Q&A: Understanding ACEs and tackling trauma

How does an understanding of ACEs change your approach to policy?

Alex Cole-Hamilton (Lib Dem): I have a long history of working in residential childcare and the voluntary sector for children. As such, since being elected, I have always been driven by an understanding of attachment disorder, trauma and loss and why we should take ACEs into account and unresolved trauma when approaching policymaking. An awareness, and greater understanding, of ACEs encourages deeper consideration throughout policymaking of the impact that certain policies can have on family dynamics through a wider context of inequality, in order to reduce the societal occurrence of ACEs. I do, however, believe that the definition of ACEs remains too narrow, so other societal factors which impact inequality such as poverty, must be taken into consideration during policy decisions.

Monica Lennon (Labour): It’s challenged me to think deeply about how we can prevent and reduce the risk of adverse childhood experiences occurring in the first place. ACE theory has made politicians and practitioners more aware of the impact of trauma and stress in the early years, but it’s not enough to be more aware. We need to see a shift in how we tackle inequality and poverty. It’s nice to say we want children to have the best start in life, but child poverty is rising and life is hard for many of our young people. If policymakers are better informed about trauma, it should lead to policies and services that better meet people’s needs throughout their lives.

Annie Wells (Conservative): When approaching something new in parliament, then it is always going to benefit me, no matter what the subject matter, to gain a greater knowledge ahead of deciding policy. Hearing first-hand of adverse experiences will allow me to make the most informed decision possible on policy.

Gail Ross (SNP): There’s already a wide range of existing SNP policy that addresses ACEs. The rising number of health visitors and expanding family nurse coverage will help support parents and early intervention. While the reduction in parental imprisonment and increase in the number of prison visitor centres will help keep families together. Let’s also not forget about the positive impact minimum alcohol pricing will bring to many families and children. But, of course, there’s more to do to help prevent and mitigate ACEs – so the SNP SG is working closely in partnerships with schools and third sector organisations to explore how families can be better supported to address ACEs.

Since it’s obvious that, for example, being abused or having a parent in prison, will adversely affect children, what do you feel the benefit is to putting a name to a group of experiences?

ACH: Although there are obvious limitations to putting a name to individual groups, doing so in this way allows for an increase in both understanding and awareness to policymakers and the wider public of the nature and prevalence of ACEs. Due to the underlying social factors which often lead to ACEs being interconnected, an increased understanding of the impact of ACEs on children’s behaviour, emotional development and both physical and mental health can help people working with children to address challenges appropriately. This, in turn, will lead to more positive outcomes, especially in educational settings. Put simply, by recording adverse events for every child, we can begin to target resources effectively and get healing to people who need it from the outset.

ML: It’s important we don’t label individuals, but a focus on the common challenges faced by people affected by trauma is constructive. When children are exposed to adverse and stressful experiences, it can have a long-lasting impact on their ability to think, interact with others and on their learning. A survey with adults in Wales found that, compared to people with no ACEs, those with four or more ACEs are more likely to have been in prison, to develop heart disease or to have health-harming behaviours such as high-risk drinking, smoking and drug use. If it is possible to identify that an individual has lived through an adverse childhood experience, it can be possible to predict the support they may need later in life. This is good for policy development at population level and hopefully, will benefit more individuals in the future.

AW: While it is very tricky to discuss many of these experiences, the benefit is that it can raise awareness of these experiences and help others to share their stories and find the best way to support others going forward.

GR: The SNP is leading a bold drive to reduce stressful and poor-quality childhoods. While there is work ongoing across the board through highly praised initiatives like ‘Getting it right for every child’, it’s important we can identify those most at risk to help prevent and mitigate ACEs, making sure nobody slips through the net.

Is ACEs a negative or positive way of looking at children?

ACH: ACEs should be regarded as a positive way of looking at children as it allows a greater appreciation of a person’s circumstances, both in their childhood and beyond. Such an approach also has a positive impact on society as a whole, and not only the person, because ACEs are critical experiences which lie at the root of so many negative life outcomes. We need to recognise that ACEs are an important part of a person’s story, but we should support them to ensure that those ACEs don’t define them.

ML: ACE theory is a useful tool to try and understand how certain experiences can affect children, but we do have to guard against simply ‘labelling’ children and young people. If ACE theory leads to positive changes in public attitudes and behaviours, as well as policy and public spending, then it can be viewed as a success. It’s outcomes that matter.

AW: While there are a lot of factors to weigh up, ACEs don’t have to be inherently negative, despite the experiences themselves obviously being extremely harrowing. The discussions do not mean the children have to be defined by the experiences, but how we can ensure a positive life for them going forward.

GR: I have no doubt that the SNP SGs’ bold drive will be hugely positive for many children and their families – improving the health and wellbeing of our young people while tackling inequality and reducing disadvantage. We have to focus on the early years. Preventative actions are always preferable to picking up the pieces in later life, sometimes when it’s too late.

What does it mean to you for Scotland to be an ‘ACE-aware nation’?

ACH: For Scotland to be an ACE-aware nation means that the wider public and those in policymaking positions can be aware of the nature and underlying factors behind ACEs. Not only does this enable greater, public-wide compassion for those who’ve experienced such an incident, but it also helps policymakers to tackle them on a larger scale. It will also help us better target interventions at those who need them.

ML: To be ‘ACE-aware’ is not enough – we must give local authorities and public services the resources to prevent adverse childhood experiences and provide proper support where necessary. It’s appalling that children have to suffer multiple adverse experiences – these are the very reasons why we need to fight for more funding at every budget, and for action to tackle the causes of poverty.

