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112-413: The concept of adverse childhood experiences refers to various traumatic events or circumstances affecting children before the age of 18 and causing mental or physical harm. There are 10 types of ACEs: The different adverse childhood experiences are not isolated and in many cases multiple ACEs impact someone at the same time. Adverse childhood experiences are common across all parts of societies, in 2009

224-866: A "heightened stress response" which can make it difficult for them to regulate their emotions, lead to sleep difficulties, lower immune function, and increase the risk of a number of physical illnesses throughout adulthood. Childhood trauma can leave epigenetic marks on a child's genes, which chemically modify gene expression by silencing or activating genes, or DNA methylation . This can alter fundamental biological processes and adversely affect health outcomes throughout life. A 2013 study found that people who had experienced childhood trauma had different neuropathology than people with PTSD from trauma experienced after childhood. Another recent study in rhesus macaques showed that DNA methylation changes related to early-life adversity persisted into adulthood. This research has centered primarily around methylation associated with

336-559: A behavioral or cognitive problem than a child with no ACEs. Another study found that students with at least three ACEs are three times as likely to experience academic failure, six times as likely to have behavioral problems, and five times as likely to have attendance problems. The trauma-informed school movement aims to train teachers and staff to help children self-regulate, and to help families that are having problems that result in children's normal response to trauma. It also seeks to provide behavioral consequences that will not re-traumatize

448-455: A child's inborn resilience. Studies suggest that resiliency can be enhanced by providing children who have been exposed to trauma with environments in which they feel safe and are able to securely attach to a healthy adult. Therefore, interventions that promote strong parent-child bonds are particularly effective at buffering against the potential negative effects of trauma. Furthermore, researchers of resilience argue that successful adaptation

560-558: A child's mental health. These types of abuse disrupt a child's sense of safety and trust, which can lead to various mental disorders including post-traumatic stress disorder (PTSD), attachment issues, depression, and substance abuse . Sensitive and critical stages of child development can result in altered neurological functioning, adaptive to a malevolent environment but difficult for more benign environments. Trauma experienced in childhood may also increase vulnerability to developing severe mental health conditions, such as psychosis, as

672-464: A child. Trauma-informed education refers to the specific use of knowledge about trauma and its expression to modify support for children to improve their developmental success. The National Child Traumatic Stress Network (NCTSN) describes a trauma-informed school system as a place where school community members work to provide trauma awareness, knowledge and skills to respond to potentially negative outcomes following traumatic stress. The NCTSN published

784-562: A combination of cognitive behavioral and mindfulness techniques. The real life heroes (RLH) treatment, a sequential, attachment-centered treatment intervention for children with Complex PTSD that focuses on 3 primary components: affect regulation, emotionally supportive relationships, and life story integration to build resources and skills for resilience. A study of 126 children found Real Life Heroes treatment to be effective in reducing symptoms of PTSD and in improving behavioral problems. The narrative-emotion process coding system (NEPCS)

896-1346: A complex puzzle of interacting biological and environmental factors. People can pass their epigenetic marks including de-myelinated neurons to their children. The effects of trauma can be transferred from one generation of childhood trauma survivors to subsequent generations of offspring. This is known as transgenerational trauma or intergenerational trauma, and can manifest in parenting behaviors as well as epigenetically. Exposure to childhood trauma, along with environmental stress, can also cause alterations in genes and gene expressions. A growing body of literature suggests that children's experiences of trauma and abuse within close relationships not only jeopardize their well-being in childhood, but can also have long-lasting consequences that extend well into adulthood. These long-lasting consequences can include emotion regulation issues, which can then be passed onto subsequent generations through child-parent interactions and learned behaviors. (see also behavioral epigenetics , historical trauma , and cycle of violence ) The social and economic costs of child abuse and neglect are difficult to calculate. Some costs are straightforward and directly related to maltreatment, such as hospital costs for medical treatment of injuries sustained due to physical abuse and foster care costs resulting from

1008-559: A dedicated small team, identify community connectors, secure long-term financial backing, and conduct data-informed evaluations throughout. Other community examples exist, such as Tarpon Springs, Florida which became the first trauma-informed community in 2011. Trauma-informed initiatives in Tarpon Springs include trauma-awareness training for the local housing authority, changes in programs for ex-offenders, and new approaches to educating students with learning difficulties. ACEs exposure

1120-402: A dose response relationship with symptom severity and prevalence including depression, attention-deficit/hyperactivity disorder, anxiety suicidality, bipolar disorder and schizophrenia. Depressive symptoms in adulthood showed one of the strongest dose response relationships with ACEs, with an ACE score of one increasing the risk of depressive symptoms by 50% and an ACE score of four or more showing

1232-635: A fourfold increase. Later research also demonstrated that ACE scores are related to increased rates and severity of psychiatric and mental disorders, as well as higher rates of prescription psychotropic medication use. Additionally, epigenetic transmission may occur due to stress during pregnancy or during interactions between mother and newborns. Maternal stress, depression, and exposure to partner violence have all been shown to have epigenetic effects on infants. Additionally, mothers who experienced ACES are more likely than those who did not have ACES to engage in illicit drug use during pregnancy, particlarly if

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1344-419: A higher prevalence than non-Hispanic whites of physical abuse, witnessing domestic violence, and having an incarcerated family member (p<0.05). Those respondents with less than a high school education compared with those with more than a high school education had a greater prevalence of physical abuse, an incarcerated family member, substance abuse, and separation/divorce. Among the five states, little variation

