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Trauma in Children – What is an ACE score?

Apr 21, 2023 | Child Therapy, Trauma

TW: Childhood abuse

Key Takeaways:

  1. ACE stands for Adverse Childhood Experience. The study that defined ACEs, described them as “various forms of physical and emotional abuse, neglect, and household dysfunction.”
  2. ACEs are potentially traumatizing moments that happen between ages 0 and 17 that can impact a child’s mental and physical health over the course of their life.
  3. It is important to understand how ACEs impact the health of a developing child in order to give children the best chance to live healthy lives.

In order to understand ACEs, we first must understand the impact that stress and “toxic stress” have on the body. When our bodies are under stress, we might feel that physically manifest as a palpitating heart, sweaty palms, uncontrollable shaking, etc. Internally, when our bodies are under stress, our brains (more specifically, the hypothalamus) will send a signal to the pituitary gland to produce a hormone called cortisol, which is created and released from the adrenal glands (which sit atop our kidneys). This release of cortisol helps our body to “jump into action” and deter the stressors in our environment. This process is called the Stress Response Cycle.

Have you heard the phrase “too much of a strength can become a weakness?” This is especially true for the Stress Response Cycle and the impacts of high cortisol levels on the body. When our bodies are under chronic or “toxic stress,” cortisol is released over and over again, which can lead to adverse health effects such as a suppressed digestive system, a suppressed reproductive system and suppressed growth processes. While the impacts of chronic stress can lead to adverse health effects at any age, they can have specific impacts on the developing child.

This leads us back to ACEs and childhood trauma. When a child experiences stressful events, especially in a patterned or repetitive way, the high cortisol levels that come with a constantly triggered stress response cycle can lead to “toxic stress” and have adverse effects on the developing child’s learning, behavior, and health over time. Essentially, adverse childhood experiences can lead to adverse childhood development.

The above explains the internal experience of trauma on the body, but what might a child who has experienced trauma look like and sound like? Of course this can be highly individual, but there are certain behaviors to look out for. Below is a non-exhaustive list of ACEs & examples of how they might present:

  • Repetitive forms of humiliation
    • A child exhibiting low self esteem and/or self worth and sharing “I’m not good enough” or “I’m not as good as _____.”
    • Feeling intimidated or in danger
      • A child who is unable to make eye contact, tends to make themselves small (hunching their shoulders, shrinking themselves), throws a tantrum when told they have to go see those who have harmed them or have to go to places where their harm has occurred.
      • Being pushed, grabbed, thrown or hit so hard that bruises were left on the body
      • Bruising on the body, flinching when approached, recoiling when touched (even when offered a high-five or a hug)
      • Drug abuse, sexual, or physical abuse in the home
      • Premature promiscuity or extreme discomfort with being touched.
      • Untreated mental illness in the home
      • A child sharing along the lines of “I don’t know why my parent acts like that.”
      • Losing a family member, especially to suicide, incarceration, divorce that resulted in relocation
      • It can be hard for a child to comprehend the loss of a person, and processing grief might translate to behavioral outbursts (tantrums, crying spells, stomping around, etc) rather than verbal communication.

      In summary, childhood trauma can present as hypervigilance, difficulty relaxing and calming down after stressful moments, and challenges in separating the past from the present. If you are noticing a child in your community who is exhibiting the above behaviors out of nowhere or following a known incident, it is possible that they are experiencing or have experienced traumatic events and might benefit from the support of a mental health professional.

      Mental health professionals have many tools to use when working with children or adults who experienced childhood trauma. There are screening tools which produce an ACE score. An ACE score can help a clinician determine the intensity of the patient’s childhood trauma and use that to inform how they create and offer treatments. ACE scores seek to standardize the experience of trauma so that treatments can be researched in a standardized way. However, each clinician will work to develop an individualized treatment plan that considers the ACE score as well as information gathered through clinical interviews when creating treatment plans.

      The Center for Disease Control (CDC) produced an evidence-based report in 2019 about how to prevent ACEs from occuring. Their strategies center around four main goals: 1) Strengthening Economic Supports for Families, 2) Promoting Social Norms that Protect Against Violence and Adversity, 3) Ensuring a Strong Start for Children, and 4) Teaching Skills to children to handle stress.

      There are both systemic ways to respond to and prevent ACEs as well as individual and interpersonal. Mental health therapy – for children individually and for their families – is one way to respond to the impacts of ACEs.

Dr. Anton Babushkin

Author: Anton Babushkin, PhD

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Blog Posts Tags: Child Therapy | Stress | Trauma
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