Preventing and/or Ameliorating the Consequences of Adverse Childhood Experiences: Findings from a New American Report

The statistics are staggering: According to a new report from the Centers for Disease Control and Prevention, one in six American adults assessed during 2015–2017 reported four or more adverse childhood experiences (ACEs) (Merrick et al., 2019). At least one adverse childhood experience was reported by 60.9% of the study sample (Merrick et al.) These data were derived from the Behavioral Risk Factor Surveillance System telephone survey administered in 27 states in the USA. Associations between ACEs and a variety of adult diseases (e.g., heart disease, cancer, diabetes, and depression) were found. It is not surprising that adults with the highest number of ACEs had the higher odds of chronic health conditions at the time of data collection. But let us think beyond those numbers to the anguish and the tears of the children who lived through the toxic stress, violence, and substance misuse in their families, reaching adulthood with the residual psychic and physical consequences. These are the clients we see in mental health settings every day, struggling to make sense of what happened to them and trying to move beyond the early trauma.

Psychiatric nurses everywhere are familiar with the acronym ACEs and the studies that first appeared in the literature linking childhood ACEs to morbidity and mortality in adulthood (e.g., Felitti et al., 1998), which were supported by later studies in England and Europe (see meta-analysis by Bellis et al., 2019). We are aware that ACEs create higher risk for heart disease and other chronic illnesses, but clinicians in our specialty are especially concerned with the consequences of ACEs for mental health and well-being. ACEs alter brain function, reduce the ability to develop healthy coping strategies, and often lead to self-medication with alcohol, nicotine, and other drugs (Merrick et al., 2019). Particularly vulnerable, based on the CDC study findings, are women and ethnic/racial minorities (Merrick et al., 2019). Women who experience ACEs are likely to have a higher risk of intimate partner violence in adulthood as well (Montalvo-Liendo et al., 2015).

What is heartening about the CDC report is its focus on prevention of ACEs. Its authors assert that substantial reductions in adverse childhood experiences are possible, resulting in higher academic achievement, reduced substance use in adolescence/adulthood, and decreased depression/suicidal behavior (Merrick et al., p. 6). For example, it is estimated that 21 million cases of depression could have been avoided by preventing adverse childhood experiences. Specific recommendations can be found in a 2019 CDC document that is available online: “Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence” (see the website referenced below).

Many psychiatric-mental health nurses are already involved in preventive and therapeutic interventions with individuals, families, and communities, in alignment with the CDC recommendations (such as teaching positive parenting, providing programs for children and parents about emotional intelligence and coping skills, and providing trauma-informed care to child and adolescent victims of ACEs).

Nurses have also made important contributions to the empirical literature about resilience among youth and adults who experienced childhood maltreatment. I have sometimes sensed pessimism in some of the ACEs literature, as though the early victimization has inevitable deleterious consequences. In contrast to this view, research by Hall et al. (2009) showed that many women were actually thriving in adulthood despite egregious childhood maltreatment, including neglect and multiple forms of abuse (physical, emotional, sexual). (It was my privilege to participate in this research and hear the stories of the women who marshaled resoluteness and resolve to move beyond what they had lived through in childhood). Another example is the research by Dang on resilience among maltreated homeless youth, published in this journal in 2014.

Much remains to be done to extinguish the intergenerational transmission of family dysfunction and the tragic outcomes ensuing from unsafe and unloving homes. All children deserve a better chance to thrive and actualize their unique potentials. Policymakers, philanthropists, and community activists must be enlisted to join psychiatric and medical professionals in bringing the CDC recommendations to fruition.