1456-440: A pattern of emotional manipulation, abusive words, isolation, discretization, humiliation and more that tends to have an internalized effect on an individual's self-esteem, ideals, values and reality. Emotional abuse in children is a distinct issue in relation to childhood trauma and the effects it has on children when growing up in an emotionally abusive household or being in relation with emotionally abusive individuals. Bullying

1568-436: A potentially traumatic event. These are called resiliency factors. Research regarding children who showed adaptive development while facing adversity began in the 1970s and continues to this day. Resilience is defined as “the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances." The concept of resilience stems from research that showed experiencing positive emotions had

1680-744: A range of experiences that classify as psychological trauma ; these might include neglect , abandonment , sexual abuse , emotional abuse, and physical abuse . They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological , physiological , and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders . Kaiser Permanente and

1792-463: A response to a single or multiple medical events. In children, they are still developing cognitive skills and because of this they process information differently. They might associate pain with punishment and could believe they did something wrong that led to them being in pain or that they somehow caused their injury. Children may experience disruptions in their attachment with their caregivers due to their traumatic medical experience. This depends on

1904-591: A restorative and preventive effect on the experience of negative emotions more broadly with regards to physical and psychological wellbeing in general and more specifically with reactions to trauma. This line of research has contributed to the development of interventions that focus on promoting resilience as opposed to focusing on deficits in an individual who has experienced a traumatic event. Resilience has been found to decrease risk of suicide, depression, anxiety and other mental health struggles associated with exposure to trauma in childhood. When an individual who

2016-482: A series of prior collectives that all had similar goals of creating community resilience in order to prevent and treat ACEs. Over the course of the two-year study, over 230 individuals from nearly 100 organizations attended one training offered by the PTICC, raising the number of engaged public sectors from 2 to 14. Participation in training and events was fairly steady and this was largely due to community networking. However,

2128-487: A sharp decrease was observed in prevalence reported by adults aged ≥55 years. For example, the prevalence of reported physical abuse was 16.9% among adults aged 18--24 years compared with 9.6% among those aged ≥55 years. Non-Hispanic black respondents reported the lowest prevalence of each ACE category among all racial/ethnic groups, with the exception of having had an incarcerated family member, parental separation or divorce, and witnessing domestic violence. Hispanics reported

2240-403: A social service worker direct their clients to interventions that meet their specific needs. Trauma-informed practices can also help social service providers look at how trauma impacts the whole family. Trauma-informed approaches can improve child welfare services by openly discussing trauma and addressing parental trauma. The New Hampshire Division for Children Youth and Families (DCYF) is taking

2352-408: A stable environment in which children can learn and create stable attachments. Physical movement in the form of "brain energizers" can help regulate children's brains and alleviate stress when done 1–2 times during the school day. In one study, both behavior and literacy skills were assessed to see how effective the physical movement, or "brain energizers" were. Literacy scores for a classroom that used

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2464-539: A standardized medical questionnaire. The medical history is completed by a health care provider who also performs a general physical examination and reviews laboratory test results with the patient. Appointments for most members are obtained by self-referral with 20% referred by their health care provider. A review of Kaiser Permanente members aged 25 years or older in San Diego and continuously enrolled between 1992 and 1995 revealed that 81% of those members had been evaluated at

2576-644: A study that discussed the Attachment, Self-Regulation, and Competency (ARC) model, which other researchers have based their subsequent studies of trauma-informed education practices off of. Trauma-sensitive or trauma-informed schooling has become increasingly popular in Washington, Massachusetts, and California in the last 10 years. In their 2002 survey, the AAUW reported that, of students who had been harassed, 38% were harassed by teachers or other school employees. One survey that

2688-887: A trauma-informed approach to their foster care services by educating staff about childhood trauma, screening children entering foster care for trauma, using trauma-informed language to mitigate further traumatization, mentoring birth parents and involving them in collaborative parenting, and training foster parents to be trauma-informed. Housing authorities are also becoming trauma-informed. Supportive housing can sometimes recreate control and power dynamics associated with clients' early trauma. This can be reduced through trauma-informed practices, such as training staff to be respectful of clients' space by scheduling appointments and not letting themselves into clients' private spaces, and also understanding that an aggressive response may be trauma-related coping strategies. Up to 50% of people with housing insecurity experienced at least four ACEs. A study in

2800-485: A wide range of difficulties compared to those who have only had one of few trauma exposures. For example, cognitive complications (dissociation), affective, somatic, behavioral, relational, and self-attributional problems have been seen in individuals who have experienced complex trauma. Beyond the experience of natural and man-made disasters themselves, disaster-related traumas include the loss of loved ones, disruptions caused by disaster-caused homelessness and hardship and

2912-488: A young child starts kindergarten and an adolescent enters high school, there is a link between weak emergent literacy leading to eventually dropping out of high school. It is crucial to intervene as early as possible.    Trauma-informed educators and clinicians can help remediate both young children and adolescents in school. With a knowledge and sensitivity of ACEs and their effects, proper and effective interventions can be implemented. This can also begin to create

3024-594: Is a behavioral coding system that identifies eight client markers: Abstract Story, Empty Story, Unstoried Emotion, Inchoate Story, Same Old Story, Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Each marker varies in the degree to which specific narrative and emotion process indicators are represented in one-minute time segments drawn from videotaped therapy sessions. As enhanced integration of narrative and emotional expression has previously been associated with recovery from complex trauma. The Attachment, Self-Regulation, and Competency (ARC) Framework

3136-482: Is a branch of cognitive behavioral therapy designed to treat PTSD cases in children and adolescents. This treatment model combines the principles of CBT with trauma-sensitive approaches. It helps introduce skills to cope with the symptoms of the trauma for both the child and the parent if available, before allowing the child to process the trauma on their own in a safe space. Studies ( systematic reviews ) have shown trauma-focused cognitive behavioral therapy to be one of

