October 2019Vol. 20, No. 8Adverse Childhood Experiences: The Time for Prevention Is Now so Every Child Can Thrive

Written by Christopher M. Jones, PharmD, DrPH, MPH, CAPT, U.S. Public Health Service, director of strategy and innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

In our neighborhoods and communities, we don't always know what is behind the faces we see. We don't know the experiences that adults or children may have had—abuse or neglect, growing up around substance misuse, or witnessing violence in their home or communities.

We also don't realize that these potentially traumatic experiences, referred to as adverse childhood experiences, or ACEs, are more common than people think. In fact, a recent study from the Centers for Disease Control and Prevention (CDC) showed that 62 percent of adults surveyed across 23 states had experienced at least one ACE, and nearly 25 percent had experienced three or more ACEs. This is concerning because research tells us that ACEs can disrupt healthy brain development, compromise immune systems, and lead to substance use and other unhealthy behaviors. ACEs are also linked to chronic health conditions and other negative health outcomes later in life. At least 5 of the top 10 leading causes of death are linked to ACEs, including cancer, diabetes, heart disease, and suicide. Beyond the impacts on health, ACEs also negatively affect life opportunities, like educational and occupational achievement. The effects of ACEs add up over time, which means as the number of ACEs a person has increases, so does their risk for negative outcomes. We need to address these patterns or they could continue into adulthood, potentially affecting both this generation and the next.

So, what can be done? How we can address the trauma and early adversity that children are currently facing? We can recognize the signs of distress that children and youth may be experiencing, like displaying "acting-out" behaviors, struggling with school, or participating in risky behaviors (e.g., alcohol or drug use, high-risk sexual behavior).

Health-care providers can help reduce these behaviors and turn things around for individuals in the following ways:

Anticipating and recognizing current risk in children and history of ACEs in adults and referring them to effective, trauma-informed services
Connecting children and adults to victim-centered services, such as housing support, social support, and community resources
Recommending effective therapeutic treatments that address depression, anxiety, posttraumatic stress disorder, and other symptoms of distress
Linking children and adults to family-centered treatment approaches that address parental substance use and offer a range of preventive services, including parenting education and training

By intervening and breaking the cycle of adversity, we can ensure that ACEs are not passed on to future generations.

While advancing trauma-informed care for children and adults is essential, it is only one component of comprehensive ACEs prevention. There are also things we can do to prevent ACEs from happening in the first place. We know that all children and families face challenges. We can shift the focus from individual responsibility to community solutions in the following ways:

Strengthening economic supports to families
Promoting social norms that protect against violence and adversity, such as those that support parents and positive parenting and those that foster connectedness and healthy relationships
Ensuring a strong start for children with home visitation programs and high-quality child care to build a foundation for future learning and opportunity
Teaching skills to parents and youth to help them handle stress, manage emotions, and tackle everyday challenges
Connecting youth to caring adults and activities to improve their future outcomes and buffer against difficulties at home, school, or in the community

So, while we don't always know what is behind the faces we see, we can create neighborhoods, communities, and a world in which every child can thrive.

For more information about the CDC's National Center for Injury Prevention and Control's ACEs prevention effort, visit https://www.cdc.gov/violenceprevention/pdf/preventingACES-508.pdf.