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Adverse Childhood Experiences/Childhood Traumas

What are ACEs/Childhood Traumas

Adverse childhood experiences (ACEs), also known as childhood traumas encompass the big stressors " big T traumas", and any other events which undermines the child’s sense of safety & emotional well being -“small t traumas”.  We often overlook the significance of these events unless if we examine  their impact on the child (0-17), who has no emotional capacity to process them. These traumas are not only actual events, but non-events, and deficits, that have a negative impact on the emotional wellbeing of the child. Our experiences in early life shapes our physiology, and brain structure which is primary to the developing personality. Contemporary studies in Adverse Childhood Experiences (ACEs) suggest that individuals  suffer “disrupted neurodevelopment” and “social emotional and cognitive impairment” following exposure to adverse and traumatizing environments during their development, which is associated with later costs to both mental health and physical health (Peckham, 2023).

The medical model has historically neglected the impact of the environment in “psychopathology”, until recent years where there is an acknowledgment of the intersection between early life traumas, and the development of emotional and psychological problems in adulthood.  In contrast, psychotherapy, particularly the analytic approaches, have always  put greater emphasis on the early life  experiences in the formation of one's personality, and the development of “psychopathology” in adult life.  I am quoting psychopathology as it implies scientific knowledge, and conceptualisation, which goes against the non scientific  model of trauma which l am subjectively in favour of. It is true that most people who seek mental health treatment, or psychological interventions have a history of complex trauma, or some form of early trauma/s.  This means, without acknowledging the significance of ACEs,  these individuals would have their suffering pathologized, and diagnosed as having some mental disorders, and subsequently medicated- they simply become commodities in a system that seeks to label and medicate.  The psychotherapy world is experiencing a paradigm shift,  to a trauma informed  approach- which is ecological rather than pathological framing. This approach privileges the impact of life experiences, over underlying "pathology". The trauma informed approach gives weight to the early life experiences, in shaping ones adult way of functioning; it also seeks to de-stigmatize, and de-pathologize one's suffering.

My work as a therapist, and mental health practitioner, as well as my own lived experiences has given me the full appreciation of the impact of our life experiences in the formative years, in shaping ones subjectivity, personality, ways of viewing the world, and relating to others. I fully endorse and subscribe to the trauma informed model- philosophically and as an approach to therapy. I strongly advocate for an ecological approach, rather than medical approach, which often gives people fixed labels, without a consideration of the contextual factors behind ones emotional and psychological suffering.  Emotional and psychological suffering should not be viewed as some form of pathology, that should require a fixed diagnosis.  I fundamentally believe that as therapists, by focusing on psychiatric diagnoses and labels, we are unintentionally shaming our clients, and objectifying them as simply a "psychiatric diagnosis". This has the effect of invalidating their unique lived experiences and the traumas that is behind one's psychological distress.  That said, l am not anti-psychiatry; l fundamentally believe that the medical model and the trauma informed approach can inform each other, and work collaboratively, resulting in a more holistic way of working. Having alternatives also mean clients are empowered; they have options to choose between the medical or trauma informed approaches to address their difficulties.

Many research studies have  demonstrated the negative impact of adverse childhood experiences on an individual. Neuroscience Research (Amann, 2022) has proven that having a combination of ACEs increases the likelihood of developing mental health and emotional difficulties in adult life; three times higher  than the average person. This study examined 93000 cases, and concluded that those who experienced childhood traumas are 15 times likely to be diagnosed with borderline personality disorder. BPD is a personality disorder where the sufferer experiences difficulties with regulating emotions and experiences the world in extreme (black and white) terms. This leads to intense highs and lows, as well as other self-destructive behaviours. People with BPD often have great difficulties building and maintaining healthy relationships, as well as emotional regulation.  The formative years are crucial to personality development and some people’s emotional challenges in adulthood are directly related to a combination of environmental and psychological factors in their upbringing. Other studies on ACEs have been carried out by Kaiser Permanente and the Center for Disease Control in the USA involving 17,337 adults and correlated the number of categories of adverse childhood experiences (ACEs) with physical and mental health outcomes.

