Adverse Childhood Experiences Revisited
Over the last twenty years we have been amassing evidence that negative experiences in early childhood have life long deleterious effects on physical and emotional health. Early maltreatment results in years of emotional pain, chronic illness, and, too often, premature death.
As David Brooks reminds us the multiple lenses through which we have been able to view the initial findings of the survey of over 17,000 patients at Kaiser Permanente have contributed to an increasingly sophisticated and nuanced understanding of the wide and long range effects of early adverse experiences. In some ways, the knowledge that the more children are exposed to adverse experiences—such as divorce, a substance abusing parent, abuse, domestic violence, or significant contact with an adult with serious mental illness—the more they will suffer has been woven into the fabric of our understanding of child development.
However, this knowledge has not been well integrated into programs designed to prevent or treat maltreatment. The reasons for this are multiple and complex and must draw on an appreciation of individual psychology, systems theory, the interface of political and economic forces and historical shifts in the ways in which we view children, maltreatment, and individual responsibility.
Photo courtesy of Natesh Ramasamy.
Although we know that adverse events in children’s lives rarely occur in isolation, we too often create programs designed to address a single issue or, recognizing that there are multiple problems, we introduce “wrap around” programs that bring together a team of experts to address the identified symptoms. Unfortunately, these professionals rarely have the time or funding to address the underlying issue, which often could best be described as chronic and unrelenting family and community chaos.
Consider, for example, children in the foster care system. The overwhelming majority of foster children have been removed from the care of their parents because of physical neglect (one of ten adverse childhood experiences). However, neglect typically results from parental substance abuse and/or mental illness, each adding an adverse experience and, most likely emotional abuse, adding yet another. Taken together, it is not difficult to imagine a child living in an environment that is wildly unpredictable with no certainty about the parent’s mood from day to day or hour to hour, no reason to assume that dinner will be on the table or that the night will not be interrupted by angry shouting.
For these children, whose lives are rife with adverse experiences, the whole is greater than the sum of the parents, particularly when the events stretch over weeks and months and even years. When they enter the foster care system, they need not only physical and emotional safety, but the security and sense of well-being that comes from a consistent, stable, caring relationship. Instead, they are often introduced to multiple people—each of whom has an important role to play—but none of whom is fully responsible for the child. This is not to discount the importance of what caseworkers, foster parents, attorneys, educational specialists, therapists, and community volunteers have to offer foster children.
What is missing for these children is the parental mind that mediates all of the child’s experiences—positive and negative. Without that single mind, the child lives in a fragmented world with no means of creating a coherent narrative. This is echoed in the systems that are supposed to be addressing the problems; they work in silos—sometimes at cross purposes, whether strategically or inadvertently.
Brooks suggests that we might begin to address these issues by bringing people together. That might be a first step or it may be just one more conference that sounds important and accomplishes little. We must not just talk about the importance of early experiences and children’s need for healthy relationships in order to thrive. We must integrate this knowledge into the fabric of every institution and program. Until we shift our culture to one that supports children and families we will continue to pay the price of psychological and systemic dysfunction.
By Toni Heineman