Research School Network: EVERYONE’S TALKING ABOUT ACES

Educational practitioners have long recognised a relationship which has been whispered in staff rooms since teachers wore brown leather elbow patches on jackets: those students with ​‘difficult’ backgrounds are more likely to not conform to behavioural expectations and generally do badly at school. The whispers might say it’s a product of their upbringing. They may blame it on nurture, or lack of it. They may say the parents only have themselves to blame.

These anecdotal thoughts have now been crystallised, exemplified and named as Adverse Childhood Experiences. The idea of the parents being to blame is an interesting one, as the research on the cycle and continuance of difficulties across generations is startling.

What are ACEs?

An American researcher, Vince Felitti, conducted a study in the early 1990s which found a causal link between adults who are considered to be obese to them having suffered a high prevalence of childhood abuse. This led to a wider study, the publication of which in 1998 named ACEs for the first time, and defined them. This study (the CDC-Kaiser study) was the springboard from which many more global studies have since been launched.

There are 10 ACEs which Felitti et al (1998) identified under three headings: child abuse; neglect; household challenges. The detail under each heading can be seen in the table below:

What does the research show?

Felitti had 18000 adult participants to whom he gave a questionnaire which asked questions about whether those participants had experienced any of the above ACEs in childhood. He then compared that with their medical data.

The main finding was that those who reported having experienced one or more ACE were at greater risk of suffering poor health in mid-life as well as mental illness, substance abuse and perpetrating violence than people who didn’t suffer any ACEs.

More than this, the findings show that this is dose-responsive, i.e. the more ACEs you have, then the greater the risk of having poor medical outcomes in later life. And this exposure to ACEs was widespread across different demographics – rich and poor alike showed the same correlation between ACEs and poor outcomes across their lifespan.

Felitti engaged with participants born across different generations and found that ACEs contribute more negatively, and across groups born in different time periods, transcending 100 years of other social and secular trends.

Wow! Read that again and consider the fact that this demonstrates that we are stuck in a cycle of poor outcomes and early death for some people due to trauma in their childhood.

What other research is there?

Most of the initial studies after the seminal 1998 study were conducted in America. Mark Bellis conducted research out of Liverpool John Moores university in the UK and he found the same correlations in UK populations, developing the model below to visually demonstrate the impact of more than 4 ACEs on life outcomes:

Bellis et al (2014)

So we know that this is not just an American ​‘thing’. We also know from global studies that this isn’t just happening in well-developed, economically stable countries, although there is less information in regards to the impact on a lifespan of wider traumas such as natural disasters and refugees.

You may also have heard of toxic stress response, which is the body’s way of dealing with continual threat. A person who undergoes regular traumatic experiences stays on high alert all the time – stuck in fight or flight mode – but this leads to a toxin build-up over time, which is obviously detrimental to health.

Consider brain development, for example. During a child’s first 2 years of life, their brain has grown from 25% to 80% of an adult size brain. If the child is on a state of high alert during that time of development, the brain’s architecture (and other organ systems) cannot develop normally and the difference between that and healthy development can, shockingly, be seen on brain scans, such as the one below.

What can we do?

This does seem very depressing. Consider the highlights:

ACEs are pervasive across generations and transcend social and secular trends;
the body of someone who has 4+ ACEs is 10 years older than someone with no ACEs (Bellis 2014);
someone with 4+ ACEs is 4 times as likely to be a high risk drinker; 15 times more likely to have committed violence in the last 12 months; 16 times more likely to have used crack or heroin; and 20 times
more likely to be incarcerated within their lifetime (Bellis 2014).

It’s grim reading.

But, the light at the end of the tunnel is that researchers believe that it is possible to prevent the cycle from continuing, and it all starts with knowledge. Informed practitioners within the key services of health, education and the police is the beginning of a strategic approach to break the cycle.

The UK Government acknowledged in their 2017 green paper on children’s mental health that the research is there to link ACEs with poor mental health, and have pledged to put a designated mental health lead in every school. This lead person will: be knowledgeable enough to be able to ensure that the staff body know and understand about mental health; support staff to be able to recognise the signs of mental health problems; and ensure that referrals happen to the right external agencies.

As schools, we need to build safe, supportive, nurturing environments for our students to flourish in. We can support students to develop their resilience and use other agencies to support us in our endeavours. Education is merely one cog in a wheel which is going to take time to grind in order to work to fix the societal problem that is ACEs. Attention must be given to adults with ACEs to break the inter-generational cycle, so our engagement with parents and parenting is as crucial as working directly with the child.

Ro King