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Supporting young people who have had adverse childhood experiences

By  Lynn Miles

Half of children will live through an adverse childhood experience and around one in 10 will suffer four or more. How can schools support these young people? Lynn Miles, who suffered ACEs herself, explains more and offers her advice

It is becoming increasingly apparent that large numbers of children in this country are growing up in a high state of distress.

Around one-third of our children are living in poverty according to the Child Poverty Action Group, while the Mental Health Foundation reports that one in 10 of five to 16-year-olds has a diagnosable mental illness.

Studies conducted in England and Wales show that around half of adults suffered one adverse childhood experience (ACE) and around one in 10 endured four or more by the age of 18 (eight per cent in England, 14 per cent in Wales) (Bellis et al, 2014 & 2015).

Such ACEs include neglect, emotional, sexual and physical abuse – often perpetrated by the primary care-giver – and living in a house where there is mental illness, drug and alcohol addiction, domestic violence or parental incarceration. The long-term impact of this adversity – particularly in the very early years when children are at their most vulnerable developmentally – on educational outcomes, physical and mental health, life chances, quality and length of life is shocking. Schools, in particular, should be aware of the extent of the issue and what they can practically do in response.

Trauma is one of the possible outcomes of exposure to adversity. It occurs when a person perceives an event or set of circumstances as extremely frightening, harmful or threatening – either physically, emotionally or both. Some experiences can be so overwhelming for children and young people that it creates a sense of terror and helplessness in the short term, which can be triggered without warning later in life.

Likewise, when children experience adversity that is extreme, severe and long-lasting without adequate support from a care-giving adult, the stress response system (fight, flight or freeze) becomes over-active and re-calibrated. This is known as “toxic stress” and it gradually wears the body and brain down over time.

It is a tremendously worrying situation, but fortunately there is increasing evidence and enough success stories out there to show us what needs to be done – and, as is so often the case, school is well placed to make a significant impact and change the trajectories of struggling children’s lives.

I am one of the 10 per cent of children who suffered four or more ACEs. At primary school I was violent and unpredictable and at secondary school withdrawn and disengaged. I was angry, hurt, could not see the point of education and I did not trust adults. Why would I – they lie, let you down and cause you pain. No-one had bothered to show me how to express my emotions or to ask for what I needed – so I threw things. I threw books, chairs, desks, even children, and, every time I did, I got the teachers’ attention.

Fortunately, thanks to a few perceptive teachers, flexibility in the school system and my welfare being more of a priority than exam results, I turned out okay. They understood what my throwing meant and took the time to build relationships with me, taught me new strategies to deal with my emotions, filled the skills gaps I had, then channelled my strength and anger into throwing javelins instead of furniture.

Somehow, these teachers just got me. I could never sit still and could not relax because I need to release my anxiety regularly. I was permanently hyper-vigilant, so every new room I walked into I scanned for safety and needed to choose where I sat – it was exhausting, for them and me, but they made the necessary accommodations. School was my safe place – it was the few hours of joy I experienced every day. I dreaded the holidays, evenings and weekends and tried to stay at school for as long as I could.

So now, 30 years after getting out of the frightening environment that I lived in for my first 18, I still deal with the damage done to my physical and mental health, my understanding of people and relationships, my education and my work – every day. If it had not been for those teachers, my life would have been very different and I would not have trained to be a teacher and chosen to work with children like me throughout my career.

All school staff need to understand what it is like to live in the body and life of a child experiencing adversity – but you can never truly understand it if you have not actually lived it. You cannot imagine what it is like never to feel safe and to be hypervigilant all the time. To this day the slightest noise wakes me up in the night, a door slamming activates my stress response system, people arguing and changes to my routine cause me to freeze, and unexpected questions from managers at work impact on my ability to think clearly. Those of us who have experienced adversity do what we must to get ourselves through the day.

However, schools can assist in making life better for these children and can even begin to help them heal. If our education system is supposed to prepare our children for life and give them the tools they need to succeed, we cannot ignore their suffering and must create environments that allow them to learn, flourish and fulfill their potential.

A handful of strategies implemented over a term by a few staff will not work here – there is no low-cost, quick-fix solution. This damage has been done to these children over many years and the current school system is exacerbating their difficulties. Whole school changes to policy and practice – consistently implemented – are the way to address these challenges and research tells us it is the best approach for all children, not just those who are having difficult childhoods.