Allan Schore's (2000) research and  pioneering work highlights the likelihood of people who have experienced childhood trauma- which corresponds with brain development- experiencing mental health challenges in adult life. Like Fonagy, he puts emphasis on the developing child's capacity to emotionally mature, enabled by their environment-the attachment  with mother and relationship with mother who is able to help the child to regulate affect.  Schore coins the term ‘relational trauma’ bound in the traumatogenic experiences happening within the ordinary transactions between parent and baby in the course of looking after the baby. Through the research work there is evidence that early trauma impacts the child's brain development, attachment styles, capacity to mentalise, which are the hallmarks of emotional and mental health difficulties in later life. Martin Teicher  researches on child abuse and maltreatment argues that “Brain development is directed by genes but sculpted by experiences” (p652). These approaches are viewed by many as medical, as they conceptualise that trauma leads to physiological changes in the brain development and functioning, leading to psychopathology. The focus is on the link between physiology and pathology.

Among other vital research, Young Minds (2018) and Bellis et al, (2014) concluded that having a situational or cumulative ACEs led to poor mental health in adult life. ACEs affect the child’s emotional development, which translates to problems with relationship with themselves, others and the world as adults. Apart from experiencing mental health difficulties in later life, people who had a combination of ACE are likely to have drug and alcohol problems, have early or unplanned pregnancies, are likely to be involved in crime, and likely to end up in the criminal justice system. Aman (2022) concluded that ACEs were related to mood disorders, depression, PTSD, anxiety disorders, eating disorders, schizophrenia, and substance abuse. For every reported type of abuse experienced in childhood, a participant’s risk for PTSD increased 47%. Each cumulative trauma also increased one’s risk for making a suicide attempt by 33%.

Examples of ACEs are:

• Physical Abuse
• Verbal abuse
• Sexual abuse
• Emotional neglect
• Parental divorce/separation
• Parental sickness or ill health
• Having a parent who experienced mental illness
• Having a parent  who went to prison
• Living with a parent who abused drugs or alcohol
• Living with a sibling who has a disability or mental health challenges
• Exposure to parental conflict-family dysfunction
• Loss through death-parent/sibling or family member
• Loss of home-boarding school, foster care
• Loss of home- foster care/adoption, house moves
• Loss of home through emigrating and or house moves
• Childhood sickness & illness eg asthma, cancer, eczema etc
• Development issues eg stutter, dyslexia, bedwetting
• Bullying
• Relational Trauma in how the child is cared for by the parent
• Accidents-car/fires/etc
• Wars/conflict
• Parental Responsibilities

The Child and the Adult

It’s easy to overlook the significance of childhood ACEs unless if we unpack and understand their long-lasting impact on one’s way of relating to the self, others, and the world, as well as one’s overall personality. Many people come to therapy unaware of the fact that some of their experiences in childhood were adverse. At times it’s a defence (Klein, 1946) against the pain of acknowledging it, while others simply genuinely lack the understanding, or the language to express it. Having an awareness of how an experience that was adverse or traumatic is impacting on one’s current life is significant. Not only is it validating, but helps that person integrate the trauma, and work through it. Knowing something about ourselves, helps us develop a more intimate relationship with ourselves, and relate to ourselves in a more sophisticated way. It makes that problematic issue less scary and we can also approach it with compassion.

Trauma and Privilege

Having a privileged life does not mean one is immune to ACEs. Parents who can provide economically but  emotionally cold, cause significant psychological harm to the child. A child who has been send to boarding school (rupture from their care givers & emotional support) is no different to a child who is placed into foster care. The emotional impact is the same.  The only difference is one has an economically privileged life, while the other comes from poverty. In her book on Boarding School Syndrome Joy Schaverien writes, evocatively, about the trauma of the privileged child who is removed from home, and send away to an artificial environment (boarding school) away from the primary care givers (Schaverien, 2015). Bullying is rife in boarding schools, and the children are deprived of love, physical affection, and emotional warmth, something that they fundamentally need in these formative years. Drawing on real life stories from ex-boarders, she is able to demonstrate how people who went to boarding school earlier on in their lives tend to experience significant difficulties with intimacy, sustaining emotional connections, have an impoverished sense of self, and lack confidence in adult life. This creates secondary issues in relationships -both romantic and interpersonal. Many ex-boarders have been negatively impacted by the separation from their care givers at a young age, tend to feel a lot of guilt and shame, and that they have no right to complain about their parents for creating such a solid foundation for them. These contradictory feelings invalidates their trauma and leaves them feeling even more isolated in their pain.   It is always important to reflect on the experience from a child's perspective, not an adult; the adult is able to make sense of a lot of things that the child was incapable of.