3248-399: Is a disruption in an attachment relationship that disrupts neurological development and can lead to death. Chronic separation from a caregiver can be extremely traumatic to a child. Additionally, separation from a parental or attachment figure while enduring a separate childhood trauma can also produce withstanding impact on the child's attachment security. This may later be associated with

3360-707: Is a particularly strong predictor of resilience. Within the context of abuse, it is thought that these secure attachments decrease the extent to which children who are abused perceive others as being untrustworthy. In other words, while some children who are abused might begin to view other people as being unsafe and unable to be trusted, children who are able to develop and maintain healthy relationships are less likely to hold these views. Children who experience trauma but also experience healthy attachment with multiple groups of people (in essence, adults, peers, romantic partners, etc.) throughout childhood, adolescence, and adulthood are particularly resilient. Personality also affects

3472-496: Is an intervention for children and adolescents impacted by complex trauma. The ARC framework is a flexible, component-based intervention for treating children and adolescents who have experienced complex trauma. The framework is theoretically grounded in attachment, trauma, and developmental theories and specifically addresses three core domains impacted by exposure to chronic, interpersonal trauma: attachment , self-regulation , and developmental competencies. A study using data from

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3584-480: Is any unprovoked action with the intention of harming, either physically or psychologically, someone who is considered to have less power, either physically or socially. Bullying is a form of harassment that is often repeated and habitual, and can happen in person or online. Bullying in childhood may inflict harm or distress and educational harm that can affect the later stage of adolescence. Bullying involvement, as victim, bully, bully/victim, or witness, can threaten

3696-541: Is complete when the patient becomes desensitized to the memory and can recall it without having a negative response. A randomized controlled trial showed that EMDR reduced symptoms of PTSD in children who had been exposed to a single-traumatic event, and was cost-effective . Additionally, studies have shown EMDR to be an effective treatment for PTSD. Dialectical behavior therapy (DBT) has been shown to be help prevent self-harm and enhance interpersonal functioning by reducing experiential avoidance and expressed anger through

3808-946: Is direct, trauma from community violence is not always directly perpetuated on the child, but is instead the result of being exposed to violent acts and behaviors in the community, such as gang violence, school shootings, riots, or police brutality. Community violence exposure whether direct, or indirect, is associated with many negative mental health outcomes among children and adolescents including internalizing trauma-related symptoms, academic problems, substance abuse, and suicidal ideation. Evidence also indicates that violence tends to beget more violence; children who witness community violence consistently show higher levels of aggression across developmental periods including early and middle childhood, as well as adolescence. Complex trauma occurs from exposure to multiple and repetitive episodes of victimization or other traumatic events. Individuals who are exposed to multiple forms of trauma often display

3920-434: Is eclipsed by the brain's necessity to survive the stress experienced in their environment outside of school. The inconsistency and instability of the home environment alters the many cognitive processes necessary for effective literacy acquisition.    Young people who are refugees experience trauma whether they were part of the immigration process or were born in the country (where they currently attend school) where

4032-439: Is high in resilience experiences a potentially traumatic event, their relative level of functioning does not significantly deviate from the level of functioning they exhibited prior to exposure to a potentially traumatic event. Furthermore, that same individual may recover more quickly and successfully from a potentially traumatic experience than an individual who could be said to be less resilient. In children, level of functioning

4144-424: Is linked to personality disorders and schizophrenia later in life. Recent research suggests that mental health outcomes from childhood trauma may be better understood through a dimensional framework (internalizing and externalizing) as opposed to specific disorders. Neglect, abandonment, sexual abuse, emotional abuse, and physical abuse are all forms of psychological trauma that can have long-lasting effects on

4256-490: Is needed for them to develop normal neurological, psychological, and social development. This dependence can contribute to their vulnerability to witnessing violence against their caregivers. Medical trauma, sometimes called 'paediatric medical traumatic stress' refers to a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Medical trauma may occur as

4368-455: Is not merely a result, rather a developmental process that is ongoing throughout a person's lifetime. Thus, successful promotion of resilience must also be ongoing throughout a person's lifespan. Trauma affects all children differently (see stress in early childhood ). Some children who experience trauma develop significant and long-lasting problems, while others may have minimal symptoms and recover more quickly. Studies have found that despite

4480-992: Is not necessarily directly perpetuated on child, but can be the result of exposure to violence within the household, often of violence perpetuated against one or more caregivers or family members. It is often accompanied by direct physical and emotional abuse of the child. Witnessing violence and threats against a caregiver during early years of life is associated with severe impacts on a child's health and development. Outcomes for children include psychological distress, behavioral disorders, disturbances in self-regulation, difficulties with social interaction, and disorganized attachment. Children who were exposed to interpersonal violence were more likely to develop long term mental health problems than those with non-interpersonal traumas. The impact of seeing intimate partner violence could be more serious for younger children. Younger children are completely dependent on their caregivers than older children not only for physical care but also emotional care. This

4592-485: Is operationalized as the child continuing to behave in a manner that is considered developmentally appropriate for a child of that age. Level of functioning is also measured by the presence of mental health disorders such as depression, anxiety, posttraumatic stress disorder, and so on. Factors that affect resilience include cultural factors like socioeconomic status, such that having more resources at one's disposal usually equates to more resilience to trauma. Furthermore,

