Nearly half of America's children live through adverse childhood experiences that can leave them vulnerable to ongoing and future challenges, sometimes severe, according to a new report that documents not just potential harm, but uneven impact based on race and state.
"The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity," was released by researchers from Child Trends, a Bethesda-based organization that studies American children's lives with an eye toward improving them. The study finds a constellation of events that can add up to "toxic stress" and negatively influence both child development and future adulthood for 45 percent of America's kids.
"This is really a critical public health issue," said Vanessa Sacks, a research scientist who wrote the report with colleague David Murphey, a research fellow.
They studied eight adverse childhood experiences, often called ACEs. Nationwide and across all groups, the most common are economic hardship (defined as "hard to cover basics like food or housing") and parents' separation or divorce. Other adverse experiences studied were a parent's death, parent incarceration, seeing or experiencing violence either from an adult in one's household or outside in one's community, or living with someone who abuses drugs or alcohol or who has a mental illness.
Kids who experience these adverse situations, some traumatic and some more subtle, may have trouble with self-control and struggle to manage emotions, pay attention or maintain personal relationships — "all life skills that are critical for later success in school and for career and interpersonal relationships," said Sacks. "These are really important experiences to recognize and address."
"What we're learning about ACEs reminds us that what happens in childhood — particularly what happens in our families of origin — can shape the trajectory of a child's future well-being," said Institute for Family Studies' Alysse ElHage. "Awareness is key, particularly in communities where these kinds of events — whether we're talking about parental divorce or neighborhood violence — tend to be more commonplace, and where maybe it can be easy to shrug off or overlook ACES as just part of life for some children."
Without mitigation, long-term negative effects are linked to "every major public health issue, from obesity to substance abuse, suicide, depression, smoking, chronic disease and more," Sacks said.
Repeated or prolonged stress may even alter the brain's structure. Besides that, among the "most sobering findings regarding ACEs is preliminary evidence that their negative effects can be transmitted from one generation to the next," including during pregnancy, the report says.
Impact severity hinges not just on the negative experience or degree of a child's resilience, but also on what kind of support system caring adults put in place to help a child overcome what happened. Children and families can be screened and helped.
The report finds variation in prevalence of negative events among different racial and ethnic groups and also in what they experience. State ACEs rates are different, too.
Nationally, more black (61 percent) and Hispanic children (51 percent) experience at least one adverse experience than white (40 percent) or Asian (23 percent) children. Overall, 11 percent of children have had two adverse experiences, while 10 percent of kids have experienced three or more such events.
No one knows if there's a "tipping point," Sacks said, but experts agree that multiple adverse experiences when one is young raise alarms. Some studies say even one experience creates harm. "The research doesn't show that one experience is worse than another, but a lot of research shows that the more you have, the higher the risk for these negative outcomes," Sacks said.
After poverty and divorce — universal across groups — the most common adverse experience for black children was having an incarcerated parent, while for whites it was living with an adult who has mental illness or abuses drugs or alcohol. For Hispanic kids, the most common experiences after poverty and divorce were living with someone with a substance abuse problem and having a jailed parent. Black children are more likely than others to have had a parent die.
The researchers used 2016 data from the National Survey of Children's Health.
More children (56 percent) in Arkansas live through an adverse experience than in other states. At least 15 percent of kids in Arizona, New Mexico, Arkansas, Montana and Ohio have experienced three or more adverse experiences, said the report, which was funded by the Annie E. Casey Foundation.
One-third of West Virginia kids experienced significant economic hardship compared on one-fifth in Minnesota, New Hampshire and North Dakota. Similarly, one-third of children in Kentucky and Arkansas have seen their parents separate or divorce, compared to fewer than one-fifth in Illinois, Maryland, Massachusetts and Utah.
Even among the rarer adverse experiences there are big differences: Nationally, up to 4 percent of kids have lost a parent or been a victim of or witnessed violence in their neighborhood. But 7 percent of kids have been abused or seen violence in their neighborhoods in Nevada and Hawaii, and 6 percent in Arkansas and Georgia have had a parent or guardian die.
Showing up for kids is a powerful antidote to adverse experiences.
"One of the most powerful buffers against ACEs is a supportive relationship with a parent/caregiver or other trusted adult," said ElHage. "I think this is so important for us to remember with kids who've faced multiple ACEs: A loving, stable relationship, especially with a child's parents, can make all the difference. For kids who are in unstable families where they don't have a healthy parental relationship, other adults can play a role, such as a grandparent, teachers, coaches or faith leaders."
ElHage has seen it work in her extended family, a story she shares to show there's hope and that even multiple adverse experiences need not define a child's future. One young relative endured parental separation, child abuse and neglect, domestic violence and a parent's drug abuse and incarceration. Despite a diagnosis of PTSD and severe depression, "through the support and stability provided by a loving grandparent, some therapy and especially thanks to the faithful mentorship of a youth pastor in his church, he is now thriving."
Sherese Patton of Detroit is among a group of caring adults who have vowed to show up for the daughter of a close friend who was shot dead in 2011.
"As her father's friends, we have all made a commitment to be there for her and her mother," she said. They want to see that the girl "grows up and is successful as her father intended."
Liz Meredith, of Anchorage, Alaska, is a juvenile probation supervisor and an ACEs instructor. She believes parents must understand what adverse experiences are — and that they're preventable. Children must be allowed to talk about their experience without a parent becoming defensive or "shutting them down" if they played a role in the experience.
Meredith said caring adults can connect affected children to helpful services. "Communities that ensure services to address adverse experiences are accessible for all families through their support for nonprofits, and mental health professionals go far to aid in the healing," she told the Deseret News.
She also suggests treating kids with "universal precautions," which includes giving all kids the benefit of the doubt. A better question than "What is wrong with you?" for a child with behavioral issues is "What happened to you?" said Meredith, author of "Pieces of Me."
Parents also help by taking care of themselves and their own mental and physical health, said Erin C. Parisi, a mental health counselor and addictions specialist in Orlando, Florida. They are role models, even if they don't want to be. "Your kids see what you're doing, so if you're neglecting your own physical or mental health and are unwilling and/or unable to ask for help, you're teaching them to do the same."
She said talking about feelings, interacting, listening, saying "I love you," and working to be "(mostly) happy and healthy with your stuff makes you the best parent and role model possible."
Consistency is a healing tool adults can offer children, promoting a sense of safety and security that helps children cope with stress.
"Kids should not be expected to rise above anything on their own," said Caleb Backe, health and wellness expert for Maple Holistics in Riverdale, New York. "More often than not, they are genuine victims of situations which are beyond their control and sometimes beyond the scope of their understanding. For a child to come out of a difficult situation in a way that will allow them to develop properly down the road, it is imperative that a parent or guardian provides a sense of reliability, guidance, routine and structure. Children — often adults, too — need those like they need oxygen."
As chaotic circumstances make kids feel adrift, adults should attempt to be a rock to which a child can attach, Backe said.