teaching them moral values.
- Contribution – Offering children a chance to contribute to the well-being of others. They learn that providing service feels good and feel more confident to ask others for help as well.
- Coping – Discovering a variety of healthy coping strategies in an effort to redirect children from dangerous “quick fixes” to stress.
- Control – Teaching children to make decisions on their own so they can experience a sense of control.3
To explore these 7Cs in more detail, click here.
Beyond the seven building blocks to help build resilience, what else can I do to bolster resilience in children?
- Parental education
- Create awareness of developmental milestones and the ability to help their child master a particular skill set.
- Learn how to discipline their children correctly and appropriately.
- Understand their own behavior has an impact on their child’s social skills, vocabulary, manners, etc. All adults in a child’s life are always being watched by children who learn from observing, particularly at such a young age.
- Physical activity
- Unstructured outdoor play, exercise, motion, sports, etc. all are necessary for the development of a resilient child.
- Reading to your child, having your child see you reading for pleasure or instruction, and helping your child to read on their own.
According to the National Child Traumatic Stress Network, one out of every four children attending school has been exposed to a traumatic event that can affect learning and/or behavior.
Possible impacts on school performance from ACEs can include, but not limited to, the following:
- Lower grades
- Increased absences
- Impaired reading ability
- Impaired memory
- Increased disciplinary consequences such as suspensions and expulsions
- Increased drop-out
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), school reporting procedures for suspected abuse should be followed.
- Work with the child’s caregiver to share and address school problems.
- Refer to community resources when a child shows signs of an inability to cope with traumatic stress.
- Learn and share facts regarding ACEs with other school personnel and administration.
Currently there are no tools to measure toxic stress exposure. Toxic stress is the prolonged activation of stress response to frequent, intense situation/events. It is this toxic stress that, when not properly addressed and reduced, can lead to long-term behavior issues and health complications and diseases that are associated with ACEs.
- It may help facilitate a conversation with parents about adversity that their family, specifically their children, may have experienced or currently experiencing. Once the score is obtained, ask permission to review their survey with them.
- Express empathy if their ACE score is greater than zero and begin a non-judgmental dialogue acknowledging that these childhood experiences may have created challenges for them in their life. Many parents will reflect about their childhood.
- Inquire about the parents’ strengths and where they have found resilience to persevere through these childhood experiences. Reflect back what you have heard.
- Ask if they worry that adverse experiences may be affecting their child’s life.
- Elicit “change talk” to find interventions that can change their child’s environment or home to reduce the impact of ACEs.
- A parent’s ACE score only needs to be obtained once, since you are asking about experiences that occurred during his or her childhood.
- For pediatric patients in a healthcare setting, The Center for Youth Wellness has developed a protocol for collecting and responding to ACE scores.
How do I begin a conversation with parents when I have reason to believe a child is experiencing toxic stress?
Talking with parents about ACEs and stress is not easy, but it is made easier when you already have a positive relationship with them.
- Begin conversations about ACEs by acknowledging that parenting is hard work and that you see how much they want the best for their children.
- Acknowledge how hard it is to do your best as a parent when you feel like you’re struggling to just keep the world from falling apart.
- Gently ask what kind of things they are dealing with, and then ask if their own parents had dealt with similar things.
- Ask them if they remember how they felt about those struggles when they were growing up.
- Talk with them about how they can manage to cope with their stress in ways that lessen the impact on their children.
- Suggest some daily rituals that can reduce stress for their children. For example, a good night hug with a simple question, “What’s the best thing that happened today?”
- Ask the parent to think of one source of stress, that if it went away or was lessened, would have a big impact. Then have a discussion with them about that one thing. Explore with them resources in the community that might help; and then be a strong advocate to connect the parent to those resources. This will be more effective than merely providing them a phone number.
- Conclude the conversation with a comment on the strength(s) that you see in them and how they can use that strength to cope with stress for the well-being of their children.
- It’s important to be prepared for the answers. Have resource lists ready and referral information available when needed. Need a reference? Check out a resource example:
- “What can be done about ACEs” – Explore this infographic created by the Centers for Disease Control and Prevention to learn more.
- Our collective experience has been that most adults are grateful that someone has actually asked about their experiences. Often it is the first time that anyone has ever asked and that, in itself, has a healing effect.
- Differential diagnoses should always be left up to a clinician trained to do so. However, it is useful to note that these symptoms can overlap, and the more history a clinician is given, the better informed he or she can be when making a diagnosis.
- Asking about ACEs is the first step in identifying a child who may have behaviors suggestive of ADHD/ADD, but might be a reaction to exposure to ACEs instead.
- Referral to a mental health provider with trauma training will then help to differentiate ACEs from ADHD/ADD.
Child abuse must always be reported to the local child protective agency.
- Ohio: 1-855-OH-CHILD (1-855-642-4453) or contact the PCSA in the county where the child and his or her parent, guardian or custodian reside – https://jfs.ohio.gov/ocf/childprotectiveservices.stm
- Hamilton County (OH): 513) 241-KIDS (5437) – https://www.hcjfs.org/services/child-protection/
- Kentucky: 1-877-597-2331 – https://prdweb.chfs.ky.gov/ReportAbuse/Home.aspx
- Indiana: 1-800-800-5556 – https://www.in.gov/dcs/2971.htm
1. National Scientific Council on the Developing Child (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Updated Edition. Retrieved from www.developingchild.harvard.edu
2. Shonkoff, J. P. & Garner, A.S. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics: Official Journal of the American Academy of Pediatrics, 129(1), e232–e246.
3. Ginsburg, K. R., & Kinsman, S.B. (2014) Reaching Teens: Strength-based Communication Strategies to Build Resilience and Support Healthy Adolescent Development. American Academy of Pediatrics.