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4704-774: Is physical trauma or physical injury caused by slapping, beating, hitting, or otherwise harming a child. This abuse is considered non-accidental. Injuries can range from mild bruising to broken bones, skull fractures, and even death. Short term consequences of physical abuse of children include fractures, cognitive or intellectual disabilities, social skills deficits, PTSD, other psychiatric disorders, heightened aggression, and externalizing behaviors, anxiety, risk-taking behavior, and suicidal behavior. Long-term consequences include difficulty trusting others, low self-esteem, anxiety, physical problems, anger, internalization of aggression, depression, interpersonal difficulties, and substance abuse. Refugee-related childhood trauma can take place in

4816-617: Is recommended by best-practice treatment guidelines. The goal of CBT is to help patients change their thoughts, beliefs, and attitudes to better control their emotions. Additionally, it is structured to help patients better cope with trauma and improve their problem-solving skills. Many studies provide evidence that CBT is effective for treating PTSD in terms of magnitude of symptom reduction from pre-treatment levels, and diagnostic recovery. Associated treatment barriers include stigma, cost, geography and insufficient treatment availability. Trauma focused cognitive behavioral therapy (TF-CBT)

4928-633: Is the ability to adapt or cope in the face of significant adversity and threats such as health problems, stress experienced in the workplace or home. Resiliency can mediate the relationship of the effects of ACEs and health problem in adulthood. Being able use emotion regulation resources such as cognitive reappraisal and mindfulness people are able to protect themselves from the potential negative effects of stressors. These skills can be taught to people but people living with ACEs score lower on measures of resilience and emotion regulation. Resilience and access to other resources are protective factors against

5040-548: Is widespread globally, one study from the National Survey of Children's Health in the United States reported that approximately 68% of children 0–17 years old had experienced one or more ACEs. The impact of ACEs on children can manifest in difficulties focusing, self regulating, trusting others, and can lead to negative cognitive effects. One study found that a child with 4 or more ACEs was 32 times more likely to be labeled with

5152-765: The CC BY 2.0 license. According to the United States' Substance Abuse and Mental Health Services Administration , the ACE study found that: About two-thirds of individuals reported at least one adverse childhood experience; 87% of individuals who reported one ACE reported at least one additional ACE. The number of ACEs was strongly associated with adulthood high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity, and severe obesity, and correlated with ill-health including depression, heart disease , cancer , chronic lung disease and shortened lifespan. Compared to an ACE score of zero, having four adverse childhood experiences

5264-466: The Centers for Disease Control and Prevention (CDC) went on to survey childhood trauma experiences of over 17,000 Kaiser Permanente patient volunteers. The 17,337 participants were volunteers from approximately 26,000 consecutive Kaiser Permanente members. About half were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and good health care, because they were members of

5376-504: The NR3C1 gene, however research into the epigenetic impact of trauma has extended to other genes, including KITLG . Survivors of war trauma or childhood maltreatment are at increased risk for trauma-spectrum disorders such as PTSD. In addition, traumatic stress has been associated with alterations in the neuroendocrine and the immune system, enhancing the risk for physical diseases. In particular, epigenetic alterations in genes regulating

5488-827: The immune system , nervous system , and endocrine system . Exposure to chronic stress can triple or quadruple the risk to adverse medical outcomes. Childhood trauma is often linked to various health issues including depression , hypertension , autoimmune diseases , lung cancer , and premature mortality. The effects of childhood trauma on brain development can hinder emotional regulation and impair of social skill development. Research indicates that children raised in traumatic or risky family environments often display excessive internalizing (e.g., social withdrawal, anxiety ) or externalizing (e.g., aggressive behavior), and suicidal behavior. Recent research has found that physical and sexual abuse are associated with mood and anxiety disorders in adulthood, while emotion abuse

5600-599: The ACEs experienced were related to high maltreatment or emotional abuse. In cases where mothers experienced emotional or physical abuse as well as intra-familial violence exposure are more likely to give birth to lighter-weight babies than those who did not have those childhood experiences. Globally knowledge about the prevalence and consequences of adverse childhood experiences has shifted policy makers and mental health practitioners towards increasing, trauma-informed and resilience-building practices. This work has been over 20 years in

5712-763: The CDC started collecting data on the prevalence of ACEs as part of the Behavioral Risk Factor Surveillance System (BRFSS). In the first year data was collected across five US states and included over 24,000 people. The prevalence of each ACE ranged from a high of 29.1% for household substance abuse to a low of having an incarcerated family member (7.2%). Approximately one quarter (25.9%) of respondents reported verbal abuse, 14.8% reported physical abuse, and 12.2% reported sexual abuse. For ACEs measuring family dysfunction, 26.6% reported separated or divorced parents; 19.4% reported that they had lived with someone who

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5824-479: The Centers for Disease Control and Prevention (CDC) estimated that the lifetime cost of child maltreatment in the United States is over $ 124 billion annually, taking into account both direct costs , which include healthcare and child welfare services, and indirect costs, which include lost productivity, criminal justice expenses, and special education services . Both direct and indirect costs significantly impact society and

5936-416: The Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences found that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments. These impairments can lead to increased risk of unhealthy self-destructive behaviors , risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As

6048-533: The Health Appraisal Clinic. All Kaiser members who completed medical examinations at the Health Appraisal Clinic between August and November of 1995, between January and March of 1996 (Wave I: 13,494 persons), and between April and October of 1997 (Wave II: 13,330 persons) were eligible to participate in the ACE Study. Within two weeks after a member's visit to the Health Appraisal Clinic, a Study questionnaire

6160-718: The Kaiser health maintenance organization . Participants were asked about different types of adverse childhood experiences that had been identified in earlier research literature: Physical abuse , Sexual abuse , Emotional abuse , Physical neglect , Emotional neglect , Exposure to domestic violence , Household substance abuse , Household mental illness , Parental separation or divorce , Incarcerated household member. [REDACTED]  This article incorporates text from this source, which is by David W Brown, Robert F Anda, Vincent J Felitti, Valerie J Edwards, Ann Marie Malarcher, Janet B Croft, and Wayne H Giles available under