There is no one-size-fits-all model either – this is complex. Buying in an intervention and training all the staff to use it will not always work – schools, particularly senior leaders, need to truly understand what they are dealing with and proactively take steps to address it, so we help children to thrive rather than just survive.

Yes, it is quicker to buy in, but all schools and contexts are different and while it can be difficult tackling these concepts, making them tangible and implementing them on the ground, it is what needs to be done. Explicit whole-school training, support, strategies and resources are therefore the best approach – this needs to be for all staff, often personalised and on-going. A few sessions can raise awareness but can merely cause frustration for teachers who are on the front-line and work in a system where the policies do not support what needs to be done.

Zero tolerance, punitive behaviour policies are ineffective and there is plenty of research to support this. They especially do not work for children who have had difficult childhoods, as incentive or threat-based strategies are not powerful enough to stop deep-rooted behaviour that has served as protection in the past. Restorative practices are needed to improve and repair relationships between people and communities. Mercifully schools are beginning to replace “discipline” policies with “relationship” polices.

Children experiencing adversity are likely to be a year behind their peers academically by the time they finish year 6. It seems some secondary schools have started to prepare children who are lagging behind from year 7 for GCSEs, but narrowing the curriculum and focusing on the basics for these children is the wrong approach. They need music, art, drama, dance, sport and technology – subjects that are practical with therapeutic qualities that help children regulate, allow them to feel a sense of success, let them express themselves and their creativity, and help to repair some of the damage done to the brain through early adversity.

These children also need the most qualified and experienced staff. Not unqualified teachers, teaching assistants or supply staff – permanent, knowledgeable professionals who understand what has happened to them and the impact it has had on their bodies and minds. Staff who will be there consistently and compassionately, no matter what these children throw at them.

Ultimately, schools need to become ACE-aware, Attachment-aware and trauma-informed to create safe environments for our children, build supportive and trusting relationships with them, teach them the skills to regulate their disregulated bodies so they can begin to manage their emotions and behaviour, and get to a place where they are ready to learn.

Recommended tools that can have a significant impact include:

  • Continuously maintain an awareness of the impact of ACEs, toxic stress and trauma and strive to ensure that all pupils feel safe, supported and connected.
  • Maintain a safe, predictable, calm environment that prioritises relationships and consistency.
  • Show unconditional positive regard to all pupils (and school staff) at all times.
  • Remember that behaviour is a symptom of the problem, not the problem. Be curious about behaviour – ask “what happened to you?” rather than “what is wrong with you?”
  • Eliminate stress triggers from the environment – loud voices, abrupt sounds, etc.
  • Take an interest in the pupils – they need to know you care.
  • Teach pupils to self-regulate and calm their stress response system.
  • Listen to the pupils more and talk at them less.
  • Focus on the positive – communicate pupils’ successes to them and their families regularly.
  • Support the pupils’ care-givers and connect with the whole family – it improves the pupils’ outcomes.
  • Follow your instincts – welcome them back after a break.
  • Take care of yourself – the children need you to be at your best.
  • Do not take things personally – it is not about you.

Implementing these changes and success with these pupils will be slow and challenging, but the evidence is clear – if we continue as we are many vulnerable children are likely to struggle for the rest of their lives.

  • Lynn Miles is a lecturer in education at Teesside University, which offers related ACE short courses, whole school CPD and, from September 2019, an MA Education (Trauma Informed Practice).

References

  • National Household Survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England, Bellis et al, BMC Medicine, 2014.
  • Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population, Bellis et al, Public Health Wales, 2015.


ACEs in the shadows Book review by:

Mike Findlay Head of Communications and External Affairs at Victim Support Scotland - I came  across this book by accident when it appeared as a recommended read on Amazon. The fact the author wasn’t named (A Survivor) intrigued me. I was curious as to what their motivation was for writing. Full review HERE



CUMBRIA COUNTY COUNCIL Public Health Annual Report 2018 Adverse Childhood Experiences

Our 'Working with ACEs' accredited training is cited in this report alongside contributions made by CUMBRIA RESILIENCE PROJECT


PUBLIC HEALTH ENGLAND North West Conference on Adverse Childhood Experiences and Trauma Evidence in Practice


Inter-generational ACEs – How Adverse Childhood Experiences can affect a family’s past, present, and future.