AW: Scotland can be proud of the fact that they are willing to lead discussions on ACEs, especially with support across parliament, which can help to shape policies that can potentially lead the way for others to follow suit.

GR: It is important that we address ACEs and the impact they have on our young people throughout their lives. It is only right that Scotland works to support those with ACEs and helps prevent these experiences from occurring within other families. We must also make sure that our public services are trauma aware and trained to deal with mental health issues. The time has passed for immediate punishment of ‘bad’ children. There is no such thing. Children are a product of their environment.

What is your reaction to concerns that the theory of ACEs may be misused, for example, to stigmatise certain groups of children with an assumption that they will underachieve?

ACH: I would envisage that heightened public awareness of ACEs would have the reverse effect, in the sense that it would lead to more equal and equitable outcomes, which should be striven for within the education system, regardless of a child’s previous experiences. We also need to broaden the definition of what we mean by ACEs and this will also help both broaden understanding and reduce stigma.

ML: Stigmatisation is a problem that may affect many groups of children, for example, those who have additional support needs or those from minority backgrounds. It is essential that all children are supported, no matter what they have experienced, their background, or any additional support need they may have. A combination of teacher training that has a focus on inclusivity, combined with adequate resources at the local authority level, will make this possible. Such support will make certain that underachievement does not become a self-fulfilling prophecy.

AW: The right structures must be put in place to ensure that no one who has suffered an ACE is treated any differently, otherwise we will fail to encourage the right people to come forward to help shape policy that will be fit for purpose.

GR: Same as third question.

Do you think people who have experienced ACEs should be treated differently by the criminal justice system?

ACH: ACEs theory is consistent with theories of crime, which have proven links between childhood factors and adulthood criminality and victimisation. This is due to prolonged exposure to stress and anxiety in childhood disrupts healthy brain development, manifesting in behavioural problems in childhood and increased risk-taking and criminal behaviours in adulthood. Context is important in the justice system, and ACEs contribute to this. Accordingly, if the aim is to rehabilitate offenders, then a focus on the impact of ACEs and prevention of such experiences needs to be considered to ensure effective rehabilitation. We need to recognise that in some cases, some offending behaviours are actually a normal response to abnormal circumstances. We need to understand the impact of unresolved trauma and attachment disorder on offending behaviour and consider that in sentencing, so as to not further compound that trauma.

ML: The criminal justice system must have a degree of compassion built in and take account of the circumstances of offenders in considering how they should be treated. Having an ACE-aware justice system is certainly part of that.

AW: ACEs should be considered, but owing to the need to achieve justice for victims, this should be dependent upon the nature of the case.

Given that research has shown that two-thirds of children in Scotland have experienced at least one ACE, does this suggest that ACEs are simply a normal part of childhood or that current policy is failing Scotland’s children?

ACH: ACEs should never be considered a normal part of childhood, and prevalence figures in England and Wales suggest that less than half of children experience an ACE. Therefore, if Scotland has a higher figure, it is plausible to assume that a gap in policy measures is responsible and needs to be addressed; a first point of call being tackling societal inequalities and the regular measuring and recording of ACEs. We also need to do more to work towards their prevention.

ML: I think there has to be a recognition that not every adverse childhood experience is the same and that some children and young people will have experienced more or less trauma than others. Support must therefore be tailored to the individual. That being said, we know that many children in Scotland are being let down at school. Underfunding of local authorities has meant many children, especially those most in need, are not being provided with the resources or support they need to fulfil their potential. Given that those who have experienced adverse childhood experiences are more likely to need additional help at school, children who have experienced ACEs, as well as those identified as having additional support needs, are being continually let down by the system.

AW: We don’t want to start from a point where ACEs are described as a normal part of childhood. The discussion needs to be wider than that. The main focus should be on preventing traumatic childhood experiences from happening in the first place and therefore breaking the cycle altogether.

GR: The SNP government is working hard with schools, health boards and third sector organisations to grasp a better understanding of the early-life experiences of adults and how these impact long-term health wellbeing and parenting. The SG should, and is doing, all it can to explore how ACEs can be avoided. For those that do unfortunately experience ACEs, there is now support available to help alleviate the negative impact and stress associated in later life, thanks to the SNP.

Has this idea of ACEs changed the way you think of your own childhood?

ACH: I had a very fortunate childhood but recognise that mental illness in one of my parents did cause trauma, which I’ve only recently resolved.

ML: Growing up should be a care-free time in a young person’s life but adversity is also a great teacher. I want to wrap my own daughter up in cotton wool, but that’s not realistic. What matters is support being available should she need it. One of my political priorities is reducing alcohol harm and securing better support for children and young people affected by parental drinking. That comes from a very personal place, but hopefully, it’s an example that hurtful experiences can influence and inspire us to make life better.

AW: I suppose it does make me think about the way I was brought up, in a way that I probably don’t going about my daily life. I was lucky to have a positive childhood, which is the approach I want to achieve for our future youngsters, who shouldn’t have to suffer traumatic experiences.

GR: I think we all reflect on experiences in our childhood. As with parents today, it’s important that the ACEs movement doesn’t result in guilt for parents or for resentment towards parents. Every family is different and parents have their own issues to deal with as well. We should never judge people, we should help them to love and understand their children, to ensure a welcoming family and to manage stresses. I think there are always situations where we can look back and wish things had been done differently.