6272-486: The PTICC faced several challenges similar to those predicted by the Building Community Resilience model. These barriers included availability of resources over time, competition for power within the group, and the lack of systemic change needed to support long-term goals. Still, Pottstown has built a trauma-informed community foundation and offers lessons to other communities who have similar goals: start with

6384-571: The U.S. Department of Education found that nearly 10 percent of U.S. public school students reported having been targeted with sexual attention by school employees. Charol Shakeshaft , a researcher in the field, claimed that sexual abuse in public schools "is likely more than 100 times the abuse by priests ." ACEs in childhood and adolescence can affect literacy development in many ways. Children who have faced trauma encounter more learning challenges in school and higher levels of stress internally. Building literacy skills can be negatively impacted both by

6496-511: The UK looked at the views of young people exposed to ACEs on what support they needed from social services. The study grouped the findings into three categories: emotional support, practical support and service delivery. Emotional support included interacting with other young people for support and a sense solidarity, and supportive relationships with adults that are based on empathy, active listening and non-judgement. Practical support meant information about

6608-772: The US National Child Traumatic Stress Network found that treatment with the ARC framework was effective, reducing behavioral problems and symptoms of PTSD to a similar degree that of trauma-focused cognitive behavioral therapy. Many school-wide interventions that have been studied differ considerably from one another, which limits the strength of the evidence in support of school-wide interventions for treating childhood trauma; however, studies of school-wide approaches show that they tended to be moderately effective, reducing trauma symptoms, encouraging behavior change, and improving self-esteem. Most studies that evaluate

6720-625: The adoption of higher rates of unhealthy lifestyle behavior including sexual risk taking, smoking, heavy drinking, and obesity. The associations between these lifestyle issues and ACEs shows a dose response relationship with people having four or more ACEs have significantly more of these lifestyle problems. Physical health problems arise in people with ACEs with a similar dose response relationship . Chronic illnesses such as asthma, arthritis, cardiovascular disease, cancer, diabetes, stroke, and migraines show increased symptom severity in step with exposure to ACEs. Mental health issues have been well known in

6832-425: The age of the child and his understanding of his medical difficulties. For example, a young child may feel betrayed by his parents if they have forced him to participate in activities that contributed to the child's pain, such as administering medications or taking him to the doctor. At the same time, the parent-child relationship is strained due to parents feeling powerless, guilt, or inadequacy. Child physical abuse

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6944-486: The appropriate support to parents who have experienced trauma, helping them to build resilience, foster attachment with their children, and prevent a family cycle of ACEs. For people whose adverse childhood experiences were of abuse or neglect cognitive behavioural therapy has been studied and shown to be effective. Objections to screening for ACEs include the lack of randomized controlled trials that show that such measures can be used to actually improve health outcomes,

7056-521: The available services, practical advice about everyday challenges and respite from these challenges through recreation. Young people expected service delivery to be continuous and dependable, and they needed flexibility and control over the support processes. The needs of young people with ACEs were found not to match the types of support they are offered. Screening for or talking about ACEs with parents and children can help to foster healthy physical and psychological development and can help doctors understand

7168-648: The being at high risk for psychosis. As an adult, feelings of anxiety, worry, shame, guilt, helplessness, hopelessness, grief, sadness, and anger that started with a trauma in childhood can persist. In addition, those who experience trauma as a child are more likely to face mental health challenges such as anxiety, depression, suicide and self harm, PTSD, substance misuse, and relationship difficulties. The effects of childhood trauma are not limited to emotional consequences. Survivors of childhood trauma are also at higher risk of developing asthma, coronary heart disease, diabetes, or strokes . They are also more likely to develop

7280-477: The brain and hormones that register fear and stress are in overdrive, whereas the prefrontal cortex, which regulates executive functions, is compromised. This impacts impulse control, focus, and critical thinking. Memory is also a struggle as there is less capacity to process new input. The stress of ACEs creates a state of "fight, flight, or freeze" which leaves children unavailable for learning. The ability to process new information or collaborate with peers in school

7392-421: The brain energizers (which ranged from movement activities found online to other movement activities selected by the teacher and students), improved by 117% from beginning to end of year. In a school setting, the person who has experienced trauma and the person who is in the moment with the person trying to talk or write about it can connect, even when language fails to adequately describe the depth and complexity of

7504-456: The brain. Multiple effects have been noted including diminished thickness, reduced size, and reduced size of connective networks in the brain. ACEs have been linked to numerous negative health and lifestyle issues into adulthood across multiple countries and regions including the United States, the European Union, South Africa, and Asia. Across all these groups researchers have reported seeing

7616-471: The breakdown of community structures. Exposure to a natural disaster is a highly stressful experiences that can lead to a wide range of maladaptive outcomes, particularly in children. Exposure to natural disaster constitutes a risk factor for poor psychological health in children and adolescents. Psychological symptoms tend to decline over time after the exposure, it is not a rapid process. Similar to community violence, intimate partner violence-related trauma

7728-484: The broad impacts of trauma, children can and do recover with appropriate interventions. Trauma-informed care tailors to the unique needs of those with trauma and produce better outcomes than standard treatments . Early and sustained support can significantly improve long-term emotional and psychological well-being for children affected by trauma . Emotional abuse is often an understated form of trauma that can occur both overtly and covertly. Emotional abuse revolves around

