After last week's school shooting in Parkland, Florida, the young survivors underwent a routine that has become all too familiar: Teams of crisis counselors were dispatched, vigils and funerals were held, and local officials debated what to do about the physical aftermath of the massacre: inspecting the school's buildings and deciding when (and if) the campus would re-open for classes. The psychological damage may be harder to assess. Among kids exposed to traumatic violence, short-term symptoms immediately after such incidents include trouble focusing, managing emotions, and negotiating relationships. The effects of childhood trauma also show up later in life: As adults, children who witnessed violence will be more likely to suffer from depression, deal with substance abuse, and struggle with obesity.
American school shootings are a comparatively rare form of childhood trauma—albeit less so than they used to be. But many other experiences that can cause lasting psychological damage, such as parental incarceration and economic hardship, are relatively common. Indeed, a new report from Child Trends, a Bethesda, Maryland, non-profit that conducts research on improving children's lives, says that almost half of all American children have experienced at least one potentially traumatic "adverse childhood experience," or ACE.
In "The Prevalence of Adverse Childhood Experiences, Nationally, by State, and by Race or Ethnicity," authors Vanessa Sacks and David Murphey used data from the 2016 National Survey of Children's Health to determine which children 17 and under are more likely to experience trauma, and where these children live.
They looked at the data regarding eight ACEs:
- Parental divorce or separation
- Parental death
- Parental incarceration
- Violence among adults in the home
- Victim or witness to neighborhood violence
- Living with a mentally ill adult
- Living with someone who has a substance abuse problem
- Experiencing economic hardship often, such as the family finding it difficult to afford food and housing
ACEs aren't limited to this set, Sacks noted, and they also change over time as scholars better understand trauma. For instance, experiencing violence in one's neighborhood and homelessness didn't used to be considered ACEs; they are now. Some researchers are calling for racism to be designated one as well. But one thing is clear: The more ACEs a child experiences, rather than any particular one, the more likely they are to struggle later.
The most prevalent ACEs that American children experience are economic hardship and divorce or separation of a parent or guardian. Nationally, one in every 10 kids has experienced three or more of them. Maryland, Massachusetts, and Minnesota had the most children with no ACEs, while in Arizona, Arkansas, Montana, New Mexico, and Ohio as many as one in seven children had experienced three or more. Arkansas had the most ACEs, with 56 percent of all children experiencing at least one, and Minnesota had the least at 37 percent—which is still more than a third of the state's children.
While Sacks said it's difficult to ascertain what causes such stark differences among states, one factor stands out: Some of the states with the most ACEs are also those with a high rate of child poverty. And though Sacks and Murphy didn't look at differences between urban and rural children, the 2011–12 National Survey of Children's Health found that rural children were more likely to experience ACEs than urban children—due in part to the fact that rural children are more likely to live in poverty than their urban counterparts.
Race is also a strong indicator of whether a child is likely to experience ACEs. "In almost every group of states we looked at, as well as nationally, white and Asian children have the lowest rates of ACEs, while black and Hispanic children tend to have the highest," Sacks said. In numbers, this translates to 61 percent of black children, 51 percent of Latino children, 40 percent of white children, and 23 percent of Asian children having at least one adverse experience.
After economic hardship and divorce or separation, white children are most likely to experience an adult living with mental illness or dealing with substance abuse, while for black children parental incarceration is the next most-common ACE. African-American kids are also the most likely to have experienced the death of a parent or guardian. For Hispanic children, the next most-common ACEs are living with an adult with a substance abuse issue and parental incarceration.
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The last Survey of Children's Health was conducted in 2011–12, but ACE statistics have remained fairly consistent. "This is sobering," Sacks said. "The persistent percentage of children with three or more ACEs is particularly distressing, because we know the host of negative outcomes associated with having multiple experiences."
To better address the daunting scope of the problem, the American Academy of Pediatrics has called for pediatricians to screen their young patients for potentially traumatic experiences, even publishing guides on how to do so. Screening can involve looking for signs of stress, such as recurring nightmares or thoughts, or re-enacting trauma through play. Children can also appear withdrawn or preoccupied. "Teachers will tell parents [their child] seems to be in a daze in the classroom," Stanford University child psychologist Hilit Kletter told NPR.
Pediatricians, social workers, or other professionals working with children can then refer those families who they identify as struggling with ACEs to appropriate services, such as counselors to help with a parent's mental illness or the proper office through which to apply for food aid. But there's also another, perhaps more straightforward means of help: If a child has just one caring, trusted adult in their life, research shows that the relationship can buffer the effects of trauma.
Breaking the cycle of ACEs is key. When a parent has experienced a high number of ACEs, chances are their children will as well—often the same ones, such as depression or substance abuse. And studies even indicate that when a woman experiences toxic stress during pregnancy, it acts as a kind of prenatal ACE, interfering with the fetal development and negatively affecting outcomes later in life, such as educational attainment and income. "When pediatricians are screening the child," said Sacks, "they're really screening the household."
Most pediatricians don't routinely screen for ACEs. But Sacks is optimistic, as legislators and policymakers—whether at the state, county, or city level—are increasingly calling for more awareness of youth trauma. And as of 2017, 20 states had passed or had pending legislation that mentions ACEs, including bills that set aside funds for research and prevention of social problems like opioid addiction. "There's an increasing awareness that these experiences are a really important public-health issue," Sacks said.
As the potential policy effects of Parkland continue to ripple out, this mounting attention given to ACEs suggests that the long-term effects of childhood trauma—both from horrific incidents like school shootings and from chronic exposure to poverty, hunger, and homelessness—need to be part of the conversation.