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Adverse Childhood Experiences (ACE's)
Adverse childhood experiences (ACE's) is considered maltreatment and adversity in a child's life before the age of 18 years old. Adversity in childhood is most commonly in the home, but doesn't completely discount for victimization occurring outside of the home. ACE's are a significant public health problem, which include caregiver separation, divorce, parental incarceration, physical, emotional, and/or sexual abuse, neglect, lack of substantial resources, substance use issues in the home, addictive behaviors, lack of adequate love, support or protection by caregiver(s).

ACE's could impact a child cognitively, emotionally, neurobiologically, potentially impacting physical health outcomes in adulthood; disrupting the developing brain and immune system health due to the overproduction of stress-related hormones (fight or flight responses). Adverse experiences started to gain more light in the health and medical field after the original study of ACE's was published in 1998. The original ACE study was conducted by Southern California Kaiser Healthcare system between the years of 1995 to 1997. Results endorsed that the more adverse experiences endured, the higher the likelihood of chronic health disparities later in life. Most research points to those who experience 4 or more ACE's have much greater relationship to negative health outcomes. Common disease outcomes significantly related to adversity in childhood includes liver disease, ischemic heart disease, cancer, chronic lung disease, among others.

The Center for Disease Control and Prevention report that nearly 61% of adults across 25 states report an ACE; one in every six adults report four or more ACES, a major issue due to the detrimental impacts on health and well-being, also impacting healthcare systems. It is said, up to 21 million cases of depression and possibly 1 million cases of heart disease alone could be improved with more preventible measures in place. More recently, a 2016 National Survey (NSCH) found that 45% of US children had at least one ACE, 31% had two or more, results gathered from parent reports of their children aged 0-17. Furthermore, nationally representative explores adversity accounts which helps to expand the understanding of adversity children are most likely to experience. Data reveals, economic hardship (22.5%), divorce/separation (21.9%), victim or witness to community violence (3.3%), violence in the home (5%), family member with mental illness (7.1%), substance use in the home (8.1%), and incarceration (7%) to be the likelihood some children will experience an adverse event before the age of 18. Economic hardship is a stark reality many families are challenged by. Poverty places children at greater risks for adversities potentially impacting long term health outcomes. The effects from poverty such as poor nutrition, lack of resources to adequate healthcare, education, and parental toxic stress are some of the mechanisms which create for poor health outcomes. Research shows the brains of children who are classified as living in poverty to be impacted by the age of 2 years old in regions responsible for memory, socio-emotional processing, self-regulation, as well as academic achievement compared to children from high socioeconomic status, evidencing structural differences in brain development.

Some research examines negative outcomes related to adverse events, and on the contrary, positive changes or post-traumatic growt h can occur as a result of ACEs. Stressful or harmful adverse experience in a child's home can cause feelings of vulnerability and insecurity, and these feelings can impact the relationships and developmental milestones fostered outside of the home. Research evidenced that children could face relational issues, interpersonal problems, impulsive/risky behavior, and/or mental health problems among others due to ACEs and lack of adequate support to foster healthy development mentally, emotionally, physically.

Early onset drinking (14 and under), was substantially related to adverse childhood experiences such as parental discord (divorce), substance abuser/mental illness in the household, and physical/sexual abuse. Alcohol use disorders are reported to be more common in those who have endured adversity such as childhood maltreatment. A study examined the relationship men and women have with alcohol, and the connection to adverse childhood experiences. Findings drawn from the NESARC population based dataset show that exposure to one ACE alone increased alcohol progression to a more serious level of consumption, however three or more ACEs endorsed a higher chance to progress to a more severe level of using alcohol and less likelihood to decrease alcohol consumption for both men and women, compared to children who only endured 1-2 ACEs. Alcohol stages ranged from no problems to moderate to severe, and increased binge drinking was found to be associated with children both male and female, who endured verbal abuse. It was also found that women who reported childhood abuse, specifically emotional abuse, neglect, or witnessed intimate partner violence endorsed more severe drinking behaviors ; the susceptibility to develop a dependence on alcohol was found to be associated with neglect and abuse in childhood in both sexes.

Additionally, a contributing factor to both the treatment and effects of adversity faced in childhood is gender and sex identities. The Intersectionality of sex, gender and childhood trauma can complicate the outcomes individuals encounter due to the victimization and stigma those who identify as LBTQ+ can face in our society. In a large study of LGBTQ+ youth aged 14-18 years of age, rates of ACEs were high, with 4 or more ACEs being endorsed, consisting of household dysfunction, neglect, and abuse being most common. Before age 11, higher rates of ACEs are reported by gender nonconforming children than cisgender peers, and 3-5 ACEs endorsed by non-identifying and LGB students in a student sample was found to be linked with higher rates of suicidality, distress, and mental health conditions against peers. This research is not to say that those who identify as LGBT+ are more at risk, it is to say that those who identify as gender non-conforming could face more complication in the treatment and experiences of adversity because of the old values and norms that still linger in our systems today.

Psychological measures of Adverse Childhood Experiences (ACE's)
There are a number of valid and reliable psychological measurement tools to determine the presence or impact of ACE's. These questionnaires are used to screen for, and determine the most appropriate course of care and action. Typically, measures are administered by a licensed mental health professional, or under the supervision thereof. Most common measures include the Childhood Trauma Questionnaire, Adverse Childhood experiences questionnaire (ACE-Q), and the Family Assessment Device (FAD), among others. Utilizing objective measurement tools in clinical care, is a measurable way to assess for possible treatment trajectories.