7840-518: The child was non-English speaking, then they are acquiring English as a new language. There already exists an achievement gap between native-English speakers in the United States and students who are learning English as their second (or third or fourth) language. The resulting literacy issues from trauma, reflected in low reading scores, puts children with ACEs at-risk for grade retention. As students, they are almost twice as likely to leave high school without graduating. While there are many years from when

7952-549: The child's country of origin due to war, persecution, or violence, but can also be a result of the process of displacement or even the disruptions and transitions of resettlement into the destination country. Studies of refugee youth report high levels of exposure to war related trauma and have found profound averse consequences of these experiences for children's mental health. Some outcomes from experiencing trauma in refugee children are behavioral problems, mood and anxiety disorders, PTSD, and adjustment difficulty. Separation trauma

8064-537: The circumstances that children and their parents are facing. By screening for ACEs in children, pediatric doctors and nurses can better understand behavioral problems. Some doctors have questioned whether some behaviors resulting in attention deficit hyperactivity disorder (ADHD) diagnoses are in fact reactions to trauma. Children who have experienced four or more ACEs are three times as likely to take ADHD medication when compared with children with less than four ACEs. Screening parents for their ACEs allows doctors to provide

8176-663: The country and the method of research used. Approximately 20% of women and 5–10% of men report being sexually abused as children, while 25–50% of all children report being physically abused. With one in four children experiencing or witnessing a potentially traumatic event, the relationship between ACEs and poor health outcomes has been established for years. With multiple adverse childhood experiences being equal to various stresses, and adversity. Children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems. Adverse childhood experiences can alter

8288-440: The development (or lack of development) of adult psychopathology as a result of childhood abuse. Individuals who scored low in neuroticism exhibit fewer negative outcomes, such as psychopathology, criminal activity, and poor physical health, after exposure to a potentially traumatic event. Furthermore, individuals with higher scores on openness to experience, conscientiousness, and extraversion have been found to be more resilient to

8400-902: The development of post-traumatic adult symptomology. Traumatic grief is distinguished from the traditional grieving process in that the child is unable to cope with daily life and may not even remember a loved one outside of the circumstances of his death. This can often be the case when the death is the result of a sudden illness or an act of violence. The health effects of childhood trauma can be mitigated through care and treatment. There are many treatments for childhood trauma, including psychosocial treatments and pharmacologic treatments . Psychosocial treatments can be targeted toward individuals, such as psychotherapy , or targeted towards wider populations, such as school-wide interventions. While studies ( systematic reviews ) of current evidence have shown that many types of treatments are effective, trauma-focused cognitive behavioral therapy may be

8512-475: The dropouts successfully losing weight under the program. Vincent Felitti, head of Kaiser Permanente's Department of Preventive Medicine in San Diego, conducted interviews with people who had left the program, and discovered that a majority of 286 people he interviewed had experienced childhood sexual abuse . The interview findings suggested to Felitti that weight gain might be a coping mechanism for depression , anxiety , and fear . Felitti and Robert Anda from

8624-455: The early life stressors caused by exposure to ACEs there are noted changes the body in people with ACE exposures compared to people with little to no ACE exposure. This is most evident in structural changes in the brain with the hippocampus , the amygdala , and the corpus callosum being important targets of study. These areas of the brain are more vulnerable than others due to the higher density of glucocorticoid receptors in these regions of

8736-426: The economy. Exposure to maltreatment in childhood significantly predicts a variety of negative outcomes in adulthood. However, not all children who are exposed to a potentially traumatic event develop subsequent struggles with mental or physical health. Therefore, there are factors that reduce the impact of potentially traumatic events and protect an individual from developing mental health problems after exposure to

8848-423: The effectiveness of using pharmaceuticals (medications) for treatment of childhood trauma focus specifically on treating PTSD. PTSD is only one health effect that can result from childhood trauma. Few studies evaluate the effectiveness of pharmaceutical treatment for treating other health effects of childhood trauma, besides PTSD. Internalization (psychology) Too Many Requests If you report this error to

8960-417: The effects of childhood trauma. One of the most common misconceptions about resilience is that individuals who show resilience are somehow special or extraordinary in some way. Successful adaptation, or resilience, is quite common among children. This is due in part to the naturally adaptive nature of childhood development. Therefore, resilience is enhanced by protecting against factors that might undermine

9072-448: The effects of exposure to ACEs. Increasing resilience in children can help provide a buffer for those who have been exposed to trauma and have a higher ACE score. People and children who have fostered resiliency have the skills and abilities to embrace behaviors that can foster growth. In childhood, resiliency and attachment security can be fostered from having a caring adult in a child's life. The Adverse Childhood Experiences (ACE) Study

9184-629: The emotions felt. While there is an inherent discomfort in this, educators can embrace this discomfort and give children a space to express this, as best they can, in the classroom. Those who are able to develop more "resilience" might be able to function better in school, but this is dependent on the ratio of protective factors compared to ACEs.   Social service providers—including welfare systems, housing authorities, homeless shelters, and domestic violence centers – are adopting trauma-informed approaches that help to prevent ACEs or minimize their impact. Utilizing tools that screen for trauma can help

9296-521: The face of childhood trauma and exposure to ACEs is no different. According to a large study conducted in 21 countries nearly one in three mental health conditions in adulthood are directly related to an adverse childhood experience. A study of high school students in Chicago showed significantly elevated levels of school problems, hyperactivity, and lower levels of personal adjustment as number of ACEs increased. Multiple mental health conditions found to have

