If you have been to a well-child visit recently you may have filled out a form about “ACE’s”, or “Adverse Childhood Experiences”.  This is a screening tool looking for instances of childhood adversity – including difficult questions related to familial hardships and medical concerns, familial separation, physical/emotional/sexual abuse, bullying and neighborhood violence. These may be difficult questions, but there is a good reason for asking: these forms of toxic stress activate the stress-hormone response system of the body, and over time this can have negative effects on the developing brain and body. The rapid growth and changes that take place in childhood make children are particularly vulnerable to chronic, toxic stress.

In addition to long term activation of the stress response, these adverse childhood experiences lead to impairment in social, emotional, and cognitive functioning. This, in turn, leads to riskier health choices and behaviors. The Center for Disease Control and Prevention (CDC) reports that these early childhood events can increase risk of chronic diseases such as obesity, depression, heart disease, cancer, substance abuse and others. New evidence suggests it can also lead to an impaired immune system and impaired memory.

So how common is this? 60% of Americans have experienced at least 1 “ACE”, and nearly 25% have experienced 3 or more 1. This suggests that chronic stress experienced by children is a population level concern, and only recently has the focus shifted to screening and prevention – that is where the ACE questionnaire comes in. Afterwards, we want to focus on the childhood response to this stress.

Resilience is the way a person responds to stress, and returns to their optimal state of health. This is also a growing field of study. Resilience is improved by protective factors – things like safe, stable relationships among family and friends, parental resilience, physical exercise, meditation, and specific community support services. Our aim is to screen for these sources of stress, minimize or eliminate them when possible, and provide connections to the appropriate community resources when appropriate.

For more information, please visit the websites below, and ask at your next visit!

https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/ – Harvard FAQ on ACEs

https://www.cdc.gov/violenceprevention/acestudy/about_ace.html – CDC – About Adverse Childhood Experiences

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Promoting-Resilience.aspx – AAP – The resilience project

www.fiveforfamilies.org – Campaign to increase knowledge of protective factors

1Merrick MT, et al. JAMA Pediatr. 2018:doi:10.1001/jamapediatrics.2018.2537