Do you ever wonder why you feel and act the way you do, or why your friend screamed at that woman for no real reason, or that your child behaves so ‘badly’ or your husband lost another job and you just can’t seem to change these things? You look at other families and wonder why their life seems so easy and their children so perfect? We used to be told that it was ‘just you’, that you were born that way and it was up to you to change. But maybe it’s not just you; it’s what happened to you, what happened to your parents and grandparents, what’s happening to your child now. But at the time no one was able to help you understand what had happened in your family and help you break the cycle. For a long time, no one knew the harm adverse childhood experiences could cause through generations of a family.

New research on adverse childhood experiences (ACEs) or the bad things that happen in childhood, is rethinking these deterministic ideas. Science is showing how diseases such as depression, obesity, diabetes, heart disease, and anxiety have their roots in childhood abuse and trauma. Importantly, research is discovering the molecular pathways of these diseases and how they begin. Once this is understood, effective treatments can be developed, and awareness raised to protect children and adults from disease and distress in later life.


In 1998 a ground-breaking study was published in the American Journal of Preventive Medicine, ‘the CDC and Kaiser Permanente Adverse Childhood Experiences (ACE) Study’. 17,500 people were questioned to investigate how childhood abuse, neglect and trauma impacted physical and psychological health in later life. It is one of the largest studies ever done and its results have been generalised into the wider international population. 

So, what are ACEs? Adverse Childhood Experiences are the horrible things children may go through, usually in their homes. The ACEs study had three categories: - 

1.Abuse: physical, emotional and sexual,

2.Neglect: emotional and physical

3.Household dysfunction: mental illness, incarceration, domestic violence, substance abuse and divorce or separation.  

Using the ACE questionnaire, the study asked each of the 17,500 participants if they had experienced any of the above before age 18. Under 18 was specified as the brain is still developing and is exceptionally sensitive to the words and actions of the caregivers.  

The results of the study were shocking, 67% of the study cohort had experienced one ACE and 12.6% had suffered 4 or more ACEs. The results went on to show that children who had suffered ACEs were far more likely to develop heart disease, diabetes, hepatitis, depression, anxiety, lung cancer, obesity and have a decreased life expectancy. In fact, ACEs were strongly correlated with problems in every area of life, and the more ACEs a person had suffered the higher and more serious the correlation became.  

At birth a baby’s brain is ¼ of its full size but nearly all the neurons she will ever have are in place. In the next three years the brain will grow rapidly and by age 3 be 90% complete. The neurons in the brain absorb and learn everything they see, hear and feel. They grow and fade depending on what they experience, or don’t. Unfortunately, there is a lot of toxicity in our world today and this often changes babies’ brains in ways we are just beginning to understand. A baby’s brain prunes neurons that are not used and coats the roots of those that are used in Myelin, an insulating substance, to protect them. Pathways develop between neurons to cope with the environment, when the environment is toxic the changes can be maladaptive and affect the child throughout her life.  

Continuous stress, whether from witnessing domestic violence or from frequent beatings is exceptionally toxic to a young child, especially if there is no respite, and no one to contain the emotion. The release of cortisol, the fight or flight hormone, becomes unregulated and large doses of this and other hormones rush around uncontrolled, in the process they cause damage to the brain that is not easily repaired. Although the exact process is unclear it seems the innate immune system is changed, that is our front line of defense against disease and also how we cope with illness and facilitate recovery. Chronic stress can change DNA pathways and gene expression, that is, some gene functions can be switched off or on causing problems throughout life.

As the child grows the damage and changes become apparent and can affect every aspect of life, from maintaining friendships, school achievement, emotional stability, adult relationships, addictions, risky behaviour, including teen pregnancy, mental illness and chronic physical disease including early death. Often a child grows up having experienced several ACEs but as an adult doesn’t link them to why they are constantly ill or behave as they do, they’ll think, ‘it’s just me’ and carry on. Unless you are aware of the potential to change you simply cannot change.

This is part of the intergenerational cycle of ACEs just a point in the cycle.