Immigration and Loss of Home

 Many people do not recognise the significance of rupture from one’s home, and the impact of not having consistency in childhood. Whenever there is a move, we experience loss of home- the environment- as well as the relationship we create with that home (environment) and other people in our lives. When children are moving from one place to the other, whether it’s a one off or repeated moves, there is an internal sense of loss they experience. There is a breakdown of attachments (emotional bonds) (Bowlby, 1969) they create with the home itself, their friendship groups, teachers etc. This leaves emotional scars where in adulthood, attaching to others is avoided as there was never a sense of permanence in their world; attaching also means experiencing loss, so their relationships remain very superficial albeit unfulfilling. In adult life it’s not unusual for these people to have difficulties building and sustaining long term relationships, and having deep emotional connections with others. Some may also have identity issues, and feel rootless at an emotional level, and untethered in life.

Parental Divorce/ Separation

Most of the ACEs listed above happen in the children’s home environments, where there is either one or both parents present. It’s obvious that any form of abuse negatively impacts on the child; parental divorce and separation also does. While it may be the best outcome for parents and the children,  children inevitably experience loss of a parental unit, a family unit, and a disruption of their lives. The parental situation is not something that they can inform, nor make a decision on- as a result children of divorcing parents tend to blame themselves for the divorce, or feel that they are a liability. The adults involved often overlook the meaning of parental divorce and separation on the children  as the focus is on themselves. Ongoing parental discord does compound this trauma, while healthy co-parenting mitigates some of the trauma.

Parentification

Another ACE to keep in mind is when the child is being given parental responsibilities, also referred to as parentification. It is not unusual for parents to give their children adult or parental responsibilities and to be put in that role. This is typically the oldest child who is made to look after their younger siblings, or becomes an emotional confidant for one or both parents. It can also be a child who is made to manage other household chores, budgeting, etc. this takes away the child’s innocence and right to be a child who does not have adult responsibilities. Often, we hear people say “she/he is very mature for his age” implying that its a good thing. What we do not recognise is that we are burdening a child with adult responsibilities, and the perceived maturity is the only way that child had to cope with the situation. People who were parentified often turn out to be adults who are not very good at prioritizing their needs and advocating for themselves. They also easily become people pleasers, and may struggle with recognising when they are being exploited.  This is because as children, they never learnt to fully take care of themselves, as the attention was on others. They also lack the sense of justice  and injustice- boundaries-as their own boundaries were infringed at a very young age.

Abuse

It is no surprise that children who experience any form of abuse-physical, emotional, sexual and neglect will develop some psychological and/or  mental health challenges in adult life. Healthy development of a child is highly dependent on an environment where there is emotional safety,  where the mother  or care giver is able to make both environmental and emotional provisions for the child. The care giver has to be emotionally available and attuned to the child (Winnicott, 1960). Any adverse experiences will interrupt the normal and natural psychological development of the child. Children do not simply mature physically, but emotionally-they have certain milestones that they need to successfully reach and succeed. Without his holding environment and the presence of ACEs mean that the development can be arrested at any time. This means a lack of psychological maturity which translates to mental health problems in adult life. Neuroscience confirms that the child’s brain develops differently where there is abuse.

Discord in Parental Relationships

Children who grow up exposed to parents’ fights are indeed being harmed by those experiences. It is adverse and damaging for the child to witness directly to have an indirect awareness of parental discord. Children need to grow up in an environment where there is emotional warmth and safety. Even if the fights are concealed from them, children are very sensitive and emotionally perceptive. Children do very easily blame themselves and adapt according to what they think is best for the parents, not for them. This means that the children end up looking out for the parents, and putting their own needs down. They mould their world around their parents' not according to their own growth trajectory.  Many parents stay in dysfunctional homes “for the sake of the children”. What they do not realise is that, raising children in an emotionally volatile environment is more harmful, and damaging to them than having two happy and warm homes, they can spend time in. Some cultures promote the idea of staying in toxic relationships for the sake of the kids which is damaging for them. For any parents, recognising the different ACES, minimising the exposure to them, and cultivating a healthy environment where the child is nurtured emotionally, supported, and their wellbeing prioritised is key.

Therapy and Healing Trauma

Neuroplasticity

Neuroplasticity refers to the capacity of neural systems to adapt and change. Neuroscience suggests that neurons in many parts of the brain continue to undergo structural change not just through childhood and adolescence, but throughout life. This means that any new experiences, at whatever age, can cause the brain to physically alter its synapses and change. In other words, we are stable enough in our environment because our genetic inheritance has been sculpted by natural selection over many lifetimes, but we are “plastic” enough to adapt to our environment within our lifetime. Peckham (2023) argues that "For so many mechanisms of neuroplasticity to have evolved indicates that the capacity to learn from and adapt to past experiences and to better anticipate the threats and opportunities we may have in the future enhances inclusive fitness, survival, and reproduction in our environment. p.5.