9408-710: The family settled. During this resettlement phase many of the second-generation refugee child's problems come to light. The disruption in education and instability in the home, as a result of the family's journey, can lead to gaps in exposures to literacy in the home . Literacy experiences outside of school include parents reading with kids and borrowing or buying books for the home. Early-childhood literacy education includes explicit teaching of reading and writing skills, building phonological awareness, and academic vocabulary. Resettlement affects children's phonemic awareness and exposure to academic vocabulary since many families are unable to fully provide these out of school experiences. If

9520-506: The high frequency of adverse childhood experiences. The original study questions have been used to develop a 10-item screening questionnaire. Numerous subsequent surveys have confirmed that adverse childhood experiences are frequent. The Behavioral Risk Factor Surveillance System (BRFSS) which is run by the CDC , is an annual survey conducted in waves by groups of individual state and territory health departments. An expanded ACE survey instrument

9632-773: The hypothalamus–pituitary–adrenal axis as well as the immune system have been observed in survivors of childhood and adult trauma. Traumatic experiences might even affect psychological as well as biological parameters in the next generation, i.e. traumatic stress might have transgenerational effects. Parental trauma exposure was found to be associated with greater risk for post-traumatic stress disorder (PTSD) and mood and anxiety disorders in offspring since biological alterations associated with PTSD and/or other stress-related disorders have also been observed in offspring of trauma survivors who do not themselves report trauma exposure or psychiatric disorder. Animal models have demonstrated that stress exposure can result in epigenetic alterations in

9744-413: The individual may have a compromised ability to regulate their emotions. In a study done by Stefania Tognin and Maria Calem comparing healthy comparisons (HC) and individuals at clinically high risk for developing psychosis (CHR), 65.6% CHR patients and 23.1% HC experienced some level of childhood trauma. The conclusion of the study shows that there is a correlation between the effects of childhood trauma and

9856-443: The lack of literacy experiences in the home, missing parts of early-childhood education, and by actually altering brain development. There are techniques that can be employed by educators and clinicians to try and remediate the effects of the adverse experiences and move children forward in their literacy and educational development. ACEs affect parts of the brain that involve memory, executive functioning , and attention. The parts of

9968-516: The lifespan and that increase the risk of a variety of health and social problems. The ACE Study was based at Kaiser Permanente's San Diego Health Appraisal Clinic, a primary care clinic where each year more than 50,000 adult members of the Kaiser Permanente Health Maintenance Organization receive an annual, standardized, biopsychosocial medical examination. Each member who visits the Health Appraisal Clinic completes

10080-561: The lowest educational attainment were significantly more likely to report five or more ACEs compared with those with higher education levels (14.9% versus 8.7% among high school graduates and 7.7% in those with more than a high school education). Overall, little state-by-state variation was observed in the number of ACEs reported by each respondent. There are no reliable global estimates for the prevalence of child maltreatment. Data for many countries, especially low- and middle-income countries, are lacking. Current estimates vary widely depending on

10192-699: The making bringing together research are implemented in communities, education settings, public health departments, social services, faith-based organizations and criminal justice. As knowledge about the prevalence and consequences of ACEs increases, more communities seek to integrate trauma-informed and resilience-building practices into their agencies and systems. Indigenous populations show similar patterns of mental and physical health challenges as other minority groups. Interventions have been developed in American Indian tribal communities and have demonstrated that social support and cultural involvement can ameliorate

10304-504: The most common causes of death and disability in the United States . These findings are important because they provided a link between the effects of child maltreatment and negative effects later in life which had not been established as clearly before this study. The ACE Study has produced more than 50 articles that look at the prevalence and consequences of ACEs. It has been influential in several areas. Subsequent studies have confirmed

10416-401: The most effective for treating childhood trauma. In contrast, other studies have shown that pharmacologic therapies may be less effective than psychosocial therapies for treating childhood trauma. Lastly, early intervention can significantly reduce negative health effects of childhood trauma. Cognitive behavioral therapy (CBT) is the psychological treatment of choice for PTSD and

10528-431: The most effective treatments to minimize the negative psychological effects of childhood trauma, particularly PTSD. Eye movement desensitization and reprocessing therapy (EMDR) is a technique used by therapists to help process traumatic memories. The intervention has the patient recall traumatic memories and use bilateral stimulation such as eye movements or finger tapping to help regulate their emotions. The process

10640-448: The negative physical health effects of ACEs. There is a paucity of empirical research documenting the experiences of communities who have attempted to implement information about ACEs and trauma-informed practice into widespread public action. A study on Pottstown, Pennsylvania 's process demonstrated the challenges associated with community implementation. The Pottstown Trauma-Informed Community Connection (PTICC) initiative evolved from

10752-475: The next generation, and such mechanisms have been hypothesized to underpin vulnerability to symptoms in offspring of trauma survivors. Enduring behavioral responses to stress and epigenetic alterations in adult offspring have been demonstrated to be mediated by changes in gametes in utero effects, variations in early postnatal care, and/or other early life experiences that are influenced by parental exposure. These changes could result in enduring alterations of

10864-443: The number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of research following the initial study has confirmed these findings. Many states, health providers, and other groups now routinely screen parents and children for adverse childhood experiences. Childhood traumatic experiences leads to stress that increases an individual's allostatic load , negatively affecting

10976-414: The relative resilience of an individual. Children with secure attachments to an adult with effective coping strategies were most likely to endure adverse childhood experiences in an adaptive manner. Secure attachments throughout the lifespan (including in adolescence and adulthood) appear to be equally important in fostering and maintaining resilience. Secure attachment to one's peers throughout adolescence

11088-654: The removal of children when they are not safe with their families. Other costs, which are less directly tied to the incidence of abuse, include lower academic achievement, adult criminality, and lifelong mental health problems. Both direct and indirect costs impact society and the economy. For example, children who experience maltreatment are more likely to perform poorly in school, which can limit their future economic opportunities and increase likelihood of unemployment. The long-term psychological effects of abuse, such as depression, PTSD, and substance abuse can lead to increased healthcare costs and higher mortality rates. A study by

