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How ACEs create children with behavioral health problems

Adverse childhood experiences, or ACEs, as they are known in the child mental and behavioral health community, can lead to lifelong conditions such as post-traumatic stress disorder, reactive attachment disorder and anxiety.

These early life traumatic experiences can include physical, sexual or emotional abuse; physical or emotional neglect; intimate partner violence; substance abuse; household mental illnesses; and parental separation, such as through divorce or incarceration, according to the Substance Abuse and Mental Health Services Administration.

Such events cause “toxic stress” and have a permanent impact on children, said JoAnne Malloy, a research associate professor at the University of New Hampshire’s Institute on Disability in Durham.

“Unfortunately, we have a lot of good research that shows toxic stress, especially in babies and young children, is highly damaging to the neurobiological system,” she said. “It releases chemicals into our brains that damage development. You can see it in brain scans, in behavior, in long-term development.”

Ellyn Schreiber, the director of the Children’s Intervention Program at Riverbend Community Mental Health, said many ACEs can be worked through when a child has supportive and nurturing relationships. Toxic stress sets in “When there are all these traumatic things that happen in the absence of relationships,” she said.

Malloy compared such stress to walking down the street and seeing a dangerous dog.

“Your entire body gears to respond to that stress,” she said. “It doesn’t allow you to think about what you are going to buy for dinner. That’s the equivalent to what babies feel when their parents are stressed.”

Except for children with multiple ACEs, the stress either doesn’t end or is triggered easily, Malloy said. Constant exposure to toxic stress can impact a child’s social and emotional development, as well as their physical health.

The Centers for Disease Control found in a landmark 1998 study that ACEs can pave the way for adopting health-risk behaviors, like substance abuse, diseases and disability, and even early death.

For a child with reactive attachment disorder – a condition characterized by a consistent pattern of inhibited, emotionally withdrawn behavior and episodes of unexplained irritability, sadness or fearfulness during non-threatening interactions with others – having an adult confront them over something like doing their homework can feel a lot like that dog, Malloy said. Their reactions are often beyond their control.

“It’s neurobiological,” she said. “If that dog is coming at you, you’re going to react.”

Schreiber said children who receive treatment at the Intervention Program are often already experiencing mental health issues before they arrive. And even with proper care and a healthy lifestyle, health risks like cancer and diabetes can still persist, she said.

Anecdotally, Schreiber said the number of children who have high-risk safety concerns and require intensive services over the last 20 years has increased. She believes ACEs are the main cause, saying substance abuse has ramped up and that the mental health community didn’t pay enough attention to the ramifications of early attachment disruption.

“There’s a group of kids who grew up not having the kind of nurturing, constant support needed to be effective parents,” Schreiber said. “They grew up and had kids. … If you’re a child predisposed to have a mental illness, you’re probably going to develop one.”

(Caitlin Andrews can be reached at 369-3309, candrews@cmonitor.com or on Twitter at @ActualCAn drews.)