Stopping childhood adversity from becoming a life sentence

Even the most hard-nosed economist will now concede investment in good early childhood has the biggest return on public investment.

But what about a reverse argument that failure to invest in prevention of bad early childhood experience is the most costly oversight a government can make?

This is the subject of my recent TedX talk in Podgorica, Montenegro, on the global prevalence of Adverse Childhood Experiences (ACEs) like neglect, abuse and dysfunctional parenting, and how they drive poor public health, low productivity and other costs amongst adult populations.

Despite massive advances in addressing childhood adversity in many high-income countries – globally the issue remains largely taboo, difficult to discuss and emotive. But the field of childhood adversity has been revolutionized through the study of ACEs – here is how it began…

A couple of decades ago in San Diego, public health practitioners baffled by constant patient drop out from obesity programmes decided to probe whether there were any shared underlying factors among those affected. They were astonished to find out that those who dropped out almost all had one thing in common: sexual abuse in childhood.

This begged the question – were there other areas of poor health in adulthood or social outcomes where the people affected had largely been victims of childhood adversity?

What followed in the mid-90s was a longitudinal Adverse Childhood Experiences Study, of more than 17,000-mostly middle-aged and middle-class West-coasters in the US, through a collaboration of Kaiser Permanente clinics and the Centre for Disease Control in Atlanta.

Firstly, the findings revealed the shocking and heart-breaking prevalence of 10 classified types of Adverse Childhood Experiences which were broken down into three areas:
1) Abuse: Sexual, physical, emotional;
2) Neglect: Failure to meet basic physical needs, leaving a child uncared for, or unloved;
3) Household dysfunction: Witnessing, addiction, crime, parent-to-parent violence, mental illness etc.

Respondents were given an “Ace Score” of 1 to 10. Two-thirds of respondents had experienced at least one ACE and 12% of respondents had an Ace Score of 4 or more.

20% had been victims of child sex abuse – a number almost identical to the much later Council of Europe estimate that 1 in 5 European children suffer from sexual violence.

The statistics on all forms of violence also broadly correlate with prevalence levels that can be seen from the global UNICEF report on violence against children: Hidden in Plain Sight.

If researchers were knocked sideways by the shockingly high levels of prevalence, including in middle- and high-income households, they were also astounded to find an almost “dose-response” correlation with high adversity and poor life outcomes, in health, education, addiction and crime throughout the lifecycle.

According to a leading ACE researcher and public health practitioner, Dr Nadine Burke Harris, in California somebody who had experienced 7 of 10 forms of childhood adversity has a 20-year shorter life-expectancy than someone who has experienced none.

It took a different type of research, from the field of neurobiology, to explain why high childhood adversity converted to poor outcomes in adulthood – through the impact of what the Harvard University Centre for the Developing Child has termed ‘Toxic Stress’ upon the physical and brain development of children.

As devastating as all of this is, we now have the knowledge and the science to build a global effort to reduce the impact of childhood adversity and violence against children. If we can reduce the dose of adversity and toxic stress we are not only fulfilling our human rights obligation to protect children, but also potentially ensuring long-term reductions in poor public health, low productivity, high crime etc.

UNICEF works throughout the CEE/CIS region in Regional Knowledge Leadership areas to help governments to simultaneously do three things:
1) Build violence prevention mechanisms, from pre-natal visits and throughout a child’s life cycle;
2) Provide interlocking services of child protection, health, education and justice that will protect the child victim of adversity and help him or her recover; and
3) Break the public taboo on childhood adversity which prevails in almost all of the countries in our region.

In Montenegro in late 2013 we had the first national discussion on child sex abuse as part of a national survey on violence against children in parliament. Services are being strengthened, reporting seems to be on the increase and there is more public discussion. But we are mindful that this is just the beginning.

This way of approaching adverse childhood experiences is flowing from high-income countries where it is studied and researched, to middle income countries where there is some type of functional child protection system. However, according to Theresa Betancourt of the Harvard Centre on the Developing Child there is an obvious need to better understand and work on childhood adversity, mental health and toxic stress in low-income countries or conflict zones, where HIV/AIDS or the recruitment of children into armed conflict, can have a deep psychological and physiological impact on children’s wellbeing.

Courtesy of the wonderful fostering promotion group ReMoved, my TedX featured the story of a resilient, fictional young girl with an Ace score of 6 called Maja. She could be any child-in any corner of the world. Frightened of her own father, uncertain of when she may reach safety or if she will ever be properly loved and cared for.

