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ACE tree 260Adversity in childhood is linked to mental and physical health throughout life

From a study in The BMJ

Today’s children face challenges, some unforeseen in previous generations e.g. climate change, effect of pandemic on family, and the biological and psychological toll is yet to be fully quantified.

The short and long term consequences of exposure to adversity in childhood are of great public health importance. Children are at heightened risk for stress related health disorders, which in turn may affect adult physical and psychological health and ultimately exert a great financial toll on our healthcare systems.

Growing evidence indicates that in the first three years of life, a host of biological and psychosocial hazards can affect a child’s developmental trajectory and lead to increased risk of adverse physical and psychological health conditions. Such impacts can be observed across multiple systems, affecting cardiovascular, immune, metabolic, and brain health, and may extend far beyond childhood, affecting life course health. These effects may be mediated in various direct and indirect ways, presenting opportunities for mitigation and intervention strategies.

A large number of adverse experiences in childhood can trigger a toxic stress response. These range from the commonplace (e.g. parental divorce) to the horrific e.g. abuse and violence. Adversity can affect development in myriad ways, at different points in time, although early exposures that persist over time likely lead to more lasting impacts. Moreover, adversity can become biologically embedded, increasing the likelihood of long term change. Contextual factors are important:

  • Type of adversity. Not all adversities exert the same impact or trigger the same response.
  • Duration of adversity. How long the adversity lasts can have an impact on development.
  • Developmental status and critical period timing. The child’s developmental status at the time he or she is exposed to adversity will influence the child’s response.
  • Number of adversities and the interaction among them. Adverse Childhood Experiences (ACE) studies provide compelling evidence that the risk of adverse health consequences increases as a function of the number of categories of adversities adults were exposed to in childhood.
  • Exacerbating factors. Children with recurrent conditions may be more sensitive to the adverse effects of other forms of toxic exposures.
  • Supportive family environments. Safe, stable, and nurturing relationships and environments are associated with reduced markers of toxic stress, as well as improved clinical outcomes of physical and mental health.
  • Pre-existing characteristics. Many of the adversities may occur more commonly in children and families with pre-existing vulnerabilities linked to genetic or fetal influences.
  • Different physiological reactions to the same stressor e.g. sensitivity.

What are the consequences of exposure to adversity?:

  • Behavioural consequences. Childhood exposure to adversity and trauma may result in a variety of behavioural and emotional problems e.g. increased risk taking, aggressive behaviour, involvement in violence (home, school, and neighbourhood), difficulties in relationships with others, elevated risk of several other psychiatric disorders, including depression, PTSD, substance abuse, self-harm, and suicidal thoughts and attempts.
  • Neurobiological consequences. Many studies have identified structural and functional differences in brain development, reduced brain activity, overall brain volume.
  • Physical consequences. Early exposure to adversities is associated with growth failure and wasting, reduced brain volume and altered functional connectivity. Children exposed to higher psychological stress have been shown to have greater risk of common diseases of childhood including viral infections, asthma, dermatitis, etc. Childhood adversities have also been associated with greater risk of adult chronic conditions, including cardiovascular disease, stroke, cancer (excluding skin cancer), asthma, chronic obstructive pulmonary disease, kidney disease, diabetes, overweight or obesity, and depression, as well as increased health risk behaviour.

If we wish for today’s youth to inherit a world that is safe and conducive to healthy development, we must do all we can to create such a world, by preventing disorders from developing and intervening once they are apparent. Even for children living in adverse circumstances, much can be done now to make a difference by preventing such disorders from developing and intervening once they have surfaced.

Read full article here.

To raise awareness of ACEs in your community, why not consider hosting the Resilience Challenge in 2021 when such meetings permitted. See more here.

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From a study in The BMJ, 16/12/2020

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