Trauma informed approach therapy validates one’s lived experiences and acknowledges the link between presenting symptoms and early trauma-ACE/s.  Since our brains are capable of changing, we can recalibrate them, and re-adapt to new experiences. The new “new experiences” can be used to heal or mitigate the impact of previous experiences; psychotherapy being an obvious candidate for “new experience”. The intersubjective relational work done in therapy enable people to work through the ACE trauma. The trauma informed approach is anti-shaming- it is very easy to shame our clients in therapy and retraumatise them, which also re-confirms their trauma. If the "new experiences" contradict the old experiences, clients are able to develop new ways of relating and being. This is what defines healing. Repeated shaming experiences generate an anticipation of shame and the experiences that trigger it. This anticipation may be referred to as toxic or chronic shame where the shame experience organizes a person’s identity and life around avoiding the anticipated and feared shame experience. Shame-driven distress and suffering is common across experiences of trauma and adversity.  “Recovery can take place only within the context of relationships; It cannot occur in isolation. In her renewed connections with other people, the survivor recreates the psychological faculties that were damaged or deformed by the traumatic experience. These faculties include the basic capacities for trust, autonomy, initiative, competence, identity, and intimacy. Just as these capabilities are originally formed in relationships with other people they must be reformed in such relationships” (Herman, 2001, p101).  Herman's words highlights  why therapy is a fundamental aspect of healing childhood trauma. Van Der Kolk one of the pioneers in the trauma gives emphasis to the neuroplastic nature of the brain and the ability for trauma to be worked through in therapy. He postulates that traumatized people experience incomprehensible anxiety and numbing and intolerable rage, and how trauma affects their capacity to concentrate, to remember, to form trusting relationships, and even to feel at home in their own bodies. This work can only be done in a therapy where there can be repair to the damage caused by trauma. For more on the trauma- The Body Keeps the Score by Bessell Van Der Kolk and The Myth of Normal by Gabor Mate are excellent copies on trauma and healing.

Attachment Styles- Secure Attachment

Bowlby's work on attachments-internal working models - relationship templates we create in childhood suggests that they can be repaired throughout the course of life. ACEs  lead to people having unhealthy attachment styles-avoidant, anxious, disorganised.  This create difficulties in interpersonal relationships as the attachment style informed behaviours and distress responses get reactivated in adult relationships. However through therapy, we can heal  and redefine these ways of relating to more secure relational patterns. The relationship with the therapist is a strong conduit for these attachment working models to change, as we can learn to trust others as reliable consistent, nurturing, and trustworthy beings.  The therapist can be experienced as a reliable care giver, and the therapy space becomes  a secure base. Donald Winnicott would have viewed this as  providing "corrective emotional experience".

Understanding the significance of ACEs helps us make sense of why some people experience emotional challenges and psychological distress in adult life. No one is damaged, we have the capacity to heal and heal others through our own healing.

References

Amann, B.,  (2022) Trauma During Childhood Triples the Risk of Suffering a Serious Mental Disorder in Adulthood, European Archives of Psychiatry and Clinical Neuroscience.

Bellis, M.A., Hughes, K., Leckenby, N. et al. National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England. BMC Med 12, 72 (2014). https://doi.org/10.1186/1741-7015-12-72

Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. Attachment and Loss. New York: Basic Books.

Fonagy, P. and Target, M. (2000) Mentalisation and personality disorder in children: a current
perspective from Anna Freud Centre. In Lubbe, T. (ed.), The Borderline Psychotic Child, 69–89. London: Routledge.

Herman J.L. (2001). Trauma and Recovery: From Domestic Abuse to Political Terror. Pandora ed. New York, NY: Basic Books

Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis, 27, 99-110.

Peckham, H. (2023). Introducing the Neuroplastic Narrative: a non-pathologizing biological foundation for trauma-informed and adverse childhood experience aware approaches.  Journal of Frontiers Psychiatry,  Psychopathology Volume.

Schaverien, J. (2015). Boarding School Syndrome: The Psychological Trauma of the privileged child: Routledge, London.

Schore, A.N. (2000) Early relational trauma and the development of right brain. Unpublished invited presentation. London: Anna Freud Centre

Winnicott, D. W. (1960). The theory of the parent–infant relationship. In: The Maturational Processes and the Facilitating Environment (pp. 37–55). New York: International University Press, 1965.

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