The child grows up and marries, has a child, the relationship fails, the father screams abuse at the mother, the mother becomes depressed and begins to drink more, she loses her job and there is no money. Already the new baby is suffering several ACEs and his chances of living a healthy and happy life decrease. The child grows up suffering depression and anxiety and the cycle begins again. This may sound fantastical, but these outcomes are directly correlated to ACEs, and are extremely common.  

The research is not about parents being blamed for the child’s problems, it’s about educating people to understand what adversity in childhood (ACEs) is and the damage ACEs can do. If you think about it, these parents are just kids with ACEs who got bigger, they didn’t grow out of anything, they grew into it. They didn’t know the effect ACEs would have on their lives and couldn’t possibly know how those effects would affect their children.  

Sometimes the effects of certain ACEs can be passed on to children genetically; a parent couldn’t possibly stop this even if they were knowledgeable and aware of the chance. When a baby was conceived it used to be thought that its DNA was wiped clean, all the genes were clear of any ‘memories’, but it was discovered that if a mother had suffered domestic abuse whilst pregnant, for example, some of the baby’s genes could carry that knowledge forward, the abuse would be remembered genetically and the same damage could occur as if the domestic abuse was happening to the child.  

If a parent suffered ACEs whist young, it is highly likely their parents also suffered from some kind of adversity in childhood. And this pattern probably stretches back for generations; and it’s almost impossible to break out of this cycle unless you have help. One reason for this has always been that ‘young parents’, ‘drug addicts’, ‘unemployed’, ‘drunks’, ‘wife beaters’ etc. were seen to be just ‘like that’, ‘it’s how they were born’, ‘it was their fault’ and nothing could be done unless ‘they grew a backbone’ or ‘found God’. They were labelled ‘ bad ones’ and left to get on with life, often landing in jail, or addiction or jobless and then early death. Hence the children and grandchildren of these ‘bad ones’ suffered from depressed, ill, violent and absent parents because the adversity in the parents’ childhood was never addressed and so the cycle continued.

Although it has been over twenty years since the links between childhood abuse and neglect was first made, the molecular pathways of how this changed children’s brains to cause physical and psychological problems was still unclear. Now this is changing, there are scientific breakthroughs every day on the pathways disease takes and how. The barriers surrounding mental health are falling and awareness is rising, it is becoming easier to talk about mental illness and its possible genesis.  

Awareness is one of the most important things, spreading the message of the ACEs movement, so that everyone in a community knows about the potential damage ACEs can do. We can encourage each other and our friends, who may be silently suffering, to go to workshops to learn about ACEs and how to help each other talk about our childhood and understand what may have happened. When everyone starts talking, a subject stop being taboo, and people start to realize they can seek help. It is often be like the proverbial light bulb being switched on and sometimes it may be very painful.

But the very best thing is that if everyone is aware of the effects ACEs and how common they are, we can break that intergenerational cycle! We know that talking therapies help, a good psychotherapist can help work through the trauma and help change behaviours for the parent and child, and grandparents. Once parents understand that their behaviours and illnesses are correlated to their own ACEs, they can understand their own child’s behavioural, emotional and academic problems. Then they can be helped to make a choice: whether to replicate the past or to make a change. Once that choice is made, they can be supported through it. There are excellent parenting courses, relationship counsellors and community workers to give a listening ear and a safe place to practice change and create a coherent narrative of their lives and understand and process what has happened to them.
 

Although change is harder the older you are due to the plasticity (ability to grow and change) of the brain slowing down it is never too late! Scientists are finding ways to increase the brains plasticity as we age so that our brains can create new pathways and change can be permanent. This is important as Grandparents who may care for the grandchildren of their addicted, depressed, incarcerated offspring need to understand their own ACEs story and be able to parent differently this time around.

 

Babies born with altered genes due to parents who have suffered ACEs can grow up healthily as long as the parents have recognized and accepted their own ACEs and sought help to change. If a mother or father is helped to be attuned and mindful towards their infant and enough money is available to make the family feel safe the baby’s harmful genes can be switched back on or off depending on need. The cycle of harm is then broken.

 

For practitioners and individuals working and living in the community there is a wealth of ACEs continued professional development (CPD) out there alongside ACEs course study and information for more in-depth learning.  Together the ACEs movement can break these intergenerational cycles so that families can have a future, grieve their past, heal and move forward.

Copyright 2019 College of Life

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