SALT LAKE CITY — It’s an established truth of child rearing that toxic childhood stressors such as grinding poverty, family violence, divorce or a substance-abusing parent can lead to poor health outcomes for children later in life.
But a new study from BYU says that positive childhood experiences can counter the impact of adverse childhood experiences, also called ACEs.
Better still, caring adults — in the home or outside it — can easily provide some of what researchers call “counter-ACEs,” according to the study, published in the journal Child Abuse & Neglect. Actions that mitigate the harm of toxic events include having access to an adult that makes one feel safe, feeling heard by an adult, liking school and even regular bedtimes and meals.
Those who lack positive childhood experiences are worse off even than those who simply experience negative stressors, the researchers found. Neutral and negative experiences both fail to help kids thrive, and the absence of positive counter-ACEs resulted in poor health regardless of how much toxic stress a child experienced, said lead author Ali Crandall, an assistant professor of public health at Brigham Young University.
The goal of child advocates and researchers to reduce adverse childhood experiences is unchanged, said Crandall. But it’s also important for those around children to create positive experiences.
“What I love is that others, like a teacher who cares, an extended family member you can confide in and youth leaders can make a difference,” she said. “Your neighborhood itself is really important — and every adult matters.”
A Child Trends research brief on ACEs gives examples such as witnessing or experiencing physical, emotional and sexual abuse, along with divorce, death of a parent, parental incarceration, poverty, seeing neighborhood violence, and living with someone who abused drugs or alcohol or has a mental illness.
Adverse events can physically change the architecture of a child’s developing brain, said Anna Thomas, senior policy analyst at Voices for Utah Children. Stresses may impact memory, thinking ability, executive functions, even ability to learn — hitting literacy skills especially hard.
The BYU study says that long term, children can suffer from “chronic conditions, addictions, poorer quality of life and life expectancy in adulthood resulting from abuse, neglect, isolation or other trauma.”
Parents and teachers may not recognize signs of toxic stress, Thomas said. Children may have trouble sitting still or regulating emotions, instead getting into fights or having outbursts. They may not read social cues well and struggle to make friends. They could zone out or act out.
Unchecked, behaviors can lead to to poor grades, suspension, being expelled, even dropping out. Studies link leaving school to higher unemployment, increased possibility of criminal activity and lifelong poverty.
There are also potential physical health impacts of traumatic childhood events, including higher incidence of risky behaviors like smoking, drinking, substance abuse and eating disorders. Children who experience toxic stress have higher likelihood of physical and mental health problems, including high blood pressure, heart disease, stroke, depression and perhaps even cancer.
Those who experience adverse events in childhood — episodic or chronic — clearly have more health conditions, though the pathway is not direct, Thomas said. And just as problematic behaviors may not be recognized as stemming from adverse events, the health impact in the short term in a doctor’s office may look like stomach problems or autoimmune issues. Kids may miss important growth milestones.
Hope and help
One traumatic event can cause PTSD, so imagine the harm of prolonged stressors over childhood, said Dr. Paul Wirkus, president of the Utah Chapter of the American Academy of Pediatrics. “It can have profound effect over the lifetime.”
But “can” is different from “will.” Many children experience terrible, toxic things in childhood and manage to be resilient, emerging as healthy, well-balanced adults, Crandall and Thomas agree.
While it’s challenging to untangle the exact ways certain childhood experiences result in damage, Crandall says the antidote is clear.
Children need adults who pay attention, said Crandall. Outsiders can do that, augmenting family by being good friends and neighbors. Other counter-ACEs include opportunities for fun and experiences that help a children feel comfortable with themselves.
Countering harm isn’t especially complicated, said Wirkus, who tells adults to take an active interest in and nurture the kids within their sphere. “Take an interest in what they’re doing, in what they’re feeling, and validate that.”
In fact, when vice president of the Annie E. Casey Foundation’s Center for Systems Innovation Sandra Gasca-Gonzalez asks youths in foster care what they most want from adults, they tell her they simply want adults to see them.
She said children need opportunities to stand out, be trusted and be chosen. It can be as simple as asking a kid to lead the line on a field trip. Children need opportunities to take risks and even fail within the context of supportive relationships. When kids are helpers, they build self-confidence and self-efficacy.
Gasca-Gonzalez said research shows if a child has at least two positive adults in his or her life, the life trajectory will be better. Adults should consider what they needed to become healthy adults and then provide it, from help with homework to reaffirming the child’s value, she said.
Pediatrician Wirkus agrees. “Kids are profoundly affected by their environment for good and for ill. It’s important to recognize that and do whatever we can to build a nurturing environment for them to live in,” he said, adding it does take a village to raise a child and the people within the village can choose to be stressors or nurturers.
Institutional protective factors might include strong preschools and kindergartens and opportunities for a child to shine in different venues, from sports to the classroom to church and community, said Thomas. Helping families stressed by poverty can reduce lifelong harm to children, while making sure they have adequate food and clean clothes.
Counting pluses and minuses
The BYU study involved 246 people ages 19 to 57 who responded to an online survey through Amazon’s Mechanical Turk survey apparatus, which recruits participants from among those who’ve signed up for its surveys.
Almost three-fourths of the respondents had at least one of the 11 adverse childhood experiences listed, with an average of 2.67 per person. But they also had an average of 8.15 counter-ACEs, and nearly 40% had experienced all 10 of the positives at some point.
The survey measured health by asking about body mass, fruit and vegetable consumption, and physical activity. It queried respondents about their sleep quality and asked if they smoke. It examined cognitive and mental health by looking at executive functioning abilities, perceived stress, depression and whether people believe they have a measure of control over their lives and what happens to them. Participants answered questions about gratitude, self-forgiveness, family closeness and challenging situations, among other questions.
The study found that “regardless of the number of ACES, counter-ACEs protect against poor health and promote better health and well-being throughout adulthood.” Counter-ACEs were associated with eating more fruits and vegetables, better executive functioning, higher belief one has some control over life, positive psychology and more connection with one’s family of origin as an adult. They also protect against depression, stress and trouble sleeping.
Crandall said the research has some limitations. A survey is a convenience sample that lets people “self-report,” which can be a problem in determining whether people are overweight because folks often exaggerate their height and report lower weight than is true.
Recollection of childhood events may not be entirely accurate, especially for older participants. And the researchers noted that people who had a higher-than-average number of positives in life might be less likely to list all the negatives. “It is possible that participants in this group felt disproportionately more shame within their family and in their neighborhoods when ACEs occurred,” they wrote.
But Crandall believes the findings provide hope and a pathway. She said increasing the number of counter-ACES in the home is a good starting place. She’s also working with the nearby United Way in Utah County to educate the community that it can play a significant role in improving the future lives of kids experiencing adverse childhood events.
Study co-authors include BYU professors Brianna Magnusson, Len Novilla, Carl Hanson and Michael Barnes, and Utah County United Way’s Barbara L. Leavitt.