Adverse Childhood Experiences (ACEs)

A child’s developing brain is a very sensitive organ that is vulnerable to damage from physical and environmental influences.

An adverse childhood event (ACE) happens when a child experiences abuse, neglect or failed attachment to parents. This untreated trauma can have a lifelong impact on the child’s sense of safety. This negatively affects the child’s brain development, immune system and future mental and physical health.

Stress during childhood can be divided into three groups:

Positive stress, which is a normal and important stress in the body, often caused by an upcoming test or sports competition
Tolerable stress, which is more severe or longer lasting—such as a death in the family—during which the child is supported by loving caregivers
Toxic stress, which describes highly stressful situations like abuse, neglect or untreated mental illness, during which a child experiences in the absence of supportive caregiver

Researchers have discovered that toxic stress caused by abuse, neglect, lack of parental attachment or support can affect the chemistry of a child’s brain.

This can damage the child’s immune system, which fights off illness. Children who experience repeated toxic stress can face several serious health problems in adulthood. This includes:

Mood and anxiety disorders
Addiction
Obesity
Poor dental health
Heart disease
Depression
Diabetes
Cancer

Screening

ACEs are often identified during well-child checkups with a pediatrician or after a parent or caregiver has raised concerns about behavior issues.

If a child’s doctor believes the problem may be the result of an ACE, the doctor may a use special list of questions, called the Q10 Questionnaire, to learn more. It is important for parents and caregivers to answer these questions openly and honestly so the doctor can provide the child with the best treatment possible.

The Q10 Questionnaire helps doctors understand how many ACEs a child has faced. While most people have experienced one or two ACEs—such as divorcing parents, loss of a relative or lack of food in the home—the more ACEs a child accumulates, the more problems he or she may face in future mental and physical health. When compared with patients who have zero ACEs:

People with three or more ACEs are three times more likely to experience academic failure, six times more likely to have behavioral issues and five times as likely to have attendance problems.
People with four or more ACEs are seven times as likely to develop alcoholism, twice as likely to develop cancer, four times as likely to develop emphysema and almost twice as likely to develop diabetes

Treatments

Fortunately, children can recover from the trauma of ACEs with the help of a caring, supportive, available parent or caregiver. Treating children who have experienced adverse childhood events is a two-step process of trauma removal and then trauma-informed care.

Trauma Removal

Removing the cause of trauma is not simple. The parents of an affected child have often experienced ACEs during their own childhoods. Creating a healthy home environment may be a new and challenging concept.

Riley at IU Health doctors understand the need to provide complete support services for families. This includes:

Primary care doctors
Psychiatrists
Psychologists
Social workers

If homelessness or hunger is triggering an ACE, a social worker will connect the family to the appropriate community resources. If a mother’s depression is preventing her from attaching properly, a doctor can begin addressing the mother’s mental health concerns.

Trauma-Informed Care

Once the source of trauma is addressed, healing can begin. Trauma-informed therapy can help improve a child connectedness to caregivers, train parents in attaching to the child and begin repairing the damage from toxic stress.

The goal is to help move a child’s brain out of the fight-or-flight stress of ongoing trauma and into a healthy and safe space where it can heal. A child’s brain has a lot of what’s called “neuroplasticity,” meaning it can adapt well to building resilience and healing.

Prevention

Finally, prevention is key to stopping the cycle of toxic stress and ACEs. Prevention begins even before a baby is born by educating new and young parents on ways to create a healthy home, how to identify and treat parental depression and how to find and use medical and social resources.

Preventing ACEs is challenging and goes beyond the doctor’s office to include community services and government advocacy. Riley Children's Health is committed to this task. By coordinating a team approach to care and providing a navigator to guide families through the resources, we are working to help stop the cycle of trauma in our patients.

What to Expect

The trauma caused by repeated adverse childhood experiences is not something that can be treated in one doctor’s visit.

ACEs are often aggravated by certain family habits passed down from generation to generation, which take time, therapy and wider availability of social support services to address. It is important that parents or caregivers discuss concerns about trauma with a healthcare provider. Together, parents and doctors can identify resources to help improve a child’s safety and well-being so that young brains have the opportunity to heal and grow.

Key Points to Remember

Repeated exposure to toxic stress without support can damage a child’s brain and immune system, leading to increased mental, physical and behavioral health issues later in life.
ACEs are caused by socioeconomic stressors and affected by lack of appropriate support for the family.
Awareness, support and therapy for children and young parents, or parents with existing ACEs, can stop the cycle of trauma

Support Services & Resources

To learn more about adverse childhood events (ACEs), use these online resources:

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Centers for Disease Control and Prevention (CDC)

Public health resources for understanding and preventing ACEs

The National Child Traumatic Stress Network

This interactive course offers ways to create a trauma lens through which providers and parents can view and better support young children as they grow and learn.

Center for Youth Wellness

ACE-Q materials in English and Spanish.

American Academy of Pediatrics

Public health information from the AAP on understanding and preventing ACEs.

Adverse Childhood Experiences (ACEs) Research

As an academic health center, Riley Hospital for Children is actively involved in research studying the biological effects and successful preventions for ACEs. These developments help us to better understand the long-term effects of ACEs and how we can prevent and heal trauma in children.

Research has included studies to identify traits among young children that may predict future addiction as well as research on the genetics of mental illness and the potency of environmental effects of early exposure to abuse and neglect.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.