11200-755: The risk of internalizing and externalizing in children. Additionally behavioral challenges can arise in children who have been exposed to ACEs including juvenile recidivism , reduced resiliency, and lower academic performance. Adults with ACE exposure report having worse mental and physical health, more serious symptoms related to illnesses, and poorer life outcomes. Across numerous studies these effects go beyond behavioral and medical issues, and include damage to DNA, higher levels of stress hormones, and reduced immune function. The effects of ACEs goes beyond just physical and behavioral health with studies reporting that people with high ACEs scores showed less trust in government COVID-19 information and policies. Due to many of

11312-595: The scale collapses items and has limited item coverage, there are no standard protocols for how to use the information gathered, and that revisiting negative childhood experiences could be emotionally traumatic. Other obstacles to adoption include that the technique is not taught in medical schools, is not billable, and the nature of the conversation makes some doctors personally uncomfortable. Some public health centers see ACEs as an important way (especially for mothers and children) to target health interventions for individuals during sensitive periods of development. Resilience

11424-461: The severity and duration of the potentially traumatic experience affect the likelihood of experiencing negative outcomes as a result of childhood trauma. One factor that does not affect resilience is gender, with both males and females being equally sensitive to risk and protective factors. Cognitive ability is also not a predictor of resilience. Attachment has been shown to be one of the most important factors to consider when it comes to evaluating

11536-468: The stress response as well as the physical health risk. Furthermore, the effects of parental trauma could be transmitted to the next generation by parental distress and the pre and postnatal environment as well as by epigenetic marks transmitted via the germline. While epigenetic research has a high potential of advancing our understanding of the consequences of trauma, the findings have to be interpreted with caution, as epigenetics only represent one piece of

11648-637: The structural development of neural networks and the biochemistry of neuroendocrine systems and may have long-term effects on the body, including speeding up the processes of disease and aging and compromising immune systems. Further research on ACEs determined that children who experience ACEs are more likely than their similar-aged peers to experience challenges in their biological, emotional, social, and cognitive functioning. Also, children who have experienced an ACE are at higher risk of being re-traumatized or suffering multiple ACEs. The amount and types of ACEs can cause significant negative impacts and increase

11760-466: The well-being of children. Bullying can be a risk factor for the development of an eating disorder, it can impact the functioning of the HPA axis, and it can impact functioning in adulthood. It increases the risk for physical problems such as inflammation, diabetes, and heart risk, and mental health problems such as anxiety, depression, agoraphobia, panic disorder, substance abuse, and PTSD. Unlike bullying which

11872-444: Was a collaborative effort between Kaiser Permanente (San Diego, CA) and the Centers for Disease Control and Prevention (Atlanta, GA) designed to examine the long-term relationship between adverse childhood experiences (ACEs) and a variety of health behaviours and health outcomes in adulthood. An underlying thesis of the ACE Study is that stressful or traumatic childhood experiences have negative neurodevelopmental impacts that persist over

11984-485: Was associated with a seven-fold (700%) increase in alcoholism , a doubling of risk of being diagnosed with cancer, and a four-fold increase in emphysema ; an ACE score above six was associated with a 30-fold (3000%) increase in attempted suicide. The ACE study's results suggest that maltreatment and household dysfunction in childhood contribute to health problems decades later. These include chronic diseases—such as heart disease, cancer, stroke , and diabetes —that are

12096-527: Was conducted with psychology students reports that 10% had sexual interactions with their educators; in turn, 13% of educators reported sexual interaction with their students. In a national survey conducted for the American Association of University Women Educational Foundation in 2000, it was found that roughly 290,000 students experienced some sort of physical sexual abuse by a public school employee between 1991 and 2000. A major 2004 study commissioned by

12208-506: Was depressed, mentally ill, or suicidal; and 16.3% reported witnessing domestic violence. Men and women reported similar prevalences for each ACE, with the exception of sexual abuse (17.2% for women and 6.7% for men), living with a mentally ill household member (22.0% for women and 16.7% for men), and living with a substance-abusing family member (30.6% for women and 27.5% for men). Younger respondents more often reported living with an incarcerated and/or mentally ill household member. For each ACE,

12320-424: Was included in several states found each state. Adverse childhood experiences were even more frequent in studies in urban Philadelphia and in a survey of young mothers (mostly younger than 19). Surveys of adverse childhood experiences have been conducted in multiple EU member countries. Childhood trauma Childhood trauma is often described as serious adverse childhood experiences . Children may go through

12432-461: Was mailed asking questions about health behaviours and adverse childhood experiences. A total of 17,421 (68%) persons responded; 84 persons had incomplete information on race and educational attainment leaving 17,337 persons available in the baseline cohort. In the 1980s, the dropout rate of participants at Kaiser Permanente 's obesity clinic in San Diego , California , was about 50%; despite all of

12544-649: Was observed. Approximately 41% of respondents reported having no ACEs, 22% reported one ACE, and 8.7% reported five or more ACEs. Men (6.9%) were less likely to report five or more ACEs compared with women (10.3%). Respondents aged ≥55 years reported the fewest ACEs, but the younger age groups did not differ from one another. Non-Hispanic blacks were less likely to report five or more ACEs (4.9%) compared with non-Hispanic whites (8.9%), Hispanics (9.1%), and other non-Hispanics (11.7%). However, non-Hispanic black respondents were not significantly more likely to report zero ACEs compared with other racial/ethnic groups. Respondents with

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