Youth mental health: What is an ACE?

Following the return of young people to school from COVID-19 lockdown, many professionals reported a stark increase in safeguarding and child protection concerns and disclosures.

Behind each of these is a potential trauma (being) experienced by a child. These traumas are what we term adverse childhood experiences (ACEs).

As we’ll find out later, the COVID-19 pandemic has been a traumatic experience for most if not all young people, but it is not the only source of childhood trauma.

What is an ACE?

Adverse childhood experience or ACEs is a term that has come into wider use later in the areas of child mental health and education. ACEs are essential childhood trauma and include any signs of prolonged experience of:

• Emotional abuse
• Physical abuse
• Sexual abuse
• Physical or emotional neglect
• Spending time in care
• The separation or divorce of carers
• The incarceration or institutionalisation of an immediate family member
• Witnessing abuse in the family home
• Witnessing substance misuse in the home

It is important to note the cumulative nature of ACEs and the reality that the more ACEs a young person experiences, the greater the negative impact on their life outcomes.

“Children’s exposure to adverse childhood experiences is the greatest unaddressed public health threat of our time.”
_{Robert W Block, Past President of the American Academy of Paediatrics}

Exposure to significant ACEs

There is a growing body of research into ACEs that have found that a child’s exposure to significant or prolonged ACEs can have an extremely negative impact on a young person’s life outcomes. Research has shown that experiencing these childhood traumas increase the likelihood of:

• Suicide and suicide attempts
• Depression
• Severe obesity
• Diabetes
• Cancer
• Stroke
• Heart disease
• COPD
• Accidental injury
• STDs

There is also an increased risk of potentially life-shortening behaviours as a result of a young person’s maladaptive coping mechanisms, including, smoking, alcoholism, drug use, missed education or work, and lack of healthy physical activity.

Finally, there is the reality that people who have experienced childhood trauma are more likely to perpetuate those same traumas. For example, individuals who have experienced five ACEs are more than four times more likely to engage in domestic violence.

ACEs and COVID-19

When we think about the impact of COVID-19 on young people’s mental health it is important to see it in many ways as an adverse childhood experience writ large. This is not just because the fear of the disease itself may have been a source of fear and trauma for young people, but also because of the associated impacts.

Whilst the confirmed presence of many ACEs are a matter for a safeguarding or Child and Adolescent Mental Health (CAMHS) referral, others on this list might not meet that threshold.

It is therefore important that we keep the idea of COVID-19 as a global adverse childhood experience at the forefront of our thinking as we work through the PEP TALK with our young people.