Author: Janessa Brown, M.S.
There is little debate across healthcare disciplines as to what constitutes an adverse childhood experience (ACE). ACEs are often conceptualized as any occurrence of maltreatment or other aversive experiences that are sustained in childhood. Though the designation of age ranges representing childhood may differ, most sources consider childhood to encompass all ages preceding adolescence, which begins around ages 11 or 12 (Balistreri & Hammond 2016; Isohookana et al., 2013; Scheidell et al., 2017; Soleimanpour et al., 2017). The categorization of the ACEs often denotes a difference between childhood maltreatment and household dysfunction (Flaherty et al., 2013). The childhood maltreatment domain includes psychological cruelty, physical violence, sexual abuse, and neglect, whereas household dysfunction includes incidents such as the substance use of a caregiver, caregiver mental health status, and violence and criminal activity within the home. Socioenvironmental influences specific to poverty and neighborhood violence are also relevant and considered highly correlative to adverse outcomes in later life development (Balistreri & Hammond 2016). The same is true for children coping with low socioeconomic status, low parental education, parental divorce, and social isolation (Balistreri & Hammond 2016; Chartier et al., 2010; Finkelhor et al., 2018). Luby et al. (2017) expand on this conceptualization to highlight that psychosocial adversity in early life becomes biologically embedded in a developing child, which then contributes to poor emotional and physical health outcomes.
Relevant literature has firmly established that withstanding aversive events during the sensitive developmental period of childhood is highly predictive of biological and psychosocial concerns in later life (Chartier et al., 2010; Flaherty et al., 2013; Korotana et al., 2016). ACEs are highly prognostic of lung, heart, and liver disease in adulthood, as well as cancer, sexually transmitted infections, obesity, lower subjective ratings of health and quality of life, and risk for premature mortality (Chartier et al., 2010; Kelly-Irving et al., 2013; Sonu et al., 2019). Accompanying a multitude of biological concerns are extensive psychosocial issues that may arise in adults with a history of ACEs. These adults often struggle psychologically with feelings of worthlessness, helplessness, powerlessness, and incompetence (Korotana et al., 2016). Such schema may then incite anxiety, depression, emotional dysregulation, and future psychological pathology (Flouri & Kallis, 2011; Korotana et al., 2016). ACEs are also correlated with the disruption of appropriate social skills development and the attainment of supportive, reciprocal relationships (Chartier et al., 2010; Korotana et al., 2016). Health-risk behaviors associated with ACEs, such as smoking, substance misuse, risky sexual activity, and sedentary lifestyles likely aid and exacerbate the aforementioned health-related outcomes in adults (Halpern et al., 2018; LeTendre & Reed, 2017).
Though much is known of the correlations between ACEs and adult outcomes, less empirical knowledge has been established regarding consequences in adolescence. Adolescence serves as a sequential link that bridges child and adult experiences. The unique position of this developmental period thereby necessitates empirical attention on the realities, potential risk and protective factors, and intervention opportunities for adolescents with ACE history. As such, some researchers have catalogued the impact of ACEs on adolescence as a newly identified public health concern meriting top-priority attention in pediatric research (Bright et al., 2016). Furthermore, it is recommended that mental health clinicians serving the adolescent population stay abreast the present research to not only inform proper assessment of ACEs, but to best apply empirically-supported treatment for this developmental age.
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