An assessment tool commonly administered in mental health and primary care practice ls called the Adverse childhood Experiences Questionnaire (ACE-Q). This is an ACE scale that ranges from 0-10, which reflects the number of adverse experiences before the age of 18. The ACE-Q is a screener that is both reliable, valid, and consistent. The ACE-Q is a brief screener that helps to gain a historical collection of adverse experiences a child might have endured. This could include any of the ACE's mentioned above. Early intervention for a child who has experienced chronic stressors is important, as health and social problems increase with a higher ACE score. An important consideration to this ACE score is that it could be an over-interpretation or underestimation of how an ACE(s) could impact a child in their development. Sources of impact could be, when the adverse or stressing event(s) happened in the child's life, repeated exposure(s), and the developmental age of the child at time of event or events. However, the projected impacts of adversity is ever evolving, as this area of research is continuing to expand as it's studied and better understood.

Additionally, the Childhood Trauma Questionnaire(CTQ) is a reliable and brief self report measure, assessing for various types of abuse or neglect that may have occurred to the child or impacted their devolopment. There is a short form of the CTQ that has been found to be reliable and even more brief taking about 5 minutes to screen, that can appropriately assess for maltreatment. The Family Assessment Device (FAD), based on the McMaster Model of Family Functioning is multi-informant and is typically filled out by all family members over the age of 12, providing multiple perspectives of potential family stressors. The measure further captures family characteristics that can be maladaptive, more specifically domains in which families are experiencing problems such as communication, roles, affective responsiveness and involvement, general functioning, and behavioral control. Again, obtaining baseline functioning aids in the development of treatment goals, and will help to assess change following treatment.

Psychological resilience in children
Adverse childhood experiences can impact a child into their adulthood in some of following ways, hyperarousal, avoidance, maladaptive relationships, negative cognitions and intrusive unmanageable thoughts, referred to as post traumatic stress symptoms (PTS). Traumatic stress symptoms are potential symptomologies that could occur after trauma. Trauma is defined as a long lasting adverse effect on the mental, physical, and functioning health of an individual from a life threatening event, circumstance, or series or circumstances Some research explains that mental health issues do not affect all children who have endured adverse childhood experience(s) because of mediating factors, one of which being psychological resilience

Despite exposure, or actual or perceived threat, early adverse experiences may not produce a negative or maladaptive consequence due to a characteristic called emotional or psychological resilience. Resilience is an internal psychological quality defined as the ability to be unaffected or "bounce-back" from stressful situations due to a myriad of factors including cultural, genetic, psychosocial, and neuro-biological systems. Resilience, can be thought of as the ability to adapt, mobilize, and/or recover quickly in the face of adversity or when in stressful or traumatic events. Resilience is a protective factor that could help mitigate the likelihood to develop PTS symptoms, as well as reduce the likelihood of the effects of adverse childhood experiences and the development of psychological disorders in the future.

There are a number of ways children learn to foster resiliency through the socialization of their upbringing. Research evidences that children with strong support systems could enhance resiliency in the face of adversity, depending on the meaning and value these systems hold to that child. Social support for children is not limited to parents or caregivers, and can extend to the social support of teachers, mentors, inter-peer relations and safe households. These systems are referred to as external functionality systems which can aid children in the ability to adapt in adolescence and beyond. Positive and strong relations result in a lower likelihood to develop depressive symptomolgy, and higher resiliency.

Research evidenced that trust, autonomy, and coping skills are some of the results of positive parent-child relationships, meaning, a child is more likely to exhibit psychological resilience with these conditions fostered Important to note is that resilience building is not a linear or concretized characteristic built from one particular set of skills. Resilience is a dynamic process that should consider the intersectionality of: individual, social, and cultural processes and the effects this has on the wellness of a child.

Intersectionality is the term used to describe the unique social identities including socioeconomic status, gender, race, sexuality, ability, religion, among others. Intersectionality impacts the privileges and powers individuals face, which in turn impacts resiliency, especially if an individual belongs and identifies with an oppressed community. A cultural consideration is how we view resiliency and the connection this charachteristic has to intersectionality. Indigenous youth and other ethnic groups may view resiliency different from the euro-centric westernized context. Psychological resilience can take the form of fostering practices and rituals specific to the culture. For example, in an urban indigenous youth sample in Saskatchewan, Canada, fostering resiliency was reported to be connected to engagement with social and community activities, cultural identity, service to self, service to community, ceremonies, spirituality, etc. Psychological resilience is an attribute that can reduce the likelihood of depression and stand as a protective factor from chronic stress in the future of the child and negative outcomes. It is important to take into context the larger sociocultural and environmental influencers on children's development and resiliency building, and how this characteristic is portrayed in a child.

Adverse Childhood Experiences account for a number of events in childhood ranging from abuse, substance use, poverty, bullying, lack of resources, among many others. Research highlights the reality of early life experiences and the relationship this has to our physical health in adulthood. Since the original ACE study conducted by Southern California Kaiser system the knowledge of this topic has expanded tremendously. There are measurement tools to capture adversity, as well as more streamlined therapeutic orientations and techniques to successfully work with individuals whom have faced such events. When considering resiliency of an individual, one must consider the intersecting identities held, and be cognizant of the impact this shares with the development of symptoms, or the resiliency fostered.