Adverse Childhood Experiences, Attachment and Resiliency

When talking about trauma, I am frequently asked about the effects of trauma on children, and if the damage can be reversed. The answer is not simple and a lot of factors contribute both to the effects of complex trauma on the child and to the ability to recover.

One of the first studies to address the effects of childhood trauma is the ACE – Adverse Childhood Experiences – study began in the 1980s and continues to this day. “The ACE Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD, the ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.” (http://www.acestudy.org/).

The study was initially begun to study obesity and weight loss. However, after finding many people regaining weight after a significant loss, the researchers began to search for clues into the reasons people began to use food, alcohol and drugs as coping mechanisms long after the weight issues were address. The researchers compiled a list of nine adverse childhood experiences and developed a point system which related to a person’s likelihood of having serious difficulties in adulthood. The nine ACEs are

1. Recurrent physical abuse
2. Recurrent emotional abuse
3. Contact sexual abuse
4. An alcohol and/or drug abuser in the household
5. An incarcerated household member
6. Someone who is chronically depressed, mentally ill, institutionalized, or suicidal
7. Mother is treated violently
8. One or no parents
9. Emotional or physical neglect

The more exposure to an ACE before the age of 18, the greater the likelihood of adverse affects as an adult. The research subjects were primarily from working class families and members of a HMO. In another ACE study that focused on childhood exposure to domestic violence, the authors found that individuals exposed to domestic violence in childhood had a two to six times greater chance of having experienced other childhood adversities. In addition, exposure to domestic violence in childhood was associated with a higher risk for self-reported alcoholism, illicit drug use, IV drug use and depression as an adult. (Felitti et al 1998, Dube et al 2001)

In addition to the extent of the history of trauma, another factor in resiliency and recovery is support and validation. This is best illustrated in the following stories:

Anna and her friend, Bridget, are seven years old, and playing outside after school one spring afternoon. Suddenly a car swerves around the corner and a gang of young men in the car start shooting at another group of men on the corner. One of the bullets hits Bridget and she is killed on the spot in front of Anna.

Anna’s family and community respond to the violence by supporting her and offering her additional counseling as needed. Her family recognizes her need for additional support and continues to check in with her on a regular basis. In addition, the community takes measure to ensure the safety of children in the neighborhood.

Sarah, also seven years old, walks five blocks to school each morning. Most mornings she is followed by a group of sixth graders who throw rocks at her, call her names, and grab at her clothing and backpack. When she tells her parents they call her a “baby’ and tell her to “toughen up” and “get over it.” The abuse continues for the full school year.

Of these two children, even given the severity of the incident, Anna is more likely to recover and have fewer symptoms of PTSD in the future. Sarah, however, will likely develop some symptoms and seek ways to escape from the emotions and fears that continue to plague her.

If the situations were reversed and Anna was not receiving validation and support, she may continue to experience nightmares and other repercussions of witnessing a traumatic death. If Sarah received support, validation, and advocacy from her parents, she may be able to recover from the effects of the abuse.

The brain is significantly affected by neglect and trauma in childhood. The following picture shows a brain of a normal three year old as compared to another three year old that has experienced extreme neglect. The brain development has been significantly impaired. The good news is that the brain has resiliency and can make positive gains once the child is placed in a home where he/she is validated, supported, and given the chance to develop positive attachments.

This relationship provides an enduring emotional bond and determines future relationships and self-regulation. It is a secure “container” that provides for basic needs and safety, and gives the freedom to explore and learn as opposed to being unavailable, lacking in safety and security. This relationship increases the child’s ability to develop trusting relationships and coping skills.

Studies on brain development have also revealed that the ability to dissociate during times of stress develops during childhood. Dissociation is the ability to psychically leave the situation and lose memory of the even. This may be due to the brain not having developed enough of the pre-frontal cortex (thinking brain) to be able to develop other skills. Dissociation may continue into adulthood.

In a future blog, I will address how cultural influences can shape a person’s viewpoint and ability to recover from complex trauma.