We can make a massive difference in the life of Maja and millions of children like her by attacking childhood adversity, making the invisible visible and creating a world truly fit for children.

Benjamin Perks is the UNICEF Representative in Montenegro

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  1. Indeed, sexual abuse has a high prevalence in eating disorders – an attempt to make the body unattractive to “suitors”, a fight against the demons of the past. Plus a craving to fill the “hole” that ill-addressed “love” left. However “… investment in good early childhood has the biggest return on public investment. …” – it goes even further and starts even earlier: recent studies also found that breast-fed children on average have higher IQs, are healthier adults and on average have higher incomes than those not breast-fed or only for a shorter time!

    1. Dear Maureen, Thanks for your excellent comments. You are right, there is a growing global consensus-in theory at least-that return of investment is greatest with public funds that are spent on ensuring the best possible start in life with children from 0 to 6 and breastfeeding is an essential element of good early childhood care.
      On your first point, we need to build awareness and services that empower victims of abuse and neglect to begin a journey of healing. This involves breaking the taboo and shame associated with the issue. In many countries now there is a public narrative and debate about childhood adversity and adults who were victims are often championing this process.
      We also need to work hard on prevention and stronger child protections systems to ensure timely intervention. Things can change for the better – @BenjaminPerks

  2. The taboo around speaking of these experiences has to be fought against. The fear of seeming weak, oversensitive, crazy…of being thought a whiner, an exaggerator, someone who needs to just “get over it” all makes it so much worse. Along with that comes the subtle empathy gap reflected in those around you who may listen but also seem to feel they would have done better in your shoes, your brain, your life. All too often I see comments like “this research/presentation/video makes permanent victims of those with bad childhoods, life is what you make it. You make your own choices now, it is your responsibility to make good ones.” While this can feel true, and may even be intended to be empowering it also reflects a lack of understanding of psychology, research and statistical probabilities and how to use them to make changes, after the fact victim blaming, and feels terribly diminishing to those struggling to understand the damage done. It undermines their ability to change it, making them feel ashamed for not already having undone – a word choice that is telling – the way they were taught to think and feel about themselves and the world. Rather than feeling empowered to change, such attitudes cause shame: shame for feeling how you feel, shame for not hiding it better. The result is all to often years of attempting to hide or numb the damage, worsening the shame which thrives on silence and secrecy. I often wonder if some of the high scorers who have experienced this are the same ones saying these things in an attempt to reconcile the way they feel with how they believe they should feel, the perceived tangible successes from numbing with the persistent lack of basic worthiness, the power they try to suck out of experiences and words in order to deny the effects.

    When the place that is supposed to be the most safe and loving is the least, at the most vulnerable time in life, it would logically follow that you equate vulnerability with weakness and weakness with being victimized even more than society already demonstrates this attitude to begin with.

    Getting out from under your past is different from getting over it, and it is often a lifelong process of analysis and understanding. It is entirely worth taking enormous criticism to help even one person who is wondering “is it just too late for me?”

  3. Dear Kay,
    What a wonderful and empathetic comment. There is some inspirational research done by Dr Brene Brown of University of Houston around shame and vulnerability that I suspect, from your comments, you may already be familiar with. She is very accessible and has done a couple of Ted Talks.
    As we learnt that childhood adversity is much more prevalent than we previously thought we can assume that a lot of adults are-as you say- “numbing” and this may be a key driver of the difficulty in breaking the taboo. The whole ACEs approach gives a scientific explanation of the lifelong impact of childhood adversity and I hope gradually it will lead to a much more constructive and shame-free public debate about how we are all in this together. This would be the best possible environment for victims to begin a lifelong journey of healing and build better futures. – @BenjaminPerks

    1. Thank you! I realized after posting that I had paraphrased Brene Brown and sent her a link to this on twitter.

      Beyond day to day bystander intervention (which I could write several rambling books on the value of), how can a driven person join in the fixing of things?

  4. Kay, I think at the very minimum it is important to be a champion of prevention and response through advocacy and democratic participation in your local community. We need to build a consensus that we can reduce Aces. For many this can also be this becomes a vocation through social work, psychology , working in the health or the justice sector or teaching. – @BenjaminPerks

  5. Reblogged this on Brenda Blackmon and commented:
    Our children are very receptive and deserve much better behavior from us.